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A Touch of Equality – contributions in full To help gather information for the ‘A Touch of Equality’ article featured in the January 2011 issue of International Therapist, a number of FHT members submitted details about their work with clients who have long-term mobility problems or a physical disability. Each submission provides a wonderful insight into the work these members are carrying out, and as we couldn’t feature them all in International Therapist, we are pleased to make these available online.

Treating disabled and seriously ill clients

By Ysobel Albone, MFHT

I have been a massage therapist with my own business, A Touch of Relaxation, since November 2009, offering Swedish massage, Indian head massage, Hopi ear candling and the Dorn method. My first opportunity to treat a very sick and disabled young man came early in my career, just one month after I had started my business. I had produced a brochure and taken some copies down to our local health centre to see if I could display them. Unfortunately I was not allowed to, but the receptionist said she would put them in the staffroom for her colleagues to have a look at.

A couple of days later I got a call from one of the district nurses, asking if I would be ‘willing’ to treat a young man with motor neurone disease (MND) at his home. I went to meet the young man and his wife to make sure that I was capable of treating him. He was 39 years old with a wife and two young children. I was shocked by his condition, as I had never met anyone who was so ill before, other than close family. He was paralysed from the neck down with very little movement in his neck, but was mentally alert with a wicked sense of humour. I completed a medical questionnaire with him and asked what he would like from my treatment. He said that he just wanted some pain relief for his body. I arranged an appointment with him for the following week and went home, researched his condition and spoke to my tutor who had trained me, to ask her advice about treating him. I even bought a special massage chair so that, if he was well enough, we could get him out of his chair (which he was in, 24/7) so that I could massage his back.

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I went to my first appointment feeling very nervous and treated him in his own chair, massaging his neck, shoulders, arms, hands, legs, and feet, and finally finished with a head massage. It was very hard work as his muscles were solid and his limbs were very heavy, but we managed. He asked me if I would visit him on a regular basis, twice a week. I was delighted to accept and I loved going, as I quickly realised that I was not only making a difference to him and the way he felt but also to his wife, who was his sole carer. She knew that during the two hours I spent with him, she could relax and have some time to herself. I wanted to do more for him and decided to try my hand at reiki, to see if that would give him more relief. Unfortunately by the time I managed to find a good reiki teacher, he had died. I treasure every moment I spent with him and his family, as I know my treatments made a difference. I have recently been asked to treat seven patients at a local care home for patients with neurological problems. The clients I treat have MND, multiple sclerosis (MS), hydrocephalus, Huntington’s disease, a birth defect and a spinal injury. They all receive a one-hour massage, concentrating on their neck, shoulders, arms, hands, legs, feet, head and tummy, as they are all bedridden. I had one young male client with MND who had been bedridden and on a respirator for nearly three years. I had difficulty massaging his back as he was difficult to turn and staff at the home were very busy, so I massaged the areas I could access. Again, he was mentally alert and wanted me to massage him every day, which I thought was lovely of him to ask. Unfortunately he developed a chest infection, which claimed his life. I have two MS clients, one a young woman who is completely paralysed and can’t speak very much. She is lovely and generally dozes off while I massage her. My other MS patient is a 70-year old gentleman whose legs are paralysed, and his arms and hands don’t work very well. However, he is ‘all about’ mentally and enjoys our time together as it gives him relief, and he loves having me ‘all to himself for an hour’. We talk, laugh and guess the year of the songs on the music channel! Great fun. My spinal injury client is a young man whose neck was broken in a car accident. He is paralysed from the neck down, with no feeling in his body below his shoulders. As well as massage, I also do Hopi ear candling on this young man, which he loves. I am very privileged to do this as he is very particular about who touches his ears! My young man with hydrocephalus is wonderful. He can’t see properly, can’t speak and is paralysed with deformed legs, hands and feet. He responds so well to massage and laughs so loud when I do it and his eyes lock on to my face the whole time - totally genuine reactions and brilliant to see. My lady with Huntington’s disease is quite hard to treat as she has massive involuntary body movements and I must be careful that she doesn’t hurt herself or me. Again, she responds so well to massage and I can tell by her sighs what she is or is not enjoying. This varies every week, so I had to learn to read her sighs and groans quickly. She is always very relaxed and calm towards the end of her treatment and sleeps contently for about four hours afterwards. I always make sure that I talk to my clients and tell them exactly what I am going to do to them, so as not to frighten them.

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The senior nurse completed all the patients’ medical consultation forms for me and I had to change my massage oil, as a couple of the patients had nut allergies. I treat these patients once a week, every week, and I love this work. It is so rewarding, knowing that you are making a difference to someone’s life by giving a simple massage. I have to be very careful when I treat these clients, as sometimes they can be more

sensitive to pressure and I must adjust my massage accordingly. I must also take care of

my own back as I treat them in their own beds and lifting deadweight limbs while

massaging with one hand can strain your back.

I also treat a couple of young ladies with MS and one with fibromyalgia on a weekly basis at my salon. This gives them immense relief and helps them sleep better. All I can say is that if you ever get the chance to treat disabled or seriously ill patients, embrace the opportunity. It is hard work but you will be rewarded tenfold. I am now training in reflexology and reiki II so that I can help more people.

My work as a Therapy Assistant Practitioner By Jenny Anderson, MFHT

I studied at Lowestoft College from 2004 to 2006, gaining qualifications in sports and remedial, Swedish, and hot stone massage. I also went on to gain diplomas in anatomy and physiology, diet and nutrition and Indian head massage in Woodbridge, plus Level 2 and 3 diplomas in the treatment and management of football injuries, held by the Norfolk Football Association. I have been practising for five years, initially renting rooms in Norwich and Great Yarmouth, as well as having a treatment room at home. Having spent two-and-a-half seasons looking after Lowestoft Town Reserves and First Team football club, I now run a group called East Coast Therapies, which consists

of colleagues and friends, some of whom I trained with. We provide pre- and post-sports massage at local sporting events. In my private work as a sports massage practitioner, I work with elderly clients and with people who have had a stroke. I also come into contact with people who have mobility problems in my role as a therapy assistant practitioner at James Paget University hospital. My work as a therapy assistant is unsupervised, but I am under the direction of qualified staff in the performance of specific tasks for an individual or group of patients, as part of their treatment and rehabilitation programmes. My duties may include:

• Initial assessment of patients and treatment planning;

• Carrying my own caseload of non-complex patients;

• Implementation of treatment plans and evaluating patients’ treatment/progress;

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• Assessing performance of everyday activities;

• Teaching patients how to use walking aids;

• Independently progressing the patient’s rehabilitation;

• Access home assessments (without the patient);

• Discharging patients;

• Delivery and simple fitting of equipment;

• Direct assistance to qualified staff with more complex patients;

• Setting goals with patients, both short-term and longer-term planning; and

• Assisting qualified staff in a group setting. My work also involves working with amputees within a group setting, assisting with mobility, exercises and manual therapies. This is quite challenging work, having my own caseload to manage and prioritise. When working with disabled people safety is a big issue. You need to consider the mobility of clients and whether they can manage steps/stairs and if they can enter your premises safely (are your premises easily accessible?). If they are unable to get onto your couch, you need to look at what alternative you can offer. Checking the client’s medical history and obtaining GP permission if necessary are also important considerations. Therapists need to understand what certain medications are being used for, and whether these may affect treatment. Understanding the client’s condition is also key, and I would recommend researching this, where possible. With the elderly, the condition of their skin is important, as the older we get the more fragile and tissue-like our skin becomes, which can tear or bruise easily. Therapists also need to consider whether the client can tolerate a full one-hour treatment – you may need to consider having to modify treatment plans for each client. It is very rewarding working with disabled and elderly people when you see improvements - no matter how small - and you know you are making a difference to their life, mobility and general well-being. As far as I am aware there is very little specific training that covers working with disabled and elderly clients. There is an element of common sense needed, but also lots of other things to consider, including those I have listed above.

Treating clients with disabilities By Janet Black, MFHT I qualified at Chichester College in 2003, having undertaken VTCT courses in anatomy and physiology, Swedish massage and aromatherapy. In early 2004 I then enrolled on the baby massage instructor’s course at the Holistic Training Centre in Southampton. I became a self-employed therapist in August 2004, and am currently visiting several residential homes and day centres on a regular basis. I treat people of all ages with physical and/or learning disabilities. I also see several clients in their own homes, some of whom have mobility problems. In addition, I provide treatments at an exclusive country castle hotel, which gives a nice balance to my week.

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As well as working as a mobile therapist, I am employed for 11 hours per week as a physiotherapy assistant for Leonard Cheshire Disability at St Bridget’s Cheshire Home, Rustington, West Sussex. I work alongside a qualified and extremely proficient physiotherapist, allowing residents to access physiotherapy on a daily basis. This might include stretching and plinth exercises, passive movements, assistance with walking and use of equipment to enable residents to stand or move their limbs, etc. Although this work is totally separate from my self-employed activities it has certainly provided me with valuable experience and knowledge, thereby increasing my confidence as a therapist. Additionally, Leonard Cheshire Disability as an organisation is committed to training, and I have attended several training events as well as received regular on-site training in health and safety, moving and handling, protection of vulnerable adults, and so on. Many of the clients I see as a self-employed therapist have some form of disability or limiting condition - e.g. Parkinson’s disease, multiple sclerosis, cerebral palsy, or stroke - and some of them also have learning disabilities. The extent of their physical disabilities range from being able to walk unaided to wheelchair users, or even in a couple of cases, to being entirely bed-bound. It is therefore necessary to adapt treatments to suit each situation. For my clients in wheelchairs, I often treat neck and shoulders and/or legs and feet. For those that are in bed, it will usually be hands, arms, legs and feet or, if they are able to lie on their side, I may be able to massage their back. I have one client, an elderly gentleman with Parkinson’s disease, who I visit weekly in his own home. His condition causes him stiffness in his back and neck. As he is unable to get onto my massage couch he sits at his kitchen table, leaning onto a couple of pillows. Admittedly, this is not an ideal position from a therapist’s point of view, but as long as I remain vigilant regarding my own position, it is quite safe and workable for a 20-minute treatment. For those clients that I treat in bed, and those that I see at the day centres, the beds/treatment couches can be raised to the correct height for me. I have one or two clients with athetoid cerebral palsy, which can make dressing and undressing potentially hazardous (for me more than them, as arms are flying in all directions). Also, the presence of a catheter and bag could prove a little off-putting to a therapist who has never come across these before. Communication skills are particularly important when treating clients with disabilities. Most of my clients I have been working with for quite some time, but it can take a long time to understand those who are non-verbal or have limited speech and language. It is also vital that you explain to the client the treatment you are about to give, especially if you are working out of vision, e.g. behind them. When treating those with disabilities it may be necessary to consider the length of the treatment. In my experience, a 20-minute treatment is quite sufficient, and clients with learning difficulties may only tolerate 10 minutes, if their mind is on other things. Given that treatments are often shorter than normal (see above), coupled with the fact that the only source of income for many clients with disabilities is from benefits, the pricing of treatments must be affordable. It might be that when treating more than one client at one

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particular place, the price of each individual treatment can be reduced accordingly. Frankly, if you are looking to make a fortune from your therapies then this area of the market is probably not for you! As a mobile therapist, working with clients with disabilities can be hugely enjoyable. It can without doubt be physically and emotionally demanding, but the benefits include variety, the opportunity to build relationships, and the knowledge that your treatment is providing a short period of relief and comfort which otherwise may not be available to these clients. Sadly, there appears to be little in the way of training for therapists who are interested in treating clients with disabilities. I don’t remember there being any provision for treating people with disabilities in my original training. Much of what I have learned has been through experience and researching the particular conditions that I have come across, as well as the help and support I have received from my physiotherapist colleague at St Bridget’s. It would be hugely beneficial if all therapy courses included an element of training in this field. Who knows – perhaps I’ll even put my own course together!

The power of gentle touch By Hilary Campbell-Martin, MFHT

I qualified as a holistic therapist 10 years ago and have spent the past seven years working full-time as the senior therapist for a community-based charity, The Forum for Action on Substance Abuse. Our remit has grown in recent years to include clients with issues around suicide and self-harm. I also run a part-time private business from home. I initially qualified in massage and Indian head massage and then continued training, and now provide traditional acupuncture, reflexology, flower remedies and several other therapies. The two therapies that really stand out for me for providing

safe, gentle, but effective treatment for a wide variety of physical and mental health problems are the Bowen technique and the Emmett technique. Both allow me to provide an effective, rapid treatment for all clients, and are enormously useful when working with clients with physical disabilities. If a client is unable to lie on a treatment couch I can work with them standing, sitting or in their wheelchair if necessary. Clients can be treated lying in a hospital or hospice bed without disturbing wiring/tubing from medical equipment. Clothing does not have to be removed, which can be reassuring for clients who may feel sensitive about their bodies, about missing or differently-abled limbs or for those who wear colostomy bags. I am lucky to work for an organisation that has provided me with a hydraulic couch. This allows me to alter the height of the bed to allow clients in wheelchairs to gain access to a treatment couch. It also makes it a lot easier for clients who have mobility problems to get on and off the couch. I find being able to alter the couch to suit each client allows me to work safely without putting my own health at jeopardy.

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I regularly treat clients who have disabilities related to their current or former substance misuse issues. Client A, who has chronic, painful pancreatitis, osteoporosis, osteoarthritis and diabetes, has found a huge increase in the quality of his life since attending for treatment. Prior to treatment he was regularly house-bound and isolated due to crippling pain. He is significantly more mobile and his pain is managed very effectively with monthly ‘top up’ treatments. Other clients have physical problems due to previous suicide attempts. Client B had a lack of sensation in one arm and hand due to nerve damage from cutting his wrists. He also has large areas of scar tissue around his chest and throat from a serious scalding accident when he was one-year old. The scarring around the neck was extensive enough to cause serious restriction in turning his head. Having had a number of treatments using Bowen technique and Emmett technique, the client now has sensation returning to the arm and hand, and almost complete range of movement in the neck. The scar tissue and underlying tissues appear to have softened enough to allow freedom of movement. Working in Northern Ireland in a post-conflict society means that we come across clients who have lost limbs as a result of bomb explosions. Client C, who was a taxi driver at the time of an explosion, had a leg removed from the knee down and has a number of pound coins embedded behind the other knee which cannot be removed. He experienced regular, debilitating ‘phantom limb’ pain. During his first session of the Bowen technique, where I performed the moves in the space where the ‘missing’ limb would have been, the client reported feeling the moves. After a number of treatments the painful cramping and spasms in the missing limb had gone. Occasionally clients will present with a condition that is very rare which may need some extra research and consideration. I was very privileged to work with a young boy with Tay-Sachs disease on a weekly basis between February 2007 and August 2009. Tay-Sachs disease is a genetic disorder that causes destruction of nerve cells and the spinal chord, eventually leading to blindness, paralysis and death. Dylan Dicks (whose parents are happy for him to be named) was an 8-month old baby when he began his treatments with me. He had many physical challenges including very little vision, difficulty swallowing and was unable to sit or stand. Using Bowen technique and especially the gentle ‘fascia Bowen’ developed by Howard Plummer, we saw a real improvement in the quality of Dylan’s life. His swallow reflex was improved, his bowels were less congested, he had more muscle strength, and according to his family, he was simply a happier child. Dylan passed away on 31st January, 2010, aged just three, which has been understandably difficult. However, this is something that one always has to consider when working with clients who have a life-limiting condition. I feel honoured to have been some small part of his life and I would hope that others would not be afraid of working with similar clients. I have not found working with clients with disabilities to be enormously different from able-bodied clients. However I found it challenging when working with a deaf client via an interpreter. It made me realise how much communication is non-verbal and I would like to learn sign language to enable me to communicate with signing clients more effectively. I find working with clients with physical impairments enormously rewarding. From the client who is not considered ‘disabled’ in the conventional sense, who comes because they can’t turn their neck due to a restriction, to the clients who have lost limbs or present with huge physical incapacities. I have been enormously lucky to be trained in therapies that make a real difference in reducing (or eliminating) pain, lessening discomfort and providing a sense of balance – both physically and emotionally.

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Complementary therapies and working with clients with disabilities By David M Godfrey, FFHT

My first therapy qualification was in reflexology in 1990, since when I have added many other disciplines to my repertoire. With a background in biomedical sciences and education, over the past fifteen years I have taught science to students with disabilities and have worked as a complementary therapist with clients presenting with a wide range of disabilities. In 2003 I received a telephone call from an ex-reflexology student who was working at the Disability Foundation at Stanmore Hospital, saying that they were looking for a complementary therapist to work with a range of clients with disabilities, would I be interested? I jumped at the opportunity and have worked there ever since.

The Disability Foundation is a charitable organisation that for more than ten years has provided low cost therapies for clients and their carers within the Orthopaedic Hospital Site at Stanmore. There are around twenty therapists offering therapies, ranging from osteopathy and cranial sacral therapy, to massage and reflexology. Each therapist commits to either a three-hour or four-hour session during a normal five-day week. I personally offer aromatherapy, massage, Indian head massage, reflexology and reiki. Clients present with a wide range of disabilities, including being wheelchair-bound through stroke, cerebral palsy, multiple sclerosis, autism, peripheral neuropathy from diabetes, spinal fusion and Parkinson’s disease. Some clients have additional problems, such as being fitted with abdominal feeding tubes. Clients are aware of the Disability Foundation and the therapies on offer through the work of the charity and its outreach group; their GP; personal recommendation; associated disability outlets; the internet; or through attendance at local events. At the point of registration, all new clients complete an initial application form for the receptionist, outlining their condition and any medication they are receiving. As the receptionist is a therapist, she then assigns a client to a therapist, or asks those working at the Foundation which treatment would be most appropriate. The therapist the client has been assigned to then carries out a full assessment, and the appropriate treatment selected. If the treatment felt necessary is outside of the therapist’s remit, they will direct the client to an appropriately trained therapist. Clients either remain with the therapist that they were assigned to, which enables a rapport to develop, or see another therapist if they wish to try a different therapy. At the end of each session with a client, full details and findings are noted in their files. This not only provides the appropriate information for a new therapist, but also reminds the existing therapist of what they found in the previous session.

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Depending on which therapy the client has requested, or which therapy is deemed appropriate at the time by the therapist, the therapist will make the necessary adaptation. If the client I am working with is having massage or aromatherapy, and they are able to get on to a couch unassisted, then with the appropriate use of pillows/supports I will carry out the massage on the couch. If, on the other hand, they are unable to get on to the couch unassisted and have arrived with a sling in place, then the mobile lifter can be used to place the client on the couch. Alternatively, the treatment is carried out whilst the client is in a wheelchair. This may mean that I have to sit or lay on the floor to carry out a leg and foot massage. I have learnt over the years how not to let sitting or laying on the floor affect me physically, by frequently shifting my position to make myself comfortable. Once the treatment is finished and before the next client arrives, I do some stretching exercises to get my circulation back. If the client is fitted with an abdominal feeding tube this is either disconnected by their carer, or, if left in place, the massage of the abdomen is carried out taking great care not to disturb the feeding tube. If the therapy requested is reflexology, the client is either placed in a chair with a raising foot rest to support the legs/feet or, if wheelchair-bound, then the legs/feet are raised and supported on my knees or a pillow, depending on the client’s flexibility. With the range of disabilities that clients attend the centre with, extreme care must be taken to ensure that any therapy undertaken does not aggravate the disability, but is carried out to ensure that quality of life is improved. Therefore a thorough knowledge of the disability and its effect on the individual is a necessity. As invariably the immune system of the client is impaired, strict hygiene is a must. As a therapist I need to be able to adapt the therapy to suit the client’s needs as no two clients, or their disability, will be the same or affect them in the same manner. As a qualified therapist, who before working at the Disability Foundation had already worked with clients with disabilities, the prospect of working with this group of clients was not really a challenge for me. Unfortunately, for a newly qualified therapist the availability of training/learning new skills is very limited and this perhaps deters people from working with people with disabilities. The internet and other sources can provide the required background to a specific disability, but does not provide the techniques that may need to be employed. My experience of working with this clientele group has provided me with the opportunity of both writing and teaching an advanced module for both massage and reflexology for the Middlesex School of Complementary Medicine, but this is only a small drop in a large ocean. From a personal perspective, working with this particular group of clients has been immensely rewarding in developing new techniques and learning about the effect that such disabilities have on the individual, and understanding how I as a therapist can actually help individuals to help themselves by providing the very best treatment that I can.

Treating elderly clients By Elizabeth Holmes, MFHT I started my training in 2001 with beauty therapy and then continued with body massage, Indian head massage, reflexology and thermo-auricular therapy. I worked part-time in

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beauty salons and at a complementary health centre for six years. My work is now all mobile, treating elderly clients whose ages range from 63 to 94, with an average age of 85. I work with Age Concern when funding allows, mainly in their day centres. I do 10 to 15-minute neck and back massage on designated clients. It was only by chance that I visited the sheltered housing complex after one of my clients cancelled at the last minute. I was invited to a coffee morning to talk about the benefit of the therapies and to demonstrate them. Luckily the scheme manager told other managers in the group and I now visit eight centres on a regular basis. At first I used the guest rooms or the hair salon but as these varied so much in size, I felt that I was unable to work safely. I now visit the clients in their flats, however they are unable to get on to a treatment couch or use an onsite massage chair. My clients suffer from various conditions – arthritis, cancer (in remission), diabetes, diverticulitis, strokes, multiple sclerosis, birth defects in lower limbs, tennis elbow, frozen shoulder, and a lady who was paralysed after a car accident. What they have in common is that they are all open-minded about the benefits of complementary therapies. The therapies are mainly back and neck massage, Indian head massage and reflexology, and sometimes a bit of pampering. I try to help them relax, improve circulation and remove any tension due to incorrect usage of their walking aids. For those having reflexology most clients own a reclining armchair, so I sit on a small stool or a cushion on the floor. For those in a wheelchair, each leg is supported on a stool and I sit on the floor. For back and neck massage, my male clients straddle a dining room chair and lean on its back. The ladies sit correctly in the chair, but I put a small bolster pillow at the base, which allows me to massage all of their back. The treatment lasts for 15 to 30 minutes, and I have adapted my method of massage to suit my clients. My movements have to be firm but gentle. I use a lot of circular movements and where I find tension at the top of the shoulder, I press harder with my thumbs, again in a circular movement. If my client is able to, I ask her to put an arm behind her back as far as possible, so that I can get to deeper muscles under the shoulder blade. I have to hold the opposite shoulder to give support to the body. I knead the side of the body and work on the trigger points at the base of the back. I treat the neck, shoulders and upper arms while supporting the upper opposite shoulder. While my clients are having treatment, they like to chat. For those who are hard of hearing, I find myself almost shouting and leaning forward, and I have to break the flow of movement so I can face them for them to understand. If they are tense I will spend more time on the neck and shoulders. At the end of the treatment I ask them to do some deep breathing and to bend their arms, which I support and raise while they breathe in, and lower when they breathe out. This is done three times. In the clients’ home environment, it provides the opportunity to see how they are using walking aids and if they require any other aids to help with daily living. The warden may be able to help. The lady who had a car accident about 30 years ago has 24-hour care and lives in the family home. The carers were very helpful, advising me what was the best way to work with my client. After weeks of gentle reflexology she was able to move her leg that

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once would only move when it went into spasm. This was very rewarding. The carers also helped me to communicate with the lady. I visit my clients on a weekly, fortnightly or monthly basis and all enjoy the therapy work and find it beneficial. They tell me about their family and I have met some of their relations. I find this work very rewarding. I look out for information that may be of use, from diets and household gadgets, to allowances they may be entitled to. I feel that my training did not cover how to adapt our basic knowledge to work with disabled persons with confidence. It was assumed that all salons would have electric couches so that clients could get on more easily. We need advice, not only on how to adapt the way we treat our clients and protect ourselves from injury, but also disabled people need to be included in college courses. People in wheelchairs need more than a hand massage, and the blind need to know exactly where the therapist is rubbing their back. We know our therapies work and we believe in ourselves. We need disabled persons to believe in us, too.

Treating clients with a disability By Janet Lindop, MFHT

I have been a reiki practitioner for 12 years, a massage therapist for 10, and a remedial sports/masseuse for six. I have also trained in Indian head massage, stress massage and stress management, together with skills acquired from various bodywork workshops. I work on a self-employed basis in commercial businesses, local community health, at NHS and City Council events, and one day a week at a local surgery, treating GP referred patients where some have varying degrees of disability. For three years, I worked one day a week as a volunteer complementary therapist at a local NHS health clinic. Within the practice was an Integrated Health Complementary Medicine

Clinic, which focused on treating patients with a wide variety of pathology. Here I gained much experience from the clinical lead who is a homeopath and experienced remedial masseur. Whilst at the clinic, it was not unusual to treat clients presenting with pathology such as multiple sclerosis, spina bifida, and myalgic encephalopathy/ chronic fatigue syndrome. Of course immobility is diverse, as factors such as other ailments, age, and mental approach can add to its severity. Immobility alone not only restricts movement but has an effect on normal life and may result in feelings of inadequacy, frustration, stress and anxiety, with clients potentially feeling isolated and depressed, particularly if no family or social network is there to support them. The physical lack of movement can cause restrictions in other areas of the body, producing unbalanced muscle function. Additionally, a sluggish lymphatic system through lack of movement can contribute to an impaired immune system, leaving the body open to even more attack.

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There are, however, other kinds of disability that we may not easily detect such as hearing, sight, and speech impairment. Inarguably much is to be considered when assessing and treating a person with disabilities. The consultation process It has been my experience that a quantifiable number of patients/clients are not aware of the importance between their whole state of health and receiving treatment. Often for clients with a disability, the disability itself takes precedence and other problems seem insignificant to them, as they have learned ‘to live with it’. For this reason, I find it necessary to conduct a more investigative consultation, which enables an accurate assessment for effective care and treatment. It is also very useful to have the first appointment for the consultation process only. Initial contact with a client is visual, so I look for any difficulty of movement and diminished strength, e.g. when opening the door, moving across the room, sitting down, or if a stick or wheelchair is used, how they manage their aids. I greet them with a positive, optimistic ‘hello’ in a clear voice and fully facing them, in case they have a hearing or sight impediment. A relative or carer may need to attend the consultation if necessary, as the patient can often be apprehensive and will forget to mention things, or have trouble hearing or answering questions. I always ensure acknowledgement and eye contact with the client, even when someone else is answering on their behalf. Completing the standard consultation may not always bring to light all information. I always conclude the consultation with a friendly chat to relax and encourage the client to talk about their life. Quite often you find a hidden nugget of information that you’re glad you discovered. As therapists, we can only try our best to extract as much relevant information as possible from the client, but we also need to realise how important this is in order to carry out an effective and safe treatment. A treatment example Treatment: massage over the upper back and arms for a client with severe spina bifida. Pathology: complete exposure of part of the spinal cord; upper thoracic deformity (body support used); paralysis in legs (wheelchair-bound); speech impediment (carer acts as interpreter); and incontinence. Treatment is typically carried out on a massage couch (non-hydraulic) to provide comfort and enable an effective treatment. The carer helps to lift the client onto the massage couch, with the wheelchair placed as close as possible. Pillows are used to support all sides of the body, allowing the client to lay in the most comfortable position, and the carer stands on the opposite side of the couch as some clients can make unpredictable, spasmodic movements. When treating clients, I maintain physical contact all the time, making sure all equipment, oils, towels, and wipes, etc, are ready and to hand. I also maintain verbal contact, explaining what I am doing, and asking if the client is comfortable and happy to proceed.

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Where necessary, the treatment or client is adjusted to ensure they are comfortable at all times. If a carer is not present and the client is unable to get out of the wheelchair I provide a chair massage, stacking pillows against the massage table and around them to ensure stability and that they will not fall. I also check the wheelchair breaks are on once in position, and I am prepared to help them undress and maintain modesty, where needed. Being prepared is vital to an unhurried and effective treatment. Some final points to consider:

• Can the client lie down? Some may have a colostomy bag or physical deformity and be unable to lay prone or supine.

• Can they sit in a therapy chair? Consider arthritis knee/hip replacements.

• Do you need assistance? If so, establish at the consultation stage whether a relative or career will be attending the appointment.

• Consider specific physiological complications with abnormal anatomy when giving a treatment. Use cautious palpation and visual assessment and, if in doubt, get advice from the client’s GP.

Working with clients who have a physical disability I must admit, when faced with my very first client with a physical disability, it felt a little daunting. Was the treatment going to be effective? Would I hurt them? Then I put things into perspective and realised that I wanted to help them and I had the expertise, so just needed to ‘get on with it’. Now every client I see is a pleasant challenge, and I aim to achieve the very best I can for them. Much of the way I adapt treatments has been learnt through experience and using common sense. Disability is not formatted, so you need to expect anything. I find that being able to truly put myself in (and feel) their predicament paints a picture of their needs very well. Helpful training would be that which comes directly from the carers or occupational health therapists. I have found working with clients who have a disability very rewarding, as they receive instant benefit, even if only for a few days. For these clients, every little helps and lifts their spirits. Also, the personal contact is very important and just as healing as the treatment, particularly if they live alone.

My work at Craig-y-parc school for children with cerebral palsy By Sally Styles, BSc (Hons) Complementary Therapy, MFHT Craig–y-parc school is run by Scope, a national disability organisation, whose focus is children with cerebral palsy. It is a day and residential school for children aged 3 to 19. The eight residential rooms can sleep up to 22 children. At Craig-y-parc children access speech therapy, occupational therapy, the onsite hydrotherapy pool and sensory room, music therapy, touch therapy, physiotherapy and

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complementary therapy. Teaching is based on the Hungarian conductive method as well as mainstream teaching of the curriculum. Physiotherapy plays a central role in managing the students’ condition. It is used to improve movement and motor skills and has the ability to develop self-sufficiency in students where it was previously absent or unmanaged.

The physiotherapy staff give advice on positioning of students for therapy. Nursing staff are available at all times to tend to the medical needs of the students. Annie, the speech therapist and therapy co-ordinator, is very supportive of complementary therapies and has brought the whole therapy team together at Craig-y-parc into a well developed, multi-disciplinary school in which all staff work closely with each other to ensure the best possible care and physical and mental development of the students.

Cerebral palsy describes a medical condition that affects the control of muscles. Cerebral relates to the head and palsy refers to anything not functioning properly with muscles or joints of the body. It is caused by damage to the motor areas of the brain before, during or just after birth, or in early childhood. Sometimes damage occurs as a result of an inadequate supply of oxygen to the brain. More rarely the cause is a maternal infection that spreads to the baby in the uterus. The disorder varies in severity, from slight clumsiness of hand movement to complete immobility. Possible causes after birth include inflammation of the brain tissue, meningitis, head injury or bleeding within the brain. In addition to problems controlling their muscle movement, children with cerebral palsy may have other neurological problems usually caused by the same brain injury. About half of all children with cerebral palsy have seizures. About 70 per cent of children have mental impairment but the rest are of normal or high intelligence. Although there is no cure for cerebral palsy, much can be done to help affected children. My background I have been a therapist for 12 years. I first trained at Hereford Technical College, where I completed my anatomy and physiology (A&P), body massage and sports massage qualifications. I was hooked on anatomy and physiology, which I found fascinating, and quickly enrolled onto the Indian head massage course to keep up my massage skills and A&P knowledge. Having worked as a therapist for several years in a leisure complex, I came across the complementary therapy degree at University of Wales Institute Cardiff (UWIC). I applied, was accepted and moved to Wales with my son and partner. I was enrolled onto the very first year of the degree, which was completely new at UWIC. The hands-on therapies included massage, aromatherapy and reflexology, with a split module of traditional Chinese medicine and advanced massage. Along with many other modules, the three years of anatomy, physiology, pathology and differential diagnosis and a module of immunology was invaluable and fed my desire to learn more about how disease affects the body and how the body fights back to protect itself.

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In the final year we spent nine weeks running a clinic at the university, which was open to the public, and nine weeks on a chosen work placement. There was a list of about 10 placement organisations to choose from and Craig-y-parc school was actually last on my list. I had chosen a drug centre for my first choice, because I was familiar with how things worked in this setting as I was already working as a volunteer in a centre and my dissertation was based on some of the service users. It was whilst on a reiki course which was run by my reflexology tutor from university that I mentioned that perhaps I should have put the school down as first choice. It was so out of my comfort zone and I felt that it would therefore be the most beneficial to my learning experiences. The next time I went to university, my tutor had changed my form and submitted the school as my first choice. I had no idea what to expect (I had barely heard of cerebral palsy) and I was worried that I would be upset working with very young children with this condition that I knew so little about. On my first day I learnt so much about the students and the range of physical ability, communication limitations, various methods of communication and mental ability. I found the school to be such an upbeat and happy environment, full of joy, laughter and really positive vibes - not sadness and pity, as I was expecting. The main therapy used was reflexology and sometimes jasmine essential oil was diffused into the room. The students all loved Linda, my mentor, and were familiar with her and the treatment room; they had a very special bond. When Linda left the school, she contacted me to see if I was interested in sending my CV into the school to replace her. I had only finished my degree a couple of weeks previous to this and was looking for any paid work, so the chance of working somewhere that I had a strong emotional bond with, plus limited experience of working with some of the students, was a dream come true. Life at Craig-y-parc

Starting at Craig-y-parc school was like starting any new job. I felt nervous as I didn’t know anybody. I was (and remain) the only complementary therapist at the school and I had limited experience of working with children, and even less of cerebral palsy. Now I was on my own as a newly qualified reflexologist and aromatherapist. Although I had many years of experience as a massage therapist in a leisure

complex, this was an alien environment for me. I got to know the students that I would be working with (funding comes from the students’ local LEA) and arranged a timetable to fit in with all of the other therapies, activities and teaching time. Starting with reflexology, because that’s what the students were used to receiving, and slowly introducing massage then aromatherapy, I got to know each

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student’s method of communication. How to interpret a ‘yes’ or ‘no’ response was most important because I needed to be sure that students actually wanted therapy and that it wasn’t being forced on to them because they had been assessed to have it. Some students have yes/no cards with symbols on and are able to look at the answer that they choose; some have vocal indicators; some have a facial expression; and some I work with intuitively. It took months to feel that I was learning their responses, with help from classroom assistants. Although I have now been working there for three years, I am still very much learning. As I work mostly with students with sensory needs, a lot of equipment is involved to ensure that they are regularly changing position and not sitting in wheelchairs all day, so treatments do have to be adapted. This equipment is an essential part of their day, so it is not always possible to plan a session in advance as I can never be sure which equipment the student will be in, if any. A lot of my work is carried out on the floor, with the student on a floor mat and supported with cushions. I carry out most treatments in this position - reflexology with lower limbs supported in a slightly elevated position with pillows, or the student can be turned to a side lying position with pillows between the knees, under the head and in front to support the upper arm for massage. I avoid putting my students prone when on the floor because they tend to have very little muscular control or support of the head. However some of my past students have been able to roll into prone position, if they had specifically required massage, and would then lie supine if they chose to have reflexology. Sometimes I see students while they are in their wheelchairs. In this case I will either massage the upper back, neck, arms and hands or pad the footplate with a pillow and do reflexology. We also have Acheeva beds in school, which are great for doing massage on as they are height adjustable and can be tilted to suit the student. A couple of students have to be carefully monitored during treatments as they need oxygen if they fall asleep because their breathing becomes very weak and shallow. I see one of these students in the residential part of the school; he has treatment on his bed so that his oxygen is close at hand because if he sleeps without it, his oxygen intake becomes critically low. Another student has a suction pump attached to his wheelchair because he regularly needs his airway cleared from mucus. There is always a classroom assistant present to deal with various needs of the students. Another learning curve for me was getting used to the different types of seizures, from absences to grand mal, and everything in between. Students are timed when they start to have a seizure and the duty nurse is called depending on the type of seizure, how long it goes on for and the needs of the individual student. Students with gastrostomy tubes fitted for feeding have treatments either in their wheelchairs or propped up on a wedge so that digestion isn’t compromised by lying flat and food is less likely to be regurgitated. This is especially important if they have recently eaten or if they have just had meds administered because if they bring it back up it isn’t safe to give a second dose.

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Many students have digestive disorders, ranging from severe constipation to indigestion. I have found that aromatherapy massage of the abdomen is particularly beneficial for digestive conditions. I use orange essential oil in a lot of blends, whether treating digestive or respiratory conditions, because it is an aroma that most children identify with as a happy, cheerful aroma, and it blends well with peppermint for digestion or frankincense and benzoin for respiratory conditions. Other useful oils are rose and geranium, myrrh, grapefruit and eucalyptus, lemon, black pepper, ginger and bergamot. To be on the safe side I do not use rosemary at all in school as it should be avoided with epilepsy. I have developed aromatherapy room sprays for various activities within school so that the students can begin to associate different activities with the aroma; this has been popular with students and staff.

Outcomes from treatments are difficult to monitor as quite often feedback isn’t given, and small things in our world can be huge milestones in theirs, such as saying ‘mumma’ for the first time, or a child with Rett syndrome who is able to lay still for 20 minutes. We have also had great success with encouraging regular bowel movements in constipated students and less suction for respiratory conditions on the day of therapy is always great news. I now take students studying the complementary

therapy degree for their nine-week placement. This is great for me, as it is a chance to hear their ideas about treatments and find out if they would do things differently, as well as introducing them to the idea of working with an open mind and showing them that it is so much more interesting when it’s not text book. Nothing is text book at craig-y-parc, from learning to communicate differently to not being able to locate a bony structure because it’s not where it said it would be in the book! It has been challenging watching children deteriorate and pass away, especially when it has been unexpected - since I started work at the school, four students have passed away. Pictures © Sally Styles, 2010.

Ayurveda and Andy

By Judith Thurston, MFHT I have been a holistic therapist for more than eight years. I run a private practice in Bramhall, Cheshire, and offer a mobile service for clients who are unable to leave their own home because of a disability, or who cannot access my property because of stairs. I became interested in ayurveda three years after I took a week’s course with Sunita Passi of Tri-dosha. Since then, ayurveda has

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become a major and most important part of my life. As I became more knowledgeable about ayurveda, I discovered that food, diet and nutrition are of paramount importance and have a massive impact and effect on the skin (we are what we eat). As a result of this, I decided to study beauty therapy (Levels 2 and 3) at my local college in Macclesfield. This has added a further dimension to my business, as I can now incorporate beauty therapy, holistic and well-being treatments into my ayurvedic practice. In March 2010, I took further training with the eminent Dr Deepa Apte of Ayurveda Pura in Greenwich, London. During the 10-day course I was taught 13 treatments, as well as learning the theory behind each treatment administered. On my return home I was to prepare for my exam, which would be four months later. I would be carrying out 28 sessions in total, with each of my seven clients receiving four treatments. I was looking for a client with a disability as part of my own continuing professional development, and Andy could not have turned up at a more appropriate time. He was an ideal candidate and eager to receive all treatments as a case study. Andy was a martial arts instructor and qualified engineer when he had a motorbike accident in 2000. As a result of his accident, he lost movement in both of his legs and in 2008, had spinal surgery for post-traumatic syringomyelia. He practices Taoist philosophy and was extremely keen to learn about ayurveda - its principles, philosophy and reasons behind individual treatments. Treating clients with mobility problems Clients with a disability should be offered a consultation prior to their first treatment date so that the therapist can assess the extent of their disability, level of freedom of movement, and to discuss their individual needs. This can also dispel any concerns or uncertainties the client may have. Certain clients will be used to being viewed by doctors; visiting clinics; having operations and drugs administered; and, of course, seeing lots of white coats. Because of this I usually wear something colourful to try to help put them at ease, and as I offer ayurvedic treatments, I felt orange was very appropriate and a good chakra color. I do however always wear my FHT badge and show my membership card on arrival at the client’s home. Be mindful that some clients have never received any kind of holistic treatment before in their lives. I enjoy explaining what the treatments are about; what is involved; how the client may have to adapt; if it is possible to alter their position on the couch (depending on the treatment); how long treatment may take; and the oils/ products that are to be used. When visiting the client’s home, it gives the therapist an indication of what may need to be adapted, and where the treatment is to be carried out. Is the bathroom nearby for hot water? Are there extra towels? Is a plug socket handy for a foot spa, heated blanket and CD player (always pack an extension lead!)? Is the lighting adequate? Music is extremely important to set the mood for complete and utter rest and relaxation. I have my laminated checklist that I tick off as I load my car in preparation for a mobile visit.

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Treating Andy Andy was unable to access my premises with a wheelchair, but I was able to offer him all seven treatments at his parents’ home, where he was able to enter the room via a specially designed ramp. The room was prepared by a friend each week before my arrival. At the pre-treatment meeting, we were able to discuss the aims and objectives of my visit. I previously asked him to write down any relevant questions that he may need to ask me, so that we could go through these. He could also email me. I explained to Andy about ayurveda - its history, philosophy and all that it encompasses. All (107) marma points are vital energy centres that are located throughout the body, which share similar locations to acupunture points. Marma therapy is used to help detoxify, tonify and rejuvenate. Treating marmas can potentially release negative emotions and remove mental blockages, which means that there is an important psychological side to treatment. During treatment, the flow of Prana is encouraged to flow throughout the body unimpeded, which provides the whole being with energetic nourishment. As the treatments are given with great reverence and compassion, they are always carried out in silence. This was extremely important as I felt I could arrive on the day and commence treatment immediately, without the client having to go through all the ifs, whys and buts, etc. My client knew his weight and so I was confident the couch was a suitable strength. The candle was lit, the room was warm, and the music flowed - as did all seven treatments, without a hitch. These included abhyanga, marma massage, shirobhyanga, padabhyanga, mukabhyanga, kati basti, and his all time favourite, shirodhara. Warm sesame oil was used during all treatments. My client felt extremely comfortable in my presence, and I with he. Upon completion of the treatment at each session, I offered aftercare advice and a specific ayurvedic herbal tea suitable for his dosha type, kapha. Andy was a fun character, extremely witty, and very knowledgeable. He has further inspired me personally with his positive mental attitude to life. He knew ayurvedic treatments were special and wanted to receive them more than anything, as he believed he would feel more whole, nurtured and connected. I was fortunate that Andy had a strong upper torso and was able to lift himself on and off the treatment couch without encountering too much difficulty. I do however realise that any future clients may not have such agility, depending on the nature of their disabilities. Some clients may encounter additional health problems, such as aching joints, slow movement, respiratory difficulties, missing limbs, a visual impairment or hearing difficulties. It has given me immense pleasure to treat Andy holistically - he has inspired me to treat more clients with a disability. He personally has gained so much from the ayurvedic experience and philosophy, as it has given him a more focused view on health and well-being than he had prior to our paths crossing. It was certainly not an inconvenience or problem to visit Andy at home, but rather a driving force to further encourage me in my quest for suitable ground floor premises for clients

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with a disability to be able to receive ayurvedic, holistic and beauty treatments without any fuss. Andy Garner – client history, treatment plan and comments Client: Andy is a 37-year old male. He is a mechanical engineer, and former martial arts instructor. Andy is a philosophical Taoist. He suffered a spinal injury in December 2000 and has been a full-time wheelchair user since. He had spinal surgery for post-traumatic syringomyelia in 2008. Andy has a generally healthy diet and active lifestyle - although he is not able to train heavily due to condition. He is open-minded, spiritual and experienced in various holistic healing therapies.

Current life situation Andy is starting to get over the emotional, physical and psychological trauma of the large operation in March 2008. He is building confidence, letting go of the past and embracing the future. Feeling unfulfilled, lethargic and low in confidence. Pre-treatment preparation Changes to diet - stopped eating red meat, reduced alcohol consumption to a minimum and reduced dairy intake. Drank at least three mugs of lemon and ginger tea per day for two weeks prior to treatment. First treatment: full body abhyanga and marma massage ‘Immediately afterwards, I felt connected to all parts

of my body. The feeling of relaxation and contentment lasted long and continued the next day, although I was physically tired and needed to rest. My mind was more positive and I found myself looking forward rather than back. I had new ideas of future projects. The second day after treatment I felt energetic, emotionally responsive and focused. For the rest of the week, I had good energy and mood and spent much time being active and socialising.’ Second treatment: padabhyanga (foot massage) ‘My legs have very little sensory feeling, but were tingling and felt warm throughout the treatment. Afterwards I felt grounded. The next day my feet were still warm and connected, I felt tired and needful of rest.’ Third treatment: full body abhyanga and marma massage ‘Deeper levels of relaxation, body feeling energised. The next day not tired this time, motivated and increased libido.’

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Shirodhara treatment: ‘First I received a relaxing back massage, as my shoulders are always tight due to the daily strain they endure. Then a head and face massage, which completely relaxed any tensions in my face and scalp. Whilst my eyes were closed I experienced pinky-purple colours in the background with golden yellow swirls in foreground. Later a bright purple spot appeared over perceived position of the third eye. The patio doors were open in the room where I received the treatment, the fresh air and sound of the rain added to the healing experience. ‘Warm oil on my head in a figure-of-eight pattern brought cyan and green colours, then purple and black. Random visions passed through the consciousness but nothing distinguishable, except for one point when I was flying in a bright blue sky over a desert. I felt so clear in the head afterwards but deeply tired. It was like a ‘restore optimum settings’ button had been pressed. I wanted to go around hugging everybody. ‘I slept well that night but was really physically tired the next day. Other observations were that senses such as taste, smell, hearing, and vision had improved. A greater awareness of what was going on around me. I didn’t realise that I was in ‘fight or flight’ mode until I was released from it.’ Conclusions: ‘After receiving the various treatments, I am in a much better place than before. My balance is restored, I have regained my ability to make life-enhancing decisions and to be more trusting and open with people. The diet and lifestyle changes have set me on a path where I know there will be further benefits. ‘This type of medicine works straight at my core, and when the core is good it seems all other health problems in the periphery improve. Essential though, is how the treatment is delivered, and through her careful, caring and skillful manner, Judy was able to demonstrate the full effectiveness of ayurvedic medicine.’

Working as a complementary therapist with clients with disabilities

By Catherine Wood, MFHT I have been working as a complementary therapy practitioner since 1994. Originally training in therapeutic massage, I gradually added clinical aromatherapy, reflexology, manual lymphatic drainage (MLD) massage and second level reiki to my therapy repertoire. My work in palliative care, alongside private practice, began as a volunteer hospice therapist in 1994 before gaining the position of Complementary Therapy Coordinator at Dove House Hospice, Hull, in 2004.

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As a therapist I offer clinical aromatherapy, reflexology, reiki and massage to patients and their carers as part of the multi-disciplinary team (MDT) at the hospice. Patients are treated in the In Patient Unit where, depending on the patient’s mobility and state of health, they can be treated in bed, in a recliner chair at the bedside or in one of the therapy rooms. Adapting therapist stance and positioning is challenged here to avoid discomfort or injury. Therapy rooms are also used for those attending the Day Therapy Unit and Complementary Therapy Out Patient Clinic. When a patient becomes disabled physically by their illness, upper and lower limb or lung function may be impaired, affecting the ability to perform normal activities of daily living that well people take for granted (such as climbing stairs, washing and dressing, going to the shops, walking into the garden, etc). Symptoms of fatigue, pain, nausea, gastrointestinal (GI) disturbances, breathlessness and anxiety can, in themselves, also disable a person’s physical activity and affect quality of life. (The ethos of palliative care is to improve that quality of life and reduce symptoms of illness). Patients disabled by neurological conditions such as Parkinson’s disease, multiple sclerosis and motor neurone disease (MND) may experience muscle spasms, pain and rigidity, gradually causing the loss of ability to independently move limbs. Speech may become impaired making verbal communication difficult, swallowing and the enjoyment of tasting and eating food may be lost and in the case of MND, eventually breathing unaided becomes difficult. Patients affected by respiratory diseases suffer from deteriorating lung function. Where once a person may have been physically active, increasingly, walking even short distances will become difficult without episodes of breathlessness. Where the use of 24-hour oxygen becomes necessary, these activities become restricted by carrying portable cylinders or being attached to lengths of tubing at home. Muscle tension and associated restricted arm and shoulder movement often develops as the ancillary muscles of the upper trunk are over-used to assist breathing. Understandably anxiety is commonly associated with respiratory disease – breathlessness leads to a cycle of anxiety, panic, tension and further breathlessness. Alongside physiotherapy, complementary therapies which aid relaxation and tension release are shown to reduce anxiety and panic attacks and can ease breathlessness, whilst chest and upper back massage can aid productive expectoration. When a patient is physically disabled by their illness, their role in life and their relationships with family members may change – earning a wage, doing practical jobs at home, cooking, keeping a home, loving and holding loved ones may no longer be physically possible. Providing complementary therapies can help people to cope with these often sudden changes and assist people to accept their situation by providing an opportunity to express themselves, find relaxation and temporary relief from symptoms. As with all types of therapy treatments, a full and extensive initial assessment must be taken before commencing treatment. This ensures the therapist has a full understanding of the person’s medical, emotional, spiritual and social state and indicates how to proceed with treatment. It is important also for the therapist to be aware of situations that may arise during treatment time, e.g. seizure, pain, breathlessness or vomiting, and how to act accordingly. When working with a person who has physical disabilities, communication skills are vital. Patience and confidence are needed when working with those with speech difficulties. The use of non-verbal communication, looking for non-verbal signs and eye contact is needed.

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It is essential to show respect and empathy, to gain the person’s perspective on their limitations: their restrictions of positioning and movement, ability to independently move limbs, flexibility and muscle tone; their sensitivity to touch and temperature. Adaptations of therapy may include guiding a person to select a therapy that will cause the least disturbance to comfort and position. Extra time may be needed for assistance with positioning, dressing and communication difficulties. Issues of timing treatment around the positive and negative effects of medication, shortening treatment time to suit levels of tiredness and tolerance and adapting pressure and touch to take into account muscle tone, touch tolerance and skin fragility are all issues for consideration. Using common sense and ‘thinking on your feet’ are essential. When working with physically restricted patients, it is vital to have a basic understanding of their medical condition, its possible effects and restrictions; remembering that each person may be affected differently by the same condition. Research relevant conditions by using information provided by support groups and online medical information websites and then of course speak to the real experts – the patients themselves. Awareness of moving and handling principles is important – never attempt to move a person alone, seek assistance when necessary; again the patient knows their own limitations but always be ready to remove shoes, carefully lift limbs, etc. All treatments must have informed consent from the patient. Explain the choice of therapies available, the principles of the chosen therapy, what it entails, its benefits and effects. Where written consent cannot be gained due to disability, implied consent should be documented. Communication with other health professionals – consultants, specialist nurses, GPs, physiotherapists, etc, will demonstrate a level of professionalism but will also aid good informed practice and therefore benefit patients. In the 16 years that I have been in practice as a therapist, I have enjoyed working with a wide variety of people. Yes, some have been disabled by their health condition but all have their own unique life experiences and would not wish to be defined by their physical limitations. For a person with disabling limitations to let us work with them, on such a close level, is a great privilege and one that brings many rewards. At times it can be daunting, especially when verbal communication is difficult, there can be embarrassment at misunderstanding or not understanding a persons needs but a smile, patience and perseverance can usually help. To see a smile replace tears, to feel a person’s body relax under the fingers, to hear of joyful imagined journeys taken in the mind - these rewards outweigh any apprehensions. My personal experience of obtaining training in treating patients with a disability has been ‘whilst in practice’: observing other disciplines, such as physiotherapists and nursing staff and by working as part of a wider multi-disciplinary team. Attending local support group events and study days also helped to inform my practice. Availability of training events will greatly depend on location but many hospices have education departments that provide lectures, conferences and study days on specific life-limiting conditions, including those which involve levels of disability. As a Hospice Complementary Therapy Coordinator, I am always willing for therapists who are interested in working in palliative or supportive care to enquire about observing therapy practice and seeking further information.

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As complementary therapists, our skills in touch and energy therapies have been shown to provide valuable benefits of reduction in pain and symptoms, improved mood and increasing the ability to cope with life changing conditions. They provide a means of opening channels of communication for patients with disabilities, leading to enhanced feelings of wellbeing and improved quality of life. The FHT would like to thank all of the contributors for their help in compiling an article about

treating clients with long-term mobility problems (IT January 2011, Issue 95) – see

www.fht.org.uk/kt/touch_of_equality