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Massage Considerations for Stroke Patients
Massage Considerations for Stroke Patients
Massage considerations for stroke patients have been suggested by authors of textbooks often used in entry level massage programs. Following these suggestions will make a massage therapists’ efforts with stroke patients easier when attempting to achieve client rehabilitation goals.
Kalyani Premkumar MD, in her book, “Pathology A to Z – A Handbook for Massage Therapists,” recommends that important goals for stroke patients is to address joint stiffness, decrease muscle spasticity, reduce skin changes, address postural changes, and re-educate client movement pattern via improving sensory stimulation. Incorporating light touch techniques can help with improving sensory neurons regain stimulation capabilities. Adding stretching to sessions can aid the joint stiffness. Using static compression upon a muscle region may help with decreasing spasticity.
Premkumar mentions two more important ideas in her textbook. First, be sure to communicate and work in conjunction with a patients’ other allopathic therapists such as an Occupational Therapist. Second, clonus (abnormal involuntary muscle contractions) of the ankle of region is common for stroke patients. Do not forget about the feet and ankle regions. Reflexology and other foot massage techniques will be helpful in this case.
Ruth Werner, in her textbook, “A Massage Therapist’s Guide to Pathology,” discusses the risks and benefits of massage to stroke patients. Ms. Werner states the major risk of a massage to a stroke patient is the possibility of another cerebrovascular accident and threat of another stroke incident occurring. Since massage therapy increases blood circulation, slowing down our massage and focusing on one body region rather than full body massage are two good suggestions how to alleviate these risks.
Werner informs that massage and other therapeutic means that include gentle stretching, exercises and building awareness will be effective additions to a stroke patient’s treatment plan. Gentle range of motion, light myofascial release techniques including skin traction and gentle tapotement can help sensory neurons improve proprioceptive messages to enhance awareness within the nervous system.
Susan Salvo, in her textbook “Massage Therapy Principles and Practice,” includes many massage considerations for patients with cardiovascular conditions. If strokes are in connection with hypertension, check in about any sensations of dizziness in correlation with massage. Have client sit up in dizziness experienced. Ms. Salvo adds studies in her textbook how massage upon the back can reduce blood pressure, decrease heart rate and improve parasympathetic activity.
Salvo also describes massage modifications for Peripheral Arterial Disease (PAD), which may contribute to stroke incident. Avoid deep, vigorous massage for these patients. Rather, remain light with pressure application to avoid further stressing arteries potentially possessing a clot. Signs of blood clot include unilateral swelling, discoloration of local skin, changes in local skin temperature and puffy appearance of local vessels.
When working with stroke patients in my private practice, I also consider these ideas:
For patients with history of stroke, I ensure during intake to assess general cognition in terms of how well they are communicating with me and moving. I have them walk my long hallway a couple of times so I can assess gait noting any changes or disruptions.
I also inquire about medications taken and side effects they are currently experiencing. Common medications taken by stroke patients include thrombolytics (Eminase, Retavase, Streptase) to dissolve blood clots, anticoagulants (Warfarin, Heparin) and antiplatelets (Plavix, Effient, Aspirin, Novasen) to limit formation of new clots and antihypertensive (ACE inhibitors, Calcium channel blockers) medications to manage blood pressure. Common side effects of these drugs include gastrointestinal challenges, blurry vision, headaches and fatigue.
During a massage session, I will check in to ensure the client can still communicate verbally throughout the session. When working the neck region, I keep the work less intense to reduce blood flow expedition into the cranium. I include cranial sacral therapy to induce relaxation on central nervous system tissues.
An important reminder here is that cranial sacral therapy or massage of any kind is contraindicated within six weeks of a recent stroke incident.
During a session, I include stretching and lighter myofascial release techniques when I feel adhesions in muscle and fascial tissues. More of my focus is upon the hips and legs to promote more blood flow circulation to the lower limbs.
Research on Massage for Stroke Patients
There is research confirming the effects of massage therapy upon stroke patients in alleviating their symptoms. In “Evaluating the Efficacy of Massage Intervention for the Treatment of Poststroke Constipation: A Meta-Analysis,” researchers suggest that massage can be an effective means to reduce the effects of constipation in stroke patients in meta-analysis conducted.
Ayurvedic-based massage can promote healing in patients with flaccidity of muscles and lead to less need for antispastic drugs, according to a 2019 study in the Journal of Ayurvedic Integrative Medicine. This was observed in study with people who has experienced both simple and complex strokes.
Adding aromatherapy and foot baths into treatments with stroke patients showed such benefits as reduced stress, improved mood and increased sleep satisfaction (even greater than those receiving only massage) of stroke patients in a study published August 2017 in the Journal of Physical Therapy Science.
In a 2020 study on the effects of tactile massage with stroke patients Nursing Open Journal showed how physical touch eased worries and anxiety sensations felt by patients. Also, physical touch generated feelings of closeness and improved sleep satisfaction.
With the information gathered from research articles and trusted textbooks, a treatment plan for stroke patients is possible. It is my experience that stroke patients benefit greatly from massage and cranial sacral therapy. Awareness of medications taken, the functional impact of the stroke and how the body is responding to massage will help guide a therapist on necessary modifications.
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About the Author
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine, and his articles include “Massage for Trauma: 3 Ways of Responding to an Emotional Release” and “TMJD: How to Assess for Dysfunction.”
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