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New Brushing Protocol

PRR (Protective Response Regime) - Pressure touch strategy (Bonnie Hanshu)

The PRR is designed to provide deep pressure sensory input for calming and integrating influence to the brain. Although it may be used alone, it is best with a sensory "diet" of input designed to help the child cope with their day. When done correctly, the PRR (brushing/joint compression) should take 2-3 minutes and can be done in almost any location.

PRR Precautions/Comments:

  • Do NOT brush over open sores or bony prominences

  • Do NOT allow your fingers or edge of brush to drag or dig into the skin

  • Do NOT hurry, but move at a steady pace (whatever pace you need to use to keep pressure even)

  • It is OK to brush over clothing or shoes.

  • DO keep brush flat, brushing with brush held sideways so that width is used

  • DO be positive about brushing, make it fun, or at least not negative for child

  • DO follow brushing with joint compressions (you may substitute hand hugs or deep rubs if child responds negatively to joint compression)

  • Although many children will hold out their hands for the PRR after having it done once or twice, some may take longer to feel the benefit.

  • IF a child reacts negatively, stop. Try again in 15-60 minutes, checking your technique.

    • Brushing: This gives deep pressure to all of the sensory areas of the arms, trunk and legs. It is calming, organizing and tends to normalize sensory reception. It feels good immediately to most people and starts to feel good to the rest after a few repetitions. To be most effective, the PRR should be done approximately every 1 ½ - 2 hrs from the time Child gets up in the morning until 1 ½ hrs before he normally goes to bed. (realistically, you ask the teachers to perform at least 3-4 times during the school day) The sensory input given by this lasts 90-120 minutes. You may or may not notice any immediate change in Child since positive results may take two or more weeks of consistent performance to be evident.

  1. Use oval, soft surgical brush provided by therapist (OT).

  2. Hold the brush in one hand with the grooved side up. Cup hand over brush so that fingertips do not drag.

  3. Hold Child's forearm with palm of his hand up.

  4. Place brush firmly on palm. Using slow, FIRM, single stroke move brush from palm up forearm to just below the elbow.

  5. Turn Child's arm so that palm faces down. Do not move brush. Maintain pressure.

  6. Brush downwards on the back of the forearm stopping on the back of the hand.

  7. In one, long stroke, brush up from the back of the hand to the shoulder. Stop.

  8. Place hand not holding the brush firmly on Child's shoulder. Lift brush and place at back of shoulder.

  9. With a single stroke, brush from back of shoulder to waist on one side of the back.

  10. Brush from waist up to the base of the skull.

  11. Brush down from the base of the skull to the waist on the other side of the back.

  12. Brush up from the waist to the other shoulder.

  13. Place hand not holding the brush firmly on Child's shoulder. Lift brush and place at front of shoulder.

  14. With a single stroke, brush from shoulder down to back of hand.

  15. Brush from back of hand to forearm just below inside of elbow, turning arm so that palm is up.

  16. Brush from elbow down to palm.

  17. While holding palm, lift brush, stoop down and place brush on back of calf just below inside of knee.

  18. Brush downwards on an angle to the outside of the ankle.

  19. Brush upwards on an angle to the front of the knee.

  20. Brush downwards, across the ankle to the top of the foot.

  21. Repeat with other leg.

  22. Follow with joint compressions.

    • Joint compressions: This gives input to joints and muscles and will help Child have a better sense of where his body is in space. It is also deep pressure that tends to be calming and help the brain to organize itself to perform task. May be used alone or in combination with brushing technique.

Technique: NOTE  this feels good and should never hurt. Stop if it does and check technique.

  1. Grasp Child's right hand with your right hand as if you were going to shake hands.

  2. Use your left hand to hold Child's right forearm. Keep your fingers straight, do not pinch.

  3. With quick, firm movements, push Child's right hand towards his wrist. Repeat rapidly 7-10 times. Some call this "thunks".

  4. Now move your left hand to cup Child's right elbow and your right hand to hold his forearm. It is easier if elbow is bent.

  5. With quick, firm movements, push Child's forearm into his elbow. Repeat rapidly 7-10 times.

  6. Now keep your left hand cupping Child's left elbow and move your right hand to rest on the top of his right shoulder.

  7. With quick, firm movements, push Child's arm up towards his shoulders. If you're doing it correctly the shoulder will move upwards slightly.

  8. Repeat with Child's left arm. You may or may not need to change hands.

  9. Have Child sit down. Cup your hand around front of his left knee.

  10. With quick firm movements, push knee towards hip rapidly 7-10 times.

  11. Place hand over top of knee. Be sure foot is on the floor under the knee.

  12. With quick firm movements, push downwards towards floor 7-10 times.

  13. Finish by holding both of Child's hands flat between yours and pressing firmly.

    • Hand hug:

  • Your hands will be held with fingers and thumbs straight, palms together (like praying)

  • Place one hand on each side of Childs' left arm, just below his shoulder. Press your hands together firmly (moderate pressure) for 5 seconds, then release. DO NOT slide your hands but lift them off of arm and move them towards the elbow. Repeat the hand hug. You should be able to fit 3 hand hugs between Child's shoulder and elbow

  • Continue with 2-3 hand hugs from just below elbow to just above wrist.

  • Place Childs' hand between yours (keep your hands and Child's hand flat) and give a hand hug.

  • Repeat on right arm.

  • Finish arms by bringing both of Child's hands in front of her and "hugging" them between yours.

  • Now perform hand hugs on Child's legs, beginning with left leg. Start just below knee and perform 3 hand hugs between knee and ankle.

  • If Child has his shoe off, perform a hand hug with his foot between your hands. If Child has his shoes on, apply downwards pressure to the top of his foot/shoe.

    • Deep rub:

  • May use lotion if desired and child enjoys

  • Hold Child's arm firmly (not hard) at elbow with both of your hands.

  • Slowly, drag your hands down Child's arm to his fingertips.

  • Repeat with other arm,

  • Repeat, with legs, holding firmly at knee and dragging down to foot.

  • Use caution so as not to irritate his skin.

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