MR. ATUL LAWRENCE
M.Sc NURSING (1 st
RATTAN EDUCATIONAL COLLEGE
COLLEGE OF NURSING
: M.Sc NURSING (1st YEAR)
: ADVANCED NURSING PRACTICE
: UNIT-V, BIO-PSYCHO SOCIAL PATHOLOGY
: SENSORY DEPRIVATION
: M.Sc NURSING CLASSROOM (1)
: 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.
NATURE OF SENSORY STIMULATION
NORMAL SENSORY PERCEPTION
♣ RETICULAR ACTIVATING SYSTEM (RAS)
♣ INPUT SENSES
CHARACTERISTICS OF NORMAL SENSORY PERCEPTION
NORMAL SENSORY PATTERN
♣ SENSOR STASIS
♣ SENSORY OVERLOAD
♣ SENSORY DEPRIVATION
FACTORS AFFECTING SENSORY DEPRIVATION
♦ PREVIOUS EXPERIENCE
♦ PERSONALITY, LIFESTYLE AND HABITS
♦ 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
♦ CHAMBER TEST
♦ FLOATATION TEST
♦ BENEFITS OF THE THERAPY
♦ SIDE EFFECTS OF THE THERAPY
ROLE OF THE NURSE
♦ NURSE-CLIENT INTERACTION
• THEORY APPLICATION
• JOURNAL ABSTRACT
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
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
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
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,
NORMAL SENSORY PATTERN
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.
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
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.
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.
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: 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.
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 (heatsense), 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
FACTORS AFFECTING SENSORY DEPRIVATION
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.
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.
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.
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.
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
≈ 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
Sensory aid not available (hearing aid, glasses)
EFFECTS OF SENSORY DEPRIVATION
Inaccurate perception of sights, sounds, tastes, smell and body position co-ordination and equilibrium
Mild to gross distortions ranging from day dreams to hallucinations
Inability to control the direction of thought content
Decreased attention span and ability to concentrate
Difficulty with memory, problem solving and task performance
Inappropriate emotional responses including apathy, anxiety, fear, anger, panic or depression and rapid
CLINICAL SIGNS OF SENSORY DEPRIVATION
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.
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
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
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-andone-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
♦ 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
♦ 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
♦ 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
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
Every effort should be made to prevent the patient from withdrawing from the environment.
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.
LYDIA HALL’S CORE, CARE, CURE THEORY
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
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.
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.
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.
LEWIS, BUCHER (2008) “MEDICAL-SURGICAL NURSING- ASSESSMENT AND
MANAGEMENT OF CLINICAL PROBLEMS”, ELSEVIER PUBLICATIONS, 7th EDITION,
SUZZANE & BRENDA (),”MEDICAL SURGICAL NURSING”, LIPPINCOTT PUBLICATIONS,
10th EDITION, PAGE NO: 1099
The American Journal of Psychiatry, October 1st, 2009, VOL-114, NO.4, 114:357-363
http://www.google.com/ sensory deprivation
http://www.wikipedia.org/ sensory perception