This therapy was developed by Patricia Wilbarger, MEd, OTR, FAOTA. The complete protocol usually takes 2-3 minutes to administer. The first step involves using a soft, plastic, sensory brush or Therapressure Brush which is run over the child’s skin, using very firm pressure; it is like a deep pressure massage. The Wilbarger brushing protocol is a therapeutical program that was developed by Patricia Wilbarger, a well known occupational therapist. Some may jokingly refer to her as the guru of OT (occupational therapy)! This program was designed to help those with sensory processing disorders.

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.

Patricia Wilbarger Brushing Programmer

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.

Resources:
Therapeutic Brushing Techniques
Therapressure Program (Trademarked) for Treating Sensory Defensiveness – Training Course
What is Sensory Processing Disorder? Monday’s with Melissa Blog

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. They often fear or resist being touched, have difficulty transitioning between activities, and may be lethargic. This therapy was developed by Patricia Wilbarger, MEd, OTR, FAOTA.

The complete protocol usually takes 2-3 minutes to administer. The first step involves using a soft, plastic,sensory brush or Therapressure Brush which is run over the child’s skin, using very firm pressure; it is like a deep pressure massage. Brushing starts at the arms and works down to the feet. The face, chest, and stomach area are never brushed because these are very sensitive areas. Brushing these areas may cause adverse reactions including vomiting.

There is not much documented research on the Wilbarger Protocol. However, many parents of children with autism have reported seeing decreases in sensory defensiveness and anxiety as a result of using this technique. Some of the benefits may include improved ability to transition between daily activities, improved attention span, a decreased fear or discomfort of being touched, enhanced coordination, and better self-regulation.

The brushing therapy is initially recommended every 2 hours while the child is awake. Therapists usually re-assess the level of brushing after two weeks. At that time they may modify the program. The brushing continues as long as the individual benefits from it. This program may be a part of sensory integration therapy in which case the child will also be directed to work with a variety of sensory toys and tools.

Patricia Wilbarger Brushing Protocol

After the brushing therapy, therapists may also prescribe gentle joint compressions to the shoulders, elbows, wrists, fingers, hips, knees/ankles, and sternum for a count of ten. Self-administration of joint compression by the client can also be done by pushing against walls, doing jumping-jacks, push-ups, or jumping on a trampoline.

Finally, the therapist may also suggest the Oral Tactile Technique, or OTT. This technique requires a finger to swipe along the inside of the person’s mouth. This is helpful for kids with oral defensiveness. (These children may have trouble with foods because of the texture or may hate having their teeth brushed.)

If you think that your child would benefit from the Wilbargar Protocol, it is important to seek guidance from an Occupational Therapist. The OT must be trained in sensory integration and must be specifically trained to use the Wilbargar Protocol. Performing the therapy in a manner other than taught by a trained professional may not be effective and can be very uncomfortable for the individual.