 |
Massage with the elderly or inactive person
This article is not meant to advise you on the use of specific essential oils although a few are mentioned as examples. The essential oils you select will depend wholly on the needs of the client at the time. Rather it is a brief outline of some of the precautions you will need to be aware of with such a special client group, mainly awareness of skin and joint care and precautions when using massage with people who are much more vulnerable to pressure and joint injuries.
Skin care Joints Cerebral palsy Pressure care References
Skin care
The elderly and inactive are much more susceptible to skin problems:
The warm living environment in residential homes can encourage the growth of common bacterial or fungal infections. Medication, inactivity, or compromised immunity can lead to frequent skin infections. Steroid medication can cause thinning of the skin. Antibiotics can lead to candida and other fungal infections, hair and scalp problems. Side effects from medication can cause skin rashes, dehydration, and sensitivity to temperature, and constant wearing of continence pads can cause irritation and skin breakdown. In addition, infections are very readily passed on from hand to hand in large establishments simply due to that fact that it is impossible to keep everything scrupulously clean at all times, particularly in a busy working environment
 |
Having to rely on staff for bathing and drying - often leaving areas of damp skin, ideal for encouraging fungal infections (for example, underneath the folds of the breasts, between the toes and around the buttocks). |
|
Those who are obese are more at risk of infections between the folds in their skin. |
|
Lack of independence or mobility can lead to having to compromise ordinary washing and moisturising routines. |
|
Harshly laundered towels can abrade already compromised skin. |
|
Compromised personal care can lead to dampness after toileting. |
|
Plastic mattress covers exacerbate sweating and dampness at night, again encouraging bacterial or fungal growth on the skin which can add to skin breakdown. |
|
People with neurological impairment such as dementia may have forgotten the normal hygiene routines that are so important to health and good skin care. |
Learn to recognise common skin conditions and parasitic infections, and which ones would contraindicate massage treatment. You can always use sprays and creams if massage is contraindicated, or vaporise essential oils to help with airborne bacteria, or to help with the clients emotional well-being and self esteem.
It goes without saying that a good personal hand washing routine between clients is imperative to avoid inadvertently passing on infection. See hand washing
|
Tea tree and Manuka are antifungal (Lis-Balchin, et al. 2000) |
|
For skin inflammation use Witch hazel (Korting, et al. 1993) |
|
For Tinea pedis (ring worm, athletes foot) use Tea tree (Tong, et al. 1991) |
|
Scabies: Verbena (Oladimeji, et al. 2000) |
|
Herpes I & II: Sandalwood (Benencia, et al. 1999) |
Joints
People who are immobile have a higher tendency to suffer from muscular-skeletal problems such as malformed, inflamed or frozen joints (particularly if accompanied by Cerebral Palsy).
Common muscular-skeletal problems include instability of the spine or cervical area, often due to kyphosis or scoliosis (curvature of the spine) from osteoporosis, or from having to stoop to use a walking frame; there may also be foot, ankle. knee, hip and shoulder problems due to arthritis, a recent fall or injury due to osteoporosis; Contracted tendons and ligaments are very common and can be damaged if handled incorrectly.
Avoid the specific joints and areas of undiagnosed pain, but massage on the areas above and below can help to improve circulation and distract from any pain and aching.
|
A knowledge of remedial massage may be required as well as seeking advice from the Physiotherapist. |
|
Make sure you have access to a manual-handling plan for your own safety and that of the client. |
|
Eucalyptus and peppermint are useful for passive muscle warming (Hong, et al. 1997). |
Cerebral palsy
Cerebral Palsy is due to motor nerve damage due to congenital problems, physical trauma before or during birth, prematurity or low birth weight, or as in many cases, the cause may be unknown. It can can affect people in varying degrees of severity from mild which may only slightly affect posture and small motor control, to severe symptoms which can affect both limbs down one side (hemiplegic) or all four limbs (quadriplegic), or the lower limbs only (diplegia) affecting the larger motor movements, coordination and speech.
Severe cerebral Palsy can also affect swallowing action. It can also result in deformation of muscles around joints and can cause curvature of the spine. Hip dislocation is also a common complication in Cerebral Palsy particularly in quadriplegia.
Massage or light brushing around the lips, cheeks and oesophagus area can help stimulate motor connections required for speech and swallowing. Regular massage can help make motor neurone connections to help with body awareness and motor control.
Pressure care
Those immobile in chairs can suffer from pressure or friction injuries around joints, bony protrusions, and areas in constant contact with the chair back or straps. Clients who are underweight are at more risk as there is little soft tissue to provide cushioning around joints and bones. Often underlying injury and tissue damage is not immediately apparent and you should always be very cautious of any reddened area of skin. Massaging over a pressure injury will only cause further damage although you will still encounter staff who trained years ago when a good 'rub' was thought effective and beneficial in getting the circulation back.
A good test for underlying tissue damage is what is called non-blanching erythema where tissue redness does not turn white when pressed with a finger. This is often an indication of the first stages of a pressure ulcer.
Please see Pressure area care
The main risk areas for massage will depend on the clients mobility, what sort of chair they use, and whether or not they are bed bound.
Alzheimer's disease and showing that you really care
References
Benencia,
F., Courreges, M.C. (1999) Antiviral activity of sandalwood oil against herpes
simplex viruses-1 and –2. Phytomedicine May;6(2):119-23
Hong,
C.Z., Shellock, F.G. (1991) Effects of a topically applied counterirritant (Eucalyptamint)
on cutaneous blood flow and on skin and muscle temperatures. A
placebo-controlled study. American Journal of Physical Medicine &
Rehabilitation 70(1):29-33
Korting, H.C., Schafer-Korting, M., Hart, H., Laux, P., Schmid, M. (1993) Anti-inflammatory activity of hamamelis distillate applied topically to the skin. Influence of vehicle and dose. European Journal of Clinical Pharmacology 44(4):315-8
Lis-Balchin, M., Hart, S.L, Deans, S G. (2000) Phytotherapy Research Dec;14(8):623
Oladimeji,
F.A., Orafidiya, O.O., Ogunniyi, T.A., Adewunmi, T.A. (2000) Pediculocidal and
scabicidal properties of Lippia multiflora essential oil. Journal of
Ethnopharmacology Sep;72(1-2):305-11
Tong, M.M., Altman, P.M., Barnetson, R.S. (1992) Tea tree oil in the treatment of tinea pedis. Australian Journal of Dermatology 33(3):145-9
© Jane Ellwood 2003-2004