Maude: a case of sensory deprivation.

The American journal oj Occupatiol/o/ Therap)' Cognitive impairment is a major cause of institu.tionalization among older adults. Approximately two thirds of nursing home residents exhibit moderate to extreme dementia (Publ ic Health Service, 1978) Judging from the literature, the most common form of treatment provided for such regressed persons is reality orientation (Holden & Woods, 1982). Although the philosophy of reality orientation is broad enough to encompass a wide range of interventions intended to reorient impaired persons to their environment, reality orientation as it is typically adminiStered is essentially a classroombased, verbally oriented therapy that focuses on the reretition and relearning of basic information, such as a person's name and place of residence (Hanley, McGuire, & Boyd, 1981). Desrite the popularity of reality orientation, there is scant evidence documenting its effectiveness. The accumulated research suggests that improvement in verbal orientation is the most likely outcome and that carryover to daily living behaviors is problematic (Holden & Woods, 1982). In fact, the most dramatic effect of reality orientation may lie in its impact on care givers. Care givers providing reality orientation reported that they felt better about themselves and the quality of care provided than did care givers not involved in reality orientation (Harris & Ivory, 1976) Since evidence of heneficial behavior effects of reality orientation for the patient is lacking, there is a critical need to explore therapeutic alternatives. One 3pproach that appears to hold promise for severely regressed geriatric patients is sensory training (Marcus, 1983; Richman, ]969; Weiner, Brok, & Snadowsky, ] 978) The primary goal of sensory training is to bring the regressed person back in touch with the environment. This is done through intensive stimulJtion of the senses. The r3tion31e underlying sensory training posits that cognitive dysfunction in the regressed patient is in part attribuwble to sensory deprivation, and that by increasing sensory stimulation, some of the dysfunction can be ameliorated. This paper describes the use and outcomes of sensory training with Maude, a severely cognitively impaired older adult (Marcus, 1983). The paper concludes with suggestions for devising sensory training programs.