The Wilbarger approach to the treatment
of sensory defensiveness is comprised of three components. These include education and increasing awareness of sensory defensiveness and its symptoms,
individualized sensory diet and an individualized professionally guided treatment program.
When implementing the Wilbarger approach,
the therapist provides information and awareness; to clients, families, educators and other caregivers; regarding what sensory
defensiveness is, what effect it may have on the client and those close to the client, what behaviors may be present when
sensory defensiveness occurs and how this relates to the client’s challenges. The Wilbargers suggest that this information
is best derived from a clinical interview including experiences of sensations in daily life, challenges the client or family
exhibits related to sensory defensiveness, and coping styles. This process should provide the therapist with a list of functional
challenges which become the outcomes that will guide treatment and demonstrate progress and treatment efficacy.
sensory diet is a form of home program intervention plan that incorporates organizing sensory input, or utilizes already existing
sensory input, into everyday life in order to assist the person to maintain a regulated behavioral state, such as the calm,
alert state required during certain school activities (Wilbarger & Wilbarger, 2006; Williams & Shellenberger, 1994;
Cool, 1990). Sensory diet strategies may be implemented at regular intervals throughout the day. In particular, these strategies
may be performed prior to times that may be considered challenging, in order to prepare or set up the body to maintain an
organized state throughout the activity, or they may also be used during activities in order to assist the client to maintain
an organized state throughout the activity (Williams & Shellenberger, 1994).
Every human uses sensory strategies, often
non-consciously, to assist them to calm down, wake up, and/or maintain attention. Such strategies, when used consciously and
strategically may be considered sensory diet strategies. These sensory diet strategies are individualized and vary from person
to person; where one person may take a shower to become more awake, another to calm down, another for both reasons and another
dislikes showers, preferring only to have baths. When helping clients and caregivers create and implement sensory diets, the
occupational therapist collaborates with them to identify what challenges exist that may be assisted by a sensory diet, what
sensory strategies does the client seek, what naturally occurring possibilities exist and/ or may be included and when to
implement the strategies (Williams & Shellenberger, 1994).
It is important to note that not all sensory
experiences are organizing, effects vary form one person to another and sensory experiences vary in how powerful they may
be in assisting the person to regulate their behavior. For this reason, sensory diets are individualized to the specific person
preferences and needs and monitored accordingly. Sensory diets generally include activities that incorporate proprioceptive
input, deep pressure and movement but may also include other sensory experiences, such as visual, auditory as well as oral
motor and respiration activities (Wilbarger, 2002). Many authors have discussed the calming effects of deep pressure and proprioception
(Edelson, Goldberg Edelson, Kerr & Grandin, 1999; Grandin, 1992; Krauss, 1987; Zisserman, 1992). Sensory diets may also
include environmental adaptations to assist functioning by promoting a more wakeful state such as opening the blinds in a
room; or reducing distractions, such as decreasing visual stimuli on classroom walls.
For the child with sensory defensiveness,
sensory diet strategies that are believed to decrease defensive behaviors are identified and used in the client’s activities
of daily living at regular intervals. As will be noted with Therapressure, the Wilbargers suggest that deep pressure and proprioceptive
input should be part of a sensory diet of a client with sensory defensiveness and should be implemented, as part of everyday
activities, every 90-120 minutes throughout the day (Wilbarger & Wilbarger, 2006).
Guided Treatment and Therapressure
Treatment of sensory defensiveness
should include professionally guided treatment based on the findings of clinical interviews, sensory history checklists such
as the Sensory Profile (Dunn, 1999), observations and standardized assessment tools where appropriate. Collaborative treatment
plans, developed with clients and families, should be individualized to the specific needs of the client and should be monitored
and adjusted where appropriate. One possible component of a professionally guided treatment plan, used regularly by occupational
therapists with clients who demonstrate sensory defensiveness, is called Therapressure (Wilbarger & Wilbarger, 2006). It should be reiterated that Therapressure
should not be an isolated treatment method but rather one part of a treatment plan focusing on all activities of daily living
(Wilbarger & Wilbarger, 2002; Wilbarger & Wilbarger, 2006).
Therapressure is the current title of the technique that the Wilbargers have developed utilizing
a soft bristle plastic brush (Wilbarger & Wilbarger, 2006). This has been known by other names such as the ‘Wilbarger
Protocol’, the ‘Wilbarger Deep Pressure & Proprioceptive Technique’, ‘Sensory Summation Technique’
and most commonly referred to as ‘Brushing’. The reason for it’s developing title has been an attempt by
the developers to avoid the perception of brushing or scrubbing which is misleading and does not effectively describe the
purpose, as Patricia Wilbarger stated, “There is nothing brushing about it” (Wilbarger & Wilbarger, 2006).
The input should consist of deep pressure and proprioception, which is continuous where possible, and limiting light touch
input. The developers are also conscious of misuse or misinterpretation where people may use brushes that are inappropriate
or believe that it sounds easy and attempt it without sufficient training. The author has heard of people using hair brushes
and even a scourer after hearing that ‘brushing’ may be effective. It is understandable that the Wilbargers should
take such precautions and make attempts to limit misperceptions.