ARTICLE: Massage Stories by Rachel Barker

Teaching skill development and positive mental wellbeing for pupils with complex/profound and multiple learning difficulties.


Neuroscience has highlighted the beneficial impact of touch on the brain and documented uses of massage in school have had positive effects on learning and wellbeing (MISA International, 2018). Likewise, the benefits of storytelling for learners with complex or profound and multiple difficulties (subsequently C/PMLD) are easily recognisable. Imray and Hinchcliffe (2014, p.159) describe storytelling as an “essential way of learning about life”. Since stories are intrinsically a shared experience, they can potentially enhance, encourage and benefit communication, even for those operating at the early stages. Massage stories combine the elements of a successful sensory story with the beneficial effects of a structured touch curriculum.

This post outlines a particular approach to implementing a massage story and considers the impact that this approach might have on communication, motor skills and social development as well as the value of touch in working with pupils with multiple and complex needs. The approach is designed for pupils who experience a lot of functional touch but less nurturing touch, are at the early stages of communication, lack motor control and/or resist tactile exploration, have or seek limited social interaction and have very few opportunities for independence. Although designed with a particular person in mind, the approach is flexible and highly adaptable to meet individual needs.

The term massage story is used here to describe an integrated approach to learning and developing new skills. Touch is used to explore a variety of connected items, providing a structured experience in which to practise and generalise communication and motor skills. The items are initially introduced sequentially and both passive and active touch is used to explore each item, with the intention of developing haptic perception, tactile understanding and confidence. However the flexibility of the approach means that pupils can develop and share their own narrative as sessions are repeated. Massage stories offer the opportunity to develop advocacy in its most basic form; Elmsäter and Hétu (2010) state the ‘right to say ‘yes’ or ‘no’ to touch” as one of the wider benefits of a massage programme, something which has significant implications for pupils with C/PMLD. This approach necessitates communication partners who are attuned to the ways pupils show rejection and acceptance and can respond accordingly, offering pupils with C/PMLD an experience which champions their right to choice.

Developing tactile confidence

An important reason for using massage as an approach is its potential to develop tactile confidence. The experience of touch is processed by the brain and the central nervous system. Young people with C/PMLD often have damage to one or both of these systems which can affect their sensation of touch. This can be seen through touch aversion, enhanced sensitivity to pain or reduced responses to overt tactile stimulus (McLinden and McCall, 2002). Nonetheless, as interacting through touch remains a primary way for young people to experience and develop emotional connections and gain “ an understanding of how their world works, how they relate to it, and how to solve problems that arise in it” , it seems crucial to establish a way of providing touch for these young people (Rowland and Schweigert, 2003). Massage offers a potential solution. Firstly, massage requires permission; touch therefore stays within the boundaries of the young person, avoiding discomfort or fear. Elmsäter and Hétu (2010) also argue that massage provides rhythmic touch, vital in offering a sense of security. This has implications for young people with C/PMLD who we often see seeking rhythm during repetitive movements such as rocking, stimming and banging. Lastly confidence is built, not only through the advocacy and security that massage offer, but because massage forges an “awareness of worth and wellbeing” (Longhorn, 1993; p. 26).

Massage as educative

The beneficial effects of massage have been recognised in the educational sphere with many schools using the approach, often specifically with young people who have special educational needs. The benefits of such an approach are summarised in Table 1.

McLinden and McCall (2002; p. 22) argue that touch acts as an “interface between our body and the external environment”. For young people with C/PMLD who may be unable to explore the environment independently or experience unusual experiences of tactile sensation, it seems vital that touch is a central part of their curriculum. Furthermore, Longhorn (1993; p.2) identifies that massage can support in developing the prerequisites for learning. She suggests that massage is a “powerful means of giving and receiving human communication through the media of touch” and since massage is usually a 1-1 experience, it creates an arena in which the fundamental communication skills can be developed.

Although, decision making and self advocacy are at the forefront of massage, it also has potential benefits for developing movement. Longhorn (1993) claims that the stimulatory nature of massage intensifies tactile and bodily experience which can benefit the proprioceptive system and Elmsäter and Hétu (2010) similarly advocate that “movement and touch are necessary for children’s healthy learning and wellbeing” (p. 36). They also argue that children have a natural tendency to learn through movement. Since, for young people with C/PMLDthis can be difficult or unachievable independently, massage may bridge that gap. Overall, it seems clear that there is evidence for the benefits of massage for specific groups of young people with C/PMLD.

The importance of stories

Despite the benefits of storytelling, the experience can easily be denied or lost to young people with C/PMLD as the demands of care overshadow the opportunity. Moreover, these young people may experience personal narrative around them without being included in the telling process. In addition, curriculum centred around narrative more often than not focuses on fictional, written narrative, showcasing specific literacy skills, something that is often not an option for pupils with C/PMLD (Grove, 2014). Co-structuring the narrative enables young people to reclaim their experience; Cameron (2015, pp. 37-40; p. 38) argues that “we all become the tale we tell”.

Clearly, using stories has significant social benefits. Grove (2009, 2015) and Cameron (2015) both suggest that stories are a way of making, building and sustaining relationships: Grove (2009) describes stories as “friendship glue” whilst Young and Lambe (2011) emphasise sharing stories fosters interaction of significance.  . Communicative aspects of social interaction are learnt such as the importance of listening and responding to others using vocalisation and facial expressions (Grove, 2009, 2015). Stories also promote a sense of identity, necessary for maintaining a social role. Cameron (2015) suggests that stories “weave the fabric of our lives” and Grove (2009) argues that narratives enable young people to structure memories and enhance their ability to recall and make sense of experience. Moreover, Grove (2015) observes that narrative allows young people the opportunity to explore hopes and dreams, enhance their decision making, and “exercise… imagination and empathy”.

It is unsurprising that storytelling therefore has an impact on wellbeing. Grove (2012; 2015) insists narrative is crucial for identity and linked intrinsically to self advocacy; the balance of power over storytelling parallels the power one has over one’s life. Furthermore, the telling of narratives gives reciprocal insight into emotions. She further expounds that when you view individuals as “intentional agents” in their own lives, stories naturally emerge, as opposed to considering young people with C/PMLD from a deficit perspective.  (Grove, 2012, pp.334-351; p. 340). Cameron (2015) further develops this view suggesting that there are negative implications for the absence of stories and emphasising the importance of the power and control to change our stories. She argues that Maya Angelou’s claim that, “there is no greater agony than bearing an untold story inside of you”,  is a fitting parallel experience resonating with the experience of young people with C/PMLD.Lastly, Young and Lamb (2011) suggest that the use of story is an opportunity to explore sensitive or difficult topics, such as bereavement, which can be difficult for young people with C/PMLD to understand and process.

I developed an extended massage story which used elements of these approaches. I used cooking as the theme as the cooking and sharing of food connotes belonging in many cultures and offers natural opportunities to share stories. It also provided a multisensory opportunity that would support communicative and motor function. The extended story planned for the use of new body signs and included opportunities to develop basic skills with objects and ways to gain access to objects (Rowland and Schweigert, 2002). It also began building developing social uses of objects by practising these skills with an adult (Rowland and Schweigert, 2003). Furthermore, since the use of cooking utensils offers a vast array of tactile stimulation and cooking itself is “a fantastic vehicle for mathematical thinking and scientific exploration” there was potential for developing the pupil’s problem solving skills (Imray and Hinchcliffe, 2014). Furthermore, cooking and eating have long been regarded as social practices which coincided with the intention to develop social skills as part of the massage story.

Extending the story rather than changing it also allowed continuity and familiarity for the pupil, something that was important to ensure that tactile confidence was not lost. The elements changed or adapted are outlined in the Table 2:


Conversations with the communication partner reported pupil confidence had increased and they witnessed obvious engagement and enjoyment throughout the sessions. They also felt that the pupil had become more active in participating in tactile experience and was initiating more interaction.

The approach allowed the communication partner to consolidate the purpose of the approach and thus impacted on both their attitudes towards, and expectations of, a massage session. Alongside the teacher input and the addressing of safeguarding concerns centred around the use of touch, this enabled a purposeful massage experience in which staff felt enabled to interact with the pupil with a positive structured touch approach. Furthermore, the consideration of the Leuven scales gave the communication partner confidence in assessing the wellbeing and involvement of the pupil and this enabled them to ascertain when it was appropriate to increase or reduce tactile and communicative demand on the pupil. Moreover, the staff enjoyed the change of pace a massage approach offered and the simplicity of the activity – in my observation and guidance of practice I witnessed the opportunities that limited resources gave them in being adaptable and creative in offering an educative experience.

The structure of the massage and observation sheet gave the communication partner autonomy in adapting the approach effectively and it was clear that her confidence in identifying progress grew, demonstrated through the increasing quality of her annotations throughout the sessions. This was partly because the observation sheet enabled the communication partner to focus her practice and she became more effective at identifying skill development.

Conclusions and recommendations

Importantly, the massage story approach gave the pupil a meaningful way of exploring their environment through touch. Moreover, the story format, particularly when combined with the communicative function, allowed the pupil freedom in building their own narrative and meant not every session was the same; the pupil was empowered through the developing ability to initiate body signs and was able to physically act upon each item in whichever way was chosen, developing or changing the narrative with each choice. Further control was handed to the pupil with the option of exploring multiple items enabling the pupil to also change the sequence of the narrative, giving the staff valuable insight into the pupil’s feelings about certain elements of the story.

One of the most valuable conclusions that can be drawn is the crucial significance of the role of the communication partner. The member of staff selected here had a secure understanding of her impact on the pupil during these sessions and a basic understanding of the impact of touch garnered through her attendance at a course about multi-sensory impairment. Importantly, she knew the pupil well, had a secure relationship with them and was patient and responsive to any idiosyncratic communication. Moreover, she was consistent in her responses and this enabled social interaction to develop. Her role in creating opportunities for advocacy was vital in developing the pupil’s tactile confidence. Since touch is both intimate and potentially invasive, it is crucial that the communication partner listens, responds and withdraws when necessary. Her development of a positive relationship with the pupil meant she was absolutely secure in applying the Leuven scales (five point scales from extremely low to extremely high) and recognising when the pupil would benefit from more or less demand during the activity, fully acknowledging the importance of “appropriate and structured stimulation… provided within an interactive context” (McLinden and McCall, 2002; p. 107).

I had originally underestimated my role in facilitating the approach for the staff. Many staff were unsure, particularly about how their actions during a touch based approach was construed, but also about the ability to recognise and respond appropriately to a pupil. Equally some had previously taken part in massage sessions that hadn’t taken into account advocacy and permission and many were concerned about looking like they were doing nothing. Ensuring the culture around massage was open, honest and reflective was key in addressing some of these concerns. Moreover, I relied on my own knowledge and understanding of touch and massage to explain and demonstrate the benefits and this was often crucial in the ability of staff to continue facilitating the massage and in changing their approach when it wasn’t working.

Despite the clear benefits to using a massage story approach, there are limitations which could impact on the effectiveness of such an approach. As previously mentioned, the communication partner is vital. Ineffective partners may have little impact or could actually be damaging. It is important that communication partners are carefully selected and well supported to facilitate such an approach. If the teacher is unable to support staff in facilitating a massage story approach, this could hinder the benefits of using massage stories. Additionally, concerns about safeguarding were regular conversations I had with staff and whilst, in my setting, I was able to reassure them and direct them to the appropriate policy, this may not be true of all settings. Longhorn (1993) recognises that, as pupils become older, taboos increase which can make it difficult to install programmes of massage in schools. Furthermore, this particular approach is unlikely to be suitable for pupils with more moderate learning difficulties (MLD) or older pupils with no learning difficulties, unless it is in the role of communication partner with a pupil with C/PMLD. This potentially leaves a gap for exploration for further research as it is clear that the story element of this approach has huge implications for sense of personal identity, feeling valued as part of a community and emotional wellbeing that massage alone potentially does not.

Within my class setting, the massage approach continues to be used with young people with C/PMLD and staff are supported by myself and more confident support staff to implement the massage successfully. They understand the importance of an integrated approach in ensuring that skills learnt are able to be generalised. Additionally, I have planned and delivered training on creating and using massage stories to the whole of the secondary site, sharing good practice. Importantly, the training highlighted how the approach fits in with current policy and addressed concerns staff had about safeguarding, both the pupils and themselves. The importance of gaining permission was also emphasised including what that might look like for different pupils. More support is needed on assessing such an approach to ensure that everyone is able to identify and set appropriate targets that fit within the school assessment system and acknowledge the benefits of a massage story, as well as how they might use the approach to teach new skills for generalisation or generalise skills previously learnt as part of the massage approach.

Rachel Barker, Expert Practitioner, Dorothy Goodman School


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