Day: June 21, 2023

If you’ve looked for sensory strategies, you may have considered Sensory brushing as an option. This post will describe what sensory brushing means, why it is used, and what the potential benefits can be. 

When faced with a new or complicated list of symptoms and behaviors, there are several techniques that may be offered or trialed by occupational therapists.  One of the more popular and widely used programs is sensory brushing.  Therapeutic techniques are definitely not one size fits all, therefore, researching, trial and error, and professional judgment are advised when trying any new technique.

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What is sensory brushing?

Sensory brushing is a layperson’s term for the Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT). 

In the past it was simply referred to as the Wilbarger Brushing Protocol, or the Wilbarger Protocol.  The DPPT 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 (the over-responsiveness of the protective responses of the nervous system).  

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.

Based on the theory of Ayres Sensory Integration, the DPPT, or sensory brushing technique, uses a prescribed method of providing stimulation through pressure touch massage, to help the mind-brain-body self-organize. 

The protocol also includes a series of joint compressions that are always used in conjunction with the brushing to enhance joint perception and feedback. This is based on proprioceptive input through the joints and deep input through the skin.

The Wilbarger Protocol is designed to be used in conjunction with an individualized sensory “diet” based on the specific needs of the child and carried out under the guidance of someone familiar with the protocol and trained in sensory integration theory and practice. 

Check out this sensory processing disorder chart on the OT Toolbox for more information on sensory processing.

 Please note: training in sensory brushing is absolutely necessary before attempting to use this technique in practice, otherwise harmful or ineffective influences may be the result.  Be sure to receive the most up to date brushing protocol training as it has changed over the years.

When to trial a sensory brushing program?

There are several situations that may be a predictor of using a sensory brush in occupational therapy as a tool to support sensory needs.

• Tactile defensiveness – fear and discomfort of being touched, touching things, or having something touch the skin. The brushing program can reduce tactile defensiveness and oversensitive responses
• Sensory seeking – adding extra deep pressure and sensory input can help the body regulate sensory information
• Difficulty with self regulation – including paying attention, transitioning between activities, motor coordination, functional communication, safe behaviors

sensory brush benefits

What does a sensory brushing do?

Sensory brushing can do several things, and depending on the individual and their sensory preferences or sensory needs, there can be different results following use of a sensory brush.

• Improved ability to transition between tasks
• Decreased discomfort from being touched, or touching
• Improved self regulation with less behavioral outbursts
• Decreased picky eating
• Ability to wear more of a variety of clothes, and engage in different textures
• Satisfy the need to explore and touch everything
• Self awareness, self control, handling new situations easier

• A sensory brush may support tactile processing differences.
• Sensory brushing can be calming or organizing when used in a sensory diet
• Use of a sensory brush can support tactile resistiveness

The tactile system sends information into the touch receptors from our skin.  There is much to consider when thinking about touch.  Pressure (light versus heavy), texture, (rough, sticky, soft, wet, dry, silky, smooth, bumpy) temperature, (hot, warm, cold), and emotions regarding texture, (will I be able to wash my hands?) People react differently to different types of touch depending on their system. 

Children with difficulty integrating the tactile system tend to look like this:

Oversensitive (defensive):

•  Does not like to be dirty
• Avoids touching food
• Fingers splayed after touching object
• Anxious about being messy
• Avoidant
• Irritated by tags or types of clothing
• Doesn’t like grooming (hair cutting, shampooing, tooth brushing, fingernail cutting)
• React negatively to touch (pulling away, hitting, or crying)

Under-responsive:

• Always dirty
• Constantly touching objects or people
• Doesn’t mind being messy
• Doesn’t notice when hands or face are messy

wilbarger brushing protocol

What do I need to know before starting the Wilbarger brushing protocol?

Because of the ready availability of (affiliate link) sensory brushes on Amazon, it can be easy to get your hands on one (and feel the effects of a sensory brush on your hands!) But, before you start using one, it’s important to consider specific things you should know about sensory brushing or the DPPT.

• The sensory brushing program, when performed correctly, can have some great benefits.  If performed incorrectly, there may be negative effects, or be ineffective
• There is a specific brush to use for the brushing program – in order to be consistent and effective, look for a (Affiliate link) Willbarger approved brush.  There is a basic and a (affiliate link) deluxe model.  The deluxe model has a larger handle for comfort and control, but is not necessary.  Other brushes, hair brushes, paint brushes, etc. are not consistent in the pressure they provide
• Apply firm consistent pressure – light pressure will disorganize the system or cause increased arousal
• Do not brush the stomach or chest.  Brushing the stomach may affect digestion, and the chest may affect respiration.  
• Stay away from the face when brushing.  It is too sensitive an area.  Instead use a washcloth, or warmed lotion
• Sensory brushing is more effective over bare skin, however if brushing over clothing pull the clothing tight and eliminate bumps
• Follow brushing with joint compressions
• Sensory brushing should not cause pain. It might take some practice and effort to complete the cycles, but it will be worth it!
• Use the most updated sensory brushing protocol
• Best practice is to brush every 90 minutes to 2 hours, stopping at least 2-3 hours before bedtime, as brushing can increase arousal level.  Aim for at least six brushes daily
• Include brushing into daily routines such as diapering, toileting, dressing, transitions between activities
• Complete two to three weeks of this intense brushing, then discuss fading with a therapist

What to watch for when using a sensory brush:

Sensory brushes, like any sensory tool can have detrimental side effects. For this reason, it’s important to consult an occupational therapy professional trained in use of these tools.

• Negative side effects such as difficulty eating, sleeping, worsening of behavior, digestive issues, moodiness, etc.  If these occur, advise spreading out the brushing until the learner’s system accommodates to it
• Positive behavioral changes – encourage caregivers to keep a record or chart to track behaviors

A word about evidenced based practice

Governing agencies strive to produce techniques that are backed by evidence and research.  While there is evidence that the brushing program can be effective, it is inconsistent.  All sensory treatment is, unfortunately, based on trial and error. 

Because the treatment does not occur in a bubble, it is difficult to get definitive results and research.  What works one day, may not work the next.  Much like the use of weighted blankets and compression garments, there is evidence found in the literature, and there is skilled experience from professionals.

A treatment protocol that seems to be working may be influenced by diet, the weather, mood, concurrent techniques, and 57 other variables.  Because the program (generally) does not cause harm, it is worth trying.  

Personal Therapeutic Experience with Sensory Brushing:

I have used the brushing program personally, and in practice during the past 25 years.  It has worked for some, but not all.  Personally I found it difficult to keep up with regimen of brushing. 

Even though it was only 3-5 minutes each cycle, remembering to do it every 90 minutes was tough.  In addition, when I was feeling better, I could not be sure it was the brushing that was affecting me.  It could have been a sunny day, my mood was elevated, I had a good night’s rest, and had a good breakfast.  It did not harm me, and even if it was a placebo, it was worth it to feel better. 

Give parents some leeway as they incorporate this into their busy lives.  Remind them it is only for a couple of weeks.  Like adding an antibiotic, it is tough at first, but will be over soon.  If caregivers can only get four cycles in a day, that is better than nothing.  If they are not doing it consistently enough to gauge progress, it might be better to wait until they are able to commit to this program before starting. 

Sensory brushing, as with any other techniques is definitely not one size fits all.  My philosophy is to offer the least restrictive or invasive option first.  Start with a sensory diet, play based activities, and therapeutic activity before jumping straight into sensory brushing or DPPT.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.