NATURE IS THE ULTIMATE SENSORY EXPERIENCE: A Pediatric Occupational Therapist Makes the Case for Nature Therapy

About the Author

Angela Hanscom is a pediatric occupational therapist and the founder of TimberNook, which focuses on nature-centered developmental programming in New England. Angela holds a master’s degree in occupational therapy and an undergraduate degree in Kinesiology (the study of movement) with a concentration in health fitness. She specializes in vestibular (balance) treatment and sensory integration. She is also the author of the upcoming nonfiction book, Balanced & Barefoot, which discusses the effects of restricted movement and lack of outdoor playtime on overall sensory development in children.

When I tell people I’m a pediatric occupational therapist and that I run nature programming, a look of confusion often crosses their face. “Huh?” they say. Or, “You’re a special needs camp?” Or, “I don’t get it. You’re going to do occupational therapy with our children?

From the beginning, I quickly realized that the concept of TimberNook is “out-of-the-box” thinking for many people. Some don’t get it at first. The concept is totally foreign to them. Typically, when people think of occupational therapy, they automatically think of children with special needs. I’ve used my skills as an occupational therapist in an unconventional manner. I view nature as the ultimate sensory experience for all children and a necessary form of prevention for sensory dysfunction.

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What most people don’t realize is that pediatric occupational therapists are in a unique position to do something about a very real problem.

More and more children are presenting with sensory issues these days. They are not moving like they did in years past. It is rare to find children rolling down hills, spinning in circles just for fun, or climbing trees at great heights. In fact, our society often discourages this type of play due to liability issues and fear of falls.

The more we restrict children’s movement and separate children from nature, the more sensory disorganization we see. In fact, according to many teachers, children are frequently falling out of their seats in school, running into walls, tripping over their own feet, and unable to pay attention. School administrators are complaining that kids are getting more aggressive on the playgrounds and “can’t seem to keep their hands off each other” during recess. Teachers are looking for answers.

Pediatric occupational therapists can help. We have the neurological background to explain why restricted movement causes behavior problems in children; why fidgeting is becoming more prevalent than ever before; and the underlying reasons why kids are hitting with more force during a game of tag.

Pediatric occupational therapists can also use their unique understanding of child development to educate others on the therapeutic qualities of nature. For instance, they can explain how listening to bird sounds in nature helps to improve children’s spatial awareness, why spinning in circles establishes a strong balance system, and walking barefoot integrates reflexes that prevent further complications such as toe-walking.

Traditionally, pediatric occupational therapists are found inside schools or indoor clinics. We’ve ventured out to start using animals and gardening for therapy in more recent years. However, I have to wonder…what if more occupational therapists started venturing out even further? What if they used giant mud puddles to get children to explore their senses more fully? What if they went deep into the woods to inspire children to think openly and creatively, while building forts and dens of their own design? What would occupational therapy look like then?

I believe occupational therapists have great potential to use the sensory benefits of play outdoors to help children integrate their senses in the most natural of ways.

Using the Outdoors for Occupational Therapy

Here are some wonderful ways therapists and others can step back and start to see play outdoors as therapeutic in design:

  1. Climbing trees. In a clinic setting, we traditionally have kids use a plastic climbing wall to work on full-body strengthening and coordination. What if we started letting kids climb trees outside for therapy? This is a little more challenging since trees are not color-coded. Children will need to use their problem-solving skills in order to scale the tree, testing branches as they go to make sure they are safe and sturdy. They would learn safety skills and the tree offers a nice tactile and natural touch experience as they hold onto the tree limbs during the climb.
  2. Playing in a mud puddle. Occupational therapists often let children play in sensory bins that are filled with colorful rice, beans, and sand. In order to fully maximize a child’s sensory experience and to make it even
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    more meaningful, what if we allowed children to play in mud puddles during treatment sessions? Our mud puddles here at TimberNook headquarters are so huge that they also have real frogs and frog eggs in them. The kids have to maneuver through the mud, using their balance, visual scanning skills, and engaging their tactile (touch) senses as they search for a frog.
  3. Walking barefoot on a log. In the clinic, we often have children go barefoot on plastic balance beams, which have been engineered to be “sensory” with little plastic bumps. If we take children outside, we could let them go barefoot on fallen trees, enhancing their sensory experience on a multitude of different levels. Not only would they be experiencing different textures, but they would feel the sensations of moist versus dry, crunchy versus soft, noisy versus quiet, and changes in temperature.
  4. Hooking up therapy swings outdoors. Therapists are SO lucky when it comes to swings! We have just about every type of swing imaginable–all for a different purpose. If we brought them outdoors, we would only add to the sensory experience for children. Now they are exposed to bird sounds, the wind on their face, and  the shadows playing across the ground as they are swinging. By taking swings outside, we engage all of their senses — not just the vestibular (balance) sense.
  5. Building forts. In clinics, it is very common and fun to have children design their own obstacle courses. This helps them with problem solving, creativity, and planning. If we took this outside, what might it look like? Children love creating forts of their own design, using everything from sticks and bricks to fabric and Plexiglas. They are still working on the same skills – only they are exposed to more sensory input, while igniting their imaginations at the same time.

Nature truly is the ultimate sensory experience and the perfect medium for occupational therapists to utilize, both for prevention and treatment methods. It is time we step beyond the confining walls of buildings, take our therapy swings outdoors for fresh air, and use the occupation of play outdoors to enrich children’s lives.

Additional Reading & Resources


TIME FOR YOUR VITAMIN “N”: Ten Great Ways Pediatricians and Other Health Professionals Can Promote Health and Wellness

VITAMIN “N” and the American Academy of Pediatrics – by Mary Brown, MD

THE WHOLE CHILD: A Pediatrician Recommends the Nature Prescription – by Larry Rosen, MD

THE “VITAMIN N” PRESCRIPTION – Some Health Professionals Now Recommending Nature Time for Children and Adults

“SITTING IS THE NEW SMOKING” — What We Can Do About Killer Couches, Sedentary Schools, and the Pandemic of Inactivity

GROW OUTSIDE! – Richard Louv’s Keynote Address to the American Academy of Pediatrics



  1. Claire

    Loved this article! As a mom, a fellow OT, and an outdoors enthusiast, I couldn’t agree with you more about the amazing benefits nature has to offer for kids of all abilities. Thanks for the inspiration and for the “out of the box” treatment ideas too!! 🙂

  2. Lisa Haverly

    Wow!!! Wow!! Wow!!! I am not alone! I have started this path as well integrating nature and OT! It is amazingly rewarding and packed full of goodness and support for kids! I live in Hudson, WI and own Rainbow Tree Therapies, LLC and host summer camps for kids! Great work! Needed work! Love that the word is getting out on its importance! Lisa Haverly

  3. Survival Curator

    A very good article. As a father of two and with all the techno babble that’s about the place…I really enjoy it when I see my kids thrive in an outdoor setting.There is something innate in us as humans to want to connect with the outdoors and I’m glad there are people like you advocating for it. Thanks again.

  4. Cheryl Nolan

    This is one of my favorite articles, ever. I am a pediatric O.T. in Northern California and feel so strongly about the importance of nature for development. Currently I work in a public school district (8 + years). Someday I will run a nature- based program. I would LOVE to keep in touch! Thank you for sharing!

  5. Nat

    Wow this is like reading my mantra verbatim. I’m so thrilled to know that ther OTs understand the value of nature for our children with sensory difficulties! Our clinic was founded on many of those principles – hooray for outdoor OT!!

  6. Molly Wilson

    What a great article, thank you! As a local pedi OT and a new mom myself, I find myself evaluating my own toddlers sensory development (and those of all of my friends kids) under a new and exciting lens. I can’t wait to share this!

  7. Naomi Sharp

    Brilliant article! i am an occupational therapist who has set up a therapy center using horses, and its really interesting to read the health benefits of using woodland, and the different positive effects it has on children’s health, Thank you 🙂

  8. Leslee Goodman

    The MOON’s issue this month on “The Wonder of Boys” confirms how important “a big corral” in nature is–for boys AND girls–but especially for boys.

  9. Lisa

    While I completely agree with your article and the importance of being outdoors, I respectfully disagree with the statement “…and a necessary form of prevention for sensory dysfunction.” My son was born with sensory processing issues and there were red flags from the beginning. We are a family that hikes and spends a ton of time outdoors. I feel like your article implies that spd is “created” by our lack of time outdoors but I’d like to specifically see the research on that.

  10. Angela Hanscom

    Claire, Survival Curator, and Cheryl – thank you for the nice feedback and support! Cheryl – I’d love to stay in touch!

    Lisa – great statement. I was waiting for someone to bring this up. Play outdoors is actually a form of prevention for sensory issues, not the disorder itself. It doesn’t fully cure or fully prevent – play outdoors enhances and engages the senses, aides in sensory integration, and helps prevent sensory issues.

    Granted a lot of sensory issues and sensitivities are genetic, but some of the reasons why we are seeing more and a greater intensity of these issues is because children are not moving enough – especially outdoors. For instance, restricted movement alone can actually cause problems in the middle ear, leading to difficulties with balance, visual skills, and auditory processing (hearing sense)…to name a few.

    The answer to your comment, requires an in-depth explanation with research interwoven throughout. My upcoming book, Balanced & Barefoot actually dives into this very issue to explain the connections between play outdoors and sensory processing. My hope is that this book will shed light onto the importance of movement and play outdoors — and how it aides in healthy sensory development.

    If this brings up more questions or you want to speak over the phone, feel free to email me at – I would love to help clarify what this all means. Thank you!

    – Angela

  11. Monica Slanik

    Great article! As a fellow BScOT, as a mom of 4 boys, I couldn’t agree more.

  12. Timothy Parks OTAS

    It does not have to be KIDS, great for adults too. Nothing like a wilderness backpacking trip to clear the mind and reconnect with the world. There are a whole bunch of occupations, performance skills, functions that can be addressed. In fact you can just about check off everything in the OTFP with a little thought. Great post.

  13. debrataylor

    One of the reasons I love hippotherapy, integrating all the nature aspects while also addressing fine motor, low muscle tone, and balance. I do this year round, in all seasons, avoid snow and rain by using an indoor arena. Totally believe in nature deprivation syndrome.

  14. barbara sher, MA,OTR

    One of my first jobs as an OT (40 years ago) was to work with a 3 year old who still crawled, was mentally challenged and rarely went outside. I brought along another young boy and the three of us went outside and played in a mud puddle. The 3 yr old was walking a few weeks later and everyone thought I was a miracle worker. I knew it was Nature that convinced the boy that there were adventures ahead once he walked.
    Walking in the woods, playing in the water are perfect therapies for “my” kids and for me. I totally support your work!

  15. Growing School Gardens

    What a wonderful experience for your clients and for you! The learning tools and opportunities Mother Nature gives us is priceless. We have found that our students learn more and are more engaged when they are actively involved in our outdoor learning environment. Our preschool students went from basically hand over hand for many activities to practically independent because they were motivated to be involved in the gardens! It’s amazing what a little dirt can do!

  16. Margo Chapski, OTR/L, Adoptive Mom

    I love it, Angela! It’s so nice to read about what you’re doing! I had a whole bunch of great memories of myself ‘playing’ in the woods, hiking, engaging with Mother Nature…brought a smile to my face! I often get my daughter out there, as well. Through the years, I have also found that children with early adversity, childhood trauma, abuse and neglect benefit from interactions through nature. It’s usually at a slower pace than neuro-typical children, but the increase in self-esteem is wonderful. I tend to see bigger smiles, more eye contact and gentler touches.
    Where are you located?

    Thanks so much for sharing, and the smiles 🙂

  17. Kim Hazelton, OTR/L

    Great insight to the need for more natural experiences for children! I have been using the resources in my back yard for clients and friends’ children for years for developmental growth. (We have 5 huge oak trees with: knotted rope swing, regular sling swing, plywood “ladder” nailed into one tree trunk with knotted rope to rappel, zip line with various attachments for different skill levels, hammock slung between 2 trees, enclosed dirt/mud pit, hammer and nails to pound into and pull out of fallen limbs, and a seed garden to name a few). I’m thinking about getting a large boulder and encouraging artwork on it (a la Cadillac Ranch style)using paint brushes, leaves, etc. The kids tend to be hesitant to trust their own bodies at first, but usually LOVE the experiences!


    indulging in close to nature and outdoor activities like this is indeed extremely beneficial for the development and growth of not just the typically developing children but also is highly therapeutic in nature for the children with SPD.

  19. Bonnie


    I just found this post and have fallen in love with OT all over again. I’m a paediatric OT in Australia and there are very few, if any, OT’s here using nature as a therapeutic tool. I love, love, love it. I am so excited by the prospects, I would love to implement these philosophies in my practice. Management and systemic hurdles will be my biggest dilemma.

  20. Lisa Haverly

    Would there be any way to create a closed group to continue corresponding with OT’s who are integrating nature in therapy?
    Lisa Haverly, WI

  21. Kandy Moen, OTR/L

    Hi all,

    I have worked in pediatric therapy for many years. Would love to have some sort of discussion board to discuss hippo therapy, animal assisted therapy, utilizing the outdoors during therapy, and so on.

    I also have questions regarding how to bill for those services.

    Thank you.

    Kandy Moen, MN

  22. JoAnna

    I can only imagine how beneficial this is to sensory kids. I noticed with my own, before he was diagnosed, how nature fed him, it is the perfect sensory diet. Kudos for thinking outside of the box!

  23. Leslie

    Im a sophomore and i want to be a therapist but I dont like being indoors. I wish to be an outdoor occupational therapist who involves around animal assisted therapy for special needs kids. I know this a lot but what do colleges, programs, experiences do you recommend for me

  24. Anna @ Kids Play Space

    As a paediatric OT, health promotion advocate and play enthusiast, I agree 100% with every point here. Thank you!! Anna (Melbourne)

  25. San. Dugga

    San.Dugga: Learning Consultant, Bangalore ,India.
    I love this post, it has refreshed my memories and rejuvenated my energy to pursue my interest in natural learning path.

  26. Carine D'Angelo, RN

    Excellent post- Angela. Your post has refreshed my best childhood memories. I have experienced and understand what nature can offer us and how being close to nature can benefit in the development of a child. Parents should also understand that nature and outdoor activities can be the best way to develop and improve sensory dysfunctions in the child.

  27. Stephanie Novacek

    My heart sings when I hear that there are more resources for children to receive therapeutic benefit in nature across the US! I am a pediatric Physical Therapist, residing on our 10-acre homestead, The Happy Hen, in Olathe, KS. Our first Well Wilderness Kids Therapeutic Nature Camps start next week. We are beyond excited to open up this space for children to grow & thrive, no matter what age or diagnosis!

    My future goal is to open a Therapeutic Nature-based Preschool in the Fall of 2017. I am planning to attend a conference in Minnesota in August. I was curious if anyone else might be attending this same conference?

    Thank you, Angela, for sharing your passion and expertise in this area. I have purchased several copies of your new book for the parents/families that will attend our camps. So grateful to have this resource for them!

    ~Stephanie Novacek, DPT

  28. Jessica

    I agree with you Angela Hanscom because I’m a part of it, in 2003 I read an article about adventure based therapy and I decided to try that and in 2004 finally I got a company and make a trip of 28 days with them, That was the day I was looking for because of some issues I faced in my past I really need a thing like that. My life got a second chance to survive in this world because of this. I learned so many things from this and I would like to my respected reader to try this at once in a life to change yourself. This is the place where a change comes into my life

  29. david

    Thank you, Angela, for sharing your passion and expertise in this area.
    Parents should also understand that nature and outdoor activities may be the best way to develop and improve sensory dysfunctions in children.

  30. charlice

    Thank you for this guide.

    There are a number of swings available today to meet any variety of lifestyles and spaces. From portable swings to swings robust enough to be used outdoors. Make sure your swing is assembled properly and won’t tip over. Always supervise your baby in the swing, and keep the safety harness buckled. Check that any toys are securely and safely connected, since loose parts that your baby gets in his mouth could cause choking.

  31. loqman

    Thank you for sharing this with us, Angela.

    Nature will always provide all the caring for human beings since that is what it is primary created for. It can benefit alot of children when their parents engage them in variety of outdoor activities.

  32. Chenden

    Thank you for sharing these ideas about nature.

    One of the things about nature is that it is complex, yet so simple. To get the best out of nature, we have to learn some things about it. With this knowledge, we can gain some of the benefits that nature has to offer us. This is particular more important for parents if they want their children to benefit fully from nature.

  33. Dan Sondas

    Thank you Angela. This post is so on point. This present generation of children are more likely glued to the TV set than be in the open climbing trees. They are more likely to play indoors than be outdoors playing. In fact, most kids might be opt to stay with their mobile phones than go outside and prick their sensory organs. This is where society finds itself now. It’s important we take an holistic look at everything as you have said and begin to make changes.

    Dan Sondas

  34. iliasyakoo

    Thanks, Angela, for sharing your passion and expertise in this area.
    moms should also understand that outdoor activities and nature may be the best way to develop and improve sensory dysfunctions in children.

  35. Katie

    Do you discuss strategies for getting in outdoor time in very cold weather in your book? My youngest refuses mittens of any kind and hats are a hard sell as well. I’ve tried letting him feel the cold and learn the natural consequence, but he will simply let them freeze. We live in WIsconsin so a good chunk of the year is at or below freezing. Thanks!


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