Supranuclear Palsy

[? ?? ?r??? s??rs]

I have been seeing a client at a retirement community since January who has Supranuclear palsy. He is in a wheel chair, unable to speak or walk. He is getting less and less range of motion. I am a fairly new therapist (graduated jan. 2009). And I want to know if anyone has feedback/input on how best to help him. The range of motion of his neck is decreasing. Can I help him or is this a symptom of the disease which I know is progressive?

 

[Loser]

Supranuclear Palsy

Is the client communicative? Does he have any voluntary control of his movements? Can he follow simple instructions?

What is your skill set? Are you trained in active therapies (i.e. Muscle Energy Technique, Proprioceptive Neuromuscular Facilitation, Active Isolated Stretching, Feldenkrais, etc.)?

Passive massage and passive range of motion work may make this client's discomfort more bearable, but will have limited impact upon his ability to function. Active therapies are needed to engage his motor cortex to improve neuromuscular function. Further, he needs to know how to work on it himself, using skills he is capable of learning.

Depending on your current skill set, you may need to start studying the nervous system and learn some new ways to work with him. Consider bringing in another therapist with significant experience in active therapies. Observe them at work with the client and see how it goes. If the client is okay with this, it might be a great experience for both of you. (NOTE: The client would pay only the other therapist; as an observer, your time should be free.)

 

[Rush is Right]

Supranuclear Palsy

Is the client communicative? Does he have any voluntary control of his movements? Can he follow simple instructions?

What is your skill set? Are you trained in active therapies (i.e. Muscle Energy Technique, Proprioceptive Neuromuscular Facilitation, Active Isolated Stretching, Feldenkrais, etc.)?

Passive massage and passive range of motion work may make this client's discomfort more bearable, but will have limited impact upon his ability to function. Active therapies are needed to engage his motor cortex to improve neuromuscular function. Further, he needs to know how to work on it himself, using skills he is capable of learning.

Depending on your current skill set, you may need to start studying the nervous system and learn some new ways to work with him. Consider bringing in another therapist with significant experience in active therapies. Observe them at work with the client and see how it goes. If the client is okay with this, it might be a great experience for both of you. (NOTE: The client would pay only the other therapist; as an observer, your time should be free.)

Thank you for your response, Jason. Client mainly communicates through grunts interpreted by his wife. He can still move arms/legs very slowly and has little to no balance. I have basic knowledge from school: Swedish, some neuromuscular (trigger point therapy primarily), also reiki, but no active therapy training at all. I do know this client needs more than I can provide. I am the only Massage Therapist available at the retirement community. I am a member of FSMTA, perhaps contacting one of the local chapter officers?

Thanks for your help!

 

[Nancy T]

Supranuclear Palsy

Thank you for your response, Jason. Client mainly communicates through grunts interpreted by his wife. He can still move arms/legs very slowly and has little to no balance. I have basic knowledge from school: Swedish, some neuromuscular (trigger point therapy primarily), also reiki, but no active therapy training at all. I do know this client needs more than I can provide. I am the only Massage Therapist available at the retirement community. I am a member of FSMTA, perhaps contacting one of the local chapter officers?

Thanks for your help!

What a wonderful wife your client has!

So, since you have a basic amount of knowledge, although you may not be the perfect fit for the client, since you are the only one avaliable, I'd think you might as well help as best you can.

You mention that you know the client needs more than you can provide, so let the wife know. But just because he needs more, doesn't mean you can't help in some way, in this case. It sounds to me like some good swedish will at least give him some relaxation and comfort. I'd like to think that would be somewhat helpful in his current condition.

This also gives you an opportunity to work at finding ways to help the client. New out of school, doesn't mean you can't use this as your pet research project. If you are interested in the parameters of the clients case, you can learn as much as possible on this problem (possibly to becoming somewhat of an expert on it yourself w/in the realm of what an MT can do). Seek out his MD and offer to take him/her to lunch and learn more about the case and diagnosis that way.

I think you have a great opportunity in front of you, if you can just find the right people who are willing to help. I certainly also recommend finding a Feldenkrais practitioner near your part of the world. Where are you at?