“See the person, not the disorder” – Meaghan Mounce RMT
I stood holding a client health history file, suddenly nervous with my mind racing.
I had never massaged someone with this condition before.
It was my first week at a new massage therapy clinic. I had just moved to the city and stepped into a busy clinic where my first week was booked solid. The second day of work I was reviewing the files of the clients I was going to see that day.
My last client of the day was a young lady in her mid twenties. I read through her file and health history form and immediately felt the butterflies I used to get when I was a student!
My client had cerebral palsy (CP), was nonverbal, used a motorized wheelchair to get around and had a care aid with her at all times. No other RMT’s on shift at the clinic worked with this girl before and I so I had no one to ask advice!
A million questions flooded my brain at once. In my four years of massage therapy practice I had not worked with anyone with a severe disability.
How would I communicate with her?
How would I know if I was hurting her?
Is she able to move around on the table?
Do I have to help with lifting and transferring her to the massage table?
Dealing With Spastic, Ataxic And Athetoid Cerebral Palsy
Luckily, I had just taught the section on cerebral palsy in the Pathology course at the massage therapy college in Victoria, BC so I had some recent information on the condition. However, as we all know, dealing with a real life patient is far different than reading about it in a text book!
Cerebral palsy is a non-progressive neurological disorder caused by abnormal development of or damage to the brain. This damage usually occurs in utero and can be caused by exposure to radiation, infections or lack of oxygen to the brain. Less commonly, CP can be caused from trauma during birth or serious infections during infancy.
There are three main types of cerebral palsy, as well as mixed CP which presents as a combination of the other three. There seems to be a wide spectrum of how the symptoms can present, from mild to severe.
Spastic CP is the most common type and causes symptoms of an upper motor neuron lesion of the brain, such as hypertonia of affected limbs .
Ataxic CP shows symptoms of damage to the cerebellum. Patients with ataxic CP often have difficulty with balance, walking and fine motor skills such as writing or typing.
The final type of CP is Athetoid and has symptoms associated with damage to the basal ganglia and to the neurological structures that affect involuntary movements. These patients will present with a mixture of hypertonia and hypotonia and will experience involuntary movements.
Learning about the Condition Beyond a Textbook
From my knowledge of the subject, I decided my lovely client had athetoid type cerebral palsy. It was not stated which specific type of CP she had on her health history form.
She was bound to a wheelchair, had hypotonia (no muscle contractions) in her lower limbs. Her legs and feet had no voluntary movement, were very thin and cold to the touch. Her upper limbs were spastic. Her fingers were curled around the thumb in flexion. While she had some voluntary control of her arms, the movements were very jerky and she often had flailing limbs that were out of her control.
She could not speak, but had an amazing computer that she could press a button and it would say a few programmed sentences for her.
On the day I was to massage her, I waited patiently, nervous but also excited for a new challenge.
Get To Know Your Client And See Beyond Types Of Cerebral Palsy
She rolled into the clinic on her motorized wheelchair, controlling it herself with her head. Her care aid walked behind her encouraging her in a relaxed manner to drive the wheelchair forward.
The first thing I saw was a huge smile on the client’s face. After I said ‘Hello’, she quickly pressed a button on her computer and an electronic voice replied, “Nice to meet you!”.
I quickly had a huge smile on my face too and some tightness in my throat from emotion.
The care aid placed my client on the massage table on her side with a pillow between her thin legs, another under her head and one for the client to hug.
I was told that she usually feels good, but often suffers from constipation. She had a feeding tube directly inserted into her abdomen, so I was shown where that was.
After the quick run down we were left alone for an hour to get acquainted. My nerves went away quickly and were replaced with admiration.
I was able to communicate easily with this client through yes or no questions. A ‘no’ response was given with a lowering of her eyes and chin towards her chest. A ‘yes’ response was shown through raising her eyes and chin. An excited ‘yes’ was accentuated with a cry of ‘yeaaaahhhhh’, which made me laugh every time!
I quickly found out about how many siblings and pets she had and that she really loved when she got to ski at the local skill hill the month before!
Massage Treatment For Cerebral Palsy
I massaged her in her side lying position the entire treatment. She confirmed she was comfortable the entire time.
I did a full body massage to all the areas I had access too. Through her lower and upper back I performed mostly general swedish massage with some gentle muscle stripping through the erector spinae and upper trapezius muscles.
On her lower limbs, I did mostly circulatory work. I started distally and used small, but broad strokes to help encourage blood flow. I massaged her feet, which were very cold, and moved her ankles through passive range of motion.
I also did some abdominal massage to help with her constipation issues, while avoiding the feeding tube.
Her arms were the trickiest to massage. With any quick movements her arms would jerk into a flexor pattern (internal rotation of the shoulder and flexion of the elbow, wrist and fingers). I used slow strokes moving from proximal to distal to relax the muscles of the upper limb.
She watched thoughtfully as I slowly opened up her palm to allow some kneading to her hands.
The client seemed to relax easily and I noticed her eyes drooping a few times into almost sleep.
Once the hour treatment was up, her care aid dressed her and situated her back into her wheelchair. She steered herself out of the treatment room and pressed a button on her computer that said, “Thank you! See you in a month”.
I was thankful she was my final client of the day because I was fairly emotional after the treatment.
Using Conditions Like Cerebral Palsy To Find A Learning Experience Anywhere
I felt extremely grateful that I got to be a small part of her health care plan. I learned how to communicate with someone who doesn’t speak the same way you and I do. I got to experience outside of school what hypertonia, spasticity and hypotonia really feel like.
Most of all I got to see what an amazing personality she had.
I was lucky enough to work with her a few more times before I moved away. Even though she no longer is my client, I will never forget her.
Working with her was one of the best experiences of my life.
From this experience, I learned to not shy away but embrace situations that may be challenging. You can communicate easily with someone even if they cannot verbally tell you their thoughts. You can use vision to see someone relax and feel tension ease. I always figured I would learn more once I was out of school and working with people. I thought I would gain this knowledge from continuing education or from the opinions of other health care practitioners. What I didn’t know is how much I would learn about each client’s view of their own condition, disease, injury or how they see themselves in the world; knowledge that you cannot find in school or a textbook. Embrace every client and experience you can! You never know what you will learn!