Monday, February 8, 2010

Brushing protocol

We have a new adventure at our house. The OT (occupational therapist)that she sees thought it was time to start doing a "brushing protocol," also called the Wilbarger Protocol with Maddy. Basically we use a surgical scrub brush (seen below) to brush along her arms, legs, hands, feet and back in long strokes. Then we do compressions on the joints in her arms and legs. We do this every 90 minutes to 2 hours all the time that she is awake, for two weeks.

So far, Maddy is not thrilled with it. She has stopped screaming for half an hour after the protocol, but she is pretty fussy through it, and for a while afterward. We are told that it may get better, or it may just be a rough two weeks. For about 60% of the kids there is some improvement, for the other 40% of the kids there isn't. But, it is worth doing either way, since it is the first step in helping her better handle sensations that are uncomfortable for her, and eventually it may even help her accept foods that she won't try now.

This is some information about the protocol, for those interested.
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.

We have been warned that it will probably have its ups and downs. One of the things they suggest is getting a new toy that Maddy only gets to play with while we are doing the brushing protocol. If anyone has any great ideas for a cool toy, please leave it in the comments. We are hoping to get her something cool and new this week so that there is a toy advantage to having the protocol done.

They also think that it is time for Maddy to start wearing shoes. It is fine for her to still wear her requisite one piece outfit, we will just get shoes big enough to fit over them. Also, because of her texture and nerve sensitivity, they want us to go to a shoe store that can fit the shoes to her feet, so that they will fit right, and not have the indentations from another child wearing them. With my older kids we always used hand-me-downs, but since Maddy is already so picky about feet things, we are told that new shoes can make a big difference in whether she will accept shoes in general. So, anyone who knows of good sales, or where to get coupons for Stride Rite or similar shoe stores, we would love the tip off. If anyone is a Nike employee, or knows one, Nike and Stride Rite were the two that her OT mentioned.

While it is going to take a lot of energy to help Maddy with the brushing protocol and the next 14 weeks of OT, I am so grateful that there are things we can do to help Maddy with moving forward. Another interesting thing to me, and probably to anyone who knew me as a child, is that the OT told us that Maddy walking on her tip-toes is probably because her feet are so sensitive and her nerves misfire more in her feet than on her toes. I guess that is oftentimes an inherited issue. I certainly walked on my toes for most of my childhood. I always thought that it was because I had tight tendons, but the OT says that tight tendons are a side-effect of walking on my toes, but probably the cause of walking on my toes was a similar sensitivity issue to Maddy's. Guess she really is my daughter. :-)


Last Family said...

The dollar store around here has a pretty good toy selection. We got a toy there that had an animal in the center and rings that attatched to it. It is very colorful and fun, with a little rattle thing inside the animal. You may not be able to find that same one, but there are lots of toy options at the dollar store so that may be a good place to look. I don't have any good suggestions for shoes.

Dorothy said...

How about giving her a roll of transparent tape and letting her pull and wad and stick the tape any which way she wants?

JuliaKoponick said...

Dorothy, that would be especially tortuous for Maddy. I will keep that in mind if she ever gets over some of her texture issues.

Dorothy said...

Oops. Guess I don't really understand her issues. Sorry! I've just seen lots of little ones through the years having a great time with tape. Maddy is not going to be one of them it seems. :) Good luck!

JuliaKoponick said...


No worries. Part of why we have such a hard time getting Maddy to try most foods is that she has sensitivity issues on her hands, feet, legs, mouth and most of her trunk. She doesn't like a lot of sensations, and anything that feels sticky or mushy are completely out of her comfort range. The OT is hopeful that by the time she is 18 months we can get her over part of it. That is a large part of why we are trying the brushing protocol, to help her nervous system accept more kinds of sensations. After she learns to accept them, then we can try to teach her to self-sooth when those sensations are on her. We are hopeful.

Personally I loved watching my older kids with tape. They still love tape so much we have to keep a couple rolls hidden so that we have some when the adults need it. :-)