Light or unexpected touch can trigger a defensive response that significantly interferes with everyday activities such as, getting dressed, brushing hair, getting along with peers, or being in a busy classroom.
Fortunately, there is much that can be done to change the nervous system’s perception or interpretation of annoying tactile input.
Brushing Program or Therapressure Protocol
Premiere among the effective interventions is the Therapressure Protocol, more popularly referred to as the brushing program. Developed by Patricia Wilbarger, M.Ed., OTR, FAOTA, the Therapressure Protocol is a specific, professionally guided treatment regime that is usually implemented by parents. Although it has its origins in sensory integration theory, the protocol differs in that it is a passively applied sensory input, rather than a sensory based activity that the child is engaged in.
Intervention Learned through Experience
There is very little published about the Therapressure Protocol, and this is largely by design. The Wilbargers (Patricia and her daughter, Julia) feel very strongly that this is an intervention protocol that cannot be learned by reading about it or even seeing a video. A person needs to experience it from someone well trained in order to understand how to correctly administer it. Therefore, families must work with an occupational therapist (OT) who has been educated to use the technique, and who understands sensory integration theory. Additionally, a comprehensive sensory diet should be in place.
Avoid the Whisper Down the Lane
In my clinic, we directly teach it to the parents and anyone else, such as a teacher, grandparent or nanny, who might be involved in implementation. It is rather like the old game of whisper down the lane, when a phrase passed around a circle, ended up being totally different at the other end.
That is what tends to happen with the Therapressure Protocol, as the teaching passes from person to person, errors tend to occur. If the technique is carried out incorrectly, it can be uncomfortable for the child and in fact may exacerbate the defensiveness. This is why it is so very important for parents and caregivers to learn this through a trained occupational therapist.
Steps to the Brushing Program
Deep Pressure with Specific Brush
The first step of the Therapressure Protocol involves providing deep pressure to the skin through the use of a specific surgical brush. As a result, for many years, it has been popularly known as the “brushing” program.
I tell parents not to think of it as brushing, but rather as a type of massage.
Locations for Input
Input is applied only to the arms, hands, back, legs, and feet. Input can be applied to the palms of hands and bottoms of feet only if tolerated. Input is never applied to the face or abdomen.
Brush Remains in Contact with Skin
Once begun, the brush should remain in contact with the skin. Some children immediately enjoy this input, and will ask to be brushed. If your child is initially resistant, try distracting them by singing or offering them a toy.
Immediately Follow with Compressions
Immediately following the “massage” stage, the child is given gentle compressions to major joints. These compressions provide substantial proprioceptive input and are felt to be a critical part of the protocol.
Frequency and Duration
The complete routine should only take about 3-5 minutes. The immediate effect is felt to last for 1 ½ to 2 hours. For that reason, it is recommended that the protocol be administered every two hours, at least for the initial 2-4 weeks, and then tapered.
Depending on the daily schedule and family demands, I typically recommend that families administer it when the child wakes up, when they go to bed, at each mealtime and then once in mid-afternoon. For the child still in diapers, it can be done with each diaper change.
Although research is limited, we have seen this protocol significantly change the lives for the better of hundreds of children and their families. If you have a child with tactile defensiveness, please seek out the assistance of an occupational therapist trained in the Therapressure Protocol. It can make all the difference.