Lost A Sale, But Initial Phone Consultations — A Big Part Of Brilliant Customer Service
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Treatment of PTSD: An Opportunity for the Practice of Integrated Medicine
PTSD is widespread across America today. Not only do many of our honored men and women in uniform bring it home with them from the war zones they have been active in, but it often follows any life-threatening event people go through when their lives have been in danger.
Meet Cheyenne: Your Future Colleague
Allow me to introduce you to Cheyenne (Chey), the daughter of some of our family's closest friends. We attend and serve at the same church together, and have known each other for many years.
NCCAOM Video Contest
The NCCAOM is excited to announce the launch of the second annual video contest "Because it Works!" 2015.
The Risks I Took
We all take risks when we choose this profession. For some, it is not knowing if you can make a living practicing TCM. For others, it is parental or cultural disapproval.
Free Yourself From the Pocketbook Practice
Let's take a journey together; there's an important lesson to be learned. Imagine a town or city just like yours.
Leg-Length Inequality and Pelvic Fixation: A New Approach to the Negative Derifield (Part 3)
A patient with sacroiliac fixation and dysfunction ordinarily demonstrates a noticeable leg-length inequality when placed in the prone position on the adjusting table.
Should You Change an Athlete's Natural Running Form?
Once past the ankle, impact forces travel at about 200 mph into the knee. In addition to allowing the quad to absorb force, bending the knee (E) prevents the hip and pelvis from moving up and down too much (F), which is important for injury prevention and efficiency.
The Source-Luo Point Combination, Part 2
The Da Cheng includes symptoms for the source-luo points that indicate when to use them for treatment. Yang defines the method as the guest-host (it is one of a variety of acupuncture point combinations called guest-host).
Integrative Medicine for the Underserved: A Seat at the Table
Numerous organizations have risen to the challenge of providing care to medically-underserved populations and here we feature one such group.
Key Changes and Updates to the 7th Edition CNT Manual
Acupuncture Today recently interviewed Jennifer Brett, ND, L.Ac. regarding the updates to the CNT manaul.
Creating Relationships at Southwest Symposium
The month of May brought many interesting activities. As I have said in many previous columns this year, this profession is moving in a very exciting direction. Make sure you are getting involved. If you're not, you just might get left behind.
Q&A With the First VA Chiropractic Residents
As you may have read previously, a major step forward for the profession occurred in July 2014 when the Department of Veterans Affairs began piloting a chiropractic residency program at five locations.
Sports Medicine 101: Surgery or No Surgery?
In the world of sports medicine, many careers are saved by surgeries that correct traumatic damage to the body. Muscle tears, ligament damage, fractures, spinal disc herniations, and joint instabilities are a few of the issues frequently addressed with surgical intervention.
Chinese Doctors Poke Holes in Australian Study
A recent Australian clinical trial, published in the Journal of the American Medical Association (JAMA) in 2014 by Rana Hinman, et el., evaluating the effectiveness of both needle and laser acupuncture for chronic knee pain.
The Three Heater Official
This Official, belonging to the element Fire, is responsible for maintaining and regulating the heating system of the body, mind, and spirit. It is named for its function. The trunk is divided into three "burning spaces" or "jiaos."
Going On-Site With Chiropractic Care
The Foundation for Chiropractic Progress has released a position paper highlighting the financial, clinical and patient-satisfaction benefits of providing chiropractic care at on-site corporate health clinics.
News in Brief
Investigating the Cellular Impact of Mechanical Force; National Board Seats (Not-So) New Officers at Annual Meeting.
Desert: A Metaphor from the Study of Genetics
In most of the human lives I know about, there are stretches of time which feel stagnant, or worse. We can feel adrift, or wounded and sidelined, and these times don't seem to carry much usefulness while they are unfolding.
I was sitting in a Pizza Hut in Peoria, Ill., with my friend Reggie, sometime in the spring of my senior year in college, when he started doodling on his paper placemat. In those days, the company had a picture of U.S. on the mats, showing all the locations of the "Huts" in the country.
Nomenclature and Classification of Lumbar Disc Pathology: Version 2.0
The Nomenclature and Classification of Lumbar Disc Pathology consensus, published in 2001 by the collaborative efforts of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology, has guided radiologists, clinicians and the public for more than a decade.
Marketing with a Microphone
When given an option, it stands to reason that people prefer to do business with those they know, like, and trust.
August, 2002, Vol. 02, Issue 08
Working with Clients Who Have Cerebral Palsy
By Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President
In my last article, I discussed the special challenges of working with clients who have survived spinal cord injuries. I had been surprised at how little input I got before I prepared that piece, and I have likewise been surprised (happily) at how much feedback I got afterward - from both massage therapists and SCI survivors (and in one case, a person who is both).Here are some examples:
I want to extend my thanks to all the people who responded to my article. It certainly seems clear that many massage therapists feel they need more education on working with clients with a wide variety of CNS dysfunction.
This month, I have chosen to focus on another type of CNS disorder: cerebral palsy. As usual, I will review some of the technical information about what manifests this set of signs and symptoms; then I will discuss some of the special issues this disorder raises in the context of bodywork.
Cerebral Palsy: What Is It?
Cerebral palsy (CP) is a term that refers to many possible injuries to the brain during gestational development, birth, and early infancy. Several different types of CP have been identified, each involving damage to different parts of the brain.
The incidence of CP in the United States is two to four out of every 1,000 live births. Around half a million CP patients live in the U.S. today. In spite of improved prenatal care, the rate of CP in the U.S. has remained unchanged for many years.
Etiology: What Happens?
Cerebral palsy is the result of brain damage, usually to motor areas of the brain, specifically the basal ganglia and/or cerebellum. The damage can be brought about in a number of ways.
Regardless of the cause of brain damage, the child with cerebral palsy will have some impairment of function. The problem could be so minor that only people who know what to look for may see it, or it may be completely debilitating both physically and mentally; it all depends on what part and how much of the brain has been affected.
Types of Cerebral Palsy
CP is classified into four types: spastic, athetoid, ataxic, and mixed.
CP may also be classified by what part of the body is affected. These terms are consistent with those used for other CNS disorders: hemiplegic CP means the left or right side is affected; diplegic CP means either two arms or two legs are affected; and quadriplegic CP means all the extremities are affected to some extent.
Types of CP may come and go, or change entirely from one kind to another, as the child grows. CP is not a progressive disorder, however, and if symptoms seem to be getting significantly worse over time, a different kind of CNS dysfunction must be considered.
Signs and Symptoms
Signs and symptoms of CP vary according to the location and extent of brain injury. Damage to the cerebellum produces different symptoms from damage to the frontal lobe, for instance. But some of the most common features of CP include hypertonicity; hypotonicity; poor coordination and voluntary muscle control; unusually weak muscles; random movements; seizure disorders; early hearing and/or vision problems; and progressive muscle contractures. About half of all CP patients have some level of mental retardation, and many are unable to communicate verbally.
Because infants don't develop voluntary motor skills until they are around six months old, CP may be difficult to diagnose earlier than this point.
CP is incurable and irreversible; as such, it is managed, rather than treated, by providing skills and equipment to live as fully and functionally as possible. For some CP patients this could mean using a brace for one foot that is slightly weaker than the other; for others it could mean intensive occupational, physical, and speech therapy for many years.
Medication for CP is occasionally prescribed to help manage seizures, and to reduce muscle spasm. Some surgical interventions have been developed to lengthen contracted muscles, to realign vertebrae that have become distorted by scoliosis, and to alter nerve pathways in the brain to reduce the severity of tremors.
Physical therapy is recommended for people with CP because the process of developing muscle contractures is slow and can be made even slower when muscles and joints are specifically stretched and manipulated to maintain flexibility. Patients may also be encouraged to use and strengthen their weaker limbs. It is important to note the many uses and benefits physical therapy has to offer CP patients, because massage therapy may also be a valuable adjunct in these cases.
What about Massage?
There is no question that massage therapy can have a valuable role in improving the quality of life of a person with CP. Unlike many CNS disorders, a lot of information about bodywork for CP patients is easily available; I'll list some wonderful sources at the end of this article. Nonetheless, these clients require some special adjustments in the way bodywork is administered, and I've had several letters from massage therapists who would like to feel their work is more effective with this population.
The damage for a person who has CP does not begin in the muscle and connective tissues. Although this is where we feel the tightening of the connective tissue wrappings around muscles, the contractures themselves are simply a symptom-a complication of a problem deep in the brain. Therefore, if all we try to do is lengthen the muscles and stretch the fascia, we will run smack into a brick wall: either no progress will happed at all, or symptoms may even be temporarily exacerbated. Most people with CP get best results if bodywork focuses on indirectly affecting muscle tone through craniosacral work, gentle rocking, slow range of motion exercises, and manipulation of the arms and legs that engages the client in ways he or she doesn't automatically resist-this often means going with the direction of muscle shortening in order to disengage the reflex. Ultimately, the therapist will have to experiment with lots of different approaches, often accompanied by extremely supportive bolstering, in order to find what techniques allow their clients to relax and enjoy their massage.
The benefits of massage to CP patients are undeniable. Parents write of their satisfaction when their child is able to sleep through the night, when postural distortions unbind, when breathing eases, when faces light up with joy because the massage therapist has arrived for a session. Imagine a child who is the object of vast numbers of painful, intrusive, unpleasant, dehumanizing medical procedures (regardless of the supportive intentions behind them). This child is handled rather than touched. Then his massage therapist arrives and arranges him carefully among pillows and bolsters on the table. She cradles his occiput and straightens his neck so he can breathe more easily. She rocks his arms and legs until their tension eases. She plays with his fingers until he realizes he can move them in lots of directions. Nothing she does hurts. What a gift, what a privilege to be invited into such a relationship!
If physical therapy is used to stretch and strengthen skeletal muscles, massage will also be a safe choice. The only caution is that people with very severe CP may not be able to communicate their wants or concerns clearly. If a massage therapist works with a client who cannot speak, other modes of communication, including nonverbal signals, become especially important. It is the responsibility of the massage therapist to make sure that his or her work is welcome and freely accepted at all times.
Our culture harbors a fear of people who look, or sound, or act differently from ourselves. Seeing or being with someone with CP can raise all kinds of fears or judgments that we never realized were there. Maybe this person can't speak, or drools, or walks funny, or doesn't walk at all. Speaking for myself, I will share that it's especially hard for me to deal with disabilities when they occur in children. And yet, here is a population that so needs the work we do! As long as basic common-sense precautions are respected (don't overwork numb areas, be sensitive to nonverbal communications, if anything you do makes symptoms worse then stop and try something else) massage can be a central coping mechanism for a child or adult with CP.
I am hopeful that any readers who have the opportunity to work with clients who have CP will feel more confident to do so. I am especially delighted to share some valuable resources that help me put together the parts of this article about bodywork:
For my next column, I'm going to offer readers a choice. I've had requests for articles on these topics:
So, what do you want to have discussed next in What's On Your Table?
Ruth Werner, LMT, NCTMB
Click here for previous articles by Ruth Werner, LMP, NCTMB, Massage Therapy Foundation President.
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