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Contraindications for people with disabilities
Autism, cancer, digestion, dilution, selecting oils, inflamed joints, oedema, Damaged skin, Epilepsy, Seizures, Photosensitivity, Snoezelen, Cardiac, Renal and Hepatic disease, Medications
People with multiple handicaps may not be able to express their feeling in a conventional way. Pain and anger is expressed through body language and challenging behaviour. Aromatherapy and massage can offer enormous benefit to the learning disabled but must be undertaken carefully so as not to exacerbate existing medical conditions. Care must be taken with pressure areas, inflamed or frozen joints. Also be aware of epilepsy, renal, hepatic, respiratory or digestive difficulties. It would be wise to stay with the 'safe oils' and a full consultation must be undertaken before commencing treatment with additional advice sought from other professionals involved in their care.
IMPORTANT: This does not mean that Therapists cannot use some of the oils listed below, but extra care and a good rationale for treatment and an appropriate level of skill and route of delivery is required.
The main considerations are:
Autism
A common feature of autism is susceptibility to sensory overload. As a result, autistic people may be over-sensitive to smells and are very wary of the invasion of their own personal space - their anxiety can be expressed as violent or disruptive behaviour. Massage or aromatherapy of any kind may be undesirable in these circumstances. As many as 20% of people with autism may have some form of epilepsy, therefore avoid substances which may trigger a seizure (see epilepsy - below).
Cancer
There has been previous concern that massage can exacerbate some cancers so it is important for the therapist to understand their client and the type of cancer being dealt with. Many nurses and hospices are now using aromatherapy regularly to help relaxation, treat nausea, and provide emotional support through the therapeutic use of touch.
Digestion
The digestive system may be more sluggish than that of an able-bodied person - wait 2 hours after eating before a full body massage to prevent discomfort.
Dilution
Because the elderly, inactive, or physically disabled may have a slower metabolism, double-dilute the quantity of essential oil used (Example: 1 drop pure essential oil to 4 ml carrier = 1% dilution).
Selecting
oils
Only use oils which have been properly researched by a reputable source as many oils have their own specific contraindication for use with this client group under each individual
oil. Because many people with disabilities or special needs may be on powerful convention drug regimes, it is important to seek advice from their consultant before commencing treatment.
Inflamed joints
Avoid the specific joint but massage on the joint above can help to improve circulation.
Oedema
Massage upwards (towards the heart) and towards lymph nodes to assist with lymphatic draining.
Avoid: Anise, Citronella, Clove (leaf, bud and stem), Lemon gum (Eucalyptus citriodora), Laurel, Lemongrass, May chang, Melissa, Oregano, Star anise, Thyme (ct. unknown) (Balacs et al. 1995)
Although not a cause of learning disabilities, epilepsy affects a greater proportion of this client group. There is a lot of incorrect information regarding the use of essential oils and epilepsy. Some publications recommend avoiding Aniseed, Dill, Rosemary, Fennel, Hyssop, Sage, and more recently, even Evening Primrose has been reported to be linked to seizures. However, in the sort of dilutions used for massage, epileptics are probably at more risk from the strong smell triggering a seizure than any adverse effect of the essential oil through absorption via the skin.
As strong smells can trigger seizures, it would be wise to avoid strong overpowering fragrances.
Many publications list Rosemary as contraindicative to epilepsy, while some maintain that it is a useful anticonvulsant when used in low dilution (2%) (Price et al. 1995). · Epilepsy can result in frequent injuries from the seizures. Know what to do in the event of a seizure and plan the massage position carefully to minimise risk from falling. · As strong smells can trigger seizures, it would be wise to avoid the Eucalyptus oils, high menthol chemotypes (Peppermint, Spearmint), camphor chemotypes (Rosemary, Lavendin, Hyssop, Sage, Camphor, Fennel) (Buckle 1997 p86, Betts 2002) and other strong fragrances in excess of 0.5%. (Also see Snoezelen below) · Conduct a risk assessment and while working with your client and position them to minimise risk. ·
Calming essential oils with established relaxation techniques and help reduce the onset of anxiety-induced seizures (Betts, 2002). ·
About 5% of Epileptics suffer from Photosensitive Epilepsy where flickering lights can trigger a seizure. Until you know if your client is affected, refrain from using light effects and projectors in the Snoezelen.
Avoid: Cumin oil Cuminum cyminum, Tagete oil & absolute Tagetes minuta, Rue oil Ruta graveolens, Angelica root, Bergamot oil (expressed) (not FCF), Bitter Orange oil Citrus aurantium, Grapefruit (expressed) Citrus paradisi, Lemon oil (cold pressed) Citrus limonum, Lime oil (expressed) Citrus aurantifolia (IFRA 2002)
Chlorpromazine medication can cause photo-sensitivity (British National Formulary 2002) so do not use ultra violet light for at least 12 hours after massage.
Avoid: · Peppermint (Balacs, et al. 1995)
Renal disease
Avoid: · Bay (West Indian) , Cinnamon leaf , Clove (bud, stem and leaf) (Balacs et al. 1995) · Juniper (Price et al. 1999).
Hepatic disease
Avoid: · Anise, Basil, Bay, Cinnamon leaf, Clove (bud, stem, leaf), Star anise (Balacs et al.1995) · Fennel (Buckle 1997)
Some people with special needs are on powerful drug regimes. You need to know and understand the medication you are dealing with and the essential oils you are using. Always seek GP or Consultant referral first and consult a properly qualified Aromatherapist because they will have more up-to-date information on the interaction and cautions of particular essential oils with medications.
Photosensitivity
Some of the more powerful medications used in learning disabilities have photsensitsation as a common side effect. Eg: Chlorpromazine, Haloperidol, Phenobarbital, Risperidone and many more. More detail
Avoid photosensiting essential oils.
Phenothiazines
Phenothiazines are major tranquillisers and anti psychotic drugs. (For example chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, promazine, thioridazine, trifluoperazine, and thiopropazate and triflupromazine). Excessive skin discoloration can be an unfortunate side effect which is exacerbated by direct sunlight or UV lighting. Excessive skin discoloration can also mask the signs of Jaundice sometimes associated with prolonged chlorpromazine medication (BMJ 1995 p85-87).
Therefore: AVOID PHOTOTOXIC OILS which may enhance the effect of sun or UV light. This includes Bitter orange (expressed), lemon (expressed), Grapefruit (expressed), Taget, Verbena, Bergamot (unless FCF), Cumin, Lime (expressed), Angelica root (mild to moderate phototoxic (Balacs et al. 1995).
Use protective carrier oils that have reported sun filtering effects such as Hazelnut, Macadamia, Coconut, Avocado, or Sesame.
Beta-blockers
Beta-blockers are used to help lower blood pressure and anxiety (eg: Oxyprenolol, pindolol, acebutolol, celiprolol, atenolol, celiprolol, nadolol, sotalol, labetalol, carvedilol, nevibolol, betaxolol, bisoprolol, metoprolol, timolol, propranolol, and esmolol). Due to their hypotensing side effect (lowers blood pressure), use hypotensive oils with caution (eg 0.5% dilution Calamus, Geranium, Lavender, Rosemary?, Taget, Carrot oil, Hyssop, Peppermint?, Rosewood (Balacs et al. 1995 p65) and advise your client to take care on rising from the treatment couch after a treatment to safeguard dizziness or fainting.
Wafarin
Avoid Sweet Birch (Balacs, et al. 1995).
Oral and topical steroids
Topical steroids can lead to an increase absorption of substances through the skin. Steroids are taken for allergies, inflammation, skin conditions, asthma, growth and hormonal problems. Long-term use of steroid medication can lead to: · Thinning of the skin which has implications for massage · Lowered general immunity · Stomach upsets · Mood swings · Insomnia.
Topical creams
Carrier oils and essential oils may interfere with the absorption and action of topical creams. Massage may also disperse topical medication over areas where it is not desirable and get onto the therapists hands. Avoid massaging areas being treated by topical skin creams.
Antibacterial creams
Some topical antibacterial creams contain Halogenated salicylanilides which can increase the potential photoallergic reactions of some essential oils. They are available as over-the-counter preparations and should be used with caution, particularly if someone is already taking oral medication.
© Amended March 2003