MASSAGE FOR SPECIAL POPULATIONS © Eleshia Venners-Howell 2011 The information contained herein shall not be used without the express permission of the Author. While massage therapy may be considered a universal treatment approach, across the broad community (and cultural) spectrum, there are a few considerations that must be undertaken in order to provide best practice and remain within statutory guidelines. GUIDING PRINCIPLES... Good interview skills Understand the client’s condition or special circumstances Determine client’s needs Establish your scope of practice in providing the service being sought Maintain clear and informative communication with all parties involved Undertake comprehensive and appropriate assessment(s) Adhere to relevant Code of Conduct. CHILDREN & ADOLESCENTS (3-18YO) While providing massage therapy for children and adolescents is not much different from providing massage to adults, it should not be automatically assumed that they are ‘just little adults’. Indeed there are numerous considerations to respect and incorporate into your treatment plan. Baby massage (0-2 yo) is a separate modality requiring specific training. Growth & Development: Be aware of child’s stage of growth and development. Prepubescent growth spurts begin between 10-12 yrs of age and will dramatically affect their body on a physiological level. Growth plates occur in all of the long bones of the body and care should be taken not to apply excessive pressure or dynamic stretching techniques to the attachment sites of muscles in these areas. Children tend to be hypermobile in their joints Muscle tissue is much less dense, so be mindful of pressure and apply superficial to medium techniques. If providing corrective exercises, try to make them fun – use household items, play equipment, etc and keep the time frame short. During adolescence, take the signs / symptoms of puberty into consideration, eg breast development, hormones, body image. Physical Contact: Thoroughly explain your intentions and ask permission to engage in physical contact. Perform techniques over clothing if necessary. Respect if the child says ‘no’. Demonstrate on the parent/guardian present if it will help the child to understand what you would like to do. Instruct the parent to perform techniques if the child is unwilling to co-operate. Legal Requirements: In NSW a minor is legally defined as a person less than 16 yrs of age. However, it is the policy with most massage therapy associations that no unsupervised treatment of a person under the age of 18 be provided. The NSW Police Safety Check is now mandatory for any person having direct, unsupervised contact with a person under 18. A minor must give consent for treatment, and the parent or guardian in attendance must sign their consent and be informed of all treatment to be provided. The parent or guardian must remain in the room for the entire duration of the treatment. Massage therapists are included under the definition of Mandatory Reporters in NSW – therefore obliged to report abuse or neglect. MASSAGE & THE ELDERLY Generally considered to range from 60 years of age, but should be looked at on an individual basis, depending on the health status of the client. Massage can be extremely beneficial during the aging process, as the integrity of body tissue diminishes, some bodily functions begin to slow and the onset of illness or age-related disease takes effect. Some special considerations when treating elderly clients include: Postural distortions – as we age, the intervertebral discs become narrower, and less able to provide structural support to the spine. Bone degeneration, arthritis, and ligament / tendon laxity also combine to cause problems with posture and mobility. Poor skin integrity – thinner skin, less fatty tissue mean greater risk of skin tears, bruising. Poor circulation – especially to extremities. Medications – always ask what they are taking and for what condition(s). Have a good understanding of side-effects and any pharmacological contraindications. Nutrition & activity levels – can both be poor as age progresses. Financial constraints Decreased cognitive function – client must be able to understand your communication. If not, request a third party to be present. MASSAGE & CHRONIC ILLNESS Chronic illness is defined as a disease, injury, or syndrome that shows either little change or slow progression. (Fritz, 4th Ed.) “Healing” may not be an option – or may be a long, slow process. Providing management of pain / symptoms, stress relief, nurturing touch & support is often the role of a massage therapist. Work in co-ordination with other allied health professionals. Gain an understanding of the progression of client’s condition, to better prepare future treatment plan. Medications – side-effects, contraindications. Be aware of energy needs of the client, and their reaction to massage techniques. Minimise undue duress / harm, including infection control (compromised immune system??) MASSAGING A PERSON WITH A DISABILITY In general terms, a disability can be defined as a conditions that, in some way, hampers or hinders a person in terms of their ability to carry out activities of daily living (ADL’s). The extent to which a condition hinders a person’s ability varies between individuals. Disability is a multi-dimensional experience* for the person involved: body structure & function; activity; participation. (*including the impairment / restrictions thereof) Self care, mobility and communication are listed as being critical elements in assessing disability. The World Health Assembly (2001) adopted the International Classification of Functioning, Disability and Health (ICF): • mild - where a person has no difficulty with self care, mobility or communication, but uses aids or equipment; • • • moderate — where a person does not need assistance, but has difficulty with self care, mobility or communication; severe — where a person sometimes needs assistance with self care, mobility or communication; and profound — where a person is unable to perform self care, mobility and/or communication tasks, or always needs assistance. People with a disability can benefit from massage in many of the same ways as any other individual. Openly discuss with the client (wherever possible) to determine their needs: - Positioning - Mobility / vision / hearing aids - Desired outcomes - Appropriate time-frame for treatment, and suitable techniques. - *Refer to Ch12 Fritz for further information MASSAGING A PERSON WITH MENTAL HEALTH CHALLENGES Encompasses developmental disorders, psychiatric conditions, learning disorders and emotional disturbances. *assess the risk of personal harm when dealing with unstable psychiatric conditions – request a 3rd party be present during treatment. Ensure the boundaries of the client-therapist relationship are clear and the client fully understands the process being undertaken for physical assessment and application of massage therapy techniques. Be aware of client’s emotions and comfort during treatment session – touch may need to be introduced gradually. The mind-body connection is powerful and massage may trigger an emotional / physical reaction. Massage can be calming, grounding, sedating, stimulating, supportive, respectful and empowering. pp586 -590 Fritz, 4th edition has some helpful information on this topic. MASSAGE FOR PALLIATIVE CARE Therapeutic touch has a way of reaching a terminally ill client on an emotional and spiritual level, as well as a physical one. Massage can help to relieve anxiety & stress, provide pain relief and encourage emotional wellbeing. Massage combined with aromatherapy has been shown (in numerous studies and clinical experience) to provide the most beneficial form of treatment. Apart from providing pain relief, there is often not much on a ‘physical’ level that massage can do. However, on the emotional level, the gain is immeasurable. • Makes them feel special • Nurturing touch • Empowering – they can choose what they want, as opposed to being told (by doctors, family etc) what they must have / do. IN SUMMARY.... Always maintain good communication between client, family, medical / allied health professionals. Assess the client’s individual needs and set of circumstances before determining the most appropriated course of action. Work within your scope of practice, professional conduct principles and legal guidelines. Document thoroughly! Remember the first rule of being a health care provider....first do no harm!