Study on benefits on Snoezelen (multisensory) therapy for

children with intellectual deficiencies and behavioral

disorders and children with cancer

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Study on benefits of Snoezelen (multisensory) therapy for children with intellectual deficiencies and behavioral
disorders and children with cancer
Note
This study was conducted within the project "Snoezelen, an innovative approach" a project co-financed by a grant
from Switzerland through the Swiss-Romanian Cooperation Programme for Reducing Economic and Social
Disparities in the Enlarged EU (http: / www .swiss-contribution.ro /).
This publication does not necessarily reflect the official position of the Swiss government. The content thereof is
assumed entirely by TOTTORO Association.
"Study on the benefits of Snoezelen (multisensory) therapy for children with intellectual deficiencies and behavioral
disorders and children with cancer", June 2015
Author: Laura A Militaru, project coordinator (Association TOTTORO)
Consultant: David Grupe, ISNA Schweiz
Keywords:
MSE - controlled multisensory environment
Multisensory room - multisensory environment - the room/rooms decorated with objects and equiped to provide
sensory stimulation.
Snoezelen therapy - multisensory therapy
ISNA - International Snoezelen Association - International Snoezelen Association

The data were collected during the Snoezelen therapy sessions sustained by:
Mirela Pancu - prof. and speech therapist, Special Secondary School no. 5 - Bucharest (Volunteer at Tottoro
Association)
Cristina Can - psychologist, Special Secondary School no. 5, Bucharest (Volunteer at Tottoro Association)
Delia Gavril - Special psychopedagogue (Volunteer at Tottoro Association)
Mariana Popa - assoc. Prof. Psychology Faculty (Volunteer at Tottoro Association)
Mihaela Neagu - prof. psychopedagogue, Special Secondary School no. 1, Bucharest (Volunteer at Tottoro
Association)
Ancua Petcu - prof. psychopedagogue, Special Secondary School no. 1, Bucharest (Volunteer at Tottoro
Association)
Costa Teodor Scoran - psychologist (Volunteer at Tottoro Association)
Dochia Filipa - psychopedagogue (Volunteer at Tottoro Association)

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Mihaela Schiopu - therapist, art therapist (Volunteer at PAVEL Association)

Simona Sandu - social worker (Volunteer at PAVEL Association)
Laura Toderici - psychologist (Volunteer at PAVEL Association)
Adela Matache - psychologist (Volunteer at PAVEL Association)

Tottoro Association, 2015

Executive Summary
There were furbished two Snoezelen rooms, one at Tottoro Association and and one at "Prof. Dr. Alex. Trestioreanu
" Oncological Institute for PAVEL Association, under the project " Snoezelen, an innovative approach", co-financed
by a grant from Switzerland, through the Swiss-Romanian Cooperation Programme. The project is implemented by
Tottoro Asosociation in partnership with the PAVEL Association and the International Snoezelen Association
Switzerland.
The study was conducted within the project "Snoezelen, an innovative approach" which provided 300 free therapy
sessions for 60 children with intellectual deficiencies from Special Secondary School no. 1 and no. 5 of Bucharest
and for 40 hospitalized children with cancer at "Prof. Dr. Alex. Trestioreanu " Oncological Institute. Also, the project
provided access to the Snoezelen room to 320 children with cancer treated in outpatient in the same Oncological
institute.
The study is based on data collected during Snoezelen therapy sessions provided by the 12 volunteer project with
background in psychology, pedagogy, speech therapy, social work, who were previously trained in Snoezelen therapy
in the project mentioned above, by expert David Grupe - Snoezelen therapist with extensive practical experience,
President of International Association Snoezelen Switzerland, Vice President ISNA-MSE.ORG, member of Board of
director of the International Association Snoezelen and international trainer in Snoezelen therapy.
The therapy sessions were conducted during 2014-2015.
The study involved 100 children, girls and boys, aged between 3 and 20 years, who were selected from among
students of the Special Secondary School no. 1 and no. 5 of Bucharest among hospitalized children with cancer at
"Prof. Dr. Alex. Trestioreanu " Oncological institute in Bucharest.
The results show the benefits of Snoezelen therapy among children with cancer and those with intellectual
deficiencies. Snoezelen therapy benefits are multiple and with diverse applicability.
Snoezelen is widely used abroad in education and care institutions for children with disabilities and autism, early
intervention, social centers for patients with dementia, emotional disturbances, behavioral, brain damage, elderly
patients with Alzheimer disease, people with mental illness and those suffering from chronic pain in palliative care
hospitals.
We want this trial to draw attention to the educational system and the professionals In Romania who provide care and
support services to children with various disorders and parents in understanding the meaning and benefits of this type

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of therapy so it the use in Romania of the therapy will increase as in other countries in the world where Snoezelen
therapy is widely used.
The quantitative analysis contains the description of items compared with the questionnaire "Wellbeing" in order to
observe the changes obtained through Snoezelen therapy on communication skills, concentration, confidence,
cooperation, relaxation, representing some of the benefits of therapy. Qualitative analysis focuses on how recipients
respond to this type of therapy and the therapy sessions impact on their quality of life, based on guided notes. The
notes higlight the importance Snoezelen therapy for children with cancer and those with intellectual deficiencies and
reflect the opinions of some parents whose children attended the Snoezelen therapy sessions.
Methodology
Subjects:
The study is based on data collected during Snoezelen therapy sessions conducted with 60 children with intellectual
deficiencies from the two Special Secondary School no. 1 and no. 5 of Bucharest and 40 hospitalized children with
cancer in "Prof. dr. Alex. Trestioreanu " Oncological Institute, Bucharest.
The four project volunteer teachers, specialists trained in Snoezelen therapy, employees of the two secondary schools
No.1 and No. Special. 5, were asked to select a group of children with whom they worked frequently in class, 30
children in each school.
Children in special schools were selected on the following criteria:
girls and boys
good attendance at school
known by the two therapists
with deficient intellect / behavioral disorders
From the Special Secondary School No. 1 there were selected 30 students, who have the following profile:
10 girls and 20 boys
age between 9 to 14 years
moderate deficient intellect / behavioral disorder
good attendance at school
known by the two therapists
From the Special Secondary School No. 5 were selected 30 students, who have the following profile:
9 girls and 21 boys
aged 9 to 14 years
moderate deficient intellect / behavioral disorder
good attendance at school
known by the two therapists
Children with cancer were selected using on the following criteria:
to be admitted to the Institute and to stay long enough to participate in the complete cycle of 15 Snoezelen therapy
sessions offered by the project.
There were selected:
10 girls and 30 boys
aged 3-20 years
The children participated in a cycle of 15 Snoezelen therapy sessions in groups of 5. They were organized during
morning and afternoon, depending on time availability of volunteers and children.

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Method:
For those 60 students with intellectual deficiencies Tottoro Association arranged Snoezelen mobile unit within the
Special Secondary School no. 1 and no. 5 in Bucharest. Beneficiaries participated in 15 full cycles of Snoezelen
therapy sessions, each session lasting about 45 minutes. The sessions were previously prepared by therapists.
Children participated in therapy sessions in groups of 5 children, at least once a week, depending on the availability
of teachers, pupils. The 30 pupils from Special School no. 1 organised 8 -10 therapy sessions followed by a break of
half a year because of the summer holidays when only 6 of them were brought constant to Tottoro Association for
therapy sessions. The remaining children resumed therapy sessions to complete the cycle of 15 therapy sessions
during February-March 2015 when it was rearranged the mobile unit at school.
The composition of the participant group to the therapy sessions was not always the same, because students were not
brought by their parents to school every day or there were days when they were sick.
Children with cancer have benefited from therapy sessions in the PAVEL Association Snoezelen room at "Prof. dr.
Alex. Trestioreanu "Oncological Institute, were allowed to participate in therapy sessions in the Snoezelen room only
with the doctor approval, after medical tests were performed. They were not always in groups of 5, often being
accompanied by a parent, and participated more frequently, sometimes daily, at different times of the day.
All therapy sessions were conducted by the specialists in psychology / pedagogy / social and formed teams of two
therapists. Teams of therapists in special schools were formed from a school teacher and an external volunteer from
Tottoro Association. At the Institute the therapists teams were formed from volunteers that knew and have contact
with them the children from previous activities (Occupational Therapy, Medical School, art therapy).
Therapists volunteers were trained in Snoezelen therapy by expert David Grupe and supervised by during therapy
sessions by the project coordinator Laura Militaru, trained in Snoezelen therapy and Snoezelen room furbishing.
For all 100 children we have been applied the same tests.
Before starting therapy sessions with therapist children filled out with the help of therapists, a form on their
preferences and non-preferences. After the first therapy session, an initial assessment test was applied (Questionnaire
on the wellbeing - developed by Prof. Dr. Krista Mertens). This questionnaire was repeated after the last therapy
session. Upon completion of cycle 15 therapy sessions, the children's parents that wanted, answered a few questions
on the changes observed during and after therapy sessions.
After each therapy session the therapists filled out based on observation, two questionnaires, namely the
questionnaire on the involvement of children in the sessions, and the mood and reaction to the session. These will be
used for the qualitative analysis as observation forms.
All questionnaires used in this research were developed by Paul Pagliano, board member of ISNA-MSE.ORG,
Associate Professor at James Cook University, Townsville, Australia, from the book "The multisensory Handbook - a
guide for children and adults with learning disabilities sensory " but the questionnaire used to evaluate the
quantitative "Questionnaire for wellbeing", developed by Prof. Krista Mertens, professor at Humboldt University in
Germany and adapted by Laura Militaru, the project coordinator, Tottoro Association.
All questionnaires were provided by David Grupe, Snoezelen therapy specialist.
The 15 therapy sessions had the same format for all beneficiaries, following both the educational objectives with the
help of projections as well as sensory exploration and relaxation.
The therapy sessions had the following specific objectives:
broaden cooperation
develop communication skills
creating a general good feeling
building confidence and self-acceptance
developing knowledge about food, tastes
involvement in activities
development of memory and thinking

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 development of concentration and attention

relaxation and calm
personal development and learning
increasing motivation through initiative and participation
decrease bullying and increase communication with others
reducing stress and inducing relaxation developing motivation for learning by increasing involvement in
activities
relieve pain caused by medical condition
increase desire for recovery
Whenever possible, the students with intellectual deficiencies were observed in terms of behavioral also outside
therapy sessions, the therapists being also teachers in their respective schools, most of them presenting frequently at
the beginning high aggressiveness and bulling behavior. This group of children have low self esteem, lack of
involvement in classroom activities, distress because of relationships with peers and family, feeling outcast, lonely,
misunderstood by family, experiencing lack of friendly relations with peers.
Children hospitalized in the Institute show distress because of long periods hospitalization, medical interventions and
awareness of the situation, and family distress, low level of confidence in the future and spending time unnatural, lack
of exercise and high levels stress.
Results:
Qualitative analysis, based on guided observations with the help of questionnaires
"The wellbeing of the beneficiary II beneficiary status" and involvement questionnaire (used as observation form)
Variable and uncontrollable stimuli:
presence of the thrapists: discussions, massage.
non-specific stimuli created by therapists: speaking with another person or in general, the movement in visual area,
glances, encouragement.
Other stimuli: voluntary or involuntary touches, noise created by others, other distracting events.
In rooms in which the Snoezelen therapy were performed we had the following items:
Optical fibers (static or moving) -permanently
Carpet with lights (static or moving) - occasionally
Snoezelen projector (moving projection) - permanently
videoprojector - short periods
Laptop for videoprojection - video, short periods
Aroma therapy - permanent
Snoezelen music - permanent
Materials for sensorial games- short periods
Story - short periods
Massage - occasionally
They were used more than 4 stimuli simultaneously. It was observed an increase in the level of interaction and
communication, from the first session, in all the children. Children have changed positions and the proximity at least
three times per session.
Guided observation is one of the most common approaches to this kind of research.

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Achieving therapy sessions were obtained through sensory and tales games and other therapeutic techniques used
such as massages, video projections, games for developing self-confidence, discussions and encouragement. Fairy
tales were selected in the light of the objectives pursued by therapy sessions (developing self-confidence, the
acceptance of self, acceptance of differences in people and situations, develop communication and cooperation). All
discussions with beneficiaries pursued these objectives.
At the first session for children with intellectual deficiencies, most children were reluctant to share their experiences,
discuss personal problems, manifest interest in certain activities and were less receptive. After the first four sessions
we begin to see greater openness and willingness to communicate. Children become more self confident, more close
to each other. Invariably, all want a happy family and friends, they begin to make associations between acquired
knowledge or personal experience and the information provided, they started to initiate new, fresh ideas (shadow
theater during birds video projection, associated with bird freedom dance, surfaces with different textures become
flowers or islands, odors association with various desserts, proposals for new themes).
Teachers volunteer therapists have stated that students who participate in therapy sessions are more willing to share
their knowledge with others and especially immediately after therapy have a better mood, cooperate better in the
classroom and have built a very good relationship with volunteers teachers, they are more tolerant with each other.
Students have been since the beginning excited with therapy sessions, with everything that happens in the Snoezelen
room. After the first therapy sessions have started, children show an increased level of confidence, they feel special
for attending these sessions, they started to tell what's going on in those sessions, they have lower rates of
absenteeism and share with others their experiences and feelings. These results were obtained by the beneficiaries in
the activities performed during therapy sessions or to give an answer to a question, or by making an activity carpet
with lights set in the middle of the room. The carpet bing centrally situated, it was perceived as a display area in front
of others and initially they were reluctant to sit in this space, feeling watched by the group, but in time, because this
rug is a great attraction and sensory games were made in this area, they managed to overcome uncertainty and to
expose its own, while gaining more confidence. Games were conducted to develop confidence in themselves and
others.
Also, due to sensory games which they could play with a high success rate, the beneficiaries were able to gain
confidence in their forces. In these exercises, we wanted to expose the children in a controlled, nondirective manner,
unimposing the approach. Since Snoezelen therapy exercises are very attractive, the beneficiaries participate in them
with pleasure and increased motivation for participation.
Children discusses about home and classroom ("I do not feel understood, they say that I am bad, naughty and do not
know how to behave, grandmother tells me that she is looking forward to get rid of me" and opposite "I get along
better with my colleagues, peers do not beat me anymore ").
In the therapy sessions we encountered various situations such as conflicts between students, jealousy, inappropriate
gestures through which students have tried to draw attention either of colleagues or therapeutists, difficult moments
of sincerity of some who wanted to share difficult experienced they go through, so we used them in order to discuss
with students and help them understand the situation they are experiencing. Also, there were parents who asked us to
talk to children about various issues. Thanks to the very welcoming environment where the beneficiaries feel safe,
and once they have gained trust in the therapists, we could achieve this intervention, individually and discreetly.
I had many moments of sincerity in which students expressed their frustrations, and moments of tenderness when
students expressed their understanding and support to others in similar situations.
I have witnessed with joy moments when students in conflict situation, get closer to each other emotionally through
massage or group activities. Also, I could see with joy that although a few minutes prior therapy session some of the
beneficiaries were violent, in the Snoezelen room no such incident happened.

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However, we often witnessed the confession that they want to come more often in the room or the desire to stay
longer in the room.
The therapy sessions conducted in the Tottoro Association Snoezelen room accounted for therapists and students as a
dettachment from the influence of time since they took three hours, therapists and children alike losing track of time.
It is amazing to see students who can not otherwise perform independent activities and who lose patience and interest
after 5 minutes, staying in the same room without being imposing, 3 hours while participating in various activities
with great interest.
The questionnaire showed a high rate of involvement in the activities during therapy sessions and a general state of
feeling good and very good.
Children who participate in therapy sessions returned to class eager to share their experience with others, more able to
focus, more cooperating with teachers and more friendly with colleagues, and they show more initiative and have a
positive mood.
They became more curious, they asked many questions in various topics such as clarifying Universe, Underwater
World, jungle, diversity. They had the opportunity to discuss their problems in the sessions with the topics: Friends,
Family, South Pole, Diversity. They enjoyed seaside journeys and in other countries. They had pic-nicks in the woods
and discovered the pleasure of cooking. They relaxed and interacted with massage sessions and they raced during
sessions of concentration games and sensory games. They enjoyed guessing the tastes and flavors. They felt free
flying like butterflies and birds.
It is difficult to monitor how they behave outside therapy sessions and outside school, as collaboration with parents is
quite weak, for objective reasons. Many parents of children involved in the project presents various deficiencies, low
intellectual, or simply a minimal - involvement in their child's school life. These factors accounted for and were
barriers to children's participation in therapy sessions over the summer. Their parents did not bring them to Snoezelen
therapy at Tottoro Association, either because they were taken outside Bucharest, at the country side, for the holiday,
or had other brothers who would get unattended or come from dysfunctional families, residence centers, foster care.
A very important aspect to consider is that Snoezelen therapy due to its specificity, is a therapy that recipients expect
and want, with great impatience, not a therapy that child is required intellectual effort or a certain way to be. This is a
therapy that affects the person regardless of level of development. The involvement in the sessions and their
frequency, dictates the intensity of the expected results.
Parents of the children from Special secondary schools No.1 and No.. 5 in Bucharest formed their own opinion about
the efficiency of Snoezelen therapy on their child, "the child tells about room, is more communicative and responsive,
he/she better comply with the rules, is happy, retain easier, he/she love music, is more interested, more courageous,
closer to grandparents and colleagues, we get closer, it is happier, more responsible, he/she helps me. "
Oncological patients have difficulties expressing themselves due to trauma they sustained. Snoezelen therapy,
through its secure environment and the wellbeing state that induces, helps a child with cancer to remember the
normality replaced by the suffering caused by disease and prolonged hospitalization. Thus the sessions it gives a
sense of the moment, even though it is full of pain. Snoezelen provides a deeply spiritual communication intervention
with the patient, creating the environment for psycho-emotional relief.
Snoezelen therapy are brought everyday missing items because of lengthy hospital stay, and a more natural
relationship with the parents.
The Pavel Association Snoezelen room at The Oncological Institute there were used, in addition to the named
already, the following techniques:

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 Dramatherapy
Cinematerapie
Body-painting
Therapy through music and dance.
Relaxation is the main objective of therapy in this case, the expression of personal experiences that generate an
improvement in wellbeing.
Observing light and changing the position of the light source through effortless gestures brings joy.
Theatre of shadows, which may be even less effort, calls and expresses much of the time the state that children have.
For those who have to lie down on the water bed because they are too weak to explore, guided imagery is a soothing
creative act which tranship them on a careless realm where everything is possible.
Movements of air into water fascinates small patients, helping them forget that they are actually in a hospital.
Mirror around bubble column increases the space, creating a visual echo. In every fragment the child sees himself as
he/she wishes or multiplied, and this it amazes and amuses them, becoming a childish game and brings relief for the
moment and a hope they may be the same as before.
The column with colored bubbles that dance intrigues at the beginning the children and make them follow their
movements forehead glued on the column, charmed as if they are in a fairy tale and soothed by the almost
imperceptible vibrations. In other words, the disease remains for a while outside Snoezelen room door and leaves
their active imagination fuel their joy. Curtain lights are like stars in universe, tiny and lost in the dark. It becomes a
place where without being required to make any movement, but simply standing on, the imagination and soft music
helps to mentally travel in a happy and smooth space created by their own desires.
Optical fibers lights are one of the greatest joys. Children wraps them around and lost themselves in the ever
changing colors and hang them on the neck, like a scented string. They have magic looking glasses through which
they see everything they want and develops concentration, following each change in color and every glimmer of light.
Unreal becomes possible. Suns can be moved by hand and the stars can be handled. With minimal effort, children
immerse in a dream and forget where they are. They arrange for minutes the optical fibers, they would like to catch
and seize the constantly changing color. It appears like the whole Universe can be tamed. The floor can become a
moving ocean.
Light is water and sky, earth and rest. The holiday atmosphere of the house recalls memories. The children relive the
Christmas they dream of, together with their loved ones in a carefree atmosphere and gains strength to go on with
their lives.
Through video projections there are activated life memories from outside the hospital: circus, playing in the park,
walking on the grass, smell the forest, anniversaries, dinner with friends, a brother/sister.
The lack of hair can be forgotten when we have the fiber optic to replace it.
Excited to find a bright spot, it capitalizes turning it into the story, and that was enough for Dragos to put a thread
after ear to become a firefly. Developing imagination and creativity occurs naturally.
Marinus pretending he can not move because it was "nailed to a circle of light." Having recovered his sense of humor,
he received a long-awaited smile from his peers and thus emotional stress relief occur.
To stare at a kaleidoscope means to dream and to concentrate on the game of colours and track geometrical, thus
developing attention.
Waterbed with vibrations that surround you can be a pretext for children to think that he/she is the sea in a boat and
relive lost normality.
They sit quietly with colorful cushions under the head and the therapist gently swaying, helping them to visualize an
enchanted holidays or that they are well and all the pain is in the past.

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For the child with cancer is an opportunity to voluntarily experience something tempting, while he/she is forced to
spend much of the day lying in his hospital bed: the children will hear "sound waves" focusing on something other
than pain, helplessness or bitterness, which produce a major mental effort.
For Anemone, the light colored movement was hypnotic. Sinked inn pillows she rested just looking at them. That
was all she could do, being brought to the sensory room in a wheelchair.
"Lying in the lounge is a nuisance. Here, I would stay in this bed up to immortality "says Michael, who was moving
with great difficulty that time, recovering after a very difficult operation.
In the waterbed is room for everyone: for pillows, dolls, Anemones feet and Yanis with his smile.
What we call "cinematerapia" means the screening of films accompanied by individual or group discussions.
For Mario "to stand still" is usually hell, regardless of how he feels. However, looking at slipping the ink in the water
or a movie with elves, something that makes him happy, arouses curiosity and calms him down.
Another aspect of cinematerapie is that it can facilitate laughter therapy.
Alex was using sensory room sessions to improve his mental state. Utterly tired, he prefers to stay in bed lying with
water and watch for hours "Tom and Jerry".
A film can be viewed backwards. This is the charm, because every child that lives in hospital in his world "must be
so" , but in this room everything can be 'as I want "; Here we can stop being so brave and dare to confess what hurts
us or that we lose hope or ask "why?". Here we can support each other and find a shoulder to cry on. But then we
gain magical powers to go further ".
Musical box has a role in the story room and grab their attention. Sounds with different pace and height have different
effects on them.
When children are very tired, everything can be limited to "music therapy" and to listen with eyes closed a discrete
line sounds, which helps them to travel mentally, which, together with color droplets scattered in the room, with their
slow movement, bring relaxation.
After a rest period, Rogaci switched with his mother, unused to be pampered and spoiled. "Ma'am, we feel people
from time to time, like now..." she said. Amazed that she is allowed in "relaxation room" the mommy of
extraordinary Contessina forgot for a while the fear for the analysis results she was expected.
Ionuts mommy feels "like in Heaven. If this would be our lounges, maybe we will not have this grif in our hearts. "
Alin's less angry. "He loves music and likes the waterbed, madam, we are living at the seaside." "He does not mind,
but here I feel how much I teeth clench day by day. Here I sit for the massage and hear something else. Light it's like
Christmas ... "
Sometimes they are painted on their faces in a slow pace, as a gentle stroke. Thus the contact with the hospital, a
space so traumatic where they are struggling with the disease every day, even for a while, increasing wellbeing.

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