Article

Évaluation du chariot Snoezelen chez des patients déments sévères hospitalisés en SSR et en SLD

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Abstract

Résumé Les méthodes de stimulation multisensorielle principalement représentées par le concept de Snoezelen sont de plus en plus utilisées comme thérapeutique non médicamenteuse dans les troubles du comportement liés à la maladie d’Alzheimer et aux pathologies apparentées. À ce jour, les études sur leur efficacité restent contradictoires. Dans ce travail, nous avons évalué l’impact, sur une séance test, d’un chariot Snoezelen chez des patients hospitalisés en SSR et en SLD atteints de démence sévère et présentant des troubles du comportement à type d’agitation ou d’anxiété. Sur une période de trois mois, 97 patients (55 en SLD et 42 en SSR) ont pu bénéficier d’au moins une séance. L’impact des séances a été mesuré avant, pendant et après à l’aide d’une échelle d’expression émotionnelle du visage allant de 1 (joie) à 7 (chagrin). Le score moyen est passé de 4,7 avant la séance à 3,1 après (p < 0,0001) en SLD et de 4,5 à 3,1 (p < 0,0001) en SSR. Parmi les commentaires des observateurs lors de chaque séance, les mots qui revenaient le plus souvent étaient « relaxé » et « endormi ». Nos résultats confirment un effet immédiat du chariot Snoezelen sur les troubles du comportement à type d’agitation ou d’anxiété dans les démences sévères. Cet effet de courte durée, de type « ici et maintenant », passe principalement par la relaxation induite par les séances.

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Trial data included in the review were restricted to those involving people aged over 60 years suffering from any type of dementia, except one subject of Baker's study was aged below 60 years. Only two RCTs fulfill the inclusion criteria for this systematic review. Two reviewers independently extracted the data from these two inclusion studies. Quantitative synthesis of the comparable data from the two trials was performed. Two trials were included. Both Baker (and Kragt examined the short-term values of snoezelen on the behaviours of people with dementia. Although the pooled results were insignificant, the trend was in the direction of favouring treatment (hence a negative value of the SMD). The standardized mean difference (SMD) was -1.22, with a 95% confidence interval (CI) (-4.08, 1.64). Kragt's result, weighted 47%, was significant in favour of treatment, with a SMD of -2.77 and a 95% CI (-4.24, -1.29). During the snoezelen session, Kragt's subjects presented significantly fewer apathetic behaviours (t=-8.22, p<0.01), fewer restless behaviours (t=-3.00, p=0.01), fewer repetitive behaviours (t=-.822, p<0.01), and fewer disturbances (t=-4.91, p<0.01). Baker's result was slightly not in favour of the treatment, with a SMD of 0.16 and a 95% CI (-0.41, 0.73). The control subjects touched objects/equipment more appropriately within the activity sessions than the subjects who participated in snoezelen sessions (F(1,47)=5.96, p=.001). Kragt did not examine the carryover and long-term effects of snoezelen, so only Baker's results were analysed. Baker used the Behavioural and Mood Disturbance scale (BMD), the REHAB, the CAPE and MMSE to assess patients mood, behaviour and cognition after (but not immediately after) four treatment sessions and eight treatment sessions. Some assessments were carried at home, some at day hospital. There were many subscores and mostly there were no differences between treatment and control. The following significant differences were found with benefit in favour of snoezelen compared with control after four sessions: apathy ezelen compared with control after four sessions: apathy score of the BRS (CAPE) (MD -3.00, 95%CIs -5.87 to -0.13, P=0.04), after eight sessions: mood score of the BRS (CAPE) (MD -2.60, 95%CIs -4.92 to -0.28, P=0.03), total score of the BRS (CAPE) (MD -6.92, 95%CIs -13.13 to -0.7, P=0.03), speech skills of the REHAB (MD 1.46, 95%CIs 0.01 to 2.82, P=0.03), psychomotor subscore of the cognitive assessment scale of CAPE (MD -3.12, 95%CIs -5.31 to -0.93, P<0.01). Two trials were reviewed. Although both studies examined the short-term values of snoezelen on people with dementia, it is not feasible to draw a firm conclusion at this stage, for two main reasons. Firstly, very limited data were available for analysis, thus limiting data inference and generalization. Secondly, different methodology and control conditions were adopted in the two trials. Such variations not only require a careful interpretation of results but also make the comparison of results across studies less valid. Hence, there is an urgent need for more systematic and scientific research studies to examine the clinical value of snoezelen for people with dementia. To our knowledge, there are four RCTs currently in progress. It is hoped that the data and results of these trials will enrich the systematic review of snoezelen for dementia in the next update.
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Behavioural disturbance, such as agitation, is a common feature of dementia, and causes significant problems and distress for carers. Snoezelen is increasingly used with people who have dementia, but there is limited evidence of its efficacy. This crossover randomised controlled study aimed to evaluate the effect of Snoezelen on the mood and behaviour of patients with dementia, in comparison to the effect of an established and accepted intervention, reminiscence therapy. Twenty patients with dementia and significant agitated behaviour, received three sessions each of Snoezelen and reminiscence. The effects were assessed using measures of observed agitated behaviour and heart rate over the course of the sessions, and mood and behaviour during the sessions. Both interventions had a positive effect. Snoezelen was no more beneficial than reminiscence in terms of effecting a significant reduction in agitated behaviour or heart rate. There was considerable variation in the way individuals responded to each intervention. Snoezelen may have a more positive effect than reminiscence, but due to the observed differences between the interventions being small, and the small number of subjects, this advantage was not demonstrated statistically. Further research, with larger numbers of subjects, and an appropriate control is required to establish the benefits of Snoezelen for people at different stages of dementia, and to identify any benefits additional to those derived from increased staff attention.
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To investigate the effectiveness of snoezelen, integrated in 24-hour daily care, on the behavior and mood of demented nursing home residents. Quasiexperimental pre- and posttest design. Twelve psychogeriatric wards of six nursing homes, spread over different parts of the Netherlands. One hundred twenty-five patients with moderate to severe dementia and care dependency were included in the pretest and 128 in the posttest; 61 were completers (included in both pre- and posttest). Experimental subjects received an individual 24-hour snoezel program, based on family history taking and stimulus preference screening. Caregivers were trained, and (organizational) adaptations were made to fulfill the conditions for resident-oriented snoezel care. The control group received usual nursing home care. Observations were made on the wards using subscales of the Dutch Behavior Observation Scale for Psychogeriatric Inpatients, the Dutch version of the Cohen-Mansfield Agitation Inventory, and the Cornell Scale for Depression in Dementia. Independent assessors observed video recordings of morning care and rated residents' behavior and mood using INTERACT and FACE, respectively. Residents receiving snoezel care demonstrated a significant treatment effect with respect to their level of apathetic behavior, loss of decorum, rebellious behavior, aggressive behavior, and depression. During morning care, the experimental subjects showed significant changes in well-being (mood, happiness, enjoyment, sadness) and adaptive behavior (responding to speaking, relating to caregiver, normal-length sentences). Snoezel care particularly seems to have a positive effect on disturbing and withdrawn behavior. The results suggest that a 24-hour integrated snoezel program has a generalizing effect on the mood and behavior of demented residents.
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Dementia in the elderly is a common, debilitating condition. Residents in long-term care facilities present with a number of challenging behaviors. Pharmacological management is not always helpful. Alternative approaches are needed. Multisensory stimulation (MSS) was developed to address sensory stimulation imbalance. In this pilot 24-week single-blinded, randomized controlled study, the authors examined the effect of MSS when given for 12 weeks in either 1 or 3 sessions per week with a control group. There is a trend for better outcomes as measured by daily observation scales (DOS) or Clinical Global Impression-Improvement (CGI-I) with the increase of sessions of treatment per week. This became statistically significant at weeks 8 (DOS) and 12 (CGI). This difference continued for 12 additional weeks after treatment ended. MSS may be a useful addition to the care of elderly patients with dementia. A larger double-blind randomized control study is required.
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