“I am also a believer in an integrated treatment approach to autism” – Temple Grandin
”Don’t think that there’s a different, better child “hiding” behind the autism. This is your child. Love the child in front of you. Encourage his strengths, celebrate his quirks and improve his weaknesses, the way you would with any child. You may have to work harder on some of this, but that’s the goal. – Claire Scovell LaZebnik
I was nervous and unsure.
There was no one to talk to who had experience working with a child with developmental disabilities..
Although I had already met him, how was I going to handle this?
I knew what I wanted to achieve, but could I actually attain any of the goals for my patient that I had set?
Due to my past experience I felt fine working with this child, but no one had ever mentioned or taught me to manage a Massage Therapy case like this.
When I talked to my teachers, they never heard of anyone doing anything like this, and I never realized how much work or how much learning it would take to pull this off.
It was hard to find any good research on the topic, so I had to figure out a lot on my own.
All the goals I set had to be broken down into tiny steps accomplishing little goals in the grand scheme hoping things would add up to the greater good for my patient.
This was a huge learning experience and I hope what I learned can make a difference for kids with developmental disabilities and other Massage Therapists who want to help them.
Massage Objectives With Developmental Disabilities
Before pursuing a career as a registered massage therapist, I worked as a community support worker/ care assistant in a group home setting with people who had developmental disabilities.
I worked with people of all ages that had mild to severe developmental disabilities.
Giving medications and providing support for our clients was all we could do to assist them, however I felt more could be done to improve quality of life.
I found it difficult the only way I could help kids with developmental disabilities was through medical intervention and emotional support.
Although those interventions did help, I felt more could be done to improve the lives of these kids.
I wanted to do a case study to determine the effects of Massage Therapy for these people in need, particularly a developing child who was nonverbal with autism spectrum disorder and global developmental delay.
Developmental disabilities are common in children and occur in all racial and socioeconomic groups.
Some developmental disabilities may include: Attention Deficit Disorder (ADD), Autism Spectrum Disorder, Cerebral Palsy, Downs Syndrome, intellectual disorders, hearing loss, vision impairment, learning disabilities, and other development delay.
Children with developmental disabilities may experience impairments in social interaction, communication, speech and language, general physical development, behavior, learning, cognitive skills, motor control, coordination, balance, and emotional stability.
I found in my case study that Massage Therapy benefits children with developmental disabilities by improving their physical and emotional well being while they are still developing.
My objective was to determine if the effectiveness of Massage Therapy could improve their focus, behaviour and motor function.
Massage Therapy, A Case Study
My participant was a nine year old male with a diagnosis of Autism Spectrum disorder, Pervasive Development Delay (PDD), Moderate Intellectual Disability, asthma, seizure disorder, and an educational designation of physical disability or chronic health impairment (PDCVH).
He also experiences challenges with focus, aggression, and functional movements as a part of his diagnosis and would elicit a rigid rocking behaviour when he became anxious.
When I first met this patient, it turned out in the past he had been turned down by other RMTs when his guardian sought treatment for him. I was nervous at first to take on this case as I was only a Massage student, but put those feelings behind and decided to take it on as the well being of this child meant way more to me than staying within my comfort level.
I performed this case study over the course of three months and was broken into fifteen treatments, seventy minutes in duration, which were divided into three phases:
Treatments consisted of manual modalities to the lower extremities and back such as:
- relaxation techniques including general swedish massage
- full limb vibrations to trick the nervous system (helping to relax muscle contractions)
- deep pressure stroking
- myofascial release techniques
- joint mobilizations
- passive range of motion
Measurement tools included:
- postural assessment
- gait analysis
- orthopedic tests
- range of motion (ROM) for the motor function aspect of the study
- focus tests and qualitative feedback from the patients guardian for the focus and behavior aspect
The results from the study concluded that the patients focus and behaviour had improved, became more social with other children, less aggressive at times of frustration, less anxious, and his balance, motor function, gait and posture had improved.
The patient also completely stopped the rigid rocking behaviour and was able to follow direction when asked to perform simple tasks.
In just three months, a young child’s quality of life had significantly improved.
This proved that more can be done for these people to help improve their lives.
It just takes health care professionals like RMTs to take a risk and work beyond their comfort levels to improve the health and wellness of people of all ages at all stages of physical and mental development.
So what are some rules I created for working with children with developmental disabilities?
Establish Trust With Your Massage Therapy Patient
When working on children with developmental disabilities (or any client really) it is important to establish trust and better yet, a therapeutic relationship.
In our typical practice, we meet a client and establish a trusting therapeutic relationship on the first appointment. If that trust is met, they will typically rebook and come back for a following treatment.
In this case, it wasn’t that simple.
I had to work slowly at introducing massage and creating that therapeutic relationship. Before starting the treatments, I met the patient and his parent guardian. I interviewed the parent about triggers, behaviours, things that he enjoys, and tips on communication.
When the treatments finally took place, it was important to introduce everything slowly.
The first treatment was conducted on the floor, while the patient cuddled with his guardian. I slowly introduced touch to the legs and feet. By the next treatment we were able to introduce the table using support from his parent.
As the treatments progressed I slowly introduced massage to different areas of the body.
To put things in perspective, finally after a year and a half of treatment, I am able to work on his arms and hands without him pulling back showing there is now enough trust to let go.
Keeping a constant routine was also important.
I found that if he missed an appointment one week, we would lose progress in comfort with receiving massage. If we made any changes to duration, treatment techniques, or the number of treatments per week/month, it had to be done slowly and only changing one thing at a time to decrease the chance of effecting progress.
Keeping a routine and working slowly will allow the client to maintain trust in you as a therapist.
Photo by: hepingting
Gaining A Thorough Massage Health History For Developmental Disorders
It was important to have the full picture on the patients health history, not only for treatment safety but also to fully understand why the patient presented as he did and how I could create a care plan that would be effective.
In order to understand the full picture I collected documents from other health care professionals about his condition and did some research. I also did an extensive interview with his guardian to gather more in depth information on the child’s condition as well as information and tips on how to work with the child.
It is our duty as RMTs to take an in depth health history to ensure the safety of any patient.
Medications, current (and past) medical condition, emotional or behavioural status, assistive devices, activities of daily living, and other therapies a patient is taking part in are all examples of things you should know to create a safe and effective treatment plan for them.
These things are not just important for working with a special population but for every patient you see in your practice.
Massage Treatment And Developmental Disabilities
As mentioned before, ease into treatment.
Slowly introduce touch and ease into longer duration treatments. When it comes to technique choice, I began with general techniques and experimented with techniques until I found what worked.
Once massage was comfortably accepted by him, I was able to use more specific techniques.
Pay attention to the little things.
Starting on the treatment table may be too much too soon. You can start out treatments with a patient in a chair (or wheel chair) or on the floor on a mat or blanket.
Massage may also not be accepted by the patient right away, you may also need to spend the first couple of treatments getting to know the patent.
Utilizing tools may help the patient feel less anxious, for example they may have a special toy they enjoy. When introducing massage for the first time, having certain objects act as a distraction may help significantly. Using toys, music, books, and sensory stimulation objects may help greatly.
I found that a thermaphore worked excellent as tool to help calm the patient.
Include Your Patient.
Note their mood.
Are they tired or playful?
This may affect how the treatment goes. During the case study, if he was acting playful, I would create a treatment that would suit his mood.
For example, one technique that he enjoyed was a bilateral leg pull.
When he was in a playful mood, I would make the technique more playful by exaggerating that he was growing tall like a tree during the pulling component then shrinking small during the compression portion.
This typically resulted in excitement and laughter. I would also typically use more stimulatory techniques like shaking and jostling when these playful moods were present.
Creating Home Care And Remedial Exercise For Developmental Disabilities
Be creative and realistic.
Utilize the patients hobbies and interests to ensure that the patient will enjoy doing their home care. Another factor to keep in mind is their home life. Quite often home life is very busy so you have to make sure to create a home care plan that will actually be obtainable by the family or care workers.
With this in mind, make sure that the home care you give is therapeutic and effective.
Improvement may happen very quickly or very slowly. To get the results during my study, it took quite a bit of time and things slowly progressed. When I first began my treatments, the patient didn’t feel comfortable on the table so it was done on the floor. During this treatment, he moved around the whole time. Finally after a few treatments, the next step of progress was having the lower limb remain still for 3 minutes! By treatment 10, the patient actually fell asleep and remained still on the table for the whole hour long treatment. Results may seem minor, but really are a big deal! The whole point of this Massage Therapy case presentation was to help improve focus, behaviour and motor function. I managed to use Massage Therapy to obtain these goals and truly believe that Massage Therapy would benefit other children dealing with these difficulties.
Because kids are so adaptable to change, there is greater benefit in using Massage Therapy to help them. After treating him for a year and a half this has developed into a rewarding experience that I never thought I would have. For all of us involved we have seen a huge difference in his development, behaviour and body awareness. Remember to be patient, and don’t forget why you became a RMT… to help improve the quality of life to the people who need it!
If you would like to read Chelsea’s full Case Presentation, you can download the word document here.