Therapeutic Brushing Techniques

The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT)

Using the Wilbarger Protocol, Occupational Therapy in Mental Health, 18, 1, 43-63. This pilot study examined the effect of the Wilbarger brushing and joint compression protocol and sensory diet on symptoms associated with Sensory Defensiveness among 3 women with histories of self-injurious behaviors. The technique was developed for sensory defensiveness. The creator of the technique, Patricia Wilbarger, MEd, OTR, FAOTA, is a leading expert on sensory defensiveness. (This is basically when the nervous system over-reacts to stimuli that would not typically be perceived as negative or harmful.). The Brush Wilbarger Therapy is designed by Patricia Wilbarger and is a fantastic tool in the treatment of sensory defensiveness. Featuring an easy to grip oval shape and high density bristles, the Therapressure brush is an highly effective calming tool. The Wilbarger Protocol (Wilbarger, 1991) is a specific, professionally guided treatment regime designed to reduce sensory defensiveness. The Wilbarger Protocol has its origins in sensory integration theory, and it has evolved through clinical use. It involves deep-touch pressure throughout the day.

The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT), which in the past was referred to as the Wilbarger Brushing Protocol, refers to the specific sensory modulation techniques developed by Patricia Wilbarger, MEd, OTR, FAOTA. Patricia Wilbarger is an occupational therapist and a clinical psychologist who is also known for coining the phrase “sensory diet.” She is a leading expert in the area of sensory defensiveness. Simply stated, sensory defensiveness is the over-responsiveness of the protective responses of the nervous system. She is a co-founder of Sensory Integration International, the AVANTI camp, and has published numerous books, articles and videos. She lectures internationally on the topics of sensory defensiveness and sensory integration. Some of these publications, the brushes used in the DPPT protocol, and a list of courses with Patricia Wilbarger can be found at Child Development Media, Inc.

Based on the theory of Sensory Integration, the DPPT uses a prescriptive method of providing stimulation to help the mind-brain-body self-organize. Patricia Wilbarger and her daughter Julia Wilbarger, MS, OTR offer workshops for professionals who wish to use these techniques in practice. Please note: training is absolutely necessary before attempting to use this technique in practice. Use requires a trained therapist otherwise harmful or ineffective influences may be the result.

Some of the benefits of the DPPT may include:

An improved ability to transition between various daily activities
An improvement in the ability to pay attention
A decreased fear and discomfort of being touched (tactile defensiveness)
An increase in the ability of the central nervous system to use information from the peripheral nervous system more effectively, resulting in enhanced movement coordination, functional communication, sensory modulation, and hence, self-regulation.

The Protocol
The DPPT uses a specific pattern of stimulation delivered using a special type of brush and gentle joint compressions. It is believed to facilitate the coordination of mind-brain-body processes in a manner that influences positive change. It is applied every two hours when first started, and then usually at a decreased amount, which is specified by the trained therapist, who collaborates with the family. However, the DPPT protocol may be used between these scheduled two-hour sessions when a person becomes overwhelmed, triggered, when waking up after having nightmares/night terrors, and before and/or after difficult transitions or situations.

The Brushing Step: A Specific Brush is Required
The DPPT requires the use of a special, soft, plastic surgical brush and no other kind. This brush is believed to be the most effective for the delivery of the specific type of stimulation to the nerve endings of the skin that is required by this protocol. The brushing portion of the DPPT applies very firm pressure, which begins at the arms and works down toward the feet. The stomach and chest areas are avoided due to the potential to influence the urge to vomit or urinate when applied over these areas. People may initially find it aversive, particularly those with sensory defensiveness. However, over time it is often much more readily accepted and may become pleasing as the system habituates. Generally, within a few sessions, it becomes a pleasurable experience. When for any reason it is not preferable to use touch methods with people, they can be taught to apply these techniques to themselves.

The Joint Compression Step
The joint compression portion of this protocol also requires a very specific pattern of application, using a ten-count repetition of light pressure. Self-administration of joint compression may also be obtained by engaging in jumping-jacks, push-ups, a routine consisting of various isometric exercises, etc.

The Oral Swipe
The final component of this protocol is an oral swipe, used for people with oral defensiveness. This step is sometimes omitted due to hygiene and/or safety concerns, as it requires fingers in the mouth. However, people can be taught to do step to themselves.

Important Note: None of these techniques should ever be painful or cause physical damage

Patricia Wilbarger Brushing Protocol

The Wilbargers promote the use of these techniques as part of one’s sensory diet. Further, the DPPT may be implemented as one of the sensory modulation modalities used in your child’s sensory diet.

References:

Wilbarger, P. & Wilbarger, J. (1991). Sensory Defensiveness in Children Aged 2-12: An Intervention Guide for Parents and Other Caretakers, Avanti Educational Programs: Santa Barbara, CA.

Wilbarger, P. (1984, September). Planning an adequate sensory diet – application of sensory processing theory during the first year of life. Zero to Three, 7-12.

Patricia Wilbarger Brushing Program

Wilbarger, J. & Wilbarger, P. (2002). Wilbarger approach to treating sensory defensiveness and clinical application of the sensory diet. Sections in alternative and complementary programs for intervention, In Bundy, A.C., Murray, E.A., & Lane, S. (Eds.). Sensory Integration: Theory and Practice, 2nd Ed. F.A. Davis, Philadelphia, PA.