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low, smooth, passive range-of-motion stretches of the neck, upper extremities, and upper back were included, along with skin rolling and friction massage at origins and insertions of spastic muscles. Deep strokes and muscle kneading of the thoracic and lumbar areas and left leg were completed for relaxation and reduction of rigidity and pain. The treatment concluded with a face and scalp massage to instill relaxation. Pre- and posttreatment measures for resting tremor, postural tremor, and rigidity were taken during each of the five weekly visits. Nearly every visit demonstrated improvements in the resting tremor and postural tremor. However, rigidity was not improved during the sessions, except slightly during the first visit. Overall, the patient did improve in terms of resting and postural tremors over the five treatments. No comments from the patient were included in the case report, so we do not know if she subjectively thought the treatments were helpful or not. There were also no final comments about her constipation, so we cannot determine if the massage was beneficial for that complaint. CASE REPORT 2 In a similar case series, 10 patients with Parkinson's disease sought massage care in addition to their conventional medication. 2 The patients were 55 to 85 years old (average 70 years) and varied from Stage 2–4 on the Hoehn and Yahr scale, indicating moderate to severe disability. Most subjects had gait disturbance with some also having frozen shoulder. A 30-minute traditional Japanese massage was provided to each subject by the same licensed massage therapist who had 20 years of experience. For each subject, the massage was conducted through the clothes and mostly included kneading to the neck, back, and associated limbs, starting on the less severe side and then moving to the severe side. Each subject received an individualized massage based on his or her areas of complaint. A 20-meter walk test (10-meter walk and return) was administered before and after the massage to the four patients with gait disturbance who were able to walk unassisted. The 20-meter walk times improved for all patients, including one patient whose time was 95.0 seconds before the massage and 21.5 seconds after the massage. Also, one wheelchair-bound patient who only ambulated with the aid of her daughter before the massage was able to walk unassisted 10 meters to her wheelchair after the massage. Changes in shoulder range of motion were also measured before and after massage for the three patients with frozen shoulder, demonstrating improvements from 10 to 25 degrees in flexion and from 5 to 35 degrees in abduction. After the massage, all of the previously frozen shoulders demonstrated nearly full range of motion. Five of the patients also demonstrated hypophonia, defined as difficulty in speaking loudly or clearly. Patients were asked to assess the severity of hypophonia before and after the massage based on a 100-millimeter visual analog scale, with the left end of the spectrum indicating no hypophonia symptoms and the right end indicating the most severe symptoms. The average premassage measure of severity was 53 out of 100 and the postmassage average was 34.2, indicating a statistically significant change in the ability to speak. Other changes in symptoms before and after the massage included individual improvements in the heaviness of lower and upper extremities, lassitude of the whole body, fatigue, shoulder stiffness, and muscle pain. Overall, this case series demonstrated multiple subjects' improvements in walking, speaking, and shoulder movement. Interestingly, the treatment was only a one-time, 30-minute traditional Japanese massage, rather than a weekly 60-minute Swedish massage over five weeks like the previous study. Future large-scale, randomized clinical trials with comparison groups are needed to determine the most effective treatment style and timing for patients with Parkinson's disease, as well as the most likely symptom to be improved in order to confirm the results of these two studies. Notes 1. Y. Casciaro, "Massage Therapy Treatment and Outcomes for a Patient with Parkinson's Disease: A Case Report," International Journal of Therapeutic Massage & Bodywork 9, no. 1 (March 4, 2016): 11–8. 2. N. Donoyama and N. Ohkoshi, "Effects of Traditional Japanese Massage Therapy on Various Symptoms in Patients with Parkinson's Disease: A Case-Series Study," Journal of Alternative and Complementary Medicine 18, no. 3 (March 2012): 294–9s. doi: 10.1089/acm.2011.0148. Jerrilyn Cambron, DC, PhD, MPH, LMT, is an educator at the National University of Health Sciences and president of the Massage Therapy Foundation. Contact her at C h e c k o u t A B M P 's l a t e s t n e w s a n d b l o g p o s t s . Av a i l a b l e a t w w w. a b m p . c o m . 53 SOMATIC RESE ARCH Nearly every visit demonstrated improvements in the resting tremor and postural tremor.

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