2021 Volume VII | Issue 1
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Editorial Board
Jitka SKOPALOVÁ (Opava) – Chair of Editorial Board
Esa ALARAUDANJOKI (Hyvinkaa), Václav BĚLÍK (Hradec Králové), Orlean BROWN EARLE (Jamaica),
Su Lyn CORCORAN (Manchester), Tomáš ČECH (Olomouc), Eros DESOUZA (USA),
Kelly EDYBURN (Santa Barbara), Ingrid EMMEROVÁ (Ružomberok), Pamela A. FENNING (USA) ,
Jolana HRONCOVÁ (Banská Bystrica), Junko IIDA (Tsukuba), Kamil JANIŠ (Opava), Monika
KRAJČOVIČOVÁ (Gold Coast), Daniel KUKLA (Częstochowa), Hristo KYUCHUKOV (Berlin), Dagmar
MARKOVÁ (Nitra), Rasa MARKŠAITYTĖ (Kaunas), Senaida MEHMEDOVIC (Kansas), Flávia de
MENDONÇA RIBEIRO (São Paulo), Irena MUDRECKA (Opole), Beata Maria NOWAK (Warszawa),
Alica PETRASOVÁ (Prešov), Ala PETRULYTĖ (Vilnius), Leslie POPOFF (New York), Ivana ROCHOVSKÁ
(Ružomberok), Jitka SKOPALOVÁ (Opava), Gerlinda SMAUS (Saarbrücken), Samuel Y. SONG
(Las Vegas), Dariusz STĘPKOWSKI (Warszawa), Éva SZABÓ (Szeged), Jiří ŠKODA (Ústí nad Labem),
Eva ŠOTOLOVÁ (Prague), Marie VÁGNEROVÁ (Prague), James WALSH (USA)
Editorial Office
Marta Kolaříková (Opava) – Editor-in-Chief
Kateřina Janků (Opava) – Associate Editor
Marek Lapčík (Opava) – Associate Editor
Vladislava Závrská (Opava) – Associate Editor
The online version of the journal is available on the following website
spp.slu.cz
The Journal is indexed in the following international databases:
Central and Eastern European Online Library (C.E.E.O.L.), http://www.ceeol.com
EBSCO Publishing, Inc., http://www.ebsco.com
English corrections
Gary FROST
Published
Silesian University in Opava, Faculty of Public Policies in Opava
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© Faculty of Public Policies in Opava, Silesian University in Opava, 2021
Journal’s title abbreviation: S.P.P.
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ISSN 2464-5877 (Print)
ISSN 2464-5885 (Online)
contents
Editorial	 7
articles	
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
Jarmila Pipeková, Jan Viktorin 	11
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION
María José Cid Rodriguez, Ramona Ribes Castells, Kateřina Janků	 35
Of Stimuli and Metaphors : Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
Agnieszka Smrokowska–Reichmann	 49
ExampleS of good practice	
Snoezelen and dementia : a case study
Ramona Ribes, Maria José Cid, Noelia Llamas	 61
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
Irena Johanka Savková	 77
Report	
A practical model for primary prevention
of risky behaviour in schools
Eva Zezulková	 91
BOOK REVIEW	
The Family’s Memory in us in the Light of Narration
of three Generations
Marta Kolaříková	 95
Kateřina Jankůeditorial 7
Dear readers and colleagues,
The  first issue of  the  journal Social Pathology and  Prevention of  2021 comes to  you
in  a  new monothematic format, which emphasizes therapeutic intervention activities
associated with the  multisensory method known as  Snoezelen and  research project
Support of the Snoezelen concept and its integration into university education. With this
edition, we aim to draw attention to the new innovative possibilities offered in the context
of prevention and real solutions to situations related to the marginalisation of different
social groups, in this case people with disabilities. Snoezelen rooms are already part
of many social services both in the Czech Republic and abroad, and their aim is not only
to provide relaxation and reduce stress, but also to systematically work on and develop
the personality of clients. Prevention activities focus on social misbehaviour and ensuring
better quality of  life for people with health or  social disabilities, particular (but not
exclusively) in institutional care.
The  first published text, a  comparative study written by  Czech authors J. Viktorin
and J.Pipeková,consistsof an analysisof 17diplomatheseswhichfocuson the educational
possibilities of using the Snoezelen concept in children and pupils with moderate, severe,
and  profound intellectual disabilities, multiple disabilities, autism spectrum disorder,
and  pupils with hearing impairment. The  unequivocal results of  this literature review
clearly demonstrate the sustainability and high level of use of Snoezelen in the education
of pupils with severe disabilities in special schools and in the prevention of problem
and risky behaviour.
The second text, a methodological study, relates to the field of diagnostics. The authors
M. J. Cid, R. Ribes, and K. Janků present a practical tool for professionals who work
in  care services (24-hour services) with people with types of  dependency and/or
developmental disability such as dementia and/or Alzheimer‘s, intellectual disabilities,
autism spectrum disorders etc. They set out to  describe how to  provide a  pleasant
and enjoyable environment and daily activities that accord with clients’ capabilities; for
this, it is important to start with the most reliable knowledge available of the sensory
capacities and sensory preferences of each client.
The third text, a theoretical study by A. Smrokowska–Reichmann, concerns commonalities
between the  Snoezelen method and  therapeutic storytelling (fairy tale therapy).
The  author’s aim is  to  highlight the  differences of  practising fairy tale therapy within
the Snoezelen room (as part of bibliotherapy) and the synergic effects this produces.
The article analyses the theoretical and practical aspects of conducting fairy tale therapy
in a Snoezelen room both with children and with adults.
The first of our two examples of good practice is centred on evaluating the benefits
of  Snoezelen stimulation in  an  elderly patient with advanced dementia. The  authors
R. Ribes, N. Llamas, and  M.J. Cid present a  pretest-posttest design involving
an intervention consisting of one weekly Snoezelen session over a five-week period. Their
results indicate immediate and short-term benefits of Snoezelen in terms of connection
with the environment and behavioural adjustment in the patient.
The second example of good practice provides insight into the implementation of music
therapy activities within holistic music therapy. The author I.J. Savková provides theoretical
information about holistic music therapy and then focuses on the application of music
therapy in the environment of a special primary school with a target group of students
with combined physical and severe mental disability. Part of the article is a description
and evaluation of a project involving holistic music therapy for pupils with manifestations
of problematic and risky behaviour in a primary school in the Czech town of Bohumín.
In a highly interesting report, E. Zezulková presents a project implemented by the Ministry
of Education and Science – A Practical Model of Primary Prevention of Risky Behaviour
in Schools (PRCH-IP-organization_0040/2021), which is  in  line with the  long-term
concept of the development of scientific and research activities of the Institute of Special
Education, newly established at the Faculty of Public Policies in Opava.
And in the final part of our current issue, readers can find a review by M. Kolaříková
of the book: Rodina a její paměť v nás ve světle třígeneračních vyprávění (2018).
We are very pleased to inform all authors, colleagues, professionals, and readers
that from the 2021/1 issue, the Journal of Social Pathology and Prevention will be
registered in the EBSCO International Database.
We thank you for your support and look forward to further cooperation with you!
Kateřina Janků & the Editorial Team
2021 | Volume VII | Issue 1 social pathology & prevention8
articles
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
11
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT
ON CHILDREN AND PUPILS WITH HEALTH
DISABILITIES
Jarmila Pipeková
Jan Viktorin
Abstract
The  literature review analyses 17 diploma theses which focus on  the  educational
possibilities of using the Snoezelen concept in children and pupils with moderate, severe,
and  profound intellectual disabilities, multiple disabilities, autism spectrum disorder,
and pupilswithhearingimpairment.Snoezelenis the namegivento approaches,strategies,
and special pedagogical support, implemented through various methods, techniques,
and means to activate development, stimulate interest, motivate cognition, and mediate
personal experience in people of different ages, but especially in children and pupils with
multiple disabilities of different aetiology or causality. The results of the literature review
clearly demonstrate the sustainability and high level of use of the Snoezelen concept
in the education of pupils with severe disabilities in special schools, under the guidance
of fully competent special educators during the period of compulsory education.
Keywords
literature review, Snoezelen, pupil with intellectual disability, pupil with autism spectrum
disorder, pupil with multiple disabilities, special primary school
Introduction
Snoezelen is applicable to all target groups, whether in terms of age or ability. Since
it does not require intellectual or other abilities, it is also suitable for children with severe
disabilities. Snoezelen was primarily intended for these individuals. At present, it can
benefit individuals with various types of disabilities, behavioural disorders, psychiatric
diagnoses, dementia, traumatic brain injuries, chronic pain, individuals in  palliative
care, and  able-bodied populations. Snoezelen can be defined as  the  induction
of  well-being and  feelings of  satisfaction through multisensory stimulation. The  word
Snoezelen is  a  portmanteau of  two Dutch words: “snuffelen” (sniff) and  “doezelen”
2021 | Volume VII | Issue 1 social pathology & prevention12
(nap). The combination of these words completely and accurately captures the essence
of  the  concept, which, on  the  one hand, helps subjects to  relax and  unwind thanks
to  the  pleasant and  calm atmosphere of  its environment, and, on  the  other hand,
supports activity and exploration, thanks to a stimulating and motivating environment.
Snoezelen is  a  dynamic set of  mental characteristics, based on  a  persistent sensitive
relationship between the participant, a qualified guide, and a controlled environment,
in which many possibilities for sensory stimulation are provided (Janků, 2018; Mertens,
2003; Orieščiková & Hrčová, 2010).
A multisensory room should be a place where the individual has enough time and space
to explore and interact with objects. If at all possible, they should have choice. Space,
time, and the right to choose are related to the basic principle of Snoezelen: “nothing
is necessary, everything is allowed”. Mediation of mainly positive experiences and positive
feedback is important. In a multisensory room, everything is set up so that it is possible
to regulate the number and intensity of stimuli, and to adapt the environment according
to the ability of an individual with a severe disability to process sensory stimuli. Individual
stimuli can be intense enough for an  individual with a  severe disability to  register
and pay attention to, or alternatively, only gentle stimulation may be provided so that
the  individual’s sensory tolerance is  not exceeded should he or  she respond hypersensitively
to stimuli. It is advisable to choose a smaller number of stimuli (perhaps only
one or two), with respect to the specifics of sensory perception of individuals with severe
disabilities; while there may not be many sensory experiences, they may be more intense
(Filatova, 2014; Švarcová, 2011; Verheul, 2008).
Individuals receive feedback on  their competence to  manipulate objects actively
and independently in the room (in the form of sound or light), and are thus able to control
and  monitor their environment, which contributes to  their development. Snoezelen
is not just a means of relaxation and gaining new experiences. In multisensory rooms,
it  is  possible to  target the  development of  individual skills and  abilities: perceptual,
motor, cognitive, communication, and  social. In  addition, it  also serves to  eliminate
inappropriate behaviour, and build a relationship with the person supervising Snoezelen.
However, the highest and most important goal of Snoezelen is to create a feeling of wellbeing
and  security for users. When applying Snoezelen, one of  four approaches can
be selected. Snoezelen can be used as a leisure activity in which no specific goals are
pursued and the Snoezelen session has a free flow. Currently, Snoezelen is more often
used as a therapeutically-oriented approach with a certain goal, and, in the environment
of Czech special schools, as a targeted pedagogical activity with a given educational
goal. In these cases, the units should be thought out in advance, they should pursue
a definite goal (in connection with the support of overall development), and the person
working in  the  room should know the  efficacy of  individual aids and  components,
and should select and use them purposefully (Hulsegge & Verheul, 1997; Janků, 2010;
Mertens, 2005).
The  multisensory environment/room can be equipped with a  wide range of  objects
that are commonly used, or  are intended primarily, for Snoezelen. It  can be focused
on stimulating one or two senses, or it can be equipped to stimulate all the senses.
There are different variations of multisensory rooms or environments. The most universal
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
13
and most used is the white room; however, other types of environment can be chosen,
depending on the target group, their needs, and goals that we want to meet. In the Czech
context, four types of environment are most often used: white, dark, and soft-play rooms,
complemented by  the  so-called ‘dream’ or  thematic room – an  interesting element
of support for individuals with severe disabilities and multiple disabilities (Orieščiková,
2015). Pagliano (2001) describes 12 embodiments of  a  multisensory environment.
In addition to those already mentioned, these include a  grey room, and  other types
of environments and zones, e.g., sound spaces, interactive zones, water zones, inclusive
zones, virtual environments, social spaces, and pluralistic environments. He also refers
to a portable environment that can be disassembled and packed up. This environment
can, to  some extent, be compared to  mobile Snoezelen. In  his more recent work,
Pagliano (2012) adds other environments, such as  olfactory, taste, and  interoceptive
spaces (an environment focused on the stimulation of interceptors, i.e., the vestibular
apparatus and proprioception). The sound space is divided into two types, according
to the intensity of the sounds (sharper sounds vs. more muted sounds).
The  vestibular and  proprioceptive system can be stimulated by  a  waterbed (it  is  still
the basic element of many rooms), positioning bags, swings, or a pool filled with balls
(it  can also be backlit, which enhances the  overall stimulation). These components
are a source of stimuli to the body and are indispensable for individuals with severe
and multiple disabilities. They allow us to gain experience of our own body, help us
to understand it, and build a body scheme. In addition, the waterbed helps to relax muscles
and encourages some degree of activity, as even the slightest movement on the bed will
cause a movement effect. Different toys or objects of different structure, texture, shape,
size, or weight can be used to stimulate touch. Another option is to install a tactile wall
or panel, or a handling panel. Various odours are used to stimulate the sense of smell,
which are used in a targeted way to achieve a certain state (relaxation, activation, support
of attention, breathing, etc.) or to complete the overall atmosphere of the room. Sounds
and music are indispensable. Music as a supporting or finishing element should meet
certain criteria. Individuals in the room not only perceive the sounds (through music,
toys, or simple instruments), but should also be guided to produce their own sounds.
It  is  advisable to  combine sounds with light or  vibration. Visual stimuli are provided
by the lighting of the room itself, which can be chosen in a targeted manner. Components
may include bubble cylinders, optical fibres, projectors with rotating thematic patterns
or projection of liquid oil paints, a mirror ball with a coloured reflector, etc. A very intense
stimulus is mediated by UV light and UV reactive (phosphorescent) objects, which create
a strong contrast to the rest of the environment, and stimulate individuals to activity,
helping them utilize their residual visual abilities and  supporting elementary visual
abilities, such as localization, fixation, or tracking (Filatova & Janků, 2011; Schwanecke,
2004; Vančová, 2010).
The rooms are (and should be) interactive in both social and technical senses; individuals
with a  severe disability are not limited to  merely passively monitoring and  receiving
various stimuli but can evoke them themselves and get feedback on their own activity.
Classic components, such as  bubble cylinders or  optical fibres, can be connected
2021 | Volume VII | Issue 1 social pathology & prevention14
by special controllers with large buttons. With them, individuals can change the colour
of fibres or cylinders. The control is simple and does not require much effort on the part
of  the  individual. Thanks to  these controls, it  is  possible for individuals with severe
disabilities to  be able to  intervene in  the  arrangement of  the  environment actively
and independently and evoke popular or preferred stimuli. In addition, interactive aids
and interactive panels can be installed in the room, which respond to touch (for example,
the  pressing of  a  button) by  turning on  a  light or  changing colour, or  by  changing
the light pattern. Verbal communication, or vocalization, can be supported by installation
of  components that respond to  sound, e.g., by  changing colour. Aids that respond
to slight movement are also in place. In addition to visual feedback, the individual’s activity
can also prompt various sounds, music, smells, and vibrations, or activate a fan to allow
the air flow to act on them. It is important that the room is safe with respect to movement
and handling of objects, and that there is enough space in it to sit or lie down. It should
be pleasant and, at the same time, motivate individuals to activity and cognition (Davies,
2012; Fowler, 2008; Opatřilová, 2013).
Methodology
The literature review has become the cornerstone of any relevant research in the field
of  special education. It  is  a  method that is  essential for the  development of  science
in  inclusive and  special education. The  importance of  the  literature review is  given
by the fact that no current research at any level can be undertaken without a thorough
analysis and mapping of what has already been discovered in the research area, and how
previous researchers have worked. Through a literature review, we can orient ourselves
in the research area that we want to build on in our work (Bearman, Smith, Carbone, Slade,
Baik, Hughes-Warrington, & Neumann, 2012). A form of traditional (narrative) review was
chosen for this literature review, which summarizes a larger set of studies on a given
topic over a period. The study is based on carefully defined perspectives or selected
research questions. It  describes the  findings from previous research, summarizes
them, and identifies inconsistencies in the views of the authors and in the presented
results of  the  authors. Thus, the  review may contain more general recommendations
and conclusions (Grant & Booth, 2009).
The  presented literature review reflects the  question of  the  positive impact
of the Snoezelen concept on children and pupils with health disabilities. To select studies
suitable for analysis, we set two basic thematic criteria: individuals with disabilities,
and the Snoezelen concept. We tried to grasp the chosen topic for the overview study
comprehensively. By analysing and then synthesizing the knowledge, we decided to focus
on the possibilities of educational use of the Snoezelen concept in children and pupils
with moderate, severe, and profound intellectual disabilities, children and pupils with
multiple disabilities, autism spectrum disorders, and hearing impairment.
For this purpose, according to  the  selected parameters, we performed a  selection
and subsequent analysis of 17 diploma theses of Masaryk University graduates which
deal with our chosen topic. The  collection and  study of  diploma theses was carried
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
15
out at  the  beginning of  2021. We searched for diploma theses for the  literature
review in  the  archive of  final theses on  the  university’s web portal. We concentrated
on  thematically focused diploma theses in  the  period defined by  the  years 2006–
2021. Based on  the  established criteria for the  selection of  suitable diploma theses,
and  according to  the  performed analysis, we synthesized the  findings from relevant
diploma theses into a literature review. We aimed to analyse individual selected diploma
theses in a systematic review, then to give their brief characteristics, their contribution
to theory and practice and, in general, to integrate knowledge on the topic of the positive
impact of the Snoezelen concept on children and pupils with disabilities. Table 1 provides
a general overview of the studies selected for this review.
Table 1 Overview of the analysed studies
Author, year Title
Research
methods
Research
sample
Research goal
Pešatová, M.,
2021
Development
of Sensory
Perception in
the Snoezelen
Room at a
Special Primary
School
Qualitative
research using
techniques:
participatory
observation
(records on the
assessment
scale), analysis
of available
documents,
case studies
Four pupils
of a special
primary school
(two girls and
two boys),
aged 8-14
years
To find out
whether
sensory
perception of
selected pupils
develops
during regular
stays in the
Snoezelen
multisensory
room
Piknerová, T.,
2020
The Influence
of the
Snoezelen
Concept on
the Social
Interaction
of Pupils
with Multiple
Disabilities
Qualitative
research using
techniques:
direct
participatory
observation
(notes from
individual
lessons in
Snoezelen),
semi-structured
interviews
with pupils’
parents and
teachers, study
of documents,
case studies
Five pupils
of a special
primary school
with multiple
disabilities
(four boys and
one girl), aged
8-16 years
To find out
what the
Snoezelen
concept
contributes
to the social
interaction
between a
pupil with
multiple
disabilities
and his/her
surroundings
(carer, family,
teachers,
peers)
2021 | Volume VII | Issue 1 social pathology & prevention16
Cmajdálková, D.,
2019
Structured
Teaching in
a Snoezelen
Environment
at a Special
Primary School
Qualitative
research using
techniques:
case studies,
analysis of
documentation
(written notes,
photographs,
video
recordings),
observation,
interviews
Seven pupils
of a special
primary school
(three girls and
four boys),
aged 9-15
years
To find out
how structured
teaching in
the Snoezelen
environment
affects pupils
with different
types of
disabilities in a
special primary
school
Krchová, D., 2019
Snoezelen as
a Means of
Developing
Sensory
Perception
in Pupils with
Moderate
and Severe
Intellectual
Disabilities
Qualitative
research using
techniques:
analysis of
documentation,
case studies,
participatory
observation
Seven pupils
with moderate
and severe
intellectual
disabilities
(four boys and
three girls),
aged 9-18
years
To find out
how the
Snoezelen
concept
develops
sensory
perception
in pupils with
moderate
and severe
intellectual
disabilities at
two special
primary
schools
Matějíčková, S.,
2019
Use of
Snoezelen
for Pupils
with Autism
Spectrum
Disorder
Qualitative
research using
techniques:
case studies,
participatory
observation
(use of field
notes),
evaluation of
results based
on a specially
designed scale
(assessment
scale)
Two pupils
(boys) of a
special primary
school, aged
8-9 years
To verify whether
Snoezelen has
a positive effect
on pupils with
autism spectrum
disorders in
the various
components
of the autism
spectrum
disorder triad:
communication,
socialization, and
imagination
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
17
Matějková, L.,
2018
The Use of
the Snoezelen
Concept in
the Education
of Pupils
with Severe
Intellectual
Disabilities
Qualitative
research using
techniques:
analysis
of pupils’
documentation
(including
medical
reports and
reports
from special
education
centres),
participatory
observation
of pupils with
an evaluation
scale,
interviews with
parents, case
studies
Five pupils
of a special
primary school
with severe
intellectual
disabilities
and multiple
disabilities (two
boys and three
girls), aged 15-
19 years
To verify the
specifics of
the use of the
Snoezelen
concept in
the education
of pupils
with severe
intellectual
disabilities at a
special primary
school
Saňáková, J.,
2018
Use of the
Concept
of Basal
Stimulation
and the
Method of
Snoezelen at a
Special Primary
School
Qualitative
research using
techniques:
case studies,
analysis of
documentation,
active
observation,
semi-structured
interviews with
a class teacher,
teaching
assistants, and
parents
Six pupils of a
special primary
school with
moderate,
severe,
profound
intellectual
disabilities,
multiple
disabilities,
and autism
spectrum
disorder (three
girls and three
boys), aged
9-14 years
To analyse
the influence
of basal
stimulation and
the Snoezelen
method on
pupils at a
special primary
school
2021 | Volume VII | Issue 1 social pathology & prevention18
Dítětová, J., 2016
The Use of
the Snoezelen
Concept
to Support
Education at a
Special Primary
School
Qualitative
research using
techniques:
analysis of
pedagogical
documentation,
direct
observation
of pupils,
special work
with pupils,
interview with
teachers and
parents
Five pupils
of a special
primary school
with moderate,
severe
intellectual
disabilities
and multiple
disabilities
(three girls
and two boys),
aged 10-13
years
To verify the
use of the
Snoezelen
concept in
the education
of pupils at a
special primary
school
Macků, K., 2016
Efficacy of
Aids used in
Snoezelen
in Children
with Autism
Spectrum
Disorder of
Preschool Age
Qualitative
research using
techniques:
case studies,
observation,
interviews,
analysis of
professional
medical,
pedagogical,
and
psychological
documents,
results
recorded in
record sheets
and evaluated
based on
scaling using
purposely
designed scale
Four children
(boys) with
autism
spectrum
disorder, aged
4-6 years
To verify the
effectiveness of
the aids used
in Snoezelen
in children
with autism
spectrum
disorder
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
19
Nečasová, L.,
2015
Development
of Sensory
Perception in
the Snoezelen
Room at the
Special Primary
School for
Pupils with
Moderate
and Severe
Intellectual
Disabilities
Qualitative
research using
techniques:
case studies,
analysis
of pupils’
personal file
documentation,
record
sheets, non-
participatory
observation,
records with
inventories
Seven pupils
of a special
primary school
(five boys and
two girls), aged
8-13 years
To find out
how senses
develop in
pupils with
moderate
and severe
intellectual
disabilities in
the Snoezelen
room at two
special primary
schools
Zedková, B., 2014
Possibilities
of Using the
Snoezelen
Method in
the Education
of Pupils
with Severe
Disabilities
and Multiple
Disabilities
Qualitative
research using
techniques:
analysis of
pedagogical
documents
(pupil
documentation),
participatory
observation
(notes,
observation
records),
interviews with
teachers, case
studies
Two pupils
(boys) of
a special
primary school
with severe
disabilities
and multiple
disabilities,
aged 11-17
years
To determine
the influence
of Snoezelen
on selected
personality
components
of pupils
with severe
disabilities
and multiple
disabilities
Krausová, V.,
2013
Use of
Multisensory
Room
Snoezelen
and Elements
of Basal
Stimulation
in Children
with Severe
Disabilities
Qualitative
research using
techniques:
participatory
observation,
analysis
of pupils’
personal
and school
documentation,
unstructured
interviews with
pupils’ parents
and teachers,
case studies
Three pupils
of a special
primary school
(one boy and
two girls), aged
7-13 years
To analyse
and evaluate
the use of the
Snoezelen
multisensory
room in the
intellectual
(attention,
concentration)
and social
(interaction
with others)
area, for pupils
with severe
disabilities
2021 | Volume VII | Issue 1 social pathology & prevention20
Cacková, A., 2009
Use of
Snoezelen as
a Prevention
of Self-harm
in Individuals
with Multiple
Disabilities
Qualitative
research using
techniques:
analysis of
documents
(medical,
pedagogical,
psychological,
etc.),
observation,
interviews
with teachers,
analysis of
activity results,
case studies
Four pupils
of a special
primary
school with
manifestations
of self-harm,
aged 6-19
years
To verify the
importance
of using
Snoezelen as
a prevention
of self-harm
in individuals
with multiple
disabilities
Plecháčková, M.,
2009
Use of
Multisensory
Room
Snoezelen
for Children
with Hearing
Impairment
Qualitative
research using
techniques:
document
analysis, semi-
standardized
interviews
with teachers
and pupils,
observation,
natural
experiments
with pupils,
case studies
Four pupils
attending
primary school
for the hearing
impaired (three
boys and one
girl), aged 11-
14 years
To describe
the Snoezelen
multisensory
room and the
possibilities of
its use in the
field of special
education
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
21
Šoupalová, J.,
2009
Aspects of
Using the
Snoezelen
Multisensory
Room
Qualitative
research using
techniques:
qualitative
observation
(participial
observation),
qualitative
questioning
(standardized
interview
with closed
questions),
qualitative
methods of
data collection,
field notes
Four special
educators
from three
facilities (home
for people
with health
disabilities,
primary school
and practical
school, special
school)
To provide
the widest
possible range
of information
regarding the
effective use of
the Snoezelen
multisensory
room and the
possibility of
increasing the
quality of life
and personality
development
of pupils
with severe
intellectual
disabilities
and multiple
disabilities
through a
consciously
selected and
manageable
offer of primary
stimuli in a
pleasant and
safe Snoezelen
atmosphere
2021 | Volume VII | Issue 1 social pathology & prevention22
Vostrejšová, D.,
2009
The Effect of
Snoezelen in
the Stimulation
of Individuals
with Severe
and Multiple
Disabilities
Qualitative
research using
techniques:
analysis of
professional
texts and
documents,
long-term
observation,
active work
with the
monitored
pupils,
interviews with
therapists and
pedagogical
staff, case
studies
Four pupils
of a special
primary school
(two boys and
two girls), aged
11-16 years
To verify the
positive effect
of perception
of basic
sensory stimuli
(auditory,
visual,
olfactory,
tactile, and
taste) in the
environment
of Snoezelen
on individuals
with severe
disabilities
and multiple
disabilities
Krzyžanková, L.,
2006
Snoezelen as
a Method of
Positive Basal
Stimulation
Qualitative
research using
techniques:
analysis of
records about
pupils in the
monitored
class, free
observation
of situations,
structured
observation
according
to selected
categories,
natural
experiments
with pupils,
non-
standardized
interviews with
pupils’ parents,
analysis of
results of
selected
pupils’
activities
Six pupils of a
special primary
school (two
boys and four
girls), aged
9-17 years
To verify the
positive impact
and effect of
perception of
basal sensory
stimuli in
pupils at a
special primary
school
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
23
Results of the Review
In  a  study, Pešatová (2021) investigated whether sensory perception develops
in a multisensory room during regular targeted educational activities of selected pupils
with severe intellectual disabilities. The research involved four pupils attending the same
class (two girls and two boys aged 8–14) who visited the Snoezelen room once a week
for the duration of the study. The study was carried out in the form of a long-term direct
observation for six months, during which time data were collected to compare pupils’
progress in sensory perception, their mental well-being, and whether their Snoezelen
experiences were transferred to  the  classroom. After the  end of  the  research, it  was
confirmed that Snoezelen had had a significant influence on the development of sensory
perception in pupils with severe intellectual disabilities, since in each of them there had
been some improvement in sensory perception. Research has shown that the more often
individual senses are stimulated, the more often pupils use them to explore the immediate
area outside the Snoezelen room. During the research period, it was also found that
the  observed pupils experienced an  increase in  their sense of  security and  general
relaxation during their stay in Snoezelen. Targeted activities affected the mood and mental
state of  the  pupils. There were no negative reactions during Snoezelen activities;
on the contrary, expressions of pleasure, e.g., smiles and even audible laughter, were
observed in the pupils. The study indicated that being in the Snoezelen room helped
to improve the mental well-being of pupils.
The goal of Piknerová’s research (2020) was to analyse the ability of pupils with multiple
disabilities to interact socially after regular targeted educational activities in the Snoezelen
room. The study focused mainly on the development of relationships and ties with family
members, teachers, and peers, and examined the effects of the concept on the educational
process, the  development of  sensory perception, communication, and  emotionality
of pupils. The research consisted of processing five case studies of pupils with multiple
disabilities, mapping family relationships, health status, and social, personal, and school
history. By  directly observing the  educational activities in  the  regular classroom
and in the  Snoezelen room during one school year, data were collected to  compare
the development of pupils in the monitored areas. The study found that there was no
drastic progress in the monitored pupils in any of the defined categories. However, there
were small changes in their ability to use visual perception (in the form of more frequent
monitoring of classmates and activities in joint activities), more frequent reactions when
addressed and given verbal instructions by the teacher, some use of hands for physical
contact with other classmates, and slight progress in activating communication. It can
therefore be assumed that the use of Snoezelen had an impact on the development
of pupils’ communication with their environment. Although the researcher found only
minimal shifts in  development in  the  monitored areas for participants, it  can also be
assumed that Snoezelen influenced the formation of social interaction in the monitored
pupils with multiple disabilities.
2021 | Volume VII | Issue 1 social pathology & prevention24
In  another study, Cmajdálková (2019) investigated how structured teaching
in  the  Snoezelen environment affected special school pupils with various types
of disabilities (including severe intellectual disabilities, multiple disabilities, and autism
spectrum disorders) in  terms of  cognitive functions (thinking, memory), behaviour,
and  communication; and  also explored the  specifics that should be considered
in the teaching of pupils with different types of disability. The qualitative research used
the case studies of seven pupils and included observation and interviews with teachers.
Structured teaching in the Snoezelen environment positively influenced the cognitive
functions and behaviour of pupils, especially pupils with moderate intellectual disabilities,
but also pupils with severe and profound intellectual disabilities. Following consistent
long-term enrolment, positive changes of  a  qualitative nature could be observed
in the monitored areas. Education in the Snoezelen environment played an irreplaceable
role in the development and education of these pupils.
The  main goal of  Krchová’s study (2019) was to  establish how sensory perception
is developed in pupils in a special primary school with moderate and severe intellectual
disabilities through the  Snoezelen concept. The  author adopted a  qualitative
research strategy, involving techniques of  document analysis, case studies of  pupils,
and participatory observation. The study ran for two months, with the research sample
consisting of seven pupils. The observed lessons in Snoezelen showed that the pupils’
individual senses were not developed to the same extent, so it can be concluded that
the  degree of  development of  individual senses depends on  the  content of  lessons
(structured thematic lessons that seek to develop all the senses, taking into consideration
the individual needs of the pupils), the pupils’ diagnoses, and the approach, abilities,
interest, and education of the teacher or therapist who leads the lesson. The research
survey recommended focusing on the development of all senses, especially stimulation
of the (very often neglected) sense of taste.
Matějíčková (2019) carried out a study on the use of Snoezelen in pupils with autism
spectrum disorder. The  goal of  the  research was to  verify whether Snoezelen had
a  positive effect on  pupils with autism spectrum disorder in  targeted development
of communication, socialization, and imagination. The selected qualitative methodology
of the study used the techniques of case studies, and participatory observation using
evaluation with an assessment scale. The research sample consisted of two pupils aged
eight and nine years diagnosed with autism spectrum disorder. The results of the study
showed that Snoezelen was beneficial to the development of pupils with autism spectrum
disorder in  the  triad of  disabilities (communication, socialization, and  imagination).
The research indicated that Snoezelen did not develop every component of each pupil’s
triad of difficulties, but suggested that Snoezelen generally had a positive effect on pupils
with autism spectrum disorders and could help them with deficits in communication,
socialization, and imagination. In the field of communication, there were developments
in  vocabulary, and  in  understanding the  meaning and  significance of  communication
(in the sense of influencing reality). The development of socialization was a guided effort
to  reduce aggression, calm the  individual, develop social relationships/teacher-child
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
25
relationships, suppress unwanted behaviour, and improve mental well-being. In the field
of imagination, a better transition between individual activities, and better acceptance
of the offered stimuli were attempted.
The  study by  Matějková (2018) aimed to  verify the  specifics of  using the  Snoezelen
concept in the education of pupils with severe intellectual disabilities to find out: how
pupils respond to new stimuli in the Snoezelen environment, whether pupils with severe
intellectual disabilities are calmed by this environment, and in which areas the Snoezelen
concept can help pupils with severe intellectual disabilities to develop. The qualitative
research applied the  techniques of  analysis of  pupils’ documentation, participatory
observation of pupils, and interviews with parents. The information from the observation
of participants was supplemented by an analysis of the available documentation: i.e.,
everythingthatwasofficiallyand unofficiallyrecorded,includingnotes.As partof the study,
five case studies (of two boys and three girls aged 15–19) were selected. The analysis
of the outcomes of the activity took place in pre-prepared structured Snoezelen lessons,
which the pupils attended during morning lessons two-three times a week. The study
indicated that the  Snoezelen concept is  a  very suitable means of  supplementing
pupils’ education. The obtained results showed that repeated stays of these pupils had
a positive effect on the development of their personality. It is important not to neglect
any of the senses that can be stimulated in pupils in preparation for Snoezelen. All pupils
responded positively to the stimuli offered in a multisensory environment, or new stimuli
received after repeated visits to the Snoezelen room.
The main goal of a study by Saňáková (2018) was to analyse the impact of the Snoezelen
concept on pupils with autism spectrum disorders, and on pupils with profound intellectual
disabilities. The research aimed to analyse whether Snoezelen improved communication
and calm behaviour in pupils with autism spectrum disorder. For pupils with profound
intellectual disabilities, it  focused on  improving gross motor skills, self-perception,
and pupils’ response to bodily contact. The method of qualitative research was chosen
for the  study, using the  techniques of  processing case studies (supplemented with
information from the pupils’ parents), active observation, and semi-structured interviews
with the class teacher and teaching assistants. The research took place over a period
of 18 months and involved six pupils of a special primary school (with autism spectrum
disorders, moderate, severe, and profound intellectual disabilities). As a result of the study
it  can be stated that the  contribution of  Snoezelen to  the  education of  the  selected
sample of  pupils was considerable, but it  was not possible to compare the  progress
in the development of individual pupils due to differences in type of disability and age.
The  main goal of  a  study by  Dítětová (2016) was to  verify the  use of  Snoezelen
in the education of pupils in a special primary school. The study used qualitative research
methods, including analysis of pedagogical documentation, direct observation of pupils,
special work with selected pupils, and interviews with teachers and parents. Five case
studies of  selected pupils aged 10–13 years were processed. The  study found that
Snoezelen offered a relatively large range of uses for working with pupils in a special
primary school. It  was possible to  use it  purposefully in  the  educational process
2021 | Volume VII | Issue 1 social pathology & prevention26
as a change of environment that was interesting and attractive for pupils, and pupils were
calmer and more focused in the Snoezelen environment. Another way of using Snoezelen
is in combination with basal stimulation, which is important in helping pupils with severe
disabilities to relax. The study indicated that Snoezelen was suitable for use in primary
schools, especially for education, rehabilitation, and relaxation.
Macků (2016) aimed to verify the effectiveness of aids used in Snoezelen in  children
with autism spectrum disorder in  preschool education. The  study was carried out
through qualitative research using case studies, which were processed by techniques
of  observation, interviews, and  analysis of  professional medical, pedagogical,
and psychological documents. Subsequently, the results were recorded in record sheets,
which were evaluated based on scaling. The research sample consisted of four preschool
children with autism spectrum disorder. The research was carried out over six months,
during which time Snoezelen was gradually included in teaching. The key to choosing
aids is to meet conditions for the development of the senses: namely aids that stimulate
sight, hearing, touch, and the vestibular apparatus. According to the results of the study,
the use of the Snoezelen method had a very positive effect on the whole personality
of children with autism spectrum disorder, with positive results reflected in both their
education and everyday life.
The main goal of Nečasová’s research (2015) was to determine how the senses developed
in  pupils with moderate and  severe intellectual disabilities in  the  Snoezelen room,
and whether all their senses developed equally. A qualitative strategy was chosen for
the study. Short case studies of seven pupils aged 8-13 studying at a special primary
school were included. Record sheets were used to  record the  events in  Snoezelen,
and  the  technique of  non-participatory observation was used for data collection.
The research indicated that ways of developing the senses were different, depending
on many aspects: e.g., the teacher who led the lesson, the pupil, his/her type and degree
of disability, his/her current mood, and the aids used in the lesson. The study concluded
that the individual senses were not developed to an equal extent in the monitored group
of pupils; visual and auditory stimuli were developed in each monitored lesson, olfactory
stimuli were supported in the middle of the observed lessons, and olfactory stimuli were
not included in the teaching at all. The author of the study recommended that teaching
in Snoezelen be based on a holistic approach, with all senses developed with the same
intensity.
The study by Zedková (2014) aimed to determine the influence of Snoezelen on selected
components of  personality (level of  communication, ability to  respond to  the  stimuli
presented) and the influence of Snoezelen on the psychological well-being of the pupil.
The author based the study on qualitative research methods, elaborating the case studies
of two pupils with severe disabilities and multiple disabilities who purposefully participated
in education in the Snoezelen room for almost one year. Stays in the room took place
regularly once a week. The results of the research showed that the use of the Snoezelen
method was beneficial for both pupils. Staying in a multisensory room provided them
with a pleasant environment for relaxation, unwinding, the opportunity to get to know
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
27
each other, better interaction with the environment, and further development of their
abilities.
Krausová (2013) dealt with the issue of supporting pupils with severe disabilities through
elements of basal stimulation, applied in the multisensory environment of Snoezelen.
The  goal of  the  research was to  analyse the  use of  multisensory room Snoezelen.
The researcher focused on: monitoring the reactions of a selected group of pupils (three
pupils from different classes aged 7–13: one boy, two girls) to new stimuli; the pupils’
reactions to teachers and classmates in the Snoezelen room; and analysis of the use
of  basal stimulation of  pupils with regard to  visual, auditory, and  somatic stimuli.
A  qualitative research approach was chosen for the  study, applying the  technique
of participatory observation, which was crucial to the implementation of this research.
The  study continued for one school year, twice a  week for 45 minutes. All results
obtained indicated that the repeated stay of pupils with severe disabilities in Snoezelen
increased their attention and ability to concentrate. This subsequently manifested itself
both in  the  activities in  Snoezelen and  in  regular schooling. Cooperation with pupils
improved overall. Pupils concentrated longer in lessons, and their acquisition of new skills
was faster. The results of the study indicated a positive influence on the development
of the interactions of the observed pupils with teachers and other classmates. The pupils
began to  accept contact more readily, and, at  the  same time, to  initiate it  more
themselves. The greatest progress was made in the development of interactions that
occurred through somatic stimulation. Based on the results of the research survey, it can
be stated that it is appropriate for all pupils to use targeted activities in the Snoezelen
environment for their development, which should be supplemented by basal stimulation.
The goal of the study by Cacková (2009) was to verify the importance of using Snoezelen
as a prevention against self-harm in pupils with multiple disabilities. A qualitative method
was chosen for the  research survey, involving observation techniques, interviews,
document analysis, and analysis of activity results. For the research project, four special
primary school pupils with multiple disabilities and  diagnosed as  self-harming, were
selected. The research focused on whether the inclusion of basal stimulation and massage
activities in Snoezelen allowed individuals to gain a positive experience through their
body, and  whether these activities contributed to  an  overall calming of  the  pupils.
During the study, it was found that manifestations of self-harm were influenced by many
factors, and therefore it could not be stated unequivocally that the inclusion of activities
in  Snoezelen alone reduced the  manifestations and  intensity of  self-harm. However,
the conclusions of the research confirmed that the use of basal stimulation, massage,
and  Snoezelen are of  great importance to  the  development of  pupils with multiple
disabilities, providing them with positive experiences gained through their body after
application of  basal stimulation. However, in  each activity, it  is  necessary to  monitor
pupils’ reactions and include and develop those activities in which a positive response
and self-assurance of the pupil is evident.
Plecháčková (2009) carried out a study dealing with the use of the Snoezelen multisensory
room in  pupils with hearing impairment. The  goal was to  describe the  functioning
2021 | Volume VII | Issue 1 social pathology & prevention28
of  Snoezelen in  a  school for pupils with hearing impairment, to  verify the  benefits
of the  multisensory room when working with pupils with hearing impairment (to find
out whether staying in a multisensory room and applying methods can be beneficial
for such pupils), and  to  characterize the  advantages and  disadvantages of  methods
and procedures used for working in the Snoezelen multisensory room with pupils with
hearing impairment. To meet the research goal, the author chose a qualitative strategy
using research techniques of  document analysis, interviews, observation, natural
experiment, and case studies of four pupils aged 11–14 from a primary school for pupils
with hearing impairment, for one school year. The results of the research showed that
the use of Snoezelen in pupils with hearing impairment was appropriate. Activities carried
out in this room corresponded to the specific needs of these pupils. Based on longterm
observations, the  advantages, and  disadvantages of  including these methods
in the educational process at primary school for pupils with hearing impairment were
specified. One advantage is the possibility of applying special pedagogical procedures
with therapeutic elements; Snoezelen is suitable for all age groups of pupils, for school
counselling centres, for school groups, and for pupils in their free time. Disadvantages
are the higher financial costs of the establishment of Snoezelen at schools, the need
for further education of teaching staff, and organizational issues around the inclusion
of the use of Snoezelen in schools.
Šoupalová’s research (2009) dealt with the  issue of  mediating the  widest possible
range of information regarding the effective use of the Snoezelen multisensory room,
and  the  possibility of  improving the  quality of  life of  people with severe intellectual
disabilities and multiple disabilities through a targeted offer of primary stimuli in a safe
Snoezelen atmosphere. The study took place in three facilities in which the Snoezelen
multisensory room was used for various selected activities: therapeutic activities, animal
therapy (dog), music therapy, and  targeted support of  visual perception in  the  form
of light effects. A qualitative research method was chosen for the study, using techniques
of  participatory observation, standardized interviews with closed questions, and  data
collection with field notes. The  research sample consisted of  four special educators
who had long-term experience of  working in  Snoezelen. In  monitored facilities, use
of the Snoezelen multisensory room is an extremely beneficial approach, provided mainly
to  individuals with severe intellectual disabilities and  concurrent multiple disabilities.
It is difficult to approximate the way of experiencing reality, thinking, and perception
of these individuals. One option is Snoezelen and the use of the multisensory room,
which allows the arousal of individual sensations. The multisensory stimulation that takes
place in Snoezelen is one of the most common and successful approaches, not only with
regard to learning, but also to therapeutic procedures for people with severe disabilities.
The study carried out by Vostrejšová (2009) aimed to verify the positive effect of basic
sensory stimuli (auditory, visual, olfactory, tactile, and  taste) in  the  environment
of Snoezelen on individuals with severe disabilities and multiple disabilities. The study
employed qualitative research techniques of analysis of pupil records, and elaboration
of  case studies of  four selected pupils (pupils who were immobile, with multiple
Jarmila Pipeková
Jan Viktorin
POSITIVE IMPACT OF THE SNOEZELEN CONCEPT ON CHILDREN
AND PUPILS WITH HEALTH DISABILITIES
29
disabilities, or  with severe to  profound intellectual disabilities). One of  the  main
methods used in the education of these pupils is multi-stimulation method Snoezelen.
In an artificially created environment, pupils with severe disabilities have deep experiences
that they would not have the chance to experience in everyday life. Snoezelen is one
of the ways to offer a form of self-realization to pupils with severe disabilities and limited
opportunities to perform activities by themselves, allowing them to enjoy success, joy,
and other sensations that they would not otherwise experience. In all the monitored
pupils, Snoezelen had a positive effect on the improvement of their quality of life; during
the  planned activities, the  pupils were generally reassured and  the  connection with
the teacher was strengthened.
The main goal of the study by Krzyžanková (2006) was to verify the expected positive
impact and effect of perception of basal sensory stimuli in pupils with severe and profound
disabilities and multiple disabilities educated at a special primary school. The chosen
qualitative strategy of the study and the techniques applied (analysis of pupils’ records,
structured observation according to selected categories, natural experiments, interviews
with pupils’ parents, and  analysis of  results of  pupils’ activities) gave the  researcher
a deep insight into the education of pupils with multiple disabilities. Pupils with severe
disabilities usually lack the  stimuli for their development, and  this can increase their
disability. The  Snoezelen concept is  based on  a  holistic approach to  individuals with
severe disabilities, fulfilling their needs for acceptance, understanding, closeness and, if
possible, sensory perception and experience. The more severe the degree of intellectual
disability in pupils, the more appropriate sensory stimulation of pupils becomes for their
development. The use of therapies in Snoezelen rooms is met with great enthusiasm
by  both pupils and  special educators. Snoezelen is  perceived as  a  place to  meet,
to  strengthen mutual belonging, a  place where they experience joy, where they feel
‘good’, and where it is possible to create a sense of security in pupils. The study indicated
a positive impact of the use of Snoezelen in targeted educational activities of pupils with
severe intellectual disabilities and multiple disabilities.
Conclusion
The studies that we have presented in the text are monothematic and focus on the use
of the Snoezelen concept in the field of support and education of pupils with severe
disabilities and multiple disabilities who are educated in special schools. In the analysed
studies, the  issue of  supporting educational goals for these pupils prevails; in  most
research, the achievement of these educational goals involves Snoezelen in conjunction
with another concept of support, i.e., basal stimulation. The analysis of studies confirmed
the expected results of using Snoezelen in the environment of special schools to achieve
educational goals set by special educators with high professional knowledge. In most
research, we learn how well-equipped the Snoezelen rooms are in special schools, which
predominate in  providing this specific support to  individuals with severe disabilities.
2021 | Volume VII | Issue 1 social pathology & prevention30
Of the 17 selected studies, 14 dealt with the support of pupils with severe disabilities
and multiple disabilities, two focused on the support of pupils with autism spectrum
disorder, one on preschool children, and one on pupils with hearing impairment. Based
on our analysis of the selected studies, it can be stated that Snoezelen is most often used
in special schools that educate children and pupils with severe disabilities or multiple
disabilities, and that special educators who work at these schools manage their pupils
with Snoezelen and basal high-level stimulation. These concepts are currently the main
educational methods in special schools for pupils with severe disabilities, complemented
by other therapeutic and formative approaches. The results of the survey study, which
focused on  the  use of  the  Snoezelen concept, clearly demonstrate the  sustainability
and high level of use of this concept in the education of pupils with severe disabilities
during compulsory education in  special schools and  under the  guidance of  fully
competent special educators.
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Authors
doc. PhDr. Jarmila Pipeková, Ph.D.
Faculty of Public Policies, Silesian University
Institute of Special Education
Bezručovo nám. 885/14, 746 01 Opava, Czech Republic
jarmila.pipekova@fvp.slu.cz
PhDr. Jan Viktorin, Ph.D.
Faculty of Public Policies, Silesian University
Institute of Special Education
Bezručovo nám. 885/14, 746 01 Opava, Czech Republic
jan.viktorin@fvp.slu.cz
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 35
SENSORY PROFILE IN THE SNOEZELEN
INTERVENTION
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
Abstract
In  this article we present a  tool for professionals who work in  care services (24-hour
services) with people with a type of dependency and/or developmental disability, such
as dementia and/or Alzheimer‘s, intellectual disabilities, autism spectrum disorders etc.
Sensory interventions for these people are primarily focused on offering them better
quality of life and increased emotional well-being.
Sensations are the  basis of  well-being and  are present and  functioning in  everyone,
regardless of  their level of  dependence. The  main challenge for professionals
and  institutions is  to  provide the  most appropriate intervention to  each person and,
thereby, ensure a pleasant and enjoyable environment and daily activities that accord
with his/her capabilities. It is necessary to start from the most reliable knowledge possible
of the sensory capacities, tastes, and sensory preferences of the subject.
The article includes practical examples of Sensory Assessments that allow us to elaborate
the  Sensory Profile of  a  person, involving every sense (visual, auditory, tactile,
proprioceptive, olfactory, gustatory, and  vestibular), in  order to  identify the  sensory
capacities of the person, his/her tastes, and sensations of displeasure and discomfort.
Based on  qualitative observational methods, the  article provides a  practical guide
to performing a Sensory Assessment.
Keywords
Snoezelen, sensory profile, sensory assessment, sensations, sensory intervention
Introduction
Our emotional well-being begins with our ability to have daily experiences appropriate
to  our basic neurological capacities, i.e., our sensations. From the  developmental
2021 | Volume VII | Issue 1 social pathology & prevention36
and learning pyramid of Williams & Shellenberg (1996), we know that all the information
that reaches us stems from our basic sensations.
Figure 1 Development and learning Pyramid. (Williams & Shellenberger, 1996)
The  first thing we must ask ourselves is  what are the  basic sensations? According
to  the  developmental pyramid above, these are the  sense of  touch, the  vestibular
(or kinesthetic)sense,and the proprioceptivesense.Wecallthembasicsensationsbecause
they are the most ancient and primitive sensations. The first sensations that developed
in our phylogenetic ancestors were these basic sensations. Also, at the ontogenetic level,
they are the  first to start operating. In ontogenetic evolution, when the  fetus begins
to form in the mother‘s womb, the first sensory capacities that appear in the amniotic
fluid are the sensations of touch, vestibularity, and proprioception. These three basic
sensations are also the last to disappear.
At the endof life,the Williamsand Shellenbergdevelopmentalpyramidoperatesin reverse.
As advanced deterioration occurs, cognitive and executive abilities may disappear, due
to possible neurological changes to the prefrontal lobe. However, the basic sensations,
located in the lower parts of the cortex, are better preserved. It should also be noted
that these sensations are close to the limbic system, and therefore, to the emotionality
of an individual. For this reason, it is important to understand that while a person with
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 37
advanced cognitive impairment may have compromised cognitive abilities, they retain
the ability to feel emotions, primarily linked to the most basic sensations.
Above the basic sensations, we find the sensations of Sight, Hearing, Smell and Taste.
These sensations are essential for the daily functioning of the individual. The correct
functioning of the different sensory systems will allow a person to be connected with his/
her environment and with him/herself in a satisfactory manner.
For each individual, especially those with a type of neurological disorder, developmental
delay, intellectual disability, mental illness, autism, etc., the functioning of their various
sensory systems is essential for their well-being. A person will have particular sensory
capacities, determined by different factors: their genetics, their habits, their environment,
their cultural context, their condition on  a  given day, and, above all, the  presence
or absence of a physical, neurological, or other type of disorder.
The Snoezelen intervention makes it possible to provide the person with emotional wellbeing
through their sensations. The Snoezelen philosophy in this sense is predicated
on  generating sensory experiences for the  person that create a  pleasant day-to-day
existence, through appropriate and varied sensory experiences. Sensoriality is important
in all people, but it is of particular importance in the profiles of people such as those
mentioned above (people with cognitive impairment, dementia, Alzheimer‘s, intellectual
disability, mental illness, autism, etc). The  Snoezelen intervention should, therefore,
allow us to provide sensory experiences in the most suitable way possible to support
the physical and emotional well-being of the person.
In order to plan an appropriate sensory intervention, it is first necessary to be aware
of the sensory capacities of an individual: to obtain the most reliable information possible
on each of their senses and their functioning. In addition to his/her sensory capabilities,
it is important to know the sensory preferences of each person: to know which intensities
and  characteristics of  each stimulus generate well-being or, on  the  contrary, cause
discomfort or  displeasure. In  this way, we can establish a  baseline, or  starting point
which we can use to plan a precise personalised sensory intervention. All such sensory
information about the person, his/her sensory capacities, his/her preferences, or his/her
sensory sensations of displeasure make up what we call their Sensory Profile.
The benchmark in terms of Sensory Profile and Sensory History is the work of Winnie
Dunn and her collaborators. Dunn‘s Sensory Profile (Dunn, 1994, Tomchek, Dunn, 2007),
in its original version, is divided into six sensory categories (auditory, visual, taste/smell,
movement, body position, and  touch) and  two behavioural categories (emotional/
social, and activity level), with a total of 125 items. A principal component factor analysis
of the Sensory Profile was carried out based on the responses of 1,115 children aged 3
to 10 years who had typical development (Dunn and Westman, 1997, Brown et al, 2001).
The resulting factor structure did not suggest categories of sensory modalities but rather
patterns of behavioural response. This factor analysis led to the development of Dunn‘s
(1997) Sensory Processing Model, which characterizes four different sensory processing
tendencies (people with low sensory registration, sensation seekers, sensory sensitive
people, and sensation avoidants).
2021 | Volume VII | Issue 1 social pathology & prevention38
One way to measure sensory processing from a behavioural perspective is to obtain
a  sensory history. Advantages of  sensory histories over other measures include
ease of  administration and  contextual relevance (Dunn, 1994). Sensory histories are
contextually relevant because they allow the assessment of behaviours in the natural
environment rather than the  commonly used alternative of  performance observation
in a clinical setting. In addition, sensory histories allow the person or family member who
is the focus of the history taking to be an active participant in the assessment.
The modelpresentedhereis verypracticaland easyto useforprofessionalsfromthe various
healthcare services. It can be used with both children and adults, with or without verbal
communication. Through the information observed in the Sensory Assessment, it allows
us to draw up a Sensory Profile of the person, in order to have a baseline that indicates
to care professionals the objectives to be considered in the planning of day to day care
for the person, and of specific interventions in the Snoezelen Room that are as targeted
as possible.
Sensory profile
Before beginning a Snoezelen intervention with a patient, it is essential to have previously
established hi/her Sensory Profile. Professionals require a  framework that provides
a baseline from which to plan an intervention in the most appropriate way. The Sensory
Profile should be an instrument that is simple to use for professionals who work in the care
of  people in  vulnerable conditions (dementia, Alzheimer‘s, intellectual disability,
autism spectrum disorders, etc.). It should be a tool that can be used in the workplace,
in specialized institutions, in schools, etc. Finally, it should be a practical tool that does
not require apparatus and instruments unavailable to these professionals.
We will now present a tool designed for this purpose, taking into account the fact that
it is a tool with limited reliability, and involves a certain degree of subjectivity on the part
of the professional who applies it. A totally reliable way to perform a sensory profile
could be, for example, from Evoked Potentials. That is, to  present a  certain sensory
stimulus to  a  person and  to  record the  brain responses to  the  given stimulus with
a  polygraph machine. We know that this way of  proceeding would be more reliable
and error-free. However, we also know that a methodology of this type is not applicable
in most institutions and services that conduct Snoezelen interventions. These institutions
do not have polygraph instruments or trained professionals able to use and interpret
them. Thus, we need a  tool that allows us to  establish a  Sensory Profile as  reliably
as possible, albeit with a certain margin of error. It should also be noted that in the group
of professionals who care for people with types of vulnerability such as those mentioned
above, there has not been a  tradition of measuring and  evaluating people‘s sensory
capacities as  objectively as  possible. Nevertheless, we think that having a  tool like
the one we propose here will be of great help to these professionals.
The Sensory Profile that we propose has been designed according to two basic premises:
it should be easy to use (the professionals who perform the Snoezelen intervention are
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 39
familiar with the tool; thus it should not cause any difficulties); and it should be quick
to use (it does not require excessive time to complete it, since professionals are often short
of time). In addition, it should be able to generate as much information as possible about
the person‘s sensoriality, so that we can design Snoezelen interventions in an appropriate
and specific way according to the individual characteristics of the person.
We will refer first to the Sensory Assessment, i.e., to the results recorded and observed
when we offer the  person different magnitudes and  types of  sensory stimuli. From
the observations we register the types of response of the person, of liking or rejection,
to  each sensory sensation that we present. When the  Sensory Assessment has been
completed, the Sensory Profile can be prepared: a record of the most significant results
for each sense. The Sensory Profile will generate the baseline from which we can plan
interventions with the person in the most appropriate way, either in terms of activities
of daily life and activities in general, and, more specifically, in the design of sessions
in the Snoezelen Room.
Sensory Assessment
The context to perform the Sensory Assessment (Methodology Guide)
The  Sensory Assessment of  a  person will take place on  a  specific day, in  a  specific
context. We should be aware that on this day, the person will be in a certain condition,
as will the professional who performs the assessment. In light of this, we should bear
in mind that the results of the Sensory Assessment are to be taken as a guide, providing
basic information that may be subject to a degree of bias. However, it will, nevertheless,
be a starting point that can mark the beginning of the multisensory intervention with
the person.
Place: it is recommended that the sensory assessment be conducted in a quiet room
which is not subject to distractions that may affect the results of the Assessment. We
want to  assess the  person‘s responses to  the  stimuli that we present to  them rather
than their responses to unintended environmental input that may also affect the results.
A Snoezelen Room is a good place to perform the Sensory Assessment, since it is a quiet,
isolated place, in which environmental stimuli can be controlled. If a Snoezelen Room
is not available, it is recommended that a space be found that is as quiet and isolated
as possible, such as the person‘s own room, a suitable room in the facility, an office, etc.
Position and  predisposition of  the  person: when starting the  Sensory Assessment,
it is essential to guarantee the well-being and comfort of the person. We want to assess
his/her responses to the stimuli that we will present to him/her, and not his/her response
to  general discomfort or  distress, for example. Therefore, it  is  necessary to  position
the  person comfortably, making allowances for their condition, postural control,
and preferences. We should also ensure that he/she is comfortable in terms of clothing
and other external factors that may influence his/her comfort.
2021 | Volume VII | Issue 1 social pathology & prevention40
Professionals and registration: it is recommended that two professionals be present
during the Sensory Assessment. One should present the different stimuli to the person.
Since the person should be made to feel as safe as possible, it will facilitate the process if
the professional is known to the patient. If not, it is necessary to devote time to building
trust. The second professional is the observer, who will record the person‘s responses
to  the  different contexts of  the  stimulus. This record may be visual (a  recording
of the assessment session) and/or written (a recording of the person‘s responses in writing
on  an  assessment sheet), and  ideally both should be made. Recording the  sensory
evaluation will allow us to observe behavioural responses that perhaps may have gone
unnoticed, revealing sensory sensations that are important for the emotional well-being
of the person.
Materials: we should have the materials necessary to carry out the sensory assessment
to hand. Materials should be specially selected and should not require overly technical
elements.
Sensory Assessment Methodology: in  practice we work with Sensory Assessment
sheets (created as part of the methodology for evaluating the person‘s sensory responses
in different situations).
Behavioural responses that we assess: the Sensory Assessment sheets are designed
to record responses of people with high levels of dependency and/or with difficulties
in verbal communication. It is important to note that answers can be adapted to take
the  user‘s profile into consideration. They are qualitative, observational responses
through which we try to record, above all, the positive or negative reactions elicited
by each sensory stimulus. The responses recorded are:
•	Eye movements: record whether the  person makes eye movements in  response
to the presented stimulus.
•	Avoidance/withdrawal: record whether the  person shows avoidance behaviours
in response to the presented stimulus.
•	Vocalizations/verbalizations of  pleasure or  displeasure: record whether the  person
demonstrates non-verbal or verbal expressions of pleasure or displeasure in response
to the presented stimulus.
•	Voluntary movements/gestures: assess whether the  presented stimulus generates
voluntary movements in the person.
•	Modification of  muscle tone: record whether the  presented stimulus generates
variation in muscle tone in the person. Variation can be in the sense of relaxation
(decreased muscle tone) or activation (increased muscle tone).
It should be noted that in addition to the above-mentioned responses, it is also important
to note down and qualitatively record any other responses from the person which we
consider significant and which is not included in the previous sections.
We will now look at how the sensory assessment is conducted for each sense.
Visual Sensory Assessment: three micro-capacities will be assessed in the visual sensory
response:
•	Visual reaction: to  assess whether the  person reacts when a  visual stimulus
is presented in different magnitudes and experimental situations.
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 41
•	Visual fixation: to assess whether the person, in addition to his/her reaction, is able
to fix his/her gaze on the visual stimulus presented.
•	 Visual monitoring: in order to assess whether the person is able to follow the visual
stimulus presented, the  visual stimulus is  moved gradually, first in  a  cross pattern
(from top to bottom and from left to right), then diagonally, and finally, in a circle. We
observe if the person follows the visual element presented with his gaze as we move
it.
The assessment is conducted in three environmental situations:
•	Maximum light or normal ambient light: with lights or with natural daylight.
•	Dim light: it  is  important to  have a  dimmer switch for ambient light to  be able
to slightly reduce the intensity of the light.
•	Darkness: the room is left in darkness, without light. A light stimulus is presented
and the responses are observed. This environmental condition is especially indicated
for those with poor visual acuity. The contrast between light and dark means we can
see whether there is any type of reaction.
The stimuli that are presented in the visual assessment are:
•	 Personal stimulus: the  professional him/herself is  presented as  the  stimulus. We
observe how the user reacts when he/she sees the caregiver.
•	 Attractive visual stimulus: an attractive visual stimulus with striking colours is presented
to the person.
•	Luminous stimulus: A luminous element (a bundle of optical fibres, a flashlight, or any
element that emits light) is presented, typically in the dark, but it can also be shown
in the other environmental conditions
Sensory Auditory Assessment: two micro-capacities will be assessed in the responses
to auditory sensory stimuli:
•	Auditory reaction: to assess whether the person shows any type of reaction when
presented with an  auditory stimulus in  different magnitudes and  experimental
situations.
•	Auditory localization: to assess whether when presented with an auditory stimulus
in  different magnitudes and  different experimental situations, the  person tries
to locate the origin of the sound source with head, eye, or body movements.
The assessment will be carried out with three different intensities of magnitude of auditory
stimulus:
•	 Low intensity of auditory stimulus: a quiet sound is emitted.
•	Intermediate intensity of auditory stimulus: a medium sound is emitted (the sound
intensity is neither low nor high).
•	High intensity of auditory stimulus: a loud sound is emitted.
The types of auditory stimuli that we will present are:
•	The  Human Voice: the  professional who carries out the  assessment addresses
the  person, saying his/her name in  the  three aforementioned intensities (low,
intermediate, and strong), for several repetitions at each intensity.
2021 | Volume VII | Issue 1 social pathology & prevention42
•	High-pitched sound: the  person will be presented with an  auditory stimulus with
a high-pitched sound, such as a musical instrument, e.g., a triangle. There will be
several repetitions.
•	Low-pitched sound: the person will be presented with a sensory stimulus of a lowpitched
nature, such as a Tibetan bowl, a drum, etc. There will be several repetitions.
•	Vibration: a vibratory sensation will be presented to the person using an element
that generates this sensation, such as an electric toothbrush or any other object that
vibrates. Several repetitions will be carried out.
Tactile Sensory Assessment: in this assessment, it is important that the person feels
comfortable and  safe, to  avoid causing them discomfort. This assessment should be
performed directly on the skin, on the upper extremities (arms and hands) and on the lower
extremities (legs and feet), provided that the person accepts it. In some cases, if the person
accepts it readily, we might assess their reaction to tactile stimulus on the face and head
and on any other part of the body, such as the trunk; however, normally only the upper
and lower extremities are assessed, since the person feels more comfortable with this
and the procedure is less invasive. For the extremities we differentiate between the two
hemibodies (right and left). This information is significant for some patients, since, due
to certain neurological disorders, they might present different tactile sensitivity on one
half of the body and the other.
The tactile stimuli that we present are: temperature, texture, and pain.
•	Warm stimulus: a stimulus that warms the person but not excessively. For example,
a material that can be heated in the microwave such as seeds placed in a sachet
or other objects that generates heat, such as a hair dryer.
•	 Cold stimulus: a stimulus that is cold, such as ice cubes wrapped in a cloth.
•	Soft stimulus: a stimulus with a soft texture, such as a soft fabric, a sponge, cotton
wool etc.
•	Rough stimulus: a stimulus that is rough or coarse, such as a scouring pad, a strong
bristle brush, a rope mitt etc.
•	Sharp stimulus: a  sharp instrument, such as  a  needle, pricks different points
on the person‘s skin.
We therefore observe the  responses of  the  person to  varied temperatures, varied
textures, and pressures on different parts of the skin.
Proprioceptive Sensory Assessment: the good positioning or comfort of the person
is  important in  this assessment. The  person might be stretched out on  a  bed,
in a comfortable chair, on a mat, etc. It is important to adapt to his/her postural control,
and to try to perform the assessment as reliably as possible.
We assess proprioception in the upper and lower extremities. If the person accepts it, we
can also try to apply pressure to the head and trunk; however, often, the head and trunk
are too invasive, and we limit ourselves to the extremities. We assess both hemibodies.
In this sense, it is important to observe if there are responses of pleasure or rejection
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 43
depending on laterality. We are interested in assessing whether the person feels pain
in certain parts of their body.
The proprioceptive assessment is performed by applying firm pressure on each limb
at a slow pace and repeating the procedure on each limb between three and five times.
The sequence is:
Upper limbs:
•	Shoulder, arm, elbow, forearm, wrist, and hand.
Lower limbs:
•	 Hip, thigh, knee, leg, ankle, and foot.
We repeat the procedure at a slow pace, applying firm pressure in the aforementioned
sequences, repeating them at  least five times, and  always looking out for responses
of acceptance or rejection from the person. If he/she has verbal communication, we also
ask him/her directly whether the stimulus is pleasant or unpleasant.
Olfactory and gustatory assessment: the assessment of preferences and capacities for
olfactory and gustatory sensory discrimination is essential in our day-to-day life. To assess
this sense, varied and  contrasting sensory sensations in terms of  smell and  taste are
provided. We try to observe which sensations the person prefers, which sensations he/
she dislikes, and we observe, in particular, whether he/she can identify what should be
unpleasant stimuli so that in everyday situations, he/she is able to discern harmful stimuli
or those that might affect their well-being.
Olfactory sensory evaluation stimuli: we present various and contrasting olfactory stimuli
to the person and observe his/her responses.
Possible olfactory stimuli to present:
•	 Floral, spicy, acidic, sweet, unpleasant smells.
Taste sensory evaluation stimuli: we will present different flavours to  be tasted
by the person. The aim is to present various contrasting flavours in order to observe
the responses of the person to different sensations, and to record their taste preferences
and dislikes.
Possible taste stimuli to present:
•	 Salt, sugar, bitter taste, sour taste etc.
Vestibular sensory evaluation: assessing the  responses of  acceptance or  rejection
of the person when presented with various vestibular sensory sensations is important
in order to offer him/her the most appropriate care and day-to-day activities for their
well-being. In this sense, it is necessary to apply the vestibular inputs gradually, always
observing the verbal and, above all, non-verbal responses, such as nystagmus (rapid
and involuntary movements of the eyes that can be: from one side to another (Horizontal
nystagmus); up and  down (vertical nystagmus); or  rotating (rotational or  torsional
nystagmus, skin coloration, etc).
The  vestibular assessment can be carried out in  different contexts, depending
on the materials available. If we have one, we can perform the assessment in a vestibulator.
If not, we can do  it  on  a  swing. With adults, if we do  not have the  aforementioned
elements, it can be performed in a wheelchair, in a crane, on a seesaw, or in an office
chair with wheels.
2021 | Volume VII | Issue 1 social pathology & prevention44
The aim is to present various vestibular movements and to observe the person‘s responses
to them. It is very important to proceed cautiously, always looking at the person‘s eyes
and face for signs of discomfort or overstimulation.
Experimental situations to assess the person‘s response to vestibular sensations:
•	Response to  linear acceleration: five swings in  the  frontal plane are performed,
followed by five swings in the sagittal plane.
•	Response to angular acceleration: five clockwise turns are made, followed by five
anticlockwise turns.
•	Responses to vertical acceleration: five vertical jump movements are performed, for
example, on a raised mat.
•	Response to inversion: the patient is turned upside down three-five times.
The  final two situations (vertical acceleration and  inversion) are only carried out with
children.
Once the Sensory Assessment has been carried out, a Sensory Profile is prepared. This
document, explained in  section 2, summarizes the  most significant results in  terms
of the person’s positive and/or negative response when exposed to each of the sensory
sensations, and  a  description of  the  response that the  person emits. The  Sensory
Profile, therefore, is  a  document in  which we synthesize the  person’s preferences
or dislikes and describe his/her responses to them. From this document, the sensory
objectives on  which to  work with the  person can be established. These objectives
involve recommendations for daily life that should provide a more pleasant daily life with
greater emotional well-being for the person. In addition, they will serve as a guideline
for multisensory activities appropriate to the person and, especially, they will indicate
the objectives to be developed in sessions in the Snoezelen room.
Examples of the repercussion of sensory profile results on everyday life
In this section we will provide examples of Sensory Assessments and Profiles, and how
they might generate 24-hour Snoezelen objectives and  proposals for interventions
in the Snoezelen Room. The improvement in Quality of Life of the person and in their
Emotional Well-being is  clearly demonstrated. Only the  most important results that
generated a significant change are included, rather than verbatim sensory assessments.
Older person with cognitive impairment
A 100-year-old lady with a level II Dependency, who lives at home with home support
and has significant health problems in terms of low weight (37 kilos) and a refusal to take
protein and  vitamin supplements recommended by  her doctor (due to  the  fact that
she is a naturopath and only ingests natural foods, without additives or preservatives).
In  addition, she has behavioural problems in  that she rejects clothes that the  home
caregivers offer her.
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 45
•	Visual sensory evaluation: she prefers bright colours, declaring that she hates dark
colours such as brown and grey. Based on this assessment, the colours of her clothes
were changed. She was offered clothing in more brighter colours, which led to the end
of behavioural difficulties when dressing her.
•	Olfactory sensory evaluation: she likes the  smell of  vanilla. As  a  result, the  social
worker bought a natural vitamin supplement with a vanilla aroma from the pharmacy.
She took it willingly and in a few weeks gained three kilos in weight, improving her
overall health.
10-year-old girl with Autism Spectrum Disorder
A person with ASD and severe intellectual disability, without verbal language and with
behavioural problems (rejection, yelling, and hetero-aggression) at school and in daily
activities at home, such as showering.
•	Touch sensory evaluation: she has a preference for cold temperatures, showing a clear
rejection of warmer temperatures. She demonstrates a preference for coarse textures
over soft textures. Based on this assessment, it was recommended that the family
shower her with cold water, using a rough sponge. Subsequently, rejection behaviours
in the shower were clearly reduced.
•	Auditory sensory evaluation: rejection responses to  high intensity sounds were
clearly observed in the sensory evaluation, regarding both the human voice and low-
and  high-pitched sounds. In  classroom situations with loud noise or  disturbance
from other classmates involving shouting or a high tone of voice, the teacher was
advised to invite the girl to another calmer classroom space. In this way, behavioural
disturbances in the school classroom were reduced.
Challenges and conclusions
The  Sensory Profile presented here should be regarded as  a  tool for qualitative
observation, available to  professionals who require clear and  reliable knowledge
of  the  responses of  children and  adults for whom they should plan and  carry out
an intervention on a sensory basis. Mention has been made of the possible bias that may
be implicit in the presented tool, since it is an observational instrument. The evidence
from the many professionals from different caring fields (teachers, occupational therapists,
psychologists, physiotherapists, etc.) who have used the Sensory Profile and  Sensory
Assessment is that it results in a better knowledge of the patient, and above all, a better
understanding of his/her behaviour and emotions.
It is important that there be two professionals when performing the Sensory Assessment.
As mentioned above, one presents the stimuli, and is in direct contact with the person,
while the  other has a  more discreet role as  the  observer who records the  responses
of the person to different sensations. It is important after the sensory evaluation that
both professionals analyse and review the results so that a sensory profile can be created
2021 | Volume VII | Issue 1 social pathology & prevention46
with the highest possible reliability, in order to offer intervention objectives appropriate
to  the  needs and  abilities of  the  person; thereby improving relationships, activities
of daily living, and activity scheduling.
The observational tool presented in this article can be a good complement to other
standardized tests such as  Dunn‘s Sensory Profile. On  the  one hand, the  structured
observation presented in this article allows us to collect responses in an “experimental
situation”, whereas Dunn‘s sensory profile collects information from parents and teachers
in  everyday contexts. In  both cases, we start from an  ecological model and  positive
psychology, taking account of the environment and strengths (in terms of the abilities
and preferences) of the person.
It  is  intended to  provide professionals with a  means to  a  deeper understanding
of the people to whom they should direct their attention and care. We regard this tool
as a starting document used by many professionals with concrete results in interventions
that have resulted in clear improvements in the day-to-day life of patients in general
terms and in terms of the design of sessions in the Snoezelen Room.
References
Brown, C. et al. (2001). The  Adult Sensory Profile: Measuring Patterns of  Sensory
Processing. The American Journal of Occupational Therapy, 55(1), 75–82.
Dunn, W. (1994). Performance of typical children on the Sensory Profile: An item analysis.
American Journal of Occupational Therapy, 48, 967–974.
Dunn, W. & Westman, K. (1997), The Sensory Profile: The performance of a National
Sample of children without disabilities. The American Journal of Occupational Therapy,
55(1), 25–34.
Tomchek, S. & Dunn, W. (2007), Sensory Processing in Children With and Without Autism:
A comparative Study using the Short Sensory Profile, 61(2), 190–200.
Williams, S. W. & Shellenberger, S. (1996) How does your engine run? A leaders guide
to the alert program for self-regulation. Albuquerque, TherapyWorks, Inc. 651 Strategies
for sensory processing disorders.
María José Cid Rodriguez
Ramona Ribes Castells, Kateřina Janků
SENSORY PROFILE IN THE SNOEZELEN INTERVENTION 47
Authors
Cid Rodriguez, Maria José, Ph.D.
Psychologist, coordinator ISNA Spain, collaborator University of Lleida.
C/Major, nº53. CP43570. Santa Bàrbara. Tarragona. Spain
mariajosecidrodriguez1964@gmail.com
Ribes Castells, Ramona, Ph.D.
Professor in the department of psychology. Faculty of education, psychology and social
work. University of Lleida.
avd. Estudi General, nº4. CP.25180. Lleida. Spain
ramona.ribes@udl.cat
Mgr. Janků, Kateřina, Ph.D.
Assistant Professor at the Institute of Special Education, Faculty of Public Policy, Silesian
University in Opava
Bezručovo náměstí 885/14, 746 01 Opava, Czech Republic
katerina.janku@fvp.slu.cz
Agnieszka Smrokowska–Reichmann
Of Stimuli and Metaphors: Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
49
Of Stimuli and Metaphors: Therapeutic
Storytelling (Fairy Tale Therapy)
in the Snoezelen Room
Agnieszka Smrokowska–Reichmann
Abstract
Thereareclearcommonalitiesbetweenthe Snoezelenmethodand therapeuticstorytelling
(fairy tale therapy). When conducting fairy tale therapy in a Snoezelen room, we deal with
the synergetic effect of sensory stimuli (characteristic of Snoezelen) and imaginary stimuli
(characteristic of fairy tale therapy). Both the symbolic space of a fairy tale and the sensory
space of Snoezelen constitute a „different“ world. Each type of art therapy, including
bibliotherapy and the fairy tale therapy it contains, affect the senses, thus supporting
sensory memory. The article analyses the theoretical and practical aspects of conducting
fairy tale therapy in a Snoezelen room with children and with adults.
Keywords
Snoezelen, therapeutic storytelling, fairy tale therapy, sensory stimuli, bibliotherapy.
Comparison between Snoezelen therapy and fairy tale therapy
There are clear commonalities between Snoezelen therapy and  the  therapeutic use
of  fairy tales. When conducting fairy tale therapy in  the  Snoezelen Room, we are
dealing with the synergistic effect of sensory stimuli (characteristic of Snoezelen therapy)
and  imaginative stimuli (characteristic of  fairy tale therapy). (Bera, 2017). This is  not
surprising, since each type of art therapy (including bibliotherapy and fairy-tale therapy)
affects the senses, thereby supporting sensory memory (Modrak 2016).
The  comparative analysis of  Snoezelen sessions and  fairy tale therapy for children
(proposed by Alicja Bera) can be reduced to the following points:
1. Both the symbolic space of fairy tales and the sensory space of Snoezelen constitute
a „different“ world, which children relate to in a special way, precisely because it differs
significantly from the everyday reality surrounding them.
2021 | Volume VII | Issue 1 social pathology & prevention50
2. In the Snoezelen Room, there is a wealth of sensory stimuli; while fairy tale therapy
presents a wide range of imaginative stimuli.
3. In fairy tale therapy, an individual approach to the participant is extremely important,
e.g., the choice of a favourite text of the child (to produce greater therapeutic effects).
In  the  Snoezelen Room there is  also a  maximally individualized approach towards
the  participant, manifested by, for example, the  appropriate selection of  stimuli,
guaranteed by the methodological principles of Snoezelen.
4. During both fairy tale therapy and  Snoezelen therapy, it  is  essential to  maintain
control over the  session. In  the  case of  fairy tale therapy, the  therapist must vet
the content according to the age, level of development, and health of the participants.
In the Snoezelen Room, the therapist must select the stimuli according to the health
condition of  a  particular participant and  their level of  fitness and  development,
and must also take possible contraindications into account.
5. Both the  person conducting the  fairy tale therapy and  the  person conducting
the Snoezelen session must be creative and responsive. Fairy tale therapy sessions
and sessions in the Snoezelen Room make high demands of the therapist, since neither
can be run according to a precise plan.
6. Another common feature of fairy tale therapy and sessions in the Snoezelen Room
is their positive appeal to the recipient.
(Bera, 2017; see also: Rawa-Kochanowska, Zawadzka 2015, Głodkowska 2001, Konieczna
2005, Molicka 2011, Szaga 2014).
The  general observations above encourage reflection on  some of  the  more detailed
aspects of fairy tale therapy in relation to Snoezelen therapy.
Imagination – creativity – development
Originally, fairy tales were not only intended for children. From the dawn of human history,
such narratives have expressed the human longing for happiness, the approval of good,
the condemnation of evil, and the affirmation of justice. They prove the power of human
imagination and creativity, and, at the same time, stimulate emotional and intellectual
development. For these reasons, fairy tales are highly valued and constantly revisited
in psychology and pedagogy. In the world of fairy tales, on one hand, the impossible
becomes possible and  there are no problems without a  solution, but on  the  other
hand, the  heroes encounter various difficulties and  dangers, which they must strive
to overcome. Properly selected and presented during fairy tale sessions, narratives can
be soothing and therapeutic, since they show how to surmount obstacles, how to actively
confront unfavourable circumstances, and how to find confidence in oneself and one‘s
competences. It is also worth noting that if the fairy tale therapy session is conducted
correctly, the therapeutic potential of fairy tales is activated naturally, as if “by accident”.
Imagination, creativity, development, overcoming obstacles, soothing, developing
competences – such terms can also be applied to Snoezelen therapy. Similarly to fairy
Agnieszka Smrokowska–Reichmann
Of Stimuli and Metaphors: Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
51
tale therapy, in the Snoezelen Room the therapeutic effects happen „by themselves“,
as if „by accident“ – provided the person conducting the session scrupulously follows
all eight methodological principles of  Snoezelen. In  general, both fairy tale therapy
and Snoezelen sessions are about activating positive emotional, cognitive, and social
processes. The  narrative, although it  does not require an  immediate and  precise
response, is  nevertheless an  unambiguous stimulus, capable of  generating a  wide
spectrum of reactions, and is, thus, an effective way to galvanize the listener. The same
can be said for sessions in the Snoezelen Room, except that in this case the activating
factor is not the words (or not only the words), but (also) various types of sensory stimuli.
The role of the therapist
Preparation for both fairy tale therapy and Snoezelen sessions first requires sensitization
of  the  therapist. In  Snoezelen therapy it  can be done, for instance, by  visualization,
as proposed by Hulsegge and Verheul, and by the therapists experiencing the Snoezelen
space for themselves before taking their first patients into the  Snoezelen Room.
The sensitization of Snoezelen therapists has been codified as part of the code of correct
fundamental attitudes and supervision (Hulsegge, Verheul, 1986). In the case of those
conducting fairy-tale therapy, sensitization training is taken, which may, for example, take
the form of an exercise known as “experiencing” fairy tales (see Kallen, 1999). The stages
of such training might be as follows:
1. After reading the fairy tale, the therapist decides which character he/she most identifies
with (whether a major or a minor character).
2. The therapist uses his/her own words to tell the fairy tale, and attempts to create
a vivid and realistic narrative. The present tense is used.
3. The therapist makes a list of characters, creatures, and things that play a role in the fairy
tale.
4. The therapist in turn tries to empathize with each of the characters listed on the list
(auxiliary questions: What does the character feel? What do they want? What are their
plans?).
5. The therapist outlines conflicts and tensions between the characters (auxiliary questions:
Who seems to be the most powerful being? Who dominates? Who is [apparently]
the least important?).
6. The therapist tries to come up with solutions other than that proposed in the fairy tale.
7. The therapist tries to answer the following questions: Does this fairy tale reflect any
part of my life? Does it say anything about my situation, my problems? Does it outline
a course of action with which I agree?
As we can see, although the leading of Snoezelen therapy sessions and fairy tale therapy
sessions may seem simple, straightforward, and even fun in the eyes of non–professionals
– in reality, it places high demands on the therapist and must be meticulously prepared
for.
2021 | Volume VII | Issue 1 social pathology & prevention52
The role of the text and space
Both fairy tale sessions and  Snoezelen sessions involve not so much a  dialogue
as  a  trialogue. In  the  case of  fairy tale therapy, the  parties are: the  participants –
the  therapist – the  text (since the  text also „works“ on  the  listener and  „demands“
a response – it is „alive“). In the case of Snoezelen therapy, the parties are: the participant
– the  therapist – the  Snoezelen space (i.e., the  equipment, their arrangement,
and the stimulation produced by them). A well-arranged and well-equipped Snoezelen
Room also „works“ on the participant, „demands“ a reaction from him/her, and resembles
a „living organism“.
Like fairy tales, the  concept of  Snoezelen is  the  product of  human imagination
and creativity. At the same time (again, like fairy tale therapy) Snoezelen therapy awakens
the imagination and creativity of the participants of the session. In younger participants
of fairy tale therapy, stories often evoke surprise, enchantment, and delight – the very
reactions that occur in those who enter the Snoezelen Room for the first time. The only
difference is that enchantment with the Snoezelen Room may occur not only in children,
but also in adults. One of my students exclaimed: „It’s like Narnia in here!“ when he
entered Snoezelen Room for the first time; this spontaneous statement from a young
adult perfectly illustrates how close the „other world“ of Snoezelen is to the world of fairy
tales.
The role of the text in fairy-tale therapy, and the space in Snoezelen therapy are also
important since both text and space constitute a medium that facilitates communication
with a person with whom communication is difficult – mainly small children, but also people
with limited intellectual abilities. Both the text of the fairy tale and the multisensory space
of the Snoezelen Room become a kind of transmission belt, used to convey a message
that, in a different form, the addressee would not be able to assimilate or would not
fully understand. However, there is another very significant common feature between
the fairy tale text and the Snoezelen space. The basic requirement for a therapeutic text
is that it should arouse the child‘s curiosity (as well as being entertaining and enjoyable
for them). The fairy tale must, therefore, be well told – the narrative should be lively,
fast paced, and should appeal to the child‘s imagination. It is important that the child
does not become bored during fairy tale therapy, and the same applies to Snoezelen
therapy. The space of the Snoezelen Room, the type of stimuli, and the way they are
provided should also be attractive, entertaining, and enjoyable for the child. Therefore,
it is important to not only conduct free Snoezelen sessions, but also to skilfully prepare
and conduct thematic sessions and sessions based on a scenario. The Snoezelen Room
should surprise the child again and again, just as new fairy tales continue to surprise them
during fairy tale therapy sessions. By conducting fairy-tale therapy in the Snoezelen Room,
the therapist‘s task is somewhat easier, since the multisensory space of the Snoezelen
Room makes the  narrative more attractive, and  the  narrative, in  turn, can serve
as the guiding motif for the scenario.
Opinion is  divided on  whether the  texts during fairy tale therapy should be simply
read by the therapist or told. Generally speaking, a story is better when told than read;
Agnieszka Smrokowska–Reichmann
Of Stimuli and Metaphors: Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
53
nevertheless, a well-read story is better than a badly-told one. The text of the fairy tale
may need to be repeated in subsequent sessions, for various reasons. It is important
to remember that what matters most is the fidelity and accuracy of the repeated text,
especially with children and  seniors with cognitive problems, since listening to  what
is already known creates a sense of security in these participants. Therefore, if the therapist
is not sure whether he/she will be able to tell a story in the same (or very similar) way
for a second or third time, it is better for him/her to read it. Here the question arises
of which voice to tell (or read) the story in. The voice of the therapist during both fairy tale
therapy and Snoezelen therapy is essential (although this is a topic for further analysis).
As  far as  fairy tale therapy itself is  concerned, the  therapist‘s voice should convince
the  participant that the  fairy tale impresses the  therapist himself/herself, that he/she
is in some way moved by it. In relation to Snoezelen therapy, the principle of the correct
attitude implies the  therapist‘s need for full involvement in  the  world of  Snoezelen.
Excessive changes in voice are strongly discouraged. It is very easy to overdo the effect,
with unintentionally comic results. The  story should not be told (read) in  an  overly
suggestive manner; as in Snoezelen therapy, the voice of the fairy-tale therapist must
be more or  less neutral to  better reflect the  statements of  the  characters appearing
in the fairy tale, and to allow participants the space to interpret and react to the narrative
freely. In both fairy tale therapy and Snoezelen therapy, the therapist must avoid imposing
his/her opinion or attitude on the participant – it is the text and the multisensory space
that should „work“ on the participant.
The  metaphorics and  symbolism of  fairy tales, and  the  therapist’s withdrawal from
a dominant role may make it difficult to characterise fairy tale therapy as an intervention,
which can also be the case with Snoezelen therapy. Of course, some clearly formulated
rules apply to  both fairy-tale therapy and  Snoezelen. In  both cases, the  therapist
maintains the role of organizer of activities, in the sense that he/she presents various
options to patients and provides certain directions. However, in both fairy tale therapy
and Snoezelen the participant‘s autonomy should not be restricted.
Integrating fairy tale therapy in Snoezelen classes with children and seniors
Most of the fairy tales used in fairy tale therapy can be divided into three acts. This simple
scheme makes it easy to integrate fairy tale therapy into scenarios in the Snoezelen Room:
– Act one, the introduction, takes place in a fairy-tale world, but it is also possible to meet
its elements in reality; for example, a family consisting of a mother, father, and children
is common to fairy tales and everyday life.
– Act two clearly plays out in  an  area of  symbolism and  magic; for example, one
of the children is turned into an animal by a magic spell, and special actions are required
to break the spell and to return the child to his/her true form.
– Act three is the ending, in which a happy solution is found, and the situation of the heroes
is as good if not better than at the beginning.
2021 | Volume VII | Issue 1 social pathology & prevention54
The Snoezelen Room provides the right conditions and opportunities to illustrate these
stages, using Snoezelen equipment and devices, as well as additional items brought
to the Snoezelen Room specially for a particular scenario. Illustrations play an important
role in fairy tale books for children. The Snoezelen Room can act as a giant illustration
into which the  children physically enter and  experience the  fairy tale. The  length
of the average session of fairy tale therapy and Snoezelen therapy for children is also
similar, at about 30 minutes.
Psychologists and  psychotherapists emphasize that the  strength of  fairy tales lies
in  their deep understanding of  the  various stages of  life and  the  problems that are
typical of these stages. Attention should be given to the special messages of fairy tales
concerning not only the world of children, but also the world of adults. For example, long
before ideas of emancipation and equal rights, fairy tales told stories of women taking
on the fate of their family and even their country. A woman in a fairy-tale world is not
the “weaker sex” at all, and her biological features do not negatively determine her.
On the contrary, the heroines of fairy tales can make superhuman efforts and achieve goals
that are beyond others. It can even be said that in fairy tales the roles and possibilities
of a woman are presented even more comprehensively than the roles and possibilities
of a man. Girlfriend, beloved, wife, mother, stepmother, sister, daughter, queen, fairy,
witch, mother-in-law, mermaid, etc. – these good (and sometimes bad) women shape
the fate of others, and they decisively follow their own path in life.
These and similar aspects of fairy tales explain why suitably adapted fairy tale therapy
can also be used when working with adults (e.g., in psychotherapy). Snoezelen therapy
is also open to adults, including the elderly.
Indeed, seniors respond extremely well both to fairy tale therapy sessions and Snoezelen
therapy sessions. They may be cognitively able seniors, but also seniors with pre-dementia
or dementia. Of course, sessions in the Snoezelen Room with seniors (cognitively able,
or  suffering from forms of  dementia) are a  subject deserving separate consideration.
However, with regard to fairy tale therapy with seniors, we should note that they willingly
listen to „classics“, that is, well-known fairy tales that they knew during their childhood,
and perhaps told their own children and grandchildren. It is best to choose stories that
are just over ten minutes long, so that even seniors with cognitive limitations will most
likely maintain concentration throughout the entire duration of the piece and can grasp
the entire message. If the fairy tale is longer, it is advisable to introduce breaks (e.g.,
for music, singing together, other sensory stimuli, such as taste stimuli, or conversations
about a fragment of the story already heard), particularly for seniors with dementia.
Seniors have a  long experience of  life, and  since they have already fulfilled most
of the basic goals in life, there is no need to attempt to specially form or correct anything
in these people. Therefore, in fairy tale therapy with this group of recipients, we can
set slightly less „serious“ goals. It is worth trying to find texts that create a good mood
and make the participants smile or even laugh. After all, old age is often a period in which
we experience loss, the repertoire of our behaviours narrows, and our health worsens;
therefore, good humour produced in  the  Snoezelen Room is  therapeutic in  the  full
sense of the word. On the other hand, many seniors also expect deeper texts that can
reference their wisdom from life, their own opinions, and other autobiographical aspects.
Agnieszka Smrokowska–Reichmann
Of Stimuli and Metaphors: Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
55
In  the  Snoezelen Room, there are optimal conditions for conducting both the  first
and the second variant of fairy tale therapy with the elderly.
For the purposes of fairy tale therapy conducted in the Snoezelen Room, the therapist
can compose his/her own texts, but he/she can also use classic fairy tales. Depending
on the group of participants i.e., children or seniors, different layers of meaning can be
revealed. Below, is an example of such use of a fairy tale: „Candles“ by Hans Christian
Andersen.
Possible additional accessories:
– candles (for safety reasons in lantern form, i.e., closed inside a housing; lanterns marked
to differentiate „better“ and „worse“ candles)
– a wicker basket
– apples
– potatoes baked in their jackets
– bows and ribbons
– „sewing“ materials (for safety reasons, no needles and threads – only make–believe
materials)
– shiny aluminium foil, spotlights, LED lamps (to create the glow that permeates this fairy
tale)
Possible use of Snoezelen equipment:
– hanging optic fibres to represent the ballroom walls (colour setting: white and yellow)
– light-and-sound track as the floor of the ballroom
– optic fibres spread on  the  floor, covered with transparent tulle in  white and  gold
(ballroom floor)
– bubble tubes in yellow (to represent the glow of the candles in the ballroom)
– CD recordings: e.g., a waltz
– low pouffes/seats in a darker corner of the Snoezelen Room (to represent the poor
widow‘s flat)
With children, the focus of the session will be:
– the depiction of a candle as the „narrator“ (a fairy-tale candle that speaks; perhaps
it is magic?)
– role playing, dancing, cooperation in a group
– emphasizing messages such as: children finding equal joy in very different things, love
between siblings, love between a mother and her children
With seniors, the focus of the session will be:
– interpretation of the symbolic layer of the fairy tale
– speaking about concepts such as  justice, love, fulfilment, self-realization, sacrifice,
happiness
– elements of autobiographical work, e.g., difficult, but also beautiful memories from
one‘s own childhood, differences in living standards
2021 | Volume VII | Issue 1 social pathology & prevention56
Possibilities of multisensory stimulation in both cases:
– visual stimuli
– auditory stimuli
– tactile stimuli
– taste and olfactory stimuli.
References
Bera A. (2017). Baśniowa przestrzeń Sali Doświadczania Świata jako miejsce recepcji
uniwersalnych wartości międzyludzkich, Ogólnopolska Konferencja Naukowa
„Terapeutyczny i  pedagogiczny potencjał oddziaływania polisensorycznego. Wokół
teorii i  praktyki Snoezelen (Sali Doświadczania Świata), Wrocław 20–21.05.2017
(notatki z wykładu). [The fairy–tale space of the World Experience Room as a place for
the  reception of  universal interpersonal values, Polish National Scientific Conference
„Therapeutic and  pedagogical potential of  polysensory influence. Around the  theory
and practice of Snoezelen (the World Experience Room)”, lecture notes]
Głodkowska J. (2001). Zabawa i nauka w kręgu baśni. Metoda wspomagania wrażliwości
edukacyjnej dziecka lekko upośledzonego umysłowo w wieku wczesnoszkolnym, [Fun
and learning in the circle of fairy tales. A method of supporting the educational sensitivity
of a mildly mentally retarded child in early school age]. Warszawa: Akademia Pedagogiki
Specjalnej im. Marii Grzegorzewskiej.
Hulsegge, J. & Verheul, A. (1986). Snoezelen, een andere wereld, [Snoezelen, another
world]. Uitgeverij Intro, Nijkerk.
Kallen, D. (1999). Märchen in der psychotherapeutischen Behandlung von Kinder, [Fairy
tales in psychotherapy with children]. München: Grin Verlag.
Konieczna, E. (2005). Baśń w literaturze i w filmie: rola baśni filmowej w edukacji filmowej
dziecka w wieku przedszkolnym, [The  fairy tale in  literature and  in  movies: the  role
of the movie fairy tale in the movie education of a preschool child]. Kraków: Universitas.
Modrak, M. (2016). Pamięć sensoryczna, czyli myśleć ciałem. Doskonalenie zasobów
pamięci zmysłowej, [Sensory memory, i.e. body thinking. Improving sensory memory
resources]. Warszawa: Diffin.
Molicka, M. (2011). Biblioterapia i  bajkoterapia. Rola literatury w procesie zmiany
rozumienia świata społecznego i siebie, [Bibliotherapy and fairy tale therapy. The role
of literature in the process of changing the understanding of the social world and oneself].
Poznań: Media Rodzina.
Agnieszka Smrokowska–Reichmann
Of Stimuli and Metaphors: Therapeutic Storytelling
(Fairy Tale Therapy) in the Snoezelen Room
57
Szaga, H. (2014). Bajki terapeutyczne, [Therapeutic fairy tales]. Kraków: Impuls.
Zawadza, E. & Rawa–Kochanowska A. (2015). Magiczny świat baśni i  bajek: metafory
i symbole w procesie wspomagania dziecka w rozwoju, [The magical world of fairy tales:
metaphors and symbols in the process of supporting a child‘s development]. Warszawa:
Diffin.
Author
Smrokowska-Reichmann, Agnieszka, Ph.D.
Zakład Terapii Zajęciowej, Instytut Nauk Stosowanych
Akademia Wychowania Fizycznego w Krakowie
31-571 Kraków Al. Jana Pawła II 78
agnieszka.reichmann@gmail.com
Example of good practice
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 61
Snoezelen and dementia: a case study
Ramona Ribes
Maria José Cid
Noelia Llamas
Abstract
From the model of quality of life and person-centered care (Kitwood, 1997), we present
a case study with the aim of evaluating the benefit of Snoezelen multisensory stimulation
(SMS)in an 88-year-oldsubjectwithunspecifieddementia,GDS6,and recurrentdepressive
disorder. For this purpose, a pretest-posttest design was chosen, with an intervention
consisting of  one weekly Snoezelen session for five weeks. To  assess the  effects
of the intervention, a record of the physiological and behavioral profile of the person was
used. The results include both the immediate effects of SMS and those after two hours.
In conclusion, the Snoezelen intervention produced immediate and short-term benefits
in terms of connection with the environment and behavioral adjustment in an elderly
patient with advanced dementia.
Keywords
Snoezelen, dementia, person – centered care, multisensory stimulation, psychological
and behavioral profile, intervention.
Introduction
Dementia is one of the most common health problems in older people. The WHO (2015
in ICD – 2010) estimates that it affects 50 million people in the world, and in the future
the trend will increase to 80 million by 2030 and 152 million by 2050. The most advanced
stage of  this neurodegenerative disease is  characterized by  cognitive and  functional
impairment, with behavioral alterations. This results in a deterioration in the quality of life
of sufferers and is a major stressor for their caregivers.
Currently, non-pharmacological therapies (NPTs) are used as  a  complementary
or alternative approach in interventions targeted at people with dementia. Snoezelen
multisensory stimulation (SMS) is  included in  this type of  therapy. SMS began
2021 | Volume VII | Issue 1 social pathology & prevention62
in the Netherlands in the 1970s, and was first described by Hulsegge and Verhuel, (cited
in  Cid, 2010) in  adults with severe disabilities. Currently, the  Snoezelen intervention
is applied in a wide variety of health problems, helping patients to improve their overall
adaptation cognitively, physically, emotionally, and behaviorally (Cid, 2012).
In people with moderate to severe dementia, its benefits in terms of adaptive behavior
have been demonstrated by increased patient well-being and quality of life (Sposito et
al., 2016; Maseda et al. 2018,). Aznar-Calvo et al. (2019) describe the implementation
of  multisensory stimulation programs in  Snoezelen rooms in  people with dementia
as a strategy to improve involvement and connection with the environment, in addition
to reducing psychological and behavioral symptoms.
The  methodology of  intervention in  Snoezelen rooms is  included in  the  paradigm
of  Person-Centered Care (PCC) for dementia (Kitwood, 1997). Kitwood stresses
the importance of empathizing with the subject and their needs and promoting their
autonomy for as long as possible. PCC is, thus, a new way of understanding professional
care, which aims to provide comprehensive personalized care. Jakob and Collier (2017)
found that the characteristics professionals associated with a successful and effective
Snoezelen space for people with dementia were: comfort, safety, meaningfulness
of activities consistent with patient age, a relaxing sensory experience, a sense of control,
and interaction to the greatest possible extent. In this regard, knowledge of the pleasant
sensory experiences’ patients have had throughout their life becomes a basic instrument
(senso-biography: annex 3).
Regarding the  presentation of  stimuli, significant environmental immersion, including
different sensory inputs, is one of the greatest potentialities of the Snoezelen room. In this
sense, recent studies have investigated combinations of sensory inputs; for example,
Flavian (2020) in a study on a young population, concludes that the addition of pleasant
ambient scents congruent with audiovisual stimuli improves affective and  behavioral
responses.
We present a single case study as an example of SMS intervention in advanced dementia.
As a qualitative study, it allows us to deepen our understanding of the behavior of a person
as a whole and to give meaning to their world of relationship interactions with people,
their motivations, and more (Fernández, 1999 in Pelekais, 2000).
First, an overview of the case at the beginning of the intervention is provided. To collect
this information, two previous coordination meetings were held between professionals
from the nursing home and the Snoezelen room. This is followed by the objectives that
were set, the design, the intervention itself, and evaluation of the results.
Case description
The study involved an 88-year-old woman (M), who had been living in a nursing home
for two years at the time of the intervention. In terms of biographical details, she was
born in a large city, where she lived until adulthood. She studied until the age of 12
and dedicated her life to embroidery and helping the family run a grocery store. When
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 63
the store closed, she took care of her nephews. She lived with her parents first, and then
with her sister. When she was older, she moved to another city, where she lived with her
niece until she entered the nursing home. Nowadays, she receives regular visits from her
nieces and nephews, and they are her current family support.
The  occupational therapist informed us that at  first, M had had difficulty adapting
to the residence, with recurrent episodes of anxiety that she continues to show today;
in addition to considerable emotional dependence on family members and professionals.
Her characteristics include persistent motor ambulation, with high risk of fall due to gait
instability. She requires individualized attention, both to perform activities of daily living
(ADL) and to regulate her emotional state and level of involvement.
In terms of physical health, she has arterial hypertension (controlled with medication),
osteoporosis with bilateral knee replacement surgery, acquired hypothyroidism, insomnia,
inguinal hernia, cataracts, and bilateral hypoacusis.
The diagnoses of interest for our study are, on the one hand, unspecified dementia (ICD-
10), GDS 6 with severe cognitive impairment (in the last year she has gone from a score
of 15 in the MEC to a score of 0). In terms of mental health, she has panic disorder
without agoraphobia, recurrent depressive disorder with a high level of anxiety (a score
of 12 on the Cornell scale) and NPI (Cummings Neuropsychiatric Inventory) score of 28.
The high level of anxiety manifests itself in compulsive wandering without specific purpose,
and  continuous agitation. Her state of  alertness fluctuates, presenting as  difficulty
in  paying attention and  responding to  her environment. Her score in  the  CohenMansfield
Inventory of  Agitation and  Cognitive Impairment (CMAI) is  44, indicating
verbal aggressiveness, constant demand for help, negativistic attitude, and complaints.
He takes antidepressant and anxiolytic medication.
Regarding her senso-biography (information about her sensory preferences), M prefers
tactile stimuli, especially those that have smooth and soft properties. She markedly seeks
contact with people (possibly related to the dependence mentioned previously, since
this may provide the security that she craves). She likes to feel welcomed and enveloped
on a physical level, both by the embrace of people and by objects such as blankets
and cushions. She prefers warm temperatures to cold. On a vestibular level, he finds
rocking and  certain smells pleasant, especially cosmetic products such as  creams
and perfumes, or drinks such as coffee. On an auditory level, she enjoys listening to music
from her youth. The visual stimuli that interest her are autobiographically associated with
her city, trips, and pleasant experiences with family members.
Once the  initial assessment had been made, it  was determined that the  problems
which caused the most overload among nursing home professionals and relatives, were
the high level of agitation and anxiety that M presented, and her lack of involvement
in the environment around her.
2021 | Volume VII | Issue 1 social pathology & prevention64
Objectives of the intervention in the Snoezelen room
The  general objectives of  the  Interdisciplinary Program of  Individual Attention (IPAI)
proposed by the professional team at the nursing home were:
•	 To regulate alertness
•	 To reduce the level of agitation and anxiety
Regarding the intervention in the Snoezelen room, the specific objectives agreed upon
were:
1.	 To improve connection to the environment:
•	fostering communication by promoting autobiographical memory processes through
reminiscence
•	 increasing autonomy and participation
2.	 To reduce the level of agitation and anxiety:
•	 by means of relaxation
Design of the Snoezelen Room Intervention
A mixedresearchdesignwasused,combiningquantitativeand qualitativemethodologies.
A unique case design of repeated measures, it included a post-test pre-test assessment.
Physiological records and observational behavioral records were used for the evaluation.
At the physiological level, the level of blood oxygen was recorded with a finger pulse
meter (with a percentage of between 90 %–99 % considered adequate), and the heart
rate was recorded in beats per minute (with normal frequency considered at between
50–100 beats per minute). Blood pressure was also recorded (with normal frequency
considered to be between 8–12 points). During the sessions, a total of seven items were
recorded in the behavioral profile: level of emotional well-being, level of relaxation, level
of  attention, level of  communication, and  level of  motivation with Likert-type scores
from 1 to 3 (see annex 2). Finally, post-intervention behavior was recorded after two
hours, i.e., during the midday meal in the nursing home. The recording was carried out
by a geriatric care provider, who had no knowledge of the intervention.
The first two sessions in the room with M were aimed at familiarizing her with its elements
and establishing a sensory assessment according to the observational register proposed
by Cid (2010) (see annex 1). This would allow us to choose sensory stimuli appropriate
to  her preferences and  needs. Ten weekly sessions in  the  Snoezelen room were
planned, from 11 a.m. to 11.45 a.m., accompanied by the occupational therapist (OT)
of the nursing home. Due to health problems and the onset of the covid-19 pandemic,
only five sessions were completed. In total, seven sessions with M were conducted nonconsecutively
over a period of three months, between January to March 2020.
The  following is  a  summary of  her sensory profile (which contrasts in  places with
the  information obtained in  the  senso-biography): M had a  positive reaction
to  and  preference for visual stimuli in  the  form of  images on  the  projection screen.
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 65
She preferred soft lighting to  bright. She showed interest in  the  optical fibers. She
had a positive response to direct touch with people with whom she was affectionately
connected, and a preference for soft and smooth textures. She was attracted to auditory
stimuli, especially music that was meaningful to her. She responded to smells (especially
olfactory stimuli that were familiar to her) and gustatory stimuli (taking into account her
remaining ability to swallow certain foods). Finally, M sought vestibular input through
rocking herself when seated, and she willingly accepted being rocked by a professional,
both on the waterbed and in the armchair.
Development of the intervention
To  work on  the  Snoezelen room objectives (considering M’s sensory preferences) we
proposed:
Objective 1: stimulating communication by  promoting autobiographical memory
processes, using large screen projections of  images reminiscent of  her hometown
and traditional festivals.
Objective 2: encouraging autonomy and participation, using the switchboard to make
environmental changes, and to select content that appealed to her on the screen.
Objective 3: reducing anxiety levels through relaxation on the water bed, and tactile
and vestibular stimulation through balancing, with the help of the therapist.
Each session consisted of three stages, the entrance ritual, the two phases of the session
(i.e.,relaxationand activation),and the closingritual.The materialsforthe autobiographical
memory activities included sewing paraphernalia (since her records suggested that she
had sewn for a long time) and images, videos, and songs from traditional festivals of her
city. In two of the five sessions, sewing paraphernalia was used, although in both cases
the presented objects produced a negative response and aversion; therefore, we did
not consider them able to evoke suitably positive memories for promoting well-being.
From the images, videos and songs, M reacted particularly positively to the images (with
relaxed facial expressions and vocalizations of pleasure in response to them); evidently,
they were a way for M to connect with the environment. Thanks to this, we were able
to work on her verbal communication with others, and the evocation of songs, observing
a clear impact on her willingness to initiate communication.
In two of the five sessions, olfactory stimulation was used with smells that M was expected
to find pleasant (aromatic plants, hand cream, cologne); a particularly positive reaction
was observed in  response to  visual, tactile, olfactory, and  gustatory stimulation from
coffee.
Gradually, it was possible to encourage in M a participatory attitude and greater autonomy
in the room – from stretching out on the bed with the OT, to stretching out and remaining
calm when left alone in the 2nd session. M demonstrated an increased ability to interact
with professionals, to express needs, and a willingness to try out new areas of the room
(e.g., the armchair under the fiber shower, and elements such as the color switch), with
the help of the therapist.
2021 | Volume VII | Issue 1 social pathology & prevention66
M using the color switch in the bubble tube
Regarding the  intervention on  anxiety, a  first phase of  relaxation was implemented
in  the  five sessions, involving the  waterbed and  massage with moisturizing cream
and soft textures. This produced a positive response, especially in areas of the body such
as the face and hands. At a behavioral level, M became increasingly calmer in the room,
and verbal expressions of needing to go to the toilet or to leave the room decreased.
A  feeling of  calm and  tranquility was observed two hours after the  intervention
in  the  Snoezelen room, at  mealtime in  the  nursing home. The  geriatric care worker
observed a reduction in compulsive eating behavior, associated with the higher levels
of calmness on days when M had been in the Snoezelen room.
The results of the physiological and behavioral assessment are detailed below.
Results
In orderto showobjectivedatarelatingto levelof anxiety(objective3)and levelof alertness
during the  sessions, Figure 1 displays the  global values of  the  psychophysiological
measurements pre-post session (except for the first session, in which the measurements
could not be carried out, due to lack of cooperation).
A  slight reduction was observed between pre- and  post- session in  the  maximum
and  minimum blood pressure for all sessions. Oxygen levels remained above 90%
saturation, and no significant pre-post changes were observed. Her heart rate in beats per
minute had a tendency to increase slightly, possibly related to a higher level of alertness
at the end of the session.
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 67
Figure 1: Physiological measurements
2021 | Volume VII | Issue 1 social pathology & prevention68
Figure 2 is a record of M‘s most notable general behaviors, pre-/post- session, and two
hours post-session.
Figure 2: Measurements of pre-/post- and 2hrs post- session behaviors
Broadlyspeaking,an increasein emotionalwell-being,relaxation,attention,communication,
and  motivation is  observed pre-post session. Two hours after the  intervention
in  the  Snoezelen room, the  level of  well-being, relaxation, and  communication was
maintained, and levels of attention and motivation had increased; although this increase
may be partly explained by the activity that took place at this time: i.e., the midday meal.
During the different sessions, there were changes in M‘s state of health, which may have
influenced the prevalence of certain behaviors. However, we observed more adaptive
behaviors as we worked with M in the room, with clear differences between the beginning
of the first session, in which we met a nervous, anxious M, almost incapable of relaxing,
and the last session, in which M was much calmer without needing to leave the room,
and without constantly making demands on the therapist’s attention.
Discussion of results
Regarding the  first objective, it  was very productive to  work with reminiscence
and autobiographical memory at a visual and auditory level. At the same time, these
reminiscence activities made it  easier for us to  work on  the  other objectives. M was
attentive to  the  screen, albeit discontinuously. We also observed how M’s language
became much clearer and more understandable during the projection of images, and she
had a greater facility to find appropriate words.
In terms of the second objective (autonomy and participation), we observed progress
in M’s ability to move around the room on her own (without needing to hold the therapist‘s
arm), and  her interest in  using a  switch to  change the  lighting. Above all we noted
a reduction in the physical need to have the therapist constantly beside her.
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 69
For the third objective (reduction of distress and anxiety through relaxation), the use
of  vestibular stimulation on  the  waterbed, together with tactile stimulation proved
beneficial. Although at times M responded with reluctance to the stimuli. and showed
displeasure, at  a  certain point a  state of  relaxation was achieved in  all sessions, so
that M could enjoy moments of calm with the help of the occupational therapist. Her
levels of  well-being, relaxation, and  communication were maintained two hours after
the intervention.
Conclusions
The results analyzed are in line with those observed by Sposito et al. (2016), Maseda et al.
(2018) and Aznar-Calvo et al. (2019). Although the results were not statistically significant,
the Snoezelen intervention in this case study was effective in: improving the level of M’s
connection with the environment (indicating the subject to be more cognitively active),
reducing her level of anxiety, and adjusting her behavior after the sessions and in the short
term. Therefore, it is evident that a subject with more severe cognitive impairment can
respond positively to  structured and  sensorially stimulating environments, reducing
the behavioral symptomatology of dementia.
Regarding the  methodology, the  Person-Centered Care model was confirmed
as a principle of personalized comprehensive care in professional intervention. We agree
with Jakob and Collier (2017) regarding the need for the meaningfulness of the activities
linked to patients’ life history, and the need to allow patients the fullest possible control
over interaction in  the  room, in  line with their abilities. Regarding the  presentation
of  stimuli, we agree with Flavián (2020) that meaningful environmental immersion,
including the various sensory inputs congruent with immersion, is a major potentiality
of the Snoezelen room.
Obviously, from an experimental research design perspective with quantitative methods,
a case study presents important limitations; however, the difficulty of working with large
samples of people with advanced dementias (GDS6/7) due to their fragile overall state
of health and behavioral problems should be kept in mind. For this reason, we decided
on  a  complementary methodology, combining quantitative and  qualitative aspects.
The case study allowed us to study a particular situation in depth, in order to understand
the development of a Snoezelen intervention and its potential benefits.
References
Aznar-Calvo, A., Vaca-Bermejo, R., Martínez-Longares, P., Villa-Berges, E., EsplugaBarquero,
S., Pozo-Lafuente, A., & Ancizu-García, I. (2019). Multisensory stimulation
in residential centers: a non-pharmacological therapy that improves the connection with
the environment. Psychogeriatrics, 9(1), 11–17.
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Cid Rodríguez, M. J. (2010). Multisensory stimulation in  a  Snoezelen space: concept
and fields of application. Revista Española sobre Discapacidad Intelectual, 41 (4), 22–32.
Cid Rodríguez, M. J. (2012). Multisensory Stimulation in a Snoezelen Space. Madrid:
Editorial Academia Española.
Flavián, C., Ibáñez-Sánchez, S., & Orús, C. (2020). The influence of scent on virtual reality
experiences: The role of aroma-content congruence. Journal of Business Research, 123,
289–301. doi.org/10.1016/j.jbusres.2020.09.036
Jakob, A., & Collier, L. (2017). Sensory enrichment for people living with dementia:
increasing the benefits of multisensory environments in dementia care through design.
Design for Health, 1(1), 115–133. doi:10.1080/24735132.2017.1296274
Lazarus, A. (2009). The multisensory classroom in an educational center: Curricular
aspects and practical applications. University of Murcia, 1–16.
Maseda, A., Cibeira, N., Lorenzo-López, L., González-Abraldes, I., Buján, A., de Labra, C.,
& Millán-Calenti, J. C. (2018). Multisensory Stimulation and Individualized Music Sessions
on  Older Adults with Severe Dementia: Effects on  Mood, Behavior, and  Biomedical
Parameters. Journal of Alzheimer’s Disease, 63(4), 1415–1425. doi:10.3233/jad-180109
World Health Organization (2015). International Classification of  Diseases: Mental
and Behavioral Disorders (10th ed).
Pelekais, C. (2000). Quantitative and qualitative methods: differences and trends. Telos,
2(2), 347–352.
Kitwood, T. (1997) Dementia reconsidered: the  person comes first. Open University
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Eumo Editorial. Vic.)
Sposito, G., Barbosa, A., Figueiredo, D., Yassuda, M. S., & Marques, A. (2016). Effects
of  multisensory and  motor stimulation on  the  behavior of  people with dementia.
Dementia, 16(3), 344–359. doi:10.1177/1471301215592080
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 71
Authors
Ribes, Ramona
Professor in the department of psychology. Faculty of education, psychology and social
work. University of Lleida.
avd. Estudi General, nº4. CP.25180. Lleida. Spain
ramona.ribes@udl.cat
Maria José Cid
Psychologist, coordinator ISNA Spain, collaborator University of Lleida.
C/Major, nº53. CP43570. Santa Bàrbara. Tarragona. Spain
mariajosecidrodriguez1964@gmail.com
Noelia Llamas
Nursing home psychologist, Lleida, Spain
Annexes
(1)	Assessment of M’s sensory profile
(2)	Behavioral observational record
(3)	Information from M’s senso-biography
2021 | Volume VII | Issue 1 social pathology & prevention72
(1)	Assessment of M’s Sensory Profile in the Snoezelen Room
Visual
In  terms of  reaction to  and  fixation on  a  luminous object, M has
an ocular response to light, although light that is overly bright can
irritate her, prompting an avoidance response. She keeps her gaze
fixed, and does not visually track any of the light intensities.
auditory
M. showed no reaction to  weak auditory stimuli, although she did
react to strong stimuli, both from the human voice and music, which
she tries to locate, and in the case of the human voice, is compelled
to approach.
We can relate her non-reaction to weak stimuli to auditory dysfunction,
while her approaching of interlocuters and looking at them when they
speak to  her could be attributed to  her need for physical contact
and „protection“.
olfactory
In terms of olfactory stimuli, M. responded by approaching the scents.
She showed a  preference for the  stimuli of  coffee and  chocolate,
responding to them with pleasure; while we observed an indifference
to  mint, lavender and  cologne (although cologne appears in  her
senso-biography as a smell she that likes).
taste
M. responded very positively to  the  taste stimuli of  coffee
and  chocolate, seeming to  want more. She does not like the  sour
taste of lemon, which causes her to close her eyes tightly.
*According to  her senso-biography, she is  reported to  have been
very keen on coffee and similar products, although, the occupational
therapist observed that she drank coffee only sporadically.
tactile
We obtained a negative response to aversive stimuli such as pressure
or friction from rough materials. M. accepts soft blankets and cushions.
She often seeks contact with people by holding their hands and arms
when they are nearby; therefore, we consider contact with others
to be a positive stimulus.
vestibular
We observed a  slight positive response to  frontal and  lateral
rocking. According to  the  information provided by  the  OT, she
has a tendencyto rock back and forth to relax, and does the same
on the lap of the OT when she is nervous and agitated (this rocking
is reminiscent of a mother rocking her child in her arms, providing
protection and skin-to-skin contact to transmit a sense of security).
Proprioceptive
She showed no reaction to pressure applied for a few seconds to her
arms and  hips, although we observed a  certain aversion when we
passed a hand gently over her legs and feet.
* It should be noted that M has small wounds on the skin of her arms
and legs, a fact that may cause a degree of sensitivity and aversion
to touch there.
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 73
2. Behavioral observational record (from Lazarus, 2009)
Emotional well-
being
When a  person shows signs of  being at  ease, expresses pleasure,
enjoys bonding with other adults, and smiles
Adapted
behaviors
Behaviors that do  not distort one‘s functioning or  interaction
with others. Absence of  self-harm, aggression towards adults,
and destruction of objects
Degree
of relaxation
A general state of stillness and calm, movements cease
Control
of stereotypical
movements
Decrease in the frequency of very repetitive, impulsive, rhythmic, selfstimulating,
or self-soothing movements which have some utility for
the individual
Attentional
level
Attention span in  the  room, i.e., whether he/she focuses on  what
is  being done; whether he/she constantly moves from one device
to another; whether he/she seems restless or agitated
Level
of communi-
cation
Whether the  person shows interest in  or  interaction with others;
whether he/she addresses others; whether he/she seeks visual, tactile,
proprioceptive contact with others; whether he/she makes gestures
of rapprochement, of seeking bodily contact, or gives warm looks
Level
of motivation
Assessment of the internal state of the subject in relation to being
in the multisensory room. Whether it is apparent he/she wants to go
there; whether he/she is  comfortable there; whether he/she shows
interest in staying longer in the room
3. Sensio-biography
Tactile and Somatic Perception
- Side: right
- She prefers warm water for showering, natural water for drinking.
- She likes soft clothing textures; she rejects rough materials.
- She is not usually bothered by her clothes, but lately she becomes distressed if she
wears too many clothes.
- She likes bodily contact very much and being touched. She enjoys intense hugs very
much.
- She likes being touched most on her hands; she does not like being touched on the face
very much.
- She likes to have her hair touched. She loves going to the hairdresser.
- She likes the hot air from hair dryers. She does not like fans.
- She likes to feel contact with soft natural elements, such as sand and grass.
2021 | Volume VII | Issue 1 social pathology & prevention74
Proprioception
- She likes walking very much, although she needs to be accompanied, due to problems
with balance.
- She is currently denied this opportunity due to high risk of fall. When she is very agitated,
she wears an abdominal restraint.
- She had always previously enjoyed swimming in a pool with friends and family, but
it now seems to cause her more distress than pleasure.
- She has never played any sports, but she has always been very keen on  watching
football (on TV).
- The application of any strong pressure causes her pain.
- She does not like going barefoot indoors.
- She likes to cover herself up in bed, feeling enveloped. She does not usually move
during the night.
- She does not use crutches or other supports to maintain her posture.
- No stereotypes appear.
Vestibular
- She likes gentle rocking very much; it calms and reassures her. She does not usually get
dizzy.
- She usually sits with her legs parallel.
- At first, she showed reluctance, but she is beginning to tolerate it more and more.
Olfactory Perception
- She likes the scent of perfumes (e.g., DKNY).
- She shows no interest in flowers or their smells.
- She likes moisturizing creams (e.g., Nivea and an olive cream by Mercadona).
- She generally likes the smell of food (e.g., peaches and coffee).
- She has a good sense of smell.
Taste Perception
- She likes soups, potato tortillas, and chorizo. She rejects mashed/pureed foods.
- She prefers drinks at room temperature.
- She likes coffee with milk and tonic.
- She does not require help with feeding.
Ramona Ribes, Maria José Cid
Noelia Llamas
Snoezelen and dementia: a case study 75
Auditory Perception
- Her hearing is becoming increasingly impaired. She frequently has ear wax blockages.
- She has always enjoyed listening to the radio.
- She likes anything connected with the royal family and celebrity gossip magazines.
- Musically, she likes zarzuela, folk songs, Luis Mariano, and Viennese Christmas concerts.
Visual Perception
- She likes to look at old family photographs.
- She likes to watch movies, although it is getting increasingly harder for her to concentrate
on them and follow the story. Her favorites are: Gone with the Wind“, and the musicals
„The Sound of Music „, and „Mama Mia“. She also likes TV entertainment shows.
- She has never had a favorite color.
- She fondly remembers a trip to Madrid by train.
- M is more of a daytime person; she has always been an early riser. She finds it difficult
to sleep at night.
Irena Johanka Savková
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
77
HOLISTIC MUSIC THERAPY AS ONE
OF THE PREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
Irena Johanka Savková
Abstract
The paper provides insight into the implementation of music therapy activities within
holistic music therapy. In its first part, it conveys theoretical information about holistic
music therapy, which can be very flexibly applicable. In the second part, the author focuses
on the application of music therapy in a special primary school environment with a target
group of students with a combined disability and severe mental disability. It presents
the forms, the course of lessons, the specifics of music therapy activities and a specific
case study of the student, in which he describes the course of music therapy lessons.
The last part of the paper consists of a description of the project of holistic music therapy
for pupils with manifestations of problematic and risky behavior in the primary school
in Bohumín and its evaluation.
Keywords
comprehensive music therapy, educational drumming, special primary school, pupils
with problem behavior, project
Introduction
Music therapy in  the  Czech Republic can be considered a  relatively young field.
J. A. Komensky was the  first important person to  attach great importance to  music
in the upbringing of children. In his work Informatorium for Kindergartens, he recommends
leading children to learn about melody, rhythm through music that is natural for humans.
Nowadays, music therapy can be studied at  universities. Knowledge and  personal
experience can be gained by  attending seminars, educational programs organized
by Czech music therapy associations and non-profit organizations. In the Czech Republic,
we record various approaches to music therapy. Their origin was influenced by traditions,
culture, music therapy foreign directions and other factors. Music therapy has a therapeutic
2021 | Volume VII | Issue 1 social pathology & prevention78
and therapeutic character, it is used in the field of health care, education, in the social sector
and in non-profit organizations. It is impossible to say which approach is better or „the right
one“, the course and subsequent influence of music therapy is influenced by a number
of factors, the choice of form of music therapy, instruments, personality and experience
of a music therapist. However, all approaches have a common goal: to comprehensively
affect the development of the personality of the student, client, patient.
The article brings, among other things, the experience with the use of Holistic Music
Therapy according to L. Holzer in the Kindergarten and primary school special Diakonie
ČCE Ostrava. The mission of this school is the education of children and pupils with
combined disabilities. These are combinations of mental disabilities with various forms
of  cerebral palsy, sensory impairments, autism, autistic traits. Most children here are
fully immobile, non-communicating, verbally requiring the  help of  another person
throughout the teaching. Some students have a tracheostomy and pegs. It is typical of L.
Holzer‘s Holistic Music Therapy that natural tuning instruments are used, which have
a positive effect on the human body. These are folk, ethnic, non-tempered instruments,
rich in aliquots, eg drums, djembe, balafon, koshi bells, shanti chimes, rain stick, ocean
drum, percussion instruments, frame drums, endings, fujars, twins, didgerida, gongs,
Tibetan bowls, sansula, kalimba, squirrels, mouth harps, slit drums, udu, shruti box
and more. An irreplaceable element here is the musical rhythmic instrument that we all
have within us – the human voice. Aliquot singing, intuitive singing, voice tone color,
accompaniment of playing instruments with a voice are used. No folk songs or lyrics
are used, it is improvisation. He does not use reproduced music, guitar or piano. Pupils
perceive the  sounds of  these instruments with all their senses. The  vibrations they
perceive during play through the largest sensory organ – through the skin, help them
to realize their body as a whole, to feel their body „from within“, affects the internal
organs and muscle tone.
Music therapy in special primary school
An  active and  receptive form of  music therapy, individual and  group, is  implemented
in the facilities of the special primary school. The form, space and instruments are chosen
by the musictherapistsothatthe courseof musictherapyis suitableforspecificpupilsor pupils,
they must know his current state of health, mental state, individual approach is necessary.
During active music therapy, students are involved in  playing instruments, the  body,
vocal expression, rhythmic movements of the body, limbs. In the receptive (listening)
form, the  children are suitably positioned and  let the  sounds of  the  instruments
played by the music therapist play on them. Previously, this form of music therapy was
mistakenly referred to as „passive“ because children do not play instruments. However,
children perceive the stimuli offered and respond to them adequately, involving them
in the process, by voice expression, rhythms.
Irena Johanka Savková
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
79
The  individual form of  music therapy takes place in  a  separate multisensory room,
in Snoezelen, which provides an undisturbed safe space, suitable lighting – dimming,
is  equipped with a  sufficient number of  positioning aids, musical instruments. Here,
a music therapist devotes 30 to 60 minutes to one child. He chooses the time and choice
of tools according to the individual needs of the child. The music therapist prepares
the room – ventilation, preparation of instruments, positions the child so that the position
is  pleasant, safe for him, with the  support of  the  head, or  to  the  half-seat. Children
try to watch where the sounds come from, sometimes they need to look at the music
therapist. The increase in the upper part of the body allows them to do this, in addition
it facilitates breathing and the possibility of vocal expression.
The  group form of  therapy takes place once a  week according to  the  number
of participating children and pedagogical staff either in multisensory rooms, in a spacious
separate classroom, in a rehabilitation room, depending on the weather and in the school
garden. It is essential that the space is large enough for all involved, does not restrict
them in  movement, playing, provide space for instruments, a  quiet undisturbed
and safe environment. Educators and children sit in a circle on chairs, in wheelchairs,
on a positioning bag, in front of them they have a drum – djembe, tubano, drums with
a mallet. The type of drum is chosen according to the child‘s motor skills. Some fully
immobile students are positioned inside the circle. In the center of the circle is a menu
area with percussion instruments. After the welcome, they play drums together under
the guidance of a music therapist, create common rhythms, and vocalize. Children for
whom drumming is impossible due to a disability play percussion instruments. A popular
activity is not only joint drumming, but also the creation of a common rhythm, music
within the  so-called music therapy orchestra. Children and  teachers will choose from
the menu area the instrument they will want to play – shakers, percussion, wooden blocks,
sounding sticks, bells, scrubs and use them to create a common musical composition.
The duration of the active form of music therapy is 1–1.5 hours.
Unwritten principles apply in the facility, for music therapists, but also for pedagogical
staff who participate in music therapy:
•	Create a quiet, safe space to experience the effects of unreproduced music (considered
the most effective here)
•	 To support and respect the individuality of the student
•	Music therapy is performed by a qualified pedagogical worker who has completed
the educational program, has theoretical knowledge and his own experience with
the effects of holistic music therapy
•	 Know and follow the ethical principles of music therapy
•	 He is capable of self-reflection, self-education
•	 Monitor children‘s feedback, their verbal and nonverbal expressions
•	The  worker who is  present at  the  receptive music therapy does not interfere
in the course, the child does not stroke, does not speak
•	In the active form of music therapy, we respect the manifestations of the child, we
do not moderate them, we do not correct them, we do not shout
•	 Children are involved in imitation
•	 The process is managed by a music therapist, we all follow his instructions
2021 | Volume VII | Issue 1 social pathology & prevention80
•	All pedagogical staff have the right to comment on the evaluation of the course of music
therapy, they know their pupils best, they are able to  adequately and  objectively
evaluate the effects of the lesson.
The  pedagogical staff of  this school evaluates the  regular implementation of  music
therapy very positively. They noted that music therapy in children:
•	 Reduces muscle tone in students
•	 There is total relaxation, inducing pleasant feelings
•	 Positively influences speech, speech rhythm, children vocalize, add vocally, hum
•	 Activation of the orofacial area
•	 Establishing visual contact, prolonging visual perception
•	 Supports auditory discrimination and spatial orientation
•	 Supports perception, remember and respect the sequence of individual actions
•	 Induction of calm, well-being, reduces states of restlessness, hyperactivity, disharmony
•	 Helps to establish a teacher x student relationship
•	 Supports mutual communication between students, joint work in a group
•	 Supports the ability of imitation, mirroring
•	 Hand rotation promotes interaction between the right and left hemispheres
•	 Overall improvement of body coordination, fine motor skills, graphomotor skills.
Figure 1 Music therapy in a special primary school in Ostrava
Irena Johanka Savková
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
81
As an inspiring approach to music therapy in a special primary school, we present
the following case study:
Boy 17 years, cerebral palsy the spastic form of quadriplegia, other mental retardation,
compensated partial epilepsy, hydrocephalus. The boy has been a pupil of this school
since he was 5 years and 8 months old, ie since September 2010, when he attended
the preparatory stage of primary school. Since September 2012, he has been fulfilling
compulsory school attendance. The boy is educated according to the school educational
program for special primary school.
Personal anamnesis
The  mother was not ill during pregnancy but was on  a  high-risk pregnancy due
to a previous premature birth. All tests during pregnancy were fine, no findings. The boy
was born at  24 week, birth weight was 700 g and  measured 29 cm. Childbirth after
the spontaneous outflow of amniotic fluid was complicated. After birth, the  boy was
raised and there was a total contusion of the child. After birth, there was severe bleeding
into the  brain and  subsequent development of  post hemorrhagic hydrocephalus,
repeatedly resolved by punctures. Due to the immaturity of the lungs, it was incubated
immediately after birth, placed in an incubator and taken to the ICU. Brain drainage
introduced in three months, repeated revisions, frequent infections. He was probed for
a long time. He began rehabilitating at the age of eleven months with Vojta‘s reflex
locomotion method, after which, unfortunately, appeared epileptic paroxysms.
In  a  boy was diagnosed a  severe multiple disability that involves CNS dysfunctions.
Cerebral palsy with a more pronounced expression on the right upper limb and left lower
limb, manifested by increased muscle tension (hypertension) and impaired coordination
of motor processes. Increased tension affects the whole body, especially controlled motor
skills, which leads to increased irritability and spasticity. Stereotypical movement patterns
predominate. When trying some motor activity, spasms of the upper and lower limbs
occur at the same time and thus grip is significantly reduced, the spasms of the limbs
also increase by eating and feeding. Due to a significant motor disability, his mental
abilities are difficult to assess. His sensory perception, communication skills and overall
psychosocial development are greatly limited. This results in  a  global psychomotor
developmental delay approximately corresponding to severe mental disabilities.
Music therapy with this boy takes place at least once a week. On Friday there is an active
form of music therapy, during the other days individually receptive form of music therapy
in Snoezelen. As part of the group music therapy, the boy is placed on a bag – he is part
of a circle of children, percussion, bells, shakers are placed in his hands and he rhythmizes
with the others. After inserting the mallet into his hand, he tries to rhythmically tap into
the sound stones of the balaphon. Within the Snoezelen environment, he is positioned
in a nest on a trampoline so that he has the opportunity to watch what is happening
in the room and watch the music therapist play instruments – basket bells, mountain
fujara, hum, djembe, Tibetan bowls, Indian flute etc.
The boy is  looking forward to music therapy, he shows it with a  smile and sounds –
he tries to sing, we see cheerful expressions on his face. He engages in spontaneous
2021 | Volume VII | Issue 1 social pathology & prevention82
percussion, relaxes muscle tone, rhythmizes the lower limbs, tries to „dance“ to move
the  whole body, torso during fast movements. Everything is accompanied by  smiles,
sounds, loud laughter and  cheers. He notices when changing instruments, followed
by a bigger breath and a longer exhalation. He loves the sound of humble, didgerid
and  shiotanka. He observes other children during collective music therapy. There
is  a  total relaxation of  the  body, deepening and  regularization of  the  breath, often
immersed in  sounds and  enjoying rhythms with closed eyes. He responds very well
to sounds. He turns behind them. He watches the instruments game closely, sometimes
he gets involved independently. He accepts body play. The main goal of the therapy
is  relaxation, inducing pleasurable feelings, improving of  the  mood, strengthening
concentration of  attention. Overall, the  boy is  after music therapy lessons more
receptive and  attentive, the  time of  concentration of  attention to  the  specified
activity has increased and visual contact has prolonged.
Project „Joint Drumming“
Music, rhythm, drumming are among the oldest instruments of communication and joint
drumming is  the  oldest form of  teamwork. Rhythm is  a  universal language that can
transcend differences between people – nationality, gender, age, race, health restrictions,
communication difficulties, physical and sensory disabilities. It is a non-verbal, primary
way of communication, which reveals the stereotypes experienced in the communication
of the group. Each person represents one tone, even if that tone is perfect, he will never
play the melody himself. Only a joint interplay with others – other tones – will create
a beautiful melody, harmony, success.
The project „Joint Drumming“, which took place in the primary school in Bohumín, focused
on  the  specific primary prevention of  problematic and  risky manifestations of  pupils‘
behavior. It was financed from a non-investment grant from the budget of the MoravianSilesian
Region. The possibility of financing the program brought to the school music
therapy, drumming, active playing a musical instrument for each student.
The  primary school is  located on  the  outskirts of  the  town Bohumín, whose pupils
are mainly from socio-culturally disadvantaged and  different backgrounds, especially
the Roma pupils. One third of pupils are diagnosed by mild mental difficulties. These
chlildren are easy target of the temptations of the environment: theft, verbal and physical
aggression, wandering, abusing of alcohol and drugs, smoking etc.
The project focused primarily on children in the preparatory class and pupils in the 1st
grade (approximately 60 pupils), as they are still open to our work during this period.
At this age, it is still possible to influence and perhaps change the opinions and attitudes
of children, which they bring from the families and are not allowed at schools. In order
for this influence of  the  teacher and  the  teaching assistant to  be more targeted
and  conscious, we need to  get to  know the  pupils even more. We know them best
in moments of controlled activity, which is close to them, in which they can fully manifest
Irena Johanka Savková
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
83
themselves. And at the same time, they themselves feel that they are actually playing.
The  close activity in  this case is  playing a  musical instrument – drums, percussion
and other like. The secondary target group was other pupils of the school (40 pupils),
families of pupils and all school staff (20 persons).
Description of project implementation according to activities
•	support for children and pupils of the school (eight hours meeting within the class
in the period from September to December of the following year, ie 14 months).
Number of children and pupils: 60, of which 1/4 were disabled (mild mental disabilities,
hearing and speech dificulties);
•	support for teachers – a  total of  8 meetings: the  first meeting took place before
the  start of  activities with children and  pupils, teachers were informed about
the structure of lessons, about the activities of pupils and their demands on them.
The  other meetings took place after the  lessons with the  pupils, when the  music
therapist and  the  teachers present at  the  lesson with the  children evaluated
the course of the music therapy lesson, pupils‘ behavior and activities etc. A total of 8
pedagogical staff participated: 5 teachers, 3 teaching assistants;
•	support for the  material provision of  the  project and  subsequent continuation
by  purchasing musical instruments in  the  total value of  52.000 CZK. The  school
bought djembe, cajon, percussion, shakers, wooden blocks, slotted drums, agoga,
kabasy, rain stick, kalimba, etc.
Project goals
•	 knowledge of pupils – diagnostic goal
•	 releasing aggression and working with it
•	activation of  pupils – prolongation of  concentration, concentration, interest
in activities, support of creativity
•	cooperation – playing together according to the rules of who controls the activity,
mutual respect for the  uniqueness of  personalities, spontaneous group creation
of a common rhythm
•	 development of communication skills.
Implementation
Active music therapy classes were held once a month, always on Mondays in one specific
class, and pupils and teachers of a specific class attended here according to the schedule.
The hour lasted 45 minutes, ie. that it was part of the morning class.
2021 | Volume VII | Issue 1 social pathology & prevention84
•	 1st lesson preparatory level + 1st grade pupils a total of 20 children
•	 2nd lesson pupils of the second and fifth year a total of 21 children
•	 3rd lesson third and fourth grade students a total of 19 children
•	 4th lesson pupils of the fourth and fifth year a total of 11 pupils
•	 5th lesson consultation with pedagogical staff.
The  room, which is  defined for active music therapy, is  spacious, there are chairs
of three sizes available to ensure a suitable sitting in a circle for all participating students
and teachers. The middle of the circle is the offer of percussion instruments. Active music
therapy is led by a music therapist.
Structure of music lesson
•	Greeting – sending the  basket from the  outside, reminding the  rules, space for
relaxation, group tuning
•	Active game on jam – warm-up, basic strokes, rhythm creation, joint rhythmization
using simple children‘s songs
•	 Music therapy orchestra – spontaneous percussion, collective creation
•	 Receptive form – listening to samsula, hum, play shiotanka
•	Termination – by sending the basket from the outside, the children pass on space for
feedback on what he liked, what he did well, how he feels.
During the play, all activities are conducted so that the students relax, begin to realize their
place in the environment and the class team, they are not alone in the classroom and learn
to work together. Spontaneous play awakens their inner motivation, desire to discover
and learn. It develops partnerships and confidence in oneself, in one‘s abilities and skills,
responsibility for a common work. Each lesson when students meet is unique, original
– created according to the immediate needs of pupils. Teachers working in the classes
monitor the attendance of students, actively participate in all activities together with
the others, observe how students manifest themselves in a lesson and in the time between
meetings. They use their knowledge for early diagnosis. The results of this observations
are lately discussed during interview with the lecturer – music therapist and teachers.
Evaluating the effectiveness of education is challenging, it is not very possible to quantify
manifestations, because the  experience is  very personal. However, by  observing
in everyday practice, teachers are able to catch changes in the behavior of pupils.
Criteria:
•	outputs from the  observation of  pedagogical staff working in  individual classes –
fulfillment of the agreed goal
•	 calming pupils and improving the class climate, and subsequently school climate
•	 conclusions from observations of pedagogical staff.
Irena Johanka Savková
HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
85
To meet our results, we needed the records of pedagogical staff in the participation
and  changes in  pupils, feedback obtained after the  end of  each block, observation
of pupils‘ behavior and actions during teaching.
The children were always looking forward to music therapy, they tried to get maximum
of our attention, most of them had short-term attention and distraction. Playing drums
was very motivating for them. Most of them had a problem with changing hands during
the  game (connecting the  right and  left hemispheres), they quickly got tired, it  was
necessary to monitor their nonverbal feedback, alternate activities and verbally motivate
them. At  the  beginning, it  was necessary to  set up the  rules, pay attention to  their
observance, the  lesson ended with feedback, the  students shared their experiences.
In the first lesson, all students had difficulty expressing their own opinion and respecting
the other‘s opinion. They were not used to asking them for their opinion, for the message,
of what they had experienced. After the first meeting, the hyperactive children were tired
and complained of a headache. The rule was again emphasized – to drink continuously
during active music therapy. Already at the third meeting, greater concentration, mastery
of even more demanding rhythms, respect for the opinion of the other, responsibility for
joint creation, quality verbal feedback for the lesson were recorded.
Within this project, the  school management wanted to  improve the  school climate,
support the activity and creativity of children, pupils and teachers, give teachers another
tool for earlydiagnostics in the classroom, creating a safe and activating environment
and find a way to improve relationships between teachers and pupils. To make children
aware of their responsibility for what they do and how they behave, which is a prerequisite
for a significant reduction in the aggressive behavior of pupils in school.
As part of the teaching of subjects, teachers recorded in children:
•	 Longer attention and focus on assigned tasks
•	 Greater respect for the teacher‘s instructions and adherence to the rules
•	Willingness to communicate with the teacher and classmates, communication calmer
without shouting
•	 Development of verbal expression
•	Overall calmer climate in  the  classroom, higher motivation to  work, willingness
to work in a group
•	Visible calming in  hyperactive pupils and  with behavioral disorders, induction
of a pupil x pedagogue relationship
•	 Joy of work done, children‘s interest in praise, awards, feedback.
Afterwards, teachers in this primary school have the necessary material equipment, their
own experience and basic instructions of how they can work with children, how to use
elements of music therapy in other subjects. As part of art lessons, they made percussion
instruments from various materials, painted them, then decorated them and used them
to rhythm in music lessons.
2021 | Volume VII | Issue 1 social pathology & prevention86
Figure 2 Music therapy in the primary school
References
GWYNETH, D. S. (2005). Neverbální komunikace dětí: Jak porozumět dítěti z jeho gest
a mimiky. Praha: Portál. ISNB 80-7367-043-7
HALPERN, S., LINGERMAN, H. (2005). Muzikoterapie Léčivá síla hudby. Bratislava:
Ekokonzult. ISBN 80-8079-044-2
HOLZER, L., DRLÍČKOVÁ, S. (2012). Celostní muzikoterapie v  institucionální výchově.
Olomouc: Univerzita Palackého v Olomouci. ISNB 978-80-244-3323-3
KANTOR, J. (2005). Muzikoterapie. In MÜLLER, O. Terapie ve speciální pedagogice. 1
(s. 169–195). Olomouc: UK Olomouc. ISBN 80-244-1075-3.
KANTOR, J., LIPSKÝ, M., WEBER, J. et al. (2009). Základy muzikoterapie. Praha: Grada,
2009. ISBN 978-80-247-2846-9
MAREK, V. (2003). Tajné dějiny hudby. Praha: Eminent. ISBN 80-7281-125-8
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HOLISTIC MUSIC THERAPY AS ONE OF THEPREVENTIVE ACTIVITIES
IN PUPILS WITH PROBLEM BEHAVIOR
87
MAREK, V. (2003). Hudba jinak: Hudební nástroje a styly, které mohou zlepšit vaše zdraví
a změnit váš život. Praha: Eminent. ISNB 80-7281-125-8
MÜLLER, O. (2005). Terapie ve speciální pedagogice. 1. vydání. Olomouc: UP Olomouc,
295 s. ISBN 80-244-1075-3.
PIPEKOVÁ, J., VÍTKOVÁ, M. (ed.) (2001). Terapie ve speciálně pedagogické péči. 1. vyd.
Brno: Paido. ISBN 80-7315-010-7.
VALENTA, M., MÜLLER, O. (2004). Psychopedie: [teoretické základy a metodika]. Vyd. 2.
Praha: Parta, s. 443. ISBN 80-732-0063-5.
VÍTKOVÁ, M. (2001). Model „vnímání-představy-myšlení“ jako základ terapií ve speciálně
pedagogické péči. In Terapie ve speciálně pedagogické péči. 2. vyd. Brno: Paido, Brno,
s. 11–17. ISBN 80-7315-010-7.
Author
PaedDr., Mgr. Irena Johanka Savková, MBA
Special pedagogue, music therapist
Mateřská škola a základní škola speciální Diakonie ČCE Ostrava
U Cementárny 23, 703 00 Ostrava-Vítkovice
i.savkova@specialniskola.eu
Report
Eva ZezulkováA practical model for primary prevention of risky behaviour in schools 91
A practical model for primary prevention
of risky behaviour in schools
Eva Zezulková
In 2021, the team of academic staff of the newly established Institute of Special Education
at the FVP SU in Opava is to implement a project of the Ministry of Education and Science
– Practical Model of Primary Prevention of Risky Behaviour in Schools (PRCH-IPorganization_0040/2021),
which is in line with the long-term concept of the development
of scientific and research activities of the Institute. Primary prevention of risky behaviour
in  schools is  an  important component of  early pedagogical intervention, especially
in  the  context of  current trends of  inclusive education accompanied by  increasing
heterogeneity of classroom collectives and increasing demands on pupils‘ social skills.
The  priority topics of  the  scientific and  research activities of  the  Institute of  Special
Education include: inclusive education with an  emphasis on  the  education of  pupils
at  risk of  school failure and  pupils with special educational needs, the  development
of  cooperation between the  university and  practice with a  focus on  the  issue
of balancing opportunities for citizens with disabilities in the Moravian-Silesian region,
and strengthening the competencies of graduates of special education for the needs
of the labour market.
The project concept is based on the needs of school practice to continuously strengthen
the development of social skills of pupils. The need to pay increased attention to this
topic is made more acute by the consequences of the crisis associated with the COVID-19
pandemic, during which the development of pupils‘ social competences was put on hold
for a  considerable period. Pupils who exhibit risk behaviours have serious emotional
deficiencies that limit their self-concept and their success in establishing and maintaining
appropriate interpersonal relationships. They often face mistrust from classmates
and teachers due to uncertainty over how to assess and respond to their risky behaviour.
Impaired social skills can significantly disrupt the process of adaptation to the school
environment and  can also negatively affect educational progress and  outcomes.
A significant period in the formation of an individual‘s personality is the period of early
school age. Fixed risk behaviours at  this age are very difficult to  eliminate later on,
and the effectiveness of educational approaches often does not correspond to the efforts
made by educators.
The  project is  intended to  support the  development of  professional competences
in school counsellors and teachers for intervention work with pupils with problematic
and  risky behaviour. The  aim of  the  project is  to  monitor risky behaviour of  pupils
in the school environment with an emphasis on the analysis of manifestations and causes
of risky behaviour, including reflection on effective means of support in dealing with risky
behaviours in pupils. The target group consists of primary school teachers and pupils
2021 | Volume VII | Issue 1 social pathology & prevention92
of younger school age (6–12 years) in inclusive education; attention will also be paid
to pupils with special educational needs, which can be a predictor of risky behaviour.
In order to develop social skills, the method of working with the target group will be
activity-based. In addition to verbal methods (narratives, interviews, discussions about
specific stories and situations), activating methods (interactive guided games and didactic
games aimed at developing particular social skills in the form of concrete experiences
of children, exercises, acting improvisations, common situations of everyday life, etc.) will
also be used.
Cooperation with the primary schools supporting the project is long-term and is mainly
based on  the  successfully implemented project Direct and Clear Support for School
Inclusion – the Question of School, Family, Neighbourhood (2016–2019). The project
addressed issues relating to  the  conditions of  inclusive education, with an  emphasis
on increasing the competences of teaching staff, on cooperation with legal representatives
of pupils with special educational needs and pupils at risk of dropping out of education,
and direct support for these pupils. Throughout the project, for more than 600 pupils,
tutoring was provided directly in the school environment, and, for 55 pupils, individually
in the environment of their homes.
The outputs of the implemented project Practical Model of Primary Prevention of Risky
Behaviour in Schools will be presented in the concrete form of final reports on the results
of  the  monitoring of  the  manifestations and  frequency of  risky behaviour of  pupils
in the school environment, and on the results of the monitoring of the needs of teachers
in  the  field of  support in  intervention work with pupils with problematic and  risky
behaviour. The findings will provide the necessary basis for the design of the Interactive
Social Skills Development Programme and its pilot testing in school practice. On the basis
of the analysis of the pilot validation, measures will be formulated for the implementation
of the Interactive Social Skills Development Programme in school curricula, especially
in minimum prevention programmes.
Author
doc. Mgr. Eva Zezulková, Ph.D.
principal investigator of the project	
Head of the Institute of Special Education	
Policy, Silesian University in Opava
Bezručovo náměstí 885/14, 746 01 Opava, Czech Republic
eva.zezulkova@fvp.slu.cz
Book review
Marta Kolaříková
The Family’s Memory in us in the Light of Narration
of three Generations
95
The Family’s Memory in us in the Light
of Narration of three Generations
Marta Kolaříková
Radmila Švaříčková-Slabáková a  Irena Sobotková (2018). Rodina a  její paměť v  nás
ve světle třígeneračních vyprávění [The family’s memory in us in the light of narration
of three generations]. Praha:Triton
Family memory is  a  very topical issue, with very few experts in  the  Czech Republic
focusing on it. The book is based on an interdisciplinary approach from the perspective
of psychology and history. The view of psychology is directed towards understanding
the  functionality of  the  family, family relationships, family resilience, while the  view
of history is important for understanding the socio-historical context.
In  the  introduction, the  authors define the  basic theoretical grasp of  the  concept
of „family memory“, which they understand as a process of negotiating and reshaping
memories in a way that gives meaning to the family in the contemporary world. The book
introduces us to the results of an intriguing research investigation in which three bloodrelated
generations of  13 families were followed; the  research sample was matched
both in terms of highest educational attainment and the ratio of men to women (17:22).
In describing the research method, the authors also pointed out, among other things,
the  added value of  semi-structured interviews, which is  the  perceived new insight
into the families‘ past. The starting point for the structure of the interviews was Anne
Muxel‘s questionnaire. The authors managed to be sensitive and protect privacy even
when dealing with very private topics. In a very extensive systematic content analysis,
the authors proceeded in two directions: generation by generation to capture changes
over time, and simultaneously generation by generation for each three-generation family
to better understand what is specific, typical and unique to them.
The authors divide the book into four main chapters, which were compiled according
to  the  results of  the  qualitative analysis of  the  data. Each chapter has a  theoretical
introduction, followed by  the  research findings, including the  direct accounts
of  the  participants, followed by  the  answers to  the  research questions and  possible
suggestions.
The  first chapter, „Family Memory“, includes testimonies of  families and  individual
generations on how they perceive the importance of their own history, to what extent
genealogy is an essential part of their family history or a mere curiosity or even a useless
thing. That family history is particularly important to the oldest generation, which fulfills
Erikson‘s generativity, is  to  be expected, but readers may be surprised to  learn that
the  youngest generation is  much more interested in  it  than the  middle generation,
and in two cases family history is even only of interest to the youngest. Only in one
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family were all generations interested in family history. There are many facts that strike
the reader as they read through the book. For example, that when the authors talked
to the participants about family history, it was mostly related to present life and childhood
memories, to  narratives and  stories, rather than to  family ancestry and  family trees.
The research confirmed the findings of other similarly focused investigations, namely that
these are mostly not whole narratives but rather memory fragments. The authors report
that across all generations it is relatively easy to recall memories of one‘s own parents
and grandparents, partially of great-grandparents, and rarely of great-great-grandparents,
but no more stories and  narratives relating to  great-great-grandparents appear.
In the second half of the chapter, the authors describe how each generation remembers
its mother, father, grandmother, and grandfather. In evaluating the results, they reflect
on how surprised they were by the stereotypical picture of parents and grandparents that
spoke across generations of gendered roles rather than personality traits.
Family stories thus form the  basis of  family memory. In  the  narratives of  the  oldest
generations, the  authors identified several features in  family history that relate
to the family atmosphere as well as to the values and traditions passed on. Functions
described were the entertainment function associated with the creation of a good mood,
the  function of  instruction, the  transmission of  values, or  the  function of  satisfaction
from the continuity of the family. The survey results only confirm that „sharing memories
in well-functioning families is perceived by all generations as important and bonding
in principle.“ However, the authors very aptly describe the importance of storytelling for
family communication and strengthening family resilience. Telling unpleasant memories
can often lead to  making amends, explaining misunderstandings, and  reconciling.
The authors present the cases of four families who were much marked by wrongs, painful
experiences, families who at first glance recalled less, families who outwardly appear
to prefer not to recall. However, if they can draw on the inner strength of the family
and do not generalize the hurtful memories, they look for the positive from them, thus
using the selectivity of memories as a necessary feature for processing and incorporation,
which at the same time strengthens family resilience. However, as the authors themselves
conclude, „the art is to distinguish what is essential and should be clarified, and what can
be left alone.“
The second chapter, „Memories and Childhood,“ was related to the goal of describing
childhood memories in a multigenerational context, as attention to this line of research
has not been given in the literature.
The  authors sought to  explore the  psychological, e The  authors sought to  explore
the  psychological, emotional, relational and  value aspects of  memories
in a multigenerational context. The description of how the participants remember their
childhood and what they would wish for the next generations was already presented
by the authors in their previous book „Even a family has a memory“ (2018). Now they
have decided to  explore what the  research participants would not wish for the  next
generation to experience from their childhood. Two main categories were analysed as part
of the analysis of the findings. The first one includes personal and family circumstances,
the  most frequently mentioned being bad relationships, break-ups, death, health
Marta Kolaříková
The Family’s Memory in us in the Light of Narration
of three Generations
97
problems; the second one consists of unfavourable memories linked to socio-historical
contexts. It was confirmed by the testimonies of the youngest generation, who could
not name the social consequences they would not wish for their children in the future,
that external circumstances and their influence on family history cannot be omitted, but
at the same time we can live in a time when the influence of these circumstances is not
significant. The authors are very positive about this trend, so if we do more to foster
good relationships in families, families will be functional and the conditions for children‘s
development will be optimal. However, the fact remains that the atmosphere in the family
is more important than external influences.
An  interesting part of  the  evaluated semi-structured interviews were also questions
about memories and meanings. The most frequent recollection was in relation to tastes
and  smells, both in  a  positive and  negative sense (Probably many of  us can recall
the smells of some of the school canteen meals that turned us on before we reached
the serving window). The second most frequently described sense was hearing, which,
unlike tastes and smells, was tied more to public spaces. However, these recollections
tended to belong to the middle and oldest generation, and were often tied to sounds
from war or other socio-historical events. According to the authors, sensory memories
are very often linked to a person‘s emotional state.
Attention is also paid to the attachment to the place of the memory; in this investigation,
too, time is  confirmed to  be an  unreliable variable for memories. For example,
the relationship to fathers‘ and mothers‘ families was also examined, which is most likely
to be formed by subjectively perceived emotional closeness. Quotes from the participants
explaining their family behaviour are very aptly chosen in the book; the authors were
looking for similar patterns of behaviour.
The third chapter is devoted to intergenerational transmission. The authors of the research
were interested in whether families continue to come together in the next generations,
whether any customs and  traditions are passed on  in  families, whether photographs
or memorabilia are kept. And the connection was proven. An interesting finding was,
for example, that the  way intergenerational learning changes over time. The  current
generation is not satisfied with the formerly accustomed model of „watch now and you
will learn“, but prefers non-violent learning, mutual communication, sharing, a  sense
of  voluntariness. Therefore, the  authors recommend that the  younger generation
should be taught by  the  older transmitting generation to  take advantage of  shared
moments and  situations in  which they pass on  experiences in  a  non-coercive way.
The advantage of the current era is the strengthening of the role of grandparents, who
are living to a higher age than they used to and have many more opportunities to pass
on to the younger generation. Understandably, this transmission is reciprocal; children
can help their grandparents navigate today‘s fast-paced era full of technical innovations.
The  fourth chapter relates the  message of  the  family. The  authors focused on  what
the  participants considered most important in  their life history, what they would like
to pass on to the next generation of their families. It was clearly confirmed that the legacy
refers especially to the emphasis placed on the functionality of the family, which must
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create a safe environment for its members.
Family history connects the generations, ensuring family continuity and family integrity.
Certainly the book under review has provided many suggestions for further psychological
research as well as many purely human, personal issues. It prompts the reader to take
many notes and stimulates a desire to navigate, record, locate, process and preserve
as much information about one‘s own family as possible before it is lost. I haven‘t read
a book as thought-provoking as this one in a long time.
(author´s translation)
Author
Mgr. et Mgr. Marta Kolaříková, Ph.D.
Faculty of Public Policies in Opava, Silesian University in Opava
Institute of Pedagogical and Psychological Sciences
Bezručovo nám. 885/14, 746 01 Opava, Czech Republic
marta.kolarikova@fvp.slu.cz
ISSN 2464-5877 (Print)
ISSN 2464-5885 (Online)