Being Paralyzed and a Neuromuscular Therapist

Many questions are asked when we see a wheelchair role into our offices. 

Do I start moving things out of the way, how are they going to get on my table,
will the client fall off, what modality can I use, will I hurt them?

Let me start by giving a little perspective from a wheelchair (chair) user’s
point of view.

Making our customers feel comfortable is always our biggest obstacle, making a big deal out of seeing a chair coming through the door is a big no, no in the disabled world.  Those
of us that push a chair around all day know exactly how wide our wheel base is. 

A bit of advice, if the individual in the chair needs something moved, the majority of individuals would rather ask you to move the item or move it themselves.  Usually, if
you move an item that didn’t need to be moved in the first place, then you have
created the obstacle.  Remember, being in
a chair is not new to them.  

If you've ever asked how they are going to get on the table; just remember we
all have to transfer out of our chairs each and every day.  They will ask
for assistance, if they need it. 
Otherwise, stand back and wait for them to get on the table.  Once on the table you can then move their
chair.

Will they fall off the table? 

It has only happened to me once while I was taking a CEU class.  During an abductor stretch the therapist that was working on me let go of my leg while it was over the edge of
the table.  This was the only time I thought
I was going to fall but thankfully, I didn’t. 
Just be conscious of where the paralytic limb is placed and held, and
you should have no issues.

What modality can I use? 

As a spinal cord injury (SCI)-incomplete, I do not detect temperature changes, have sensations that are not actually there and live with spasticity.  I have also worked with
numerous disabled Athletes over the past 14 years, including Paralympians, with
paraplegia, quadriplegia and hemiplegics. 
Personally, I have had every type of complementary care possible
available through Department of Veterans Affairs; including dry needling,
acupuncture, physical therapy, medical massage and SCI rehab.  During my certification as an NMT and Sports
Massage Therapist, I have experience lymphatic drainage, la stone,
hydrotherapy, sports massage, cranial sacral, tui na and if you have every
experienced NMT you know we use PNF, MET, PIR, MFR and trigger point (TrP) therapy
as well as stretching affected areas.  In
my humble opinion, the modality is not necessarily the issue, as much as the
way the modality is applied.

When dealing with new students that are going to be working on me, I normally ask them to think of my lower body as that of a new born, fragile in the sense that there is the possibility of
ligament/tendon tears or joint dislocations. 
I advice them, that they must be aware of the “restriction barrier”, which
is meant to indicate the place where the first signs of resistance are noted, and
to watch for joint movement while stretching the paralyzed area.   I
advice them, not to push the stretch to the greatest possible range of movement
available, so as to prevent the possibility of injury. 

If you are using a modality, such as PNF, MET or PIR where you are requesting a contraction of the agonist or antagonist; as suggested by Chaitow for acute pain, request your paralyzed
client to visualize them self engaging the required muscle, to induce an
isometric contraction.  This
visualization of the contraction has a profound affect on increasing the ROM.  Furthermore, include visual synkinesis “eye
movement” of the client; requesting them to look in the direction of contraction,
as well as to look in the direction of stretch.

Over the years I have found numerous TrP’s in my paralyzed clients and myself.  As a NMT, I utilize gentle ischemic compression to release TrP’s. 
Rather than the normal referral pain patterns associated with TrP’s, I
have encountered both personally and from paralyzed clients, during a TrP
release, a since of intracranial pressure change.  Ask your clients if they are experience any
changes through out the body during TrP therapy.

Edema is normally a daily fight in lower extremities, for most individual whom sit for extended periods of time, due to lack of movement and inguinal lymphatic nodes being restricted and congested.  If you are trained in MLD, I would highly
recommend not only draining the intestinal trunk, superficial inguinal nodes,
deep inguinal and subinguinal nodes, but I would also encourage therapist to
teach their clients to perform self MLD to these areas.

Eliminating TrP’s and helping your clients regain ROM and encouraging your clients to perform self-stretching, self-MLD, yoga, tai chi on a daily basis will help them tremendously in reducing pain, fatigue and
spasticity.  

I began learning the art of massage/bodyworks in 1989, in Indonesia from Sensei Tono and Sensei Albert.  While serving in the Army, as a Military Intelligence Soldier, incurred a Spinal Cord
Injury.  I have participated in numerous
sporting events on the national level, including Alpine Skiing and serve as a
mentor and therapist to disabled athletes.

Don G Peters II, NMT

http://murphyslaw.massagetherapy.com/