Understanding the Wilbarger Brushing Protocol:
A Comprehensive Guide for Sensory Processing Support
The Wilbarger brushing protocol represents one of the most widely recognized and effective interventions in occupational therapy for addressing sensory processing challenges in children. Developed by occupational therapist Patricia Wilbarger, this specialized technique has become an essential component of sensory diets for children experiencing various sensory processing difficulties. Understanding why and how to use the Wilbarger brushing protocol can be an important part of a child's comprehensive sensory treatment plan.
What is the Wilbarger Brushing Protocol?
The Wilbarger brushing protocol is a systematic sensory intervention technique used primarily in occupational therapy to address symptoms of sensory processing disorder (SPD). This evidence-based approach specifically targets children who exhibit sensory seeking behaviors, sensory defensiveness, or other manifestations of sensory modulation difficulties. The protocol works by providing controlled tactile and proprioceptive input to help regulate and organize the nervous system.
As a treatment option for SPD, the Wilbarger brushing protocol provides internal organization through carefully administered tactile and proprioceptive stimuli. The technique is most commonly implemented for children diagnosed with sensory modulation disorder, which represents a significant subcategory of sensory processing disorder. However, its applications extend beyond SPD alone, proving beneficial for children with autism spectrum disorders or ADHD when there is a clear sensory component contributing to their symptoms.
The Science Behind Sensory Integration
To understand how the Wilbarger brushing protocol works, it's important to grasp the underlying principles of sensory integration theory. The human nervous system constantly processes information from various sensory channels including touch, movement, body awareness, sight, sound, smell, and taste. For children with sensory processing difficulties, this integration process becomes disrupted, leading to either over-responsiveness (sensory defensiveness) or under-responsiveness (sensory seeking behaviors) to sensory input.
The brushing protocol addresses these challenges by providing deep pressure touch and proprioceptive input in a structured, predictable manner. This systematic approach helps to desensitize an overactive nervous system or provide necessary input to an under-responsive system, ultimately promoting better self-regulation and functional behavior.
Professional Supervision and Implementation Requirements
The Wilbarger brushing protocol requires strict professional oversight and cannot be implemented without proper training and supervision. The program must be supervised by an occupational therapist who has extensive experience and specialized training in using this specific protocol. This professional requirement exists because improper implementation can potentially overstimulate or negatively impact a child's nervous system.
The protocol is notably intensive, requiring families to commit to administering the procedure every 90 minutes to 2 hours during all waking hours for a minimum of one week. This frequency is not arbitrary but is based on neurological research indicating optimal timing for sensory integration benefits. The timing between sessions is critically important: intervals must not be less than 90 minutes, as shorter gaps may overload the nervous system and cause adverse effects. Conversely, allowing more than two hours between sessions significantly decreases the desired therapeutic effect.
After the initial one-week intensive period, the supervising occupational therapist conducts a comprehensive re-evaluation to determine whether the child would benefit from continuing with additional sessions. This assessment considers the child's response to the intervention, any behavioral changes observed, and the family's ability to maintain the protocol effectively.
Step-by-Step Protocol Implementation
Each session implementing the Wilbarger brushing protocol follows a specific sequence designed to maximize therapeutic benefits while ensuring safety and comfort. The session begins with the use of a specially designed sensory brush, which differs significantly from regular household brushes. This therapeutic brush features specific bristle density, firmness, and size to provide the appropriate level of sensory input.
The brushing technique involves applying moderate, consistent pressure along specific body areas in a predetermined sequence. The process starts with brushing the full length of each arm, moving from shoulder to fingertips with firm, steady strokes. Next, attention turns to the back, where the brush is applied across the entire surface area, maintaining consistent pressure throughout. Finally, each leg receives the same systematic brushing treatment, working from hip to toes.
Following the brushing phase, a series of joint compressions are carefully applied to the child. These compressions involve gentle but firm pressure applied to major joints including shoulders, elbows, wrists, hips, knees, and ankles. The joint compressions serve a crucial purpose in the protocol, helping to extend and maintain the organizing effects of the brushing until the next scheduled session.
Individual Responses and Considerations
Children's responses to the Wilbarger brushing protocol can vary significantly depending on their specific sensory profile and the particular subtype of sensory modulation disorder they experience. Some children will immediately embrace and thoroughly enjoy the deep pressure input provided by both the brushing and joint compressions. These children, often identified as sensory seekers, may actively request the intervention and demonstrate visible relaxation during sessions.
Conversely, children with sensory defensiveness or tactile sensitivity may initially show hesitation or resistance to the protocol. For these children, the intervention may feel overwhelming or uncomfortable at first, requiring careful monitoring and potential modifications to pressure or technique. Experienced occupational therapists skilled in the protocol understand these individual differences and can adjust the approach accordingly while maintaining therapeutic effectiveness.
Remarkable Results: Sleep and Communication Benefits
One of the most frequently reported benefits of the Wilbarger brushing protocol involves significant improvements in sleep patterns and quality. Many families report that the Wilbarger brushing protocol eliminates sleep problems that have persisted for months or even years. Children who previously struggled with falling asleep, staying asleep, or achieving restful sleep often show dramatic improvements within the first week of consistent protocol implementation.
Additionally, parents frequently observe increases in verbal communication and overall language development. This improvement likely results from the nervous system's enhanced organization, which allows children to better focus on and engage in communication activities. The calming effect of the protocol appears to reduce the sensory overload that may have previously interfered with language processing and expression.
Understanding Sensory Seeking Behaviors
Children identified as sensory seekers often display constant movement, difficulty sitting still, excessive talking, and apparent inability to focus on tasks. These behaviors typically stem from an under-responsive nervous system that requires additional sensory input to achieve optimal arousal levels. The Wilbarger brushing protocol addresses this need by providing intensive, organized sensory input that helps satisfy the nervous system's craving for stimulation in a structured, therapeutic manner.
For sensory seeking children, the protocol often results in decreased hyperactivity, improved attention span, and better behavioral regulation. Parents frequently report that their previously "constantly moving" child becomes more settled and able to engage in quiet activities following consistent protocol implementation.
Real-World Success Stories
Many families share transformative experiences with the Wilbarger brushing protocol. Parents often describe children who previously struggled with focus, attention, and behavioral regulation showing remarkable improvements in these areas. One common pattern involves children initially thought to have autism spectrum disorders who, upon closer evaluation, demonstrate primary sensory processing challenges rather than autism-specific symptoms.
These children typically maintain strong social engagement and connection with others but struggle with attention and self-regulation due to sensory overload. The distinguishing factor often involves their social awareness and desire for interaction, combined with apparent distractibility caused by sensory processing difficulties rather than social communication challenges. I personally implemented this protocol with my son when he was 3 years old under the supervision of an occupational therapist and noticed dramatic improvements in his focus, sleep and communication. He was also an extreme sensory seeker constantly moving and touching everything he could get his hands on. At one point we were unsure if he potentially had autism, because eye contact was hard for him simply because he was so distracted by everything around him sensory wise. After consulting with an OT that had extensive experience in sensory integration, we learned the symptoms he was presenting were actually more related to sensory processing challenges.
Long-term Considerations and Ongoing Support
While the intensive phase of the Wilbarger brushing protocol typically lasts one week, the benefits often extend well beyond this initial period. Many children maintain improved regulation and sensory processing for weeks or months following the intensive intervention. However, some children may benefit from periodic "booster" sessions or integration of similar sensory strategies into their ongoing sensory diet.
The protocol's effectiveness demonstrates the remarkable plasticity of the nervous system and its capacity for positive change when provided with appropriate, systematic sensory input. For families dealing with sensory processing challenges, the Wilbarger brushing protocol offers hope and concrete tools for supporting their child's development and daily functioning.
Additional Resources:
- Additional information about Sensory Disorders
- Vestibular Disorder
- Proprioceptive Dysfunction
- Oral Defensiveness
- Olfactory Dysfunction
- Auditory Dysfunction
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