18 Responses to “Joint Compression”

1. MM Says:
   January 8th, 2010 at 1:11 pm

   I have been working in at a pediatric Occupational therapy practitioner for 14 yrs. More importantly, I have been trained by Patricia Wilbarger, on the Wilbarger therapressure protocol, which is what this is. The brushing, and the joint compressions are part of the protocol. If possible, I would remove that 3rd video, as she is doing the entire thing the wrong way. Ms. Wilbarger does not recommend that any therapist or parent participate in the protocol without being properly trained. As an OT, I can then train other OT’s that I work with, since I have been to the training. The problem is, there are a lot of therapists out there that have heard about this, and just start doing their own form of brushing and joint compression which can be harmful. You need to know what you’re doing, and understand this. For one thing, the brushing is all about pressure, not brushing. The gal above is doing light brushing, which will elicit the opposite effect of what you are looking for. You are also never supposed to allow the brush to touch the tops of the sleeves when you are brushing, this will elicit light touch. Therapressure brushing is done with the therapeutic brush you can order, and it is VERY firm pressure, followed by joint compression. The top video shows much more accurately how to do the compressions, the bottom one is incorrect. There is a lot to it, and no one should engage in this program unless they are trained by a therapist who has been to the Wilbarger training, or has a therapist that was trained by a co-worker who has been through it.

2. RumorQueen Says:
   January 8th, 2010 at 1:24 pm

   I said that the way she was doing the brushing was nothing at all like the way I’d been taught – but the way she is doing the joint compression is very close to what I do. Are you saying both are wrong, or just the brushing? When I did the brushing it was on bare skin, it was all going the same direction, and I think it was a lot firmer and with more “purpose” than what she’s doing. But, I don’t think the brushing helps TT (we can stop it and can’t tell a difference in behavior), where the joint compression makes a big difference in behavior. I’m glad you spoke up, because I was wondering if perhaps the brushing hadn’t worked because I’d been doing it wrong. But, I’ve been shown by three people (between going through this with two kids), and all three showed basically the same way, so I had no reason to believe I’d been shown wrong.

   I mainly put that last one up because it shows the joint compression in a way that looks a lot like what I do – not because of the brushing. I remember when people talked about “joint compression” before I’d been shown what it was, that I had no clue what might be involved, but it sounded kind of scary and intimidating. So, I wanted to give people an idea of what it is. It doesn’t take a terribly long time, it’s not a traumatic experience, and it’s fairly easy to do.

3. doc33 Says:
   January 8th, 2010 at 2:07 pm

   RQ and MM where would you find someone to help you learn these techniques? I know our county offers services for OT’s but are all of the OT’s trained in this area, or just a certain type of OT? I am very interested, but a little unsure of where to look for help. A private practice, or a state funded program?

4. Katiebug Says:
   January 8th, 2010 at 2:37 pm

   MM- I have been told by multiple OT’s that the brushing protocol is not to be used on infants under 1 and I have also heard up to 2, we started the protocol with our daughter but stopped because she was under 1 at the time plus she seemed to hate it, I felt like I might hurt her by accident because she would squirm like a corkscrew to get away. I was told not to break the cycle/lift brush to keep it as 1 stroke even if it was in different directions but with dd the brush was coming off due to her movement. Also have you heard anything about it possibly triggering seizures for those under 2? I have used and worked with sensory intergration with my special education students for those who needed it.

5. MM Says:
   January 8th, 2010 at 2:51 pm

   RQ, no, I do not believe the lady in the 3rd video is doing the compressions correctly. If you watch, she is not compressing from both sides. I don’t like any of what she is doing, the brushing for sure, and the compressions either. She has obviously never been through the training, and is doing her own thing.
   The other thing to keep in mind is that this program is for kiddos that have sensory issues, and only a therapist can determine that for sure, to make sure that you are not looking at something else. This isn’t a program for a parent to just look at and go “I’ll try that” because it needs to be monitored, and again, the person doing the therapressure, and compressions needs to be trained well, by a skilled therapist. I always train my parents, have them do it in front of me first, then two days later I always have them show me again how they are doing it. It never fails that they are not carrying it out correctly, because this is not something that is easily learned the first time. Usually after the second time I demonstrate, then have them do it, they get it.
   doc33-Most OT’s that get the training are in the pediatric field, so I would check with a local ped’s therapy clinic to find someone trained in it.

   Kateibug-I will need to double check, but it is either 6 months, or under 1 that you shouldn’t do this with. I use it on 2 yr olds a lot, and it is very deep pressure. Most kiddos I use it on love it, both the compressions, and therapressure brushing. They ask for it. Again, the child needs to be assessed by an OT to make sure it is appriate for them and that they really are displaying defensiveness. I use a big checklist that I go over with the parents first, before determining if the Wilbarger protocol is appropriate. Yes, you are not supposed to let up on the brush at all. I am not going to go into the exact technique, because again, you need hands on training, by a skilled OTR. Never heard that it could trigger seizures.

6. RumorQueen Says:
   January 8th, 2010 at 2:58 pm

   Thanks for the input MM. I’m coming at it from both sides, I hadn’t noticed she is not. I was looking more at the over all picture of what she’s doing, I guess.

   I agree with you that people need someone to show them how to do this, it’s not something to do without instruction. I wanted to post videos because I think that a lot of people are afraid to check into it all because it is such a big unknown, and it sounds kind of scary until you see what is involved.

7. Katiebug Says:
   January 8th, 2010 at 2:59 pm

   MM- Thanks, she has been evaluated by 2 different OT’s and found to have multiple sensory issues. I was trained once in school by the OT for certain students and then her 1st OT showed me how to do it again but we left her after our 2nd visit due to the location and went somewhere that had the SLP dealing with feeding issues and the OT dealing with overall sensory issues. I do some deep pressure with her by rolling her up in a blanket like a burrito and the she had to wiggle free, she does like this, maybe know that she is over 1 (13mts) we can try it again.

8. shanggirls Says:
   January 8th, 2010 at 2:59 pm

   I have to say that I have never heard of this and given the first few seconds of the videos……..I would probably not do them. I just can’t watch them. I wish there were more on the why this works rather than on the how to do it.

9. Noendinsight Says:
   January 8th, 2010 at 3:09 pm

   There is a yahoo group to help with SID (sensory integration dysfunction) RAD (reactive attachment disorder) and attachment issues PTSD (posttraumatic stress disorder)
   ODD (oppositional defiant disorder) ADD/ADHD anxiety and speech & language delays.

   http://health.groups.yahoo.com/group/NEUROnetwork/

   RQ – have you heard of the companies that test brain chemicals/neurotransmitters like serotonin and dopamine with a urine test?

   It can test to see if the brain is running in stress mode 24/7. Usually some levels are good, while others are far from normal in post-institutionalize kids.

   Neurotransmitters are responsible for regulating sleep, restlessness, stimulation, flight/flight responses, agitation, stress, etc.

   They then customize supplements. They’re not drugs; they are doses of amino acids found naturally in proteins we already eat. From there the child is monitored and his/her levels are checked at intervals.

   The child doesn’t need to take them forever; they help prompt the body to regulate neurotransmitters on their own. It’s not a quick fix – but proponents say it helps.

   I don’t know a lot about it so I am not recommending or not recommending it. Just wondering if anyone is familiar with this?

10. RumorQueen Says:
    January 8th, 2010 at 3:16 pm

    I have found explanations that made sense in the past, but I think that was in literature handed to me, not online. I don’t see anything online that explains it very well.

    From what I remember, there are a lot of things at work, and some of it has to do with getting various nerves to fire triggers towards the brain in a way that helps the software (you know, the brain’s software) figure things out and work better with the hardware (the nervous system).

    But there was also some stuff about endorphins and I think maybe dopamine involved, natural chemicals created by the brain while you’re doing this. And to be honest, that part made the most sense to me. It’s like you’re medicating your child with medications made by their brain, instead of medications made from a pharmacy.

    But all of that is from memory, and it may be I’ve remembered it completely wrong. I’ve had zero schooling about any of this, so if someone who can explain it better wants to give it a try, feel free to do so.

11. ratgirl Says:
    January 8th, 2010 at 4:11 pm

    As I said in my post on yesterday’s topic, I am very leery of these methods. First of all, I really think that a lot of these sensory issues are symptoms of something deeper that needs to be investigated first. My son, the one who was treated for cancer, had a lot of sensory issues. We did the brushing thing, but it was useless and may have made things worse. Why? I realized later, working with a different therapist, that my son’s real issue was trauma. He literally could not trust that any physical symptom wouldn’t turn into acute pain. He also felt no control over his own body. He was hypervigilant about any physical stimulation as a result. I think this kind of reaction is very common among children who have been exposed to intense pain while too young to understand what is happening – whether from medical treatment, illness, or physical abuse. It isn’t the result of understimulation while small or a brain miswiring like you might see in a child with autism. That is why I think it is very important to not give out blanket labels. And unfortunately, many OTs do not work with children who have suffered a lot of trauma, so they have no experience to go on.

12. ratgirl Says:
    January 8th, 2010 at 4:17 pm

    I forgot one other thing in my last post. The therapist who was most effective with my son used a combination of play therapy, movement and relaxation methods. She was very experienced in working with kids who were cancer survivors, and also adopted children who had experienced trauma. I have noticed that on websites that discuss PTSD in children, play therapy seems to be the most typically mentioned therapy for these kids. My son was 4 when he was seeing that therapist.

13. RumorQueen Says:
    January 8th, 2010 at 4:42 pm

    Most of our children are not cancer survivors, they are SWI survivors. They’ve lived as infants and toddlers in an environment with hardly any sensory input. GG was in a dark room with a tiny little grimy window and no lighting source. There was no color on the walls, there was nothing soft except the blanket (and it wasn’t actually all that soft).

    TT’s SWI had more sensory input as far as colors and music and light, but none as far as being held and loved. None that had anything to do with interacting with her environment. TT’s problem is the opposite of GG’s, also. TT learned to not exhibit signs of pain – her “volume” is turned down too low, where GG’s “volume” is turned up too high. In both cases, these techniques helped (and are helping) a great deal.

    I don’t think it’s accurate to say that because these techniques didn’t work for a child who survived cancer, that they won’t work for a child who has lived their entire life until adopted with minimal sensory input.

    That’s not to say we shouldn’t also use play therapy and relaxation stuff… those things can also be very helpful. The point is to make sure you find someone qualified, so they can come up with the best all around plan to help your child. And if you don’t think something is helping, speak up.

14. ratgirl Says:
    January 8th, 2010 at 4:50 pm

    I agree that methods for a child who has been traumatized may not work for a child who has not been exposed to sensory input. That is precisely what I am saying – that you need to understand the underpinnings of the problem. However, you should also realize that some adopted children have been abused and may fall into the trauma category.

    I just did not like the way that the first OTs that we saw tried to shoehorn my son into a “sensory integration” category that, on the surface, he appeared to fit but which was not a good category for him.
    See these links
    http://www.rainbowkids.com/expertarticledetails.aspx?id=116
    http://attach-china.org/ (scroll to the links on PTSD)

15. RumorQueen Says:
    January 8th, 2010 at 5:20 pm

    I am very familiar with the whole PTSD thing, as we’ve dealt with that with GG (still have to keep it in mind, actually). But that doesn’t mean the joint compression and brushing did not work with her. Her sensory issues were a result of lack of sensory input. Her trauma issues were, well, that’s a bit too personal to get into, just suffice to say it was a separate matter. And confusing the issues would not have helped her.

    I would say that if someone doesn’t see a difference in whatever therapies are prescribed for their child then of course they should have a conversation about that and come up with a different course of action. But to just toss these very effective techniques out the window because they didn’t help a child with a completely different reason for his sensory issues… that would be a bad call.

16. OT mom Says:
    January 8th, 2010 at 11:25 pm

    As a pediatric OT trained in Sensory integration I would HIGHLY suggest NOT to follow the above videos. Without the direction of a TRAINED therapist effective sensory integration treatment is rarely effective.

    While most of our children will have various sensory processing issues, every child is unique in how their systems are affected and which sensory strategies will be effective in treating their needs. Sensory treatments MUST to be tailored specifically for each child. The above brushing technique is NOT something we would recommend for every child.

    Here is a little information on SI I hand out to parents when introducing the theory.

    Sensory integration is the ability to take in sensory stimuli, process it, and carry out an adaptive response. Sensory stimuli include tactile, vestibular, proprioceptive, oral, visual, and auditory inputs.

    ? The tactile system is comprised of our skin and millions of receptors that provide the brain information regarding temperature, texture/touch, pressure, and pain. This is the largest of all the systems and is instrumental in self-regulation and social-emotional communication and bonding.

    ? The vestibular system is located in the inner ear and is the sensory system that responds to the position of the head in relationship to gravity and movement of the body through space. It is responsible for integrating neck, eye, and body responses to movement as well as postural control and refined postural adjustments.

    ? The proprioceptive system is made up of many receptors located in the muscles and joints of the body. These receptors respond to changes in position of the muscles and joints and are responsible for communicating to the brain information regarding where the body is in space, and what each segment is doing at any given time. This system, in conjunction with the vestibular system is the foundation for body scheme and motor planning.

    How these sensory stimuli are perceived can greatly affect a child’s attention span, body organization of planned movement, and ability to learn. Children who display problems in this area can either show hypersensitivity or hyposensitivity to the above-mentioned stimuli.

    The entire nervous system operates based on excitation and inhibition. Excitation occurs when the neurons are more likely to respond or are “activated”. Inhibition occurs when the likelihood of responding is decreased or responses are “blocked”. It is the balance of these operations that determine when responses are generated; some refer to this balance of the neurological continuum as modulation.

    Modulation is the brain’s regulation of neural messages by facilitating or inhibiting responses. When modulation is intact, the nervous system responds to some stimuli while ignoring other stimuli, and the child develops an appropriate response to the situation.

    The extreme ends of the neurological threshold continuum are called habituation and sensitization.

    Habituation is a process that represents the nervous system’s recognition that something familiar has occurred. At the cellular level, we can say that the brain has experienced the firing pattern, and after a time, this familiar pattern no longer needs attention. At a system level, children need habituation to cope with the myriad of stimuli available at any moment in their day. Without habituation, children would be distracted continually by each new stimulus, including how their clothing feels, the sound in the hall, leafs blowing in the wind outside, the sound and feeling of saliva being swallowed, etc. Humans need habituation to focus attention to tasks at hand.

    Sensitization is the nervous system mechanism that enhances potentially important stimuli. Some stimuli require attention right away, although they might be familiar. This is particularly true when the organism anticipates harm or danger associated with the stimulus. Once the nervous system identifies a stimulus as one requiring heightened attention, more neurons can be recruited to make the message more powerful and subsequently generate an immediate and powerful response. For example, although the smell of smoke could be a relatively small stimulus in the room, after bedtime this stimulus could trigger sensitization (based on its potential harmfulness) so the person would arouse (even from sleep) and take immediate action to gather more information and get out of harms way. Children develop and use sensitization through life experiences as they grow up.

    As Children grow, their nervous systems are evolving and their experiences are shaping the nervous systems evolution. As part of this process a balance of habituation and sensitization must develop to support adaptive behavior or appropriate responses to environmental demands. The point along the neurological continuum that is most likely to generate a response for a particular child is called that child’s threshold for that stimulus. There is a range of thresholds that support adaptive behavior and thresholds that are outside of acceptable ranges for functional performance.

    Children whose thresholds are too high (i.e. habituation, hyposensitivity) tend to be under responsive (i.e. it takes a lot of input to reach the threshold as seen when children don’t respond to cues around them for example when a child needs to be tapped on the shoulder to respond).

    Children whose thresholds are too low (i.e. sensitization, hypersensitivity) tend to be overly responsive (i.e. very little stimuli causes a reaction as seen when children are distracted by every stimulus for example becomes overly agitated when someone brushes against you [tactile defensiveness]).

    Treatment focuses on each child’s specific modulation, habituation, and sensitization needs in each area of tactile, vestibular and proprioceptive inputs. The therapist can only tailor a “sensory diet” after each child assessing with a detailed sensory observation of skills and completion of a parent questionnaire. PLEASE PLEASE PLEASE Seek professional help with this one.

17. portlandval Says:
    January 9th, 2010 at 11:15 pm

    I am not sure if this is at all a helpful comment but here goes. I have taken my daughter to see every specialist under the sun, OT, Ph.D., M.D….everyone seems to have a piece of the puzzle related to her brain and behavior. All were helpful but no one seemed to have a comprehensive solution or approach. The person who comes closest to talking about the overall picture of what I am seeing in her behavior is Bruce Perry, M.D., Ph.D. He has published numerous scholarly books and articles about how trauma (of any kind) impacts the child’s developing brain. The theory is that my daughter’s foundational brain development was affected by severe depreviation. Trying to build new skills over a foundation (RQ would call this the HARDWARE) that is under-developed will be challenging. My intention is to get her some evaluations by neuro-integration specialists soon but it is not covered by insurance because it is so new and un-researched. It all seemed like hocus-pocus to me until I read Dr. Perry’s work. I know how hard it is to gain research approvals for children as subjects so I’m going to hold an open mind for my daughter’s sake. Here’s a link to Dr. Perry’s work

    http://www.traumacentral.net/TC_brucedperry.htm

    I am a very skeptical person but the whole brain/nerve “exercises” approach seems very plausible. If it doesn’t work, I can stop at any time. The joint compressions and brushing were very calming to my daughter but the OT’s comments are right…brush pressure was everything! If anyone is facing what I have been facing with my daughter, they will know when they have to keep seeking answers.

18. bsinchina Says:
    January 11th, 2010 at 2:32 pm

    I admit I haven’t watched the videos. But we use joint compression with our son (as trained by an OT) all the time. He’s almost 7 now, and he knows when he’s overwhelmed and we can tell him to “go give yourself feedback” or he’ll ask us if he wants us to give him “feedback.” His favorite two things are for us to rub his hands (palm side) and joint compressions. (When he does it himself, he tries jumping jacks, mostly.) In any case, if he doesn’t get the feedback when he needs it, he ends up rubbing his head on me . . .