resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
PCOM Granted Regional Accreditation
Pacific College of Oriental Medicine (PCOM) recently announce it has received regional accreditation from the Western Association of Schools and Colleges (WASC). This achievement reflects five years of hard work on the part of faculty, staff, and students.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
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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