MUSCLE CONTRACTURES DUE TO BRAIN DAMAGE

[Honeybear13]

I have clients who are patients in a local hospital on a sub-acute unit. They are on life support. I do range of motion exercies and soft tissue work mostly. When these patients have been in bed for a long time, the muscles shorten and they can develop some pretty severe contractures. I have been working on this one patient, six days a week at the request of her husband. I am not having long term effects. Her hands are trying to turn outward, and her feet are trying to turn inward. All joints are very stiff. She is on a trach and a gastric tube for food. I have to work around the equipment. She is usually on her back, but sometimes on her side. Biotone Polar Lotion seems to soothe her. She can't talk, but she seems to relax when I use this. The charge nurse says her contractures are caused by brain damage. She went without oxygen for more than 10 minutes before she was revived. Does anyone have any experience with this or suggestions? Thanks!

 

[Lexie]

Harmony401,
The nurse is correct that the outward turning of the hands indicates brain damage.
I was just discussing this the other day with one of my sisters, as I have a 35 year old niece in the hospital who experienced a brain bleed last week. They had to do surgery to remove one clot, some dead brain tissue and removed a portion of her skull to allow for swelling. She's got 2 inoperable clots which they hope to dissolve with Hepparin. (Clots the Drs feel were caused by birth control.) She's making good progress, though it'll be a long recovery I'm sure.
Anyway, I was discussing brain damage with my sister from GA because her sister-in-law had been in a car accident when they first moved there which left her in a coma for 6 weeks. My sister had asked if my niece had done the posturing (the contractures) or that outward turning of the hands with Jill, and there had not been anything of that nature... so we were relieved.
Her sister-in-law still walks with a walker, even though it's been over 10 years since her car accident. She had to be re-taught to walk and talk... but they count themselves fortunate to have gotten as much of her abilities back as they did. I've heard that her personality has somewhat changed as well. Donna's brain injury included damage to the brain stem area however. I know that my sister feels Donna's husband really helped speed her recovery because of his knowledge of herbs and alternative therapies. They would often go in and use music, essential oils and massage/ROM on Donna even when she was in a coma.
The damage to Jill's brain was in the language area of the brain, so far anyway... we hope that's all that's affected but will not rest easy until the other 2 clots are dissolved. Yesterday she started speech therapy. And I think the Drs are very pleased with how quickly she's progressing.
You don't mention the age or health condition of your client and that's probably a factor to consider as well. My friend Gina died at age 25 of heart failure and I know I massaged Gina the night before she died and she was already having the contractures you mentioned, fingernails were turning blue, etc.
The brain can survive quite a bit of trauma, can create new neural pathways... but I'm not sure you can do anything for her than massage with the intent to comfort after that long without oxygen. Her Dr would be the best one to ask about her prognosis.
But IMHO Harmony401, you are providing a wonderful service just in your warm and caring touch and if the "aromatherapy" effects of the Biotone Polar Lotion are comforting to her... I'd continue using it.
When I went to the hospital on Friday, I took my essential oils with the intent of using them on my sister whose daughter, Jill, was in the hospital. I knew they would help calm my sister... and it's vital we keep Jill calm because of those 2 remaining blood clots.
So our family and friends had pretty much taken over the ICU waiting room, but I gave my sister a hair clip and asked if I can work on her neck for a few minutes while the nurses were with Jill and she said ok.
So within about 15 seconds of opening one of the essential oil bottles and starting to work on my sister half the girls in the room were standing next to me. LOL
She probably only got 5 minutes of massage but we were ALL more relaxed for having taken a few minutes to try to calm down in such an emotionally charged atmosphere.
Anyway, I hope that something I've said was helpful to you! I'd love to see you posting more on the board in the future as well! It sounds to me like you have a very interesting practice.

 

[out_of_africa56]

Contractures due to Brain Damage

Thanks for your reply Nancy! Sounds like you have been through alot.

I use aromatherapy also with the patients, in addition, music also. I always talk to my comatose patients, something I try to minimize with a client who is not sick.

I have experienced a four year period during my life where I was very sick. I had several strokes several years ago, which left me with ephasia ? (not a good speller LOL). It was very difficult to communicate. My daughter was the only one that could tell the staff at the hospital what I wanted. How she knew, I don't know. I guess she just knows how I think. Fortunately, I recovered completely.

I have also been hospitalized and had tremendous pain and people would talk around me like I wasn't there, or they thought I couldn't hear, but I could. You just don't know what someone is experiencing when they are in a situation where they are unable to communicate. Because of this, I think it has made me more sensitive to patients who are severely ill. I like working in a hospital-nursing home setting. Touch is so reassuring and relaxing. I can remember when someone just held my hand, how important that was to me when I was sick, even though I wasn't able to tell them.

I feel that people who are in a coma or just waking up from a coma, still have a spirit, and I just pray that I am communicating to that sprit, and that somehow, some of my intentions are getting through.

I can tell that the massage relaxes my patients. I would love to have more success in getting the contractures to release, but with this one patient, her contractures always return, and she is very stiff. I know she is benifiting from the touch, but I sure would like to be able to help those contractures also.

I recently got a new patient. I used to work on his roomate. Most of my hospital patients are like "Terry Schiavo?". Even though he is considered to be in a coma, because he cannot respond to commands, he has periods where he is awake. His mother has stopped his treatments and says she is saving money for his funeral. He has been on life support for six years. Was injured in a car accident and has permanent brain damage. I feel so sorry for him. He hears my voice when I am working on his roomate. He cuts his eyes toward me when I come into the room, before I close the curtain. His mother just leaves him to the nurses and rarely visits. It really makes me sad to not have an order to work on him any longer. I think he did respond to the touch and was at least on some level reassured. I feel like he must wonder why I am not working on him, but you do what you can do. I try to bring comfort to as many of these patients as I can. Of course, all of them require a doctor's order or permission, so I can only work on the one's I have orders for. Working on these types of clients is a wide open area. In a town of about half-a million people and many massage therapists, I am only aware of one other massage therapist that is doing this. I am glad to be one of them. Maybe when I get old someone will massage me huh?

I have tried numerous products for pain relief on both myself and my clients. I really like the Biotone, Polar Lotion and Nature Sunshine's Tei Fu Massage Lotion. It is easy to work with and the ingredients are good. I tried Biofreeze, but I really didn't like it as well, and you don't get the pain relief that you get with the Polar Lotion or Tei Fu Lotion.

Anyway, thanks again for you reply.

Ann (harmony401)

 

[Pompal 09.]

I spent Saturday afternoon, Sunday and Monday morning in Milwaukee with my family.
Jill was put in rehab with 2 sessions of PT, OT and Speech Therapy per day. She seemed to be making really good progress with everything. Sunday morning I was even given permission to lightly massage her (I just did her arms and along her spine lightly as I would do for an infant. And I didn't go anywhere near her neck or head.)
When asked later by her Mom how she'd enjoyed her massage she said, "Good, Nancy gave it to me." Which we all found quite remarkable due to her memory loss and aphasia. We were so delighted in the progress she was making.
On Monday morning she complained of a headache again and the Dr ordered another MRI which was given before most of the family got to the hospital yesterday morning. I saw her briefly while she was having her lunch and said goodbye, telling her to eat well and do her PT because it'd help her to get strong again.
This morning at 9:30 or so my niece Jill suffered a seizure or something and died.
My family's still in shock.

 

[God]

maestra,

I am SOOOO Sorry and am in shock as I read this last entry.

Your family is in my thoughts and prayers!!!

Sincerely,

CaringHandsMss