A tale of two touch pathways
The terms touch pressure or deep touch pressure are used by therapists to refer to firmer touch. Therapressure brushes or surgical brushes are one way to provide it. However, it can also be done with the hands, through massage and hugs. This post will explore:
A tale of two touch pathways
The terms touch pressure or deep touch pressure are used by therapists to refer to firmer touch. Therapressure brushes or surgical brushes are one way to provide it. However, it can also be done with the hands, through massage and hugs. This post will explore:
Types of touch
I will get to touch pressure in a minute, but first you need to understand the touch sense. As I explain this article on the touch sense, our skin processes many different sensations. It receives messages about touch, pain, vibration and temperature. The post also explains that there are three different types of touch. If you are not familiar with them, I would recommend reading the article first, but in summary, the three types of touch are:
Why is it important to understand the differences between the types of touch?
It is important to consider the differences between these types of touch for a few reasons. Firstly, light touch is designed to protect us. It is activated when we walk into a spider web. It triggers our flight, fight, freeze response. Individuals with touch sensitivity can experience this response to everyday sensations.
Touch pressure on the other hand can be more regulating. It is activated when we receive a massage. For most people, this is a very different feeling than walking into a spider web. It has the opposite effect on the nervous system and helps it to calm down. This is why touch pressure can be used to help children, and adults, to regulate and calm down.
Some examples of touch pressure in everyday life:
Touch pressure can have a very powerful effect for some children (and adults!). However, you must be aware of the precautions and also follow the child’s lead.
Precautions for using touch pressure
It is important to understand a few precautions before looking at specific strategies. Anyone using the strategies suggested below should be aware of these precautions.
Touch pressure is not a restraint
At no point should touch pressure be used to restrain or hold a child.
The child must consent to receiving the touch pressure
It would be expected that the child would voluntarily stay with the adult whilst they are receiving any touch. And, that they are indicating they are ok. Watch for both outward and inward expressions of discomfort. Outward expressions of discomfort could include moving away, shouting, or lashing. They are usually quite obvious. However, some children internalise their discomfort and it may be less obvious. Internal expressions of discomfort could include going quiet, choosing not to join in or daydreaming.
The child should always be able to request to stop
Regardless of their communication level, there must be a way for the child to indicate they have had enough. They child must be able to request that you stop. If the child is non-verbal, stop every 20-30 seconds and watch for an indicator that the child wants more. This could be that they push back into you, or move your hand back. Some children will be able to request more, just make sure you know the child.
Touch pressure is different to pinching
While touch pressure is referred to as firm touch, it is not a pinch or a hard squeeze. It should never leave any marks on the skin. It is important to keep your fingers together and to use the palm of your hand to apply pressure if you are using your hands. Keep your fingers straight, so that they do not curl around the child’s limbs. If you curl your fingers around, it has the potential to leave a bruise.
Seek additional advice if there is a history of trauma
It is also recommended that you seek out additional professional advice if there is a history of trauma. Touch is a very powerful sense and it can be triggering for some children. An excellent knowledge of the child’s history should be known. And, it is advised to consult with the child’s professional team for additional advice.
How Harry uses touch pressure
Harry uses hugs and squashing to help support his arousal. He is quickly overwhelmed by noises and is sensitive to sounds. Harry finds hugs and squeezes from his mum when there is a lot of sound in the environment very helpful. And, he loves to be sandwiched and squashed between the two beanbags they have in the sensory room at school.
How can I apply touch pressure?
As identified above, touch pressure refers to firmer touch or a squeeze. It occurs when pressure is applied to the skin. It can be provided using the following strategies.
A hug
Whilst this is not always appropriate at school, it’s available at home. You can also create a bit of a cocoon if the child faces forward and puts their back on your stomach.
With your hands
Hands are a free and readily available option you can give a squeeze to the child’s shoulders or limbs or hands. Keep a consistent pressure, and make sure you don’t slide if you move your hands up or down. Remember to keep your fingers straight and use the palm of your hand.
A therapy/gym ball
This strategy is a common one. The child can lie on a mat and then the larger ball can be rolled on their limbs or back. Use a consistent firm pressure, avoid the genital area. AND, check with the child where they would like you to roll the ball.
Weight blankets
These automatically provide touch pressure to the skin, we explore precautions and tips for using weighted blankets here.
Sandwiches
Sandwiching the child between two soft cushions or beanbags is a great way to provide touch input. And it’s a lot of fun. Some children do this themselves by squeezing into small spaces, or between cushions on the sofa. Make sure you can always see their head or if they are verbal talk to them if they put their head inside.
Hot dog or sausage roll
Have the child lie-down on a blanket or yoga mat and then roll then up inside it like a hot dog. Pressure can be applied to the sides once they are rolled up. Then, they can roll out. Like with sandwiches, make sure you can see their head and monitor how they are doing.
Massage as touch pressure
Some children like the feeling of different commercially available massagers. This includes different textured balls, wooden massagers or wire head massagers. Children can use them themselves, or, if it helps, adults can support them with these.
When at home, some children really love massage with the hands! Many parents use this strategy before bed to help with calming down.
Tight clothing and Hug t-shirts
Whilst there are some commercial products available, bicycling trousers and Lycra sun-shirts can provide a similar squeeze to the skin. Some children prefer to wear a small sized vest (singlet) or t-shirt as this give a bit more of a squeeze and the fabric moves less on the skin.
Therapressure Brushes
There are a number of brushes designed to provide touch pressure. The branded version is called a Therapressure Brush. These are robust and worth the cost if you are using them at home. Surgical hand scrubbing brushes have the same bristles and are a more cost effective solution if larger numbers are needed.
There is a specific programme called the Wilbarger Protocol (also referred to as DPPT) which requires training and therapist supervision. However, some children like the feeling of the brushes. These can be used to brush the skin by either the child or an adult. The precautions above should be noted and children should always have control if the adult is doing the brushing.
The brushes are designed to be used with some downward pressure. It is recommended the brushes are only used on arms, hands and legs. If you are brushing a child, hold their limb with one hand and brush in a rhythmic manner in the direction of hair growth. Lift at the end of the limb and go back to the top each time. Stay consistent with your pressure and rhythm.
The input should help to calm the child. Not all children like them, and they should NEVER be forced onto a pupil. Always ask for permission and follow the pupil’s lead.
Requesting touch pressure
Finally, make sure you consider how the child can request touch pressure. Some children link the receipt of support strategies to their behaviour. So, they associate negative behaviours to receiving a squeeze. Or, in schools that restrain, they associate negative behaviour to getting a big hug.
Therefore, it is helpful to teach the child that they can request a ‘squeeze’ or a ‘hug’ in a proactive way. Some will be able to do this verbally. Others may need a sign or a symbol. For children that understand their arousal level is increasing, they can also be taught that touch pressure is a strategy they can use to help to calm down.
Where to Next?
Touch pressure is often used alongside heavy work you can learn more in this post – The Mystery of Heavy Work.
Kim also explores the different types of touch in Level 1 of Sensory Processing with GriffinOT. Join our community using the button below and get started, it’s free!
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