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Massage Today
August, 2014, Vol. 14, Issue 08

How To Effectively Work with Wheelchair-Bound Clients

By Sharon Puszko, PhD, LMT

There are more than 1.7 million people in the U.S. who depend on wheelchairs and scooters to get around. Most of these people are currently over the age of 65, which means massaging them requires specific knowledge about how to work with geriatric clients, as well as clients with mobility issues.

With the growing number of elderly in our country, as well as veterans of war, practitioners would benefit from learning how to properly work with wheelchair-bound clients.

Common Issues

Injuries to the elbow, wrist and hand are common among wheelchair users, but shoulder injuries are the most prevalent. Torn rotator cuffs and tendinitis are often the causes of shoulder pain. Muscle imbalance caused by overuse can lead to abnormal biomechanics and thus, injury. The most common disparity in strength associated with rotator cuff tear or tendinitis is an imbalance between the internal and the external rotators of the shoulder. Also, the prevalence of carpal tunnel syndrome among manual wheelchair users is between 49% and 73%.

Proper positioning in the wheelchair is probably most important for the prevention of repetitive strain for manual wheelchair users. A combination of manual mobility and powered mobility may be a workable compromise for some wheelchair users. Modern manual wheelchairs are easier to transport and easier to carry than powered wheelchairs. However they may not offer the same degree of independence for users with chronic arm or shoulder pain.

wheelchair - Copyright – Stock Photo / Register Mark Many people who use wheelchairs suffer from foot pain as well. Walking and standing allows people to stretch the achilles tendon that runs up the back of the leg. Constantly sitting can cause the achilles tendon to shorten, placing the foot in a constant state of extension. Many people using wheelchairs develop plantar flexion, a condition in which the achilles tendon shortens as a result of sitting for most of the time. When the foot is being pulled into an extended position by the ever shortening Achilles tendon, it becomes very painful as it progresses. Plantar flexion also makes relearning to walk after a stroke even more difficult because it disrupts the normal heel to toe gait. An extended foot massage can help relieve some of this pain. Passively flexing the foot and stretching the calf muscles can also help with pain management of this condition.

"Massage therapy is seen as a positive method of pain management, but just treating the pain is not an end in itself," said James Laskin, MS, PT, adjunct professor for the division of rehabilitation services at the University of Oklahoma and the Health Services Center of Oklahoma City. He emphasizes the importance of treating the problem, not just the symptom.

Pressure Sores

Many people who spend their time in a wheelchair will develop pressure sores. These lesions are caused by unrelieved pressure over a period of time sufficient to cause the destruction of soft tissue cells. The pressure between bone and searing surface compresses the soft tissues of the buttocks and forces the blood out of the tissues. The longer one sits without movement to change the pressure areas, the greater the cellular damage. The same process occurs for those of us who can walk when we sit on a hard surface for too long. However, our subconscious nervous system causes us to move periodically, shifting the pressure points and allowing blood to re-enter the compressed tissues. Spinal cord injury causes a loss of the sensation that is vital to this process.

Most paraplegics and quadriplegics have no feeling in their soft tissues. They feel no distress, fail to move periodically and consequently develop pressure sores. Chair-bound individuals are advised by their physicians and therapists to change their position every 10 minutes or so by doing "pressure lifts" or other pressure point changing routines designed to stimulate the flow of blood to soft tissue. This allows the blood to re-nourish the tissues that have been under high pressure. The sad fact is that people forget to move, or may be unable to move themselves. The use of massage therapy on the coccyx, ischium (pelvic bone) and lower back can help prevent pressure sores on wheelchair users.

Even with the best passive cushion technology available, pressure sores are one of the greatest health risks a chair-bound person can have. They can cause a drastic decline in quality of life. Curing a sore may require weeks or months lying face down on the stomach or even skin grafts. Deep sores may very well develop into life-threatening bone infections, and can change a productive, self-sustaining individual into a bed-ridden patient dependent upon others for a long period of time.

Ultimately, the benefits of massage therapy for wheelchair-bound clients include improved range of motion, circulation and alleviated decubitus ulcers. This specific modality is also important for the massage therapists who are led to the rewarding practice of working in nursing homes and with assisted-living residents.

Click here for more information about Sharon Puszko, PhD, LMT.


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