Beyond the Physical: How Sensory Processing Shapes Personal Care
By Kate Sheehan, Occupational Therapist
When we think about personal care needs, as occupational therapists, our assessments tend to focus on physical function. It makes sense, particularly when we are working within statutory frameworks like the Disabled Facilities Grant, where we are asked to identify the barriers that prevent someone from bathing and managing personal hygiene safely and independently. We consider range of movement, standing tolerance, the fine motor skills needed to operate taps and shower controls. These are important considerations, but they tell only part of the story.
How well are we really accounting for sensory processing needs when we assess someone’s ability to manage personal care?
Sensory considerations are not entirely absent from our assessments. We routinely check whether someone can see controls clearly, detect water temperature, or identify scalding risks. But sensory processing influences function in ways that go much further than this. Publications such as the British Standard on Design for the Mind (Neurodiversity and the Built Environment – PAS 6463) , and the work of Steve Maslin, an autistic architect who has collaborated closely with occupational therapists, are helping us understand how the bathroom environment can be overwhelming, confusing, or distressing for people with sensory processing needs in ways we might otherwise miss.
The bathroom is where this becomes most visible. Lighting is a useful place to start since it sits closest to what we already tend to notice. Glare on hard, reflective surfaces can disorientate anyone, and for a person living with dementia it can make the environment deeply confusing. One case that illustrates this well involved a referral where the presenting concern was difficulty transferring onto the toilet. On assessment, the issue was the way natural light entered the bathroom at certain times of day, hitting the toilet pan in a way that made it impossible for the person to interpret what they were seeing. No amount of grab rails would have resolved that.
Acoustics is another dimension we rarely document. Bathrooms are hard-surfaced spaces where sound bounces and amplifies, and for someone with sensory sensitivities, the echo of a shower or the hum of an extractor fan can be genuinely overwhelming. The sensation of water itself is equally easy to overlook. A standard shower spray can be unbearable for someone who experiences sensory hypersensitivity on the skin, a barrier that would never appear on a traditional transfer and mobility assessment.
Odour is perhaps the most overlooked dimension of all. The smell of bodily waste, or the fragrance of soaps and shampoos, can be a significant sensory trigger, particularly for autistic people or those with acquired brain injuries. And these sensitivities do not stop at the bathroom door. The texture of toothpaste, the sensation of a toothbrush, the noise of a hairdryer, all of these can make other personal care tasks equally challenging. Where sensory distress goes unrecognised, it can also contribute to behaviours of concern, and understanding the sensory environment may be key to understanding why those behaviours are occurring.
What connects all of these examples is that none of them would be captured by a focus on physical function alone. When assessing personal care needs and designing adaptations, we need to be asking how lighting affects perception and comfort, what the acoustic environment feels like, whether ventilation manages odour without introducing new noise, and whether water delivery can be adjusted to accommodate different sensory needs. More broadly, it means considering the textures, smells, sounds, and physical sensations involved in every personal care task, alongside the traditional functional questions.
As occupational therapists, we are well placed to recognise and respond to sensory needs, but only if our assessments create the space to explore them.