Social Stories in physiotherapy.
The majority of people I work with are Autistic, which means I inevitably draw from occupational therapy for tools and strategies to add to my tool kit. Earlier this year, I started using social stories as a tool in my clinical practice. In part because autistic folks who need clear, unambiguous information about the thing/s I’m asking them to do, and because developing a social story means I need to be able to distill down the core reasons to one or two clear and simple sentences. For this reason, social stories have become a huge part of my own reflective practice.
A social story is a concise narrative about a situation, concept, behaviour, or social skill. It is an individualised resource, specifically written for one person about one concept, and is implemented according to specific guidelines. First introduced by Carol Gray, social stories are a tool to help people learn social skills, which in turn enables participation. Every social story has it’s roots in a philosophy that abandons all assumptions, regards the social impairment in autism as shared, recognises that the perspective of people who are typical and autistic people are equally valid but at times different, never argues about perception, and understands that curiousity is confusion with a good attitude.
I love it.
When we think about physiotherapy practice, and what we often are asking patients to do, we assume that there is some ground-level understanding of what exercise is and why we prescribe exercises as physiotherapists. The more I work with autistic folks who often have had little to no exposure to exercise, because of dyspraxia or sensory processing differences, the more I understand that providing context about why exercise is useful is so important.
Being a physiotherapist, I have a bias: exercise is important not only for health and wellbeing, but as a tool for sensory and emotional regulation. Exercise is a learnable skill that requires a person to understand: body mechanics, effort regulation, and movement execution. When we consider that exercise can and should be used as a regulation tool for autistic folks, the use of a social story becomes almost obvious.
The more I use and implement social stories in my own practice, the more it surprises me that physiotherapy more broadly have not yet adopted social stories when introducing exercise or movement to not just autistic folk, but children too.
I use social stories because not everyone I work with has an understanding of what exercise is. Not everyone I work with considers exercise to be a skill that is learnable. Of course as a physiotherapist, I fully believe that everyone can learn to exercise. But just telling an autistic person to do something “just because“ will not make exercise safe; for an autistic person to engage in a task, there must be emotional and sensory safety first. Social stories can provide that safety.
If you’re interested in knowing more about how to use social stories in clinical practice as a physiotherapist, I’ve developed a free resource that outlines the how of social stories. You can find it here.