To Brush or Not to Brush...That is the Question
Written By: Angie Voss, OTR
The Wilbarger Brushing Protocol also known as DPPT is a very specific technique used for tactile defensiveness and sometimes other sensory processing challenges. The technique can be effective, BUT it is misunderstood, and often not taught correctly, and way over used in my professional opinion. Here are some very important points to remember about brushing:
When the brushing protocol is prescribed and recommended to address tactile defensiveness, overall sensory over-registration and/or sensory modulation difficulties it is very important to follow these guidelines....
Personally as a clinician, I do not use the technique of brushing. I feel there are so many alternatives to brushing that are just as effective (likely more effective) and well tolerated and accepted by children. In my career I have had one too many parents report to me that they were taught incorrectly and how the brushing caused MORE sensory dysregulation. The brushing technique can be of particular concern for the children who struggle with sensory modulation, mainly because of the powerful amount of sensory input involved, and the nervous system simply can not handle it all at once.
In my clinical opinion, the therapeutic benefit of the brushing protocol is the deep pressure touch which is involved during the process. So why not just incorporate full body deep pressure touch throughout the day instead? It is very well accepted, enjoyed, and can easily be added to so many daily activities throughout the day. The best part is deep pressure touch is the most accepted form of sensory input and is regulating, organizing, and calming or alerting for the brain. Toss in a little joint traction and joint compression via wheelbarrow walking, jumping, hopping, hanging from a bar, etc. and you are good to go!
It is SO important to remember that no matter what areas you are working on in regards to the sensory systems, working on the sensory foundation is the key to sensory integration and overall improved sensory processing. If there is one technique to teach first, I would pick full body deep pressure touch. And number two, I would focus on the vestibular system.
EXCEPTION TO THE RULE:
If brushing is included as part of your sensory home program simply as a form of deep pressure touch and tactile input that the child enjoys (for instance, a sensory seeker or a child who under-registers sensory input overall)...then the above guidelines are not as rigid. Also, if your child has completed the recommended Wilbarger protocol in regards to length of time and need, then occasional brushing with likely not be disruptive to the nervous system.
When the brushing protocol is prescribed and recommended to address tactile defensiveness, overall sensory over-registration and/or sensory modulation difficulties it is very important to follow these guidelines....
- Brushing needs to be done every 2 hours, faithfully (during waking hours). If not, it can back fire on the nervous system and create further sensory dysregulation and sensory processing difficulties. If you can not commit to the every 2 hours, than don't do it.
- The technique must be taught by a trained professional in order to establish competence in the amount of pressure and pattern for brushing.
- Do not let your child brush him/herself...unless they are old enough and competent to be trained to due it with the specific technique and protocol.
- Never brush the stomach, it can cause a severe systemic reaction.
- If the child is not tolerating the brushing, do NOT force it, not even in the beginning. The cornerstone and number one concept of the sensory integration theory is, CHILD LED and CHILD DIRECTED.
- You can always provide joint compression and/or joint traction independent of the brushing, and this can be achieved through a variety of activities.
Personally as a clinician, I do not use the technique of brushing. I feel there are so many alternatives to brushing that are just as effective (likely more effective) and well tolerated and accepted by children. In my career I have had one too many parents report to me that they were taught incorrectly and how the brushing caused MORE sensory dysregulation. The brushing technique can be of particular concern for the children who struggle with sensory modulation, mainly because of the powerful amount of sensory input involved, and the nervous system simply can not handle it all at once.
In my clinical opinion, the therapeutic benefit of the brushing protocol is the deep pressure touch which is involved during the process. So why not just incorporate full body deep pressure touch throughout the day instead? It is very well accepted, enjoyed, and can easily be added to so many daily activities throughout the day. The best part is deep pressure touch is the most accepted form of sensory input and is regulating, organizing, and calming or alerting for the brain. Toss in a little joint traction and joint compression via wheelbarrow walking, jumping, hopping, hanging from a bar, etc. and you are good to go!
It is SO important to remember that no matter what areas you are working on in regards to the sensory systems, working on the sensory foundation is the key to sensory integration and overall improved sensory processing. If there is one technique to teach first, I would pick full body deep pressure touch. And number two, I would focus on the vestibular system.
EXCEPTION TO THE RULE:
If brushing is included as part of your sensory home program simply as a form of deep pressure touch and tactile input that the child enjoys (for instance, a sensory seeker or a child who under-registers sensory input overall)...then the above guidelines are not as rigid. Also, if your child has completed the recommended Wilbarger protocol in regards to length of time and need, then occasional brushing with likely not be disruptive to the nervous system.