comparing&amul/sensory&approach&to&tradi/onal&speech ... · research poster...
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• Providing therapy within a multisensory environment with various clinical populations can be very advantageous (e.g. Fowler, 2008; Fava & Strauss, 2010; Lotan, & Merrick, 2004; Mays & Baird, 2015).
• This offers various sensory experiences, within an atmosphere of trust and relaxation, promoting the stimulation of the senses.
• This environment could lead to increased abilities in communication, attention and concentration in people with learning disabilities or other impairments.
• Multisensory environments are common practices among the physiotherapy and occupational therapy fields.
• This approach can apply to many different clients, young and old, with physical or sensory impairments, cognitive delay, as well as developmental and intellectual disabilities, such is the case with the foetal alcohol syndrome population (FAS) or Fetal Alcohol Spectrum Disorder (FASD) (e.g. Franklin, Deitz, Jirikowic, and Astley, 2008; Abele-Webster, Magill-Evans and Pei, 2012).
Context
Method
Preliminary results
We would like to thank Santé Canada and the “Consortium national de formation en santé”(CNFS) for their financial contribution to this project. 1. Abele-‐Webster, L. A., Magill-‐Evans, J. E., & Pei, J. R. (2012). Sensory processing and ADHD in children with fetal alcohol spectrum disorder. Canadian Journal of Occupa0onal Therapy, 79(1), 60-‐63. 2. Fava, L., & Strauss, K. (2010). Mul/-‐sensory rooms: Comparing effects of the snoezelen and the s/mulus preference environment on the behavior of adults with profound mental retarda/on. Research in Developmental Disabili0es, 31(1),
160-‐171.doi: doi:10.1016/j.ridd.2009.08.006 3. Franklin, L., Deitz, J., Jirikowic, T., & Astley, S. (2008). Children with fetal alcohol spectrum disorders: problem behaviors and sensory processing. American Journal of Occupa0onal Therapy, 62(3), 265-‐273. 4. Fowler, S. (2008). Mul0sensory rooms and environments: Controlled sensory experiences for people with profound and mul0ple disabili0es. Jessica Kingsley Publishers. 5. Lotan, M., & Merrick, J. (2004). Reb syndrome management with snoezelen or controlled mul/-‐sensory s/mula/on. A review. Interna0onal Journal of Adolescent Medicine and Health, 16(1), 5-‐12. 6. Mays, J. & Baird, E. (2015). Children with Complex Communica/on Needs in the Snoezelen Room: A communica/on and Wri/ng Aids Service « CWAS Snoezelen group Pilot Project».
Discussion and Conclusion
Objectives
Lauren/an University, Sudbury ON, Canada
Élisa Langlois,B.Sc.S, M.Sc.S. student Chantal Mayer-‐Cribenden, Ph.D.
Comparing a Mul/sensory Approach to Tradi/onal Speech and Language Interven/on: Effects on the Language Abili/es of Children with Fetal Alcohol Syndrome (Preliminary Results)
ObjecFves and hypothesis
Measures (dependent variables): 1) Repeated measures (see table 1.) 2) Standardized pre/post–treatment assessments (see table 2.)
Table 1. Repeated measures effect sizes *Effect sizes of 0.8 or larger indicate clinically significant change ** Covers: internal and external social-emotional behavior, compliance, motivation, attention, ability to attend to the task, etc.
PROBLEMATIC Research showing the efficacy of a mul/sensory therapy approach in the field of speech and language pathology is scarce. There is a lack of in-‐depth knowledge and research on the effects of this mul/sensory approach. The maintenance and construc/on of a mul/sensory room requires considerable financial investment.
1 • To compare the short terms effects of a mul/-‐sensory approach on children's communicaFon, behaviour, moFvaFon, aIenFon and language with a tradi/onal approach in SLP.
2 • To determine the feasibility of this type of study by creaFng a mulFsensory room within a budget of $1500 (Canadian dollars), making it more accessible to clinicians from various seongs.
Hypotheses 1:
If various clinical popula/ons benefit from a mul/sensory approach then it is postulated that greater gains in communica/on will be made by the children diagnosed with FASD in the mul/sensory approach group in comparison to those made by the children in the tradi/onal group and the delayed therapy group.
Hypotheses 2:
Since the access to mul/sensory materials and equipment is now readily available on various online centralized networks (i.e. Kijiji) and since there are many do-‐it-‐yourself projects within this type of environment, the crea/on of a mul/sensory room for $1500 should be feasible.
P1 (MulF sensory)
P2 (TradiFonal)
P3 (Delayed)
Test Pre-‐test Post-‐test Pre-‐test Post-‐test Pre-‐test Post-‐test
SLDT-‐MI 78 95 80 83 87 N/A SLDT-‐IN 76 84 <60 63 77 N/A SLDT-‐MI 75 95 75 75 85 N/A SLDT-‐SP 65 85 91 85 92 N/A SLDT-‐Total 68 82 67 67 79 N/A CELF5-‐SC 6 5 9 1 5 N/A CELF5-‐WS 2 3 7 -‐-‐ 4 N/A CELF5-‐FS 2 4* 5 5 1 N/A EVT 75 80 76 78 88 N/A PPVT 74 84* 92 90 88 N/A ENNI-‐A1 <1 7 <1 <1 <1 N/A ENNI-‐A2 <1 <1 <1 <1 <1 N/A ENNI-‐A3 <1 3 7 7 2 N/A
P1 (mulF sensory) P2 (tradiFonal) P3 (delayed)
Task Type Effect size Type Effect size Type Effect size Sentence repeFFon d -‐0,62 d 0,85* d N/A
SMDbaseline -‐0,27 SMDbaseline 0,27 SMDbaseline N/A SMDpooled -‐0,46 SMDpooled 0,35 SMDpooled N/A
Rapid AutomaFc Naming (Fme)
d -‐0,45 d -‐0,27 d N/A SMDbaseline -‐0,32 SMDbaseline 0,69 SMDbaseline N/A SMDpooled -‐0,05 SMDpooled 0,28 SMDpooled N/A
Rapid AutomaFc Naming (errors)
d 1,10* D -‐1,35 d N/A SMDbaseline 0,93* SMDbaseline -‐1,88 SMDbaseline N/A SMDpooled 0,58 SMDpooled -‐0,63 SMDpooled N/A
ObservaFon checklist** d 2,20* d -‐1,41 d N/A SMDbaseline 1,44* SMDbaseline -‐1,34 SMDbaseline N/A SMDpooled 1,46* SMDpooled -‐0,47 SMDpooled N/A
Sustained AIenFon d 0,97* d 1,61* d N/A SMDbaseline 0,66 SMDbaseline 0,76 SMDbaseline N/A SMDpooled 0,69 SMDpooled 1,02 SMDpooled N/A
VISUAL STIMULATION AUDITORY STIMULATION TACTILE STIMULATION • Fiber op/c lights • Mul/ple light effects • Light projectors • Disco ball • Mirrors • Lava lamp • Aquarium with LED light, fish and bubbles • Interac/ve carpet with op/cal fibers • Veiled tent • Glow stars
• Relaxa/on Music • Background noise • Bubble
• Giant beanbag • Panel with tac/le sensa/on (sos, rough,
smooth, hard…) • Variety of toys • Kine/c sand • Fan • Colorful rice play-‐tub • Water play-‐tub • Sos pillows
A single subject design (SSD) was used. At the outset, 8 par/cipants were included in the study. Two par/cipants didn’t meet the inclusion criteria, two par/cipants didn’t complete the interven/on sessions which lead to the elimina/on of a control subject to balance out the groups, leaving us with 3 par/cipants. ParFcipants: Measures: Two types of measures were used in this study: repeated measures and pre-‐post standardized assessments. Five repeated measures were used track progress in targeted skills at baseline and across the treatment period. Environment
Groups P1 P2 P3 Age 7;08 7;01 8;02 Gender Male Male Male Leiter (IQ) 79 87 85 Diagnosis ARND Full FASD Par/al FSAD
P1 The first par/cipant received speech and language therapy in an mul/sensory environment (8 sessions; twice a week)
P2 The second par/cipant received tradi/onal speech and language therapy (8 sessions; twice a week)
P3 The third par/cipant (control) will receive interven/on aser the two first groups (delayed): control group
• Standard room (suitable for this purpose): table & chairs TradiFonal environment
• Mul/-‐sensory s/muli were presented simultaneously through sensory modali/es of vision, hearing and touch
MulF-‐sensory environment
q FASD: Fetal alcohol spectrum disorder q ARND: Alcohol-‐Related Neurodevelopmental Disorder q pFAS: Par/al Fetal Alcohol Syndrom
Collec/on of these data are currently in process
References
The creation of this multi-sensory room: Included in this room were items we purchased from various online centralized networks (e.g. Kijiji), materials created in-house (e.g. Panel with tactile sensation) as well as items that our speech language pathology clinic already owned (i.e. objects commonly found in clinical settings).
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11 12
% W
ords Correct
Session
Sentence RepeFFon Tradi/onnal
Mul/ sensory
Control
0 5
10 15 20 25 30 35 40 45 50
1 2 3 4 5 6 7 8 9 10 11 12
Items fou
nd / 30 secs
Session
Substained AIenFon Tradi/onnal
Mul/ sensory
Control
Baseline
0 20 40 60 80
100 120 140 160
1 2 3 4 5 6 7 8 9 10 11 12
Time (sec)
Session
RAN/Time Tradi/onnal
Mul/ sensory
Control
0 1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9 10 11 12
# of errors
Session
RAN/Errors Tradi/onnal
Mul/ sensory
Control
Table 2. Pre- and post-test scores for standardized language tests
* Post-test score exceeds the 90% confidence interval surrounding the pre-test score when available
The results obtained in the pre and post- evaluations showed that participant 1 made more gains than participant 2. More gains were made post-test by participant 1 who receive intervention in the multi-sensory environment on tests that assessed pragmatic skills, narrative skills and receptive vocabulary. For the repeated measures, pragmatic abilities improved significantly over time for P1 but not for P2. In fact, P2 regressed in this area. P1 also showed gains in lexical processing efficiency (RAN). P2 showed gains in sentence repetition. It should be noted that P1 had a lot of difficulty with this task. Both participants made gains in sustained attention. However, since we are still missing a few data from participant 3 (currently in process), we are unable to confirm with certainty hypothesis 1, though the preliminary results are very promising. Hypothesis 2 can be accepted. The multisensory room was created within a budget of $1500.
0 10 20 30 40 50 60 70 80 90
100
P1 (MulF sensory) Pre-‐test Post-‐test
0 10 20 30 40 50 60 70 80 90
100
P2 (TradiFonal) Pre-‐test Post-‐test
Collec/on of these data are currently in process
Acknowledgement
Baseline
Baseline Baseline
Treatment
Treatment
Treatment
Treatment