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6A WRAPPING UP To conclude the process, there are several options. If using this technique to treat anxiety, it is customary to reverse the process by eliminating strokes until the therapist is performing only Stroke 1, ending with passive touch or energy-related work. It is not necessary to repeat every stroke 10 times. If using it as an introduction to leg work or for a general geriatric or hospice massage session, then once the seventh stroke is achieved, simply move forward into the next modality. Often, I find segueing into a period of stroking distally from the knee to the ankle along the peroneus longus is a satisfying conclusion. The resting position (page 54) is excellent to use prior to disconnecting from the client. FINAL REMARKS Here are a few more important suggestions to consider when using this technique: 1. Use a long-lasting, ultra-smooth cream for this process, preferably one that will endure approximately 20–30 minutes of use without need for reapplication. Lotion is absorbed too quickly. Oil is not recommended for dehydrated, frail, and/or elderly skin. It may be more dangerous, too, if the person is currently ambulatory and neglects to use slippers or stockings postintervention while walking on non-carpeted flooring. Also, oil is more difficult for caregivers to wash off of inflatable mattresses or sheets and it offers too much slide without enough grasp on the skin. 2. Gloves are not recommended. However, they may become necessary if your client has mycotic nails, numerous warts, or healing wounds. Be aware of allergies to latex and the susceptibility that gloves break down and tear after short periods of use with cream. 6B STROKE 6B:The nondominant hand follows as before. Perform Strokes 1–6 at least 10 times. STROKE 6A: During the conclusion of Stroke 5, as the thumb approaches the metatarsalphallangeal joints, Stroke 6 begins. Instead of joining the fingers to engage in Stroke 1, it veers medially, sliding along the proximal aspect of the joints toward the great toe. When it is distal to the great toe, the thumb moves upward on the joints themselves. Here, as the thumb moves laterally toward the fifth toe, it simultaneously describes three circles. After the third circle is formed, the thumb should join the fingers once again to initiate Stroke 1. 3. Hospital beds come in a variety of designs, most of which are ill suited to foot work. It is best to elevate the bed to a height that is comfortable rather than attempting to perform this process seated. If the bed is such that the foot board can be removed, do so, but be aware of the placement of mattress air pumps, charts, and other equipment that may be attached. If the board can't be removed, then perhaps elevating the feet will bring them into a suitable position. Some air mattresses have their own foot piece, which is extremely challenging to overcome and work around; these typically require the process to be abandoned or greatly altered. 4. Attempt to make the surroundings as soothing as possible. Obtain permission from the roommate (if there is one) to lower or turn off the television, inform the staff not to interrupt for the duration of treatment, turn down the lights, draw the privacy curtains, and make your presence tranquil. Initiate aromatherapy if appropriate and allowed in your setting, and with permission from the client. 5. This is best performed with the client lying supine in bed. However, it has been successfully applied with clients seated in recliners, tilt-in- space wheelchairs, Geri chairs, Broda chairs, and while lying on a floor mattress or sofa. With these other options, please provide cushioning, preferably firm foam with a thick towel well secured under the client's feet. 6. Music is quite helpful, for both you and the client. Of course, the selection will be influenced by personal taste and cultural/societal background, but essentially it should be slow, spatially oriented, and without an emphasized beat. connect with your colleagues on massageprofessionals.com 59