Nurturing Touch for Pediatric Cerebral Palsy
, LMT, CPMMT, CPMT, CIMT
Nurturing Touch for Pediatric Cerebral Palsy
, LMT, CPMMT, CPMT, CIMT
Working with children teaches you many things, and makes you realize that being fully present is the difference between a positive session and one where nothing is accomplished.
his is extremely important when you are working with someone who is nonverbal. You have to work together to find the best way to communicate. Of course, you should inquire as to any methods a family or healthcare team is already using to communicate with the child. However, as a massage therapist, your first thought might be of the tactile sense. We should actually use all of our senses to make that first connection.
The opportunity to work with children who have been diagnosed with cerebral palsy has presented me with many occasions to communicate with children in a variety of ways. Some of my clients have specific ways they move their eyes to signal yes or no. Others can give you their version of "thumbs up" or "thumbs down," while some use communication devices or a few words. It is important to establish communication when providing massage therapy. Not only to explain a session or positioning, but also to establish rapport and request permission prior to applying nurturing touch. In order to provide massage for anyone, especially a child, you must have their express consent.
Many people believe that if someone is nonverbal, you cannot communicate with them. This is obviously not true. Our work is founded in communicating in a nonverbal manner. We use our first language, touch, to really communicate with our clients. I've probably learned some of most valuable lessons working with clients who speak in a different way.
Cerebral palsy is a non-progressive disease, meaning it does not worsen. However, there are many conditions that develop as a result of cerebral impairment. Remember that the child is a child with a diagnosis. The diagnosis does not give you the full picture. Take the time to really see the client.
A child with cerebral palsy might present with very mild symptoms or a combination of symptoms.
Some of these symptoms and conditions include:
- Skeletal deformities: In some cases, only one side of the body is affected. When this is the case, the child may have shortened limbs on the affected side. This condition may lead to scoliosis and tilting of the pelvis.
- Joint contractures: Children with spastic cerebral palsy may develop severe stiffening of the joints due to the surrounding muscles being of different tones. Joints are pulled by high tone muscles while others are not well supported by those that are low tone.
- Mental impairment: This is not to be confused with the term "mental retardation." Some children, but not all, may have some degree of mental impairment.
- Seizures: Approximately one third of children with cerebral palsy have seizures. Seizures may appear as large seizures (very pronounced), petit mal (slight eye flutters), repeated words or even a blank stare.
- Speech problems: Speaking is controlled in part by movements of muscles, specifically the tongue and throat. Some children with cerebral palsy are unable to control these muscles movements.
- Swallowing problems: Swallowing is a very complex function and requires precise interaction of the muscles. Children with cerebral palsy may have challenges controlling these muscles and they often have difficulties eating, drinking, sucking and controlling their saliva.
- Hearing loss: This is a common condition associated with cerebral palsy. Children who have cerebral palsy may not respond to sounds or may have delays in speech.
- Vision problems: Three quarters of children with cerebral palsy have strabismus (turning in or out of one eye), caused by weakness of the muscles that control eye movement. Very often this condition causes nearsightedness and may lead to further vision problems.
- Bowel and/or bladder control problems: Often times, the child may have constipation. Both constipation and incontinence are caused by lack of muscle control.
As with any diagnosis, it is important that we meet our client and consider an individual approach of what they might need. One big consideration is positioning. Children with cerebral palsy experience spasticity. In addition to touch, positioning may increase spasticity as well.
Pediatric massage is also more effective with a foundation of strong communication. So, working with children who are nonverbal creates a special opportunity to connect through touch. Once you have established this connection, your hands-on work may provide a multitude of benefits.
The benefits of massage for children with cerebral palsy are unquestionable. These potential benefits include:
- Improved sleep;
- Improved social interaction/communication;
- Increased range of motion and muscle flexibility;
- Improved gastrointestinal functioning and increased motility (relief of constipation);
- Improved digestion and absorption of nutrients;
- Reduced spasticity; and
- Improved motor function.
As much as the physical benefits are important, the emotional benefit of providing nurturing touch for a child that has been exposed to repetitive medical interventions is profound. Even if a child hasn't had numerous medical interventions, when a child appears unlike others, many people in our society treat them differently. In our culture, people fear those who look, act or sound differently from themselves. Many times, isolation and depression are side effects of being "different" than others.
The best approach with cerebral palsy is to realize massage therapy is not a cure, but can be an effective non-invasive intervention to address the various symptoms that are associated with this diagnosis.
One little boy I worked with recently showed me this first hand. During my work in orphanages in Vietnam, his eyes called to me. Immediately, I noticed he was so severely contracted and lying in one position that there were wear marks in the wooden slats where his body touched and wore out the wood. As I lifted him from that crib, I wondered what he was thinking. Doing my best to explain, still I wondered if he understood I was there to do no harm. Using nurturing massage and some range of motion, I tried to loosen his tight muscles and frozen joints. This proved a challenge to find any movement. We spent a majority of our time making eye contact, while I held him, rocked him and spoke to him. It wasn't long before he laughed. He laughed, it was amazing! He understood my safe touch, funny faces, songs and stories. It didn't matter that we didn't speak the same verbal language. He understood through touch and eye contact. I wasn't initially sure if this little boy understood what was happening, but now I knew that he did. My dear little friend now knows someone in the world loves him enough to hold him and treat him just like another child. He is not different from another child. He just needs love, attention and nurturing to find his childlike giggle.
Sometimes, it is not so much about using our hands to affect muscle tone, increase range of motion and ease constipation, but rather to make a connection and allow a child to feel relaxed enough to laugh.
- Edward A Hurvitz MD, Christina Leonard , Rita Ayyangar MD and Virginia Simson Nelson MD MPH (2003), "Complementary and alternative medicine use in families of children with cerebral palsy," Developmental Medicine & Child Neurology, 45: 364-370.
- Barlow J, Cullen L., (2002), "Increasing touch between parents and children with disabilities: preliminary results from a new programme," J Fam Health Care, 12(1):7-9.
- Hernandez-Reif, M., Field, T., Largie, S., Diego, M., Manigat, N., Seoanes, M., & Bornstein, J. (2005), "Cerebral palsy symptoms in children decreased following massage therapy," Early Child Development and Care, 175, 445-456.
- J. Arvedson, L. Brodsky, Singular Thompson Learning, Pediatric Feeding and Swallowing, Second Addition.
- Stewart, K., et. al. (2000), "Massage for Children with Cerebral Palsy," Nursing Times 96(1): 51.
- Zhou XJ, Zheng K., J Zhejiang Univ Sci B. (2005), "Treatment of 140 cerebral palsied children with a combined method based on traditional Chinese medicine (TCM) and western medicine," Affiliated Children's Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.; 6(1):57-60.