Peripersonal Space, The Body Schema and it's relevance to care and dementia design.
The mind sees the body, clothes, tools and the space around it as an extension of itself – it’s body schema - and will do this to greater or lesser degrees depending on the sense of ownership of that space or item. For example in your bedroom, your peripersonal space may extend to fill the room – the room becomes, to your mind, sensitive like your body, an extension of yourself. On the London Tube Train however your peripersonal space may extend simply a few centimetres from your body, with no sense that the shared space is part of you.
Un-prepared for intrusion into an individual’s peri-personal space can result in defensiveness, increased anxiety and stress.
In a residential care environment this is important in respect to design, as abrupt changes in the mind’s relationship with it’s surroundings can cause anxiety, preventing natural, easy engagement.
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This is why, we have been developing a design approach for care and dementia where space hierarchy is clear, the level of space ownership is clear, and every place within a given space is naturally meaningful through it’s arrangement. Transition points between private and increasingly public spaces are cushioned using intermediary zones that give opportunity for pause and reflection, before making a choice on one’s journey, no-one is left feeling like they have been forced by a doorway into an un-known world, where there is doubt and fear as to the level of ownership or type of use for that newly entered space.
A clear example of this in our dementia design strategy is the use of personalised space outside each individual room or residence, allowing individuals to move through graduated ownership of space, take their time, sit down and watch the world, in space still inhabited by their belongings, as they get ready to make choices from there as to where to go, or what to do that day. They can make decisions through the use of key views and semi open plan areas that their room opens onto.
Subtle use of Architecture can support confidence, help develop selfhood and sustain long term wellbeing, without costing more to construct than standard designs.
We have been developing an economic and rapid construction method for our building typology using a new form of lightweight steel frame. Further to the economies of this construction method it delivers you a building which is easy to maintain, extend or alter into the future, you are able to continually maintain a building which matches the needs and requirements of care for your local community onward and long into the future.
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body schema, self perception and feeling rather than seeing
Your mind creates an image of your body within itself, and this image expands to include things you wear, tools you are using, even growing to fill spaces you are using and associate with your identity. So this image of yourself in your mind is a source of an individual's sense of personal identity. The creation of this visualised identity in the mind explains why exaggerated anxiety, anger and frustration occur when damage or intrusion is caused to an item or place that has become a part of one’s personal identity. Because what happens to these things is ‘felt’ as though they are part of your own body. (we know the standard exaggerated responses to a scratch on someone’s car, the entering of someone’s room un-announced or the un-solicited borrowing of a person’s precious things).
What is interesting is that we might think our body image is generated through seeing, when in actual fact it is primarily generated by feeling. The neurons that generate movement, awareness of threat, awareness of shape are neurons whose primary purpose is touch, pressure, texture, sensation, and secondarily their function relates to sight. When you interact with your surroundings you move and feel, not in response to sight, but rather in response to touch sensations your neurons are predicting will occur. You are not moving because you see something, you are moving because your sight or other stimulus is generating a sensory prediction - that is felt. Those neurons of feeling fire increasingly rapidly as the predicted sensory event becomes imminent.
In a study of young people’s self perception, dance (a physical + tactile experience) when compared with 3d simulation computer games (solely a visual experience), it was found that the dancing was associated with the development of positive self image. Tactile sensory qualities are needed to develop positive and effective images of ourselves in our minds. In a study of multi sensory environments and their use by people living with a dementia, carried out at Kingston University, it was found also that users of these suffered less falls, and less challenging behaviours. In a study of Firemen, when judging which openings, they can or cannot fit through when wearing full equipment, it was found that better performance, i.e. better mental image of their shape and scale associated with gaps or obstacles to move around was only improved through conscious practice of feeling – i.e. bumping into practice obstacles to feel their shape and up-date their mental image of themselves – through feeling it, not seeing it.
So greater engagement with feeling senses (not seeing senses) is linked with developing a correct self image, more able to move efficiently and make good judgements about movement. But more importantly perhaps, it is the feeling senses that are also linked with the development of a positive self image – feeling good about yourself.
So when we are in a care home and people are simply lined up around the walls, or watching T.V. this is doing very little, or nothing, for the development of a positive sense of self – for the care team too. Not maximising the purposeful use of the senses of feeling, leads to a less correct self image, which in turn leads to bumping into things, and greater likelihood of falls, that’s on top of a less positive sense of self to boot, remember.
How can design bring the sense of feeling into care? Modern design has traditionally shunned texture and tactility – it is associated with cleanness, and straight, clear line formation.
However design for care should maximise where possible use of texture and sensory choice. So when you see something, it has a texture or sensory difference that your mind predicts the feeling of, you can choose therefore to approach it and engage with that sensation physically, or just enjoy the predicted sensation – you can see other places offering different experiences, you can make a real choice based on living in that moment, and how you feel in the now. Each day we make choices that inform our self image, that make us different from others. In most care environments the available choices are androgynous, therefore there is little or no opportunity to develop your identity. There is little sensory differentiation between places in a single room, and even when rooms may offer quite different sensory opportunities these are not usually arranged so that a real independent choice can be made between the choices offered i.e. you cannot simultaneously view and so cannot directly compare the rooms or opportunities. Our design method is focused on the development of sensory choice and clear meaningful spaces, which supports not only the service users, but also the care team. Evidence demonstrates that care teams who are clear about their role in given situations are happier and organisations that provide this clarity through a strong care model achieve reduced staff turnover and in fact also reduced challenging behaviours in service users, i.e. lower anxiety, greater happiness.
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