‘The use of the hands as a means to convey friendship, to comfort and to heal the sick, to express love and tenderness, to quiet and titillate the child, is as old as life itself-’ (Bernard Gunter)
The information we receive from our senses—touch, sight, smell, taste, hearing—enables us to understand our surroundings. People who have more severe/profound learning disabilities are often unable to respond to sensory information; this may be due to sensory impairment or lack of opportunity.
Touch and communication
‘Touch is a universal language, a way of connecting, exchanging information and communicating’ (Sanderson, Harrison and Price). Touch is central to working with people with learning disabilities, but usually it is in the context of daily routines: ‘Touch may be experienced in many functional ways, for example, being assisted with dressing, bathing, toiletries or moving around. This form of touch may be perceived as being affirming and supportive, but it may also be felt to be rough and manipulative. For people who have severe or profound learning disabilities, touch may be the clearest way they have of understanding the world and receiving information from the people around them.’
Touch and behaviour
‘Touch is a basic behavioural need, in much the same way that breathing is a basic physical need.’(A. Montague) The American neuropsychologist, Prescot states that the absence or withdrawal of physical affection in early life, and even in adult life, may be responsible for many types of disturbed behaviour, such as depression, violence, aggression and negativity. Similar results have been found by Bowlby and Rutter in their studies of maternal deprivation.
People with learning disabilities often display challenging behaviour, including self-stimulatory and rocking behaviours. Other behavioural problems include head-banging, frequent masturbation, physical aggression—all involving tactile stimulation. Could it be that a lack of touch in their lives leads to such behaviour and that their self-abusive behaviour is partly due to insufficient tactile stimulation?
Touch and massage
Massage is an appropriate, valued way of incorporating touch into a person’s life, at home or in the learning environment. Massage has a long and health-promoting history. It is an extension of the natural urge to ‘rub something better’. Professional massage treatment is available in a variety of forms—therapeutic massage, aromatherapy, reflexology, shiatsu, rolfing, biodynamic massage, touch-for-health, and many more. Massage has wide-ranging physiological and psychological benefits, with many of its applications are available to people with learning disabilities.
Massage is a form of non-verbal communication. People with severe learning disabilities often have additional physical and sensory impairments. Among people with an intellectual disability, 48 per cent also have a sensory impairment of at least moderate severity, and of those, 18 percent also have a dual sensory impairment. The sense of touch may open new avenues through which they can make contact with their environment
For people who have severe learning disabilities, communication can be developed through ‘interactive’ massage, which encourages the client to imitate massage movements on the therapist’s hands. It encourages responsiveness, interaction and participation, rather than aiming purely at sensory awareness. Interactive massage involves/supports the client through a series of eight stages:- resistance, toleration, passive cooperation, enjoyment, response, cooperative leading, imitation, initiation. One of the objects of interactive massage is to encouraging bonding and relationship.
Another type of massage suitable for people with learning disabilities is multisensory massage. This involves using different textures, tools, talcs, lotions and fragranced oils—to provide stimulation to the senses. The aims of multisensory massage include increased awareness of tactile experiences, increased tolerance of touch, and the development of a positive body image. Tools which may be used in this type of massage include percussors, gyrators, textured rubber mitts, wooden massage rollers and tennis balls. Different textures include Velvet, spongy cotton wool, silk or soft brushes. Holistic massage can enable people to become more aware and appreciate of their sense of touch and, if essential oils are added, it can improve the sense of smell.
Aromatherapy is the use and application of essential oils to promote health and well-being through massage, inhalation, baths, compresses, creams and lotions. Aromatherapy is a holistic therapy which considers the person in terms of mind, body and spirit, and the strength of aromatheraphy is seen to lie in the interrelation of the essential oils, the massage and the therapist/client relationship. Sanderson and Ruddle outline five reasons to use aromatherapy with persons with learning disabilities:- to invigorate and promote activity and alertness; to facilitate relaxation and reduce stress; to stimulate sensory awareness, to facilitate and encourage interaction and communication, and to treat medical problems using substances. The direct chemical action of some oils can induce feelings of comfort and relaxation, along with the support and reassurance provided by massage.
Massage is well-known for its effects in relaxing the mind and body. People who have a learning disability regularly experience frustration and stress over not being listened to and not having control over their lives. Through massage, relaxation can be promoted in people with learning disabilities. Challenging behaviours are often precipitated by tension and anxiety; and massage can be used to alleviate this tension and reduce challenging behaviours. Massage has been shown to reduce psychomotor seizures, phobias and self-injurious behaviour in persons with learning disabilities. Hegarty and Gale agree that challenging behaviours may be a symptom of emotional stress and psychological isolation. Using stress as a therapeutic medium can reduce stress levels. McPhail and Chomore (cited in Sanderson) have shown the effects of relaxation training on two groups of adults with learning difficulties and verbal, aggressive, movement or other disruptive behaviour. The results showed that ‘relaxation significantly and substantially reduces disruptive behaviour.’
Farrell, McGinsley and Schell (cited in Sanderson) indicate that sensory reinforcement may be the underlying motivation for self-stimulation and self-injurious behaviour. By providing alternative activities (e.g. massage) which stimulate the same senses, unwanted behaviours are abated. Another reason for self-injurious behaviour may be that it stimulates the production of endorphins. Endorphins, the brain’s natural opiates and pain blockers, are triggered by such stimuli as pain, fear, music, meditation, food and exercise. (Eating is generally associated with comfort, and vigorous exercise can lead to the athlete’s ‘high’.) Massage also results in the production of endorphins, and it can be substituted as a more appropriate way of achieving the same effect.
Tiarks, a nurse in Leytonstowe House in London, is a practitioner of ‘metamorphic massage’ with persons with severe learning disabilities and additional physical and speech impairments. The treatment, which involves foot massage, is reported to have increased the communication skills and concentration span of her clients, and reduced some challenging behaviours. Gray also reports working with a young woman with a severe learning disability who displayed disruptive and severe self-injurious behaviour. After twelve months of weekly one-hour sessions, it was reported that she was less tense, more sociable, and that her self-injurious behaviours had reduced.
Massage has far-reaching implications and benefits for people with learning disabilities. Although the methods employed may sometimes differ from conventional massage, they have the same underlying benefits—increased body awareness, tolerance of touch, and relaxation. ‘To permit simple contact is to permit, and necessarily to experience, the natural reinforcement that the living has for the living’ (Thomas).
On a personal note: as a health-care professional working in the field of learning disabilities, I would strongly advocate the benefits of holistic massage for both service users and service providers. As a qualified holistic massage therapist I have come to realise through experience that a client benefits most from a treatment session when the therapist is at his/her most relaxed. I also feel that we can apply the same theory to any of the professions. We work in stressful environments, often with limited resources and large caseloads. Holistic massage and other forms of stress management enable us to work to our best potential, and we should not see them as a luxury but as a vital part of our lifestyle.