OT Weighted Blanket Survey

For our book on weighted blankets, I did a 2015 survey of occupational therapists (OTs) about weighted blankets, with over 300 respondents. My co-author, OT Cara Koscinski, and I wove the survey results into the book.

Read the detailed results here…

 

 

 

 

Here are the detailed results, which include:

1. What is your practice setting?
2. From your knowledge, what disorders have a weighted blanket helped?
3. What results have you witnessed or have been reported by caregivers?
4. How long do you advise keeping on the weighted blanket?
5. What weight of blanket do you advise?

1. What is your practice setting?

Clinic/Outpatient 31.1%
Hospital-Skilled Nursing or Rehab 9.2%
Group Home 2.0%
School    41.6%
Home Health Care 5.5%
Jail 0.0%

Other    29.0%

• Home (6)
• Residential ED Treatment for Adolescents & Adults
  Social Skills and School Services Provider
• Mental health
• One-to-one client practice 15 yrs and up to adult
• University – educator (2)
• Pharmacy
• Mental Health
• Residential aged care facility
• Adult mental health, state hospital
• Developmental Center
• ECI (Early Childhood Intervention)
• Inpatient mental health (7)
• State psychiatric hospital
• Private Practice (6)
• State Hospital – Mental Health
• Education
• C 3 – 4 Quadriplegic (postinjury 8/19/70)
• Long term care
• Vocational rehab facility
• County
• Community based
• Forensic mental health
• Early intervention/cpse/cse school with medically fragile/developmentally
• delayed/children
• Parent of child with autism and down syndrome
• Mental health intensive care unit
• Home health- pediatrics
• Pediatrics out patient
• Behavioral Health
• Early intervention (8)
• Home/daycare/preschool
• Mental/behavioral health with kids & adolescents
• Adult home health care
• Integrated preschool
• VA
• Home health (3)
• SNF (Skilled Nursing Facility) (4)
• Developmental disabilities
• ABA center
• Preschool – high school
• Pediatric residential hospital long term care
• Community

2. From your knowledge, what disorders have a weighted blanket helped?   

SPD 80.7%
Autism    85.6%
Stress/Anxiety    77.5%
PTSD    21.8%
TBI 12.6%
Chronic pain 9.5%
Major mental illness 22.5%

Other (please specify)    11.9%

• Dementia (2)
• Cerebral palsy, postural disorders (3)
• Borderline personality disorder, fibromyalgia, detoxing from substance/alcohol use
• Uncontrolled athetoid movement, cerebral palsy, issues with compulsive masturbation, incontinence, sleep disturbances
• Cognitively Impaired – Dementia
• Rhett syndrome
• Insomnia, Restless Leg Syndrome, chemical withdrawal
• Alzheimer’s disease
• Working with preschoolers I now rarely recommend weight blankets. Because of safety issues and body size of the children I work with. Where parents have highlighted a usefulness it tends to be hit and miss, ie some kids liked them and some kids didn’t.
• urrent recommendations from British Association and lit searches by a colleague here in the UK question their efficacy.
• Breast Cancer
• Trauma
• I don’t know but I have a gut feeling that it would help restless leg syndrome
• ADHD (10)
• Motor agitation
• During chemo (adult family member); severe multiple medical disorders in young child- palliative care
• Down’s syndrome
• The disorder is less important than the symptoms.

3. What results have you witnessed or have been reported by caregivers?

Seeking the weighted blanket 60.4%
Calmer/reduced anxiety 90.4%
Better able to control behavior 47.5%
Increased focus/more aware of surroundings 55.7%
Better sleep 64.6%
No difference    9.3%

Other (please specify)    10.4%

• Better control of movement, body in space
• At times, people feel claustrophobic or uncomfortable – especially with certain trauma histories.
• Improved quality and quantity of sleep, improved nighttime routine and decreasing the length of time needed to fall asleep, no longer needing sleep aides such as melatonin
• Lessens OCD behaviours
• Increase in length and depth of sleep
• Improved concentration & attention span
• Patient’s report the feel safer and comforted by the weight
• The blankets are in the facility however new to this setting. We are in the process of getting medical approval.
• Too heavy
• I have heard amazing things, but have not tried them ourselves
• One child started pulling blankets and pillows on her at home as we use the blankets at school during rest period only.
• Varied but more none than positive.
• Increased attention
• Seeking weighted blanket because they like how it feels, but did not change behavior or ability to focus or comply to non-preferred activities
• Results vary by child
• Helped regulate sleep after chemo treatments finished
• Decrease in self-stimming behaviors
• Stiller body
• This varies per individual. Some kids have had no changes in their sleep or calming with use.
• Extended “quiet body” periods
• Decreased Rigors (severe chills/shivers) during chemo
• No way of predicting what reactions, or who are good candidates until it is trialed individually
• Longer sleeping times
• Decrease in sensory seeking behavior
• Better transition from play to rest

4. How long do you advise to keep on the weighted blanket?   

10 minutes 10.6%
20 minutes 38.7%
As long as you like 46.7%

Why?    36.1%

• It depends on the child and what their needs are at that point in time.  Some kiddos only need 1-2 minutes with the blanket to calm down and some kiddos need up to 30 minutes. I tell patients after 30 minutes effects of blanket drastically decrease. Research has shown wearing weighted objects should only be worn for strict periods. This varies with the person need etc., but typically 20-30 min.  Effects seem to vary with patient neurology.  Comfort for sleeping is different then weights for calming.  Weights for calming generally are shorter periods of time like 20 minutes.  (9)
• Up to 30 mins, so child does not overheat (hot weather where i work)
• So as not to get used to the feel of the weight. If they always used it, it would serve no purpose when they need it.  To give them the additional tactile input to regulate their body and stay in a calm state.  I recommend until the patient calms (I usually use them for children with TBI). This to prevent the patient from getting used to the blanket, thus decreasing its effectiveness.  I’ve always heard that if you keep it on too long, then the effects can lessen over time and the person will need more weight to get the same calming effect.  (4)
• Some like to sleep with it, others are able to determine if they are uncomfortable. If I would use it with anyone with cognitive or communication issues I would start at 10 min and watch response.  To give people the option to relax with it for sleep, to use it as needed, or to stop using it if uncomfortable/painful.  The entire night when used for sleep quality and duration.  My son used to use it for comfort or when stressed.  Now that he’s older, he just sleeps under it every night.  20 min mainly to ensure safety if used at night time on younger children.  Removal is advised once asleep  (7)
• Varies depending on the individual.  For some, their anxiety increases significantly when the vest/blanket is removed so we will remove some of the weights but leave the blanket/vest on.  It varies from patient to patient based on their needs and tolerance, however long it seems to help.  Depends on the child’s age, needs and ability to request/refuse input. Depends upon reason using.  Patients have different levels of tolerance.  Some use it for brief naps during the day and others benefit from use all night.  the aim is to reduce children’s patterns and dependency,  (8)
• Take breaks, especially with the weighted collar – to prevent any shoulder tension or injury.  We only use them during rest period usually only 45 minutes.  I use weighted blankets as a preparatory method to prepare the child for participation in a self care or play task.  Usually during circle time, so about 10 minutes.  10 minutes for calming throughout the day.  Duration of break or rest period or PRN (“pro re nata,” meaning “as needed”)  to avoid satiation of input and increased effectiveness.  (5)
• For the duration of the dental procedure
• If the child is old enough to choose, I allow them to choose when to use. I rarely recommend it for children who are not old enough to either say that they don’t want it or push it off of them.  Have observed students take off on their own typically.  Want this intervention to be in the client’s control.  (4)
• Didn’t work for us
• As long as my son wants it
• Protocol for our district.  There is no protocol out there that I have found stating  the optimal recommended amount of time .  There is a lot of theory stating 10 minutes, but nothing to back it up.  (2)
• Sometimes if weighted lighter, through the night in the beginning, it depends on the child and some like it longer and others not so long.
• The body gets use to the input…change it up.
  Depends on the circumstances.  Some may purchase for home use, in which case it could be used while sleeping as long as the weight is appropriate for the user.
• Needs to be supervised with small children
  For sleeping it seems cumbersome to be taking it on/off often. During day I may suggest 20 minutes just to decrease habituation
• Client specific. I have children that sleep with them and others that use 20 minutes
  Typically, I suggest during seated tasks or where focus/control is expected and take off after completion to encourage pairing task and proprioceptive input for improved self-regulation
• Would habituate to the weight
• I work with young children and other weighted items I limit the wearing time but most of my clients like to use the weighted blanket for naps and all night use and children seek it for longer durations as long as the client is verbal and can remove the blanket themselves.
• Weighted blankets can be used at night or as a rest break modality.  We use same recommendations as a weighted vest since we do not have guidelines specific to blankets
  Depends on the child and situation. Either for particular activity or in the case of difficulty falling asleep, remove after child is asleep.
• Depends on what using it for…
• Short periods of calm seem helpful during the school day. also not enough time to habituate.
• Much like a security blanket, it gives the user more of a feeling of control over their sensory system
• I have found that if it is used for longer periods of time, my students acclimate to it and it loses effectiveness.
• I primarily encourage use at bedtime/naptime, so as long as it takes to fall asleep, and then no real need to take it back off again
• I have no recommendations for my own son, he is 13 and can regulate taking it on and off. I have used weighted lap pads in clinic setting for as much as 15 min for table top activities most of those children are able to tell me that want it off or on.
• I start with 15 minutes as tolerated and state that if the child removes it or appears agitated to remove it immediately
• Acclimation to weight being non-effective, reduce risk on injury after child falls asleep
• Most effective to reach outcome
• Depends on reason blanket is recommended
• Most of our patients sleep with them
• I instruct client/caregiver the premise and theory behind the weighted blanket recommendations and instruct them on behaviors that can guide the use of it; and of course respect the Inner Drive towards homeostasis. We trial most of this in the clinic before families spend money for one.
• Still unsure what the correct time is.
• My son had difficulty unwinding at the end of the day. His weighted blanket helped him calm and sleep at the end of the day.
• So the client does not habituate to the weight
• Lack of knowledge otherwise. He keeps on maybe 5 min when upset, but likes to keep it on a very long time for sleep
• Very light weighted blankets used as everyday blankets, nothing heavy
• I have not heard of any protocol for weighted blankets like there is for a weighted vest. I have been told that because of the even pressure it provides it can be used for longer periods of time.
• Depends on child’s age.
• 30 minutes
• Prolonged use can make it ineffective
• Up to one hour
• Let individual decide
• Usually depends on clinical reasoning. For sleep lighter weight for extended periods. For self regulation heavier for shorter periods
• Depends on what I am using it for. I have had students use it for extended periods of times 30-45 minutes if we are looking for calming and it seems to work. 10-20 minutes for regrouping/organization prior to interactive activities.
• It depends on the child and the situation
• The body accommodates the weight.
• The child’s excitatory and inhibitory responses are very sensitive and if too calm the child will sleep
• Varies between children. If a child can easily remove it and / or recognizes when they have achieved optimal benefit, I allow them to use as long as they want. I have children that either aren’t aware of temp or don’t regulate their temp so I am cautious with allowing longer than 20 min. I also consider the differing opinions regarding habituation concerns.
• To reduce possibility of acclimation to weight and therefore require more weight to achieve results
• As tolerated
• 30 minutes or until child’s tolerance level is reached, don’t want to wear too long or they will no longer benefit from it because body with adapt.
• The person knows their body best. If sleeping with it, I recommend it not exceed 10% of their body weight, they can free themselves of it, and they minimize other blankets as to not overheat. If used at school, shorter durations since the ultimate goal is to get the student back to class/instruction. I will send back with a weighted lap pad as needed.
• If it helps a child sleep, then I would allow them to sleep with it. If it’s during a treatment session, I just gauge the time according to the child being modulated.
• Depends on the child’s needs- 20 minutes maximum

5. What weight of blanket do you advise?

What the client/patient likes based on using it in your practice 24.6%
Based on what has worked for other clients/patients 7.4%
10% of body weight 61.4%

Other (please specify) 24.3%

• 5% of body weight (2)
• 5-10% of body weight (9)
• Suggested 10% as a base but they have added up to 5 lbs
• Up to 20% of body weight (2)
• 15-18% of body weight
• Start with 10% of body weight and modify as needed based on tolerance and compliance, according to student’s response (2)
• 10% and add a pound, although if it is for individuals that will be lying down I will go higher as the weight will be more evenly distributed over the entire body
• 11% of body weight/sometimes increase to 11% if child seeks intense deep pressure (2)
• I suggest 10% to start with but really customize based on student need. I’ve had students who want it heavier than 10% of their body weight. (3)
• 10-15% of body weight as a general rule, however I will adjust that based on what the client likes and can safely tolerate or anything under 10%, nothing more. If extra is needed, I would suggest some deep pressure activities prior to weighted blanket
• 10% of body weight plus 1-2 lbs based on comfort level (for children) (3)
• I begin with 10 percent of body weight- esp for little ones.  I often use more than 10 present body weight in a blanket where the weight is widely dispersed
• 10-20% of body weight depends on seeing a physiological response or calming response
• 10% is the maximum I recommend I start with lower weight first to see if we can achieve desired results at a lower weight (2)
• Size/weight, health condition.  Physical problems may interfere with too heavy of a blanket
• If parents are purchasing I refer them to the company they’re buying froms own guidelines
• We typically use a twin size blanket of 15 lbs for the majority of our children that sleep in a twin size bed. We also have a crib size of 8 lbs.
• Consultation with OT regarding weight.
• Varies with individual tolerance and need
• We base it on the significance of the dysfunction
• Whatever is figured out by the company and the parent
• About 3 pounds
• We use a preset blanket size for all the children
• Begin with full weight of blanket and add or remove to reach desired effect
• This is recommended but I have not found any quantitative research to back this up.
• Plus one or two pounds depending on the student/client some need more or less
• Depending on their body weight and tolerance
• Whatever we have available to try
• Also client driven from trial and error during treatment time.
• I use the measurements specified by the company I’m/they’re buying from based on the size of the child.
• I make and sell weighted blankets. Generally 4 pounds for a preschooler and 8-10 pounds for an elementary through high school student.
• We have several types and several kinds we can ‘layer’. It’s really a Goldilocks thing….when it feels ‘just right’
• A little bit more depending on the need of the child
• I was not an OT at the time I made my son’s weighted blanket. I made it much heavier that protocol advises – but he LOVED it! He was highly sensory seeking.
• Comfort/tolerance -not restraining
• Heavier than a normal blanket,this is for my kids- not pts
• Generally use the weight of the blanket that is ordered for our use
• Unsure
• Increase up to 15% if needed
• Usually 10%, but it depends
• Adjust for personal preference, but sometimes more or less depending on need /condition of student. I start there and work slightly up or down until I find the optimal amount.
• Research supports 10% for safety, but in skilled sessions we trial higher %
• I often recommend just using a very heavy quilt

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