Stroke case study
May 07, 2013
Guest blog: Written by massage therapist Elle Rossi, who is a valued friend of the National Stroke Foundation and regular donor supporter. Thank you Elle for your ongoing support.
In this essay I would like to share with you my experience and feelings as a massage therapist in treating and helping a client who had suffered from a cerebrovascular accident (CVA) by using a number of tools or techniques that may be incorporated under the general heading of Remedial Massage. It is written in a simple narrative style describing my client’s (I will call her Jane in this text) journey to recovery over an 18 month period.
In July 2004 Jane presented to my clinic seeking in her words “therapy” for her shoulder and arm. She had suffered a CVA or stroke 2 years previously on the left side of her brain leaving her with a complete paralysis of the right arm and partial paralysis of the right leg. She felt that she had had a further “mini stroke” the previous weekend as her speech had become slurred for a few days and mobility further impaired.
Jane had previously had extensive physiotherapy in a rehabilitation hospital and regained the ability to walk with the aid of a tripod walking stick but her right arm remained useless. On examination I found :
• The right arm was cold and blueish in color and hung limply with no feeling or movement from her elbow down.
• There was oedema (swelling) of the whole arm.
• The fingers of the right hand were curled and a splint was needed to keep them straight.
• There was subluxation of the Glenohumeral joint, probably due to the constant weight of the arm hanging and over stretching the ligaments. Jane informed me she had been given a referral to an orthopedic surgeon by her GP to correct this surgically.
• In the meantime, although wearing a supportive brace, she was experiencing a great deal of pain in the shoulder and was unable to sleep at night because of this.
I had learned during my nurse training in the 70’s that the optimal window for rehabilitation post CVA was only 6 months in duration after which the chances of regaining useful movement in an affected limb were very limited therefore I felt strong doubts that I would be able to improve Jane’s condition 2 years on. I discussed expected outcomes with her under the circumstances and suggested a physiotherapist may be able to help her more but she preferred to give massage a try.
At the time, not having caught up with the research into neuroplasticity and the power of the brain to heal and transform itself, I privately felt at a loss as to where to begin with a treatment plan so simply started with a gentle massage to the shoulder and arm to improve the circulation and some gentle passive arm movements within her pain limitations.
We scheduled for 2 sessions a week gradually extending the massage to include the whole body releasing tight muscles on the left side that were working harder to support the right and passively moving the joints of the right shoulder, arm and hand through their range of movement i.e. abduction, adduction, flexion,extension,pronation and supination etc. While doing this I intuitively asked Jane to link the exercises to an act of daily living in a form of creative visualization. For example when I flexed her arm forward and up Jane imagined pegging out the washing or reaching for a cup in an overhead cupboard. Each movement was accompanied by a thought or mental picture of doing something useful and specific. In a seated position facing me I held Jane’s hand and asked her to imaging pushing me away or pulling me forward while I moved the arm for her.
By October after 3 months of treatment Jane’s pain levels had lowered considerably and she was sleeping well at night. Her arm felt warm and looked a normal colour again. The oedema had gone and the first sign of improved movement was noted as she could actually pull her arm back from me. The orthopedic surgeon decided to wait before operating and advised continuing the exercises and gave her a cortisone injection into the shoulder to help. Happily surgery was cancelled altogether some months later.
We added proprioceptive neuromuscular facilitation (PNF) exercises to strengthen each new little movement that slowly came back to her fingers, hand, elbow and shoulder joints and continued with full body massages and more specific remedial massage to the arm and hand. By March 2005, 8 months into treatment Jane was able to straighten her fingers, flex her wrist and elbow and grip weakly with her hand.
During this time Jane had other health issues to deal with and experienced angina like chest pain and gastric pain for which she received medical investigations and treatment. In order to support this some of her sessions with me were dedicated to Healing Touch techniques mainly aimed at opening and balancing the chakras. In addressing and correcting the energetic blueprint aspect of her body we aimed to subsequently influence and improve the physical recovery.
In September 2005 Jane was able to lift her arm unaided to her mouth, opposite shoulder and place it behind her back. She could also carry her purse in her right hand for the first time but still needed work to improve the dexterity of her fingers. We also worked on improving strength by filling a water bottle and using it in some weight training for the arm.
Around November/December 2005 Jane went through a plateau in the healing process and felt “flat and despondent” .Unfortunately in January of 2006 her husband sadly passed away adding an additional emotional trauma to overcome. Although going through bereavement Jane continued treatment and I worked using craniosacral techniques to her head and sacrum in order to give her central nervous system the best possible environment in which to function and heal. She reported an improvement in mood and greater ability to use her hand before ending her treatment.
Shortly after Jane moved away from the area but her family tell me she is still well, using her hand to play cards and lift a glass of good wine!.
In 2007 a book by Norman Doidge, MD was published called The Brain That Changes Itself. The chapter on page 132 specifically addresses the topic of CVA or strokes and although treatment has come a long way in the past years the rehabilitation aspect in standard hospital care world wide still leaves a lot to be desired. Victims are discharged before recovery is complete and full potential is rarely realised.
In reading this book I was able to understand why the techniques used in Jane’s treatment were effective and feel saddened that many people are not able to avail themselves to appropriate follow up treatment within the health care system.
Since then I had the privilege to meet another younger stroke victim in my clinic who had been discharged from hospital still unable to walk. He told me he had hired a therapist and instructed him to ” get me out of this wheelchair! “. At the time of our meeting he had sufficiently recovered enough to walk and tandem cycle around Australia with his wife in order to raise awareness on this subject!.
My hope is that in reading this article other massage therapists will feel more confident in helping those who have suffered a CVA and perhaps sooner rather than later it will become part of standard care in a rehabilitation program available under Medicare.
Elle Rossi
www.pembertonmassage.com.au
Disclaimer: You must not rely on the information on this blog as an alternative to medical advice from your doctor. If you have any specific questions about any medical matter you should consult your doctor
In this essay I would like to share with you my experience and feelings as a massage therapist in treating and helping a client who had suffered from a cerebrovascular accident (CVA) by using a number of tools or techniques that may be incorporated under the general heading of Remedial Massage. It is written in a simple narrative style describing my client’s (I will call her Jane in this text) journey to recovery over an 18 month period.
In July 2004 Jane presented to my clinic seeking in her words “therapy” for her shoulder and arm. She had suffered a CVA or stroke 2 years previously on the left side of her brain leaving her with a complete paralysis of the right arm and partial paralysis of the right leg. She felt that she had had a further “mini stroke” the previous weekend as her speech had become slurred for a few days and mobility further impaired.
Jane had previously had extensive physiotherapy in a rehabilitation hospital and regained the ability to walk with the aid of a tripod walking stick but her right arm remained useless. On examination I found :
• The right arm was cold and blueish in color and hung limply with no feeling or movement from her elbow down.
• There was oedema (swelling) of the whole arm.
• The fingers of the right hand were curled and a splint was needed to keep them straight.
• There was subluxation of the Glenohumeral joint, probably due to the constant weight of the arm hanging and over stretching the ligaments. Jane informed me she had been given a referral to an orthopedic surgeon by her GP to correct this surgically.
• In the meantime, although wearing a supportive brace, she was experiencing a great deal of pain in the shoulder and was unable to sleep at night because of this.
I had learned during my nurse training in the 70’s that the optimal window for rehabilitation post CVA was only 6 months in duration after which the chances of regaining useful movement in an affected limb were very limited therefore I felt strong doubts that I would be able to improve Jane’s condition 2 years on. I discussed expected outcomes with her under the circumstances and suggested a physiotherapist may be able to help her more but she preferred to give massage a try.
At the time, not having caught up with the research into neuroplasticity and the power of the brain to heal and transform itself, I privately felt at a loss as to where to begin with a treatment plan so simply started with a gentle massage to the shoulder and arm to improve the circulation and some gentle passive arm movements within her pain limitations.
We scheduled for 2 sessions a week gradually extending the massage to include the whole body releasing tight muscles on the left side that were working harder to support the right and passively moving the joints of the right shoulder, arm and hand through their range of movement i.e. abduction, adduction, flexion,extension,pronation and supination etc. While doing this I intuitively asked Jane to link the exercises to an act of daily living in a form of creative visualization. For example when I flexed her arm forward and up Jane imagined pegging out the washing or reaching for a cup in an overhead cupboard. Each movement was accompanied by a thought or mental picture of doing something useful and specific. In a seated position facing me I held Jane’s hand and asked her to imaging pushing me away or pulling me forward while I moved the arm for her.
By October after 3 months of treatment Jane’s pain levels had lowered considerably and she was sleeping well at night. Her arm felt warm and looked a normal colour again. The oedema had gone and the first sign of improved movement was noted as she could actually pull her arm back from me. The orthopedic surgeon decided to wait before operating and advised continuing the exercises and gave her a cortisone injection into the shoulder to help. Happily surgery was cancelled altogether some months later.
We added proprioceptive neuromuscular facilitation (PNF) exercises to strengthen each new little movement that slowly came back to her fingers, hand, elbow and shoulder joints and continued with full body massages and more specific remedial massage to the arm and hand. By March 2005, 8 months into treatment Jane was able to straighten her fingers, flex her wrist and elbow and grip weakly with her hand.
During this time Jane had other health issues to deal with and experienced angina like chest pain and gastric pain for which she received medical investigations and treatment. In order to support this some of her sessions with me were dedicated to Healing Touch techniques mainly aimed at opening and balancing the chakras. In addressing and correcting the energetic blueprint aspect of her body we aimed to subsequently influence and improve the physical recovery.
In September 2005 Jane was able to lift her arm unaided to her mouth, opposite shoulder and place it behind her back. She could also carry her purse in her right hand for the first time but still needed work to improve the dexterity of her fingers. We also worked on improving strength by filling a water bottle and using it in some weight training for the arm.
Around November/December 2005 Jane went through a plateau in the healing process and felt “flat and despondent” .Unfortunately in January of 2006 her husband sadly passed away adding an additional emotional trauma to overcome. Although going through bereavement Jane continued treatment and I worked using craniosacral techniques to her head and sacrum in order to give her central nervous system the best possible environment in which to function and heal. She reported an improvement in mood and greater ability to use her hand before ending her treatment.
Shortly after Jane moved away from the area but her family tell me she is still well, using her hand to play cards and lift a glass of good wine!.
In 2007 a book by Norman Doidge, MD was published called The Brain That Changes Itself. The chapter on page 132 specifically addresses the topic of CVA or strokes and although treatment has come a long way in the past years the rehabilitation aspect in standard hospital care world wide still leaves a lot to be desired. Victims are discharged before recovery is complete and full potential is rarely realised.
In reading this book I was able to understand why the techniques used in Jane’s treatment were effective and feel saddened that many people are not able to avail themselves to appropriate follow up treatment within the health care system.
Since then I had the privilege to meet another younger stroke victim in my clinic who had been discharged from hospital still unable to walk. He told me he had hired a therapist and instructed him to ” get me out of this wheelchair! “. At the time of our meeting he had sufficiently recovered enough to walk and tandem cycle around Australia with his wife in order to raise awareness on this subject!.
My hope is that in reading this article other massage therapists will feel more confident in helping those who have suffered a CVA and perhaps sooner rather than later it will become part of standard care in a rehabilitation program available under Medicare.
Elle Rossi
www.pembertonmassage.com.au
Disclaimer: You must not rely on the information on this blog as an alternative to medical advice from your doctor. If you have any specific questions about any medical matter you should consult your doctor