Issue link: https://www.massageandbodyworkdigital.com/i/68165
actively maintains 20°–40° immediately following a treatment. Her left elbow passively opens to 100°. Passively increasing 40° in left elbow extension seemed impossible five years ago. When Carol sees me at her home, she giggles and begins to give me a high five. BEHAVIOR Improving ROM is a small percentage of work done with developmentally disabled clients. Many in this population exhibit behavior problems. The most severe is self-injurious behavior (SIB). The activity is performed without thought, like nail biting. The problem can be attributed to neurological development and may be triggered by physical or emotional pain. It can manifest as scratching, picking, gouging, hair pulling, biting, or head banging. To curb this behavior, many occupational therapists suggest a sensory diet or some form of sensory integration, (see Sensory Diet, right) As massage therapists, we offer an abundance of sensory input for our clients that can contribute to altering behavior patterns. Tom's behaviors consisted of yelling, jumping, pulling, pushing, and throwing himself. After noting that weighted lap blankets caused agitation and continuous verbal noise, his occupational therapist suggested massage therapy. Treatments started at twice monthly sessions of 15 minutes. After one year, our sessions were increased to 30 minutes. Tom liked his head, neck, and shoulders held with compressions. Encompassing arms and hands was tolerated. Yet, many sessions consisted of hand-holding, while rocking on a porch swing. Tom's behavior dictated how each session progressed. One day, while Tom sat aggressively rocking, his care review was taking place nearby. I announced my presence and purpose (Tom is also blind). One of the participants in Tom's care discussion turned to me and said, "Good luck with that [referring to massage]. He has touch issues. Especially his hands." Five minutes later, Tom slowed his rocking and calmly sat while I worked his neck and shoulders. The same person turned in amazement: "What a difference—and without medication." When Beth started receiving massage treatments, she banged her head against the walls and floor. At the time, Beth's doses of Risperdal were changing to curb her injurious behaviors. She also obtained a helmet to protect herself. In two months, her medication was stabilized. Our treatment sessions gradually became longer intervals of mostly back compressions and rocking. After three years, a major breakthrough occurred. Beth saw me enter the facility and got out of her rocking chair and into her wheelchair. She rolled past me and then looked back to see that I was behind her. She stopped her chair at her bedside and crawled on top. She waited for me to sit next to her. That day, our session lasted 40 minutes. During the treatment, Beth smiled and raised her arms to express celebration. She sat close to me and at one point put her head in my lap. "Wow, progress," concluded my notes. Beth and I have worked together five and a half years. She accepts shoulder and joint compressions well, and she enjoys the encompassing of her limbs. Some sessions are more successful than others. A continuous, 30-minute treatment is usually possible. Beth's nurse reported the positive effects from massage: "Beth is very calm after a massage. She will sit quietly and rock gently. Beth has a history of self- injurious and self-stimulating behaviors. These behaviors decrease after a massage and the effect usually lasts for several hours." Today, Beth rarely Sensory Diet A sensory diet is a personalized activity schedule providing nervous system input to assist in staying focused. The input has several components: • Proprioception is body awareness. It is an awareness of how the body is positioned in relationship to the rest of itself. Receptors in muscles, joints, and connective tissue allow the body to coordinate movements. • Vestibular is a sense of movement and balance that is processed by the inner ear. • Tactile is the sense of touch, including texture, temperature, and pressure. • Auditory is neuroanatomically connected with vestibular sense, including hearing and listening. • Visual activities involve making eye contact, processing what is seen, and interpreting it. • Smell is a powerful sense. Certain odors can calm, stimulate, or cause overload. connect with your colleagues on massageprofessionals.com 57