NB: This article is written for the parents of children who have SID and related problems. We publish it here because we know that therapists like to give their client’s caregivers as much information as possible.
By: Debbie Woodward
Many children with Sensory Integration Disorders exhibit symptoms of tactile defensiveness. In layman’s terms this simply means that they have hypersensitivity to touch and/or tactile input. This in turn may cause:
The Wilbarger Protocol is a therapy program designed to reduce sensory or tactile defensiveness. Children who exhibit symptoms of tactile defensiveness are extremely sensitive to touch. This can cause a fear or resistance to being touched, difficulty transitioning between activities, and/or lethargy. DPPT: As aforementioned, Wilbarger defined three DPPT aspects of the protocol, with the first being brushing (2005). The brush, clearly a critical factor, can be disposable brush, a corn brush, an oval brush, or a brush with a sponge. Each has different qualities that would make.
- Difficulty transitioning between activities
- Lack of attention or focus
- A fear or resistance to being touched
Your child may benefit from what is commonly known to most parents as “Brushing Therapy”. It is known in Occupational Therapy circles as The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT). It was developed by Dr. Patricia Wilbarger, MEd, OTR, FAOTA, an occupational therapist and clinical psychologist that has been working with sensory processing theories for over 30 years.
When first introduced to this, many parents are a bit skeptical. How can “brushing” my child help them with their sensory integration issues and tactile defensiveness? The theory behind it is that our skin is the human body’s largest sensory organ, and therefore it is in constant contact with our nervous system; relaying information that allows us to interact effectively with our environment. Often times, the inability for the human body to process sensory input effectively can cause motor skill delays, tactile defensiveness, or social and emotional difficulties. Brushing therapy seeks to use this connection between the skin and the nervous system to assist kids who may be having difficulty organizing sensory information properly.
It is thankfully, quite simple to implement. The first step in the therapy involves using a soft, plastic, surgical brush which is run over the child’s skin, using a very firm pressure, starting at the arms and working down to the feet. The chest and stomach area are always avoided as these are sensitive areas that can cause adverse reactions. There can be some drama at first, until the child becomes accustomed to the therapy, but most children find it pleasurable after a few sessions and may even ask for it when they are feeling “off”. Along with the brushing, most practitioners will also prescribe joint compressions. In this phase of the treatment, the therapist or a parent trained by a therapist provides gentle compressions of each of the child’s major joints for a count of ten. Finally, the therapist may also suggest the Oral Tactile Technique, or OTT. This technique involves using a finger to swipe along the inside of the child’s mouth. This has been found to help with some children who have an issue with what is known as oral defensiveness. If your child is adverse to new foods because of their texture, or has a severe aversion to having their teeth brushed, they may have an issue with oral defensiveness.
If you think that your child would benefit from this form of therapy, it is important to seek guidance from an Occupational Therapist. Performing the therapy in a manner other than taught by a trained professional can be, at best, useless and could possibly do more harm then good.
Article Reprinted with Permission of Debbie Woodward
Dear Melissa,
My 4-year-old son is having frequent tantrums at preschool. I was browsing a sensory processing parent support group webpage when I saw several parents discussing “brushing” and how it helps with calming their children. What exactly is it, and would it be appropriate for my child?
Ahhh…The illusive “brushing” technique. I think I was asked this question in half a dozen different ways over the past month. It seems as if every parent with a child with sensory processing disorder has heard of this technique, but no one is really sure what it is. In addition, many preschool teachers are mentioning it to parents as well. Even after 9 years as an OT, I was not really sure of the true protocol. I tried researching “brushing” in the literature, asking colleagues, browsing then internet, even YouTube, but found few answers. As a last-ditch effort, I searched the term on Wikipedia and found an article riddled with red flags stating that the information provided still needed to be verified. No wonder everyone is confused by “brushing”!
Getting to the Source
I try my very best to be a research-based occupational therapist. I try to focus on those techniques that have been proven both safe and effective. I knew that “brushing” was a technique created by Patricia Wilbarger, M.Ed, OTR, FAOTA. She has been a leader in the field of occupational therapy for decades and presents training courses along with her daughter Julia Wilbarger PhD, OTR, who is a leader in the field in her own right. So when another OT TEAM member (Katie Gehrki) and I found a 2-day course taught by the Wilbargers themselves, we jumped at the chance to receive training directly from the source.
The Wilbargers’ “Brushing” Program
In the course handout, the Wilbargers described their program as “an advanced treatment program used to specifically treat Sensory Defensiveness. The program uses the consistent and frequent application of Deep Touch Pressure and Proprioception without noxious input such as scratching or tickling. Although research on this technique is limited, clinical experience over many years with a wide range of clinical populations and ages indicates that the it can be very beneficial in reducing or eliminating sensory defensiveness when applied consistently and used within the context of a comprehensive treatment program.”
Yes, but what is it???
In functional practice, the brushing program involves taking a specific brush, very similar to a surgeon’s nail scrubbing brush, and rubbing it firmly on the child’s skin in a particular manner. This is followed by deep pressure to the joints every 2 hours while the child is awake. According to the Wilbarger Protocol this is ideally done 8 to 10 times per day for several weeks. Brushing has been renamed by the Wilbargers as the “Therapressure Program.” However, I have also seen it documented in the past as “The Wilbarger Deep Pressure and Proprioceptive Technique” and “Wilbarger Brushing.” I will continue to use the term “brushing” for this blog for the sake of simplicity.
Is it “All or Nothing”?
You are probably asking, “What? Do this every 2 hours? That is a HUGE time commitment! I can barely get my child’s socks on in the morning. I don’t think I can add something to our routine every 2 hours!” You are absolutely right. Though this technique is very inexpensive, it does take a lot of time. So I asked Patricia Wilbarger herself: Is it OK to complete the technique less often? Her reply: If you aren’t going to complete the program exactly, don’t do it at all. Simply focus on the sensory input and forget about the brushing.
The Wilbargers list many do’s and don’ts:
DO only use the brushing program if you have been directly trained in the Wilbarger Therapressure Program or very closely trained and monitored by an OT who has received this training.
DO only use the specific brushes designed for the protocol.
DO follow the “every 90-120 minute” protocol strictly.
DO report any adverse reactions to your supervising OT.
DO NOT brush the stomach or groin area.
DO NOT complete brushing or joint compressions on areas with any injuries such as cuts, scrapes, swelling, bruises, etc.
DO NOT complete with infants under 2 months of age.
My own do’s and don’ts:
I will add a few of my own precautions, as I have seen many parents completing brushing incorrectly and actually causing much more harm than good.
DO only use the brushing technique once properly trained by someone who has been to the course. I have seen many parents brush in the wrong direction, brush the wrong areas of the body, use too light of pressure, lift up and replace the brush with every stroke, etc. All are wrong! Again, completing this technique incorrectly can most definitely exacerbate the situation rather than help it.
DO NOT apply brushing once a “meltdown” has occurred. Brushing should only be used on the scheduled timeline. Providing brushing when a child is already in “flight-or-fight” mode can just cause the situation to escalate even more.
Does it work?
So, cut to the chase, does it work? Hmm…maybe? In reality, I see very few families that are able to make the commitment to brushing every 2 hours, utilizing the correct technique every time. In my own life, this would be impossible, so why would I ask this of another parent? In addition, the Wilbargers themselves report that there is limited research affirming the efficacy of this technique. Therefore, in my own practice, I do exactly what Patricia Wilbarger recommends: I focus on providing the other sensory input that is needed by the child to calm his sensory system. But wait! Are you still itching to try it? Come on over. I will be more than happy to teach you! Give my clinic a call. We have several TEAM OTs trained by the Wilbargers in the Therapressure Program.
Have you used brushing in the past with your kiddo? What did you think? I would love to hear feedback from parents who have been in the trenches with the brushing technique!
Do you have a question or comment for Melissa? Contact us to share your insights.
About the author:Melissa Foster, MS, ORT/L, is a veteran therapist with many years of experience in pediatrics.
Patricia Wilbarger Brushing Programmer
Resources:
Therapeutic Brushing Techniques
Therapressure Program (Trademarked) for Treating Sensory Defensiveness – Training Course
What is Sensory Processing Disorder? Monday’s with Melissa Blog