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UPDATED June 2015
Every 40 seconds someone in the U.S. has a stroke. It is the fifth leading cause of death behind heart disease and cancer and the number one cause of adult disability. Eighty percent of strokes are preventable, according to the American Stroke Association.
Depending on the severity, recovery can be long and difficult. A major stroke can result in a person being unable to walk or speak; a mild stroke makes recovery easier and resulting disabilities are barely noticeable. Quick intervention, within 48 hours, is most effective in reducing the negative impact of damage to the brain. Unless you work in a hospital setting this is difficult but, as doctors become aware of how massage helps, this may change.
The causes of stroke, or cerebrovascular accident (CVA), include:
- Cerebral thrombosis, which is caused by a clot lodged in a cerebral artery and accounts for about 88% of strokes.
- An embolism, similar to cerebral thrombosis, differs in origin. Inefficient pumping of the heart allows blood to thicken, forming clots in the left atrium, which then enter the bloodstream and, ultimately, the brain.
- Cerebral and subarachnoid hemorrhages are caused by ruptured blood vessels as a result of uncontrolled chronic hypertension, head trauma or malformed blood vessels, which produce tissue death in the brain.
The extent of damage depends on the part of the brain affected, how much of it and for how long. Motor damage can be seen in either partial or full paralysis on one side of the body (hemiplegia), a loss of language (aphasia), personality changes and/or loss of memory.
Massage therapists offer a first line of defense in helping to recognize the symptoms of stroke and later, during recovery, to reduce its effects.
If a client appears to have a sudden onset of numbness in one arm, speech is slurred or difficult to understand, if they cannot repeat a simple phrase, or their face appears to droop on one side, it is time to call 911.
Prompt intervention is the best treatment, including administration of anticoagulants for blood clot reduction, except in strokes caused by a hemorrhage. Massage would typically not be introduced into the recovery regimen for several weeks or months and requires approval from the attending physician.
Massage Reduces Anxiety and Pain
In a 2004 study, Hong Kong Polytechnic University, Department of Nursing and Wong Chuk Hang Hospital in Hung Hom, Lowloon, Hong Kong, found that slow-stroke massage on elderly stroke patients treated for anxiety and shoulder pain resulted in significantly lower pain, anxiety, blood pressure and heart rate. The subjects had an average age of 73 and received no other pain relief measures. They received ten minutes of slow-stroke massage prior to bedtime for seven days and an evaluation before receiving massage on the first day, again on the last day of the study, and three days after the sessions ended.
The authors, Esther Mok and Chin Pang Woo, wrote “the results of this study support the view that [slow-stroke back massage], as an alternative adjunct to pharmacological treatment, is a clinically effective nursing intervention for reducing anxiety and shoulder pain in elderly stroke patients.”
As the study indicates, slow-stroke massage reduces two of what may be the most important factors in stroke recovery – pain and anxiety. Deep or vigorous strokes are counterproductive and may cause more harm than good. Slow, soothing techniques and gentle stretching help with flexibility and proprioception.
3 Complementary Therapies for Stroke Rehabilitation
In addition to slow-stroke massage techniques, a client’s recovery may also be helped by the use of familiar complementary therapies such as reflexology, aromatherapy or shiatsu.
- Reflexology might be used if Swedish massage is inappropriate. It gently helps the body recover from a stroke. Clients are helped without using techniques that increase blood flow, and contraindicated in someone with blood vessel weaknesses.
- Aromatherapy is also helpful. Using an essential oil such as lavender helps relieve stress, while oils of rosemary and lemon may help circulation.
- Another option is shiatsu. In Chinese medicine, chronic weakness of Qi blocks the blood flow to the brain, causing strokes. Shiatsu helps restore this flow, offering a session that is both rehabilitative and relaxing. Using points known as Four Gates (LI4 and LV3) relaxes tension in the head, reduces pain and calms the mind. GB20 improves circulation to the head, thus bringing much needed oxygen to the brain.
Documentation through accurate and thorough SOAP notes is an important factor in the treatment of stroke victims. You will most likely be working in conjunction with other health care professionals, and sharing the outcomes of your sessions provide important evidence of a client’s progress. While initial intake is important in determining the type of massage treatment, ongoing notes will record the client’s improvement, help to update the primary care physician and demonstrate how massage can be an effective and valuable tool in the rehabilitation of stroke survivors.
While there may be no definitive studies proving the efficacy of massage in preventing or reducing strokes, it has been shown to positively affect predictors such as improving circulation and lowering stress and blood pressure. The effects of stroke continue to be one of the most debilitating disability issues. Massage therapists may help prevent stroke in those who are most vulnerable, and help victims recover with dignity.
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