1person Wheelchair

That Person In The Wheelchair Needs Your Touch b y Meir Schneider and Carol Gallup

Massage, passive movement and assisted movement help prevent the physical and emotional losses that wheelchair-bound people face.

When

7-erl-ic~ i r d l e y - ~ o rolunteered hr to bring massage theraI,y to Muscular Dystrophy Camp in St. Louis, Missouri, she was over\vllelrned by the yo~~ngsters' response. "They all wanted to get on the table; the demand was incredible. When we couldn't Set them up on the table, I worked o n them in their wheelchairs. I let them tell me where they wanted me to work. Every one oi'rhem had a different ache or pain and some had numb places where they wanred to feel again. These kids desperately needed to be touched. We put some bodies on the table that felt like a ball of rubber - so much lnuscle had been lost and replaced by connecti\~etissue. "There were 52 cxmpers, age 6 to 2 1, and 42 were in wheelchairs," Yxrdley-Nohr continued. "Most of the kids had D~lclienne[ ~ u c h e n n emuscular dystroplly, an early-onset, deadly form of MD]. You could see rhe whole ~ i a t ~ ~history r a l of the disease, looking st the diff'srent ages - rhc 6-year-olds could still move pretty well, then it got worse every year and eventually mol-c of them were in wheelchairs, and finally there were campers wirh so many life support devices attached to the chair that you rhought you probably wouldn't see r h e ~ nhere next year." Yardley-Nohr said she became a massage therapist because of a friend with I-~iuscular dystrop!ly. "Five or six years ago, he was going through a tremendous trauma - his noth her was dying of ca:icer and his dystrophy was going through the roof. His back and neck were al\vays in excruciating pain. I'd rub his back, and he'd say, 'You have a wonderf~lltouch.' H e became my guinea pig when I was in massage school, and he's been a regular client, one or two sessions a week, ever since. He invented a stretching routine chat he does every night for 30 to 45 minutes. Right now the disease is affecting his low back and hips, 2nd he's in a lor of pain. H e said, 'Your massage is thc only thing that keeps me going."' When people with serious movement limitations find massage therapists like Yardley-Nolir, the res~lltsat-e wonderful. Bu't many people in wheelchairs are not getting the touch they need, and the coli.icquelices, while slow ro ni.ri\.c.. ; ~ i - i .serious. The health of every sysreln of the body depends o n regular, nctive movement. For the whcclc1iai1--bo~~nd and those wirh limited movement, circulation diminishes. 11e1-vefi~ncriondeclines, ; ~ n dmuscles .~tropliy2nd s l ~ o r t c ~CI-c;iring i, contracturcs (tight joints tli.ir c;ili't straighten nol-ni.lll!~). \%'it11 pool- cic-cul:ition,skin breakdown bcgins, srarting witli sli:tl~nS,thcn pressu~-esores; eventually there c;ln be open \vouncl\ \o deep that n skin grafr h e c o ~ i i inil>o~\ii>lc. ~\ I ~ i ~ l i ~ c s t i, 1o1 1l ~i 1~ o ~ ~ \ ~ i ~;I!-c > af~rccluentl!, rio~i ,I l > ~ - o l > l ~()f'tcn ~~ii. t l i ~ , ~ i \ c~ o l t o \ i !L\ t ~ t ~ , : i ~ootr1c1 1 \~l ) i ~in ~ ethe

frontal plane); with the chest constricted, heart and respiratory problems are more likely. The mind is affected by serious movement loss too. The chronic pain gets bad enough that pain-killing medications can become a way of life. Resisting depression becomes a challenge; everything is harder to do when disabled, stressors get magnified, and disabled people can feel like outsiders, different - they don't look like the people on television shows or magazine covers. When active movement is severely limited or impossible, touch - massage, passive movement and assisted movement - can do a lot to prevent these physical and emotional losses. It can even turn them around, creating new possibilities of active movement and new hope. When 60-year-old Gene Carlson first started getting massage therapy 18 months ago, he had sustained more than his share of losses to multiple sclerosis. MS is a progressive disease in which patches of myelin, which insulates nerves in the brain and spinal column, die; symptoms can include paralysis, loss of sensation, incontinence and vision losses. Carlson was blind and paralyzed from the waist down; his upper body was weak and stiff, his left shoulder almost paralyzed. And, not surprisingly, he was very depressed. Then Carlson began receiving massage from Fred Baker, one of 10 licensed massage therapist volunteers with the King County Multiple Sclerosis Association in Seattle, Washington. Carlson gets a free session from Baker every other week through that organization. "Most of what I do with Gene and other MS patients is the somatic work of Dr. Thomas Hanna [Ph.D.]," Baker said. "And I use some neuromuscular therapy and Self-Healing massage techniques that I learned in workshops. Where there is no motor control, I do a lot of variation ofjostling, shaking, rocking and other passive movements - my own creation, with influences from [Milton] Trager and others." Soon Carlson saw enough improvement to get weekly sessions and pay for the difference. "To begin with, he was kind of motivated but still depressed; it gradually turned around," Baker said. "Then we triggered something About three months into it, when he felt stronger, he got inspired and decided to start working out with a physical therapist. I helped him with the program. Now he does a full upper-body workout every day and lifts weights with both arms, including the shoulder that was almost paralyzed. His doctors are amazed at how loose his arms and neck are and at his tremendous upper-body strength; he probably could pick himself up with a chinning bar -all this in the last year and a half. He's working out in parallel bars to regain his legs. He still hopes to get his sight back. Gene is phenomenal." Baker also works with people who have Parkinson's disease, a brain disorder that causes tremor, muscle rigidity, weakness and a hard-to-initiate, slow, shuffling, unbalanced walk. "I've had a limited amount of Trager" training, and his method works well with Parkinsorr's, so I use that," Baker said. "My Parkinson clients are making progress - it's really effective." A woman who lay bedridden for eight years, paralyzed from injuries sustained in a plane crash, tried for years to find a physical therapist or massage therapist who would work with her, and no one would. When Meir Schneider and a physical therapist agreed to take her on, she was so motivated she worked on her home program seven hours a day. When Schneider last saw her, she had recovered intelligible speech and could feed herself, manage a

wheelchair, walk short distances with a brace and had moved out of her parents' home to live independently. "These people fall between the cracks," Schneider said. "Everyone is writing them in one of off, including the medical profession. I had a physician - . my training classes; we were talking about a severely disabled client and this doctor said, 'I wouldn't touch that case.' I said, 'So who are you going to send her to?' "Doctors and physical therapists cope with the secondary problems as they come up. T o get improvement, they'd need to work with these patients on a day-to-day basis, allowing small improvements to build up. They won't do that, because it doesn't fit their treatment model, which is fairly drastic interventions drugs and surgery. Physical therapy is given only when fairly big changes in functional level can be made in a limited number of 20-minute sessions. But there is one health professional with a wider treatment model that fosters intuition, inventiveness and a strong body awareness, who has the potential to create real improvement and forestall the terrible consequences of limited movement and paralysis. And that's the massage therapist. This is the profession that can make the difference." Schneider continued, "People with severe weakness or paralysis have an incredible need for bodywork. They need [to] stretch, they need better circulation; even getting their shoulders squeezed is bliss. In my 24 years in massage therapy, I've helped about 300 people overcome paralysis. But I've met and heard of thousands more. I've learned that as a bodyworker, you already have what you need to help them -you have skilled touch. Find the touch that is pleasant to them. Don't be afraid to touch them, and don't assume you can't help these clients. You may be the one who will give them back their quality of life."

Working with paralysis and limited movement Schneider believes that 90 percent of paralysis can be reversed or eliminated. Our collective expectations, he feels, are a big part of the limited progress we've seen so far. "Even the very militant disabled people -working for independent living, lobbying for disabled access, doing wonderful things for themselves - have tended to believe, like the rest of us, that their condition is written in stone, and it's not. There's not enough research into how it could be different, and given this kind of collective hopeless attirude, that's not surprising." The following are principles that Schneider and other SelfHealing therapists have found important in working with paralysis and limited movement:

Pain is an excellentguide. If your touch is pleasant during the massage, doesn't provoke pain afterward and reduces pain, you're on the right track. Nineteen years ago, at age 35, Darlene Cohen came down with rheumatoid arthritis. Shortly afterward, she began working with Schneider. As she describes it in her recent best-selling book, Arthritis - Stop Suffering, Start Moving, her pain was so intense that "I couldn't stand to be touched, and I shrank from Meir's fingers. Because I also couldn't bear to move, 1 refused to do the prescribed exercises. My body felt like a closed, dense, heavy cage. I felt restriction in my chest every time I breathed ....[ T]he practice of self-healing [is to] manipulate the sensations, thoughts, perceptions and feelings that you are able to observe in order to improve you1 he<~lth ....[ Bly focusing on my MASSAGE

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Self-Healing actual bodily sensations, I began to find the smallest movements here and there, places in my body that were neither paralyzed nor painful. I discovered a tiny movement in my chest that I could make without pain, so for the first time in many months I could enjoy breathing That place was such a refuge, such a joy, I returned to it again and again, like a cat lying in a favorite spot in the sun. I found that I could move my thighs together and apart when I lay on my back. I delighted in feeling these small and precious spaces in my fossilized body and then enlarging them, spreading them into other restricted areas of my body." This was the beginning of Cohen's recovery. She became a massage therapist and today also teaches arthritis and pain management in rehabilitation settings.

Bear in mind which organ system is weak; this will tellyou where you need to be carefitl. Arthritis is a disease of the joints; you need to touch and move them very gently, but unless the muscle is very atrophied you can touch it vigorously. Muscular dystrophy is a disease of muscle; avoid fatiguing dystrophic muscles with your exercise program and touch these muscles lightly. But normally you don't have to worry about the joints with M D , so you can throw an arm or leg from hand to hand in passive movement without causing any harm. With a recent stroke, you need to avoid provoking a seizure with your exercise program, so keep exercise bouts shorter and do them more frequently. With polio, you can work the weak muscles hard, beyond fatigue - the loss was an isolated incident, when a virus killed motor nerves that bring the nerve signal from the spinal column to the periphery. Just as important, you need to rest, relax and unstiffen the intact, overused muscles, so that you create more balanced use. Schneider feels that physical therapy teaches polio patients to overuse the muscles that are strong, "and in my opinion it's this imbalance that causes post-polio. Creating balanced use can prevent or overcome post-polio," he said.

Consider whether the paralysis is caused by the original problem (the disease or injury) or whether it is secondary. ''I had a client who had lost strength in her calves from multiple sclerosis," Schneider recalls. "This in itself didn't prevent her from walking, but she compensated for the calfweakness by stiffening her hips so much that it caused her to need a walker and later a wheelchair. So she gained a lot more movement when we relaxed her hips through massage and movement, which isn't that difficult. "I often give polio clients an impossible challenge to the weak muscles. Vered, one of my earliest clients in Israel and now a Self-Healing teacher, had had polio," Schneider continued. "When I met her, she usually dragged her weak left behind her as she walked. We worked hard and she became strong enough to lift that foot three inches off the ground. A year later, in a training class in San Francisco, I asked her to put her foot onto a stool six inches high. She said, 'You're crazy.' I demanded that she lift it onto a massage table three feet high. She laughed at me but tried to do it. I did a shaking/releasing massage and asked her to put her foot onto the stool, and she succeeded. Imagining doing something so impossible for her broke through the belief that comes with the emotionally traumatic experience of paralysis, a belief that more movement is impossible. Eventually, she did lift her leg up onto the table - and literally fell over backwards with

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astonishment. Emotionally integrating a sudden, big improvement is hard for anyone; it requires a lot of work."

Timing can be important. Take, for example, stroke. Stroke is damage to part of the brain from hemorrhage or from interruption of its blood supply; sensation, movement or function governed by the damaged area is impaired. Usually movement and sensory losses occur on just one side of the body. With stroke, physical therapists tend to leave these patients alone during the early flaccid stage and begin work during the spastic stage, and, in Schneider's opinion, "That's a mistake. One day in a training class in Israel, a student said to me, 'My husband has just had a very serious stroke because of an emotional shock. The doctors don't think he's going to survive. You must come and help.' I was very sorry to have to tell her that I was seriously overbooked, and I simply couldn't. The class and I put a lot of ideas and good energy into her and sent her to work with him. She got in there right away, while he was still flaccid; she did the Self-Healing Neurological Massage [a cross between brisk shaking and tapotement that results in the muscle being moved rapidly in many directions, described in this column in the JulyIAugust 1996 issue] and passive movement with him for four hours every day. Initially he was paralyzed on the affected side. The doctors said he'd be in the hospital for about six months, but he limped out of there after two weeks -and came to our class. He was depressed, almost suicidal, but he sat in the class and seemed to soak up the energy and movement around him."

Getting the client moving is critically important with paralysis. Movement leads to more movement. Use your massage, the client's self-massage, and passive movement liberally before asking for movement and between the client's attempts. "With a lot of massage, we got this stroke sufferer moving every single day," Schneider said. "When a stroke client can't open his hand, you can have him do self-massage - tap on the fingers and forearm of the affected side. You can have him bend and straighten his elbow repeatedly, then make circles with his shoulder, then with his elbow, then with his wrist, then with his fingers. All of this enhances the tremendous stimulation you're giving them with the Self-Healing Neurological Massage - you've got the brain and spinal cord getting all kinds of feedback about movement and creating new connections, new paths. And then you're ready to ask for the movement you want the lost function. We worked on his lower body too, and got him to lift his leg onto a chair, and walk backwards and sideways important coordination exercises - and his walk improved. Finally, we motivated him, in this case with an atmosphere of fun - he was allowed to chase the students and try to pinch them. He had a wonderful time with this goofy activity, and his hand function and his walk got much better. Eventually all his symptoms cleared up."

Intersperse the client > attempts at active movements with having him or her visualize the movement, picturing it as fight, easy and spacious. Visualization is very powerful when it is used properly. You don't ask a wheelchair-bound client to visualize jogging on the beach; that would be useless. Have the client visualize a movement he or she can do, or barely do, becoming smoother or

Self-Healing easier. A multiple sclerosis client of Schneider's walked like a drunk, clutching walls and furniture indoors, cars outdoors. Not surprisingly, he fell and broke a clavicle. Bedridden for two weeks, he visualized himself walking well, in great detail. H e walked much better after the fracture mended.

People with paralysis or limited movement, especially with a nervous system problem, need balance and coordination exercises. If a stroke or head injury has affected their eyesight, try patching the areas that see well and getting them to use areas that don't. Find movements that are available that the client doesn 't know of Therapist Dror Schneider recalls, "I was working with a child with very severe cerebral palsy [damage to the brain in pregnancy or early childhood resulting in nonprogressive postural or movement losses] who had no voluntary movement at all. Afier a few sessions of massage, we took her to a warm pool. Suddenly she could kick! You should've seen the pleasure on her face."

Look for the position or angle where movement may be possible - with gravity eliminated,for example, lying on the back and moving the legs out to the side -or even with gravity helping a bit. Meir Schneider has had many clients with spinal cord injury with no movement or sensation from mid-thorax down. "I may put them more or less prone, put their knee into extreme flexion and begin yelling, 'Straighten your leg.' Gravity is working for them, so all they need is a little effort. This is one way that I find movements that no one knew they had. Every challenge in this situation needs to be a reasonably possible challenge. Once the client has found a new movement, let them enjoy the movement and develop it to the max; it will lead to more." Be aware that, in our Western civilization, as people get older and their lifestyles create ever more stereotyped, limited movements, they may haveforgotten that many movements arepossible. Once, during a conversation with a healthy, intelligent, highly educated friend, Schneider suggested he move his obviously stiff shoulders,

and the man asked, in all seriousness, "Can shoulders move?" Ana Paula Figueiredo, an occupational therapist and advanced Self-Healing student from Sao Paulo, Brazil, worked with a client with a nervous system disorder who had this kind of all-too-prevalent cluster of problems - "very poor body awareness, with a stressed, rigid, body and mind, a lack of relaxation - the body gets so tired, so stiff, and it needs massage so badly," Fipeiredo said. "I've been working- with him for two months, and the sad thing is, the disease worsens all of these problems, which I feel helped bring it on, though I can't prove it." The way she worked with this client illustrates most of the principles we've been discussing: "He walked like a robot -joints, muscles, everything rigid, stiff. He's a 56-year-old police officer - a very stressful job, with long shifts. Two years ago, he was diagnosed with cerebellar ataxia [a degenerative brain disease resulting in jerky, staggering gait and other uncoordinated movements (the cerebellum plays a major role in maintaining posture, balance and coordination)]. He couldn't walk

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Self-Healing \s.ithour liL,ll>;when his wife helpcd him wnlk, shc would often 6111 down with him, bccause he's a large man. H e could~l'r st;lnd independently without failing. and \\it11 eating, food would fall off his fork or he'd miss his mouth. His job became even more stressful - he couldn't d o any work; he wasn't in danger of losing his job but IIC W;IS SO depressed about it he said, 'For lne, it's better to die.' You don't want to I-etirein 13razi1, because of the inflation. " H e got a lot better in just the first two sessions," Figueiredo said. "The [SelfHealing] Neurological massage relaxed him, released tnuscle tightness, improved circular;on, created body awareness, and, \vith the passive movement of the neck, shoulders, elbows, hips, knees and feer 1 g ~ v chim, increased joint mobility, broke up some of his rigid patterns and showed his brain another possibility. W e did somc coordination exercises, including walking backward and sideways. H e was a sh.~llowbreather, so we worked on inhaling and holding the breath for increasingly longer counts. "His feer were frozen [immobile] in his shoes; he didn't like to take them off to d o the exercises," Figueiredo continued. " H e couldn't move his toes. Frozen feet rend to limit movement all the way up the body; I always check for that right away with a new client. W e did a lot of movement, especially circular movement, with his toes and feer, stopping often to visualize lightness and ease in the rotations. "I changed his awareness about standing. As he sat, I did a light, circular rapping o n his abdomen around the navel, teaching him to feel his center. I had him t ; ~ pon his thighs and visualize their strcngrh, th:lt it ...was they, not .~.' the back and --,. .

:~l~domen, that would cause him to stand, ant1 I had him visualize the connection of his feet with the floor. During- the second session, he could stand without assistance arid walk forward and backward independently. After three sessions, he regained the ability to button his shirt and dress himself independently," Figueiredo said. "If he's going to go on improving, he's going to have to move out of the depressed attitude that the body is an enemy that has betrayed him. He'll have to d o the home exercise program regularly --you can't make serious progress without it - and go on improving his movement and developing body awareness." Apparently, surviving parts of the brain took over some of the lost functions and further deterioration was prevented.

Turning around an inexorable disease Over the years Schneider has become increasingly aware of a need for scientific documentation of his results. "With good research, we can convince the muscular dystrophy associations that there are more possibilities for MD patients than painkillers and wheelchairs -we can get credibility. And we need to make this work available to people who can't afford it now research can lead to insurance coverage. As a massage therapist, I want to see our profession become respected for its achievements; there's some great work out there - and research is essential for that." Schneider feels hopeful about these goals, because his Self-Healing Method is the subject of several scientific studies. Two of the studies are still in progress; a third, a master's thes~sproject at San Francisco State University, was presented

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Education Confercncc of the 8rncric;ln Massage Therapy Association in June. All the studies address Schneider's work with muscular dystrophy. T h e disease is an ideal choice for research because it is relentlessly progressive. T h e medical profession has nothing to stop its progress or turn it around. N o one study proves anything, but well-documented improvement with M D suggestb that at least some part of the therapy program is effective, because it couldn't possibly happen by chance - there are no spontaneous improvements. Typically, you start with a single-subject study, or case study, to explore what you may find and hone your research tool; then you move on to a larger study. It helps to have more than one research group studying your work. Muscular dystrophy is a group of inherited diseases with a comtnon outcome: fragile muscle fibers that get over-challenged and damaged easily, and then die. Dead muscle fibers may be replaced by fat or connective tissue. Dystrophic muscles are often shrunken and look wasted, hut if there is extensive connective tissue replacement, they will look bulky and feel very fibrous. This is called pseudohypertrophy, a classic sign of Duchenne M D - ironically, the young MD patient looks like he has the calves of an athlete. Muscular dystrophies differ as to what gene is defective and which muscles are affected, how early and in what sequence. Science has identified only two of the genes - one causes myotonic dystrophy, which attacks many systems of the body and ranges from mild to lethal; the other causes Duchenne M D , which is early-onset, fast-progressing and deadly, and two milder forms, Becker and symp-tomatic Duchenne carrier.

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Self-Healing muscle is a jumble of healthy, damaged The third, the Self-Healing and dead muscle fibers) and macroscopic Buildup Massage, may begin (for example, a weak bicep and strong delweeks or months after the first toid on one arm and the reverse on the cwo massages. You must observe other). puffing before you begin Buildup Studies of muscular dystrophy often Massage. Buildup Massage is a measure things like strength, speed in cergentle rotation of both thumbs tain tasks or muscle cross-sectional area or on the muscle, using only a little composition. Gallup chose to look at more pressure than with support. functional change instead. Changes in Alternate among Buildup, strength or bulk of specific muscles don't Support and Release Massage. necessarily translate into functional When the muscle responds Self-Healing Support Massage is thefirst step improvement, and function is the bottom well to the massage, passive to muscle regeneration. All 1Ojngertips line for a disabled person. Her measuremovement is added to the promake a vey light, gentle rotating motion; ment tool, kinematic analysis - a margram. The next step, usually deep penetration is achieved through visualiaztion. riage of physical education and bioengiwithin four or five sessions, is neering made possible by photography active movement, much of it T h e Self-Healing therapy for MD and, later, cinema - affords a wealth of pool work, talung advantage of the gravityinformation about sports, rehabilitation, Schneider's regimen for muscular dystrocountering effects of buoyancy and of the any kind of movement, much of which phy begins with a sequence of three maslow, even resistance of water. Many of the was totally unavailable in the past. And it sage techniques that release tension from movements are frontal plane or circular; we the muscle, improve local circulation and live and get overuse patterns in create a sense of nurturing. the sagittal (fonvardlbackward) The first technique, the Self-Healing plane. Circular movements espeSupport Massage, is a very light, fingercially tend to create new muscle tips-only (use all 1O), circular motion, recruitment patterns. If a muscle patiently going over and over a dystrophic is very weak, the number of repemuscle for 30 to 90 minutes, while you titions will be small at first and visualize that your touch is penetrating increase only gradually. The deeply. The fingertips need to be very body moves toward a more even, aware, very alive. If a muscle is very dysnon-stressful use while endurance trophic, you may need to work so lightly is built up with these exercises. Self-Healing Release Massage releases tension that you touch only the hairs above the in the muscle. Spread out thefingers and shake skin or work on an adjacent area instead, The San Francisco State the musclegently. As with all massage of to begin with. The massage is successful University study dystrophic muscle, the touch is nonvigorous when the muscle noticeably enlarges, or Because Self-Healing therapy and light (no pressure or weight are used). "puffs," and the tone improves. appears to be especially successThe second, the Self-Healing Release offers a certain reliability; if there are quesful with facioscapulohumeral dystrophy Massage, performed only after puffing is tions, you've always got the film. (FSHD), one of the milder muscular dysobserved, releases tension in the muscle. It Gallup was lucky enough to work with trophies, Gallup chose to do a case study is the major tool to reduce connective tisone strong contributor to the field, Joseph of an FSHD client. The disease affects sue replacement, which palpably decreases R. Higgins, Ph.D., and to rub shoulders perhaps one in every 20,000 Americans; with others in the Kinesiology with this massage. Spread out your fingers researchers may be close to finding the Department at San Francisco State. "The and shake very lightly. gene. FSHD is characterized by early department is incredible," Gallup said. signs of progressive weakening "You stay away a few days and come back and functional loss in the face, to find better cameras, more computers, a shoulders and upper arms, but new dynamic EMG [an electromyogram other parts of the body can susgives a graphic record of the contraction of tain losses at any point in the a muscle as a result of electrical stimuladisease course. People with tion], people getting rcady to present their FSHD may have trouble talkdata at some conference. One new faculty ing, whistling, chewing, closing member they brought on had revolutiontheir eyes, lifting and carrying ized swimming. The day I first walked things, reaching for objects on into the department, a professor told me high shelves, walking and with with tears in his eyes that he had just taken other functions; some become delivery on a piece of equipment that was Self-Healing Buildup Massage is done wheelchair-bound. The pattern the same model they had on a space shutaftpr muscle 'pufing''is observed. of muscle loss is kaleidoscopic tle, state-of-the-art." Gently rotate 60th tl~zinzbson the ~,,usc/e. on levels both microscopic (the

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Self-Healing In kinematic analysis, the subject is videotaped performing certain tasks; centers of relevant joints are marked with reflective tape. Later, sequences of video images are captured as individual frames into a computer program. In programs that lack automatic digitizing, the program displays the frames one by one and instructs the operator to digitize each joint center in sequence. The program compares the location of the marked pixels on the screen with a meter stick, an on-screen object of a fixed size, to generate metric distance, velocity and acceleration data. It also generates data on angle and angular velocity and acceleration of joint and limb segments. Gallup videotaped her subject, Karen Myers, a 3 1 -year-old woman with FSHD, in a variety of functional tasks during a three-week baseline period and then throughout five and a half months of therapy in the Meir Schneider Self-Healing Method. Myers had three to four sessions a week. One task was suggested by Myers herself after nearly four months of therapy. During a filming session in September 1995, Myers told Gallup that during a recent visit to an arts festival, shehad found that she could carry a plate of pizza at waist level, a task that a very dystrophic right biceps brachii had made impossible for three or four years. "Normally I would carry the plate of food in my left hand and the soda with my right hand, with that arm hanging at my side, because it's too much of a strain to hold anything up for more than a few seconds with my right arm. But I noticed that I was carrying the soda in my left hand and the plate of food in my right, and I didn't have to stop and put it down or change hands. I yelled, 'Hey Lisa,' [to her companion] I'm carrying a plate of

pizza! I walked around feeling happy for hours. This was the first time I noticed that there was a big improvement in my abilities, that my body just naturally did something because it became strong enough to do it." Gallup invited her to carry a one-kilogram (2.2 lbs.) weight on camera until she felt the muscle begin to tire. Myers carried the weight at waist level continuously for more than half a minute. Myers was examined by her neurologist before and after the course of therapy. H e found that the strength of her right biceps had gone from 40 percent of normal the previous year to 80 percent of normal, and reported improvements in the strength of other muscles as well. Gallup found that Myers' progress in walking showed up most clearly in the "platform event." Disabled people have to cope with curbs and low steps, so Gallup created a low platform to simulate this problem, and looked closely at a moment of challenge -when weak hip muscles would have to work eccentrically, or in a lengthening position, as Myers descended from the platform. One of Myers' problems in walking is what physical therapists call a gluteus medius limp - the gluteas medius pulls down the hip of the leg you are standing on and thus passively raises the hip of the leg that is swinging forward, to ensure toe clearance. When the gluteus medius and its helpers are weak on one side, a person can passively lift the opposite hip instead by tilting the shoulders laterally, away from it; with that strategy, the hip and shoulder on the side of the stance leg get closer to each other, while those on the other side are drawn further apart. Myers' pathological shoul-

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November I December 1996

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Self-Healing derlhip distances showed a modest improveme~~t from the early trials to the late trials as she descended the platform. Myers has problems controlling the upper body in descending from the platform. She tends to lean backward as the stance leg accepts weight; this reduces the challenge to her weak hip extensors while increasing the challenge to the hip flexors, which are much stronger. There is a modest decrease in backward lean during this critical period from the early trials to the late trials. After the second leg comes off the platform and the leg you are standing on bears all the body's weight, normally that leg is fairly straight at this time - bur Myers has an abnormal bending, or flexion, of the hip and knee at this time. Several parameters showed a modest improvement in this problem from the early trials to the late trials on the more challenged left leg. Gallup expected to see a very modest in~provenlentresulting from this brief course of therapy. As the chair of her committee, Virginia Saunders, Ph.D., head of the Physiological Psychology Department at San Francisco State, said, "Medicine has the cannon - powerful, invasive interventions with drastic effects, including side effects. Holistic health has the peashooter - gentle therapies with much smaller effects that take a longer time to arrive." T h e change in Myers' right biceps took Gallup by surprise. T h e improvement, she believes, was the result of neuromuscular adaptation - changes at every level of muscle and nerve that accompany exercise regimens. Physical education/kinesiology has long studied such effects, mostly with skilled performers. More studies are needed to determine whether these effects differ with disabled subjects; this was part of what Gallup wanted to begin to explore. Until there are a great deai more studies of the effects of massage it will be difficult to characterize its contribution. Fortunately, a team at the Touch Research Institute at the University of Miami headed by Tiffany Field, Ph.D., is creating such studies, and is teaching other massage therapists to perform their own - an encouraging sign that the profession is taking

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MASSAGE

Issue Number 64

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Novt.~r~l,erIDecembe! i99E

itself seriously and establishing itself in the world. Gallup sees her study as part of that trend. Gallup plans to look for funding for a larger study with the faculty at the Kinesiology Department at San Francisco State, adding two new tools - a dynamic EMG system, which measures timing and intensity of actions of muscles involved in an action; and a force plate, which yields information about floor contact and forces that affect There was a human cost to the present study - Myers left her family, friends and job in Philadelphia to risk participating in an unknown therapy. She said she's glad she did: "I really felt a dramatic improvement over the course of the therapy. M y stamina is much better, even my balance is better, my strength in my arms is a lot better. T h e massage is awesome; I felt like it supported my muscles and made it easier to exercise, and when I was tired from exercising it nurtured me. I had gone to physical therapists and they wore me our with exercises without making me stronger. This is the first time that I found exercises that I really enjoy doing and that have been so beneficial." Ul

Meir Schneider, Ph.D. L.M. T , an internationally known therapist and educator, is the creator of the Meir Schneider Self-Healing Method, the author of two books, Self-Healing: My Life and Vision andThe Handbook of Self-Healing, and tl7efounderldirector of the Center and Schoolfor Self-Healing in San Francisco. As a teenager, lye overcame blindness caused by congenital cataracts and other serious vision problems and today has an unrestricted driver? license. For fitrther information, call (415) 665-9574. Carol Gallup is an advanced student of Self-Healing, Registrar of the Schoolfor Self-Healing, staffwriter of the Self-Healing Research Founddtion, and the author of numerous magazine articles. She stz~diedphysicaltherapy at the Mayo Clinic and is now a rnmrter; degree candiddte in research psycho logy at San Francisco State University.