Snoezelen (pronounced snuzelen; editor's note) is a rapidly developing method that is relatively new in the Czech Republic. It comes from the Netherlands, where in the 1970s two civil service workers built the first Snoezelen in a tent and tried to provide new sensations to clients with severe intellectual disability. Today the Snoezelen method is much more developed. I would define it as providing new experiences and stimuli that should take the client out of their usual environment, provide a new stimulus for their development, and offer them new possibilities. Snoezelen is called both a method and the room in which therapy takes place. There are twelve basic types of environments defined, which have different uses for different clients and can also be combined with one another.
- White room – where it is possible with projectors to project a variety of effects on white walls, floor, and ceiling. It is most often used as a leisure activity and an opportunity for relaxation, also for clients with severe and profound intellectual disabilities. In the white room, vision is primarily stimulated. It is often combined with the soft zone, where a client can comfortably lie down and watch the projection in any position.
- Gray room – a soundproof, minimally equipped room that reduces stimuli, equipped with a weighted vest, a small den, and a study corner. This environment is suitable for clients who have attention problems, especially with autism spectrum disorders. In an environment with few stimuli, the client can concentrate on one thing, as the surroundings do not disturb them. The therapist can better distinguish reactions to individual sensations. Weighted blankets and vests are especially suitable for clients with autistic disorders. They are filled with metal balls, which, through their weight and structure, better give the client information about the boundaries of their body. They provide a sense of safety and certainty and calm the client.
- Black room – a room where effects can be projected with the highest possible resolution and without additional undesired, distracting visual impressions. It is primarily used for visual stimulation.
- Sound space – a soundproof room providing the client with intensive isolated perception of sounds either produced by the client using their body, various aids, materials, musical instruments, or played from a recorder. This environment is suitable for clients with visual impairments, where the client receives the majority of stimuli through hearing. Here they learn how certain materials sound, how instruments sound, and in a real environment they can better orient themselves and then "pull out" sounds for their orientation and other practical activities that are important. Another use is for clients with autism spectrum disorders, where clients enjoy listening to sounds and enjoy producing them in varied ways, humming and playing with echo in an empty room.
- Interactive zone – an environment allowing exploration of cause and effect. By means of various switches, it is possible to control the environment and different stimuli. In the interactive zone, there can be not only projectors but also a hairdryer, bubble machine, scent diffusers, and so on. The interactive zone can be used primarily for special pedagogy as a teaching opportunity for clients with profound intellectual disability, where the client can practically and reliably distinguish the environment’s reactions to their behavior better than in everyday environments, where a reaction may come later and the client no longer connects it with their stimulus.
- Water zone – allows proprioceptive stimulation through a pool and other equipment such as a whirlpool and others. For clients with limited mobility, stimulation of body surface, proprioceptors in the muscles and tendons, and receptors in the joints, which inform the brain about body position, as well as stimulation of the vestibular system, is very useful. With reduced stimulation due to limited movement, this system may over time provide false information, or the brain may then respond inappropriately to normal stimuli. Conversely, a client left inactive may over time react to movement with fear and refusal. In contrast, a client who is well stimulated and whose brain has quality information about body and individual limb positions is more mobile, more confident when moving, and overall calm and content.
- Soft zone – a fully padded area with multi-level flooring, stairs, and ramps, where clients can experiment with the environment and their possibilities, and take risks in a safe setting. Suitable for all clients so they can freely move across obstacles and try out their movement abilities, and despite their disability, they can "position" themselves and fully learn where the limits and restrictions of their disability are and what, conversely, they are capable of. Then they can better use their remaining abilities in practical life.
- Portable device – allows some elements of Snoezelen to be brought with the client, for example into the home environment. Examples include tactile, auditory, olfactory, and even visual stimulation through optical fibers, and so on. This is primarily useful in outreach services when the therapist goes to the client's home, or in facilities with a lack of space for an independent room. Of course it has limits and disadvantages, but it is still usable. And mobile cabinets with equipment for Snoezelen are appearing on the market.
- Virtual environment – through interactive 3D display, it is possible to gain experiences that cannot be obtained in real environments. The range of programs is broad—from everyday activities such as virtual shopping to, for example, a parachute jump. It is certainly an interesting enrichment, especially for clients with physical limitations.
- Inclusive zone – is an ordinary environment that, with suitable equipment, allows a client with disability to share the environment with the majority population. An inclusive zone can therefore also be called a playground equipped with multisensory elements and controllers suitable also for children with multiple impairments. This is a very useful element for integrating people with disabilities into majority society, where integration should not be rushed and children with and without disabilities should generally share not only playgrounds.
- Pluralistic environment – clients stop perceiving an unchanging environment as stimulating. Even a multisensory environment needs to be varied so that it does not become over-familiar.
- Social space – space for meeting with friends, family, etc.
Snoezelen as a leisure activity or as therapy takes place only according to the client's needs, the therapist's imagination, and their relationship, mutual understanding, and therapeutic intention. Snoezelen does not affect only individual senses, but also the client's cognitive abilities. It may also be used for personality development, communication skills, socialization, and social interaction.
When setting the goal and method of therapy, the therapist must thoroughly get acquainted with the client's biographical anamnesis, in which a detailed analysis of pleasant and unpleasant stimuli, different types of reactions, and ways to offer the client a sense of safety and calm them if they do not feel well in the new environment and new situation must not be missing. The second point is to define the therapy goal. The goal may be calming through relaxation, or, on the contrary, awakening the client from lethargy, "starting" the senses for intense stimuli. Snoezelen can also support goals in special pedagogy.
From personal experience, I can describe therapies carried out in our Snoezelen at Center for Care of Disabled People ALKA. Our clients are mainly children and young adults with multiple impairments. Its use, however, is also possible for children in kindergartens, for seniors, and for other target groups. In our center we built a white room (see type 1 above). It is a fairly small circular space built into a room measuring 3.5 x 3 m from drywall, whose practically entire inner surface is occupied by an elevated bed filled with PES beads, under which a vibrating mat is placed. The walls are padded to the height of a seated person's shoulders; around the entire perimeter a small padded seat is created at the height of the bed. The room is equipped with a control panel, several projectors (various light effects—UV light, water, fire, stars, moving shapes, kaleidoscope, room color changes, etc.), disco ball, colored spotlights, speakers, BassShake system, and player, but also air conditioning.
Therapy in the Snoezelen is led by social service workers. Each conducts therapy according to intentions corresponding to their profession, experience, and above all, client needs. It is advantageous if they have a course in basal stimulation, on whose concept the therapies should be built. The client is offered various visual stimuli through projectors. The vibrating bed gives the client tactile comfort, which we can also provide by inserting different tactile "toys." Hearing is stimulated by different relaxing music, to which the vibrating mat in the bed responds (it converts music into vibrations). For some clients, stimulating rhythmic music is used instead. Smell is stimulated with aromatic oils. As part of therapies, calming or activating massages, diametrical massage, or massage stimulating breathing (from the concept of basal stimulation) are provided. All these ways of stimulation have a deeper meaning for the client than is obvious at first glance.
Clients usually respond enthusiastically to the new therapy. A client who does not fixate their gaze on objects placed in the hand attentively watches the patterns on the wall. Clients with visual and/or hearing impairment favor the vibrating bed and relaxing music, which completely envelops everyone due to the placement of the speakers on the ceiling. Bed vibrations are also very beneficial for clients with a spastic form of DMO, who have major problems with relaxation (relaxation of spastic muscles).
For clients with DMO, therapy is probably most complex. The most important element is diametrical massage; afterward, the relaxed spastic limbs may be wrapped in a blanket or inflatable splints, and possibly weighted, which prevents the limbs from jerking out. It is followed by a relaxation phase with music and gentle vibrations into the bed, which help relax the muscles and create a pleasant feeling for the client. Snoezelen is primarily meant to enrich the service offer for clients with severe disabilities, but it benefits everyone, whether for some “just” as a leisure activity, for others as medical therapy, or as social activation. Therapy in Snoezelen enriches not only clients but also therapists. It helps establish a better relationship with the client, with whom one goes through this therapy together. Communication expressions are often visible that in the enclosed environment of Snoezelen are perhaps more expressive, perhaps it is simply that individual reactions to certain stimuli can be distinguished more clearly. It also becomes a new stimulus in work and a motivator for new approaches to both the client and the therapist’s work.
Kateřina Tichá, DiS. occupational therapist (editorially revised)
Professional journal Social Services - August / September 2011 More information can be obtained on the websites http://www.socialnisluzby.eu and http://www.apsscr.cz.