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Massage Today
March, 2011, Vol. 11, Issue 03

Understanding Alzheimer's Part 2

By Ann Catlin, LMT, NCTMB, OTR

Part one of this article dealt with facts about Alzheimer's disease. As an educator, I believe that facts are a good place to start to understand a topic.

Facts give us the big picture about the disease, demographics and guidelines. I've been around people with dementia my entire professional career. I've seen how this disease takes the brain a little at a time and the heartbreaking loss that families endure. My formal education focused on impaired intellectual and functional abilities as the phrase "death by a thousand subtractions"1 reflects.

But facts are only part of the story when it comes to understanding Alzheimer's disease. A new body of knowledge is emerging that shines a light on the inner life of the person living with Alzheimer's and what remains intact. I'm excited to find others speaking out about what I've witnessed for years - that, in spite of the disease, the individual within remains and is capable of a worthwhile life.

New Perspectives

Alzheimer's old man - Copyright – Stock Photo / Register Mark Personhood is defined as "the state of being an individual or having human characteristics and feelings". A person living with Alzheimer's is often thought of as a former person - one who has lived but is no longer "there". New perspectives beg to differ. We now see that Alzheimer's is about much more than memory loss, but rather complex layers of both cognitive deterioration and largely intact abilities. The key, it seems, is to find ways to focus on the abilities. John Zeisel in his book, I'm Still Here2, tells us:

  1. The skills and capabilities of people living with Alzheimer's that don't diminish over time, or do so more slowly, provide windows for connection and communication.
  2. Through those windows lie opportunities to establish and build new and vibrant relationships supporting both care and well-being.

I couldn't agree more. Through my work as a Compassionate Touch practitioner, I've witnessed the profound impact of touch in bringing forth the intact person within the fog of the Alzheimer's. A gentleman, I'll call James, resided in a skilled nursing facility. When I met him he was able to share much of his life and was very engaged with his family. James had been an entertainer and a businessman.

As a young adult he was a radio broadcaster and loved to sing. He shared with me a recording of him singing a beautiful Italian song. His young tenor voice was lovely. We played that recording many times during our visits and, while I gave him a back massage, he would tell me stories that music brought to mind. As his condition worsened and he no longer knew who I was when I arrived, the touch and music helped him access the memory of our relationship. One day he surprised me by asking about my son, clearly remembering things I had told him months before. Even near the end of James' life he enjoyed the connection we had through the medium of touch.

Touch As Connection

What is it about touch that is so powerful? That is a complicated question but two reasons are near the top of the list in my opinion: oxytocin and hardwiring. Oxytocin is a neurotransmitter in the brain related to childbirth, sexuality and social behavior. Touch stimulates production of oxytocin leading to feelings of safety, caring, trust and decreased anxiety. It's been called the "care and connection" hormone.

Zeisel talks about hardwired human abilities. These are universal abilities all humans share. He explains that touch is one, along with emotions, singing and facial expressions. People with Alzheimer's don't lose the capacity for human emotion or recognition of a caring touch. What I've seen is that even a person in the very late, severe stage of Alzheimer's retains all these capacities.

A case in point is a woman who was largely non-verbal, her muscles were contracted and she barely could move. She could no longer feed herself or tell someone if her nose itched or if she was in pain. Her days were spent either in bed or in a reclining chair with very little interaction with others except during her physical care.

I saw her weekly for 30-minute sessions. Sometimes I would see very little obvious response to the hand, shoulder or foot massage I provided. But I had a sense that there was more than met the eye happening. She seemed to relax into her bed a little and her face relaxed. And sometimes she would look me in the eye with a little smile. One day as I massaged her hand she held my hand, turned to me and said in a weak voice, "You are very kind. I love you." Not only was she capable of receiving love, she was capable of giving it - also a hardwired human trait.

Benefits of Sensitive Massage and Focused Touch

I believe that touch - in the form of sensitive, gentle massage and holding - taps into reserves of hardwired abilities resulting in the following special benefits for those living with Alzheimer's disease:

  • Increases body awareness increasing a sense of self and alertness.
  • Feelings of reassurance and trust, diffusing overwhelming confusion or anxiety.
  • Builds a bridge of connection with people and activities in immediate surroundings.
  • Helps to calm agitation that is often based in fear and confusion.
  • Eases the effects of isolation, loneliness and boredom.
  • Acknowledges and affirms the individual within encouraging feelings of worthiness and well-being.
  • Reduces pain leading to improved physical comfort and sleep quality.

A hand massage, back massage or simply holding a person has the power to elicit positive, life-affirming feelings and responses. For the person with Alzheimer's, touch becomes a language of the human heart and a remembrance of his place in the world.

Along with the references listed, the following books are great resources for more information on this topic: Alzheimer's Disease: The Dignity Within by Patricia R. Callone et al (Caring Concepts, 2006); and Inside Alzheimer's: How to Hear and Honor Connections With a Person Who Has Dementia by Nancy Pearce (Forrason Press, 2007).

References

  1. Shenk D. The Forgetting. Doubleday, Sept. 4, 2001.
  2. Zeisel J. I'm Still Here. Penguin Group, Jan. 2009.

Click here for more information about Ann Catlin, LMT, NCTMB, OTR.

 

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