1. Multi Sensory Environment (MSE) Training SENSORIUM 3
Sandra Fornes, Ed.D.
Partial proceeds from this training goes to the Hidden Angel Foundation 1

2. * MSE - Theoretical Framework
Based on the literature and current research a MSE should be:
Artificially created supported by the natural environment
Devoted to stimulate all the senses,
Safe, comfortable, and predictable,
Designed to empower by providing self-choice,
Demand-free and choice driven activity – consumer controlled,
Passive and interactive,
Provide for trained facilitators ,
Provide of techniques to change brain arousal and motivation
Based on the literature, research, and emerging themes in MSE and neuroscience, a theoretical framework and delivery model of MSE was developed to improve physiological and psychological outcomes for populations with various disabilities. Based on the findings of this study MSE should be: (a) artificially created but include the natural environment as well; (b) devoted to stimulate all the senses, (c) safe, comfortable, and predictable, (d) designed to empower the individual by providing self-choice, (e) a demand-free leisure activity rather than a controlled therapy; (f) passive and interactive, (g) have trained facilitators , and (h) affect brain arousal to heighten awareness and/or increase relaxation.
There is a need to develop a clear theoretical basis for the use of MSE, answering questions as to: (a) why does MSE appear to be so beneficial? (b) Is MSE more effective as a controlled therapy or a demand free recreational activity? (d) what effect does the facilitator have on the outcome when using a MSE? (e) Is a passive or interactive approach to MSE more effective? (f) Does a natural MSE environment provide the same outcomes as an engineered multi sensory environment? 18

3. MSE - Theoretical Framework
Artificially created supported by the natural environment.
Limitations impeded the ability of an individual to interact with a natural environment in a meaningful way.
An engineered environment:
a. Helps make interactions meaningful.
b. 0ffers more stimuli than the natural environment.
c. A child’s natural environment becomes less chaotic as he or she learns how to control sensory input.
While, a MSE can be a natural environment, it important is that individuals with cognitive challenges are constantly and consistently provided elements of multi sensory stimulation.
An engineered environment may provide more or additional sensory stimulation for people who due to their disabilities are not spontaneously able to seek such stimulation on their own. Various limitations may impede the ability of an individual to interact with a natural environment in a meaningful way. For example, a blind child may not have the ability to see light in a natural environment; however, in an artificially created MSE, certain light illuminating equipment, such as the fiber optic, may stimulate the optic nerves. In an artificially created environment the sensory stimuli can be intensified or reduced and provided in a constant and consistent manor offering more stimuli than the natural environment.
When a child is left without appropriate environmental modifications the child’s ability to engage with the external environment may be serous compromised. For children with disabilities the natural environment may seem chaotic and unpredictable, yet through the use of an artificially created MSE, a child’s natural environment becomes less chaotic as he or she learns how to control sensory input from their natural external world. 18

4. MSE - Theoretical Framework
Devoted to stimulate all the senses
Adequate multi sensory stimulation of all the senses
Produced in sufficient frequency, intensity and duration change brain arousal and motivation
Intense periods of sensory stimulation that uses repeated movements, sound, touch, and visual exercises helps slowly create new neural pathways
Multimodal stimulation (stimulation of three or more senses) has more dramatic results than unimodal stimulation.
Adequate multi sensory stimulation of all the senses (consisting of auditory, visual, tactile, gustatory, olfactory, and kinetic modes) produced in sufficient frequency, intensity, and duration excites and exercises the brain, improves its organization, heightens awareness, and permits increased functional activities. Intense periods of sensory stimulation that uses repeated movement, sound, touch, and visual exercises helps slowly create new pathways in the brain where they were damaged or underdeveloped. Multimodal stimulation (stimulation of three or more senses) has more dramatic result than unimodal stimulation (stimulation of one sense). Those in multisensory environments have more recall with better resolution that lasts longer, evident even 20 years later. Additionally, research has shown that exercise and repetitive movements in physical activities involving kinesthetic stimulation have lead to positive effects on behavioral challenges and improved brain function. 18

5. MSE - Theoretical Framework
Safe, comfortable, and predictable
Produce an atmosphere of trust.
Physical comfort, i.e. temperature, lighting, noise levels, or seating options, must be anticipated for the individuals.
Personal space must be honored.
A user friendly environment that is constant and predictable for the individual is required to facilitate learning and development.
The MSE must be a dedicated space that remains constant and consistent
All elements of physical comfort must be anticipated. Control of the temperature, lighting, noise level, seating options and number of people in the room must be controlled for and preset for the individual
Aimed to change brain arousal, a MSE should be safe, comfortable, consistent, providing constant sensory stimulation, and produces an atmosphere of trust. All elements of physical comfort, such as temperature, lighting, noise levels, or seating options, must be anticipated for the individuals. Individuals’ personal space must be honored. Children and adults with multiple disabilities need opportunities for play, relaxation, and enjoyment in a quiet, yet stimulating environment. A user friendly environment that is constant and predictable for the individual is required to facilitate learning and development. 18

6. MSE - Theoretical Framework
Designed to empower by providing self-choice
The individual’s choices are honored and respected
If they wish to leave, after any period of time, they can
If they wish to explore and stay with one piece of equipment, they can
By providing a demand free, self-choice environment an individual is empowered and his/her self-determination enhanced.
Self-determination is critical in predicting various performance and satisfaction outcomes and is viewed as a fundamental human right
Self-determination contributes to educational and work goals by increasing self-sufficiency, autonomy, and valued life outcomes.
By providing a demand free, self-choice environment an individual is empowered which enhances his/her self-determination. SD is critical in predicting various performance and satisfaction outcomes. Self-determination theory (SDT) is a general theory of human motivation concerned with the development and functioning of personality within social contexts. The theory focuses on the degree to which human behaviors are self-determined or the degree to which people endorse their actions by engaging in the actions with a full sense of choice. SD is viewed as a fundamental human right to govern one's life without unnecessary interference from others. Self-determination contributes to educational and work goals by increasing self-sufficiency, autonomy, and valued life outcomes like community integration, independent living, and inclusion. 18

7. MSE - Theoretical Framework
Demand-free activity
MSE used as a non-directive, demand-free, recreational activity and /or educational tool, has therapeutic value.
Facilitator acts only as a guide introducing the equipment
Studies show no benefits when used as a controlled therapy which makes demands.
MSE showed more positive outcomes when used as a demand-free, self-choice activity.
No demands are made of the individual, No questions are asked , No directions or instructions are given.
No initiating talking to the individual - Silence is observed
Speak only when spoken to.
Today’s providers use MSE mainly as a non-directive, demand-free, recreational activity, and/or educational tool that has been identified to have therapeutic value. The non-directive, leisure nature of MSE has been emphasized with relaxation, enjoyment, learning, facilitation of interpersonal relationships, and improvement in brain functioning. In a demand-free, self-choice environment a facilitator acts only as a guide introducing the equipment to the child.
A therapy is a controlled activity where a professional leads a patient through activities that the therapist feels are needed. For example, Sensory Integration Therapy is a controlled therapy where a therapist makes demands on the child to accomplish certain sensory motor activities. Sensory Integration Therapy is not a Multi Sensory Environment but the terms are often incorrectly used interchangeably. SI is a treatment approach, not an environment. SI makes demands of the child and is not choice driven nor is it demand-free.
Studies have indicated that sensory integration as a controlled therapy is ineffective and that its theoretical underpinnings and assessment practices are invalid.
Studies on the effects of the use of a MSE showed more positive outcomes when MSE is used as a demand-free, self-choice activity. For example, while voluntary wheel-running in mice results in increases in plasticity molecules and cognitive enhancement, forced treadmill running did not improve cognition, probably, due to stress. Based on this research, MSE as a voluntary leisure/recreation activity is more likely to produce positive therapeutic outcomes than used as a controlled therapy. 18

8. Are there any rules? Yes No shoes No nakedness No sleeping
No endangering themselves or others
No deliberate destroying of property
At any point in time if one of the above occurs, the session stops immediately and the individual is escorted outside.

9. MSE - Theoretical Framework
Trained facilitators
First stimulus
Guides user through MSE experiences
Provides warm interaction, guides user toward sensory stimuli and engagement of objects.
Facilitator must :
Be empathetic and caring,
Have an understanding of the user’s sensory interests
Know how to introduce stimuli to change brain arousal and motivation
A key determinant of an effective MSE experience is the facilitator who serves as the first stimulus and guides the user through the MSE experience. The facilitator provides warm interaction, not interfering with the person’s choice and pace, and guides the person towards sensory stimuli and engagement of objects.
A facilitator is a significant person to the individual and, therefore, knows him/her well. The facilitator can be a parent, a sibling, a personal assistant, therapist, or teacher. The facilitator must (a) be empathetic and caring, (b) have an understanding of the user’s sensory interests, and (c) know how to introduce the sensory stimulation to the user to affect brain arousal and brain synchronization that leads to increased enjoyment, focus, motivation, and learning. It is important to have an understanding of the individual’s likes and dislikes to avoid any sensory overload (too much stimulation). While this is usually not an issue for low functioning individuals that require multi stimulation in order to achieve higher awareness and functional activity, it can be an issue for children that have sensory processing issues. 18

10. MSE - Theoretical Framework
Techniques to change brain arousal and motivation
Three premises to brain arousal and the well-being
Central to quality of life is cognition and brain activity and emotional function;
(b) The central nervous system arousal is fundamental to all cognition, brain activity, and emotional function;
(c) The core to increasing one’s brain arousal is sensory stimulation.
Brain arousal is higher in those who are (a) more alert to multi sensory stimuli, (b) more motor active, and (c) more reactive emotionally. Arousal is a dynamic changing process related to direct and indirect responses to internal and external stimuli.
Brain arousal is fundamental to all cognition and behavior. Nearly all health problems flow from over-arousal, under-arousal, or instability in the central nervous system. Neural pathways are the underlying mechanism for brain arousal. Disrupting brain arousal mechanisms cause problems ranging from mild loss of vigilance or sleep, to the devastation of a vegetative state. There are three premises to brain arousal and the well-being of an individual: (a) Central to quality of life is cognition and brain activity and emotional function; (b) The central nervous system arousal is fundamental to all cognition, brain activity, and emotional function; (c) The core to increasing one’s brain arousal is sensory stimulation. Through sensory stimulation, brain arousal is increased and improves cognition (through alertness, attention, and orientation) and emotion (through temperament, mood, and feelings). The strength of a learned response depends on the arousal and drive of the individual. Brain arousal provides the fundamental force that makes animals and humans active and responsive, so they will perform instinctive behaviors or learned behaviors directed toward goal objectives. MSE promotes changes in arousal levels and affects drive and motivation through changes in neurochemistry. Brain arousal is higher in those who are (a) more alert to multi sensory stimuli, (b) more motor active, and (c) more reactive emotionally. Arousal is a dynamic changing process related to direct and indirect responses to internal and external stimuli. 18

11. MSE - Theoretical Framework
Techniques to change brain arousal and motivation
For a human to be aroused, there must be some change in the environment. If there is change, there must be some uncertainty about the state of the environment.
Brain arousal increases with intensity, complexity, novelty, unexpectedness, inconsistency, infrequency, changing environments, incongruence, the unusual.
Arousal can be decreased with constancy, repetition, familiarity, and neutrality.
The optimal level of arousal is unique to each individual and is based on their sensory needs and interests.
For a human to be aroused, there must be some change in the environment. If there is change, there must be some uncertainty about the state of the environment. Brain arousal increases with intensity, complexity, novelty, unexpectedness, inconsistency, infrequency, changing environments, incongruence, the unusual. High degrees of novelty, uncertainty, and unpredictability have high information content and promote brain arousal. The more uncertain we are about the occurrence of an event or action, the more information is transmitted when the event or action does happen. Similarly, the more uncertain we are about an action or event, the more brain arousal is produced. For example, there are two events, the waving of a red or blue flagag not at all, no information is transmitted by either flag, nor is there any brain arousal. However, if the flag selection is random, with a 50:50 chance of either flag being selected, information being transmitted is unpredictable and brain arousal is increased. Information conveys peaks when two probabilities are equal – that is, when the observer is least able to predict what will happen, the uncertainty, the surprise, and the information content are at their highest. Disorder maximizes information flow and increases brain arousal. At the opposite extreme, perfect order minimizes information flow and brain arousal. It is clear that in a monotonous environment, lacking change, a human or an animal will lose arousal and become less alert – failure to thrive. Arousal can be decreased with constancy, repetition, familiarity, and neutrality. The optimal level of arousal is unique to each individual and is based on their sensory needs and interests. 18

12. MSE - Delivery Model Building MSE to Enrich Quality of Life
STEP 3 - Techniques to facilitate change in brain arousal.
Based on the theoretical framework, the delivery model of an engineered Multi Sensory Environment consists of 3 hierarchal steps. The first step is to provide a physical space (room design and equipment selection) that is safe, comfortable and engineered to provide consistent and constant multi sensory stimulation
STEP 2 - Facilitator who understands the users sensory needs and guides the user through demand-free, self-choice opportunities to facilitate empowerment and self determination.
STEP 1 - Physical space (room design and equipment selection) to provide a safe, comfortable environment with consistent and constant stimulation of all the senses.
THE MSE DELIVERY MODEL
an engineered environment devoted to simulation of all the senses 18

13. MSE - Delivery Model Building MSE to Enrich Quality of Life
STEP 3 - Techniques to facilitate change in brain arousal.
The second step is a trained facilitator that has an understanding of the individual’s sensory interests and provides demand-free, self choice opportunities to empower and increase self-determination.
STEP 2 - Facilitator who understands the users sensory needs and guides the user through demand-free, self-choice opportunities to facilitate empowerment and self determination.
STEP 1 - Physical space (room design and equipment selection) to provide a safe, comfortable environment with consistent and constant stimulation of all the senses.
THE MSE DELIVERY MODEL
an engineered environment devoted to simulation of all the senses 18

14. MSE - Delivery Model Building MSE to Enrich Quality of Life
STEP 3 - Techniques to facilitate change in brain arousal.
Based on the theoretical framework, the delivery model of an engineered Multi Sensory Environment consists of 3 hierarchal steps [highlight bottom of triangle]. The first step is to provide a physical space (room design and equipment selection) that is safe, comfortable and engineered to provide consistent and constant multi sensory stimulation
STEP 2 - Facilitator who understands the users sensory needs and guides the user through demand-free, self-choice opportunities to facilitate empowerment and self determination.
STEP 1 - Physical space (room design and equipment selection) to provide a safe, comfortable environment with consistent and constant stimulation of all the senses.
THE MSE DELIVERY MODEL
an engineered environment devoted to simulation of all the senses 18

15. For further information:
Our Inspiration
Christopher Douglas Fornes ( )
For further information:
Sandra Fornes phone:
fax:
Christopher Douglas Hidden Angel Foundation (CDHAF) is a registered charitable organization in Canada and the USA. 1