Fetal Alcohol Spectrum Disorder 101

Education & Support

The Blog

Wilbarger Protocol Brushing Technique/Joint Compressions

Posted by fasd101 on September 10, 2013 at 2:35 PM


The Wilbarger Protocol is a deep pressure technique used with students who have sensory defensiveness. The purpose
is to alter and normalise sensory processing which will assist with the students ability to function within the
school setting and impact on the students social and work behaviors.

Use the brush with a firmeven pressure. Do not sweep brush. Hold brush horizontally. Move slowly. Think of steam
cleaning and press hard enough to move the skin. Brush over clothes and or skin but do not move from skin to clothes.
ie: on arm just do skin when brushing over clothing pull it tight down to maximise pressure.

Each student should have there own brush for hygiene reasons. Always maintain contact with the person during the
brusing procedure. Use hand palm versus finger tips.

Student should be in a seated position if possible. Inform the student of the procedure to occur. Do procedure in a
calm, quiet area.

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

This is the ideal brush and to use

Here are the handles to help reduce hand fatigue.

I have never needed them.

The Wilbarger Protocol (Wilbarger, 1991) is a specific, professionally guided treatment regime designed to reduce sensory defensiveness. 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. Patricia Wilbarger, M.Ed., OTR, FAOTA, an internationally recognized expert who specializes in the assessment and treatment of sensory defensiveness, developed this technique.

Ms. Wilbarger offers training courses where professionals can learn how to administer her technique and has produced videotapes, audiotapes, and other publications. At these courses, she also shares strategies for integrating the protocol into intervention plans and training parents, teachers, and other caregivers.

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. Many adults with autism have also reported reduction in sensory defensiveness, decreased anxiety, and increased comfort in the environment through the use of this technique.

An occupational therapist who has been trained to use the technique, and who knows sensory integration theory, needs to teach and supervise the Wilbarger Protocol. This statement cannot be emphasized enough. If the technique is carried out with-out proper instruction, it could be uncomfortable for the child and may lead to undesired results. So ask your OT to teach you how to use this method.

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.

Behaviors to watch for, Change means the program is working


Behavioral Changes
__more motivated
__thinking before acting
__more open-minded
__improved organization
__sequencing improves
__improved focus
__less sensitive to smells
__less sensitive to touch
__less irritable
__better at beginning or completing projects
__less rigid behavior
__longer attention span
__decreased hyperactivity
__decrease impulsivity
__improved transitions
__participation in more activities
__ more appropriate
interactions with peers 
Physical Changes
__improved sleep patterns
__increased tolerance of grooming tasks
__increased independence in self-cares
__improved gross motor skills
__improved eating habits
__less wiggling
__more physically active
__improvement in handwriting
__more touching, hugging
__more consistent energy level
__increased tolerance to clothing
__increased repertoire of foods

Social/Emotional Changes
__improved disposition
__less controlling
__improved talking/communication
__improved tolerance of people
__less overwhelmed
__less anxious
__more emotional
__more needy
__increased self-confidence/self esteem
__less defensive
__more responsible
__more patient
__more calm and relaxed
__improved mood
__more acting out
__more affectionate
__decreased frustration
__increased interactions with others
__improved eye contact


Place your hand on the top of either shoulder and press down together 10X
Place hand on top of other shoulder and under elbow arm at the students side and press together 10X
Place fingers in a scissor position behind knuckle joints and hold finger streight with other hand.
Keeping joints streight press together 10X
Do the same for the other arm next.
Place hand on buttockand other at the front knee. Press together 10X, Alternatively press front of knee with
students bottom pressing against the back of the chair. Place hands on the top of both knees press down 10X.
Place other hand under clavicles on chest and other on back between shoulder blades, Press together and down 3X.

Wilbarger Protocol should be done every 90-120 minutes, 8-10 times per day for maximum effectiveness.

Even if you cannot keep up with that schedule, doing the most you can can really benefit your child.

I have seen it benefit my children.

Keep spreading awareness.

This disability is 100% preventable. Together, we can eliminate it!

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Please leave me any questions or comment below,

I would love to know what you think. 

Don't miss another posts, subscribe to our site in the box to the right.

And Follow me on


Categories: Advocacy Helps

Categories: Sensory

Post a Comment


Oops, you forgot something.


The words you entered did not match the given text. Please try again.

Already a member? Sign In