Massage Part of a Hospice and Palliative Care Program

Massage part of a hospice and palliative care program

Definition: it involves manual techniques placing pressure on the body for therapeutic purposes. Massage can be applied by hands, fingers, elbows, knees, forearm, feet or a massage device.

Through the ages, massage has been practiced, each culture developing their own techniques.

Who can perform massage?

Human massage therapist. May need to have 500 to 1000 hours under their belt of class and training before applying for a state license.

Veterinary side/license/states/country: be aware of your state laws in case you use a human massage therapist.

Which structures will we have an effect on?

-skin -lymphatic vessels, PLN -vessels -fascia/connective structures -muscles/tendon -nerves: PNS, CNS, ANS -glands -bone -internal organs (direct and somatovisceral effects)

Benefits:

Bond with the doctor and/or staff. This could be the difference between the pet liking you or running away from you. A good method to get acquainted before treatment and/or as an adjunct to your medical plan. Since anxiety and pain are processed in the same place in the brain, increased anxiety in a patient may exacerbate pain perception.

In children with cancers, massage decreased anxiety and pain

Can help improve quality of sleep in cancer patients, post-op patients

In humans, massage may help deal with behavioral and psychological symptoms of dementia. So possibly may help dogs with CDS (cognitive dysfunction syndrome).

Can reduce blood pressure in hypertensive humans.

Massage has some medium effects on affective symptoms and pain in fibromyalgia in humans.

More than just a touch, massage has profound physiological changes. Moderate pressure massage (increase parasympathetic tone) has been shown to: - increased weight gain in preterm infants, - Reduced pain in different syndromes including fibromyalgia and rheumatoid arthritis - Enhanced attentiveness - Reduced depression, anxiety and heart rate (increased vagal activity and decreased cortisol levels), and it altered EEG patterns, as in a relaxation response - Enhanced immune function (increased natural killer cells and natural killer cell activity) - Functional magnetic resonance imaging data have suggested that moderate pressure massage was represented in several brain regions including the amygdala, the hypothalamus and the anterior cingulate cortex. These regions are involved in stress and emotion regulation.

Types of massage:

Acupressure Anma massage: traditional Japanese massage involving vigorous kneading, rubbing, tapping and shaking. Aquatic bodywork Ashiatsu: In ashiatsu, the practitioner uses their feet to deliver treatment. The name comes from the Japanese, ashi for foot and atsu for pressure Balinese massage: Balinese massage techniques are gentle and aim to make the patient feel relaxed and calm throughout. The techniques include skin folding, kneading, stroking,and other techniques. Bowen technique: rolling movement over fascia, muscles, ligaments, tendons and joints. It is said not to involve deep or prolonged contact with muscle tissues as in most kinds of massage, but claims to relieve muscle tensions and strains and to restore normal lymphatic flow. Breema: performed on the floor with the recipient fully clothed. It consists of rhythmical and gentle leans and stretches. Biodynamic Massage Champissage massage: massage technique focusing on the head, neck and face that is believed to balance the chakras. Craniosacral therapy: approach that releases tensions deep in the body by applying light touch to the skull, face, spine, and pelvis. Esalen massage: Foot massage Hilot massage: traditional healing technique from the Philippines that uses massage Infant massage Kum Nye: wide variety of Tibetan religious and medical body practices. Lomilomi and indigenous massage of Oceania: traditional massage of Hawaii Lymphatic drainage: Manual lymphatic drainage is a technique used to gently work and stimulate the lymphatic system, to assist in reduction of localized swelling Medical massage Metamorphic Technique Myofascial release Pediatric massage Postural Integration Prostate massage Reflexology: based on the principle that there are reflexes in the hands and feet that relate to every organ, gland, and system of the body. Shiatsu: Sports massage Stone massage Structural Integration: Rolfing, Hellerwork, Guild for Structural Integration, Aston Patterning, Soma, and Kinesis Myofascial Integration. Tantric massage Thai massage: usually a combination of Indian and Chinese traditions of medicine. Traditional Chinese massage Traditional Chinese massage, Tui Na Trager approach Trigger point therapy. Watsu

Lastly the Swedish massage: the most widely recognized and commonly used category of massage is the Swedish massage. The Swedish massage techniques vary from light to vigorous. Swedish massage uses five basic strokes: effleurage (sliding or gliding), petrissage (kneading), tapotement (rhythmic tapping), friction (cross or with the fiber) and vibration/shaking.

Today we will go over the effleurage stroke. Effects will be: heating up tissue, loosening of the soft tissue and relaxation. Effleurage is a gentle touch, using the palm of one or 2 hands, even alternating. Mold your hands against the body part and do a sliding or gliding movement. This is a way your hands are introducing yourself to your patient and their body. This stroke is used at the beginning of a session, or a treatment. And usually used in between massaging parts and at the end to say good bye.

It’s a great moment to do an overall assessment of painful regions.

Keep your hand on the patient at all time so they do not wonder where you are, and maintain a smooth consistent rhythm.

Hand pressure: Very important, dog usually require less pressure than humans Light: 0.5 grams to 5 pounds Mild: 5-10 pounds Deep: 10-15 pounds

Preparation Quiet area so conductive for relaxation, no distractions Surfaces: depending of pet preferences hard floor, dog/cat bed, yoga mat Owner presence, other family members, or other pets if needed to get the pet relaxed Use known olfactory relaxant like lavender Adequate temperature for the pet: cold, AC, fan, water bed, or the opposite Music Beware of your own body mechanic, quiet mind

Contraindications/caution -deep massage could injure internal organs -coagulation disorder, anticoagulant therapy: lighten pressure, no deep tissue massage -cancer: no massage over the region -bone cancer: fracture so avoid region(s) -radiation dermatitis/open wound: massage could spread infection, cause pain so avoid these regions. -MRSA/MRSI: wash your hands afterward -immunosuppression: wash hands before -allergies, mast cell tumors: mast cell degranulation -surgical lymphatic vessels removal -peripheral nerve entrapment -disk herniation, spinal instability (wobbler), CNS inflammation/infection -heart disease: potential of moving large amount of fluid back in circulation, can the pet handle that amount (apply less pressure). If parasympathetic system stimulated, can the heart handle the change -medications: .strong analgesic decreases feedback by your patient about your hand pressure/technic .steroids use: muscle atrophy, skin more fragile, decreased immune system

Pet insurance: covered by most pet insurance company. Inquire before treating You can refer to the following document to know actual coverage: http://rehabvets.org/_docs/AARV_Pet_Insurance_Summary_2014-06-13.pdf

Classes: -Medical massage, 2 day class for veterinary medical team http://www.onehealthsim.org/medical-massage-for-animals/ -Physical canine rehabilitation: Canine Rehabilitation institute: http://www.caninerehabinstitute.com/ University of Tennessee Certificate Program in Canine Physical Rehabilitation: http://ccrp.utvetce.com/

Book: https://www.aaha.org/professional/store/product_detail.aspx?code=CNMDM&title=canine_medical_massage_techniq ues_and_clinical_applications#gsc.tab=0

Goals of this lab: show effleurage stroke of the Swedish massage technique to relax the practitioner patient, learn the effects and contraindications/caution to massage, make the practitioner be aware of the power of their hands, develop a gentle touch.

References

Azermai, Majda, Dealing with behavioral and psychological symptoms of dementia: a general overview, Psychology Research and Behavior Management, 2015:8 181–185

Corbin, LM, Safety and Efficacy of Massage Therapy for Patients With Cancer, Cancer Control, July 2005, Vol. 12, No.3

Field Tiffany, Massage therapy research review, Complementary Therapies in Clinical Practice 20 (2014) 224-229

1 Kashani F , Kashani P, The effect of massage therapy on the quality of sleep in breast cancer patients, Iran J Nurs Midwifery Res. 2014 Mar;19(2):113-8.

1 Liao IC , Chen SL, Wang MY, Tsai PS, Effects of Massage on Blood Pressure in Patients With Hypertension and Prehypertension: A Meta-analysis of Randomized Controlled Trials. J Cardiovasc Nurs. 2014 Nov 21

Medical Massage for Animals, Fort Collins, CO; Oct 16-19, 2011

1 Perrot S , Russell IJ. More ubiquitous effects from non-pharmacologic than from pharmacologic treatments for fibromyalgia syndrome: a meta-analysis examining six core symptoms, Eur J Pain. 2014 Sep;18(8):1067-80

Susan Thrane, RN, MSN, OCN, Effectiveness of Integrative Modalities for Pain and Anxiety in Children and Adolescents with Cancer: A Systematic Review, J Pediatr Oncol Nurs. 2013 Nov-Dec; 30(6): 320–332. Wells, DL, Aromatherapy for travel-induced excitement in dogs. Jam Vet Med Assoc, 2006:229: 964-967

Wikipedia, the free encyclopedia online, “Massage”