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Modernization of Chinese Medicine
Language – written, spoken, signed, or otherwise is learned as a means to express our individualized perceptions about the world around us. Language is designed to communicate our personal experiences.
Practicing with Authenticity
To extrapolate from the above quote, patients love healthcare providers they can trust. One way to earn the trust of your patients is by practicing with authenticity. What does that mean, exactly?
Why More Patients Don't Come to Your Office
Every so often, something turns out to be much easier than anticipated. It's like ordering a piece of furniture or a child's toy that comes in 167 pieces.
The Food Conversation: Nutrition and Your Practice
It's morning and your first patient rolls in with a triple espresso steaming in one hand and a frazzled, desperate look in her eye. "You gotta help me, doc, I am constipated unless I drink one of these, and I am exhausted and anxious all the time."
We Get Letters & Email
It was with great interest that I read "Trouble in the Wellness Waters?" in the May 1, 2015 issue of Dynamic Chiropractic. I heartily applaud Dr. Hayes for his insightful and informative article.
Managed Care Subverts Chiropractic
A study published in the American Journal of Managed Care underscores why so many chiropractic patients go out of network in order to get the care they need: Managed care may be effectively locking them out.
Fertility and Poly-Unsaturated Fatty Acids
Starting or expanding one's family is a major milestone. It's something that more and more people seek out health care advice and support for.
Thinking About Cohen's Kappa
Let's think about some notions of reliability and validity, and about what it means for diagnostic examiners to agree in meaningful ways. Diagnostic tests must obviously be both reliable and valid.
The New Age of Communication
In the age of technology, everyone, including the patient, is seeking faster, easier ways to communicate. With a wealth of social media, blogs, websites and videos, we are constantly barraged with information – to the point of overload.
Help: A Need at Every Level
One of the great gifts of training in acupuncture is the ability to take good care of oneself. I recently had a bout of frozen shoulder — an inflammatory syndrome which can be debilitatingly painful and take years to resolve.
Troubleshooting: Billing Multiple Fees for the Same Service
I am afraid I may doing something illegal. I have heard I cannot bill different fees for the same service.
An Acupuncturist's View of Medicinal Marijuana
The use of cannabis for medical purposes is very controversial. Use as a panacea by physicians uninitiated to the proper application of herbal medicine, as well as an excuse for recreational use have greatly confused the issue.
Do You Have a Post-ICD-10 Strategy?
Post-ICD-10 planning is critically important to the health of a practice, in part because ICD-10 is brand new to providers, payers and related affiliates alike.
When Patients Lie (Bribe or Flatter)
Recently, a new patient told me about what I thought was a novel twist on the doctor-patient relationship. She felt she had to lie to her DC to discontinue her treatment.
Getting a YES: An Effective Strategy for Overcoming Patient Objections
Patients make more excuses for declining care from an acupuncturist than perhaps any other type of doctor. Various reasons hold them back from making a commitment to care.
Nuts Reduce Risk of Heart Disease, Cancer and Other Health Problems
Several recent studies suggest regular consumption of nuts may provide a significant degree of protection against certain types of cancer, heart disease, possibly type 2 diabetes and some neurodegenerative diseases.
Do Some Good and Grow Your Business with Cause Marketing
Cause marketing is truly one of the best ways that you can promote your services as a acupuncture professional. Cause marketing refers to a type of marketing where a business partners with a non-profit organization to help bring awareness to a charitable cause.
Dietary Fat and Prostate Cancer: An Important Update and Review of Mechanisms
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
A Tribute to a True Chiropractic Leader
President of Texas Chiropractic College (alumnus, class of 1950) and the American Chiropractic Association (ACA) Board of Governors. President of the Texas Chiropractic Association and twice-appointed member of the Texas Board of Chiropractic Examiners.
Improving Communication Between AOM and Biomedical Providers
How comfortable do you feel talking to Western medical providers? If you are like me, you may not feel as comfortable as you would like. Some of my interactions with MD's haven't been the fruitful steps toward integrative medicine for which I had hoped.
The Short Leg Dilemma
When evaluating a new patient, it is common to note a relative shortening of one leg to the other. Some patients will even tell you they have one, and then pull out the store-bought heel lift they read about online.
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 1
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Oriental Medicine on the World Stage
"Let me win. But if I cannot win, let me be brave in the attempt." This simple, yet powerful statement was lived out time and time again by so many of the athletes from around the world during the Special Olympics World Games in Los Angeles.
Active Care for Ankle Sprains
An ankle sprain is a common injury, since this joint is required to perform complex movements under high forces during normal walking. In fact, 10 percent of all emergency-room visits are ankle-sprain related and an estimated 25,000 ankle sprains occur in the United States daily.
Healing Trauma: Cultivating Resilience and Presence Through Mindfulness, Part 2
In the last issue of Acupuncture Today, the first part of this article introduced the topic of trauma and resilience, and their relationship to the autonomic nervous system response and the concept of the spirit being grounded in the body, and suggested the importance of mindfulness as a tool for healing.
September, 2009, Vol. 9, Issue 09
Massage and Alzheimer’s Disease, Part 2
What does the literature say?
By Ann Catlin, LMT, NCTMB, OTR
Mary, an 81-year-old female, has resided in a nursing home for seven months. Her medical history reveals that she has Alzheimer's disease; anxiety (state unspecified); dementia with behavior disorder; insomnia; osteoarthritis; osteoporosis; and recurrent urinary tract infections. She requires a wheelchair because she no longer is able to safely ambulate and has fallen several times; she has increasing difficulty communicating her needs because she cannot find the appropriate words to express herself; she has recently begun to yell out and, at times, bangs on her wheelchair for long periods of time. She relies on staff to assist her with activities of daily living; she is incontinent of urine; she attends group activities, but the yelling and banging is upsetting to the others and she is removed from the group. She spends much of her time in her room or in the hallway. She has difficulty sleeping and is often anxious at night, which increases her yelling behavior. This concerns staff because they have difficulty calming her and other residents are awakened.
Following a referral for massage therapy, I arranged for sessions twice a week and it was agreed the need for continued session would be determined after six weeks. I saw Mary in her room while she was sitting in her wheelchair. Each session lasted 20 to 30 minutes and typically took place in the morning before lunch. Mary was receptive to having massage lotion applied to her hands in the form of a hand massage and she seemed to enjoy the one-to-one attention.
Following three weeks of sessions, the activity director reported that Mary was able to remain in more group activities without disruptive yelling and only occasional banging on her wheelchair. This resulted in less isolation and opportunities for social interaction for Mary. After six weeks, I demonstrated a simple hand massage technique that the staff could use in addition to continued weekly massage therapy sessions. The nurse assistant reported that Mary was more cooperative during self care activities and that she had decreased restlessness and agitation at night. The overall impact of massage therapy was an increase in the quality of life for Mary and decreased job stress along with increased feelings of satisfaction for the staff.
This scenario illustrates that, indeed, massage appears to have a positive impact on the care and quality of life of an elder living with the effects of Alzheimer's disease. I'm not alone in witnessing these effects -- many of my colleagues share similar stories that point to the efficacy of massage in Alzheimer's care. But our stories may not be enough to substantiate what we experience during our sessions. As massage therapy becomes more recognized as a health care profession we are expected to back up our stories with data. Like it or not it is the world we live in. Fortunately there is a long-standing and growing body of evidence that substantiates the value of massage and touch in Alzheimer's care. While there is need for further research, studies indicate that the use of some forms of massage are effective in managing challenging behavior often exhibited by elders living with Alzheimer's disease and other forms of dementia. What follows is a brief report on a few such studies and articles. While this is surely not an exhaustive collection of articles, it will give you some interesting data on which to hang your hat (or your holster!). I've included Web links so you can access the full text of each article.
Studies in Dementia
Editor's note: The following abstracts were taken from various Internet sources; author, title, publication and Web links of each abstract are cited.
Hicks-Moore S, Robinson B. "Favorite Music and Hand Massage: Two Interventions to Decrease Agitation in Residents with Dementia." Dementia, 2008;7(1):95-108. http://dem.sagepub.com/cgi/content/abstract/7/1/95
Agitation in individuals with dementia living in the nursing home environment affects care and quality of life. Relaxation techniques such as music and massage are showing promise to decrease agitation and improve quality of life in individuals with dementia. Using an experimental 3 x 3 repeated measures design, 41 residents with mild to moderate dementia participated in a study to test the effectiveness of favorite music (FM) and hand massage (HM) in reducing agitated behaviors. Agitated residents were randomly assigned to either the treatment or control groups. Residents in the treatment group received each of three treatments, HM, FM, and HMFM, with each treatment lasting 10 minutes. Residents in the control group received no treatment. Agitation was measured using the Cohen-Mansfield Agitation Inventory (CMAI) at three different intervals. The results suggest that FM and HM individually and combined are effective in significantly decreasing agitation immediately following the intervention and also one hour post intervention.
Forbes D et al. "Nonpharmacological Management of Agitated Behaviours Associated with Dementia." Geriatrics & Aging, 2005;8(4):26-30. http://www.medscape.com/viewarticle/503816
Abstract: Strategies such as simulated presence therapy, pet therapy, light therapy, validation therapy, music, massage, therapeutic touch, aromatherapy, and multisensory stimulation have shown promising results in decreasing physical aggression, physical nonaggression, verbal aggression, and verbal nonaggression in older adults with dementia. Further research is needed to identify which strategies are most effective in managing symptoms of agitation associated with the different types of dementia and at different levels of cognitive impairment.
Nonpharmacological approaches have several advantages. They address the psychosocial and/or environmental reason(s) for the agitation, and compared to pharmaceutical interventions they avoid potential side effects, drug-drug interactions, and masking of behaviour that may serve as a signal for a need. The purpose of this review is, therefore, to assess and summarize research evidence on the efficacy of nonpharmacological strategies in managing agitated behaviour associated with Alzheimer's disease and related dementias.
Cohen-Mansfield J. "Nonpharmacologic Interventions for Inappropriate Behaviors in Dementia: A Review, Summary, and Critique." American Journal of Geriatric Psychiatry, 2001;9:361-81. http://focus.psychiatryonline.org/cgi/reprint/2/2/288
Abstract: Inappropriate behaviors are very common in dementia and impose an enormous toll both emotionally and financially. Three main psychosocial theoretical models have generally been utilized to explain inappropriate behaviors in dementia: the "unmet needs" model, a behavioral/learning model, and an environmental vulnerability/reduced stress-threshold model. A literature search yielded 83 nonpharmacological intervention studies, which utilized the following categories of interventions: sensory, social contact (real or simulated), behavior therapy, staff training, structured activities, environmental interventions, medical/nursing care interventions, and combination therapies. The majority are reported to have a positive, albeit not always significant, impact. Better matching of the available interventions to patients' needs and capabilities may result in greater benefits to patients and their caregivers.
Massage/Touch. Six articles report studies of massage or therapeutic touch. Usually, the procedure took about five minutes and was performed once or twice per day. One study reported unequivocal success (using a combination of massage and verbalizations). The other studies reported either a positive trend, partial effects (on physical and verbal behaviors) or no effect of the intervention (on aggression).
Snyder M et al. "Efficacy of Hand Massage in Decreasing Agitation Behaviors Associated with Care Activities in Persons with Dementia." Geriatric Nursing, March/April 1995:60-3. http://www.ncbi.nlm.nih.gov/pubmed/7774819
Summary: The purpose of this study was to explore if administering hand massage before care activities that were often associated with agitation behaviors would reduce the frequency and intensity of these behaviors during these care activities. Both aggressive and non-aggressive forms of agitation were studied. A hand massage protocol that took five minutes to give was chosen as the intervention. Hand massage was performed in the morning and afternoon for ten days. Results showed that hand massage decreased the frequency and intensity of agitated behavior during morning care routines, although not during evening care. Staff reported that reducing the intensity of the behavior made it easier to care for the elders.
Kilstoff K et al. "New Approaches to Health and Well-Being for Dementia Day-Care Clients, Family Carers, and Day-care Staff." International Journal of Nursing Practice, June 1998;4(2):70-83. http://www.ncbi.nlm.nih.gov/pubmed/9748936
Abstract: This study was conducted in one multicultural dementia day-care centre over a period of 18 months. It introduced a gentle hand treatment for clients using three essential oils. The study evolved out of the process of action research where the family carers and day-care staff participated with the researchers to choose, design, develop and evaluate a hand treatment program. Data was collected through in-depth interviews pre-and post-treatment, focus group discussions, client observation logbooks and a disability scale. The findings indicate a positive strengthening of the relationship between the person with dementia and their family carer, and an improvement in feelings of health and well-being for both. The specific improvements for clients include increased alertness, self-hygiene, contentment, initiation of toileting, sleeping at night and reduced levels of agitation, withdrawal and wandering. Family carers have reported less distress, improved sleeping patterns and feelings of calm. They also found the treatment useful in helping them manage the difficult behaviors exhibited by their relative with dementia. The benefits of this treatment for nursing practice are that it is safe, effective and easily administered by staff in any setting.
Want to learn more?
I invite you to explore this topic further. Who knows; maybe the next study will be conducted by YOU! Additional online resources that I have found helpful are:
I leave you with this quote: "If you have knowledge, let others light their candles at it." Margaret Fuller
Read Ann's previous article "Massage and Alzheimer's Disease, Part 1 What would Maslow say?"
Click here for more information about Ann Catlin, LMT, NCTMB, OTR.
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