SENSORY DEPRIVATION

INTRODUCTION

An individual’s senses are essential for growth, development and survival. Sensory stimuli
give meaning to events in the environment. Any alteration in people’s sensory function can
affect their ability to function within the environment

SENSATION
Sensation is an animal's, including humans', detection of external or internal stimulation
(e.g., eyes detecting light waves, ears detecting sound waves). It is different from perception,
which is about making sense of, or describing, the stimulation (e.g., seeing a chair, hearing a
guitar).

Sensation involves three steps:

1. Sensory receptors detect stimuli.

2. Sensory stimuli are transduced into electrical impulses (action potentials) to be
decoded by the brain.
3. Electrical impulses move along neural pathways to specific parts of the brain wherein
the impulses are decoded into useful information (perception).

For example, when touched by a soft feather, mechanoreceptors – which are sensory
receptors in the skin – register that the skin has been touched. That sensory information is
then turned into neural information through a process called transduction. Next, the neural
information travels down neural pathways to the appropriate part of the brain, wherein the
sensations are perceived as the touch of a feather.

Children are often taught five basic senses: seeing (i.e., vision), hearing (i.e., audition),
tasting (i.e., gustation), smelling (i.e., olfaction), and touching. However, there are actually
many more senses including vestibular sense, kinesthetic sense, sense of thirst, sense of
hunger, and cutaneous sense.

1
TYPES OF SENSATIONS

Visual

The wavelength, intensity and complexity of Light are detected by visual receptors in

the retina of the eye. There are two types of visual receptors: rods and cones. Rods are
sensitive to dim light, which makes them useful for seeing at night. Cones are more sensitive
to color and bright light, which makes them more useful in daylight. Signals from rods and
cones are transduced into useful neural information via the optic nerve. Blindness is the
complete or nearly complete inability to see.

Auditory

The frequency, intensity, and complexity of sounds waves in the external world are detected
by auditory receptors (cilia or hair cell receptors) in the ear. Different patterns of cilia
movement lead to different neural codes, which ultimately lead to hearing different loudness,
pitch, and timbre of sounds. Deafness or hearing loss may occur in one or both ears.

Gustatory

Taste receptors (i.e., taste buds or papillae) are activated by the presence of food or another

object on the tongue. Four basic tastes include sweet, salty, sour, and bitter.

Olfactory

Smells in the external world activate hair receptors in nostrils. These receptors then send
signals to the olfactory bulb, which is located at the base of the brain. Anosmia is the inability
to smell.

Somatosensory

Somatosensory sensations occur when receptors detect changes on one's skin or within one's
body.

Cutaneous sensations

Sensations on the skin are detected by cutaneous receptors. These receptors may feel
sensations such as pain, tickle, cold, hot, soft, and rough. Mechanoreceptors detect light
pressure (e.g., caress), vibration, and texture, nociceptors detect strong pressure (e.g., pain),
and thermoreceptors detect temperature.

2
For example, if your dog lightly presses its nose on your leg, mechanoreceptors in your skin
will sense the smooth texture of your dog’s nose whereas thermoreceptors will detect its
coldness. When a dog bites someone, nociceptors detect the sharp pressure. Astereognosis is
the inability to identify an object by touch.

Proprioception

Proprioception is the “sense of bodily position.” It includes the vestibular sense (i.e., one’s

sense of balance) and kinesthetic sense (i.e., one’s awareness of one’s movements).

Osmoreception

Osmoreception is the body’s sensation of thirst. When the amount of water in one’s body
falls below a certain threshold, the concentration of osmolytes (e.g. salt) increase in one’s
blood.. Osmoreceptors, or sensory receptors in the hypothalamus, detect these changes
in osmotic concentration. These signals are then transferred to neural signals of thirst.

COMPONENTS OF SENSORY EXPERIENCE

 There are two components of sensory experience

 Sensory reception and sensory perception

Sensory reception

 It includes external stimuli and internal stimuli

External stimuli: It occurs when an external stimuli such as touch approaches and body
responds accordingly. Eg: may be flexion or extension

Internal stimuli: It is further 2 types, Kinesthetic and visceral

 Kinesthetic: it is related to position and movement of body parts in response to

stimuli. One term which is related to kinesthetic is sterognosis is which means the
ability of brain to understand an object through touch by its shape, shape and texture.
Eg: when a person touches a ball he recognize it is as a circular ball, of medium size
and rough texture.
 Visceral: it refers to any large organ within the body. Eg: when a a person eats food ,
then he recognize feeling of full stomach.

3
ASPECTS OF SENSORY PROCESS

The aspects of sensory process includes

 Stimulus
 Receptor
 Impulse conduction
 Perception

Stimulus: it is an act or agent that stimulates a nerve receptor (also called transduction).

Classification of stimulus

 mechanical
 Photic(light)
 Thermal
 Chemical
 Extreme of mechanical,thermal,and chemical energy or pain

Mechanical :touch,pressure,stretch,sound,equilibrium,blood pressure

Receptors:,

Receptors are specialized nerve cells or nerve endings which detect a change in energy level
or stimulus and transmit this information to CNS as action potential. receptor act as
transducers, convert one form of energy to another form Eg:mechanical to electrical

visual the nerve cell acts as a receptor by converting the stimulus to nerve impulse. Most of
the receptors are specific and sensitive to only one type of stimulus. Eg: touch, auditory

Impulse conduction: the impulse travels along the nerve pathway to spinal cord or directly to
the brain via ascending sensory tract to reach the RAS (reticulating activating system). Then
certain nerve impulses travels to the cerebral cortex where they get perceived.

Neurotransmitters is the chemical substances liberated at the nerve endings and help to
transfer the message of the nerve impulse in the presynaptic neuron to the adjacent cells.

Eg:acylylcholine ,nor epinephrine

This chemical impulses travels to spinal cord(marginal nucleolus)the first order neurons
sensitized it will transmitted the impulses to medulla oblongata, after that 2 nd order neurons
sensitized and travels the impulses to thalamus from that stimulate 3 rd order neurons carries
the impulses to sensory cortex of the brain(perception)

Perception: in perception, awareness and interpretation of stimuli take place. It occurs

through specialized brain cells that interpret the nature and quality of sensory stimuli. It is
important to note that the level of consciousness affects the interpretation of stimuli.

4
FACTORS AFFECTING SENSATION

Developmental stage

Perception of sensation is critical to the intellectual, social, and physical development of

infants and children.

 Vision in a new born develops during the first year

 Visual acuity decreases after the age of 60 years
 Hearing is most acute at 10 years of age
 By the age of 65 years about 55% has some hearing loss
 Persons older than 60 years have some loss of taste
 There is a decline in smell after the age of 70 years

NEWBORNS
Sensory perception is rudimentary .repeated stimulation is required for the maturation
of nervous system response to cuddling ,holding, soothing, rocking and changing
position. vision becomes more discriminating as it grows. development of hearing is
at peak at 8-10 months

TODDLER AND SCHOOLER

Learns full acquaintances with the world by exploration with all the senses .lack of
meaningful stimulus can lead to motor and sensory development delays .toddler is an
explorer. Preschoolers use much organized plays like singing, story telling to respond
to stimuli
Child and adolescent
Learning occurs at an accelerated pace..Reading and listening improve the sensory
perception.

ADULT AND OLDER ADULT

Sensory perception is at peak in an adult .sensory perception decrease markedly at 60s

and 70s.gradual reduction in efficiency occur after wards
Social

5
 People with sensory problem will have less social interaction. A deaf person will have
less social interaction and verbal communication sensory impaired children will have
low self esteem and less communication initiatives compared to normal children.
Sensation/perception is affected by restricted unstimulating environment

Culture

Cultural deprivation or cultural care deprivation is a lack of culturally assistive, supportive,

or facilitative acts.

Stress

During stress, people find their senses already overloaded and thus seek to decrease sensory
stimulation

Medication and illness

Certain medications can alter an individual’s awareness of environmental stimuli. Eg:

narcotics, sedatives. Some medication can injure the auditory nerve and cause hearing loss
that may be irreversible.

Lifestyle and personality

Life style influences the quality and quantity of stimulation to which an individual is
accustomed. Peoples personalities also differ in terms of the quantity and quality of stimuli
with which they are comfortable. Some people delight in constantly changing stimuli and
excitement, where as others prefer more structured life with few changes.

Your patient is at high risk

An environment with decreased or monotonous stimuli ( such as institutionalized patients or

those confined to a small living area at home, on bed rest, in ICU or in isolation) impaired
ability to receive environmental stimuli (patients with impaired vision or hearing, or tactile
stimulation or with affective disorders)

OCCUPATION

Types of occupation and occupational environment affect the sensory perception. people
who are exposed to loud noise for a prolonged period may develop hearing problems. people
who use their hands repetitively may develop trauma on median nerve and carpel tunnel
syndrome

PATHOLOGICAL

Clients with DM may experience an alteration in vision, the presence of visual ,auditory,
olfactory ,gustatory or tactile sensory deficits may cause a decrease in sensory stimuli.

6
THERAPEUTIC

 Excessive environmental stimuli in ICU

 Isolation
 restricted visiting hours in the icu
 smoking, endo tracheal intubation
 pharmacologic(aminoglycoside anti biotic, analgesic and sedatives)

ALTERATION IN SENSORY STIMULI

 Sensory deficit
 Sensory over load
 Sensory deprivation

DEFINITION (sensory deprivation)

It occurs from inadequate reception or perception of environmental stimuli. The cause may
be physiologic such as sensory deficit.

TYPES OF SENSORY DEPRIVATION

There are mainly 3 types of sensory deprivation;

 Visual deprivation
 Auditory deprivation
 Tactile deprivation

Visual deprivation

 The very fast change in the ocular dominance of the cells during monocular
deprivation
 It depends on the speed at which deprivation effects

Auditory deprivation

 It refers to person’s lack of adequate hearing stimulus.

 With auditory deprivation the brain gradually loss some of its information processing
ability.
 The ability of the auditory system to process speech declines due to lack of
stimulation

Tactile deprivation

7
  Deprivation in coma/ immobilization
 The long-term care of a poorly responsive patient will be confirmed to bed being
turned every 3-4 hours, occasionally ambulated.

CLIENTS AT RISK SENSORY DEPRIVATION

 Confined in a non stimulating environment

 Have impaired vision or hearing
 Have mobility restrictions such as quadriplegia or paraplegia
 Unable to process stimuli
 Have emotional disorders
 Limited social contact with family and friends

EFFECTS OF SENSORY DEPRIVATION

The effects of sensory deprivation include;

 Cognitive
 Affective
 Perceptual

Cognitive

 Reduced capacity to learn

 Inability to think or solve problem
 Poor task performance
 Disorientation
 Bizarre thinking
 Regression

Affective

 Boredom
 Restlessness
 Increased anxiety
 Emotional liability
 Panic

Perceptual

 Visual/motor coordination
 Color perception
 Apparent movement
 Tactile accuracy
 Ability to perceive size and shape
 Time judgment

8
MANAGEMENT OF SENSORY DEPRIVATION

The management of sensory deprivation includes;

Visual stimulation

 Pictures, flowers, greeting cards etc in the room

 Minimizing glare by selecting no gloss finishes for walls and countertops at home.
 Wearing sunglass before going outside
 Clients with reduced visual acuity may need corrective lenses
 Use pocket magnifiers
 Provide telescopic lens, eyeglasses which are smaller, easier to focus and have a
greater range

Auditory stimulation

 Call the person by his or her names

 Reorient the patient
 Speak slowly, clearly, maintain eye-to-eye contact
 Procedure explanation
 Use sensory aids
 Allow time for the client to express himself/ herself
 Televisions and telephones can be amplified
 Alarm clocks that shake the bed or activate a flashing light are useful adaptive devices

Gustatory and olfactory stimulation

 Attention to the oral hygiene and properly fitting dentures

 Serve fresh food
 Food of different textures, colors, temperatures served attractively
 Smell food before eating
 Seasoning foods or having favorite foods brought from home.
 Removal of unpleasant odor from the environment
 Clients room should be clean, empty bedpans or urinals, remove and dispose of soiled
dressings and bathroom doors closed

Tactile stimulation

 Provide touch therapy

9
  Ai brushing, combing, a back rub and touching of the arms or shoulders are way of
increasing tactile stimulation
 When invasive procedures are being performed, it is important to use touch by
holding the client’s hands, and keeping them warm and dry.
 Minimize irritating stimuli

EPS(Extrasensory perception)

EPS is most commonly called the sixth sense it is sensory information that an
individual receive which comes beyond the ordinary five senses.
It can provide the individual with information of the present ,past and future as it
seems to originate in a seconded or alternative reality. its a branch of parapsychology

RESPONSIBILITIES OF A NURSE IN SENSORY DEPRIVATION

The roles and responsibilities includes;

Health history

Clients level of functioning, current sensory problem, client current occupation, home
enviorment,ability to performed both daily routine and self care activity provide emotional
stability such as agitation,euphoria,irritability,hopelessness

 Neurologic assessment
 Check all cranial nerve function
 Assessment of all sensory function

its includes(vision,hearing,touch,smell,taste,position sense(balance test and Romberg’s test)

The exam is based on the premise that a person requires at least two of the three following
senses to maintain balance while standing: proprioception (the ability to know one's body
position in space); vestibular function (the ability to know one's head position in space);
and vision (which can be used to monitor and adjust for changes in body position).

10
A patient who has a problem with proprioception can still maintain balance by using
vestibular function and vision. In the Romberg test, the standing patient is asked to close his
or her eyes. An increased loss of balance is interpreted as a positive Romberg's test.

Nursing diagnosis

 Sensory perceptual alteration related to an unfamiliar environment

Promoting healthy sensory function

 Early screening to detect problems in the visual and hearing function is essential.
 Women who are considering pregnancy should be advised of the importance of
testing for syphilis and rubella.
 Healthy sensory function can be promoted with environmental stimuli that provide
appropriate sensory input.
 Nurses should teach clients at risk of sensory loss, how to prevent the loss and should
teach general health measures, such as getting regular eye examination and
controlling chronic disease such as diabetes.

Preventing sensory overload

 For clients who are at risk of overstimulation, nurses should reduce the number and
type of environmental stimuli.
 The nurse can counteract sensory overload by blocking stimuli and by helping the
client organize the stimuli and alter responses to the stimuli.
 Dark glass, window shades or drape can reduce visual stimulation
 Earplug reduces stimuli, as do soft background music and earphones.

Cognitive input

 Orient the patient to environment, encourage client participation ion self-care, discuss
current events, reinforce reality without arguing.

Emotional output

 Encourage clients to share fears, concerns, and perceptions, reassure client, supportive
facilitative acts to nursing care.

Impaired vision

11
  Orient the client to the arrangement of room furnishing and maintain a non cluttered
environment.
 Keep pathways clear and do not rearrange furniture without orienting the client.
 Organize self care articles within the client’s reach.
 Assist in ambulation
 Provide color sheet and dress
 Pictures flowers in the room
 Wearing sunglass before going out side
 Visual acuity less provide corrective glass

Impaired hearing

 Assess the client frequently

 Obtain the client with devices that either amplify sounds or respond with flashing
lights to sounds such as a doorbell or smoke detector.
 Speak slowely,clearly,maintain eye to eye contact
 Use sensory aids
 Procedure explanation
 Television and telephone can be amplified
 Reorient the client

Impaired olfactory sense

 Teach about the dangers of cleaning with chemicals such as ammonia.

 Keep gas stoves and heaters in good working order.
 The clients need to carefully inspect food for freshness and check expiration dates on
food package
 Fresh food should be serve attention to provide oral hygiene
 Smell the food before eating
 Seasonal food and favorite food brought in the home setting
 Removal of unpleasant odor from the environment
 Client room should be clean and empty the bed pan and urinal

Impaired tactile sense

 The clients with impaired sense of touch may not be aware of hot temperature, which
can cause burns, or pressure on bony prominence, which can produce pressure ulcers.
 Provide touch therapy
 Individualized nursing minimize irritating stimuli hair combing, back rubbing, and
touching of the arms or shoulder are the ways of increasing tactile stimulation
 Nurse client interaction should maintained
 When invasive procedure are being performed it is important to use touch by holding
clients hands and keeping them warm and dry

12
 OTHER NURSING DIAGNOSIS

 Risk for injury related to sensory dysfunction

 Impaired skin integrity related to prolonged immobilization
 Sleep pattern disturbances related to multiple environmental stimuli
 Fear and anxiety related to multiple environmental stimuli

Communication methods for aphasia client includes, listen to the client and wait for the client
to communicate, use simple short questions use facial expression ,if the client has problem in
speaking ask such questions that require simple yes or no answers or blinking of eye, offer
picture or communication board so that the clients can point ,give the client time to
understand be calm and patient

SENSORY DEFFICIT

A deficit in the normal function of sensory reception and perception

Managing of sensory deficits

The client with a tactile deficit ,avoid the following

 Sun exposure
 Hot water bath
 Hot water bottles, hearing pads
 Carrying hot food
 Sitting on objects that may be hot
 Eating hot foods ,such as pizza or other items that maintain heat for an extended
period with out testing the temperature
 Over exposure to very low temperature should be avoid

Visual impairment
 Look directly at the client while speaking
 Keep furniture and other items and object
 Use normal tone volume and rate of speaking

13
  Inform client when you are entering or leaving the room
 Ask for the permission of the client before touching him or her

SENSORY OVERLOAD

INTRODUCTION

Sensory overload occurs when one or more of the body's senses experiences over-

stimulation from the environment. There are many environmental elements that affect an
individual. Examples of these elements are urbanization, crowding, noise, mass
media, technology, and the explosive growth of information.

DEFINITION

When person recieves multiple sensory stimuli and cannot perceptually

disregard or selectively ignore some stimuli

Causes
Internal factors such as thinking about impending surgery

 Anxiety

 Environment

 Icu or crowded ward

 Uncontrolled pain

 Excessive Noise

 Excessive Light

14
As component of other disorders and conditions
Sensory overload has been found to be associated with other disorders and conditions such
as:

 Attention deficit hyperactivity disorder (ADHD)

 Fibromyalgia (FM)
 Chronic fatigue syndrome (ME/CFS)
 Posttraumatic stress disorder (PTSD)
 Autism spectrum disorders[6][7]
 Generalized anxiety disorder (GAD)
 Schizophrenia (see also sensory gating)
 Synesthesia
 Sensory processing disorder
 Tourette Syndrome

CLINICAL FEATURES

 Complaints of fatigue
 Sleeplessness
 Irritability
 Anxiety
 Restlessness
 Disorientation
 Reduced problem solving capacity and task performance
 Increased muscle tension
 Scattered attention and racing thoughts
15
Prevention
There are two different methods to prevent sensory overload: avoidance and setting limits.
The process of avoidance involves creating a more quiet and orderly environment. This
includes keeping the noise to a minimum and reducing the sense of clutter. To prevent
sensory overload, it is important to rest before big events and focus your attention and energy
on one thing at a time. Setting limits involves restricting the amount of time spent on various
activities and selecting settings to carefully avoid crowds and noise. One may also limit
interactions with specific people to help prevent sensory overload.

Treatments
There are many different ways to treat sensory overload. One way to reduce this tension is to
participate in occupational therapy; however, there are many ways for people with symptoms
to reduce it themselves. Being able to identify one's own triggers of sensory overload can
help reduce, eliminate, or avoid them.[8] Most often the quickest way to ease sensory overload
symptoms is to remove oneself from the situation. Deep pressure against the skin combined
with proprioceptive input that stimulates the receptors in the joints and ligaments often calms
the nervous system. Reducing sensory input such as eliminating distressing sounds and
lowering the lights can help. Calming, focusing music works for some. If a quick break does
not relieve the problem, an extended rest is advised. People with sensory processing
issues may benefit from a sensory diet of activities and accommodations designed to prevent
sensory overload and retrain the brain to process sensory input more typically. It is important
in situations of sensory overload to calm oneself and return to a normal level.

Nursing management
 Address the client by his or her name .

 Provide explanation of all the procedures

 Modify the environment to reduce excessive multisensory stimulation, reduce

distraction, loud noice,and excessive light

 Behave in a calm and the composed manner when communicating with the client

 Provide private room

 Plan the delivery of care to allow forest periods with no stimulation

16
  Use soft background music

 Keep the environment free of strong odors

 Limit the number and frequency of visitors.

Research evidence

Sensory deprivation as an experimental model of psychosis,

Conducted by Christina Louise Daniel, a thesis submitted to the research department

of clinical, education psychology

ABSRACT

The development of novel experimental models of schizophrenia and psychosis are critical to
developing a better understanding of these complex and poorly understood disorders.
Existing approaches such as animal and drug models have major limitations to their use. An
alternative approach to modeling psychosis is proposed, built upon the premise of continuum
theory, focusing on ‘high risk’ hallucination prone individuals from within the healthy
population. A systematic review considered existing non-pharmacological approaches for
inducing psychosis-like experiences (PLE’s) in such individuals. The thesis then addressed
how one such method, short-term sensory deprivation, can successfully induce transient
psychosis-like experiences (PLE’s) in this population.
The Revised Hallucinations Scale (RHS: Morrison et al. 2002) was found to accurately
predict individuals most likely to experience PLE’s in sensory deprivation. Individual
differences that may contribute to reports of PLE’s were explored: the most powerful
predictor of PLE’s in sensory deprivation was verified to be hallucination proneness.
Additional personality traits such as fantasy proneness and suggestibility were not implicated.
A revised four factor structure for the RHS was also developed, using Exploratory Structural
Equation Modeling (ESEM). This model showed improved fit to the original non-replicable
factor structure. The ESEM approach is arguably more appropriate than traditional factor
analysis for modeling data with high inter-factorial correlations.
Quantitative Electroencephalogram (EEG) data was collected in order to establish whether
this approach could provide a robust neurophysiological correlate for psychosis-like
experiences. Initial pilot data suggested hallucination prone individuals may be characterized

17
by reduced levels of theta, alpha and beta activity, alongside elevated levels of cortical hyper-
excitability. These findings support weakened inhibitory processing theories of psychosis.

Overall, sensory deprivation was found to have the potential to contribute

significantly to our understanding of psychosis, and could be utilized effectively on a
stand-alone basis, or as an adjunct to existing animal and drug models.

REFERENCE

 Text book of advanced nursing practice ,NAVADEEP KAUR BRAR,HC Rawat,1 st

edition

 Jaypee publication page no:454-464

 Text book of advanced nursing practice,SHABEER K BASHEER,jaypee

publications,1 st edition, page no:

 Text book of fundamentals of nursing KOZIOR AND BARBARA,3 rd

edition,elsiever publication page no:
 European Court of Human Rights, "Ireland v. the United Kingdom" January 18, 1978
 Solomon, P. et al. (eds.) (1961) Sensory deprivation. Harvard U Press.
 Goldberger, L.(1966). Experimental isolation: An overview. Am. J. Psychiat. 122,
774-782.
 Zubek, J. (ed.) (1969). Sensory deprivation: Fifteen years of research. Appleton
Century Crofts.
 Dirk van Dierendonck & Jan Te Nijenhuis - Flotation restricted environmental
stimulation therapy (REST) as a stress - management tool: A meta-analysis.
 Marvin Zuckerman & Nathan Cohen (1964). Sources of Reports of Visual Auditory
Sensations in perceptual-isolation experiments.
 P.R Corlett, C.D Frith, P.C.Fletcher (2009). From drugs to deprivation: a Bayesian
framework for understanding models of psychosis.

18
 PRESENTATION
ON

SENSORY DEPRIVATION
AND
OVER LOAD

SUBMITTED TO: Mr ARUN S SUBMITTED BY : SREEDEVI T SURESH

ASST:PROFESSOR I st YEAR MSc NURSING

WEST FORT COLLEGE OF WEST FORT COLLEGE OF

NURSING NURSING

SUBMITTED ON: 16-11-2018

19