SENSORY INTEGRATION IN MEDICAL CARE

BY BEN HUDSON

Equality in care demands a focus on sensory needs.

Imagine going to a fancy restaurant. There's soft lighting, quiet background music, and comfortable seating.

Now imagine that same restaurant, but lit like a Home Depot.

No matter how incredible the food tastes, the harsh warehouse lighting completely transforms the experience.

All of us have sensory preferences and expectations which impact how we relate to our environments. These preferences influence the way we organize our workspaces, our homes, and our lives. When we design spaces to be used by others, we must take these concepts into account.

For individuals with developmental disabilities, certain sensory environments can cause extreme distress, requiring potentially injurious interventions and increasing the likelihood of lasting trauma. According to the CDC, one in six children in the United States is impacted by a developmental disability. The population of people with sensory needs expands to include adults with developmental disabilities, and individuals with PTSD, dementia, and Alzheimers. Most medical environments do not account for the sensory environment, creating a significant barrier to healthcare for this population.

A person with sensory needs has difficulty integrating external stimuli from the environment. What a neurotypical person may find annoying but tolerable – the low drone of a fluorescent tube, the bustle of a crowd, the buzz of a dental drill – can be physically painful to a person with sensory needs.

In recent years, there has been a push for more inclusive medical education. Groups such as the American Academy of Developmental Medicine and Dentistry (AADMD) work with institutions to improve provider understanding of developmental disabilities. Better education helps providers understand this population and feel empowered to provide care to the best of their abilities. Better medical understanding plays a role in increasing access to quality care for this population, but strict medical education is just one piece of a larger puzzle. To truly address barriers to care, we must combine education with a focus on sensory environments.

Going to the doctor can be stressful for everybody. Setting aside the reason for the visit, which may be a stressor on its own, a typical clinical environment introduces a barrage of new sensory inputs. Evidence suggests that many of the behaviors deemed difficult by providers are a result of negative reactions to sensory stimuli. No amount of provider education and training can prevent a stress reaction to an unchangeable environment. Only by altering the environment to better accommodate the patient can we lower these risks.

MEDICAL HISTORIES

We rightfully include allergies in a patient's medical history so as not to present a treatment option that will do more harm than good. For patients with sensory needs, the physical response to negative sensory stimuli is just as critical to developing a treatment plan. An unaccommodating sensory environment leads to potential distress. A patient in distress is much less likely to receive a diagnosis and, therefore, a treatment plan.

Why, then, do we not include a patient's sensory profile in their medical record? Patients and their caretakers know that works best for them; they are the experts and would happily provide this information if asked.

In a 2016 study published in the Journal of Pediatric Healthcare, providers were given a “Quick Tips Card” in advance of seeing pediatric patients with autism. The card was provided by parents and gave information around the child’s likes and dislikes, sensory triggers, and communication abilities. Of the providers who participated, 73% of them found the child’s sensory dislikes to be valuable information, and over 85% highlighted the importance of knowing both what upsets and calms the patient.

Patients and caretakers are the ultimate authorities of their own histories. We must use this information in our push for more equitable care.

COMMON SENSE: Most medical environments do not account for sensory environment, creating a significant barrier to healthcare for this population.

EMERGENCY CARE

Neurodiverse patients require emergency room services at a higher rate than neurotypical patients for a variety of reasons, including higher rate of self-injurious behavior and difficulty finding adequate primary care providers. From the moment a patient enters an emergency room, they are presented with unfamiliar sights, sounds, and smells. No matter how well-trained the ER staff may be, the sensory environment is unwelcoming, frightening, and potentially physically painful to a patient with sensory needs.

As the last resort for patients who cannot find care in other areas, it is incumbent upon emergency departments to take sensory needs into account. A handful of emergency departments around the country have developed incredible sensory-friendly ERs due to the