client with paralysis

[Sudeep King of Scorn]

About 5 months ago a friend of the family was ambushed (she’s a police officer) and shot several times leaving her, along with other minor injuries, with 2 broken arms and paralyzed from the waist down. Several officers who know what I do have called and asked if I would work on her. When I visit the injured officer I gently work on her hands and scalp which just seem like a natural, nurturing thing I would do to comfort someone, but they are requesting a full massage. I have declined as I don’t have a lift table and quite frankly, it’s a bit overwhelming to me as I have never worked on anyone with such extensive injuries before. I have been looking around for other therapists to refer her to but haven’t had any luck with anyone who’s willing to work with this situation. Well, the injured officer has now specifically requested me and asked if I would just come over and work out her back, neck, shoulders while she’s sitting. She’s a friend and I want to help her so I feel I need to leave my comfort zone and learn what I have to in order to give her some nurturing. I will, of course, contact her doctors and physical therapists first for permission and contraindications, but has anyone had a similar situation? I could really use some tips on ways to be effective or things to look for …or hey, I’ll even take some encouragement! Your input is greatly appreciated! Thank you.

 

[C C]

I work on a guy twice a month who has quadriplegic paralysis. He sits in his chair and I work on his neck, shoulders, upper to mid back, chest, arms, forearms and hands. We do a lot of stretching because he gets really tight from cold and also from trying to do certain tasks. (He has very limited gross motor ability in his arms.)

I'm not sure how you'd do a breast drape for a female client, my client is naked to the waist, but if you can get your hands on a body cushion, you can fold it up, put it in her lap and lean it on a table, like the kitchen table. It works really well for seated massage for the mobility impaired.

I work on my client as if he has current rotator cuff injuries, because his shoulders get so aggravated from doing all of the work. I focus also on lev scap and traps, scalenes, think of the tight areas a desk jockey has... since she is sitting all day, every day, she will have the same ones.

I would really encourage you to do this. #1, you'll learn really great things about what you can do with massage, and #2, she hasn't done this before either, so nothing you do will be "wrong." Just pay attention to what feels good and helpful, and encourage her to speak up with any ideas about what might be better, or what feels not so good.

 

[Prodigy]

Thank you so much for your reply! The ideas are great and your encouragement helps me to keep moving forward. It is definately time to move out of the comfort zone and learn something new.

I will look into body pillows and experiment with what works for her this afternoon.

I appreciate your time!

 

[M.E.]

you can work on the paralysed tissues, just be aware that they cannot tell you what is too much. THings like light vibrations, light tapotement are wonderful for encouraging circulation, and what ever nerve growth opportunities there may be. ROM exercies to encourage circulation are wonderful. Back neck and shoulder work would be wonderful for them. If they are in a chair, if you can get your hands on a table topper (basically a face rest that sits on t a table) may be very comfortable.

 

[another therapist]

Once you get started, it will all be very natural for you. There is no reason to not do a full body massage, unless the injuries are so recent that the doctor says to wait a bit longer. This will be one of the most rewarding times of your career.

Experiment with different positions, and you'll find one that is comfortable for you both. I find that working with the paralyzed client in a recliner works well. Frequently I can turn them and put a pillow under the hip to work the back. Everything but glutes are accessible in a recliner, and parts of those are.

She doesn't have to be undressed, if draping is an issue, but oil on the skin is nice if you can manage it. Even some skin...like arms and legs.

Like Breathe said, nothing you do will be "wrong".

 

[gina]

I have worked on numerous mobility-challenged people. They are often able to get on the massage table themselves. If I know in advance, I lower my table and do most of the massage sitting/rolling around on the stool. Or just give my quads a good workout. Often, people have caregivers that can help them onto the table.

I draw the line at lifting people onto the table, but will do anything else to assist differently abled people. I have had some good laughs with some clients that I help completely undress, assist them onto the table, and then modestly drape them.

Asking questions about people's capabilities in a matter of fact manner pretty much always seem to be well received.

I encourage you to work with this woman, I bet it will be very rewarding, and just being upfront about your lack of experence, but willingness to work with her and figuring out what will work out best; I'm sure will make her very happy!

Noel

 

[FiFi]

You all are amazing! Thank you! You have given me new ways to look at this situation and suddenly it doesn't seem so overwhelming. Thank you for reminding me I don't have to be perfect, that part of the learning experience is experimentation and a good attitude. Danita will be the perfect person to learn with. She's very patient.

 

[Lol]

Update please?

I am doing a case-study on a man who has spinal cord injury due to surgical complications.

I am very curious to hear about your session(s). How did things go?

 

[Leanatan]

The client and I are still talking and I've been contacting her Doctor and pHysical therapist and have not had our first session. It will be next Sunday and I'm happy to tell you how it goes! She has SOAP notes from a MT she went to while rehabbing in GA, but I have not received them yet. I'm very interested in seeing the process and what has been accomplished so far. I was formerly unaware that she had been receiving massage and I have a bit of relief that she will be able to "teach" me through this.

 

[Bean on Board]

Vita, how is it going? I'd love to hear how you are doing with this.

 

[BrownGuy]

Just an update...

I have been working with this client for five months now and it has been a wonderful experience. Most times the massage is more comfort oriented and we often work with her wheelchair pulled up to a table, with her leaning forward into pillows, sometimes she simply sits in a chair.

The positioning allows me to work her favorites, lower back and shoulders (traps, scalenes in particular). I also have worked arms, hands, neck, scalp and most recently (during allergy season) we've started to do a lot of lymphatic (I've been taking LDT) covering face and arms. We've gotten creative with stretching and this has really taken our work to the next level!

I'll admit, I started out very conservative as this was my first time with someone with more medical conditions than I was used to at the time, but together we've grown and are both always looking to try new things!

Things I've learned:
1. She's not going to break!
2. Even when I'm afraid massage is going to be boring (same strokes) do it anyway because to her it is heavenly and nurturing.
3. I've gotten much better at communication with my clients - all of them - and I'm becoming more effective at getting the info I need to know to make the experience the best I can.

This experience has given me an interest in exploring massage with clients beyond my comfort zone. I have begun a series of courses on Oncology massage and continued education in LDT.

Thank you for all your input and encouragement! All of it came in handy (as you see, I took many of your suggestions!).

 

[Dr. Strongrod]

Vita, that sounds great! Good for you in all your new ventures!!! I'm happy to hear it is going so well for both of you.

It is amazing how much we learn, grow and receive when giving.

 

[Misfit.]

Stretching

Thanks for the update! I am glad to see it turned into such a positive experience for you both.

We've gotten creative with stretching and this has really taken our work to the next level!

Can you elaborate on your creativity?

After our case study the subject became my first regular client and of all the techniques that I have used, MFR stretches are what he appreciates the most. Like you, it seems that the massage is "too routine", but it's what he needs, and I know that my intent is the most important aspect.

For those with Accupressure and/or Tuina training, this is a very effective shoulder sequence I use for him that our teacher (a L.Ac) taught us in Tuina:

Press and hold, then rub SI 11
Press and hold, then rub SI 12
Press & hold Ashi Points:
1st point is about 3 cun lateral of T1
2nd point GB 21
3rd point SJ 15 (insertion of the supraspinatus about 2 cun inferior and 1 cun medial to GB 21)
4th point SI 10 use scraping technique on this insertion of the teres minor.

After working the points, apply finger rubbing on anterior shoulder capsule; palm rubbing over entire shoulder capsule, working down the arm and finish with shaking technique of the shoulder.

It works great in chair massage!

 

[Princess Sandie]

Hi Vita,
You are describing a scenario which, unfortunately, I have seen and treated on a daily basis in my practice. It sounds like you are doing a nice job with her. Just one question – are you working on her lower limbs at all? If you are comfortable doing this then I have some suggestions. At this point you would be looking to preserve vascular, nerve, muscle and joint tissues (and joint space) – preventing contractures and increasing lymph and general circulation in her lower extremities. I assume she is in a seated position frequently and possibly not being ranged on a schedule at home?
I know you have been working with her for many months now; however, this type of situation raises too many questions for me regarding her prognosis and current status. I would be happy to talk to you, as a quick verbal exchange of questions and responses could take place much faster and we could cover more info in a short time rather than writing down all the possibilities for tx here on this forum. So, feel free to PM me with your # and I’d be happy to call or you can call me; either way would be fine.
Keep up the great work…
Best of luck,
LG