Vision for Doing
Assessing Functional Vision of Learners who are Multiply Disabled
Chapter 6 The Other Senses
Section 6 Learner's Sense of Smell
Aims of section 6
In this section we have four categories of items. These correspond to the topic headings Awareness, Attending, Recognising and Understanding. You will notice we have omitted Localising from the checklist. Although we are familiar with the saying: "Just follow your nose", we are not convinced that many human beings have a sense of smell sufficiently well developed to be able to follow a trail or consistently locate through odours!
In the same way as you did in Sections 4 and 5, you will be using these headings to give some idea as to the learner's level of responsiveness to olfactory information about the world. This knowledge will help when selecting which of the intervention strategies are most relevant to your learner.
How to use Section 6
Refer to the diagram. For each of the items under the four broad headings to the left you will want to record whether the learner responds Consistently, Occasionally or Never. If you have already carried out previous sections of this chapter, you may already be able to complete some of the items of this section. If so carry on and complete these items.
Transferring Results to Section 18
For this to be the case you may not have found any specific response. Instead, you will observe only vague and non-specific responses to smells.
If, therefore, your results show that the learner responds Consistently or Occasionally to the item, go to the Summary Chart (at the end of PART TWO), find the row for Section 6 'Smell' and put a tick in the box for Awareness. Then move on to the next topic (Learner attends to..)
If instead the learner responds Occasionally, try again on different occasions. If the result is still Occasionally use Awareness as the level of responsiveness. If so, go to the Summary Chart, find the row for Section 6 'Smell' and put a tick in the box for Awareness.
If the learner Never responds to any of the items under this heading go on to Section 7 dealing with 'Taste'. Note that you should not have results in which the learner Attends, or Recognises or Understands by Smell but is still not Aware. A learner has to be Aware in order to Attend to, Recognise or Understand.
Learner attends to..
In order for you to observe an ability to Attend, you must first have found that the learner is Aware. If you are uncertain, read over the previous information on "Learner shows awareness..">
For the learner to Attend you will have observed a more specific response to different smells indicating that the learner is attending to these.
If your results show that the learner Consistently responds to each of the items on the checklist under Attends, go to the Summary Chart, find the row for Section 6 'Smell' and put a tick in the box for Attending. Then move on to the next topic (Learner uses smell to recognise..)
If the learner responds Occasionally try these again on different occasions. If the result is still Occasionally use Awareness as the level of responsiveness. The Summary Chart should already have been ticked.
If the learner Never responds to any of the items under this heading go on to Section 7 dealing with 'Taste'. Note that you should not have results in which the learner Recognises or Understands through smell but does not Attend through smell. A learner has to be able to Attend in order to Recognise or Understand.
Learner identifies location by smell..
There is no facility in the checklist under localises for smell. This is simply because it is taken up in the next section.
Learner uses smell to recognise..
In order to observe an ability to Recognise by smell, you must first have found that the learner can Attend. If you are uncertain, read over the previous information on "Learner attends to..">
For the learner to Recognise you will have observed specific responses to a wide range of smells indicating that these are familiar to the learner. In order for you to justifiably say that the learner Recognises through smell, it has to be very clear to you that the learner is making a clear distinction between a range of familiar and unfamiliar objects, people and places by smell.
If your results show that the learner Consistently responds to each of the items on the checklist under "Learner uses smell to recognise.." go to the Summary Chart, find the row for Section 6 'Smell' and put a tick in the box for Recognises. Then move on to the next topic (Learner uses smell to help understanding..)
If the learner responds Occasionally to one or more of the items, even if one item is Consistent, still take Attend as the level of response. In this case tick Attend in the Summary Chart. Do not move on to "Learner understands.."
If the learner Never responds to any of the items under this heading go on to Section 7 dealing with 'Taste'. Note that you should not have results in which the learner Understands through smell but is not first Aware, Attends and Recognises. A learner has to be able to Recognise in order to Understand.
Learner uses smell to help understanding of..
In order for you to observe an ability to Understand through smell, you must first have found that the learner can Recognise. If you are uncertain, read over the previous information on "Learner uses smell to recognise..">
For the learner to Understand you will have observed very clear responses including an understanding through smell of a wide range of uses of objects. It has to be clear to you that the learner is making sense of this wide range of objects, people, events and places.
If your results show that the learner Consistently responds to each of the items on the checklist under "Learner uses smell to help understanding of..", go to the Summary Chart, find the row for Section 6 'Smell' and put a tick in the box for Understands. Then move on to the next section (Section 7) dealing with Taste.
If the learner responds Occasionally to one or more of the items, use Recognise as the level of responsiveness. If this is so, do not tick Understands.
If the learner Never responds to any of the items under this heading go on to Section 7 dealing with 'Taste'. Note that you should not have results in which the learner Understands but is not first Aware, Attends, and Recognises through smell. A learner has to be able to Recognise in order to Understand.
Where to go now?
Having noted the results of your observations and transferred these to the Summary Chart, you are then ready to make a choice.
Either: you can skip the remainder of this section and proceed directly to carry out Section 7 dealing with Taste. By doing this you will complete assessment of the learner's use of 'The other senses'.
Or: postpone further assessment and read the remainder of this section. In it we suggest activities for curriculum development. These are to do with the use of smell. At some point you should still carry out further assessment of the remaining section of this chapter.
Using the sense of smell as an intervention technique: general points
The sense of smell is sometimes neglected as an intervention technique. There are good reasons for this omission. When compared with sight, sound and touch, chemical stimulation comes a poor runner in the amount of information it can offer the learner. For most humans the sense of smell indicates direction of an object only crudely; size not at all; distance is poorly defined; and gives no clue as to the texture of an object. Lower order features such as colour, shape and orientation as well as specific features are beyond the capacity of the sense of smell.
Smell versus other senses
To see why this is so, refer back to Figure 2.1. Imagine that all the information provided by each of your senses is presented in terms of how much and what kind of information that sense can detect.
Where would you place on that dimension each of your senses of sight, hearing, touch, smell and taste? That is, how much information can be carried by each channel of information? As a rough guide we can see this in Figure 2.1. (not drawn to scale). This shows us that vision carries most information, followed by hearing, touch, smell and taste. It follows that if you want to get the best out of your intervention you should try to use the sensory modalities that carry the most information. It also follows that the sense of smell should not be given as high a priority in your intervention as for using remaining sight, using hearing and using touch.
The sense of smell is then quite limiting in terms of devising strategies for intervention. The absence of a sense of smell is, for a human being, not a disabling condition in the same way as lack of sight, hearing or touch would be. But this not mean that smell should be ignored as an avenue for our intervention.
The very fact that smell is usually ignored as an area of intervention can turn out to be its real strength. Its novelty means that for the learner its use is often not tagged with the same negative associations as for other stimuli. There are three general categories in which the sense of smell is very useful. First is where the smell of objects, people(!), events, or places are motivating to the learner. Second, on its own smell can be very powerful in prompting information for locating1. Third it can be used in association with other sensory information. We can now turn to see how these can be used within the structure for intervention adopted in other sections of our procedure for assessment.
Research confirms that young babies can distinguish between pleasant and unpleasant smells. Children under five can also use scent to recognise the substances of which an object is made. Girls are stated to be more sensitive to smell than boys.
You may well have a friend who has no sense of smell. If so, you will notice that the absence of a sense of smell has had very little impact on that person's life - unless she happened to be employed in the quality control of perfumes!
Smell is most useful at this stage where there is little evidence of the learner being Aware of the events in her world. You may well have encountered the use of a 'Coma Kit'2, used to try to stimulate people who are in comas by presenting familiar associations. The purpose there is to instil some association with events that the patient has experienced. However it is relatively simple to assemble a variety of odours from our daily living.
Smell as motivator and mood manipulator
Supermarkets have a nice little number going in blowing that wonderful aroma of newly baked bread out onto the aisles or onto the streets outside. Three other examples of the use of the sense of smell can be found in aromatherapy, Snoezelen and in massage.
At several places in this book we have stressed the need to consider not only the disabilities but also the abilities of the learner who is multiply disabled. And in a very early section of the assessment procedure we asked you to think of what the learner liked. Knowledge of the learner's motivation is a key to entering the learner's world to sharing his perspective. One aspect worthwhile investigating is whether aromatherapy is helpful. Some examples of ways in which it can be used are in discovering smells which are motivating, in offering choices, and in following the learner's lead as they explore familiar and unfamiliar aromas. Like massage, which we discussed in Section 5, it can be used in helping to establish interaction with learners.
This approach, referred to elsewhere in the book, has as one option a set of bottles containing substances with different smells. The criticism often made of the Snoezelen approach is that it is passive - in its raw form it does not conform to the commandment on following the learner's lead (contingency - see Chapter 4). But it is not difficult to imagine how control by the learner may be built in to Snoezelen equipment3. A variety of switch operated mechanisms may be used. If you would like to proceed with this then you could get in touch with some friendly engineer. Or consult with the distributor of the equipment. At the time of writing they, along with practitioners in the field of visual impairment, are looking into ways of offering control to the learner.
You should note, though, that the introduction of control may actually contradict the philosophy behind the concept of Snoezelen. It is easy to resolve depending on whether you want to bring the equipment under the learner's control, or just to allow the learner some fun and relaxation and the opportunity to explore by themselves.
We have already mentioned the uses (and potential abuses) of massage in the previous Section on Touch. To recap what was said in Section 5, too often potential active use of massage is ignored in favour of passive massage. Whilst being massaged a learner may indicate anticipation of body position; or may make movements which could easily be taken as attempts to communicate - but it could all be lost in favour of passive stroking of areas of the learner's body.
Pleasant aromas could be utilised for encouraging the development of appropriate YES/NO responses in a learner who has severe communication difficulties. A YES response is much more easy to instil than NO - just as an able child developing language for whom the negative appears much later. Substances which are attractive can be introduced on one side and those which are disliked can be introduced on the other.
The difficulty with head turning to signify NO, in association with a pungent odour, is that the aversive response is likely to produce a head turn in the opposite direction! In the establishment of eye pointing, some learners may be helped by using chemical stimulation in this way. Where an asymmetric tonic neck reflex (ATNR) is present then the object could be placed on the side opposite to the ATNR. (Consult with a physiotherapist to determine if there are reasons why this should not be done with your learner.)
Whether used as a cue heightener or on its own, interesting combinations can be made using switches. In this case, it lends itself particularly well to the situation where the smell is produced as the result of an activity. Small pipettes can be covered and uncovered by the action of a switch. This can be made to puff out a particular odour. (See Appendix I on Switches and Interfaces for a discussion on some of the relevant issues).
Use smell in association with other sensory information about objects and events to help direct attention to other events. In this way you move the learner to more difficult types of attending.
Improving recognising and understanding/4
No doubt you have had the experience of entering a room or visiting a place and having a strong feeling of deja-vu - you felt as if you had been there before. Different odours can have a very powerful effect on presenting that feeling of deja-vu.
The reason it works so well is because we generally ignore the use of smell, so when it happens to come along it can be a strong reminder. There are several ways to use this information in the form of location cues.
One or two (at most) daily activities could have a specific odour attached at their site. Try to choose odours which can also be 'portable' so that they can be used as a signifier in a tactile calendar. That way the onset of the activity + smell can be cued by a signifier + same smell on the tactile calendar.
At several points in this book we have emphasised the usefulness of associating information through more than one sense. Heightening the information about an activity can be particularly advantageous at the time of introducing the unfamiliar to a learner.
Examples of its use in association could be when the learner squeezes a bright object in a stabile, resulting in a smell of mint or other pleasant odour being released. There are obvious uses within the realm of producing a tactile calendar. For example trips to the swimming baths could be signified by swimming hat or trunks suitably impregnated. (Beware though the use of chlorine which, while easily associated with swimming pools, is also highly toxic).
Other examples from the world of books are the familiar 'Scratch and Sniff Books' from Random House.