Therapeutic Climbing: A Pediatric Top-Rope Rock Climbing Program for Sensory Integration Through Social Prescribing

Introduction to Sensory Integration

Sensory Integration (SI) is a theory and model developed by Jane Aryes in 1972. It gives name to neurological processes that determine how the brain organizes, interprets, and deciphers what to do with incoming sensory information- from both outside ourselves in the world around us, as well as from inside our bodies (interoception) (Ayres, 2005). Providing children with SI in the form of rich multisensory experiences has been shown to heavily improve the physical, cognitive, and social-emotional development of children with sensory processing dysfunction. Physical exercise has also been shown to have benefits for children with sensory impairments (Castano et. al., 2024). This article discusses the foreseen benefits that top-rope rock climbing can have on the overall health, wellness, and development of children by way of using SI and Sensory Processing (SP) through skilled occupational therapy (OT) interventions and leisure activities, through the model of social prescribing.

Therapeutic Benefits of Rock Climbing

Climbing and Proprioception​

Incorporating climbing into the lives of these children provides them opportunities to combine SI with exercise as a purposeful OT intervention and/or leisure activity. Climbing heavily involves proprioception as the climber has to continually receive and interpret proprioceptive input from the rocks/holds, their hands, feet, and the harness, as they shift their body weight to target the rocks/holds they need to climb to and use their strength to lift, pull, and push their way up the wall through a variety of both static and dynamic, weight-bearing movements (Klymus et. al., 2023).

Climbing and Tactile Input

Another sensory system that is heavily involved in climbing is the tactile system. Having exposure to different tactile sensations has been shown to improve tactile processing and decrease a child’s tactile defensiveness (Camarata et. al., 2020). Climbing provides a rich tactile experience as there are many different holds with varying sizes, shapes, and textures. The climber also may choose to use chalk throughout their climb as wanted/needed to improve their ability to execute an initial grasp as well as maintain their grip once they have made contact with a hold.

Climbing and and Motor Coordination

Climbing also requires motor coordination and praxis. Climbers use their whole body to move up the wall, requiring motor planning, eye-hand coordination, balance, muscle strength, postural control, reaction time, reaching, as well as other gross & fine motor skills (Liu et. al., 2022). Children that have sensory impairments often need help with some if not all of these skills (Klymus et. al., 2023). Climbing also helps children develop better fine motor skills such as grip and finger strength, both of which can translate over to better participation in I/ADL tasks through generalization.

Emotional and Social Aspects of Sensory Integration

Climbing can also help improve a child’s mental health, social interactions, self-confidence, and self-efficacy. (Mazzoni, 2009). Climbing gives the child a sense of mastery and intrinsic motivation that comes from problem solving as they go up the wall (Ceciliani et. al., 2008). Incorporating top rope climbing specifically has great potential to help children socially as it requires being tied to their belayer (climbing partner) on the ground. This would provide them the opportunity to practice trust and communication skills (Liu et. al., 2022). Top-rope climbing (TRC) also has the potential to help children lower their levels of anxiety and depression as the child is moving their body, balancing their sensory systems, and achieving a sense of self-accomplishment and mastery. Many children with vestibular deficits/difficulties most likely will have anxiety (Bart et. al., 2009) as they may be dealing with or are afraid of provoking gravitational insecurity, feelings of dizziness, vertigo, etc that can evoke a lot of fear. Therefore, kids with vestibular issues especially may have fear when it comes to rock climbing (May-Benson et. al., 2020). However, through using proprioception and repeated exposure to the linear-and therefore more tolerable, raising and lowering of the body to the ground, in a way that the climber can control the movement, vestibular sensitivity may decrease and/or the child will have less vestibular-triggered fear.

Climbing and Autism Spectrum Disorder (ASD)

Many children with sensory processing deficits also have Autism Spectrum Disorder (ASD) Patil, O., & Kaple, M. (2023). Rock climbing can be appealing to children with autism for many reasons. Some children with autism enjoy risk-seeking behaviors such as climbing or jumping (Fahy et. al., 2020). TRC would give them a safe and appropriate environment to do so. Kids with ASD also may enjoy the simplicity of rock climbing, as there isn’t much sequencing, and there is just one main objective-to get to the top of the wall. These kids also may enjoy the fact that each climb ends with completion of a task, which is a big draw for a lot of children with ASD, seeing a task through from start to finish. Expectations are also clear, with routes outlined for them by color so all they have to do is follow the correct color up the wall, which also outlines a more straightforward pathway to completion/the goal, which may not be as clear in other sports. Kids also may enjoy that rock climbing can be performed at varying levels concurrently with others (should they choose to climb with a group) and that their performance on the wall doesn’t include physical contact with other people, there aren’t social cues to navigate, and they don’t or have people relying on them to score points like they do in team sports.

How Rock Climbing is Currently Being Used in Pediatric OT

Currently, in some pediatric occupational therapy clinics there are short rock walls where children can boulder (a form of climbing performed without being secured by a harness and rope for safety). While this is beneficial to an extent, there is reason to believe that the use of a harness and rope as used during TRC would benefit kids more than that of bouldering.

For example, if a child is bouldering, they know they aren’t fully secure, leading to fear, especially for a child with hypersensitive systems, which can lead to lack of motivation to try the wall, or get as much out of the wall (i.e working on various sensory, motor, and other goals) as they don’t feel as free to move due to the fear of falling. The harness provides more feelings of safety and security which would allow the child to more fully participate in climbing.

Sensory Integration theory says that tactile, visual, and vestibular are three sensory systems that work very close together. TRC allows for sensory-rich exposure in these areas. Proprioception helps to decrease sensory overload from the vestibular system. Therefore, it is also hypothesized that the extra proprioceptive input from the harness at the hips will allow for better sensory integration of the child, being that the more proprioceptive feedback there is, the more balanced the child’s vestibular system (for example) will feel.

The Therapist’s Perspective

In addition, some occupational therapists currently might not feel totally comfortable facilitating a child up the rock wall in its current state because a child could fall on them if they don’t feel strong enough to hold the child. The child can also only get as far off of the ground as the therapist can reach, which isn’t far at all. The therapist may also be hesitant to use the rock wall in its current bouldering state because there is more danger due to the falling typically necessary in order to get down from the wall. Although crash pads are in place under the child, the child does still have to land on the ground abruptly, with various points that they could make contact, which isn’t as safe as compared to top-rope climbing where the child would be slowly lowered down to the ground, feet first.

Therapeutic Climbing Through the Social Prescribing Model

Social prescribing is a newer model that is currently being used primarily in the U.K. Through this model, patients can be connected to resources outside of clinical care in their community to receive additional wellness support through social connectedness and meaningful activities (World Health Organization, 2021). Patients are connected with a link worker who assesses the needs and goals of the patient, and works with them to fill in any gaps in care with activities and/or programs for group learning, physical exercise, and community/social engagement, for example (Bradley & Scott, 2021). After identifying the goals of the patient, the link person helps them create an action plan to address their goals and connects them with the appropriate resources. A rock climbing program for kids with sensory disorders and dysfunction, overseen by occupational therapists and trained climbing coaches, in addition to OT sessions would be beneficial for these children’s physical and emotional health as well as improve social skills. The idea is that improvement in these core areas will lead to improvements in I/ADLs and the skills that they learn, through generalization, can transfer over to other tasks and increase overall feelings of self-mastery and well-being in their daily lives.

Summary and Considerations

In summary, both SI and physical exercise have been found to be beneficial to children with sensory impairments in a variety of ways. Climbing has been found to be a therapeutic modality that can help children increase their physical, mental, and social well-being. Currently, climbing is used on a small scale for children with sensory impairments. However, there is great potential for climbing programs to be implemented and made available to those children with sensory difficulties, allowing them to work on a number of skills that will help them in their daily occupations in life such as academics, play, social, self-care, and participation (Kompán et. al., 2021). Social Prescribing is a means by which these children could become aware of and receive access to these climbing programs.

Social Prescribing Process for Children and Youth

Social Prescribing Toolkit Template (for OTs)

A Social Prescribing Toolkit was designed to support OTs in effectively implementing social prescribing programs and interventions. It provides a structured approach to identifying, referring, and monitoring clients as they engage with community-based support. Top rope rock climbing (TRC) was used as an example for how the Social Prescribing Toolkit can be used. Please reach out to Julianne for more detailed information about the specifics of the program.

Author Bio

Julianne Kindt is an occupational therapist practicing in Arizona. She graduated with her Doctorate of Occupational Therapy from Northern Arizona University and received her Bachelor of Science degree from Brigham Young University. She first started climbing in college and has loved it ever since! Early on in school she realized that she wanted to combine her passion for rock climbing, occupational therapy, and interest in working with people with neurological disorders. This led her to develop a rock climbing program for sensory integration as well as motor, cognitive, and social-emotional skill development. She will be presenting this program at the annual American Occupational Therapy Association (AOTA) conference in April 2026.

To connect or discuss additional details about the program please email: juliannekindt@gmail.com