First, some background. Ava seems to have a fair amount of tactile defensiveness. Prior to beginning occupational therapy she hated tags in her clothes. She never allowed me to fix her hair with barrettes or hair bands. She barely tolerated brushing her hair. For months, brushing her teeth involved pinning her down and brushing them as she screamed. She panicked every time she needed a band-aid. She is an extremely picky eater and her pickiness seems to be related to food texture. She doesn't like to get her hands messy and even as a very young toddler taught herself to use utensils rather than have to touch her food. Art activities were only tolerated when a paint brush or some other tool kept the paint from her hands.
Several weeks ago our occupational therapist gave me a surgical brush and showed me the brushing/deep pressure technique. At first it felt awkward and I was self conscious. Ava was a bit intolerant at first as well. After only a few sessions it became something we both enjoy. I tell her it is time for brushing and she hops right into my lap.
Now, you are supposed to do the technique every 90 minutes to 2 hours all day long. We don't. We do the technique twice a day before nap and before bedtime. I am going to try to incorporate it right after morning dressing as well. However, even with a twice a day schedule I have noticed changes.
Ava now lets me fix her hair. She is more tolerant of a wide variety of clothing situations. She is more adventurous with touching art materials, sticky foods, and muddy or dirty things. She's allowing band-aids without much of a fight. For Ava, the brushing technique has worked wonders.
She's also having a bit of a speech and language and social developmental spurt and I'm not sure that is all coincidence. I think that she's feeling more comfortable in her own skin and less overstimulated by her environment. That translates into more mental resources left over for communication.
So what is the Wilbarger Deep Pressure and Proprioceptive Technique?This technique of brushing the skin and joint compressions was developed by Dr. Patricia Wilbarger, an occupational therapist and clinical psychologist with 30 years of experience working with children with sensory processing issues. The technique involves running a soft surgical brush (it reminds me of the brush the hospital uses to clean newborn babies) over the arms and hands, back, and legs and feet of the child with a firm pressure. The brushing is followed by a sequence of gentle joint compressions of the fingers, elbows, shoulders, hips, knees, ankles, and spine. The entire process takes only minutes and is often soothing and enjoyable for both parent and child.
Here is a link to a youtube video of an OT using the brushing technique with a young toddler. The video is pretty different than the way we do it. Our way separates the brushing from the joint compressions and is smoother, slower, and more relaxing.
Instructions for the Wilbarger Deep Pressure and Proprioceptive Technique (brushing technique)Before I explain how we do the technique I should say that this is just the way that we do it as shown to us by our particular occupational therapist for our child. The technique may vary in other situations. Also, I highly recommend that you only perform this technique after being shown how to do it by a certified occupational therapist (which I am not).
Use a soft surgical brush. Use pressure firm enough that the bristles on the brush bend. You may do the technique through clothes. My daughter often seems to be a little hot and sweaty and the technique seems to be easier to administer through clothing. Never brush the tummy or face.
We sing a song as we do the technique. At first I would modify the "This is the way we wash our hands, wash our hands, wash our hands. This is the way we wash our hands so early in the morning." song. The first verse would be, "This is the way we brush our arm, brush our arm, brush our arm. This is the way we brush our arm, brush our arm with Mommy." (and so on for each body part). Now I just sing the numbers 1-10 to the melody of a lullaby. It is soothing and peaceful and helps us keep a calming rhythm during the entire technique.
Sit down with crossed legs and invite your child to sit in your lap. Their back is towards you. Begin on whichever side of the body is most comfortable with you. We begin on the right. With a firm pressure, stroke up and down the full length of each body part in the sequence described from 3-10 times (as many as your child will tolerate) moving smoothly from one section of the body to the next.
- Right arm and hand. (Both sides.)
- Back. (Have child lean forward so you have room.)
- Left arm and hand. (Both sides.)
- Left leg and foot. (Both sides.)
- Right leg and foot. (Both sides.)
You've now worked your way around the body in a circle with the brushing. Set the brush down and move right into the joint compressions. These are difficult to describe in text, which is why it is so important to have an OT demonstrate the technique for you. I will try.
- Right elbow. Bend elbow 90 degrees supporting elbow from bottom with left hand and holding the wrist with your right. Gently push elbow down into your left hand 10 times.
- Right shoulder. Straighten child's arm. Place left hand on top of shoulder still holding wrist with your right hand. Hold arm away from body and push straightened arm towards the shoulder 10 times.
- Right hand's fingers and thumb. Gently squeeze each finger and thumb between your thumb and finger (one at a time) starting at the base of the finger and sliding towards the tip. Do this once per finger.
- Left elbow. Same technique as before.
- Left shoulder. Same technique as before.
- Left hand's fingers and thumb. Same technique as before.
- Left hip. Cradle the left hip from the bottom with your left hand. This is kind of like having your child sit on your left hand with the left side of their bottom. With their leg bent bring their leg towards their tummy almost like they are going to hug their legs. Place your right hand on their left knee and press down toward their hip 10 times.
- Right hip. Same technique as before.
- Knees and ankles. With the child still in your lap place both feet firmly on the floor with their legs bent at a 90 degree angle. Place your hands on top of their knees and gently press down towards the floor 10 times.
- Back. Set them down on the floor right in front of you and have them cross their legs and sit up straight. Place one hand on their chest and the other on their back and press gently towards the floor 10 times.
Ava just melts into my arms by the end. It is a really peaceful time where we are completely focused on each other and we both enjoy it. The trick is to find the time in a busy day to work it into your routine.