Positive Health Online

Introduction

Stroke is the biggest cause of severe disability in adult life in the UK and the third commonest cause of death in developed countries.[1] Every five minutes one person will suffer a first stroke, with about 10% of those people being under the age of 55.[2] In the elderly population, stroke remains a major cause of death.[3] The use of reflexology to aid the rehabilitation of people with stroke has been undertaken and people's intrinsic ability to self-heal combined with this gentle treatment encourages that process.[4]

Working a reflex point on the big toe

Most people are aware of reflexology as a complementary therapy whereby specific pressure is applied to the feet and sometimes the hands. Modern reflexology dates back to 1913 when Dr William Fitzgerald introduced 'zone therapy' to the Western world. Reflex areas on the feet and hands relate to areas within the same zone of the body and by working these areas in a specific way it can help to restore the body to its natural state. It is a balancing treatment that works on the body, mind and emotions, with people who receive treatment reporting a feeling of well-being and a reduction in a variety of symptoms relating to digestive disorders, headaches, muscular aches, fatigue, and a multitude of stress-related conditions. The importance of reflexology being 'complementary' means that it can be used alongside other orthodox medical treatments or complementary therapies.

Although I am concentrating on stroke in this instance, reflexology does not treat specific symptoms of disease but rather treats the whole person and as a result most people benefit from several sessions of reflexology adapted as a treatment plan tailored to the individual's needs.

Risk Factors of Stroke

The term 'stroke' is used to describe "rapidly developing clinical symptoms and signs of focal, and at times global, loss of cerebral function lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin".[5] Stroke can be referred to as a 'cerebral thrombosis' or 'cerebral embolism'. Other terminology denoting the varying degrees of stroke include 'transient ischaemic attack' (TIA) and 'cerebral vascular episode', formerly called a cerebral vascular accident or CVA. Most strokes are caused by a blockage in one of the arteries carrying blood to the brain. A stroke may also be caused by a haemorrhage in the vessels of the brain caused by a ruptured artery. Depending on the damage situated in the brain and the area in which the thrombus is localized, the person will have different physical symptoms.

Factors that put people more at risk of having a stroke are high blood pressure, cigarette smoking, high blood cholesterol, being overweight, high blood sugar and, for women, the contraceptive pill, with many of these factors correlating with a stress-related lifestyle.

Aims of Reflexology

The holistic focus - looking at the whole person - is essential to me as a reflexology practitioner, and after taking a detailed case history it is important to find out what the client hopes to achieve from reflexology. Healing is more likely to take place when someone is fully relaxed, and reflexology encourages greater relaxation and increases the overall effectiveness of the individual's ability to heal. With the condition of stroke, it is not just the actual symptoms experienced during the episode that are the problem, it is the devastating effect left on the person after diagnosis, due to localized damage of the brain and forced changes due to physical limitation.

Case Study - William

Aims of Treatment

The aims of treatment for my client, William, were first and foremost relaxation, enabling him to switch off from everyday stresses created by work and his lifestyle. Another main aim of the treatment was to ease the muscular ache in his shoulders, which was the result of the stroke. The antihypertensive and anticoagulant medication prescribed following the stroke reduced William's blood pressure to normal, as this was high preceding the stroke and diagnosed as a main contributing factor. William hoped that reflexology would help to stabilize his blood pressure further, so dependency on the drugs could be reduced (under GP supervision).

Other conditions noted during treatment and through the initial case history information showed that William had a tendency to feel discomfort and increased sensitivity in the gut, therefore alleviating the symptoms of this was also seen as a secondary aim of reflexology. However, this was not the reason that William undertook reflexology, as his primary aim was to alleviate the pain he felt in his shoulders.

How Did the Stroke Affect William?

Physically

Physical symptoms clear at the onset of William's stroke included problems with balance and co-ordination; paralysis on the right side of the face affecting the mouth, accompanied by dysarthria (slight slurring of speech); difficulty in swallowing for a few days following the stroke; pain in both shoulders particularly when the arms were lifted above shoulder height and when turning or stretching; and increased sensitivity to cold temperatures. This last observation may be due to the fact that he was prescribed medication with anticoagulant properties to reduce his blood pressure, in effect making him more susceptible to feeling the cold.

Mentally

The association of stroke with the brain is very relevant to the mental effect that it can have on the sufferer. William took one month off work at the recommendation of his doctor, which was totally out of character for him as he had rarely had a day off sick before this. William's acknowledgement of the effects of his stroke and his acceptance that he needed to relax highlighted the seriousness with which he addressed his state of health after the stroke.

Emotionally

Disturbances in mood will occur if specific parts of the brain are affected. A severe loss of appetite may follow a stroke, and the physical limitations brought about by stroke may lead to depression. William did not suffer severe symptoms such as these; however, his self-confidence was negatively affected by the loss of control he experienced after his stroke, i.e. not being able to drive or work. William was very positive once his condition had been diagnosed, as he regarded this as a warning sign for him to slow down.

Socially

Physical symptoms that continue for some time after the stroke will interrupt the social life of the person. For example, if the person has difficulty swallowing or paralysis of the face, it may be embarrassing for them to eat out socially or even be seen in public. There is also stigma attached to loss of bladder and bowel control, which could cause embarrassment and inconvenience to the stroke sufferer. William was slightly uncomfortable with the thought of eating out in a public place until his face had fully recovered, as he found it difficult to consume liquids without dribbling.

Initial Reflexology Consultation and Observation of the Feet

William suffered a minor stroke in January 1999, although he was originally informed that it might be Bell's palsy. His GP diagnosed hypertension and the results of a CT scan showed that he had suffered an acute ischaemic stroke; consequently he was signed off work for four weeks. He was told not to drive for at least one month and then to have a check-up with the doctor to ensure that he would be safe after this period of time. He believed that the onset of the stroke was caused by stress brought about by work pressures.

My initial consultation with William (aged 55) took place 15 months after the stroke occurred and gave me a clearer picture of different aspects of his life: past and present state of health, and his diet and lifestyle. At the time of taking the case history, William was still in a demanding job that involved a great deal of travelling by car. To this end, it was fair to say that he was under considerable pressure at work. William used to smoke 20-30 cigarettes a day when he was younger but gave up completely over 30 years ago. His exercise routine included walking at the weekends in addition to being physically active both in and out of work. He had been having difficulty sleeping preceding the stroke but noted that he had always been a light sleeper and easily woken. When asked what he did to relax he firstly said he didn't know but with further probing he said that he had a drink (alcohol) or watched TV.

His weight at 13 stone was also a contributing factor to the stroke and as a result William had already started to amend his diet. Although William claimed to have no known allergies, some foods caused him discomfort and it was evident that his digestive system was severely affected. William said that his current liquid intake was two pints of water per day, and six cans of cider plus two to three glasses of white wine per week.

I took William's blood pressure before and after the initial treatment and during the course of his reflexology treatments. His prescribed medication included Aspirin (75mg per day), Atenolol (50mg per day) and Amlodipine (10mg per day).

Observation of the feet is a major part of treatment to gain further information about the client and the condition of his health. William's feet were dry, cracked and scaly in texture with rippled, loose skin on the dorsal and plantar surfaces. There was a mixture of mottled tones, red and white denoting areas of inactivity and hypersensitivity. All his toenails were yellowing, with some blackened and very uneven, indicative of a weakened immune system. Calluses had formed on his upper fourth and fifth toes, inner big toe and inner heel. A noticeable tiny lump was felt beneath the surface of the skin on the left big toe, which is the reflex area associated with the brain.

The treatment plan involved working the areas of imbalance which were shown as marked sensitivity in all the toes with emphasis on the left big toe (brain reflex opposite side to paralysis), shoulders and spinal reflexes, the digestive system, solar plexus, heart and diaphragm.

Results of Reflexology

I believe that progress was made in reducing William's blood pressure during the reflexology sessions and this became apparent to me from the readings taken before and after treatments and his GP reducing his dosage of Amlodipine from 10mg to 5mg following his sixth reflexology treatment. It appears that William's shoulders have also benefited from reflexology, as when he originally started treatment both his shoulders were tense and painful; after each session they improved gradually and now cause him no distress. William reduced his intake of alcohol and cut down on foods high in fat. He also introduced fresh vegetables and fruit into his daily diet and as a result the irritability of his bowel has considerably eased.

I am aware that William was quite sceptical about the benefits of reflexology when I first started treating him, but I am now constantly reassured that he feels a positive benefit from it. Needless to say, this case confirms that William has gained a lot since having reflexology treatments, because with increased relaxation his body has been able to heal naturally and his ability to get a good night's sleep has improved.

Case reports and anecdotal evidence indicate that reflexology is useful for the treatment of the effects of stroke, in particular the stabilization of blood pressure, however more research is required to ensure that clinical recommendations for treatment can be supported.[6]

Future Treatments and Forward Planning

William continues to have monthly reflexology treatments to aid relaxation and maintain homeostasis. He has since retired from his full-time job, and his physical demeanour has dramatically improved through losing excess weight and eating a more balanced diet. It is wonderful to see William so contented, relaxed and positive, compared with the tired, stressed individual he presented at the initial consultation. As a result of this case, implications for future practice include clinical research and the use of study to establish a proven correlation between reflexology and the administration of orthodox medicine in improvements in hypertension and effects of stroke. It would no doubt be beneficial to organize other studies to support the use of reflexology in stroke rehabilitation relating to the many effects that stroke can have, e.g. paralysis, problems with balance and co-ordination, pain and numbness, bowel or bladder control problems, fatigue and emotional problems. To ensure that holistic attributes are applied, this may be carried out through the use of diary-based assessments.

References

1. Bonita R. Epidemiology of stroke. Lancet. 339: 342-4. 1992.
2. The Stroke Association. Reducing the Risk of Stroke. Leaflet. The Stroke Association. 1997.
3. Bamford J, Sandercock P, Dennis M, Warlow C, Jones L and McPherson KA. Prospective study of acute cerebrovascular disease in the community: the Oxfordshire community stroke project. 1981-1986. 1. Methodology, demography and incident cases of first ever stroke. J Neurol Neurosurg Psychiatry. 51: 1373-80. 1988.
4. Dalai K. Reflexology as an efficient therapy for relieving pain involving neuro-muscular-skeletal dysfunction. ICR Newsletter. 8(1). 1999.
5. Hatano S. Experience from a multicentre stroke register: a preliminary report. Bull WHO. 54: 541-53. 1976.
6. Frankel BSM. The effects of reflexology on baroreceptor reflex sensitivity, blood pressure and sinus arrhythmia. Complementary Therapies in Medicine. Churchill Livingstone. London. p80-84.

Bibliography

Hewer RL and Wade DT. The Stroke Recovery Plan. Vermilion. London. 1996.
Kumar P and Clark M. Clinical Medicine. 3rd ed. Balliere Tindall. London. 1995.
Minett Wayne and Rubenstein. Human Form and Function. HarperCollins. London. 1998.
Roberts A and Gardiner P. Systems of Life Volume 2. Macmillan. London. 1994.
The Stroke Association. Researching the road back to independence. Stroke News. Stroke Association. 15(1). Spring 1997.
The Stroke Association. Secondary prevention of stroke. Stroke News. Stroke Association. 13(1). Spring 1995.
The Stroke Association. Aspirin and Stroke. Leaflet. Stroke Association. London. 1997.
The Stroke Association. Facts About High Blood Pressure. Leaflet. Stroke Association. London. 1997.
The Stroke Association. High Blood Pressure? - Why You Need to Take Your Drugs. Leaflet. Stroke Association. London. 1997.
The Stroke Association. Keeping Well After Your Stroke. Leaflet. Stroke Association. London. 1997.
The Stroke Association. Reducing the Risk of a Stroke. Leaflet. Stroke Association. London. 1997.
The Stroke Association. Stroke - 20 Questions and Answers. Leaflet. Stroke Association. London. 1997.
The Stroke Association. Stroke - Questions and Answers. Leaflet. Stroke Association. London. 1997.
The Stroke Association. What is a TIA? Leaflet. Stroke Association. London. 1997.
Tortora GJ and Grabowski SR. Principles of Anatomy and Physiology. 7th ed. HarperCollins. London. 1993.
Turner A et al. Occupational Therapy and Physical Dysfunction. Churchill Livingstone. London. 1996.
Woodham A and Peters D. Encyclopedia of Complementary Medicine. Dorling Kindersley. London. 1997.

Further Information

For more information on reflexology please contact The Association of Reflexologists, 27 Old Gloucester Street, London, WC1N 3XX; Tel: 0870 5673320; www.aor.org.uk
The Stroke Association can be contacted at Stroke House, Whitecross Street, London; Tel: 0845 3033 1000 (helpline); www.stroke.org.uk
(c) Polly Hall 2002