INTRODUCTION:

Cerebral palsy is the most common physical disability in early childhood. (Kathy Jones 2010). It has been clinically defined as a group of motor, cognitive, and perceptive impairments secondary to a non-progressive defect or lesion of the developing brain (CorrieErasmus2009).A variety of prenatal, perinatal and postnatal factors contribute to the development of cerebral palsy. The human brain undergoes development during the prenatal period and upto 2 years of age, a brain insult or injury occurring during this period may result in cerebral palsy. (Whaley and wongs 2009).

A collaborative perinatal project was conducted; in which 45000 children were regularly monitored from in utero to the age of 7 years found most children with cerebral palsy had been born at term with uncomplicated labour and deliveries. In 80percent of the cases, features were identified pointing to antenatal factors causing abnormal brain development.10 percent of the children with cerebral palsy had evidence of intrapartum asphyxia.(Michael Johnson 2010)

Significance:

The world wide incidence of cerebral palsy is approximately 2-2.5 per 1000 live birth (Kathy Jones 2010). A study conducted in United states over the past several decades reports about 7,64,000 children and adults are currently have cerebral palsy, about 500000 children under the age of 18 are currently have cerebral palsy, about 10,000 babies born each year will develop cerebralpalsy.

Around 8000-10000 babies and infants diagnosed every year with cerebral palsy. Around 1,200-1,500 preschool children are diagnosed every year with cerebral palsy. (http;//cerebralpalsy. Org 2013). In India 25 lakh people are with cerebral palsy. (IMA 2010). In kerala 2 lakh children are affected with cerebral palsy. (Census of 2001).

Cerebral palsy is not a disease it is a condition caused by developmental differences and with adequate care it can be managed effectively. (Shashikala 2010). Behavioural problems are frequently used as an indicator of abnormality or mental dysfunction (Shapricotal 1997) Children with cerebral palsy have various associated disabilities; around 50-75 percent of them have mental retardation. (Parthasarathy 2010). And also 30-50 percent of the children present with behavioural problems, such as aggressiveness, lack of attention and hyperkinetic behavior. Behavioral problems are culturally abnormal behavior of such intensity, frequency or duration that the physical safety of the person or others is likely to put in jeopardy ,or behavior which is likely to limit the use of or result in the person being denied access to ordinary community facilities. some of the behavioral problems seen in cerebral palsy are self injurious behavior aggressive behavior, stereotyped behavior, and non person directed behavior. (Emerson1995)

Behavioural problems and cerebralpalsy:

Brassard conducted a study on behavioural difficulties of adolescent with cerebral palsy. The result confirms that behavioural problems are common in cerebral palsy.36.9 percent of the adolescent were present with behavioural difficulties and 61.9 percent of them were present with peer problems. Yet another study conducted by (Suzanna1996) reports that 25.5 percent of the children had a behavioural problems. Specific behavioural problems that were most problematic with cerebral palsy children were identified as dependency, head strong and hyperactive. M. Halln, Majnemer. A et al (2012) conducted a study on behavioural problems in school age children with cerebralpalsy. Seventy six s parents completed the strength and difficulties questionnaire using the total difficulties score 39.4 percentage of the sample scored in borderline to clinically abnormal range, peer problems were most common 55.3 percentage. Parental stress was associated with behavior difficulties across all domains of the strength and difficulties questionnaire. Better socialization skill and lower parental stress were correlated with more positive behavior.

Snoezelen:

Snozelen is a combination of two Dutch words for (doze and smell) snoezelen room offers a relaxed atmosphere with pleasant surrounding, soothing sounds, captivating aromas, tactile experiences massage and vibrations, vibrosonic sensation and gentle movement. Behaviors are sensory driven. One another treatment available to this population is the provision of sensory stimulation by means of snoezelen. This stimulation invokes environmental manipulation to effect internal change in the child, decreasing the maladaptive behavior, reducing stress and producing more adaptive behavior. Snoezelen is built in such a way that no harm can come to the subject. The room is soft and equipment is secured and therefore the children feel a sense of security.

How snoezelen stimulates our senses:

In a study Dr. Neubauer found that children who suffer from cerebral palsy have area showing low levels activity another approach available to these children is sensory stimulation by means of snoezelen. Snoezelen will stimulate the children physically and mentally through their senses such as sight, smell, taste, touch and hearing. (Ahmad Fairuz 2010).

The term sensory integration (Snoezelen) which signifies a neurological process was first developed by Ayres. This process enables the spatial-temporal usage of the sensory information the individual gets from his body and environment and the perception, interpretation, and integration of information in order to plan and form organized motor behavior (Ayres 1972a, Fisher and Bundy 1992, Scheerer 1997).

Sensory integration (Snoezelen) theory is based on the view that neural plasticity and sensory integration occur in the developmental order, and brain functions integrate with the related systems hierarchically. Adaptive motor response is the most significant parameter of sensory integration. "An adaptive response is a purposeful, goal directed response to a sensory experience" (Ayres 1972b, 1979).

Three main sensory systems play a role in the growth and development of the child-tactile, vestibular, and proprioceptive systems (Williamson and Anzalone 2001). But snoezelen integrate all the five senses including vestibular and proprioception.

Vision (visual):

The most common use of a snoezelen is for visual stimulation. It may be used to encourage awareness to light, tracking and other visual skills. For example, bubble tubes may be used to for tracking and fiber optics may be used to increase light awareness.

Smell (olfactory):

The snoezelen is excellent place to experience smell. Use tranquil environment to set the mood along with smells from aromatherapy kits or real objects such as oranges, apples or fresh flowers.

Hearing (auditory):

In a snoezelen use music, instruments or even movies playing through a data projector to experience sound whether using a CD player, stereo, radio, or data projector remember to move it around the room to let all participants experience the difference in volumes as a result of a change in proximity.

Taste (gustatory):

Our sense of smell is closely tied to our sense of taste .You may present the participants with simple to eat foods once they have achieved a state of relaxation.

Touch (tactile):

The snoezelen provides multiple tactile experiences. Different textures on panels, products such as balls, sponges, and brushes, as well as vibrating mats and massagers, offer head to toe tactile stimulation opportunities. Tactile system provides information about the environment by the sense of touch. The stimulus of the tactile system is received by the receptors in the skin which is the largest organ of the body. The tactile system has two components. The first is the protective system which informs when touching is harmful, and the other is the discriminative system which informs of the difference between harmful and beneficial touch.

Vestibular and proprioception-Vestibular system receptors are within the inner ear and are related to hearing. The receptors in this system respond both to movement and gravity. The vestibular system is a systems that affects balance, eye movements, posture, muscle tone and attention.

Proprioceptive system:

A proprioceptive system is a system which receives sensory stimulus from the muscles and joints. Push and pull activities related to muscles and joints provide maximum stimulus to this system. The proprioceptive system is also important for the development of fine and gross motor muscles. The insufficient proprioceptive system also negatively affects motor planning ability. Walking across a floor covered with mats in a snoezelen room incorporates both the vestibular and proprioceptive senses. Use of furniture in the snoezelen room help the participants experience these senses. Bean bang chairs and the leaf chair are great for providing vestibular and proprioceptive stimulation. In cerebral palsy the major problem is with motor deficit and most of them are present with behavioural problems so snoezelen will be one the best method to stimulate this children

Behavioural problems and snoezelen:

(Michele Shapiro2004) conducted a study on efficacy of the snoezelen in the management of children with mental retardation are who exhibit maladaptive behavior. The study result shows that a reduction of these self stimulating behavior was seen in the snoezelen where as this did not occur in control room. The snoezelen has thus been found effective as a therapeutic tool during treatment, and they recommended that follow up research need to be carried out on the use of snoezelen with children exhibit developmental difficulties like autism, cerebral palsy, attention deficit and others. (Meirlotan and Christian gold 2009) has conducted a study on Meta analysis of the effectiveness of individual intervention in the controlled multisensory environment (snoezelen) for individuals with intellectual disability. Twenty eight relevant articles were reviewed the primary finding was that the snoezelen approach, when applied as an individual intervention for those children ,enabled significant and large effect size in adaptive behaviors with generalization to the participants daily life.

Yet another study conducted in Brassels compared the behavior of profound autism in both class room and snoezelen setting. The study result claimed a 50 percent reduction in distress and stereotyped behavior and 75percent less aggression and self injury in the snoezelen environment. (ask.com.wki.snoezelen.com). A study conducted by (Martin. N1997) on ‘Behavioural effects of long term multi sensory stimulation (the benefits of snoezelen experience). Regular access to a multi sensory environment was compared with a non complex sensory environment for individuals with severe/ profound learning disabilities who exhibited challenging behaviour. Conditions were compared over sixteen weeks periods using a double cross over design were matched for social conduct and attention from the enabler. Behavior was assessed before and after each phase. Some participants become more calm and relaxed while in the MSE. Objective measures of behaviour outside the treatment settings revealed no difference between the multisensory environment and control condition. The University of reading (United Kingdom)

Baillon and Vandiepen 2004, has conducted a study on effect of snoezelon and reminiscence therapy on the agitated behavior of patients with dementia, cross over randomized controlled design was used. Twenty patients with dementia and agitated behavior, received 3 sessions each of snoezelan and reminiscence. The effect were assessed both intervention had a positive effect. Snoezelen have a more positive effect than reminiscence. (International Journal of Geriatric Psychiatry. Vol (11) pp1047-1052).

CONCLUSION:

By reviewing all these literatures ,there are three major conditions coming under developmental delay is (mental retardation ,autism, cerebral palsy) Even though most of the studies been published on mental retardation and autism, since cerebral palsy also one among those ,more over children with cerebral palsy are with multiple disabilities do not just happen to play ,because of motoric problems, a low cognitive level, behavioural problems, limited language skill, it is important that these children need to be stimulated. This literature review strongly suggest that snoezelen provided as supplemental environmental enrichment can enhance the arousal level, increases the gross motor and fine motor development ,and reducing the maladaptive behavior and improving with more adaptive behavior of individual with developmental delay. The accumulating evidence evaluated within the scope of present article provides preliminary support for the assumption that snoezelen could be used as a therapeutic milieu to reduce behavioural problems in individuals with cerebral palsy. Nevertheless, in order for more conclusive finding to be obtained, interventions as well as research methodologies in this area should become more rigorous, and future investigations should take in to consideration larger participating groups.

REFERENCES:

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Received on 17.10.2014 Modified on 28.10.2014

Int. J. Adv. Nur. Management 2(4): Oct. - Dec., 2014; Page 286-288