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Best Practice: Weighted Blankets

The use of weighted blankets remains controversial in the practice of Ayres’ Sensory Integration, and indeed in the world of occupational therapy. Responses to the use of weighted blankets are very individualised and require careful assessment of need. Where therapists try, choose to use or recommend a weighted blanket, the following reading may help you to manage the risks and to give advice including the current evidence.

It is essential therapists have and develop a local policy to inform clinical practice in line with guidance from their national professional body, and with reference to current research and evidence. This is especially important where junior colleagues may be making equipment recommendations requiring more advanced clinical reasoning.

Research and Evidence:

1. Allan Hvolby & Niels Bilenberg1. (2011) Use of Ball Blanket in attention-deficit/hyperactivity disorder sleeping problems, Nordic Journal of Psychiatry, 65:2, 89-94, DOI: 10.3109/08039488.2010.501868

2. Bryan Gee, Tyler McOmber, Jesse Sutton, Kimberly Lloyd; Efficacy of Weighted Blankets for Children With Autism Spectrum Disorder, Sensory Overresponsivity, and Sleep Disturbance. Am J Occup Ther 2017;71(4_Supplement_1):7111515242.

3. Brian Mullen BS, Tina Champagne MEd, OTR/L, Sundar Krishnamurty PhD, Debra Dickson APRN, BC & Robert X. Gao PhD (2008) Exploring the Safety and Therapeutic Effects of Deep Pressure Stimulation Using a Weighted Blanket, Occupational Therapy in Mental Health, 24:1, 65-89, DOI: 10.1300/J004v24n01_05

4. Kathryn Eron, Lindsey Kohnert, Ashlie Watters, Christina Logan, Melissa Weisner-Rose, Philip S. Mehler; Weighted Blanket Use: A Systematic Review. Am J Occup Ther 2020;74(2):7402205010.


Importance: Sensory integration modalities, such as weighted blankets, are used in occupational therapy practice to assist with emotional and physical regulation. However, the research related to the use and effectiveness of weighted blankets is sparse.

Objective: To identify, evaluate, and synthesize the current literature to help develop the impetus needed to launch a research study into the effectiveness of using weighted blankets to decrease anxiety and insomnia.

Data Sources: A literature search was conducted between January 23, 2018, and March 1, 2018. Databases and sites included the Cochrane Library, PubMed, PsycINFO, CINAHL, OTseeker, Web of Science, and Nursing Reference Center Plus. Search terms included weighted blanket, deep pressure, and occupational therapy as well as combinations of these terms.

Study Selection and Data Collection: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the study used weighted blankets as the modality of deep pressure stimulation. Data from presentations, conference proceedings, non–peer-reviewed literature, dissertations, and theses were excluded.

Findings: Only 8 studies were included: 4 Level I, 2 Level III, and 2 Level IV studies. The outcomes of these studies suggest that weighted blankets have the potential to be beneficial in limited settings and populations.

Conclusion and Relevance: Weighted blankets may be an appropriate therapeutic tool in reducing anxiety; however, there is not enough evidence to suggest they are helpful with insomnia.

RCOT Safe Use of Weighted Blankets (for children and adults) Briefing (Feb 2019)

Shared by Liz Brown, Greater Glasgow and Clyde NHS: Weighted Equipment Guidelines 25102019

Saskatchewan Society of Occupational Therapists. (2019). SSOT Position Paper: Use of Weighted Items. Saskatoon, SK: SSOT.

Every weighted blanket should come with clear instructions for safe use. See below this Southpaw Guidance about Weighted Blankets :

Click to access 2275_4.pdf

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