“The activity on the trampoline not only stimulates the cardiovascular system, but also provides significant mental stimulation at the same time. It's fun for C - it's one of the few times I see him laugh!”
Callum MacKinnon (Founder & Lead Occupational Therapist at bOunceT) was asked to write an article for PMLD Link about the benefits of rebound therapy. After successfully submitting his article to the editors of the journal, Callum shared the blog below to this website so the information can be accessible to everyone.
A similar blog defining rebound therapy in the UK and the experiences of an Occupational Therapist using rebound therapy in practice was published in September 2020. You can view it here -
Defining ‘rebound therapy’ & where it fits within Occupational Therapy
Highlight: July 2022
Author – Callum MacKinnon, Specialist Occupational Therapist – bOunceT
Bounce OT (bOunceT) is a social enterprise delivering a range of Occupational Therapy (OT) services, based in Scotland.
Our vision is for everyone to be able to do the things they want, need, or have to do. Similarly, our mission is to improve the quality of life and participation in meaningful activities for children and adults with disabilities, and their family carers.
As the name of the organisation might suggest, a huge focus of our work is delivering inclusive rebound therapy sessions. In my experience, rebound therapy is either hugely popular - or not known about at all. The benefits of this therapeutic activity can be obvious, especially when seeing the smiles on people’s faces as they take part, or when hearing direct feedback from parent carers. However, a lack of research into this intervention leaves room for doubt and confusion about its accessibility, and benefits.
What is Rebound Therapy?
Let’s look at some facts about this intervention:
• In the UK ‘rebound therapy’ is a descriptive term which means the therapeutic use of a trampoline (Intellectual Property Office, 2013).
Think of this as an intervention that a wide range of people, from various professions, are trained to deliver in their workplace or in the community with the people they support.
• There is no regulatory body for rebound therapy, and there is not one mandatory training course to certify people in rebound therapy (ASA, 2016).
• Rebound therapy is not a registered trademark (Hayward-Giles, 2016).
• This intervention is commonly used by professionals across Education, Health, and Social Care settings.
• Research mainly across Physiotherapy has enabled rebound therapy to grow an evidence base and become implemented in various services across the public and private sector.
• Rebound therapy is often used alongside other interventions like Hydrotherapy.
• The Chartered Society of Physiotherapists (CSP) special interest group ‘Rebound Therapy Association for Chartered Physiotherapists’ acts as a benchmark for best practice in rebound therapy.
• There are some suggested contraindications to participating in rebound therapy - like
pregnancy, dwarfism, detachable retinas and a positive AAI screening.
Rebound Therapy & Occupational Therapy
Despite OT’s not regularly using rebound therapy in practice – or having a special interest group like
CSP - OT’s are experts in activity analysis and finding the ‘just right’ challenge for people.
OT’s often support children and adults living with PMLD to access meaningful sensory experiences, and
therapeutic play opportunities. Also, as bOunceT is an independent service from the public sector
we have more flexibility to offer different, more diverse, services. Therefore, it was a no brainer to
set up an activity-based service that was different to anything else in my local area at the time.
The approach we take to measuring outcomes and progress in rebound therapy is by following our
‘Physical, Social & Sensory’ model. For example, considering physical development, social and
communication skills, and sensory regulation.
we do, and how we do it. We call this being ‘occupation centred’ and ‘occupation focused’. As a
result, typically goals for rebound therapy are not solely about skills like ‘improving eye contact and
develop communication’ – or ‘increase stamina/ duration of activity’.
Instead, we work with the person with PMLD, and their family, to ensure participation [in their meaningful activities] leads the way we make playing on a trampoline purposeful. Additionally, we seek to complete joint assessments with other professionals to be as consistent as we can, combining multiple therapeutic benefits into one session.
For example, link in exercises from Physio, and communication strategies from Speech and Language Therapy into the play.
This is slightly different to other rebound therapy sessions provided by different services and professionals, who might only have the capacity or skills to measure physical or educational outcomes.
The benefits ...(that we know to date)...
Although there is a lack of empirical research into rebound therapy, it is still widely accepted that this is a beneficial intervention - especially for those living with PMLD.
- Having fun!
This is always overlooked and under rated.
- Cardio-Respiratory fitness!
Parent carers have commented this is one of few activities that can increase the individuals heart rate and physical activity levels. - Prevention of coughs and colds!
Especially in winter months when there are reduced opportunities to even go outside/ for walks. - Improved bowel movements!
From participating in physical activity. - Altered Tone!
Low and slow bouncing can help to reduce tone in those with hypertonia (high tone). This is another – safe – way of getting individuals out of their chairs for a full body stretch (even without touching them/ doing hands on physio). - Improved balance!
Coordination and vestibular skills. - Improved sensory awareness (proprioception)!
Movements on the trampoline stimulate the joints, skin and muscles. - Stimulating Movement & Sensory Regulation!
The mixture of bouncing roughly and intensely, compared to soft and slow, can bring your senses ‘up’ (hyper) and ‘down’ (hypo). - Improved Communication & Social Skills!
Especially when participating in play and different games during time on the trampoline.
Feedback from parent carers:
“The activity on the trampoline not only stimulates the cardiovascular system, but also provides significant mental stimulation at the same time. It's fun for C - it's one of the few times I see him laugh!”
“K loved her rebound therapy sessions. She loved being bounced with her imagination taking her on a roller coaster or on horseback (her favourite things).”
“J has been getting great physical exercise – it is one of only activities he is able to access, and is actually interested in participating in! His mental health is getting better too as a result. His dad and I get a short break too, we really need it”
The barriers
As mentioned, some people still have no idea what rebound therapy is, or how it can improve the health and well-being for children and adults living with PMLD. This will only be resolved once there is further clarity across both research, and marketing of services, about what this intervention is - and why it should be used more often.
Unfortunately, many parent carers have commented they cannot access learning opportunities about this intervention – for them or the paid staff supporting their child. The limited occasions when they can is only to complete a formal training that’s too expensive and designed for schools/other professionals. Furthermore, trampoline parks and leisure centres do not let parent carers - or paid care staff – facilitate playing on a trampoline without this formal qualification. Often this about liability for using the heavy equipment and being trained in the set up/take down of the trampoline, instead of what therapy is happening during the activity.
Finally, there are some contraindications that cannot be compromised on when considering if rebound therapy is a suitable intervention for individuals with PMLD – but keeping abreast of research and evidence from across the field is necessary.
Too many children and adults are being denied access to rebound therapy on unfair grounds.
One common example is that individuals who have had surgery on their spine cannot participate in rebound therapy. There is research within Physiotherapy to highlight that with clearance from a medical professional, and risk assessments in place from a Physiotherapist, having surgery or a spinal rod should not be a barrier to accessing this intervention.
Conclusion
Rebound therapy is clearly a valued intervention by many as it is a fun opportunity to try a new activity, whilst improving the health and well-being of children and adults with PMLD.
However, it is still not commonly used by professionals across learning disability services – or by parent carers, and paid carers, in their community.
This is due to various factors, but mainly confusion around what rebound therapy is, and its accessibility.
Recommendations - What's Next?
Services delivering rebound therapy should…
• Continue delivering 1:1 and group sessions, and encourage multidisciplinary team working with other services and professionals – e.g. between sectors, and Education/ Physiotherapy/ Occupational Therapy.
• Continue providing training to staff in workplaces - enabling rebound therapy to be practiced in more places, by more people.
• Create opportunities for parent carers to access reduced cost training. This will allow parent carers and paid care staff to lead therapeutic play on a trampoline at home, or in the community.
This could be a different learning experience to formal training for workplaces (that require strict risk assessments and policies).
• Liaise with trampoline parks and leisure centres to make rebound therapy more accessible (e.g. formal training to their staff, health promotion).
• Partner with Universities to provide student placements and explore research opportunities -
to initially define the intervention, then measure its impact both quantitatively and qualitatively.
References
ASA (Advertising Standards Authority),. 2016. ASA Ruling on Rebound Therapy Ltd. [online] Asa.org.uk. Available at: Rebound Therapy Ltd - ASA | CAP [Accessed 1 July 2022].
Hayward-Giles, S. 2016. ASA upholds CSP complaint over misleading ‘rebound therapy’ ad. [online] CSP.org.uk. Available at: ASA upholds CSP complaint over misleading ‘rebound therapy’ ad | The Chartered Society of Physiotherapy [Accessed 15 June 2022]
Intellectual Property Office. 2013. Intellectual Property Office - Decisions. [online] Ipo.gov.uk. Available at: Intellectual Property Office - Decisions (ipo.gov.uk) [Accessed 15 May 2022].
