Reblogged from: Wilbarger Protocol for Sensory Defensiveness via The Parents’ Place.
Ask the Expert: The Wilbarger Protocol for Sensory Defensiveness
Autism Asperger’s Digest magazine Sept-Oct 2004 issue
Ask the Experts
The Wilbarger Protocol for Sensory Defensiveness
By Ellen Yack, B.Sc., M.Ed., O.T., Shirley Sutton, B.Sc., O.T. & Paula Aquilla, B.Sc., O.T.
Q: My 5 year-old daughter was recently evaluated for sensory processing difficulties. One of the treatments being suggested is the ‘brushing technique.’ What can you tell me about it?
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. Patricia Wilbarger, M.Ed., OTR, FAOTA, an internationally recognized expert who specializes in the assessment and treatment of sensory defensiveness, developed this technique.
Ms. Wilbarger offers training courses where professionals can learn how to administer her technique and has produced videotapes, audiotapes, and other publications. At these courses, she also shares strategies for integrating the protocol into intervention plans and training parents, teachers, and other caregivers.
There currently is a lack of documented research to substantiate this technique. However, the protocol has been used by many occupational therapists who have noted positive results with a variety of populations. Many parents of children with autism have reported that their children have responded positively to this technique, including reduction in sensory defensiveness, as well as improved behavior and interaction. Many adults with autism have also reported reduction in sensory defensiveness, decreased anxiety, and increased comfort in the environment through the use of this technique. We have observed significant behavioral changes in many of our clients following the introduction of the Wilbarger Protocol.
The Wilbarger Protocol represents one of those difficulties in clinical practice where positive results are observed in treatment regimes that have not yet been fully validated by scientific research. However, because of the strength of anecdotal reporting and our own observations, we feel we would be doing a disservice if we did not advise our clients about this technique. When we discuss this option with our clients, we review why it is being recommended and provide them with information on sensory defensiveness. We also inform them about the absence of research in this area, and we make it clear that it is their decision if they want to include the technique in their treatment regimes.
An occupational therapist who has been trained to use the technique, and who knows sensory integration theory, needs to teach and supervise the Wilbarger Protocol. This statement cannot be emphasized enough. If the technique is carried out with-out proper instruction, it could be uncomfortable for the child and may lead to undesired results.
The first step of the Wilbarger Protocol involves providing deep pressure to the skin on the arms, back, and legs through the use of a special surgical brush. Many people mistakenly call this technique “brushing” because a surgical brush is used. The term “brushing” does not adequately reflect the amount of pressure that is exerted against the skin with the movement of the brush. A more appropriate analogy would be that it is like giving someone a deep massage using a surgical brush. The use of the brush in a slow and methodical manner provides consistent deep-pressure input to a wide area of the skin surface on the body. Ms. Wilbarger has found and has recommended a specific surgical brush to be most effective. The face and stomach are never brushed.
Following the “massage” stage, the child receives gentle compressions to the shoulders, elbows, wrists/fingers, hips, knees/ankles, and sternum. These compressions provide substantial proprioceptive input. Ms. Wilbarger feels that it is critical that joint compressions follow the use of the surgical brush, and if there is no time to complete both steps, then compressions should not be administered.
The complete routine should only take about three minutes. This technique can be incorporated into a sensory diet schedule. The procedure is initially repeated every ninety minutes. After a period of time, the frequency is reduced. Eventually the procedure can be stopped, but gains can be maintained. Some children immediately enjoy this input, and others resist the first few sessions. You may distract the child by singing or offering a mouth or fidget toy.
Some children really like the administration of this protocol and will seek out the brush and bring it to their parents, teachers, or caregivers. Other children tolerate it with little reaction, and occasionally a child is resistive. If the child continues to resist, and you see negative changes, you must reconsider the use of the technique and contact the supervising therapist. This has rarely occurred in our practice.
A sensory diet is a planned and scheduled activity program designed to meet a child’s specific sensory needs. Wilbarger and Wilbarger (1991) developed the approach to provide the “just right” combination of sensory input to achieve and maintain optimal levels of arousal and performance in the nervous system. The ability to appropriately orient and respond to sensations can be enhanced by a proper sensory diet. A sensory diet also helps reduce protective or sensory defensive responses that can negatively affect social contact and interaction.
There are certain types of sensory activities that are similar to eating a “main course” and are very powerful and satisfying. These activities provide movement, deep-touch pressure, and heavy work. They are the powerhouses of any sensory diet, as they have the most significant and long-lasting impact on the nervous system (Wilbarger, 1995; Hanschu, 1997.)
There are other types of activities that may be beneficial, but their impact is not as great. These “sensory snacks,” or “mood makers,” are activities that last a shorter period of time and generally include mouth, auditory, visual, or smell experiences.
A sensory diet is not simply indiscriminately adding more sensory stimulation into the child’s day. Additional stimulation can sometimes intensify negative responses. The most successful sensory diets include activities where the child is an active participant. Every child has unique sensory needs, and his sensory diet must be customized for individual needs and responses.
This material was adapted from Chapter 5, “Strategies for Managing Challenging Behaviors” that appears in the authors’ book, Building Bridges Through Sensory Integration.
Ellen Yack has practiced occupational therapy since 1979 and is currently the Director of Ellen Yack & Associates Pediatric Occupational Therapy, a private agency providing occupational therapy services to children, adolescents, and their families in Toronto. Her areas of expertise include sensory integration, autism, and learning disabilities.
Shirley Sutton has worked as an occupational therapist for children with special needs for more than 25 years. She currently has a private practice in Collingwood, Ontario, and also works with Children’s Therapy Services of OSMH in Early Intervention.
Paula Aquilla is an occupational therapist who has worked with adults and children in clinical, educational, home and community-based settings. She was the founding executive director of Giant Steps in Toronto, and directs Aquilla Pediatric Occupational Therapy, also in Toronto, serving families with children who have special needs.