By Sean Cailteux on June 17, 2010
This article from the August 2002 edition of Massage Today outlines the benefits of Massage Therapy for those living with Cerebral Palsy.
Cerebral palsy (CP) is a term that refers to many possible injuries to the brain during gestational development, birth, and early infancy. It is the result of brain damage, usually to motor areas of the brain, specifically the basal ganglia and/or cerebellum. The damage can be brought about prior to birth (maternal illness), during the birthing process (birth trauma), or may occur during early infancy as a result of head trauma, infection, or vascular problems.
Regardless of the cause of brain damage, the child with cerebral palsy will have some impairment of function. The problem could be so minor that only people who know what to look for may see it, or it may be completely debilitating both physically and mentally; it all depends on what part and how much of the brain has been affected.
The most common form of CP is known as Spastic Cerebral Palsy, and it accounts for 50 to 80% of all CP patients. Spastic CP means that in some areas of the body muscle tone is so high that the tight muscle’s antagonists have completely let go. This is called the “clasp knife” effect. Other types of CP are Athetoid Cerebral Palsy (involves very weak muscles and frequent involuntary writhing movements), Ataxic Cerebral Palsy (involves chronic shaking and tremors, and very poor balance), and Mixed Cerebral Palsy.
Signs and symptoms of CP vary according to the location and extent of brain injury. However, some of the most common features of CP include hypertonicity; hypotonicity; poor coordination and voluntary muscle control; unusually weak muscles; random movements; seizure disorders; early hearing and/or vision problems; and progressive muscle contractures. About half of all CP patients have some level of mental retardation, and many are unable to communicate verbally.
CP is incurable and irreversible; as such, it is managed, rather than treated, by providing skills and equipment to live as fully and functionally as possible.
There is no question that massage therapy can have a valuable role in improving the quality of life of a person with CP. Unlike many CNS disorders, a lot of information about bodywork for CP patients is easily available; I’ll list some wonderful sources at the end of this article. Nonetheless, these clients require some special adjustments in the way bodywork is administered.
The damage for a person who has CP does not begin in the muscle and connective tissues. Although this is where we feel the tightening of the connective tissue wrappings around muscles, the muscle contractions themselves are simply a symptom-a complication of a problem deep in the brain. Therefore, if all we try to do is lengthen the muscles and stretch the fascia, we will run smack into a brick wall: either no progress will happen at all, or symptoms may even be temporarily exacerbated.
Most people with CP get best results if bodywork focuses on indirectly affecting muscle tone through craniosacral work, gentle rocking, slow range of motion exercises, and manipulation of the arms and legs that engages the client in ways he or she doesn’t automatically resist-this often means going with the direction of muscle shortening in order to disengage the reflex. Ultimately, the therapist will have to experiment with lots of different approaches, often accompanied by extremely supportive bolstering, in order to find what techniques allow their clients to relax and enjoy their massage.
The benefits of massage to CP patients are undeniable. Parents write of their satisfaction when their child is able to sleep through the night, when postural distortions unbind, when breathing eases, when faces light up with joy because the massage therapist has arrived for a session. Imagine a child who is the object of vast numbers of painful, intrusive, unpleasant, dehumanizing medical procedures (regardless of the supportive intentions behind them). This child is handled rather than touched. Then his massage therapist arrives and arranges him carefully among pillows and bolsters on the table. She cradles his occiput and straightens his neck so he can breathe more easily. She rocks his arms and legs until their tension eases. She plays with his fingers until he realizes he can move them in lots of directions. Nothing she does hurts. What a gift, what a privilege to be invited into such a relationship! The only caution is that people with very severe CP may not be able to communicate their wants or concerns clearly. If a massage therapist works with a client who cannot speak, other modes of communication, including nonverbal signals, become especially important. It is the responsibility of the massage therapist to make sure that his or her work is welcome and freely accepted at all times.
By Ruth Werner, LMP, NCTMB
Massage TodayAugust, 2002, Vol. 02, Issue 08