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Occupational Therapy for Armed Forces:
Providing a Sensory Diet to Service Men and Women
By Capt. Tim Fahey, OTR
Army Reserves
Service personnel in war zones benefit from
incorporating a sensory diet into their lives. |
I was deployed to Kuwait in 2003 and to Iraq in 2005. On both deployments, I was assigned to the 883rd Combat Stress Company out of Boston, Massachusetts.
The 883rd is an Army Reserve unit that provides intervention and psychosocial intervention to service members in stress. The unit included social workers, a psychologist and psychiatrist, psychiatric nurses, and a grand team of support personnel. The goal of the 883rd is to return service members back to their units.
My role as an occupational therapist was to help maintain service personnel's function through work hardening, maintaining activities of daily living, and providing coping skills for overwhelming stress. One intervention that worked well was teaching service personnel to be aware of their sensory needs using a sensory diet approach. This helped the personnel to calm down to the point where they could function. Those having too much stress were referred to a higher echelon of care.
In my work, I told soldiers about sensory modulation - the brain activity that informs how a person regulates information through the senses of sight (visual), smell (olfactory), hearing (auditory), tactile (touch), vestibular (movement), and proprioception (joint sense). Some service men and women have difficulty modulating sensory input, especially blocking out, processing, or organizing sensory input for a functional task. Some are under-responsive to sensory input - they don't notice a person speaking or feel stimulation that others might find painful. Soldiers who are over-responsive might respond to sensory input such as a light touch or movement with excessive emotional reactions, increased activity level, or behavioral problems. I suspected these service men and women were experiencing sensory processing disorders. The pattern I started to see was that some soldiers could not get organized. If the central nervous system was on high arousal, they could not calm down. Those who were under-aroused could not stay focused.
To help them, I used an approach similar to what I had used when I worked in a school system - teaching these soldiers to monitor their senses with a top-down approach. I explained how we could provide input to the central nervous system to help us run high or low. Those who were over-responding were provided with a diagram of a head and all the sensory input that bombards us every day. We discussed how they could calm down by using their sensory systems. One service member had a picture of her dog. We were able to use the dog photo as a visual reference for sensory intervention. Listening to music or talking to a good friend or even imagining listening were ways to add the sense of hearing to a sensory diet. With smell, I remember this one Marine - a great guy - we put him to work in the kitchen. We had him attempt to make pizza. It didn't taste that great, but the odors were calming and provided him with a tremendous sense of calm. Taste is also important so I encouraged soldiers to chew gum or eat hard candy.
We also wanted to stimulate the proprioceptive input to muscles and joints. Some soldiers love PT (physical training) while others hate it. We taught yoga and deep pressure activities like pushing hands together. We did deep breathing, too, because we know that when people are stressed, they don't breathe correctly. With more oxygen in the lungs, blood, and brain, it's possible to focus more clearly.
To really provide sensory input, I taught some soldiers to do slow rocking, stimulating the vestibular system. The vestibular system is a mechanism in the inner ear that senses movement. Slow movement calms, fast movement excites, so we used rocking according to the person's sensory needs.
As noted in most literature, developing a sensory diet takes a lot of detective work and time to figure out the right fit for each person. Interestingly, once people are aware of their sensory needs and address them, they can get back to their work with the self-reliance to move forward. The military provides great structure that helps organize individuals. When structure is missing or the stress becomes too much, service members may become depressed, suicidal, or violent. Occupational Therapists have known for years that providing sensory activity can help individuals cope.
Capt. Fahey circulated this report with a request for those who read it to sign our petition in support of including Sensory Processing Disorder in DSM-5. Our application for diagnostic recognition of SPD in the 2013 revision of the manual is now complete, and SPD is on the final list of new conditions still under consideration. For additional information about the DSM-5, visit DSM Central on our website.
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