How sensory overload and underload shut down engagement before you introduce a single activity.
Last week we looked at the Emotional Spoke, how fear, grief, and a lost sense of purpose show up at activity time and what to do when you recognize them. This week we move to the spoke that is most often overlooked and most easily fixed.
The Sensory Spoke.
Of all five spokes of the Wheel of Function Framework™, this is the one where a single small change can shift everything. Turn off the television. Dim one light. Clear the table. Sometimes that is all it takes.
But you have to know what you are looking for first.
What the Sensory Spoke Actually Measures
The sensory spoke asks one question: what is the brain doing with the information it is taking in from the environment right now?
A brain affected by dementia processes sensory input differently than a brain that is not. The filtering system that allows most of us to tune out background noise, adjust to lighting changes, and focus on what is in front of us becomes less reliable as dementia progresses.
What registers as mild background noise to you may register as overwhelming input to the person you support. What feels like normal lighting to you may feel harsh or disorienting to them.
This is not a choice. It is neurology.
And it means that the environment itself can become a barrier to engagement before you have introduced a single activity, said a single word, or placed anything on the table.
The sensory spoke helps you read that barrier and remove it.
Two Ways the Sensory Spoke Wobbles
The sensory spoke can wobble in two directions. Both interfere with engagement. Both look different. And both require a different response.
Sensory Overload
Sensory overload happens when the brain is taking in more input than it can process. The nervous system becomes overwhelmed and begins to shut down or protect itself. In dementia care, this is far more common than most caregivers realize.
What sensory overload looks like at activity time:
• Agitation that arrives quickly and without obvious cause
• Covering ears or eyes
• Pushing away objects or people
• Becoming rigid or resistant when you approach
• Repeated attempts to leave the room or the space
• Distress that seems disproportionate to what is happening
Common sources of sensory overload in dementia care:
• Television or radio playing in the background
• Multiple conversations happening at once
• Loud appliances (dishwasher, HVAC, fans)
• Bright overhead fluorescent lighting
• Strong smells from cooking, cleaning products, or personal care items
• Busy visual environments with lots of patterns, clutter, or movement
• Clothing that is uncomfortable or constricting
What to do when you are reading sensory overload:
Stop before you introduce anything. Scan the environment first. Identify the loudest, brightest, or most visually busy element and remove or reduce it. Give the nervous system two to three minutes to settle before you try again. Do not interpret the agitation as refusal. Interpret it as a signal that the environment needs to change before the activity can begin.
Sensory Underload
Sensory underload is less discussed but equally important. It happens when the brain is not receiving enough meaningful input. The nervous system becomes under-stimulated and the person withdraws, becomes flat, or loses interest in their surroundings.
What sensory underload looks like at activity time:
• Flat affect or disconnection
• Difficulty sustaining attention to anything
• Appearing drowsy or disengaged even when rested
• Responding slowly or not at all to prompts
• A general absence of expression or engagement
Common causes of sensory underload in dementia care:
• Very quiet, unstimulating environments
• Limited social interaction or touch
• Lack of movement or physical sensation
• Absence of familiar smells, sounds, or textures
• Long periods of inactivity or television watching without interaction
What to do when you are reading sensory underload:
Introduce gentle, familiar sensory input before the activity. A familiar piece of music. A warm cup of something they enjoy. A texture they associate with comfort, a soft blanket, a familiar object, the feeling of warm water on their hands. You are priming the nervous system to engage before you ask it to do anything.
Music as a Sensory Bridge
Of all the sensory tools available in dementia care, music is the most consistently powerful.
Music from a person’s formative years, roughly ages 15 to 25, is stored in a part of the brain that dementia affects last. This is why a person who cannot tell you their address can sing every word of a song from 1962. The musical memory is intact long after other memories have become inaccessible.
This makes music uniquely useful at activity time. Not as background noise, but as an intentional sensory bridge.
Before you introduce an activity, play two to three songs from the person’s era at a comfortable volume. Watch what happens. Does their body relax? Do they begin to move or hum? Do their eyes brighten? That shift is the nervous system moving from closed to open. That is your window.
The activity you introduce after that window opens has a dramatically better chance of landing than the same activity introduced into a flat or agitated state.
This is the sensory spoke in action.
Reading the Sensory Environment: A 60-Second Scan
Before you begin any activity, do this scan. It takes less than a minute and it will tell you more than any activity planning guide.
Sound: What is playing or running in the background? Television, radio, appliances, other conversations? Can any of it be turned off or reduced?
Light: Is the lighting harsh, dim, or inconsistent? Are there windows creating glare? Would softer or warmer lighting change the feel of the space?
Visual: Is the surface where you are working clear and uncluttered? Is the broader environment busy with patterns, movement, or visual noise? What is the person looking at when they are not looking at you?
Smell: Are there strong smells in the space? Cleaning products, cooking, personal care items? Are any of them familiar and comforting, or unfamiliar and potentially disorienting?
Touch and temperature: Is the person physically comfortable? Is the room too warm or too cold? Is their clothing comfortable? Is the chair or surface they are sitting on appropriate?
If you find something in this scan that needs to change, change it first. Then wait. Then begin.
The Sensory Spoke and the Wheel of Function Framework™
The Wheel of Function Framework™ treats the sensory spoke as the environmental layer that either supports or undermines everything else. You can have strong emotional safety, a physically comfortable person, a cognitively matched activity, and a well-designed space, and still have engagement fail if the sensory environment is working against you.
This is why the sensory scan comes before the activity, not during it.
The goal is not a perfectly controlled environment. That is not realistic in most caregiving situations. The goal is awareness. Knowing what to look for, what it means, and what to change first. That awareness is what separates a caregiver who is guessing from a caregiver who is reading the situation.
What Comes Next
Next week we look at the Physical Spoke: what is happening in the person’s body at activity time, and why pain, fatigue, and physical discomfort are among the most under-identified drivers of activity refusal in dementia care.
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A Tool for This Week
Music is one of the most powerful sensory tools available in dementia care, and it is also one of the most accessible. You do not need training, equipment, or a quiet room. You need the right songs and a few minutes.
I built Calm for Caregivers, a free Spotify playlist designed specifically for the moments this post is about. Fifteen tracks organized into three categories: morning grounding, mid-task calm, and end-of-day release. Use it for yourself when you need to reset, or use it as the sensory bridge described above before introducing an activity.
If You Are Ready for a Deeper Conversation
If you are looking at what is happening with your person and you want help mapping a way forward using the Wheel of Function Framework™, a discovery call is where we start.
Thirty minutes. Free. Specific to your situation.
Notes
- Gerdner, L. A. (2000). Effects of individualized versus classical “relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s disease and related disorders. International Psychogeriatrics, 12(1), 49–65. https://doi.org/10.1017/S1041610200006190
- Gitlin, L. N., Liebman, J., & Winter, L. (2003). Are environmental interventions effective in the management of Alzheimer’s disease and related disorders? Alzheimer’s Care Today, 4(2), 85–107.
- Kovach, C. R., & Meyer-Arnold, E. A. (1997). Preventing agitated behaviors during bath time. Geriatric Nursing, 18(3), 107–111. https://doi.org/10.1016/S0197-4572(97)90114-8
- Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Thaut, M. H., & Hoemberg, V. (Eds.). (2014). Handbook of neurologic music therapy. Oxford University Press.
About the Author
About the Author
Carlyn Lenfestey is a licensed Physical Therapist with 25 years of clinical experience and 15 years of dementia specialization. She is a Certified Dementia Practitioner (CDP) and Certified Alzheimer’s Disease and Dementia Care Trainer (CADDCT), and the creator of the Wheel of Function Framework™. Her work helps family caregivers and healthcare professionals transform the hardest moments of dementia care into manageable, dignified ones.
Disclaimer
The information provided in this post is for educational purposes only and should not be considered medical advice. Always consult with a physician or licensed healthcare provider before making any decisions about treatment. Every individual's situation is different, and professional guidance is essential.
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