Massage Therapy Issues and Guidelines

Question 1

How can relaxation techniques help patients with spasticity during massage therapy?

Answer 1

Relaxation can reduce overall reactivity, while stress, agitation, and physical activity can increase reactivity.

Question 2

What should be emphasized at the beginning of a massage treatment for spasticity?

Answer 2

Emphasize relaxation techniques at the start and incorporate them throughout the session.

Question 3

How should the massage therapy environment be maintained for patients with spasticity?

Answer 3

Keep the environment peaceful, consistent, and predictable. Inform the patient and avoid unexpected actions.

Question 4

What qualities should hands-on techniques have when treating patients with spasticity?

Answer 4

Techniques should be consistent, smooth, and comfortably firm. Avoid anything ‘pokey’ or with a stop-start quality.

Question 5

What types of massage techniques should be avoided for spasticity patients?

Answer 5

Avoid targeted reflex techniques like vibrations and tapotement.

Question 6

When might nociceptive-stimulating techniques be used in spasticity treatment?

Answer 6

Only with strong indication and within the patient’s tolerance of the resulting responses.

Question 7

What is usually the neutral position for spastic joints?

Answer 7

Flexion is typically the neutral position for spastic joints.

Question 8

How should spastic joints be positioned during massage treatment?

Answer 8

Position the limb in the most neutral position possible, with extra pillowing if needed to maintain comfortable flexion.

Question 9

Why is sidelying often preferred for treating patients with spasticity?

Answer 9

Sidelying helps maintain a neutral, comfortable position for spastic joints during treatment.

Question 10

How should flexors and extensors be managed during massage for spasticity?

Answer 10

Keep flexors shortened while moving the limb, and move extensors into extension as much as possible within the flexion-dominant range.

Question 11

How long should you wait before manipulating muscle tissue to calm muscle spindles?

Answer 11

Wait at least 30 seconds before beginning tissue manipulation.

Question 12

How can GTO responses be used effectively despite being weakened?

Answer 12

Isolate the stretch to the tendon, avoiding muscle stretch during the technique, and target the mid-tendon or aponeurotic attachment precisely.

Question 13

What temperature range is generally best tolerated for hydrotherapy in spasticity treatment?

Answer 13

Warm temperatures are usually well tolerated, while cool may help soothe pain or inflammation in some cases.

Question 14

Why is it important to ensure a warm treatment space for spasticity patients?

Answer 14

A warm space helps reduce hyperreflexia and keeps the patient comfortable, with extra blankets if needed.

Question 15

What are the steps for performing ROM work on spastic joints?

Answer 15

1. Start with comfortable flexion and hold for 30 seconds.
2. Slowly extend to resistance or early spastic reaction.
3. Reduce by 10 degrees, hold for up to 30 seconds.
4. If resistance lessens, stretch more.
5. If the reaction is intense or spreads, return to neutral and rest.

Question 16

What should you avoid when performing ROM work on spastic joints?

Answer 16

Do not massage and stretch at the same time.

Question 17

How can joint mobilization benefit spastic joints?

Answer 17

Joint mobilization stimulates joint cartilage succussive action, loosens and maintains joint capsules and ligaments, and can avoid triggering hyper-reflexive responses.

Question 18

What should be done before stretching spastic tissues?

Answer 18

Warm up the tissues as much as possible, but adjust based on the patient’s tolerance.

Question 19

When is it best to perform massage therapy for patients with spasticity?

Answer 19

When the patient has an optimal amount of anti-spastic medication in their system.

Question 20

What preference might some patients have regarding stretching in treatment?

Answer 20

Some prefer stretching interspersed throughout treatment rather than at the end, especially if end-of-session stretching leaves them unrelaxed.

Question 21

What spasticity-reducing technologies might be used before massage treatment in institutional or rehab settings?

Answer 21

Equipment that supports standing or rolling prone over a large ball can help reduce spasticity before massage treatment.

Question 22

What is the ideal preparation for a massage treatment in institutional settings?

Answer 22

Have the patient in the treatment position, with clothing adjusted as needed, and allow them time to rest quietly beforehand.

Question 23

How does ischemia contribute to increased spasticity?

Answer 23

Poor circulation from increased tone and decreased mobility causes irritability in poorly perfused and/or drained muscles, worsening spasticity.

Question 24

How do altered biomechanics and degenerative joint changes affect spasticity?

Answer 24

Abnormal range, mechanics, and degenerative changes increase reflex reactivity, even if not perceived as painful.

Question 25

What impact do compensatory postures and movements have on spasticity?

Answer 25

They overstress muscles and exacerbate spastic reactions.

Question 26

How does contracture contribute to increased spasticity?

Answer 26

It compromises tissue circulation, joint health, and reduces tolerable movement, increasing spastic reactions.

Question 27

How can poor tissue healing affect spasticity?

Answer 27

Inflexible or matted scarring and poor tissue health add to irritability and spastic reactions.

Question 28

How can resistance exercise benefit patients with spasticity?

Answer 28

It helps maintain muscle strength and function while also reducing tone levels in spastic muscles.

Question 29

Why is cardiovascular (CV) status important to monitor in patients with spasticity?

Answer 29

Spasticity, especially full-body spasticity, can stress the heart, requiring regular CV status checks.

Question 30

What should be avoided with medically induced functional contractures?

Answer 30

These contractures should not be removed.

Question 31

Why is skin care essential for patients with spasticity?

Answer 31

Poor voluntary movement can lead to skin care issues; watch for signs of breakdown and ensure good skin health.

Question 32

What precautions should be taken for skin care during massage?

Answer 32

Avoid massaging early-stage decubitus ulcers, prevent bunched sheets or repeated rubbing on bony prominences, and follow any temperature or lubrication restrictions.

Question 33

Where can additional skin care guidelines be found for spasticity patients?

Answer 33

Refer to Spinal Cord Injury notes for further skin care guidelines.