The Wilbarger Brushing Protocol

The Wilbarger Protocol is a deep pressure technique used with children who have sensory defensiveness. The purpose is to alter and normalise sensory processing which will assist with the child’s ability to function within the school or home setting and impact on the child’s social and work behaviours.

The first step of the Wilbarger Protocol involves providing deep pressure to the skin on the arms, back, and legs using 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. 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.

The complete routine should only take about three minutes. 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.

 

When Using the Brush:

  • Use the brush with a firm and even pressure.
  • Do not sweep the brush.
  • Hold the brush horizontally.
  • Move slowly.
  • Think of steam cleaning and press hard enough to move the skin.

 

Notes:

  • Brush over clothes and/or skin but do not move from skin to clothes.
  • Each child should have their own brush for hygiene reasons.
  • Always maintain contact with the child with your other hand during the brushing procedure, especially when moving to other areas of the body. Use hand palm versus finger tips.
  • The child should be in a seated position during brushing if possible and it should be done in a calm, quiet area.

 

The Procedure:

  1. Brush arms covering as much surface area as possible, 5 strokes in a up/down motion, covering the area 2X.
  2. Brush Palms 5X
  3. Brush back 5X up and down and 5X side to side.
  4. Brush the other arm.
  5. Brush legs below the knee covering as much surface as possible, % strokes in a up/down motion covering 2X.
  6. Brush feet holding one hand on top and the other using the brush in a in a sweeping movement. Move top hand in sync with the bottom one 5X.

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, but this has rarely occurred in practice.

 

The Wilbarger Technique and Science

The Wilbarger Protocol (Wilbarger, 1991) is a specific, professionally guided treatment regime designed to reduce sensory defensiveness, developed by Patricia Wilbarger. 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.

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. The Wilbarger Protocol represents one of those difficulties in clinical practice where positive results are observed in treatment regimens that have not yet been fully validated by scientific research.