Issue link: https://www.massageandbodyworkdigital.com/i/969285
42 m a s s a g e & b o d y w o r k m a y / j u n e 2 0 1 8 ACCOMMODATIONS I have used phrases like "make appropriate accommodations for client needs" for decades, but I have come to the conclusion that this is an inadequate piece of advice, and it might be useful to offer a list of specific accommodations that massage therapists can make as part of session planning for clients who live with health challenges. I have divided these accommodations into four categories: technique, environment, equipment, and special services. I would love for readers to look at this list and identify what I've missed—then let me know, so I can improve the way I communicate about this important topic. 1. Accommodations of Technique This heading refers to any special skills or modalities that might be more suitable than others for a given situation. And within those modalities we can also adjust for: Areas of the body to focus on, to avoid, or to treat with special care. An example would be an area where sensation is impaired. We don't have to avoid it altogether, but it is not appropriate to try to change the quality of the tissues in an area where a person cannot give accurate feedback about pressure or comfort. Another example is the feet of clients with diabetes. Because this disease can cause nerve damage and delay healing, sores here might be both painless and potentially dangerous, and we are in a position to recognize that risk. Pressure. I hope this is self-evident: we adjust our pressure according to the resilience and feedback of our client. This may change dramatically from one session to another, and not always in the same direction. Sometimes clients ask for or expect a depth of pressure that is not necessarily in their best interest. In these situations, we must communicate that we respond to what we feel in their tissues—where they begin to resist is where we must begin to back off. There are some special skills for conducting those difficult conversations, but that is a topic for another time. Frequency and duration of sessions. Most massage therapists work in 50–90-minute sessions. This is a convenient amount of time, and it works well for lots of situations. But in some cases, an hour is too long or too short; or once a week is too often or too seldom. It is completely appropriate to alter the frequency and duration of sessions to accommodate for what will help our clients accomplish their goals with massage therapy. 2. Accommodations of Environment This heading addresses what we can do to make our workspace friendlier for our clients who may have certain limitations or challenges. Temperature. This can refer to the temperature of the room (some medications cause flushing, so a cooler room is a nice option) or to how we use our equipment— which we'll look at in the next section. Remember, stones, packs, and other devices We can say some situations indicate or contraindicate massage, but in reality, I believe it is more accurate to say that massage therapy addresses the person, rather than the disease. can be hot or cold—and our clients may have situations that call for one over the other. That table warmer that is delicious for most clients might be terribly uncomfortable for the client with multiple sclerosis who doesn't tolerate hot temperatures well. Other ambient features: sound, odors, light. Music or ambient sound can have a profound impact on a person's ability to relax in the massage therapy room. Some people are extremely sensitive to odors, and others may derive benefit from skillfully used aromatherapy. Even the levels of light can be an issue: if our clients are photosensitive, then strong lighting can be problematic; if they are vision-impaired, then dark rooms become hazardous. Privacy. It is normal to expect that a massage session is conducted in complete privacy, but that might not suit some clients. Some situations may even be best addressed with work in quasi-public areas, like in a seated massage space where familiar people are close by for a client who lives with a condition that makes it uncomfortable to be separated from others. This might describe a person with posttraumatic stress syndrome or some kinds of anxiety disorders, or someone with Alzheimer's disease or other types of dementia who is easily disoriented. Level of undress. "Undress to your level of comfort" is a direction I've heard from a lot of massage therapists, and this is a good thing. Some people will be happy to "take it all off" and others will want a layer (or more) between you and them in addition to the top sheet. We need to be willing to meet them wherever they fall on that spectrum. This level of comfort may also vary from one appointment to another, and clients have no obligation to be consistent in determining what their comfort level is from one day to the next. Timing. Most clients won't have major health issues related to what time of day they receive massage, but some do. The