THIS ISSUE:
Massage in Hospital Settings
Swedish Institute on-line newsletter for our students, faculty and community.
Integrative Medicine at MSK
The luxurious interiors once part of an upper East Side bank combined with the
abundant sunlight that comes streaming through two-story windows into an art
filled lobby, create a reliable "wow" factor for those entering the
Bendheim Integrative Medicine
Center of Memorial Sloan-Kettering Cancer
Center. Newly opened on July 26, the Center, at First Avenue and 74th Street, is
a fine setting for its current treasure: the highly-skilled practitioners who
provide its integrative therapies. They offer sessions of massage therapy,
Reiki, Shiatsu, Thai massage, pregnancy massage, reflexology, nutrition,
acupuncture, aromatherapy, yoga, exercise and mind/body therapies that include
guided imagery, self-hypnosis, pre-surgery hypnosis, meditation and
mindfulness-based stress reduction for MSKCC outpatients and staff, as well as
for the general community,
Wendy Miner ('85) LMT, leads the corps of ten massage therapists and eight instructors working there. As she walks across the lobby of the Center to greet a visitor, she exudes a radiant gentleness that belies the strength she possesses. Like the practitioners she supervises, Miner embodies the unique qualities it takes to bridge the world of high tech medicine and high touch therapy, a personality that respects the current medical model yet seeks to expand it with modalities that until recently were not considered therapeutic.
In 1999, when Barrie Cassileth, Ph.D. initiated the Integrative Medicine Service within MSK Cancer Center, the oldest and largest private institution in the US devoted to patient care and research in cancer, it was greeted with skepticism. However, the climate has changed. Miner says that a significant number of the 1,300 clients they see a month now come from doctors' referrals. "We're past the point of having to convince them of the benefits," she said. "We've been here 6 ˝ years, we've never hurt anyone, and the patients have only good things to say." Sessions are offered to patients to alleviate stress, reduce pain and anxiety, manage symptoms and promote a feeling of well-being.
Practitioners who work at the Integrative Medicine Center are carefully selected for their experience, flexibility and communication skills. They go through a mentoring period during which they learn the cumulative wisdom that has been culled by this pioneering group. Though treatment guidelines are in place, every session is completely individualized. "Our therapists are professional caregivers," says Miner, "who listen a lot and refrain from offering advice or presenting their personal view of what constitutes healing. I think a lot of people are dissatisfied with the medical model because they feel they're not being recognized as individuals; if we try to convince clients to see things from our point of view, isn't that repeating the same phenomenon?"
To find out to what extent complementary therapies are useful in easing the way during cancer treatment and recovery, the Integrative Medicine Center is conducting a number of research projects, including two in massage therapy. Studies include outpatients, as well as the inpatient population practitioners see at rotations in the hospital on York Avenue. Miner will be presenting preliminary findings at the Massage Therapy Foundation's first conference highlighting massage therapy research in CAM, being held in New Mexico in September.
As to whether massage and other complementary therapies might lose what they offered in the first place if they are merely added to an existing medical model without changing it, Miner says with characteristic conviction, "The work stands for itself and can never be compromised."
For more information
What is "integrative medicine"? The Consortium of Academic Health Centers for Integrative Medicine has the following definition on its web site: Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.
The Bendheim Integrative Medicine Center of Memorial Sloan-Kettering is at 1429 First Avenue, New York City, 212.639.4700, www.mskcc.org/integrativemedicine Its services are offered to a wide variety of people, from those seeking to optimize wellness, recover from sports injuries, undergoing cancer treatment, or who are long-term cancer survivors. Integrative Medicine service is also available at Memorial Sloan-Kettering's facility in Hauppauge, at 800 Veterans Memorial Highway, 631.863.5150.
Licensed massage therapists interested in the Center's classes on medical massage for patients with cancer or Reiki classes can go to www.mskcc.org/intmed and then to educational programs for upcoming dates.
Wendy Miner will present a mini Level I class in "Medical Massage for the Cancer Patient" on November 11, 12 and 13 at the New York State Society of Medical Massage Therapists (NYSSMMT) conference held at the Hudson Valley Resort and Spa. Details and registration available at www.NYSmassage.org or 1.877.697.7668.
Details about the Massage Therapy Foundation research conference, being held Sept. 25 through 27, 2005 in Albuquerque, NM are posted on its web site.
The August 2005 issue of Consumer Reports published the results of a survey of 34,000 of its readers, who were asked to rate the effectiveness of conventional and complementary treatments for their two biggest problems over the last two years ("Which Alternative Treatments Work?" pages 39 to 43). The issues that came up most frequently were back pain, neck pain, fibromyalgia and osteoarthritis, syndromes that do not respond well to standard medical treatments.
Deep tissue massage therapy was ranked as the top treatment for pain associated with osteoarthritis and fibromyalgia, providing more relief than even prescription and over-the counter drugs. Massage therapy was a close second after chiropractic for back pain and neck pain, though the report points out that massage has fewer risks.
Tiffany Field, Ph.D., director of the Touch Research Institutes (TRI) at the University of Miami School of Medicine, explains that massage's ability to work well for these conditions is due to the cascade of biological effects that rhythmical, focused pressure to muscles and soft tissue creates. In the article she advises those considering massage therapy to find a qualified professional. "I always recommend that people go to their local massage school for a referral," she says.
Dr. Field has been a principle researcher in many recent studies involving massage therapy that go beyond its ability to decrease pain. Her breakthrough study, published in 1987, involved the use of massage therapy on hospitalized premature infants, an intervention which helped them gain weight and improve behavior scores, with infants in the treatment group able to leave the hospital 6 days sooner than the control group. Since then, researchers at TRI have broadened their studies of massage therapy to include its use in reducing the intensity of depression, improving immune function and enhancing learning, among many others.
For more information
To find a graduate of our Massage Therapy Program licensed to practice go to our Locate a Practitioner feature to search by modality, location or name.
Find out more about Dr. Field and her research studies at the Touch Research Institutes.
The National Center for Complementary and Alternative Medicine (NCCAOM), part of the National Institutes of Health, reports that visits to massage therapists and chiropractors represent 50 percent of all visits to CAM practitioners. According to an NCCAOM overview, between 2 percent and 14 percent of the adult population have used some form of massage therapy, with over 114 million visits to massage therapists reported in a 1997 survey.
Pre and Post-Surgery Massage at Columbia
People in hospitals may get great medical care, but
they often need more; ways to help ease pain, soothe anxiety, and
chart a course from trauma towards healing. A growing number of
hospitals now offer integrative techniques proven to be useful for
alleviating some of the discomfort and emotional effects associated
with standard treatment.
The Cardiac and Thoracic Surgery Unit at Columbia University Medical Center in New York City is known world-wide for its innovative acceptance of such therapies, thanks to its Integrative Medicine Program. Under the direction of Mehmet Oz, M.D., the unit offers therapeutic massage (Shiatsu, Swedish, Reflexology and Craniosacral therapy), yoga, guided imagery and stress management techniques to its patients. Ericka Clinton, a faculty member of the Massage Therapy Program at the Swedish Institute and Director of Student Services, was recently hired to provide Swedish massage sessions at patients' bedside.
"The unit has two massage therapists who together provide massage sessions five days a week for patients on the unit," Clinton reported. "We see patients either before or right after their surgery. They may be there for a heart bypass, post-stroke treatment, or heart or lung transplant. At the beginning of the week we get a roster of patients, and as soon as we can, go introduce ourselves to patients and offer them a 15-minute treatment as part of their service. We have over a 90 percent acceptance rate." Clinton checks in with nursing supervisors to be alerted to any patient conditions that may necessitate extra precaution. While on the unit she wears a white lab coat and a name tag to identify her as part of the hospital staff.
"I provide a Swedish style massage, because many patients want to have the pressure and movement associated with this style of bodywork," she said, explaining her approach. "I quickly learned that I have to modify what I do, mostly in terms of finding the position in which patients will be most comfortable. I find that even within the 15 minute treatment time, people are able to relax, close their eyes and drift into a light sleep. I often feel muscles in the back or neck unclench, as they are touched in a way that nurtures and soothes, unlike handling that occurs during many procedures."
If patients want additional massage time, they contract directly with the therapist in a fee for service arrangement. In addition to the contact with patients, Clinton says she is learning quite a bit from her ongoing interaction with the nurses, physical therapists and social workers who work together on the unit to ensure optimal outcomes for their post-op patients.
For more information
Find out about the Integrative Medicine Program at Columbia University Medical Center in New York City.
Students in the Swedish Institute Massage Therapy Program go to many hospitals and nursing homes in New York City as part of their Off-site Internships. Off-site clinics have included:
Patients in the Cardiac Surgery and Heart Transplant Units at Columbia-Presbyterian Hospital
Rehabilitation patients at Cabrini Pain Center
Parents of children at Ronald McDonald House
Alzheimer's patients at Cobble Hill Health Center
Radiology patients at Hospital for Special Surgery
AIDS/HIV clients at St. Lukes -- Roosevelt Hospital
Patients at the Jacob Perlow Hospice at Beth Israel Medical Center
Read an article about our Off-site Clinics, "Building Bridges to the Community" in our newsletter archive.
Diego Sanchez, LMT, who has also worked at this unit at Columbia-Presbyterian, will teach a class in Asian Bodywork for Hospital Patients. Check our Professional Continuing Education listing for details.
Submitted by B. A. Goldschmidt ('85) LMT
People isolated in nursing homes and hospitals are most at risk for being deprived of the touch and conversation that passes freely between people every day. In 1996, a research project at Cobble Hill Health Center in Brooklyn, New York, aimed to study the effects of massage therapy and music therapy on its residents with severe dementia. Would focused touch be accepted and meaningful for these residents? Fifty-four residents were selected for the study, funded by the New York State Department of Health, which started its active phase in June 1996.
Choosing a hand massage protocol
I was asked to create a protocol for the experimental group and responded with a hand massage which I thought would be appropriate for a number of reasons. First, it would be relatively safe given a wide range of medical conditions. Second, it would be easy to use even for those confined to bed or a wheelchair. Last, but not least, for this population massaging the fingertips seemed especially relevant, since they occupy a large part of the cerebral cortex and, in Eastern energetics "open the orifices", that is, send energy to the eyes, ears and tongue. Before starting the program I wanted to try out the protocol, which consisted of a 15-minute massage to each arm and hand, on a resident. I was led to a room of one of the participants by Nan Kramer, the attending psychologist. Little did I know how challenging and revealing the simple hand massage would be.
It began quietly enough, as we approached a resident I'll call Iris who was lying in bed with both hands tightly clenching a blue acrylic blanket. Dr. Kramer asked Iris if we could try some gentle touch with her, and though we couldn't make out any distinct words Iris clenched her blanket more tightly and seemed to shrink back into the bed, a response Dr. Kramer and I took as a "no". We agreed to leave and try again a little later.
When we returned, Iris seemed to agree to our request with a slight nod of her head, though she still didn't make any distinct words, only a low, whining noise.
Applying the protocol
I started by lightly stroking Iris's arm along its length, a proprioceptive touch meant to bring awareness to the area. Then I stroked her tightly closed hand, maintaining eye contact with her. She watched me with large, luminous eyes, then in a trembling whisper started to ask for her father. After I stroked her hand a few times she let go of the blanket and extended her fingers, letting me take her hand in mine. Surprisingly, she then grasped my fingers in return. At this point she said to me, quite clearly, "I'm sad."
I assured her it was okay to feel sad. I didn't try to persuade her to talk anymore, but continued my technique, going into massage of the palm. I moved from massage of her hand to her individual fingers. I stroked Iris's thumb and then rotated it. I explained to her, "I'm going to exercise your thumb a little, Iris. Can you believe you're exercising now?" Then I added, "You know, the thumb is supposed to be your smart finger." She laughed. So I replied, "Maybe your thumb is your funny finger." And she laughed again. Her laugh was cute, sort of mischievous. It gave me the sense of the twinkle in her eye she must have had as a younger person. Near the end of the 30-minute session she said directly to me, "I feel like singing," and she sang a little song.
Outcome
As our session came to an end, I thanked Iris for letting me work with her. I felt a lot had happened in that short time, for it seemed that her mood had moved from depression and withdrawal, to one of pleasure and interaction. As I walked out of the room I realized I was wet with perspiration, our interaction had been that intense for me. I had never put so much into a massage. Needless to say, I was satisfied that the protocol could be useful in our goal of reaching out to residents with an activity that could add meaning to their daily lives. The research project would later bear out these initial findings, showing a significant outcome of relaxation and
some decrease in depression for those residents receiving massage therapy. It was also almost universally accepted by the residents.
For more information
Read Dr. Kramer's report, "Music and Touch Therapies for Nursing Home Residents with Severe
Dementia" on the research results.
A study on the use of foot massage for patients hospitalized with cancer found that the intervention had a significant immediate effect on perceptions of pain, nausea and relaxation. Researchers concluded that the use of foot massage as a complementary method is a relatively simple intervention for patients experiencing nausea or pain related to the cancer experience and suggested further research into its effectiveness in the management of these symptoms.
(Cancer Nursing. 23(3): 237-243, June 2000.)
For more information
Read an overview of Cancer Care and Massage Therapy written by Niamh Van Meines, LMT and Nurse Practitioner with a specialty in oncology and integrative therapies.
“Integrative medicine is the medicine of the future.”
Victor S. Sierpina, MD, "Teaching Integratively: How the Next Generations of Doctors Will Practice", Integrative Cancer Therapies, Vol. 3, No. 3, Sept. 2004, p. 201 - 207.