When I was in school I knew I didn’t want to work with this population.

Weren’t they always grumpy, complaining about life and fragile in their movements and abilities?

With these thoughts in mind I entered my career as a RMT thinking I would steer clear of the elderly population.

I haven’t had a lot of experience working with or being around people over 75 years old. My grandparents passed away when I was a child and even though I have older parents (my dad is 70 but you would never guess that) they have never acted ‘old’. 

For this reason I felt extremely nervous about massaging my first almost 90 year old client.

A few years ago, I was working alone as a locum in a lovely space. Many of the clients there were loyal and dedicated to that clinic, including a mother and daughter who usually received a massage after one another.

At the time of our first appointment together the mother was 89 years old and I was unsure how things would go.

In she walked with the help of her cane, her hair a gorgeous shade of white and perfectly combed. She wore mascara showing off her bright eyes and blush accentuating cheekbones that any girl would die to have.

She had a clear voice but a shy smile and I could tell she was as nervous as I was. She was used to her regular Massage Therapist, who I was locuming for but our first treatment went well and we had a blast getting to know each other.

After my locum was complete this lovely lady became my regular client.

She drove herself to the clinic where I worked, every second Friday for a 45 minute massage. During the years I got to massage her she turned 90 and then 91 and to my knowledge still receives her regular massage.

Giving Respect To Your Elderly Massage Patient

I learned a lot from this lady not only massage wise but life wise.

Can you imagine out living your husband by 30 years? How about out living a son?

She has seen the world change drastically and told me all about it. To say you cannot and should not become attached to clients is crap! She was one of my favourite clients and one of the best people I knew (and still know). I made sure to treat this lady well and to help her out when possible.

If she didn’t give me 24 hours cancellation notice, I didn’t mind. 

If she forgot an appointment, I would call to make sure she was ok but never charged her for a missed appointment.

I often parked her car for her if it was a tricky parking spot to get into and always stood near the massage room outside the door while she was getting undressed and redressed. 

If she needed help I would be there.

I ALWAYS walked her to her car after her massage to make sure she got there ok. She would put one hand on my arm and use her cane to shuffle along the sidewalk.

If she had to park a long distance away, I would run to the car and drive it back to the clinic.

I also gave her my cell phone number in case she needed to get in touch.

When I was instructing at the Massage Therapy College I always referred to this client as my “90 year old” when providing examples of massage clients and treatments to my students. Eventually my students would start asking about her and referred to her often.

Massaging The Elderly

Each massage treatment was similar.

She had been diagnosed with stenosis of her lumbar spine and complained about weakness, numbness and tingling and cold lower limbs and feet.

Spinal stenosis is a narrowing of the vertebral canal, where the spinal cord runs. The most common cause of spinal stenosis is wear and tear changes such as degeneration of the facet joints and intervertebral discs and the formation of bone spurs within the canal.

While massage therapy cannot change or reverse the progression of spinal stenosis, it can help to decrease pain and tight musculature around the affected area.

She also had scoliosis, which I believe was caused by degeneration, and resulted in her leaning more to one side. 

She was always sore though her hips and lumbar spine and really enjoyed the relaxation of thoracic spine and upper trapezius work. Would I ever truly help with these conditions of a 90 year old woman? 

No, but I certainly know she felt good during the massage (she would honestly tell me if she didn’t) and if I could help ease some pain or make her feel good for 45 minutes then I would do my best.

She was able to get onto the table and lie prone (face down) herself. I would use a moderate amount of pressure to massage through her gluteus medius and minimus, quadratus lumborum and lumbar erector spinae muscles. 

I always did a general treatment for her mid and upper back and neck, then would do a lot of circulatory work for her posterior lower limbs.

It was a slow process, but I would always ask her to turn supine without my help

In my opinion if she wanted to stay independent she needed to be able to move on her own. She wouldn’t  benefit anything from me helping to turn her on her back. She never asked me for help but if she really couldn’t turn over, she would have told me.

Once supine, I would massage her arms for relaxation and circulation, then finish each treatment with  circulatory work on the lower limbs and feet.

Once the massage was finished I would stay in the room until she was in a seated position. Again, I didn’t help her get up off the table but was there in case she needed me. After I left the room she would dress herself.

Communicating With The Elderly In A Massage Clinic

She always asked the same questions. 

I assume she would forget the answers that I told her the weeks previous and often had to repeat myself due to her forgetting her hearing aids, but she always understood what I told her.

“Do you feel my legs tingling like that?” – No only you can feel that!

“Do my feet feel cold?” – always!

“Why do my legs feel this way? My doctor doesn’t tell me much.” – I always gave her an honest answer of what spinal stenosis is.

“Do you think my muscles are still in my leg?” – yes absolutely! 

She had amazing looking legs for 90 years old. While strength and stability was decreasing quickly, the shape and tone of her leg musculature would make a 20 year old jealous.

What The Elderly Can Teach Their Massage Therapist

She would often make hilarious statements followed by her huge laughter:

“Meaghan, I thought instead of getting a massage today that we could just trade legs! No? Oh fine…rub away then. I guess I can’t have everything in life!”

“I only come here because you laugh at my jokes!”

Then there were statements about life. I often wrote these quotes down and called them ‘wisdom from my 91 year old client’:

“I don’t understand how people get bored! Go do something! Go dancing, play cards, have sex! How can you get bored doing those things?”

“When you get to my age, you watch most of your friends go…and it makes you realize how great it was to love them and to laugh with them”

“I think people think life is like a bowl of cherries. They take, take, take, chew up and enjoy half and spit the rest out like it’s useless. We should be eating life like it’s seedless grapes! Enjoy the whole thing!”

“I’m 91 and I’m not ready to go yet! I want to see how things turn out. Life is too short even at 91.”

Was she grumpy? Never. I have not laughed with a client as much as I did with her.

Did she complain about life? Not once. She told me beautiful stories of times with her husband and kids. She talked about her grandkids and great grandkids. She asked me about my love life and gave me hilarious advice.

Was she fragile? Not in my eyes. She was more on the ball than most people I know who are a third of her age! She had more wit than most. She was blunt and honest. Massage wise, she could take a good amount of pressure and rarely said anything felt too sore. 

Movement wise, she was slow and unsteady. She fell at home a few times and once had a hard time getting back on her feet but she continued to live on her own and drove herself around the city. In most ways she was not fragile at all.  

Unfortunately, as we age we see a decrease in function in many areas: strength, stability, mobility, memory, physiological processes, metabolism and even mental health. While massage therapy may not regain anyone’s youth, I am a firm believer that it can help with mobility and stability issues and can have an incredibly positive impact on one’s state of mind. The elderly may have to deal with disease processes, slowing bodily function, loss of partners, friends and memory, but a Massage Therapist can provide a quality of life that helps them to feel better, be more positive and in my case get a ton of laughs. I moved away from the city where my 91 year old client lives but I get updates from colleagues about her. She taught me a lot about how amazing life is and that you should do the things you love and be around the people who make you smile. Since working with her, I haven’t felt nervous being around elderly people or massaging them. I learned how much the elderly can still do, their abilities and what they have experienced in life. Embrace every client and experience you can! You never know what you will learn!

As she would say, “Isn’t everyone so much more beautiful when they smile.”

 

“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:

• phase 1- introduction to touch and massage
• phase 2- behaviour and focus
• phase 3- motor function

Treatments consisted of manual modalities to the lower extremities and back such as:

• relaxation techniques including general swedish massage
• rocking
• 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.

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.

Be patient!!

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.