1. Chapter 7: Superficial Reflex Techniques Outcome-Based Massage: From Evidence to Practice © 2009 LWW

2. Objectives At the end of this presentation, you will have the information needed to: Describe 3 superficial reflex massage techniques Explain the outcomes they produce Know when to avoid them or modify their use Begin manual practice

3. Definitions Superficial: pertaining to or situated near the surface Reflex: an involuntary reaction in response to a stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord ©2009 LWW

4. Reflex Effects of Massage Are mediated by the nervous system Peripheral receptors send impulses to centers in the brain or spinal cord, which then cause a local or systemic response. E.g., stroking a persons hand at the right rate and rhythm can cause drowsiness.

5. Mechanical Effects of Massage Are caused by physically moving tissues, by: –Compressing –Stretching –Shearing –Bending –Twisting E.g., stretching scar tissue causes it to lengthen.

6. Superficial Reflex Techniques Engage the skin and affect level of arousal, autonomic balance, or perception of pain. Include: –Static contact –Superficial stroking –Fine vibration

7. Static Contact Motionless contact of the therapists hands with the clients body, performed with minimal force The least mechanically forceful of the massage techniques An important part of systems such as Therapeutic Touch, Reiki, and Polarity Therapy

8. Static Contact: Outcomes and Uses Increases rapport Decreases anxiety, improves relaxation Analgesia May improve growth of premature infants Is used to assist with client education May affect clients electromagnetic field

9. Static Contact: Contraindications and Cautions Contraindicated in areas of acute inflammation because of pain Clients who have much pain or distress may not tolerate touch at all. Be sensitive to the needs of frail, high-risk, or terminally ill clients. Even though static contact causes minimal mechanical effects, it can give rise to complex physical and emotional responses, including touch- triggered memory.

10. Performing Static Contact Use a relaxed upright posture and fully relaxed hands. Breathe using your diaphragm. Encourage relaxation and diaphragmatic breathing in your client. Observe client for signs of relaxation. For a relaxation response, try applying static contact to the clients occiput, sacrum, face, hands, or feet.

11. Static Contact Applied to the Occiput

12. Static Contact Used to Teach Breathing

13. Superficial Stroking Gliding over the clients skin with minimal deformation of subcutaneous tissues Usually applied unidirectionally over large areas of the clients body Often used at the beginning or end of a region or intervention

14. Superficial Stroking: Outcomes and Uses Reduces pain Improves mood and reduces anxiety Changes level of arousal (alertness) Improves growth of premature infants May alter level of neuromuscular tone

15. Superficial Stroking: Contraindications and Cautions Contraindicated in areas of acute inflammation because of pain Clients who have much pain or distress may not tolerate touch at all. Be sensitive to the needs of frail, high-risk, or terminally ill clients. Recent myocardial infarction With bypass surgery, wait 48 hours. Ticklishness: use a broader contact, more lubricant, or more pressure

16. Performing Sedative Stroking Use: –Relaxed contact with the entire palmar surface –Slow, stable rate –Caudal direction (down limbs and back)

17. Performing Stimulating Stroking Use: –Fingertip contact –Fast irregular rate –Multidirectional strokes

18. Superficial Stroking of the Face

19. Superficial Palmar Stroking of the Back

20. Fine Vibration Fast oscillating or trembling movement produced on the clients skin with minimal deformation of subcutaneous tissues Manual technique is hard to perform long enough to be effective. Perform using a machine that vibrates at 100 Hz

21. Fine Vibration: Outcomes and Uses Analgesia for both acute pain and chronic pain Improves ability of clients with neurologic problems to perform exercise (through temporarily raised neuromuscular tone)

22. Fine Vibration: Contraindications and Cautions When pain is due to acute inflammation, the weight of a hand or of a machine may not be tolerated locally

23. Performing Fine Vibration Analgesia is much greater when: –Vibration is applied continuously for longer than 30 minutes –Rate is 100+ Hz So use a machine! You can attach it to the client, freeing your hands to perform other manual techniques.

24. Using a Fine Vibration Machine

25. References The references for the material in this PowerPoint presentation are found in Chapter 7: Superficial Reflex Techniques.