Patterns of Touch
by Gretchen Ashton, CFT, SFT, SFN, SSC, NBFE,
and PAC Certified Independent Consultant
Massage therapists are probably the most refined regarding the use of touch and patterns of touch to heal the human body. Just think about it. We give permission for another individual, most likely a stranger, to touch nearly every surface of our body. Healthcare professionals, therapists, fitness professionals, and care partners also provide services that involve touch. Depending on our need, we give permission to first responders, physicians, and nurses to repair an injury or determine what is wrong with our body in hopes of a cure. Therapists and fitness professionals apply touch to assist specific movement and rehabilitation goals; involving dexterity, improving strength and flexibility for the body along with speech and brain function. Care partners seem to do a little bit of each and all the above, particularly when working with people living with dementia (PLwD).
People living with dementia for the most part, respond well to touch techniques, as we see when we apply the Hand-under-Hand® approach. We also know the shoulder is another good place where assistive touch is accepted. With practice we perfect these techniques and find them invaluable. Of course, there are aspects of care that require extensive hands-on applications. Sometimes, because of a catastrophic health event or accident, feeding, moving, bathing, and toileting become unanticipated needs all at once. Hopefully, there is a progression leading to this level of care, which although we don’t want to see others decline, we have an opportunity to develop our use of touch a little at a time. Care partners that haven’t used touch as purposefully, have opportunities to become comfortable with touching methods and PLwD have time to adjust to being touched in assistive ways they might have never imagined. We can create unique patterns of touch specific to each PLwD.
An easy way to begin developing a pattern of touch that works for almost everyone is with cueing. Cueing is usually a gentle brief touch or tap on a part of the body to get the brain’s attention. It is a reinforcing mechanism for physical movement. For example, when someone is using great effort to bring a spoon to their mouth, we can use light finger taps on the inside of the upper arm. This touch assists the mind-muscle connection of the biceps muscles which flex the elbow joint. A large muscle example of cueing is when someone is transitioning from a seated to a standing position. The knees often endure a great deal of stress during this movement because there isn’t an understanding of how powerful the buttocks muscles (glutes) are in extending the hip joint. Squeezing the glutes is the natural biomechanical function of the body for standing. If we say squeeze the buttocks (which is coaching), and place a hand on the buttocks, do you think we will get slapped? Maybe. But gradually this kind of touch can become appropriate and comfortable between care partners and PLwD. Another place to touch instead of the buttocks might be the lower back. It’s not as effective, but can be a transition. When PLwD require more physical assistance and we are slightly lifting with them, or guiding the movement, it is referred to as spotting.
The touch of comfort is key in developing patterns of touch. Every evening when I say good night to my Daddy, who is living with Lewy Body Dementia, I gently rub his head. Once his head is on the pillow and we have it adjusted perfectly, I begin at the forehead and slowly smooth back his hair. I do this while thanking him for sharing the day with me. Sometimes we discuss something we did that day, or a person we met. Other times we plan for tomorrow. It is the perfect time for listening to what is on his mind and heart. Whatever our conversation, I use comfort touch to reinforce our relationship, create calm before sleeping, and in the process am consistently developing a pattern of touch that helps him know it is bedtime, and most importantly that I love him.
Patterns of touch help care partners and people living with dementia get through each day with purpose, help maintain the mind-muscle connection for both physical movement and skills, encourage communication, and evolve with changes in levels of care, ultimately helping with future care.