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Treatment Protocol and Plan for Sensory Tactile Defensiveness

1. Address sensory defensiveness to tactile input with a sensory diet routine that includes:

• Therapeutic Brushing Protocol as demonstrated by your trained OT only please. This is done every 90 min-120 minutes. Make sure that you are giving the correct brushing technique with long deep strokes as described on handouts & in OT meetings!
• The brush should only be the oval surgical brush like the one in the picture above. 
• Use with deep pressure starting at palms of hands and going up and down arm, back, and other arm without letting up and long strokes. Then continue from lower back down onto the outer thigh, large muscle areas of the legs, top and bottom of feet. 
• Never brush the inner thigh, pelvic area, stomach, chest, neck or face.
• Follow brushing with a pull and push on the joints as shown by your OT.  Do joint compressions 10 times at least to fingers, thumb, wrist, elbow, and shoulder, and ask them to jump with straight legs if time is short for legs 20 times.
• This is the most important part of treatment for sensory defensiveness and needs to be followed every 2 hours for at least 2 months to see results that will last for severe tactile defensiveness!
• Offer sensory calming activities throughout their day that give very strong proprioceptive input with joints and muscles and linear vestibular input throughout their day.
• After calming sensory input offer fun touch play like:  rice buckets, sand buckets, gooey play, oobleck, homemade slime, etc.
• Corn starch play: Put corn starch in a bowl and gradually add water. It will feel crunchy and gradually soften. The more water you add, the looser the corn starch will be. When allowed to sit, the cornstarch will harden on the bottom of the bowl and still watery on top. It is great to hide poker chips, coins, etc. in the mixture. Allow her to dig her fingers in and retrieve the hidden objects. As they pull the cornstarch up from the bottom of the bowl it will feel crunchy. Then it will gradually soften in their hands.
• Rice Play: Rice is a different texture that many children do not like and will help to stimulate the touch receptors. Hide objects in tubs of rice.

2. Address need for a sensory diet rich in vestibular, proprioceptive, and deep pressure touch sensations to help the brain stem regulate and process sensations appropriate and maintain a neutral learning state and decrease stress chemicals:

Vestibular input is the strongest of the brain stem sensations and lasts the longest in the brain chemical release of calming and regulating neurotransmitters. It is the fastest way to calm anyone: use slow, gentle, rhythmic swinging from a single hung point or rocking if they are gravitationally insecure. Decreases stress chemicals the fastest.

Getting a swing that is hung from a single point will give them more effective and stronger, longer lasting vestibular input.

Swinging is the ideal source of vestibular input, and if done for 15 minutes on a single point swing the calming effect can last up to 8 hours in the central nervous system, the other types of input only last 2 hours or so, so they must be done more often.

I would highly recommend swinging for at least two 15 minute sessions a day one first thing in the a.m. and again in the afternoon, and before bedtime.  This will help give the calming and organized vestibular input that is needed to help keep an individual responding to sensory input appropriately. 

If swinging can be a calming choice throughout the day, then I would highly recommend it above anything else in the home & classroom. You can have a swing hung from the ceiling or from a "hammock swing stand" and let them swing themselves, just make sure it is slow, rhythmical, and not erratic. When on the playground, try to encourage linear swinging, and avoid rotary at this time as rotary swinging may "hype" them up too much.

Other options for vestibular input include (remember these are not nearly as effective as swinging  from a single suspended point):

• porch swing or hammock outside or in room hang a hammock or swing in doorway
• holding the individual on a large ball, bouncing, rocking back and forth onto hands and feet, rocking gently to calm with their head down towards the floor, give good strong input to hands when coming down to the floor while over the ball. Then walk out onto hands with the ball under them then under their feet.
• rocking in chair or swinging in a blanket (two people hold on either side) & gliders
• Rocking on all fours on a water bed mattress filled with air
• wrapping in blanket (weighted blankets are best) and rolling
• JUNGLE GYMS, HANGING UPSIDE DOWN, CLIMBING, AND PLAYING ON GYMS
• Figure Eight Walk: Walk in the figure eight pattern while doing the bear walk. Walk this with them following you and then you following them. Do this to music change positions to the monkey walk. Alternating pats from one knee to the other. Introduce by walking backwards so they see. Do the walk while keeping eyes focused on one point in room (have them read list of pictures or letters or numbers from paper taped up on wall). This is an amazing vestibular-visual integration activity. Look on YOU TUBE for Infinity Walk Therapy!
• Linear Swinging from a single point: calming if in the cocoon swing made out of lycra spandex for deep pressure touch as well, with all visual information filtered by swing around , and auditory information also filtered some.
• Rotary Swinging from a single point: they may get dizzy very quickly, allow them to spin at their own rate no more than 12 rotations in both directions , 3-5 times per day. Position in cross leg sitting. Important to go in both directions. Observe their eyes for the reflex response. Please journal and report to the OT the outcome.

3. Next address muscle tone, strength and proprioceptive modulation by giving strong doses of joint and muscle input:

Proprioceptive input is sensory input to the joints and muscles and is best to do every 2 hours for 20 minutes. Proprioception helps the joints and muscles be "awake" and more responsive to motor control and helps with motor coordination as well as calming the brain. Proprioceptive input also helps with maintaining good muscle tone and coordination. Proprioceptive input is the best source of sensory input to help keep a good balance of serotonin in the brain which helps to regulate all the other brain chemistry and keep a neutral and relaxed learning state. Proprioceptive input is the best type of input to help with sensory modulation & regulation disorders.

Some activities include:

• JOINT COMPRESSIONS to a level joint dont forget fingers, thumb, wrist, elbow, shoulder, ankles, knees, and hips a minimum of 10 times each joint. Strong, quick compressions are best! You can do joint compressions even if you can't do the brushing, you can do them more often than the brushing as well. Trying them during more difficult times such as while walking in the hall, in the car, in the grocery store, when having to sit and attend for longer periods of time, it is the best Aquick sensory diet choice! Try giving this input before, during, and after a difficult task such as a test or quiet work time as well!
• Deep pressure down the spine through pressure on each shoulder pushing down 10 times, combine with diapragmatic breathing techniques. 
• Weighted vests and blankets- wearing a weighted vest, using weighted lap pads and wearing ankle and wrist weights can be very calming. You can also make a neck wrap that is weighted to wrap over the shoulders (fill a very long tube sock with large feed corn or beans), this can also be laid over the lap when sitting or over the shoulders.
• Weight bearing like crawling (on belly) and creeping (on all fours) are vital to joint input as well as a great way to help with eye hand coordination, left and right awareness (laterality and directionality), fine motor skills, muscle strength and endurance, and reading and math. Crawling and creeping are the most important developmental milestone and going back to that developmental stage helps the two hemispheres of the brain talk again and communicate better which is essential to good attention, reading, and other academic tasks!
• Set up the house and classroom with lots of tunnels, tents, air mattresses, and other things to crawl over, under, and on! For younger children they love to play animal walk games and imitate dog, cat, bear walks. This is a great way to give a sensory motor break in the classroom as well! Many teachers place hand and feet stickers on the floor and students "follow the trail" in the room for a break from sit down work and to "wake up the brain". Do creeping and crawling for at least 5 minutes each a day!
• Therapy ball exercises like laying on tummy over ball and walking out on hands, rocking over ball onto hands and sitting and bouncing on the therapy ball are all great vestibular and proprioceptive sensory calming activities.
• Rock slowly and rhythmically to hands and feet, with a strong push into the floor with good input to their hands at least 20 times. Give firm touch on their back. You can end this with a wheelbarrow walk or just a handstand off the ball for a few minutes, or as long as tolerated.
• WEIGHTED medicine balls at Walmart or sports stores are fabulous for therapy needs!  Play weighted basketball, hold while jumping on trampoline and play catch.
• Any weighted tasks, pushing, pulling, lifting, stacking wearing weights or lifting heavy objects above shoulder level.
• Elevate anything to make them reach up high to promote stretching and elongation.
• Vibration Massager to limbs, hands, feet, mouth, and back. Do not place vibration on neck, stomach or chest area (they can do it to those areas, but from another person it is too strong to these sensitive areas).
• For younger children play in a tent, tunnel, laundry basket, or big tub or kiddie pool filled with balls, rice, beans, sand, etc. Encourage crawling, rolling, laying on tummy, and pushing up from tummy position to weight bear as much as possible.
• Jumping on a trampoline- keep it organized by counting to 100, doing times tables, saying ABCs for each jump.
• Scooter boards laying on tummy and pushing with hands, playing hide and seek (the looker is on the scooter board) or pushing a therapy ball with their head to a certain designated place, or picking up weighted items along the way.
• Anything with weight, weighted vest, wrist and ankle weights, carrying or pushing heavy grocery cart, throwing weighted ball above head, stacking books or blocks.
• Weighted Vest worn every hour for up to 20 minutes. (10% of body weight evenly distributed)
• Hanging from monkey bars and pull ups
• Trampoline and jumping an old mattress pulled to the floor.
• Aerobics, karate, gymnastics, running clubs, sports, SACC, HANNA MANNA HIPPOTHERAPY- HORSE BACK RIDING!
• Tug of war
• HIKING-nature hikes (wear a backpack with some weight too!)
• Use pillows and play bumper cars. Take pillows in to their arms and bumps into people. Variations include wrapping the pillow around the child or having the child fold his arms across his chest.
• Play the hamburger game. The child lies down on a cushion (bun) you place bean bags (relish) on them, then roll a rolling pin over their body as if your are spreading mustard or ketchup. Add a heavy blanket (lettuce) and another cushion (bread). This one is a big hit at sleep overs just before bed.

4.  Provide lots of calming "Deep Pressure Touch"
Deep Pressure Touch is very important every 2 hours and helps keep the brain focused, clear, and enables us to concentrate and stay with a task longer. Dopamine & Serotonin are released when there is pressure touch.

Caution: Avoid light touch and textures that they do not like, NEVER FORCE TOUCH OR TEXTURES OR ANYTHING!!! You can try new textures after all this has been given, but never force any textures onto a child!

Deep pressure touch is the total opposite of light touch.

Your body has two different touch systems:

Light touch is the one that is there to "protect and defend" by telling you that someone is near by a light brush on the arm, a bug has landed on your skin, etc. This light touch system causes a Sympathetic Nervous System response which results in a "Flight or Fright" response in the body and brain chemicals are released that may cause aggression, fear, anxiety, and overall a stressor. When an individual has Sensory Defensiveness, then this light touch system in heightened and reacts very easily. This is why they often touch you too firmly, or push, wrestle, or play hard (they are giving you the input they crave: deep touch).

The best way to give deep pressure touch is make sure you are giving the Therapeutic Brushing and Joint Compression Routine every 2 hours as demonstrated in OT sessions.

Other Deep Pressure Touch activities:

• Deep pressure massage (try coconut oil).  Use the flat of palm and fingers rather than fingertips. Tell body parts in a calming voice to help with body awareness. Give firm, long strokes for calming input.
• Slow but firm hand squeezes up and down the arms and legs
• Wrapping in spandex, lycra, or other firm yet stretchy material.
• Some wear Under Armour or similar tight shirts and long pants under their clothing
• Weighted vests and blankets
• Steamroller- have them lay on a soft bed or couch and gently with the pressure they like, roll large ball over their body while they lay on their belly starting at upper back down to feet, the ab roller elliptical ball works well for this and the bumpy massage ball as well.  You can also use the ball or a bean bag and Play "What kind of sandwich are you? ...Turkey!" and give deep pressure squeezes.
• Pressure Vest (can be purchased in therapy catalogs on resource page or made easily if you sew, just wraps around the chest, stomach, and back firmly)
• Fidget toys available  such as a balloon filled with water beads, flour or rice, stress balls, etc. Go shopping and let child pick a hand held quiet fidget toy, often it is an eraser or something simple that they can carry in their pockets!
• May need other options for clothing such as seamless socks found in Sensory Comfort catalog online.

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