THE WILBARGER PROTOCOL FOR SENSORY DEFENSIVENESS
The Wilbarger Protocol (Wilbarger & Wilbarger, 1991) is a specific professionally guided treatment regime designed to reduce sensory defensiveness, which involves the provision of deep touch pressure throughout the day. This technique was developed by Patricia Wilbarger, an occupational therapist, who specializes in sensory defensiveness. The technique has its origins in sensory integration theory.
There is no research yet to substantiate this technique. However, we could not ignore the favorable responses that were reported about this technique. We now have observed significant behavioral changes in many of our clients following introduction of this technique and a growing number of parents and individuals with autism are reporting similar findings.
This technique needs to be taught and supervised by a trained occupational therapist who has the expertise in the area of sensory integration. Here is a sample of the instruction sheet that we provide our clients.
WILBARGER PROTOCOL
Apply heavy, consistent pressure, on the arms, hands, back, legs and feet in an up and down motion using the special surgical brush provided.
Always keep in physical contact with the child.
The brush should be held horizontally to provide input on the arms and legs. You can brush directly against their skin. When brushing over the clothes, hold the brush vertically for stronger input.
Repeat the procedure every 90 minutes to two hours (six times per day). The input provided by this protocol to the nervous system lasts approximately tow hours. Repetition on this schedule keeps the input to the nervous system consistent.
The order of the body parts brushed does not matter. Following with joint compression is essential.
METHOD
Brush up and down the arms three times while bolding the hand and rotating the arms to brush the surfaces on the front and back.
Brush the back of the hands in the same manner as the arms but scrub the palms of the hand quickly for approximately five seconds.
Perform the process on both arms and both hands.
Brush the back (up and down, side to side and in circles – all strokes are acceptable (brush back between brushing of right and left arms).
Brush legs and feet in same manner as arms. Scrub the bottoms of the feet as well.
Order of the body parts brushed does not matter. Following with joint compression is essential.
NOTE: Brushing must be followed by the following JOINT COMPRESSIONS, repeating compressions 10 times. Ensure joints are supported in alignment and again, order of joint compressions does not matter.
Numbers 1 – 5 are done on both sides of the body.
1. HAND TO ELBOW
Elbow – hold hand in handshake position, stabilize elbow and quickly press hand back into direction of elbow
2. ELBOW TO SHOULDER
Shoulder-stabilize elbow and quickly press down at shoulder
3. HIPS TO KNEES
Hips-preferable in seated position, press knees back into hips
4. KNEE TO FOOT
Knees-press down on knees through the ankles and onto the floor
5. FINGERS
Fingers-stabilize palm and quickly pull out and in on fingers
6. SHOULDERS
Press down on both shoulders 10 times
7. For the final step, apply three quick compressions on the chest, pressing down and back against the sternum (chest bone). Stabilize with one hand on the back.
PRECAUTION: NEVER BRUSH THE FACE OR STOMACH
WHAT TO KEEP IN MIND:
The brush needs to be held horizontally to the arm or leg and sufficient pressure needs to be exerted to flatten the bristles.
The complete routing should only take about three minutes.
Use the correct brush provided by your therapist. Store it in a plastic bag and replace it when it becomes stiff or scratchy.
Try to commit to this technique for a period of two to three weeks, every 90 minutes to two hours. Monitor your child’s responses and observe for changes in behavior and reactions to other sensations. After this first two to three weeks, you may find it helpful to do this technique two to three times per day.
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. If the child continues to resist and negative changes are observed, contact your therapist.
Every child has a unique response to this input
This technique can be incorporated into a sensory diet schedule.
REDUCING HYPERSENSITIVITY IN THE MOUTH
Patricia Wilbarger has also developed a specialized program to help reduce hypersensitivity in the mouth. This type of sensitivity, sometimes called oral defensiveness, can result in limited food choices and interfere with teeth brushing and face washing.
WILBARGER’S ORAL PROGRAM
Best results are seen if the Wilbarger Oral Desensitization is done three to five times daily, preferably a few minutes before snack, meal times and tooth brushing
The pressure should be similar to the amount of pressure used when rubbing an eyelid. Use a quick sweeping movement (mouth sweep) with your index finger on the ridge just behind the child’s top teeth. You do not need to go far into the mouth. Do these mouth sweeps three times (to the right, left and right again).
Follow the sweeping motions with gentle downward pressure applied to the lower jaw by placing your fingers over the lower teeth and pressing down once (jaw pressure technique).
THINGS TO KEEP IN MIND AND OTHER SUGGESTIONS FOR
CHILDREN WITH ORAL HYPERSENSITIVITY
If you are uncomfortable using your finger and/or concerned about biting, try alternatives including an infa-dent toothbrush, NUK brush, bottle nipple or a smooth infant chew toy.
Distract the child by roughhousing, counting or singing.
The jaw pressure technique can be repeated often throughout the day, even without the mouth sweep. Many children enjoy the proprioceptive input and will open their mouths willingly or even ask for the pressure. (Clean hands are essential!)
If the child resists all the above, you may try massaging the temporal mandibular joint (at the side of the face in front of the ear), the cheeks and the lower jaw.
If the program is done several times daily, changes should begin to occur within a few days. You may notice your child’s eating time has decreased, there is a better tolerance for more textured foods, less drooling, or less mouthing of inappropriate objects.
Be sure to offer other mouthing toys such as rubber “chewies”, straws, and other suitable mouth toys during this time. (Beverage tugging can be used as a mouthing toy)
If stimulation to the mouth is not tolerated, you may need to start elsewhere on the child’s body (arms and shoulders, and progress to the head and face).
When touching the face, begin with cheeks, jaw then move towards the lips. This massage can be done with your hand, a face cloth or vibrating toothbrush. Remember, light touch may be alarming and pressure touch may be calming!
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