Brushing with a firm brush can feel invigorating and exfoliates dry skin. This experience, when repeated over time, can support the development of body awareness, particularly if a person has limited movement.

Body-brushing can feel unusual if it hasn’t been experienced before but is usually enjoyed when the person relaxes into the new sensations. If you have not yet tried it, it would be worth body brushing yourself (with your own brush) to experience how it feels and experiment with variations in pressure over different areas of the body. 

Body brushing can be done over clothing or directly on the skin. The person’s preferences, your relationship, the context or situation and any risk factors, including sexual arousal will determine how much clothing (if any) it is appropriate to remove, and which parts of the body you brush, either with or without clothing.

Brushing directly to the skin feels different and is more stimulatory than over clothing. In a warm environment it might be possible brush on bare arms, feet and calves, rolling sleeves and trousers up as necessary and appropriate. Because body-brushing exfoliates the skin it can be a good idea to do it before showering or bathing.

Important precautions:

Check that there are no sores, bruises, rashes or pressure ulcers on the person’s body. If there are, do not brush that area until they have cleared up. If a person has had a break or surgery in this area in the last 12 months, a skin condition or a condition that makes their bones brittle such as osteoporosis seek medical advice before brushing.

Take caution if the person has altered tone, particularly spasticity. Body brushing may stimulate the stretch reflex, in an already over stimulated muscle, causing clonus (rapid and rhythmical contraction of muscle)and possible discomfort. 

Areas of the body that aren’t appropriate to be body-brushed are the very sensitive areas of breasts and groin. The abdomen should also not be brushed to avoid interfering with the functioning of the bowel.  

Brushing on the bottom can be very beneficial for blood flow if a person is seated for prolonged periods each day. However the brushing needs to be carried out carefully, and only if assessed to be appropriate for the person, with the following precautions.

1. If the person has a history of vulnerability to their skin on their seated surfaces, such as pressure sore/ pressure ulcers, then brushing the bottom should be avoided.

2. If the person has areas of redness on their bottoms that remains following a period of being seated, then the brushiong should be very light and for only a very short time  no longer than a minute). Brushing over light clothing such as underwear or thin leggings will protect the areas of red skin.

What you need

• A body brush which can be bought from larger chemists or health food shops.  Some people don’t enjoy the firm texture of a body brush and prefer softer brushes such as those used by decorators and shaving or make-up brushes. It is suggested that you trial a body brush before trying a softer alternative because a body brush will usually provide a better experience.   
• A soft blanket for the end of the experience, if required, which can be warmed (if the person is not too hot) to feel comforting and luxurious.

Guidance and instructions

1. Assess the person each time before embarking on body brushing and throughout, and check for undesirable responses, as they may react differently, depending on various factors (e.g. how well they slept the night before, how well their bowels are functioning). 
2. Ensure that you are in a calm, relaxed state before you begin as feelings of tension or calmness can be transmitted through your touch. Take a few slow deep breaths.
3. Communicate what is going to happen, particularly if body brushing is an unfamiliar experience. Explore the texture of the brush together in a way appropriate to the person e.g. looking, smelling, feeling the texture of the bristles gently against the arm, chin, fingertips, toes etc.
4. Ensure that the person is comfortably positioned and posturally supported as necessary. Also consider your own positioning, which should allow you to be comfortable and protect your own posture as much as possible.  
5. Always brush in the direction blood flows to the heart – i.e. from extremities towards the torso. You should hold the brush in one hand and brush in the direction blood flows to the heart. The other hand strokes immediately over the area brushed in the same direction. Thus, creating the rhythm ‘brush-stroke-brush-stroke’. This also allows you to keep one of your hands in physical contact, which helps to maintain connectedness and support their anticipation of the experience. Depending on the feedback from the person, the brush-stroke rhythm can be repeated multiple times over a body area, perhaps a dozen or more repetitions.  
6. Whilst body-brushing, continually look for feedback from the person. Are there body areas that they indicate they like or dislike being brushed?  How much pressure do they prefer? What speed do they like to be brushed and stroked at? Continue to do what they enjoy and move on from anything they show they dislike. End the body-brushing if the person indicates that they do not like body brushing at all. 
7. If the person is able to indicate, ask them which leg they wish to be brushed first. You may be able to support this by stroking down each of their legs and gently squeezing their ankles and watching for which they give the most positive response.  
8. Avoiding the soles of the feet, which can be very sensitive and tickle, start with the top of the foot and brush-stroke from toes to knees, repeating the action multiple times. Move onto the calf and brush-stroke from their heal to the back of their knee, repeating multiple times.  
9. Move onto the thigh and brush-stroke on the top-side from knee to hip repeating multiple times. If the underside of their thigh is accessible brush-stroke from behind the knee up to, or onto the buttock and repeat multiple times (as appropriate – see above).  
10. The outer-side of the thigh and buttock can be brushed in a small circling action with your other hand resting on their hip.  Make small circles with the brush moving up from outer-mid-thigh to hip or buttock, as appropriate. Avoid any areas  at risk of pressure sores.
11. Pause and think through the person’s responses before repeating with their other leg, adapting how you brush-stroke to what they indicated they preferred on their first leg.
12. Once both legs have been body-brushed, if the person is able to indicate, ask them which arm they wish to be brushed first. You can support this by stroking down each of their arms and gently squeezing their hands and watching for which they give the most positive response.  
13. Start with the back of their hand and brush-stroke from fingers to shoulder repeating multiple times. 
14. The inside of someone’s arms are usually more sensitive than the outside and may tickle. Try to accommodate for this and brush-stroke from palm up their arm, stopping before reaching their armpit.  
15. Pause and think about the person’s responses before repeating with their other arm, adapting how you brush-stroke to what they preferred on their first arm.
16. If they are positioned so their back is accessible, brush-stroke from the outside to the centre of the back working anti-clockwise or clockwise, i.e. right shoulder to centre, nape of the neck to centre, left-shoulder to centre, left side to centre, top of left buttock to centre, coccyx to centre etc.  Once you’ve got back to where you started you can repeat the radiating action in the same direction or reverse it. Repeat multiple times.  
17. It may be appropriate to repeat body-brushing using the radiating action on a child or male’s chest. Do not body-brush breasts.  
18. To finish, check how warm the person is and if appropriate, place a blanket over their body and communicate that body-brushing has finished. Their body may be tingling, and they could feel very relaxed or may feel energised.  Allow them time to shift their focus back to the immediate environment. Body-brushing could create thirst, so if appropriate offer a drink.  

What to observe, assess and record

Consider observing and recording before, during and after:

• Facial expressions before, during and after the body brushing
• Muscle tone and posture, looking and feeling for signs of relaxation, tension, comfort and discomfort
• Changes in skin colour and temperature to the touch
• Breathing
• Levels of energy 
• Behaviours before and after the massage
• Effect on sleep
• Effect on appetite and thirst

Contributor

© Julia Barnes, MEd, Special Needs Teacher and postgraduate researcher in nurturing touch at the University of Birmingham

Created October 2020