resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Integrative Cardiology: The Heart of TCM & Western Medicine
Patient centered therapy is a growing trend in hospitals that are expanding to boutique services.
Insomnia Treatment Based on the Yu Theory
In recent years, acupuncture has risen in popularity as a form of alternative or supplemental medicine for the treatment of many different types of disorders.
Treating LBP the Right Way: Think Natural
An updated clinical practice guideline from the American College of Physicians (ACP) recommends spinal manipulation and other non-invasive, non-drug therapies as first options for acute, subacute and chronic low back pain, rather than pain medications, as stipulated in the original 2007 guideline.
News In Brief
A "Modern" Business Model. Acupuncturists may have a new professional atmosphere to consider, as a new concept is on the horizon - at least for one business.
Help Save an Important Chiropractic Landmark
The chiropractic profession has a splendid and varied history. Sadly, many landmarks have been lost to bulldozers and wrecking crews, such as the Ryan Building, Little-Bit-O-Heaven, Spears Chiropractic Hospital, and Clearview Sanitarium.
Making Sense of Liver Regulation
In Chinese medicine, the liver has the function of moving and storing qi and blood. In its moving function, the liver smoothly distributes qi and blood to the tendons, muscles and flesh through microcirculation.
How to Correct a Cuboid Subluxation
Cuboid subluxation is a poorly recognized condition, even though it is not uncommon. It has been described in the literature under various names: cuboid subluxation, cuboid syndrome, locked cuboid, dropped cuboid, cuboid fault syndrome or peroneal cuboid syndrome.
Good Works at the Canandaigua VA
Faculty and students of the Finger Lakes School of Acupuncture and Oriental Medicine (FLSAOM) of the New York Chiropractic College have provided acupuncture to veterans at the Veterans' Administration Medical Center (VAMC) in Canandaigua, New York since September of 2007.
Toxicity & Kids: The Importance of Environmental Intake
The old adage is true that children are not little adults. Traditional Chinese medicine (TCM) has long known that the physiology of children is unique, as are the diseases that plague them.
Scope of Chiropractic Practice: Why Now Is the Time to Expand
In my January article, "Scope of Chiropractic Practice: Is It Time for Change?" I discussed the use of the term primary spine care practitioner, the loss of privileges to diagnose in Texas, and the fact that the definition of "chiropractic" varied from state to state.
NSAIDs No Better Than Placebo for Spine Pain
A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."
The First (Only) Choice for Spinal Pain
The study on NSAIDs for spinal pain summarized on the front page of this issue is intriguing on a number of levels, the most obvious being the conclusion that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."
Waist Circumference: A Conversation Starter (Part 2)
Now let's discuss the clinical approach to reducing WC and implementation in today's chiropractic practice. The primary intervention centers around dietary modification and lifestyle habits aimed to reduce adiposity, improve insulin sensitivity and ultimately, diminish systemic metabolic dysfunction.
The Qi Focus: A Guide to Managing Stress
Stress, are you experiencing heightened stress levels? Your own, and your clients? Is Trumpitis getting to you? I recently polled a cluster of acupuncturists, Asian Bodywork Therapists (ABT) and psychotherapy colleagues on the issue.
Chiropractic: A Great Fit for the White House
Dr. Eric Kaplan is a New York Chiropractic College alumnus; a No. 1 best-selling author whose books include Awaken the Wellness Within and The 5 Minute Motivator; a chiropractor for professional sports teams and elite athletes; and even served as an advisor under the Clinton Administration to the President's Council on Sports & Physical Fitness.
5 Ways to Enhance Your Family Practice
Every practice has a personality style. A practice that caters to athletes, PI cases or adults, for example, projects differently to patients than a family wellness practice.
Caring for Refugees in Greece
At the beginning of 2016 I had no idea what was in store for me, but I was looking forward to a personal retreat on the Greek island of Paros; a graduation gift to myself after 22 years of motherhood, and four-plus years of Chinese medicine school.
Shedding Light on the Benefits of Heliotherapy
I can't imagine anyone not feeling good strolling in the sun on a beautiful spring day. The sun is responsible for all life on earth and is best illustrated along the equator touting the richest biodiversity on the planet, in stark contrast to the Arctic Circle and South Pole.
What's Bugging You? Probiotics and Your Health
An estimated 100 trillion microorganisms representing more than 500 different species inhabit every normal, healthy bowel. Gut-dwelling bacteria keep pathogens in check, aid digestion and nutrient absorption, and contribute to immune function.
The Chiropractor's Guide to CRISPR
Science magazine's "Breakthrough of the Year" award for 2015 was described as "the gene-editing tool called CRISPR." CRISPR stands for "clustered regularly interspaced short palindromic repeats."
Give Your Patients the Ergonomic Advantage
Prolonged sitting contributes to low back pain and is a health risk. When I discuss my POLITE technique practice recommendations with patients, ergonomics may be last, but not least!
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.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.