Individuals with Sensory Processing Disorders (SPD) often have challenges interpreting and responding to sensory stimuli- such as touch in a functional manner. They may
- interpret a tap on the shoulder as an assault
- refuse to touch objects that are gooey, oozy or drippy such as paint, lotion and even water
- avoid eating and touching many foods and
- prefer to grasp and manipulate objects using their fingers rather than inside the palm, resulting in weak hands with flat arches and poor motor control.
Individuals with SPD including those with autism spectrum disorders often crave deep pressure touch. It is calming and research shows that sensory integration techniques are effective in reducing sensory defensiveness (sensitivity to touch) and promoting self-regulation. The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) is an additional tool for your bag of tricks to decrease tactile defensiveness. The DPPT is also known as the Brushing Protocol. The efficacy is backed by anecdotal evidence and non-independent research by the creators- occupational therapists, Patricia and Julia Wilbarger.
What is Therapeutic Brushing?
The Brushing Protocol specifically requires use of the surgical brush shown in the above photo. It involves using very specific techniques learned by therapists who attended the Wilbarger training and then shared with other staff and perhaps parents. The program consists of
- performing the brushing for 2-3 minutes every 2 hours throughout the day.
- Using just the right amount of firm pressure, starting at the arms and working down to the feet.
- The DPPT protocol includes the 2 additional techniques of joint compression and Oral swipes.
Considerations when Implementing the Brushing Protocol
Many teachers, therapists and caregivers may find it difficult to perform the protocol every 2 hours and to do it correctly! In addition, training opportunities are not always readily available and may be quite expensive. It may seem like playing "telephone" when an occupational therapist trains other staff, who then train parents. The major concern is that using the wrong amount of pressure may result in agitation.
Let the Individual's Behavior Guide the Brushing Technique!
I'm a big believer in trial and error based on sound therapeutic theory. Always assume that what works for one individual may be aversive to another person. Here are a few ground rules:
- Never physically force brushing, joint compression or any physical modality on another person.
- The face, chest, and stomach area are never brushed because these are very sensitive areas.
- Avoid brushing over or near broken, infected, discolored or questionable skin.
- Frequently stop and ask if the person wants "more".
- STOP as soon as the person loses interest, indicates wanting to stop or seems to be becoming agitated.
- Offer the option to grasp and use the brushing tool independently.
While following these guidelines, consider incorporating different types of deep pressure brushing into other activities. In the feature photo at the top of this post, I am using a paint roller instead of a brush. I first demonstrated rolling it up and down my own arms and it felt great. I asked the individual to reach out if he wanted me to roll it on his arm. I frequently asked if he wanted "more".
This developed into a game where he took balls from left of the mat to insert into the garbage can on his right. I periodically offered deep pressure with the paint roller and after a while he used it independently.
Types of Brushing Tools
Some sensory/fidget tools are great for brushing as well as rubbing or squeezing! The following video demonstrates a few of my favorites.
Sometimes I place the person's hands on top of a vibrating cushion while I brush to see how he or she responds. The woman in the following photo has Rett's Syndrome, no hand use and is easily agitated. She became calmer as I brushed, pressing her hand down against the vibrating cushion..
Some individuals, including me enjoy a variety of hair brushes used on the head, arms and hands. This may be incorporated into a sensory or spa group.
Mermaid pillows have become popular and I love rubbing my hands and feet across them, too. Its very cool to make the colors change or form shapes on them as a prewriting activity.
The individual in the following video is blind. He enjoys the tactile aspects of the brush as he uses it to perform an "adapted stringing" activity.
There are lots of rough and even some not so rough textures that can meet a person's need for deep pressure brushing. I wrapped Hook velcro around my steering wheel to get a sensory fix while on the road. I also like the sensation of spikey rings, balls and gloves.
I assume that if I like a particular sensory experience, others may also. Of course, we must always individualize and respond accordinging when they find a stimuli aversive.
Lastly, I share a video of a client who enjoys the combination of deep pressure touch and movement incorporated into a repetitive fine-motor task.
References, resources and additional information