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September/October 2012 IssueBack to September/October 2012 Article List
Insight for Bodyworkers
Connecting with Blind and Visually Impaired Clients
By Mary Kathleen Rose
Clients of all shapes, sizes, and abilitiesfind their way to our massage tables. For the most part, the work and the intent remain the same; it’s the nuances that change. This understanding holds true when working with people with visual disabilities. While I will undoubtedly approach their aching back just like I would a sighted client, it’s how I greet a blind client, how I bring him to the massage table, and the communication skills I employ that might require greater forethought. Understanding this client a little better will make our work together more valuable in the long run.
In my career as a massage therapist, I have worked extensively with the elderly and people with chronic illnesses. Because of this, I have a keen appreciation for the challenges faced by people who are blind or visually impaired.
Pathologies Affecting Sight
Nearly 70 percent of all the sensory receptors in the body are in the eye, and nearly half of the cerebral cortex is involved in some aspect of visual processing.1 For most people, the eye takes in thousands of bits of information, which are then interpreted by the brain, forming our perception of the world around us.
According to the National Federation for the Blind (NFB), it is estimated that 10 million Americans are blind or visually impaired. Of these, approximately 1.3 million people are legally blind. (Legal blindness refers to central visual acuity of 20/200 or less in the better eye with the best possible correction, or a visual field of 20 degrees or less.) Just 1 percent of the blind population is born without sight. Diseases and conditions affecting vision are widespread among people of all ages, but they are most prominent in the elderly, often representing a challenging loss of function.
Conditions of the eyes range from common eyestrain, myopia (nearsightedness), and presbyopia (age-related farsightedness) to diseases that threaten significant loss of vision, such as cataracts, glaucoma, macular degeneration, and retinopathy.
While there are treatments to delay these conditions, as of yet there are no cures. Any of these visual conditions can increase difficulty in determining color and detail, as well as limit contrast, depth perception, and night vision.
When eyesight is impaired, the individual may suffer from eyestrain or myofascial tension in other parts of the body as she struggles to compensate for the visual impairment. For example, holding the head in awkward positions to “try and see better” can contribute to tension in the head, neck, shoulders, and upper back. Decreases in depth perception or sensitivity to light can affect balance as the individual braces to avoid falling or bumping into objects. Just like the rest of us, visually impaired individuals often hold tension in their muscles and don’t realize it.
Psychosocial Challenges for the Visually Impaired
The practical challenges of living with blindness or visual impairment are obvious, considering the dependence on the visual sense that most of us take for granted. Vision loss affects everyday activities of living, and also involves innate annoyances with light perception (increased glare, diminished light perception, loss of color perception, loss of contrast, etc.). But the psychosocial aspects of coping with loss of vision are also significant. The NFB reports that, since the 1980s, blindness rates among the most feared afflictions, along with cancer and HIV/AIDS.
As people struggle with sudden or gradual loss of vision, they may experience a full range of responses and emotions, as with any significant loss.2 Some common responses include anger, depression, fear, frustration, sadness, and uncertainty not only about the health aspects of losing sight, but also the implications regarding work and home situations. Other issues facing visually impaired individuals include:
Changes in social life. Due to their own fears or lack of knowledge, not everyone is supportive or capable of empathy for those undergoing visual challenges. Damon, a man in his mid-30s dealing with newly diagnosed glaucoma and facing the necessity of surgery to halt the progression of the disease, was disheartened by the reaction of a friend who told him, “Hey man, you best not talk about your eyes. It bums people out.”
Loss of mobility. Driving a car is a key aspect of independence, and the inability to drive is a significant loss in itself.
Isolation. Reduced mobility can lead to isolation. With loss of hearing, one can still see what is going on, but with loss of sight, one loses the ability to see faces and the nonverbal communication that goes with facial recognition. In social situations, people often tend to avoid people who are blind, whether out of fear or ignorance.
Safety issues. Many visually impaired or blind people hesitate to leave home or venture out in unfamiliar territory because they feel insecure.
With the support of health professionals, low-vision specialists, family, and friends, people with visual impairment and blindness do adapt to changes in their loss of visual function. Many of the coping skills that lead to this healthy adaptation involve making generally wise lifestyle choices: getting regular rest and exercise, eating wholesome food, enjoying time in nature, and receiving nurturing massage and bodywork. But it also involves having appropriate medical interventions where necessary and taking advantage of specialized training to maintain independence, safety, and quality of life. Vision rehabilitation can help people maximize existing vision or cope with visual loss via use of adaptive tools and devices, including large-display devices and specialized computer software.
Jim Theall’s Story
“The doctor told me I could be sorry for myself or cope with it.” At age 24, Jim Theall was diagnosed with an incurable condition called retinitis pigmentosa and was told he would eventually go blind. This news brought more than tears; it brought the end of his career in the US Air Force.
“I cried myself to sleep that afternoon, awoke early in the morning, stared at nothing in the darkness of the hospital ward, and resolved to take the doctor’s advice,” Theall recalls. “The doctor told me I could indulge in self-pity and make everyone around me miserable, or I could accept the circumstances and go on with my life. It would be necessary to make some radical adjustments, but life could still be full.”
From his initial diagnosis in 1957 until 1972, Theall worked as an accountant. During that time, his vision kept deteriorating until, in 1974, he was not able to pass a driving test. “This was the hardest adjustment of all,” he says. (Failing a driving test is a significant marker for visually impaired individuals because of the implications of losing their independence.) Theall attributes the support of his family and friends, and especially his wife, Lorraine, with his healthy adjustment to blindness.
Now 79 years old, Theall is blind with no light perception. He leads a full life and enjoys music, woodworking, and is an avid reader. He also loves to travel and meet people.
His biggest pet peeve is to have someone fail to address him directly, such as when a waiter asks his wife, “What does he want?” in a restaurant. He appreciates others who ask if he needs help, and usually does best if he can be oriented to the space he is in. “A blind person is just like a chain—pull, don’t push. For example, say, ‘Give me an arm, follow me,’” he says.
“It is not important for me to know what it is like to be blind,” says Theall’s wife, Lorraine. “It is more important that I know how to guide him. I move next to him. I take a hand so he can walk behind or beside me.” Theall can still use his cane to sweep in front of him while Lorraine gives very short descriptions to help guide him, such as “curb,” “step up,” or “obstacle.” (Similar cues can be used in the massage room.)
Theall enjoys receiving regular massage and has a massage therapist who comes to his home. He appreciates the value of overall relaxation for health and well-being, and emphasizes the importance of massage to alleviate stress.
Therapeutic massage and bodywork serves as a wonderful complementary therapy for people who are blind or visually impaired. It can be helpful in alleviating some patterns of compensation to the musculoskeletal system or general tension due to physical and emotional stress. For people who have lost significant function of their sight, massage provides a nurturing experience through another avenue of perception: the sense of touch. It also helps provide emotional support to those suffering from the trauma of sudden or gradual vision loss.
The Trap-Ease Treatment
Common areas of pain for those with vision-related challenges are the neck, shoulders, and upper back. The “Trap-Ease” Treatment, a simple protocol incorporating acupressure to the shoulders, back, and occipital ridge, can help alleviate this discomfort. These techniques can all be done on a fully clothed client who is sitting in a regular chair. You may wish to place a towel over the back of the chair to allow the client to sit upright. You can stand behind the client, or sit on a stool or chair behind or beside the client.3
The Trap-Ease Treatment can be done as an on-site treatment, or before a full-body session on the massage table. In just a few minutes, it can bring significant relief and full-body relaxation. Pressure should be applied slowly to allow for relaxation and integration of the touch. The contact can be firm, according to the preferences of the client. When using any of these techniques, work closely with the feedback of the client regarding the amount of pressure used and the length of time pressure is held.
(Author’s note: This protocol does not include specific direct pressure on the neck, as this can cause discomfort or damage. Correct use of the following techniques on the structures adjacent to the neck can bring great relief to pain in the neck.)
1. Broad contact pressure. With the palm of the hand over the belly of the mid-trapezius muscle, apply broad contact pressure perpendicular to the skin. The motor point of the trapezius corresponds to the acupressure point Gallbladder-21, also called “shoulder well.” Pressure to this point melts tension in this muscle and can also alleviate general body tension (Image 1).
2. Lift and squeeze. Using the flat surfaces of the fingertips of the index and middle fingers and the thumbs, take a firm hold of the bellies of the trapezius muscle. Lift and squeeze. Hold for a few seconds as the client releases tension in this muscle. Pressure and length of time held will depend on the client’s preferences. Release. Repeat 2-–3 times (Image 2).
3. Specific contact pressure. For this technique, the therapist stands to the side and back of the client. To work on the right side, let the palm of the left hand rest over the left side of the trapezius muscle. The fingertips of the right hand (leading with the middle finger) sink into the motor point of the trapezius muscle. The angle of pressure is perpendicular to the skin. Visualize the motor point, about 1 inch deep into the muscle, as you let your touch gently in. Hold for a few seconds. Repeat to the client’s preference, then repeat on the other side (Image 3).
4. Broad contact pressure on erector muscles. For this technique, stand to the side of the client. The left hand rests gently on the client’s left shoulder. The heel of the right hand presses directly into the erector muscles of the upper back between the spine and the scapula. As with all of these techniques, the direction of pressure is perpendicular to the surface of the skin, thereby avoiding any friction to the skin. This also allows a firm pressure to penetrate the muscle, allowing it to relax. Repeat on the other side (Image 4).
5. Acupressure points on the occipital ridge. Stand or sit at the client’s left side. Place your left hand gently on the client’s forehead (above the eyebrows). Place the broad surface of your right palm with a firm pressure on the back of the neck. Hold for a few seconds to allow the client to relax into this hold.
Located on the occipital ridge, the Bladder-10 points are lateral to the midline and approximately 1½–2 inches apart. The Gallbladder-20 points are further lateral, approximately 3–3½ inches apart. Apply specific contact pressure to these points with your thumb and/or fingertips. Hold for a few seconds and release. Repeat according to the preferences of the client.
The Bladder-10 points are often referred to as the “eye points,” because they are known to relieve eyestrain and discomforts of the eyes. The Gallbladder-20 points, along with the Gallbladder-21 points (motor points of the mid-trapezius muscle), are helpful in alleviating head, neck, and shoulder tension. They are especially important in working with vision-related body issues, as they also contribute to overall relaxation of the body (Image 5).
6. Closing. Standing behind the client, place the palms of your hands over the motor points of the mid-trapezius on the top of the shoulders as in Step 1. Let the warmth of your hands penetrate into the motor points. Hold for a few seconds, then bring your hands away from the body about 1 inch. Hold for a second, then let your hands come completely away from the client’s body to end the treatment.
Whether in your massage practice or your daily life, your ability to respond to people with blindness or visual impairment can make a big difference to them. With your kind intentions and curiosity, you open the door to an expanded quality of life for those with visual impairment and bring new insights into your own awareness.
1. Elaine N. Marieb and Katja Hoehn, Human Anatomy and Physiology (Saddle River, NJ: Pearson, 2007).
2. Mary Kathleen Rose, “Grief and Loss: Providing a Safe Haven for Clients,” Massage & Bodywork (July/August 2011): 60–7.
3. Mary Kathleen Rose, “Seated Massage: Time to Sit up Straight and Relax,” Massage & Bodywork (February/March 2006): 26–33.
Mary Kathleen Rose would like to thank Dr. Paulette Foss—area coordinator for American Council of the Blind of Colorado, email@example.com—whose work was invaluable for this article.
Practice basic communication skills. Always state your name and who you are when greeting the client. Don’t assume she will remember the sound of your voice on a subsequent visit. Before beginning a session, ask, “How are you? How can I help you today?” Let the client know she is free to speak up anytime she has a question or to give feedback on the massage.
Touch the person when you meet.
It is usually good to greet your client with a handshake when you say hello and introduce yourself. Sometimes a light touch on the shoulder is appropriate.
Orient the person to the space. Let your client know the basic layout of the room, such as location of the massage table and other furniture, including a chair where she can sit. You might want to walk her to the restroom if necessary.
Designate a place for clothes and other personal items. It is important to have a table for personal items, such as eyeglasses, where they can easily be found after the massage.
Accommodate a guide dog. If your client has a guide dog, be sure there is adequate space for the dog to be in the room.
Adjust lighting to suit the needs of the client. Ask for the client’s preferences. He may want more or less light according to his own needs. (Some visually impaired people wear dark glasses or yellow lenses to increase contrast and reduce glare.)
Assist the client on and off the table. If the client needs assistance getting on or off of the table, you may wish to use a footstool to make it easier.
Customize promotional materials. Printed materials are easiest to read if they are in a simple format with common font types in large print on plain white or yellow tinted paper. Clients with usable vision can read materials with the help of magnifying glasses. Online information can be read using shortcut keys to zoom or enlarge the font size. Clients with no usable vision may be able to read online with an audible screen reader.
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