You will see in the following Case studies, that Restrictions/Demands and Transitions can co-occur and overlap, and sections are categorised this way.
Case study One: Ren
Overall Strategies:
- Affirming his emotional state. Always be respectful and not talk about him while with him or acknowledge it and apologise if it is absolutely necessary to do so.
- Use observation skills and the knowledge about him to pre-empt his needs. E.G. offering verbally to open, and actually opening the door to the garden unprompted, to enable him to go into the garden to self-regulate his temperature etc.
Transitions/Restrictions
With Ren there are many, subtle transitions within the session. We usually walk with him for the full hour within the home and garden. He seems to struggle with transitions and they require some preparation to enable him to complete them successfully. If he is warm, he undresses completely and so on and combined with the fact that he can be impulsive and seems to like/need to action things instantly, means that if, for instance, we go into the garden, he would probably go outside just in his underwear. He needs active reminders and clear prompts that we all need to wear shoes and sometimes a jacket etc. He is easily distracted, especially by food, drink and clothes, and these things seem to trigger an instant “I want that” or “I need to wear this” to the point of it looking compulsive.
Realistically, many of us probably have the same response to food and drinks we like. If someone else has a fresh cappuccino, or we see someone with a plate of gorgeous cake, our first response is probably on some level, “I want that.” We have trained ourselves to not just go ahead and take that cake right off their plate (but how satisfying would that be sometimes?) and, we also usually have more opportunity to fulfil these desires ourselves, not usually being dependant as much on others having more financial freedom. For example, I can delay my desire; by telling myself I will stop by a certain garden centre to get a perfect gluten free cake during lunch. For Ren there isn’t just a delay, as he almost certainly never gets the reassurance that he’ll get the cake later in the day delivered in a way that is accessible to him, and with a 100 percent rate of fulfilment. The motivation to use the chance of the moment is therefore even stronger and logical.
Strategies
When he gets upset/angry/frustrated, I acknowledge his emotion first, saying out loud that I can see he is unsettled, and that I would be frustrated too, that I am hungry too. This signals to him that his emotions are valid and I can fully relate. I usually can.
Authenticity is important here. Sometimes this is enough for him to spark some humour into the situation and relax the tension a bit. We then redirect and go outside to the trampoline to jump out frustration or distract together in a creative way. We also offer alternatives. We have an agreement with the residential home, that we can offer two fruits per session and fruit juice/decaf tea. Usually, Ren is happy to settle for a banana instead.
Demands
Avoiding “trigger-words” like “No” but instead offer friendly redirection and an alternative where possible. It is important to show respect for and work within boundaries/rules of the home as this will hopefully make it easier for him in the long run.
When Ren brings us to the entrance door to “go for a drive” we don’t say “No we can’t go out there.” We say: “We can go into the garden together.”
Know your person. Have conversations and spend time observing them to figure out their specific trigger-words, how much understanding of verbal communication they have in order to develop communication tailored to them.
Proximity/Touch
Clearly it is of benefit for Ren to be able to accept varying levels of appropriate touch easily to enable personal care tasks to be carried out smoothly, but also to be able to choose it for comfort and/or regulation. We used a very slow build up with no expectation around how he would respond and only offered touch that could be meaningful and useful to him (like deep pressure to give proprioceptive feedback, which seems to instantly relax his nervous system). Over time he developed an understanding that touch can be positive for him and a gain.
- We observe his body language and expressions to gauge if he is ready for the next step.
- We focused on using touch in an area that is appropriate and additionally used by himself often. For instance, he often moves his shoulders up and down and leans into our hands with his head at times. We assessed these as being neutral enough areas to try without surprising or scaring him.
- We made sure we always initiated these moments while standing directly or diagonally in front of him, so everything happened within his view. He then has the choice to physically signal to us to stop, or back away from the touch if he would like to.
- In case verbal input can’t be processed quickly enough, moving slowly and in a way that is easy to see even within peripheral view is important and provides the safety and predictability that is needed.
- We gradually built this contact up week by week and only initiated touch, when he seemed to be in a calm and relaxed mood and touch can be a joyful addition introduced playfully and in this predictable way.
Example from a time where he was already familiar with how we incorporated touch to his shoulders/arms:
Ren was slowing down his walking pace and vocalised in happy ways “Wwwwwewewe! Ssssssseseses! Or Ahahaaah!”. Zoë and I would look at each other to coordinate our actions, and then move slowly towards him from either side, keeping him in the middle until all our shoulders aligned. At this point we leaned in towards him, squeezing him firmly with our bodies, shoulder to shoulder. He laughed and giggled, looked at us, and vocalised with increased volume. We joined in, laughing as well and often repeated the interaction. Ren seems to enjoy these connected, social moments and they also seem to increase his own awareness of/for his body. He often seems calmer afterwards.
Case study Two: Michael
Overall strategies:
- Adapting his environment and the timing of the session as best as possible to suit his sensory needs and sense of safety.
- Have an agreed strategy across Interaction Practitioner teams on how to approach proximity and touch with Michael so Us in a Bus sessions are predictable and feel safe for him.
- Utilise playfulness and humour (two of his strengths as well) and enjoy time together.
Transitions
Transitions between rooms seem to be challenging for Michael, partly as he has mobility issues, a visual impairment and we think it likely, that he has some sensory processing complications. He often declines to walk even though his legs would be able to, and we think it is due to him having more control of his body within the surrounding environment when he’s seated on/moving close to the floor. It is safer, too if he has less vision and gets easily overwhelmed. His specific disability is linked with hypermobility which is often associated with autonomic nervous system disfunction, which can contribute to dizziness while standing, blood pressure drops etc. This all contributes to transitions being difficult and challenging, and he often appears slightly closed off and unsettled afterwards. We have arranged that he is supported to the room we see him in, half an hour before we start, so he gets a sensory break on his own and has enough time to settle. This preparation of his environment makes a significant difference to his ability to engage with us.
Demands
There aren’t really demands in our session with Michael as he is very self-contained and we are given our own space to be with him. We do not have to navigate a whole set of residential home rules during the session.
Proximity/Touch
Similarly to Ren, we built up very slowly, with no expectation and used touch we thought could be meaningful for him (like deep pressure to give proprioceptive feedback which seems to instantly relax his nervous system). Over time he develops an understanding that touch can be positive for him and realises he gains something from it (a regulated nervous system/he feels safer).
Example
We know from our experience with Michael that letting someone else touch his head seems challenging for him on most days and we know that his home team/staff members experience this when they are supporting haircuts/washing etc.
It seems it is a sensitive area or one where he feels especially vulnerable when touched and because I know this, I choose to rarely offer touch to his head, using instead his elbows, feet, shoulders and sometimes chin, all of which he is happy to include in our playful interactions. Only when I observe him to be particularly relaxed, rubbing his own head for instance and I have successfully explored other “touch areas”, do I gauge how agreeable this is for him and offer a head rub.
On this occasion I offered rubs on his elbow first, then shoulders. As he had on many occasions declined shoulder touch, it made me more confident to predict that he was having a “good-touch-day”. Because his nervous system isn’t overwhelmed by other sensory stimuli or stress related tension, he more easily experiences a level of relaxation and happiness that allows for processing predictable touch.
When he made a row of raspberry-sounds (his happy sound) in a particular rhythm, I used the palm of my hand to replicate the same rhythm on his forehead using round movements in a playful way. He looked at me with surprise, and smiled.
This connecting moment set the tone for the rest of the session.
The key seemed to be to responding to the movements of his fingers by interspersing hand touches, elbow touch, leaning back again giving him more room and replicating his rhythms on the bean bag with tapping and playful sound exchanges. Creativity and patience being at the centre of the exchange.
These are all communicative, social interactions that seem to be more easily processed for him.
All of the above support flow of the interaction and hold the energy and connection without making the head-touch the only focus.
After such a successful, playful and agreeable exchange I often explore asking “head again?” by speaking, hold eye contact and my hand up. Sometimes he declines, moving his head slightly to the other side, so the spot I would be reaching for is further away from me, or lifts up his hand a little (as if in protection) and this indicates he seems to know exactly when he will be able to process it and have a positive experience, and when not.
We trust his communication skills and judgement of his own bodily experience and display constant respect and compassion and consequently his processing seems to work much faster as he has a clear choice, and time to prepare himself for the impact of touch. When I translated the rhythm, amount and intensity of the raspberry sounds into massaging movements of his forehead correctly, he laughed, smiled or giggled and looked at me. This continued throughout the whole hour.
This continuous work on closer proximity and touch throughout the last few years means that he embraces even shoulders, chin and sometimes head rubs on a regular basis, seeming to find it amusing, funny and comforting. The change of location described under transitions/demands, means less disruption and almost certainly plays a role as well. He initiates close proximity and touch more often, laying his legs on ours, and even pressing his feet towards our legs gently but strongly. We playfully move as if he’s pushing us over the floor and share a smile every time. We take all initiations as him showing confidence and trust, as well as him sharing his humour.
Luca Grys, Interaction Practitioner July 2026
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