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A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
The Life & Legacy of James Sigafoose, DC (1933-2014)
Surrounded by his family and closest friends, Dr. James M. Sigafoose passed away quietly on Thursday, July 3, 2014. With his wife of 60 years, Patsy, along with his children, Tina, Daun, Kieth, Selina and Carey – all chiropractors – at his side.
Watch Out for Red Herrings
In clinical practice, when one condition mimics another, it makes it difficult to obtain an accurate and timely diagnosis.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Building the DC-MD Bridge
From MDs practicing integrative holistic medicine to the family internist, many DCs are enjoying unprecedented attention from their allopathic colleagues.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
Get Ready For AOM Day
This year, AOM Day 2014 falls on Friday, (October 24th). This is a great opportunity to make your AOM Day celebration or event even bigger by extending it throughout the weekend!
How to Find Your Ideal Patient – and Help Your Ideal Patient Find You
Just imagine: You're at the front desk looking at the scheduler and a smile creeps across your face. Row after row, name after name, hour after hour; you're blessed with an entire day of ideal patients. Every day should be like this, you whisper. Exactly!
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
From the Other Side of the Table
People come to us to gain freedom from pain, to feel better, to live better. As D.D. Palmer stated, "We Chiropractors work with the subtle substance of the soul." Therein also lies the rub.
Decompression-Traction: A Core Treatment Method in Chiropractic's Future
We're all competing for new patients. We're competing for new patients with physical therapists, massage therapists, medical specialists and hospital fitness centers. We're even competing with side-effect-ridden medications that quit working every four hours.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
Your Patients' Best Health Resource
There is nothing as powerful as information. The right information has won wars, saved lives and changed hearts; lack of information has led to hesitation, poor decisions and unintended consequences.
News in Brief
Oregon Gov. John Kitzhaber (a medical doctor, no less) proclaimed October 2014 "Oregon Chiropractic Health and Wellness Month" in an official proclamation signed Aug. 25, 2014.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
Ringing in a Fiscal New Year With a Recommitment to Cost-Effectiveness
Back when the Foundation for Chiropractic Education and Research was in its heyday, I used to send out New Year's greetings and virtual noisemakers to some close friends on July 1 – the beginning of our new fiscal year – wishing for prosperity in the year ahead.
Detoxification for Athletes: The Key to Winning Performance
One of the most dangerous culprits that affects an athlete's ability to perform at an optimum level also happens to be one of the most elusive.
Don't Forget About the Performers
Donald Petersen Jr.'s recent article, "Your Chance to Go Back to High School" [May 1, 2014 DC], focused on the injuries incurred by high-school athletes and the subsequent opportunities for the chiropractic profession.
Take Care of Your Skin: Tips to Pass on to Your Patients
Many of our patients are not aware that the largest organ in the human body is actually the skin. Accounting for 16 percent of total body weight and covering up to 22 square feet of surface area, the skin is more than just a "covering," as originally thought.
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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