Positive Health Online

For decades dementia has been on the increase due to a burgeoning ageing population and is now one of the greatest pressures on healthcare systems around the world. Over the past 18 years I have given many reflexology sessions, mainly on the hands, to nursing home residents and others who are living with dementia. There many stages of dementia and clients may be uncommunicative and others will be articulate, lively, responsive and very aware that their cognitive faculties are beginning to fail. Dementia can take many forms, including Alzheimer’s disease, and all conditions have the potential to respond favourably to a therapeutic touch.

The G8 summit on dementia in December 2013 is expected to agree to a package of measures that will see collaboration on research, sharing of expertise and closer cooperation as part of a worldwide push similar to global efforts to fight cancer, malaria and HIV and AIDS.[1]

There are a growing number of research studies and trials in relation to reflexology and the following paper by Nancy A Hodgson RN PhD CS Efficacy of Reflexology as a Palliative Treatment in Nursing Home residents with Dementia: Pilot Study July 2006[2] suggests that reflexology “may be an effective treatment for older adults with dementia, appearing to relieve pain and improve psychological well-being”.

Hodgson’s results showed that the following analysis of variance for repeated measures demonstrated a significantly greater decrease in symptoms of pain, depression and physiologic measures of stress for the residents given reflexology treatment than for those in the control group. The conclusion was that “these clinical findings support the use of reflexology in nursing home residents with mild/moderate dementia.”

Anecdotal Examples of the Results of Hand Reflexology Treatments

Oran Aviv, a senior reflexology tutor in Tel Aviv, Israel was taught Vertical Reflexology Techniques (VRT),[3], including simple VRT Nail-working on the thumb nails and immediately incorporated these into her care plan when working with Alzheimer/Dementia residents.[4] In 2007 JDC-ESHEL-The Association of the Planning and Development for services for the Aged in Israel developed a pilot program to train Day Center staff in the basics of Aromatherapy. Four staff members of the Kfar Saba Day Center participated in the program. The Day Center then implemented the program by leading both group and private sessions of simple hand massage. Jeffrey Lieder, the Manager of the Day Center reported, "When Oran offered her expertise in reflexology and volunteered her professional knowledge and training to expand and improve the program it was a perfect fit". Oran Aviv describes the project:

I incorporated some of Lynne Booth’s Vertical Reflexology Techniques (VRT) in the Hand Reflexology course I taught to caregivers of patients with Alzheimer's/Dementia. I have come to realize that the VRT nail-to-nail technique is absolutely amazing. I feel it is like a way of covering the whole body in a very short time and space. I can see how different areas of my own nail are sore depending on my own state of health and the state of health of my own clients.

In the Hand Reflexology course, the caregivers found the VRT nail-to-nail technique to be one of the most important techniques they use on the residents. Sometimes the caregivers only have a few minutes to work on a client before they get agitated or bored and the nail-to-nail technique is one of the techniques they use.

The main emphasis of the course was divided into several areas:

1. Working the fingers to stimulate head/brain;
2. Working the digestive system;
3. Working the respiratory system;
4. Techniques and reflex points to reduce anxiety.

The results of caregiver's Hand Reflexology Course have been very exciting. Some Alzheimer's/Dementia patients are sleeping better, some are less agitated, one no longer suffers from constipation and one caregiver said her resident is starting to eat by herself - which she has not done since the caregiver came to work for her.

When performing Hand Reflexology the reflexologist and client sit opposite from each other on chairs. There is constant facial contact and they can speak to each other.  This makes giving reflexology to the patient with Alzheimer's/Dementia much easier and does not cause unnecessary tension or anxiety. The carers meet weekly for classes and then practised on themselves, friends and eventually as they became proficient, on their charges.

A caregiver is taught to work on a patient at the Kfar Saba Day Center, Israel

The cost to healthcare is huge, with dementia now one of the greatest pressures on healthcare systems around the world. Globally, 36 million people have dementia and the World Health Organisation predicts that numbers will nearly double every 2 decades - meaning 66 million people will have dementia in 2030 and more than 115 million in 2050. In simple terms, that means someone in the world is diagnosed with dementia every 4 seconds.[1]

In the book From Heart Through the Hands: The Power of Touch in Caregiving by Dawn Nelson[5] she refers to a 1996 pilot study in a Chicago care home where a correlation between certain kinds of touch, on specific parts of the body, and specific behaviour patterns in people with dementia. This refers to massage rather than reflexology but it is worth reflexologists experimenting with the following findings to see if a certain reflexology approach works better. Nelson suggests that “Foot treatment: works well for those who are hyperactive, restless or have a tendency to wander. Hand treatment: generally works well for those who are sad, anxious and fearful.”

I run short training sessions for relatives, carers and medical staff and demonstrate simple but effective hand techniques and methods of helping relax and calm a person who is living with dementia. Relatives welcome this skill as they often feel powerless when visiting a loved one who does not respond or communicate easily. The nursing staff gain valuable techniques to use in various situations when the person may become distressed. 

Dementia is one of the greatest medical challenges of the 21st century and reflexology is a complementary therapy that should be considered, alongside other modalities, in offering valuable support to this group of clients or patients and those who care for them.

Case Observation: Role Reversal where the Client gives the Therapist Reflexology

Recently I had a moving and unique experience while working on an 80 year old lady, Miss Y, as she gave me a hand reflexology ‘treatment’. Miss Y has grown frail over the past 2 years and her speech and cognitive abilities have become increasingly impaired. She can, on occasions, be very aware of her surrounding and always enjoys being smartly and tastefully dressed. By using some of the Vertical Reflexology nail-working techniques,[1] plus pressing on precise reflex points on the hands, Miss Y often begins to focus more and concentrates on her words and often makes understandable comments or remarks. Occasionally she will suddenly say, “I am very lucky” or “Come again” or tries to impart complicated phrases.

On this particular day Miss Y was not particularly communicative but I worked gently on reflex points to help support her digestive system and to relax and calm her generally. At one point she had been staring into space then she suddenly, but gently, took my hand, palm down, in her two hands and stroked and squeezed it. She gave a little smile, then held my hand in hers while she precisely pinched and worked each of my fingers individually. She took my thumb and tapped on the nails, and then turned my hand while she worked up and the down the palm which is part of a relaxation treatment for the organs and trunk. She was in deep concentration but a couple of times looked up at me and I thanked her for giving me such a lovely session. To finish she stroked up and down and then pressed the reflex points on the medial side of my thumb down to the wrist which refer to the spinal reflexes.. She followed that by gently brushing her fingers down my hands. This experience took about 10 minutes and only ended when I told I better start working her hands again so she got some benefit too!

Several interesting points can be taken from that unusual reflexology session:

The resident, Miss Y, can sometimes seem disconnected from everyday life and appears not to observe her surroundings at times. Yet, the power of the therapeutic touch had not only reached her but she had felt, observed and learnt various aspects of reflexology that she was able to share at an intuitive, precise and practical level.

Her next reflexology sessions appeared positive in terms of her response but there has been no repeat so far of her caring and relatively accomplished skills as reflexologist.

Miss Y gives an accomplished, impromptu hand reflexology ‘treatment’ to her therapist.

Reference

1.  G8 Summit on dementia UK Government Press Release December 11th 2013.  www.gov.uk/government/news/g8-dementia

2.  Hodgson,  Nancy A RN PhD CS Efficacy of Reflexology as a Palliative Treatment in Nursing Home residents with Dementia: Pilot Study. July 2006.  

3.  Aviv, Oran Article: Caregivers Learn Hand Reflexology to Help Patients with

Alzheimer's/Dementia.  www.reflexandmore.com

4  Nelson. Dawn, From the Heart Through the Hands: The Power of Touch in Caregiving   Findhorn Press. ISBN-10: 1844090833. 2006.

5.  Booth, Lynne. Vertical Reflexology for Hands. Piatkus Books, London. ISBN: 0-7499-2319-9. 2003.