The OT we are working with through California Early Start has suggested Brushing Therapy for Payton. She has shown me how to do it and wants me to do it every two hours while he is awake.

I am to brush up-down-up-down 10 times on the tops of his arms, the underside of his arms, his back, then the tops and backs of his legs. Then I am to go back through and do gentle compression of his joints.

Have you heard of this and if you have, what do you make of it? I am skeptical.

Hi Krista:

What a precious little guy you have! I ironically have brought up the Wilbarger brushing protocol several times in threads to my moms in this website. If it is taught and used correctly, it can make a big difference. Hopefully your OT gave you handouts with instruction and background and talked about the Wilbarger protocol specifically.

This form of therapy can be used on individuals who are hyper OR hyposensitive to touch. I had a couple bring me their 5 year-old daughter in desperation a few years back. Their daughter had been sleeping in their bed as an infant and they could not get her out. Not only was she sleeping in their bed, but she had to be sleeping right up against the mother AND under her arm. This poor mother had not slept for years let alone been intimate with her husband! This child was seeking out deep pressure input (from her mother's armpit!) We started brushing therapy on her and she was out of their bed within a week.

On the other end of the spectrum, I have many patients who cannot stand getting their hands dirty, picking up food, or being hugged. These kids are hypersensitive to touch. Brushing therapy for them helps "normalize" their sensation so wearing clothing doesn't make their skin feel like it is on fire. Brushing therapy is like getting a nice message....it wakes up the pressure receptors under the skin that innervate the nerves, which innervate all of our muscles. Joint compressions must accompany the brushing. If it is done right, it is very enjoyable. If it isn't, you are wasting your time.

Every 2 hours seems a little extreme. Look at it realistically. It is typically recommended every 3 or so hours. I tell my parents to provide it before stressful situations and to help the child relax before nap time and bedtime. Do it when you can and try it for 3 weeks. If it is not making a difference in your child's behaviors, discontinue the practice.

I hope that helps :)

Robynne

Wow! Thank you!

She showed me know to do it, but didn't give me any handouts. I wish she had. I cannot find anything on the web other than a basic description of what the technique is - there are no specifics.

What I did find, however, describes the technique slightly differently than what our OT has said to do. That worries me as there are big red warnings plastered up all over the sites saying if it is done incorrectly, it can cause harm to you child. Eeek.

Is there a source for handouts or a specific description of the technique so I know I am doing it correctly? If I am going to make the commitment to the process, I want to be sure I am doing this correctly.

Also - should it be done with clothing on or on bare skin? I'm confused about that part.

I hope this helps Krista:

OT: Brushing/Joint Compression Protocol

The Wilbarger Approach

1. Many people call it a brushing technique because it uses a brush, but it’s really much more than that and it doesn’t involve brushing. Instead the key to its successful results is a pressure touch. The technique requires a specific kind of surgical brush (it’s really a potato brush) that does not scratch, tickle or itch when stroked firmly across the skin. The pressure on the stroke must be firm enough to bend all the bristles of the brush and press all of the tactile receptors in the area.
2. The “brushing” should be quick, moving all over, avoiding repeated stokes to the same area. The objective is to cover a large area quickly and then follow it immediately with compression/traction to all joints.
3. It is important to smoothly and evenly apply deep pressure. Therefore, hold the brush in a horizontal direction when going over the skin. Keep it moving. It is best to brush over the skin directly. It can be done through clothing if necessary, but the effectiveness will be diminished (i.e., slower, less dramatic change).
4. Never “scrub” back and forth over the same area. Take long strokes, turning the limb or moving around so you’re stroking all over.
5. Brush all of each arm, leg, back and buttocks, usually starting at the top and working your way down. Be sure to brush the palms of the hands, and if possible, the soles of the feet.
6. Never brush someone’s stomach, and don’t let the person brush this area either. There are lots of nerve ganglia located around the visceral organs. When we brush over muscles and skin we know what happens to the receptors and what nervous system loops are involved. We don’t know what happens when we brush over the stomach except that brushing to the stomach can drive the nervous system into acute distress.
7. Also leave the face and head alone because these are personal and protected spaces that most people don’t like others to touch under most circumstances. If the individual brushes his or her own face, that’s okay.
8. When done correctly the brushing doesn’t feel like brushing. Instead it feels like pressure with a flush of tactile sensation spreading quickly over the area. To accomplish this, the brushing must be done quickly and over large areas, moving constantly.
9. Brushing must be followed immediately with compression. Compression is given as 10 quick presses to the key joints of the upper and lower extremity. It is especially important to give compression into the shoulders, elbows and wrists, and into the hips, knees, ankles, and 3 times to the chest. What happens with compression is that the brain thinks the bone is going to be displaced so all the proprioceptors in the immediate area fire at once to stabilize and protect the joint. This
proprioceptive firing provides a flood of strong (epicritic) calming or inhibitory input to balance the effect of the brain centers that are firing so much excitatory flow. You must remember that the side of the joint that is closet to the center of the body is held still, and the side that is further is what is moved by your hand. Be careful that you are doing a joint compression, versus just moving the skin, and that the joint is well-aligned and your movement keeps the muscles and bones in good alignment. (An OT should train you).
10. The protocol says you can repeat the regimen every 90 minutes to 2 hours according to the schedule set up by your responsible occupational therapist. The input or sensation you are providing is known to last most systems about that long (2 hours), which is why the protocol recommends the repetition so frequently. Robynne the OT says be realistic and look at the big picture! If you have other children and responsibilities, life cannot stop for you to brush your child. On the other hand, if your child’s wheels are shooting off and you know the protocol is going to provide a calming input that will help him/her, by all means, provide! The objective is to keep the calming input in the person’s system to help the individual remain in the optimal zone of sensory modulation (that is calm and alert but not overly aroused).
11. If this is going to help the individual, we should see positive change within several days. It may be evident on the first day. In most people, it is evident within the first few days. If there is no positive change after several days, the benefit of the technique should be evaluated by the responsible occupational therapist. It is important to not discontinue the technique prematurely once it is started. That’s why it is absolutely essential that the Wilbarger technique not be used indiscriminately and that its appropriateness for a specific individual be determined by an occupational therapist who is knowledgeable about sensory processing disorders.

Precautions:
1. Avoid brushing over skin lesions, burns, rashes or other obviously tender or sensitive skin areas.
2. Pay close attention to the person who is getting this input for the first time to quickly detect any unexpected responses.
3. If the skin turns red while you are brushing you are probably seeing a histamine reaction. This may indicate that you’re spending too much time on the same area. Keep moving, avoiding red area. Try to cover a big area fast.
4. If anything unusual or unexpected happens notify your occupational therapist as quickly as possible.