Massage for Neurological Conditions: Spinal Cord, Stroke

• Study notes on massage therapy for neurological conditions

Spinal Cord Injury

• Direct or indirect injury to the spinal cord from damage to surrounding tissues, bones, or blood vessels.
• Key history involves understanding sensations, prior surgeries, spasticity/flaccidity, diagnosis level, hypertension considerations, ADLs, and goals.
• Autonomic Dysreflexia awareness is crucial for injuries at T6 or above.
• Focus on promoting relaxation with diaphragmatic breathing.
• Maintain joint nutrition using passive range of motion (PROM).
• Reduce spasticity using inhibitory techniques like Rood's approach.
• Emphasize gentle joint mobilizations, diaphragmatic breathing, and stretching of compensatory areas.
• Proprioception exercises are important.
• Be cautious of bone density issues and blood clot risks.
• Avoid vigorous massage techniques.

Stroke/Hemiplegia

• Stroke involves blocked blood flow or bleeding in the brain, leading to paralysis on one side (hemiplegia).
• Key history includes onset, stage (Brunnstrom), symptoms, splints/bracing, other healthcare providers involved, ADLs, recovery progress, and good vs. bad days.
• Gait is assessed, looking for circumduction, and ROM, with goals, and checking for ulcers if immobilized.
• Goals include improving function, gait, ROM, and preventing ulcers.
• Promote relaxation with diaphragmatic breathing.
• Maintain joint nutrition with PROM.
• Decrease spasticity with inhibitory techniques like Rood's approach.
• Incorporate gentle joint mobilizations.
• Stretch compensatory areas.
• Address proprioception.
• Avoid prolonged or vigorous treatment.
• Be mindful of edema, osteoporosis, and spasticity.

Brain Injury (mTBI/Concussion)

• A non-progressive motor disorder caused by brain damage in an immature brain.
• Key history explores symptom improvement, triggers including headaches, diagnosis, and clearance, timeline, and headache-related questions.
• Assess posture and ROM.
• Evaluate proprioception.
• Focus on decompression and palpation.
• Promote relaxation using diaphragmatic breathing.
• Reduce headache frequency with effleurage away from the head.
• Improve positional faults, reduce muscle tension, and perform scalp massage.
• Encourage light aerobic exercise and diaphragmatic breathing.
• Avoid prolonged or vigorous treatment.
• Be cautious with neck movements involving rocking and shaking.
• Sensitive to sound, light, and other triggers.

Cerebral Palsy

• Group of non-progressive motor disorders due to brain damage to an immature brain.
• History includes how the patient navigates life, systemic issues, breathing, decubitus ulcers, drooling, communication signals, triggers, and ADLs.
• Assessing breathing, gait (scissor, equinus), functional abilities, and checking for skin ulcers.
• Utilize diaphragmatic breathing, gentle joint mobilizations.
• Stretching compensatory areas and proprioception exercises can improve functional movement.
• Promote relaxation with diaphragmatic breathing.
• Maintain joint nutrition with PROM.
• Decrease or maintain spasticity with inhibitory Rood's techniques.
• Avoid prolonged or vigorous treatment.
• Be aware of sores if immobilized.
• Accommodate excess salivary secretions, if present.

Parkinson's Disease

• A progressive neurodegenerative disorder affecting the basal ganglia, leading to slowed movements (bradykinesia), tremor, and rigidity.
• Assess progress, good/bad days, medications, respiratory issues, and gait (festinating, shuffling).
• Bradykinesia and postural assessments.
• Monitor PROM (cogwheel/leadpipe).
• Promote relaxation with diaphragmatic breathing, plus extension, such as semi-Fowler's position.
• Rood's (inhibitory) techniques.
• Yoga and water walking are helpful.
• Muscle activation is fatiguing.

Multiple Sclerosis (MS)

• Demyelination of nerves leads to scar tissue, causing flare-ups.
• Important to note flare-ups, stages, triggers, massage experience, communication signals, sensation changes, ROM changes, and bladder function.
• Determine where demyelination is located.
• How often are you tripping, cramping, or experiencing muscle weakness?
• Breathing and gait assessments.
• Relaxation and improving circulation is key.
• Diaphragmatic breathing and short walks help.
• Heat is generally avoided.

Amyotrophic Lateral Sclerosis (ALS)

• Fatal neurodegenerative disorder with progressive paralysis due to motor neuron degeneration in the spinal cord, brainstem, and cerebral cortex.
• Coordination assessment, any cramping, any weakness and breathign is important to note.
• Relaxation techniques and maintaining circulation are prioritized.
• Segmental strokes should be avoided.
• Diaphragmatic breathing and short walks can improve quality of life.
• Stretching for cramps is important.
• Muscle activation may be exhausting.
• Generally avoid heat, but not always the case.
• Accommodate excess salivary secretions, if present.

Huntington's Disease

• Inherited neurodegenerative disease with choreiform movements and progressive dementia.
• Assess coordination, cramping, weakness questions and breathing issues.
• Postural as well as bradykinesia should be monitored.
• Use diaphragmatic breathing, relaxation, and PROM with care, avoiding resisted movements.
• Cued rib breathing.
• Pillow support is important.
• "Fight" any choreic movements or change them
• Avoid vigorous and fatiguing treatment.
• Lower the massage table.