Advanced Remedial Massage

1. Advanced Remedial Massage Multiple Sclerosis

2. What is MS? • Chronic, disabling disease • Randomly attacks the central nervous system • Progression, severity and symptoms cannot be predicted • Range of symptoms from tingling and numbness to paralysis and blindness • No cure

3. Who gets MS? • 2 times as many women as men • Onset between 20 and 40 • No evidence that MS is directly inherited • More common among Caucasians, especially those with northern European ancestry

4. Causes MS • Unknown • Body’s immune system attacks it own myelin, this disrupts the nerve transmission • Could be genetic or environmental factors that trigger this disease but no one knows for sure • Symptoms result from the inflammation and breakdown of the myelin, causing scar tissue, called “sclerotic” patches

5. Is MS fatal? • No • MS suffers have normal to near-normal life expectancy

6. Does MS always cause paralysis? • No • Majority of people with MS do not become severely disabled • Studies have shown 50% of people with MS are independently mobile after 15 years

7. Is MS contagious? • No • Neither contagious or directly inherited, genetic studies have shown some individuals more susceptible to the disease

8. Can MS be cured? • Not yet • Medications can help with the symptoms • Medications are now available that have been shown to affect the underlying disease course

9. Why is MS so difficult to diagnose? • Complex process • Symptoms could be from a number of other disorders • No single laboratory test • MRI has aided the diagnosis but is often not conclusive

10. Medications • Betaferon, Copaxone, Rebif and Avonex for relapsing forms of MS • Helped to lessen the frequency and severity of MS attacks • Reduce the accumulation of lesions in the brain

11. Multiple Sclerosis Types • Relapsing Remitting – Most common form with acute episodes followed by partial or complete recovery • Primary-Progressive – After an initial period of relapsing/remitting, disease takes a progressive course with remission • Progressive-Relapsing – Continuous worsening from onset, but unlike primary-progressive includes distinct acute flare ups and remissions.

12. How many people have MS? • 2,500,000 people in the world • 15,000 Australians • (national health Survey 2001)

13. Typical Symptoms • Unpredictable • Extreme tiredness • Impaired vision • Loss balance and muscle coordination • Slurred speech • Tremors • Stiffness • Bladder and bowel problems • Difficulty walking • Short term memory loss • Mood swings • Severe cases • Partial or complete paralysis

14. Consultation questions • When was the diagnosis of MS made? • When were the first symptoms first experienced? • What were your symptoms? • How has the MS progressed? • What are your current symptoms? • What kind of MS do you have? • How long did it last? • Have any of the symptoms remained? • Are you taking any medications? • Is their any pain? • Do you have an diminished sensory perception? • Do you get fatigued from massage? • How long does it take you to recover? • Do you have any reactions to heat? • When was the last attack? • Have you had a massage before?

15. Contraindications • Techniques or modalities that will fatigue the client are contraindicated • DTF’s, vigorous work increase sympathetic nervous system firing • Heat over a large area will affect nerve conduction and exacerbate fatigue • Deep techniques over areas with altered sensation • Any red, inflamed areas over bony prominences notices, inform client (ulcers)

16. Testing • ROM’s Active, passive and resistive • Sensory testing • Specific orthopedic tests for presenting conditions

17. Treatment strategies • Decrease sympathetic nervous system firing • Avoid inducing fatigue • Caring touch in a supportive environment • Positioning may be limited due to spasticity, size of client or wheelchair • Cold can something reduce edema, inflammation and spasticity, it depresses afferent and efferent firing • Heat to trigger points (small areas)

18. Treatment goals • Avoid exacerbating spasiticity • Maintain proper body alignment • Decrease sympathetic nervous system firing • Prevent fatigue • Provide emotional support • Improve and maintain tissue health • Reduce oedema

19. Goals continued • Limit contracture if possible • Address postural changes and muscle imbalances • Decrease pain • Address secondary conditions • Decrease spasticity temporarily • Maintain joint health • Provide emotional support • Encourage whole body integration

20. Self-care goals • Increase functional ability through improving strength, range of motion and balance • Educate about the maintenance of tissue health • Encourage relaxation • Refer client if necessary

21. Rx frequency • 1 hour treatment on a weekly basis beneficial for stress reduction, increased functional ability and greater sense of well being • If client needs painful work distributed the work over several shorter session, ½ hour sessions twice per week

22. References • 2000, Rattray and Ludwig; Clinical Massage Therapy – Understanding, assessing and treating over 70 conditions • http://www.msaustralia.org.au