Handicapped/Wheelchair bound massage

[satty jr]

Anyone out there have any experience with this type of massage? I was recently asked to write a paper at work concerning this type of massage. I have worked on a total of one client with this situation. I haven't had any experience with elder massage or with handicapped massage, but I did work in a nursing home for just over a year several years back. I am aware of the thinning of the skin for the elderly, but I think what I am looking for specifically is problems you may have found in regards to this type of situation, particularly in a wheel chair or some one who is not easily transferable from bed/table to chair. Any thoughts or suggestions are greatly welcomed! t083

 

[Cynthia rodriguez]

I have experience with one client too. I don't know exactly what to add, but give me a few days to get my thoughts together plus a little time and I'll see what I can come up with.

 

[Ricardo P]

Wheelchair massage

I've worked on a couple of wheelchair clients-one was at a running race, the other was a young man who was having neck and shoulder spasms. At the running event I did a mix of pre-event Sports massage and chair massage. The other client need specific work like Trigger Point therapy. Both of these persons were not elderly and home bound, so I don't know if this is heldful so...
I'd imagine some of the same precautions as working with elderly clients.
Good luck,
rubmyster

 

[Armyn]

A good share of my clients are elderly and/or disabled. This is my primary target market group.

Give me some specific questions, and I will do my best to help you.

Most of my clients can transfer themselves from the wheelchair (or walker) to my table. I do have some who need my help. Having worked in a nursing home, you already know the body mechanics involved in transfers. Don't be afraid to use that experience.

Most of them prefer not to have to undress and redress, so I employ lots of shiatsu, creative mobility and stretches. There are some, however, who love swedish and are willing to have to go through the hassle of undressing for that!

The most important thing is your intake form and communication. They won't often think to tell me about a new medication, so I ask every time. I ask if they have had any falls, new diagnoses or symptoms, and if they have any specific requests for this session.

Most doctors are all for their patients getting a massage, but there are some who are offended (??) and will not give permission. (One doctor disregarded the permission form and told the family he would NOT write an order for massage, he would prescribe pain pills. Several months later they have come back to me to see if we can do this "off the radar", because the pills don't help, have awful side effects, and they believe massage will help their mom. She doesn't NEED doctors orders, or even permission, really, as she has no contraindicated conditions. My consent form at that time was the standard request for permission.) Therefore, I have quit asking for every elderly or disabled client to get physician consent, and instead take it case by case, as with the rest of my clients. If there is a condition that requires consent, I send my form, but I have changed it. Instead of asking permission, I inform the doctor that his/her patient has made the decision to receive massage therapy, and I am requesting that any precautions they have be noted and signed. I may note that I have so far only provided shiatsu, and describe that as gentle compressions along the fascial lines, until I hear back. I then list the usual effects of massage and give space for them to note if that may be done. (such as increase circulation - someone with congestive heart failure should not have a full body swedish massage, as the heart may not be able to keep up with increased circulation. Someone on blood thinners should not have deep work done, as internal bleeding could occur.

We have to be more patient with our work. When a trigger point has been in a muscle for 14 years, we can't work it out in half an hour!!! Be gentle without being afraid to be firm or to work deeply. Positioning must be done carefully, and may need to be modified or more frequently changed.

Let me know what your specific questions are. This is a passion of mine!

 

[Mudassir]

I think for the moment what I am looking for is proceedure more or less.

The one experience I am talking about was a parapalegic who is basically bed bound and is unable to do much of anything for himself. His mother had bought him a half an hour gift certificate for Christmas. I had heard about him through other therapists, but was unaware of the fact that personal care is at a minimum for him. His mother even filled out the intake forms due to his inablity to write. He has a motorized wheel chair, which he controls himself, quite well I might add. His basic complaint was upper body aches and pains, due to his inablities. He is a four person transfer, so putting him on a table is out of the question. At first I was caught a little off guard when I began, but the therapist in me kicked in, and eventually any apprehensions wore right away. Before I knew it the time was up, but unfortunately I have not seen him since, as it is very difficult for him to get out.

I am sure that you take each client you work with in this kind of condition on a case by case, day by day basis. Do you incorporate a lot of ROM when you work on them? Are there specific areas that you target more than others? Do you do outcalls, and how much do you charge if you do? Do they come to your office more or less than most clients? What do you charge when they come into the office? The same as others? More? Less? Is massage covered for specific conditions by insurance? Or are they mostly out of pocket? Do you see those with chronic pain? If you do, how well do you find they respond to treatment? Are there specific types of chronic pain clients that you have such as RSD?

Any information or directions you can send me in would be great. This is a whole new door for me to go through, but the body is the body, no matter what shape or form it is in. Thanks for your time!

 

[Artemisc]

Do you incorporate a lot of ROM when you work on them?
Yes, for the shoulders, elbows and wrists, no for the neck.

Are there specific areas that you target more than others?
Neck, especially sides, traps, scaps, axilla, biceps, forearms, wrists and hands. (For the wheelchair bound.)

Do you do outcalls, and how much do you charge if you do?
Yes, IF there is medical necessity, (I don't do relaxation outcalls,) AND if they are unable to come into my office and get on a table. I charge a nominal travel fee $10 for the metro area, which is less than half the going outcall surcharge around here. I figure I'm not lugging a table or doing set-up/takedown. The only extra time or task I do is helping the client disrobe.

Do they come to your office more or less than most clients?
Depends. My quad outcall is every single week. He is wheelchair work, he cannot be transferred to a table.

What do you charge when they come into the office? The same as others? More? Less?
If they come to the office, it is the same charge, unless I have a special arrangement with them based on either their need or another reason. I have one client that I have a standing arrangement with, she can get as much work as she needs at $25/75 minute session. This is because she has a severe and uncommon condition, and we use it to try new things to "see what works." The $25 fee allows her to get in at least once a week, and allows me to be comfortable "experimenting," instead of feeling that since she is paying a full fee we have to stick with conventional methods.

Is massage covered for specific conditions by insurance? Or are they mostly out of pocket?
Depends more on the insurance than the condition. There are a couple of insurance companies that "won't cover massage," but if you speak to them, have a prescription and point out that it is medically necessary, prescribed and recommended for a specific ailment, they will occasionally cover part of the treatment.

Do you see those with chronic pain? If you do, how well do you find they respond to treatment?
Yes, FMS, RSD, contractures, DJD, DDD, confined to wheelchair, surgical scars/adhesions, etc. They respond very well when treatment is regular and they are willing to do self-care.

Are there specific types of chronic pain clients that you have such as RSD?
yes, see above.

 

[Pompal 09.]

Do you incorporate a lot of ROM when you work on them?

Yes, but within the boundaries of their current ROM, in order to maintain what they have. If they request that I try to improve the ROM, I will work, with physician permission, to the point of pain, but not beyond that. I have seen an increase in ROM, much to the delight of the client.

Are there specific areas that you target more than others?

Yes, just as with any other client. It depends entirely on the individual, their disability/compensation and desire. I have a young client who has CP and is wheelchair bound. She does not have a motorized wheelchair, so her entire shoulder girdles, arms & wrists always need TPT & stretching. Her illiopsoas and QL's always need to be stretched.

Do you do outcalls, and how much do you charge if you do?

I do not have an office yet, so all my own clients are outcall clients.

Do they come to your office more or less than most clients?

They are much more regular than my able-bodied clients.

What do you charge when they come into the office? The same as others? More? Less?

My charge is the same, by the length of the massage. It does take quite a bit more time, though. When I have an office, I will charge a set-up fee for outcalls.

Is massage covered for specific conditions by insurance? Or are they mostly out of pocket?

My clients are all self-pay. Insurance is one headache I don't intend to set myself up for. MANY great therapists don't mind working with insurance companies, but I abhor them, so I don't.


Do you see those with chronic pain? If you do, how well do you find they respond to treatment?

Yes, and they respond very well. I have an 81 year old who no longer walks with a cane, with regular massage. One man is able to turn his head from side to side for the first time in YEARS. It is extremely rewarding.

Are there specific types of chronic pain clients that you have such as RSD?

I have a couple of fibromyalgia clients, some with hip replacements, the girl with CP, one with MS, and some just very elderly with chronic generalized pain. Arthritis is common among my clients.

Some who cannot be transferred to the table are able to relax in a recliner, and I have found this to be very workable. They can be turned from side to side in the recliner so that all areas of the body can be massaged. I haven't been able to stretch the QL's in the recliner, but most everything else that the client is able to receive can be done in the recliner. My body mechanics do not suffer (much, usually, lol) and I can do an hour massage, if needed. [/i]

 

[Can]

I think for the moment what I am looking for is proceedure more or less.
...
I am sure that you take each client you work with in this kind of condition on a case by case, day by day basis. Do you incorporate a lot of ROM when you work on them? Are there specific areas that you target more than others? Do you do outcalls, and how much do you charge if you do? Do they come to your office more or less than most clients? What do you charge when they come into the office? The same as others? More? Less? Is massage covered for specific conditions by insurance? Or are they mostly out of pocket? Do you see those with chronic pain? If you do, how well do you find they respond to treatment? Are there specific types of chronic pain clients that you have such as RSD?!

I'll answer as best I can. I have had the one massage client in a wheelchair and one other that I will PM you about.

I don't have a particular proceedure, as this client is a "para" and able to drive (very nicely set up large size SUV), get up on the table himself, etc. He is VERY strong in the upper body. I do have to lower the table way down low and since it is not a hydrolic, it is a bit harder for me to work with him in a few aspects. (I like my table real low... but not THAT low )

I don't incorporate a lot of ROM, just some.

For his bodywork I have to really target the ribcage, forarms and neck. But, I do full body proceedure for him.

No outcalls, but if I did, I would charge $10 - $20 on the backside for the travel.

He comes less than most clients, a LOT less... but it is due to his high stress job. He's like an average Joe. Too much going on and not enough time to fit it all in. Other things do take priority for him. To be sure, he hasn't been in in at least 8 months. He's a very sporatic client.

I charge the same price as I do for everyone else.

He pays out of pocket.

He does have some chronic pain, and it is helped by the massage - but again, since he doesn't come in frequently the benefit is outweighed by the non-ferequency factor.

I'll PM you about the RSD too.

Hope that helps some.

 

[Pompal 09.]

Procedure suggestions

I can not afford to maintain an office so I only do outcall work except when I am at the chiropractors office. I have 12 years experiance with this chiropractor and was trained to mesure the X-ray profile so I got to see the underlying conditions that contributed to the losses.
Working in the clients inviroment is very valuble for seing what would be most practical for self and family care. I hav worked with clients in probably every position you can conceve. One That has not been mentioned is draped over their exersise ball. [wich I sold to them by the way]
I work with clients mostly clothed usualy stretchy shirt and pants. The typ of work I do is strain counterstrain, Trigger point therapy, CranioSacral and my personal repritoar which includes an Oster H and Vibrator on each hand. With the hand vibrators my fingers can monitor the tonus of the muscles the releace of trigger points and whether referral points are responding [it is nice to have long arms wen you need to hold the foot and the diaganoly oposit sholder]
I almost always start and end sessions by checking the cranio sacral rythem at the inferior edge of the mastoid. So mainy of the eldrly and invalid have disrupted CSR usualy from hip distortion preventing sacral movment. since the mastoid mirrors the ilium I am able to plan my session according to the distortion. If the mastoid is low on one side the ilium will be high on the same side. If the mastoid is anterior ithe ilium will be anterior on the same side.
It is after midnight now so if you want to know more you will have to ask at another time.
Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist