Therapeutic Brushing Techniques
The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT)
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.
- Patricia Wilbarger, MEd, OTR, FAOTA, developed the Wilbarger Deep Pressure and Proprioceptive Technique (DPPT), formerly known as the Wilbarger Brushing Protocol or WBP, and the Oral Tactile Technique (OTT).
- Patients with the Wilbarger Protocol, it is important to receive proper training and to update training regularly (Wilbarger and Wilbarger 1991, 2002a &2002b). Workshops on Sensory Defensiveness and Deep Pressure Touch Protocol contact Avanti Educational Programs (818) 782-7366 or go to Seminars and Workshops on Website.
- 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.
Related Resources. Check Out The Issue # 21 Edition of the Sensory Companion Newsletter Titled: The Wilbarger Protocol For Sensory Defensiveness Body Brushing In Babies: Benefits & How To Safely Do It - When body brushing is done correctly, it has numerous health benefits for a baby.
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:
Patricia Wilbarger Brushing Program
- 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
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.
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.
NB: This article is written for the parents of children who have SID and related problems. We publish it here because we know that therapists like to give their client’s caregivers as much information as possible.
By: Debbie Woodward
Many children with Sensory Integration Disorders exhibit symptoms of tactile defensiveness. In layman’s terms this simply means that they have hypersensitivity to touch and/or tactile input. This in turn may cause:
- Difficulty transitioning between activities
- Lack of attention or focus
- A fear or resistance to being touched
Patricia Wilbarger Brushing Programme
Your child may benefit from what is commonly known to most parents as “Brushing Therapy”. It is known in Occupational Therapy circles as The Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT). It was developed by Dr. Patricia Wilbarger, MEd, OTR, FAOTA, an occupational therapist and clinical psychologist that has been working with sensory processing theories for over 30 years.
When first introduced to this, many parents are a bit skeptical. How can “brushing” my child help them with their sensory integration issues and tactile defensiveness? The theory behind it is that our skin is the human body’s largest sensory organ, and therefore it is in constant contact with our nervous system; relaying information that allows us to interact effectively with our environment. Often times, the inability for the human body to process sensory input effectively can cause motor skill delays, tactile defensiveness, or social and emotional difficulties. Brushing therapy seeks to use this connection between the skin and the nervous system to assist kids who may be having difficulty organizing sensory information properly.
It is thankfully, quite simple to implement. The first step in the therapy involves using a soft, plastic, surgical brush which is run over the child’s skin, using a very firm pressure, starting at the arms and working down to the feet. The chest and stomach area are always avoided as these are sensitive areas that can cause adverse reactions. There can be some drama at first, until the child becomes accustomed to the therapy, but most children find it pleasurable after a few sessions and may even ask for it when they are feeling “off”. Along with the brushing, most practitioners will also prescribe joint compressions. In this phase of the treatment, the therapist or a parent trained by a therapist provides gentle compressions of each of the child’s major joints for a count of ten. Finally, the therapist may also suggest the Oral Tactile Technique, or OTT. This technique involves using a finger to swipe along the inside of the child’s mouth. This has been found to help with some children who have an issue with what is known as oral defensiveness. If your child is adverse to new foods because of their texture, or has a severe aversion to having their teeth brushed, they may have an issue with oral defensiveness.
If you think that your child would benefit from this form of therapy, it is important to seek guidance from an Occupational Therapist. Performing the therapy in a manner other than taught by a trained professional can be, at best, useless and could possibly do more harm then good.
Article Reprinted with Permission of Debbie Woodward