Tuesday, July 31, 2012

Therapy Secrets: Wilbarger Deep Pressure and Proprioceptive Technique

Looking dapper!

 I have added new treatment regimens to Baba's daily schedule.  Honestly, I didn't want to and I resisted it for quite some time.  However, I have seen immediate improvement, which is wonderful and awful.  I feel guilty for not doing it sooner.  Sigh.  Anyway, I thought I'd share them with you.

We started the Wilbarger Deep Pressure and Proprioceptive Technique.  It is a Sensory Integration technique that I have used for years in my practice.  We use a special brush (looks like the brush surgeons use to prep for surgery) to brush a child's back and limbs.  Then we gently push various joints together (joint compressions). 

Click here for link location.

My son suffers from mild tactile defensiveness and some sensory modulation difficulties.  I have noticed an increase in tactile (touch) defensiveness since our move, resulting in less solid food consumption.  This isn't unusual, as stress can increase sensory issues.  He was also getting more easily startled, scratching around his diaper, tugging at his clothes, pulling off his sun hat, and generally appeared uncomfortable.

Does it work?
It's only been a few days and there is dramatic improvement.  He seems more comfortable, he isn't tugging on his diaper as much, he is able to tolerate tooth brushing and face washing, he kept his sun hat on, and does not seem as easily startled. 

Is it easy?
Yes, it's easy to learn.  No, it's not easy to brush a very mobile toddler, every 2 hours.  At least I can rest when he's sleeping!

Who should do it?
Any child who experiences sensory modulation problems could potentially benefit from such a program. Seriously, I used it on almost 90% of my caseload.  It really seemed to help children modulate their senses, calming their mind and body, so they could concentrate on the rest of the therapy session.  Children with Autism, cerebral palsy, or any illness that causes movement issues are also likely to suffer at least a mild sensory processing issue, so they would benefit from this technique too.  

Who can do it?
Anyone can be trained to do this technique.  In fact, it has to be implemented by parents, babysitters, nannies, teachers, aides, or any person who will be watching your child for more than 2 hours. 

It is very important to be trained, for improper technique can actually make things worse.  But it's worth the effort. 

How long do I have to do it? 
It's usually for at least 2 weeks of intense treatment (brushing every 2 hours when awake) and than as needed for high need periods, or a regimen recommended by your therapist.  It can be helpful for children who really respond to deep touch.

I hope you found this helpful.  For more information and training ask your occupational therapist for details.  NOTE:  Not all OT's are trained in this technique, though many are.  Ask your therapist if they have been trained.  If they don't have the training, ask if they can refer you to someone with the training to help you.

Can you show me how to do it online?
It's really not a good idea to get this training by video.  It's really important to know how hard to push, how to set up your child for the technique, how to get over any resistance, and what pattern of movement to follow.  It's also important for a trained therapist to give you a sensory diet...which is part of this program.  They can only do that, if they know your child and is able to prescribe the appropriate program.

Here are some links for more information.

For general information on the technique:

More detailed information on why we use this technique despite lack of research:

If you want very detailed information:

Have a great day!


Update and precautions:
Baba is having a flare of of eczema so we have to stop the treatment until the flare up goes away.  It's usually not a big problem for mild skin issues, but it's not a good idea to brush on any part of the skin with an open soar.  If it's a small area and you can avoid brushing it, then it's probably okay to continue the program.  However, it's best to ask your occupational therapist for recommendations. 


  1. We've been doing brushing with Lily off and on for years and I'm always amazed at the difference it makes. And it really is an easy technique to learn. :)

    1. Yes, easy to learn...not so easy to implement: )

  2. I brushed my son with SPD twice daily, which was recommended by his OT for his tactile seeking. It's best not to brush right at bedtime, because after brushing, children are more aroused. Some days I still brush him as I'm waking him up after a friend told me that she wakes her son that way, and he wakes up in a better mood than on days when she does not brush him. Brushing also improves focus, thought to be due to dopamine released in the brain as brushing is done, so this is helpful for kids with ADHD. I've even heard that in adults with early Parkinson's, brushing is helpful for them.

    1. Hi Janna! Thank you visiting and for your helpful suggestions!

      I'm glad this method is working for your child. This technique is very helpful for those with SPD.

      You're right. It's probably a good idea not to do it minutes before bed, but it's usually ok to do it half hour before bedtime. It usually puts a child into quiet alert mode, which can help them calm down from hyper-alert state and finally to drowsy.

      The key is to do a very comprehensive joint compression session at the end. The brushing wakes up the body and the joint compressions calm the body. If your child is having a particularly hard day, you can also add soothing deep massage to help them calm their system further.

      It's also important to calm your own body first before starting the brushing. We are essentially transferring our energy as we brush our children. When our energy is calm, we are literally healing with our touch.

      Yes! I have also seen benefits in adults, though it's harder for us to find someone to brush us! I have never tried it on someone with Parkinson's, but I can see how it might benefit them!

      Thank you for your thoughtful comment!

  3. You son is gorgeous and I am a fan of the DPPT! Although in the school setting it is not nearly as easy to implement appropriately as in birth to three OT! I have been a pediatric OT in early intervention (0-5) for 13 years and continue to see most of the children improve with this technique. Some even become putty in your hands! This has inspired me to do a blog post about it too, although as OTs we need to be careful that people realize there is a specific training required and we need to be careful not to demonstrate and then not provide appropriate followup care and direction.

  4. Where can I get trained in DPPT?


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