SEMINAR ON

SENSORY DEPRIVATION

SUBMITTED TO SUBMITTED BY

MRS.PARMESS MR. ATUL LAWRENCE

LECTURER M.Sc NURSING (1 st YEAR)

RATTAN EDUCATIONAL COLLEGE RATTAN EDUCATIONAL COLLEGE OF NURSING OF NURSING

MOHALI MOHALI

SUBMITTED ON

COURSE : M.Sc NURSING (1st YEAR)

SUBJECT : ADVANCED NURSING PRACTICE

UNIT : UNIT-V, BIO-PSYCHO SOCIAL PATHOLOGY

TOPIC : SENSORY DEPRIVATION

VENUE : M.Sc NURSING CLASSROOM (1)

AV-AIDS : POWER POINT PRESENTATION

NAME OF THE STUDENT : Mr. ATUL LAWRENCE

NAME OF THE EVALUATOR : Ms. Ratinder

DATE AND TIME :

OBJECTIVE OF THE SEMINAR:

At the end of the seminar, students will be able to gain knowledge regarding

concept of sensory deprivation and will effectively apply it during the

theoretical and clinical aspects of the nursing profession.

INTRODUCTION

NATURE OF SENSORY STIMULATION

NORMAL SENSORY PERCEPTION

RETICULAR ACTIVATING SYSTEM (RAS)

INPUT SENSES

CHARACTERISTICS OF NORMAL SENSORY PERCEPTION

NORMAL SENSORY PATTERN

SENSOR STASIS

ADAPTATION

SENSORY ALTERATIONS

SENSORY OVERLOAD

SENSORY DEPRIVATION

FACTORS AFFECTING SENSORY DEPRIVATION

ENVIRONMENT

PREVIOUS EXPERIENCE

CULTURE

PERSONALITY, LIFESTYLE AND HABITS

ILLNESS

MEDICATIONS

VARIATIONS IN STIMULATION

SENSORY DEPRIVATION IN HOSPITAL SETTING

EFFECTS OF SENSORY DEPRIVATION

PERCEPTUAL RESPONSES

COGNITIVE RESPONSES

EMOTIONAL RESPONSES

CLINICAL SIGNS OF SENSORY PERCEPTION

PHYSICAL BEHAVIOURS

EMOTIONAL BEHAVIOURS

CHANGES IN PERCEPTION BEHAVIOUR

CHANGES IN COGNITIVE BEHAVIOUR

IMPACT OF ACTIVITIES ON DAILY LIVING

RELAXATION TECHNIQUE

CHAMBER TEST

FLOATATION TEST

BENEFITS OF THE THERAPY

SIDE EFFECTS OF THE THERAPY

ROLE OF THE NURSE

NURSE-CLIENT INTERACTION

THEORY APPLICATION

JOURNAL ABSTRACT

SUMMARY

CONCLUSION

BIBLIOGRAPHY

INTRODUCTION

Sensory stimulation is a subject of interest to both biological and social scientist. From conception to death,

the human being uses sensory organs to learn about the environment in which he lives. Stimulation of the sensory

organs also promotes development of these organs and contributes to the overall well being of the individual.

Sensory stimulation programs are one of the most common types of activities found in long-term care facilities.

Simply stated, sensory stimulation is a technique that provides meaningful and common smells, movements, feels,

sights, sounds, and tastes through the stimulation of all six senses. There are many benefits to providing sensory

stimulation such as increased communication, environmental awareness, relaxation, cognitive stimulation,

opportunity to build a rapport, enjoyment of a leisure experience, increased quality of life and much more.

NATURE OF SENSORY STIMULATION

Sensory impulse: Phenomenon of polarization and depolarization through which the abnormal activity of a fibre spreads through a nerve.

Sensory neuron: Nerve cord carrying sensory stimuli to the brain.

Dendrite: Cytoplasmic extension of a nerve cell.

Cell body: Part of the nerve cell between the axon and the dendrite.

Axon: Extension of a neuron.

Motor neuron: Nerve that produces muscular activity.

Motor end plate: Muscular organ that becomes active in response to stimuli.

Myelin sheath: Envelope of phosphorated fats.

Receptor (free nerve ending): Receiver of nervous stimuli.

For a person to receive data, FOUR conditions must be met. They are:-

• A STIMULUS: An agent, act or other influence capable of initiating a response by the neurons by the

nervous system must be present.

• A RECEPTOR OR SENSE ORGAN must receive the stimulus and convert it to a nerve impulse.

• THE NERVE IMPULSE must be conducted along a nervous pathway from the receptor or sense organ to

the brain.

• A PARTICULAR AREA in the brain must receive the impulse into a sensation.

The study of stimulation begins with nerve cells, NEURON. The cell has a projection or process called DENDRITE or DENDRON, that carries an impulse to neuron. It also has an AXON which carries an impulse to CNS. Sensory

nerves carry some impulses to areas of the brain where the individual becomes aware of the stimulus

Perception then occurs with awareness

When impulse reaches consciousness, the individual becomes aware of outside world (e.g.: Optic nerves carry messages from the eye, Olfactory nerves carry from the nose and so on)

The structure that receives stimuli is called a RECEPTOR (e.g.: Eye is the receptor of light waves, and Muscle is the receptor of skeletal muscles)

NORMAL SENSORY PERCEPTION

Sensory Perception involves the conscious organization and translation of the data or stimuli into

meaningful information. Sensory perception depends on the sensory receptors, reticular activating system (RAS), and

functioning nervous pathways to the brain. The RAS influences awareness of stimuli, which are received through the

five senses: sight, hearing, touch, smell, and taste. Kinaesthetic and visceral senses are stimulated internally.

RETICULAR ACTIVATING SYSTEM (RAS)

It is responsible for bringing together information from the cerebellum and other parts of the brain with the sense

organs. The RAS is highly selective. For example, a parent may be awakened in the middle of the night at the

slightest murmur of an infant in a bedroom down the hall but may sleep through the loud traffic noises outside the

bedroom window. Destruction of the RAS produces coma and an electroencephalograph pattern characteristic of

sleep.

INPUT OF SENSES

Sensory function begins with reception of stimuli by the senses.

Externally, the senses receiving stimuli are

Vision, hearing, smell, taste, and touch

Receptor organs are the eyes, ears, olfactory receptors in the nose, taste buds of the tongue, and nerve endings in the

skin. Internally, the kinaesthetic and visceral senses receive stimuli. These receptors are nerve endings in the skin and

body tissues. The kinaesthetic sense influences awareness of the placement and action of body parts. The visceral

sense receives stimuli that affect awareness related to the body's large interior organs.

Vision, hearing, smell, and taste are termed, special senses. Touch, kinesthetic sensation, and visceral sensation are

termed somatic senses.

After stimuli are received, they are perceived with the help of the RAS. Sensory perception is a consociates process of

selecting, organizing, and interpreting sensory stimuli requiring intact and functioning sense organs, nervous

pathways, and the brain.

CHARACTERISTICS OF NORMAL SENSORY PERCEPTION

These are the normal measures in quality and quantity of the special and somatic senses.

NORMAL VISION is associated with visual acuity at or near 20/20, full field of vision, and tricolour vision

(red, green, blue).

NORMAL HEARING is associated with auditory acuity of sounds at an intensity of 0 to 25 dB, at frequencies of

125 to 8,000 cycles per second.

NORMAL TASTE involves the ability to discriminate sour, salty, sweet, and bitter.

NORMAL SMELL involves the discrimination of primary odours, such as cainphoraceotrs, musky, floral,

peppermint, ethereal, pungent, and ptitrid.

SOMATIC SENSES include discrimination of touch, pressure, vibration, position, tickling, temperature, and

pain.

NORMAL SENSORY PATTERN

SENSOR STASIS

Each person has his or her own comfort zone. This comfort zone varies from person to person and is the range at

which a person performs at his or her peak. Sensor stasis is a state of optimum arousal-not too much and not too little.

The RAS is viewed by some theorists as a monitor for sensor static balance.

ADAPTATION

Beyond the point of sensor stasis, sensory adaptation occurs. Sensory receptors adapt to repeated stimulation by

responding less and less. Lead time and after burn are two necessary time periods crucial to helping a person deal

with new stimuli.

– Lead time is the time each person needs to prepare for an event emotionally and physically.

– After burn is the time needed to think about, evaluate, and come to terms with the activity after it

happens.

The necessary amount of lead time and after burn is different for each person. Lead time and after burn helps

person process stimuli so he or she can respond appropriately without becoming overwhelmed.

SENSORY ALTERATIONS

A change in environment can lead to MORE or LESS normal stimuli. When stimuli is different from what one

is used to it leads to sensory alterations. Hospitalized patients will experience sensory alterations due to different

stimuli loads.

Sensory alterations can result in either sensory overload or sensory deprivation.

SENSORY OVERLOAD

It occurs when a person is unable to process or manage the intensity or quantity of incoming sensory stimuli.

The person feels out of control and overwhelmed by the excessive input from the environment. Routine activity in the

health setting can contribute to sensory overload in clients.

These activities fall into three main categories:

– Internal factors,

– Information, and

– Environment

• Internal Factors : such as thinking about surgery or the meaning of a medical diagnosis, can contribute to anxiety

and cognitive overload so that the person cannot process additional stimuli. Pain, medication, lack of sleep,

worry, and brain injury also can contribute to a person's vulnerability to sensory overload.

• Information: It is Imparting information to a client may lead to sensory overload. Some examples include

teaching a client about a procedure, informing a client about a diagnosis, making requests of a client, or helping

the client solve a problem. Anxiety related to medical diagnosis, prognosis, and treatment can contribute to

sensory overload. Lights and frequent activity may cause sensory overload in a premature newborn in the

neonatal intensive care unit.

• Environment: The environment of the healthcare agency provides a higher than usual amount of sensory

stimulation. A client newly admitted to the hospital, for example, may have to cope with adjusting to a new

roommate, having the television on more than usual, bright lights, paging systems, meeting many staff members,

having the bed move up and down at someone else's bidding, waiting for someone to answer the call light,

uncontrolled pain, and having strangers touch and not respect private body areas. Clients in intensive care units

often exhibit symptoms of sensory overload because of the high degree of light, noise, and activity around the

clock.

SENSORY DEPRIVATION

Although sensory deprivation can be thought of as the opposite of sensory overload, they share many elements.

Sensory deprivation generally means a lessening or lack of meaningful sensory stimuli, monotonous sensory input,

or an interference with the processing of information.

Sensory deprivation or perceptual isolation is the deliberate reduction or removal of stimuli from one or more of

the senses. Simple devices such as blindfolds or hoods and earmuffs can cut off sight and hearing respectively, while

more complex devices can also cut off the sense of smell, touch, taste, thermoception (heat-sense), and 'gravity'.

Sensory deprivation has been used in various alternative medicines and in psychological experiments (e.g. isolation

tank).

Short-term sessions of sensory deprivation are described as relaxing and conducive to meditation; however, extended

or forced sensory deprivation can result in extreme anxiety, hallucinations, bizarre thoughts, and depression.

FACTORS AFFECTING SENSORY DEPRIVATION

Environment

Sensory stimuli in the environment affect sensory perception. For example, a teacher may not notice the noise

in a consistently noisy environment, such as the school cafeteria. But the same teacher may perceive a loud

television set very differently in his or her own home, which is usually quiet.

Previous Experience

It affects sensory perception in that people become more alert to stimuli that evoke a strong response. For

example, a person may drive to work by the same route each day, noticing little along the way. A person may

listen to the radio inattentively until a favourite song is played, then listen to every word. A new experience, such

as hospitalization, may cause a client to perceive a barrage of threatening new stimuli.

Culture

– An individual’s culture often determines the amount of stimulation that a person considers usual or normal. (E.g.

A child reared in big-city neighbourhood, where extended families share responsibilities for all the children may

be accustomed to more stimulation, than a child reared in sub-urban of scattered single family.

– In some culture’s touching is comforting and in some it’s offensive.

– Some patients find cultural symbols or religious symbols re-assuring and their absence, a source of anxiety.

– A sudden change in cultural surroundings experienced by immigrants to a new country- language, dress,

behaviour, it could result in cultural shock.

Personality, Lifestyle and Habits

It affects sensory perception. One person may enjoy a lifestyle surrounded by many people, frequent changes,

bright lights, and noise. Another person may prefer less contact with crowds, less noise, and a slow-paced routine.

People with different lifestyles perceive stimuli differently.

Cigarette smoking causes atrophy of taste buds, decreasing sensory perception of taste. Chronic alcohol abuse

may lead to peripheral neuropathy, a functional disorder of the peripheral nervous system those results in sensory

impairment.

Illness

Certain illnesses affect sensory perception. Diabetes and hypertension cause changes in blood vessels and nerves,

leading to visual deficits and decreased sensation of touch in the extremities. Cerebrovascular disorders impair

blood flow to the brain, possibly blocking sensory perception. Pain, fatigue, and stress caused by illness also

affect perception of stimuli.

Medications

Some antibiotics, including streptomycin and gentamicin, can damage the auditory nerve, impairing hearing.

Central nervous system (CNS) depressants, such as narcotic analgesics, decrease awareness and impair perception

of stimuli.

Variations in stimulation

If a person experiences more sensory stimulation than he or she is used to, then distress and sensory overload may

occur.

On the other hand, if a person experiences less than the usual stimulation, that person is below his or her optimum

state of arousal and may be at risk for sensory deprivation.

Reactions to sensory overload or sensory deprivation are special challenges that nurses frequently

encounter in themselves and clients. Sensory overload and deprivation can lead to perceptual, cognitive, and

decisional problems. When the RAS is overwhelmed with input, a person may experience sensory overload and feel

confused, anxious, and unable to taken constructive action. When the RAS fails to recognize a stimulus because it is

below the threshold level or lacks relevant meaning to the person, sensory deprivation may occur, and the person

experiences depression, restlessness, and hallucinations.

SENSORY DEPRIVATION IN HOSPITAL SETTINGS

In the hospital such occurrences fall into two general categories:

– altered sensory reception

– deprived environments

Altered sensory reception

Occurs in such conditions as spinal cord injury, brain damage, changes in receptor organs, sleep deprivation, and

chronic illness. The person does not receive adequate sensory input because of an interference with the nervous

system's ability to receive and process stimuli.

Deprived environments

It can have negative effects on a person's sensor stasis. A person who is immobilized or isolated for any reason is

deprived of the usual amount of stimulation and may show manifestations of sensory deprivation.

RISK FACTORS FOR SENSORY DEPRIVATION IN THE HEALTHCARE ENVIRONMENT

• Private room

• Eyes bandaged

• Bed rest

• Sensory aid not available (hearing aid, glasses)

• Isolation precautions

• Few visitors

EFFECTS OF SENSORY DEPRIVATION

PERCEPTUAL RESPONSES

Inaccurate perception of sights, sounds, tastes, smell and body position co-ordination and equilibrium

Mild to gross distortions ranging from day dreams to hallucinations

COGNITIVE RESPONSE

Inability to control the direction of thought content

Decreased attention span and ability to concentrate

Difficulty with memory, problem solving and task performance

EMOTIONAL RESPONSES

Inappropriate emotional responses including apathy, anxiety, fear, anger, panic or depression and rapid mood changes

CLINICAL SIGNS OF SENSORY DEPRIVATION

PHYSICAL BEHAVIOURS

Drowsiness

Excessive yawning

ESCAPE BEHAVIOURS

Eating

Exercising

Sleeping

Running away to escape the deprived environment

CHANGES IN PERCEPTION BEHAVIOUR

Unusual body sensations

Pre-occupation with somatic complaints (Dry mouth, palpitations, difficulty breathing, nausea) and changes in body image, illusions and hallucinations

CHANGES IN COGNITIVE BEHAVIOUR

Decreased attention span

Inability to concentrate

Decreased problem solving and task performance

IMPACT ON ACTIVITIES OF DAILY LIVING

• Sensory perception dysfunction may have effects on activities of daily living (ADLs). Visual deficits cause problems with self-care activities as basic as dressing, toileting, and preparing meals. Hearing deficits may restrict people from watching television, listening to the radio, and answering the telephone. Safety hazards also exist for who are hearing impaired.

• People with taste and smell deficits may lose interest in eating.

• Those with sensory deficits involving touch are at risk for burns and injuries to the extremities. Moving around outside the home may be impossible without special aids or help.

• Many jobs are prohibited for people with sensory deficits, and driving may not be allowed.

• This further restricts the environments in which they may move about safely, making them dependent on others. If the affected person is the major wage earner, a reduction in or loss of income may occur.

• People with cognitive dysfunction from sensory overload or deprivation may exhibit poor judgment and problem solving during everyday activities, increasing the necessity for family members to monitor activities and decisions.

All these concerns place more stress on the family to cope with sensory dysfunctions.

RELAXATION TECHNIQUE

RESTRICTED ENVIRONMENTAL STIMULATION THERAPY (REST)

Sensory deprivation, or Restricted Environmental Stimulation Therapy (REST), is a technique by which sensory input (sound, light, smell, etc.) is minimized. This practice encourages an extremely deep level of relaxation. There are two basic methods of restricted environmental stimulation therapy (REST):-

Chamber REST and Flotation REST

CHAMBER REST

In chamber REST, subjects lie on a bed in a completely dark and sound reducing (on average, 80 dB) room for up

to 24 hours. Their movement is restricted by the experimental instructions, but not by any mechanical restraints.

Food, drink and toilet facilities are provided in the room and are at the discretion of the tester. Subjects are allowed

to leave the room before the 24 hours are complete, however fewer than 10% actually do.

FLOTATION REST

Modern float tanks are large enough in size and shape to allow a full-sized adult to easily enter, exit, and lie

comfortably. The bottom of the light-proof and sound-insulated chamber is filled with 30% Epsom salt solution. The

density of this solution provides the floater with complete buoyancy and weightlessness. Indeed, the solution's density

makes it impossible for the user to sink.

A float session begins when the tank's door is closed. Light is completely eliminated and sound is reduced to near

zero through the combination of the tank's insulation and submersion of the floater's ears. Earplugs can further block

outside noises. The air and water within the tank are maintained at a constant skin temperature. This neutral

temperature prevents the physical and mental distractions caused by cold and heat. The silky nature of the solution

further reduces the separation between the floater's skin and its surroundings, so that the body seems to gradually

disappear. The combined elements of the tank, therefore, virtually eliminate all external stimulation for the floater

Without environmental stimuli to process, the central nervous system's level of activity drops dramatically sending

the floater into a state of deep relaxation. The body undergoes positive physiological changes that work toward

achieving homeostasis - the state of physical equilibrium. Muscular tension is released and proper blood flow is

enhanced. Additionally, the body begins to balance any neurochemical imbalances caused by tension and stress.

There is increased production of endorphins and T-cells, which provide pain relief and increased immunity,

respectively. In essence, relieved of outward stimuli, the floater's central nervous system can concentrate most of its

energies inward for the restoration of physical and mental health.

During a float session, the brain also enters the theta state, usually accessible only in the brief moments before falling

asleep. This level of consciousness provides access to the right hemisphere of brain, which is associated with

concentration, creativity, and learning. The brain can more easily retain information while in the theta state.

A typical float session lasts an hour, although longer sessions are available. After the floater rinses off the salt

solution in a shower, most float centers provide a rest area to recuperate and reflect on the float session. This

downtime with other floaters and staff enhances the relaxation process. In total, the entire session lasts one-and-one-

half to two hours. Repeated weekly sessions are suggested to achieve the full benefits of Floatation REST.

BENEFITS OF THE THERAPY

These therapies have many physical and mental benefits.

It provides an unparalleled level of relaxation

Old wounds and injuries are allowed to heal faster

Strengthens the immune system

Vasodilatory effect (the body's circulation is increased while the blood pressure and heart rate are reduced)

Muscles and joints release tension

Reducing pain and fatigue

Increase vitality and further reduce levels of stress and tension

Stress-related health problems as migraine headache, hypertension, and insomnia are similarly reduced

Can help with eliminating compulsive behaviors such as alcoholism and smoking

People with psychological and emotional problems as anxiety and depression can also benefit from this

therapy

Added benefit stems from the Epsom salts which provides buoyancy (Epsom salt "draws toxins from the

body, sedates the nervous system, reduces swelling, relaxes muscles, and is a natural emollient (and

exfoliative)." Also, because the solution does not leach salt from the skin, the floater's skin will not wrinkle

during the treatment)

SIDE EFFECTS OF THE THERAPY

Prolonged exposure to the Epsom salt solution may cause diarrhoea and dry skin. Otherwise, this therapy

has no known negative side effects.

ROLE OF NURSE

Nurse-Client Interaction

The nurse-client interaction promotes sensory health function. The nurse must compensate for the patient’s absent

sensations to prevent sensory deprivation. This is done by stimulating the patient above the level of injury. Clients at

risk for sensory deprivation may need frequent interaction initiated by the nurse.

In any case, provide appropriate stimuli, such as addressing the client by name, explaining all activities, and when

leaving, acknowledging the client that the nurse will return. Length, tendency, and content of interactions should be

based on individual needs. Talking to the client, showing the client equipment or articles used in care, encouraging

the client to smell and taste food that is served, and touching the client are appropriate stimuli during interactions.

Conversation, music, strong aromas and interesting flavours should be a part of the nursing care plan.

Every effort should be made to prevent the patient from withdrawing from the environment.

NURSING INTERACTIONS

• Providing meaningful external stimuli can help a client overcome sensor' deprivation or sensory deficit as; playing the television or the radio occasionally playing tennis,

• Encouraging use of a clock and calendar,

• Encouraging the client to dress or the day's activities, putting till pictures,

• Encouraging visitors, opening the drapes, and turning on lights,

• Plan: the bed or chair so the client can see or hear activities in the area.

THEORY APPLICATION

LYDIA HALL’S CORE, CARE, CURE THEORY

CORE CARE

CURE

JOURNAL ABSTRACT

SENSORY DEPRIVATION: A Review

PHILIP SOLOMON; P. HERBERT LEIDERMAN; JACK MENDELSON; DONALD WEXLER

The American Journal of Psychiatry, October 21st, 2011

VOL-114, NO.4, 114:357-363

Abstract

Sensory deprivation has been produced experimentally by reducing the absolute intensity of stimuli, by

reducing the patterning of stimuli, and by imposing a structuring of stimuli. Explorers have experienced it

voluntarily and prisoners have had it thrust upon them. While there are many separate factors operating in

these various situations, it is clear that the stability of man's mental state is dependent on adequate

perceptual contact with the outside world. Observations have shown the following common features in

cases of sensory deprivation: intense desire for extrinsic sensory stimuli and bodily motion, increased

suggestibility, impairment of organized thinking, oppression and depression, and, in extreme cases,

hallucinations, delusions, and confusion. Though the basic concepts regarding perceptual and sensory

deprivation are not new, their recent importance in experimental and real life situations has made them

increasingly interesting. Future studies in this area may well contribute to our knowledge of the

psychological and behavioral patterns of man under conditions of normality and stress.

SUMMARY

Sensory deprivation a condition in which an individual receives less than normal sensory input. It can be caused by physiological, motor, or environmental disruptions. Sensory deprivation facilitates the production of an altered state of consciousness through the reduction of extroceptive stimulation and/or motor activity.  Sensory deprivation functions in a similar manner as meditation; both reduce the perception of external stimulus. Effects include boredom, irritability, and difficulty in concentrating, confusion, and inaccurate perception of sensory stimuli. Auditory and visual hallucinations and disorientation in time and place indicate perceptual distortions due to sensory deprivation. Symptoms can be produced by solitary confinement, loss of sight or hearing, paralysis, and even by ordinary hospital bed rest.

There are many opportunities throughout the day to provide opportunities for stimulation. There are still many ways to provide stimulation for people who are no longer able to participate in daily activities of living or leisure pursuits. What is most important is to find ways to stimulate, otherwise without stimulation, a human being will decline.

CONCLUSION

Today we have dealt in detail about sensory deprivation- the normal sensory perception and the normal sensory stimuli, how sensory deprivation occurs, the factors causing sensory deprivation, the effects of sensory deprivation, its impact on daily activities, relaxation technique and the role of nurse in sensory deprivation.

BIBLIOGRAPHY

BOOKS

LEWIS, BUCHER (2008) “MEDICAL-SURGICAL NURSING- ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS”, ELSEVIER PUBLICATIONS, 7th EDITION, PAGE NO-1603

SUZZANE & BRENDA (),”MEDICAL SURGICAL NURSING”, LIPPINCOTT PUBLICATIONS, 10th EDITION, PAGE NO: 1099

JOURNAL

The American Journal of Psychiatry, October 1st, 2009, VOL-114, NO.4, 114:357-363

NET REFERENCES

http://www.google.com/ sensory deprivation http://www.wikipedia.org/ sensory perception