[libribook.com] Traumatic Scar Tissue Management 1st Edition

16.06.2020 Views

Scope of Practice ConsiderationsWe began Chapter 1 with a quote from esteemed massage therapist and educatorPamela Fitch – we are not just treating scars; we are treating people with scars –because this encapsulates the very essence of our work –the totality of the personmust be considered during treatment.People who survive injuries that lead to traumatic scarring can face a series ofmultiple sources of distress which include emotional and monetary challenges,disfiguring and debilitating scars and functional limitations and the challenge ofvocational and community reentry along with a feeling of isolation and feelingalone after discharge from hospital or treatment center (Wiechman et al. 2015).It is beyond the MT’s scope of practice to diagnose or treat psychologicalsymptoms. However, we routinely find ourselves at the treatment table assistingthose with traumatic scars and addressing how their distress manifests asimpairments that impact them on many levels.It is well established that the mind and body are not separate, but intimatelyintertwined, and thus MTs must be present and attentive to the person and theirscar on every level. It is beyond our scope of practice to provide psychologicalcounseling but it is not beyond our scope of practice to provide empathy,compassion and care. And it is certainly not at all uncommon for the therapist tobe required to navigate somatic memory and emotional responses that occurduring treatment.Somatic/Tissue MemoryIn addition to trauma memory being stored in the various memory centers of thebrain, various parts of the CNS and nerve plexus, trauma can also be stored as aform of somatic/tissue memory and expressed as changes in the biological stressresponse (Barral & Croibier 1999, van der Kolk et al. 1997, Pert 1999).Tissues can retain trauma memory and symptoms which may arise long after thetraumatic event, with or without apparent cause or direct stimulation (Minasny2009, Bordoni & Zanier 2014).According to Pert (1999), the science behind mind–body medicine suggests that

not only does the brain carry memories but that cells and neuropeptides hold andtransport memories throughout the entire body. According to Levine (1997),memories are not literal recordings of events but rather a complex of images thatare influenced by arousal, emotional context, and prior experience. Levineasserts that psychological wounds are reversible and that healing comes whenphysical and mental release occurs.Intense emotions at the time of trauma initiate the long-term conditionalresponse to reminders (triggers) of the event, which are associated with bothchronic alterations in physiological stress response and dissociative disturbances.Animal research suggests that intense emotional memories are processed outsideof the hippocampus mediated memory system and are difficult to extinguish (vander Kolk et al. 1997, van der Kolk 2014).The individual’s perception of the danger, the force of collision, reactive lesions,pain and other alarm sensations, all combine to create the preserved, intense,information. The stored information may get triggered, resulting in reactionssuch as fear, panic, syncope (partial or complete loss of consciousness), andsomatization – a tendency to experience and communicate psychological distressin the form of physical symptoms.MT may spark a somatic response or implicit tissue memory. Unexplained oratypical responses relate to the client’s trauma history memories (e.g. recall ofthe traumatic event, the moment of injury, consequent surgeries or otherlifesaving interventions) rather than to the MT intervention or technique(Andrade 2013, Fitch 2014).For example: during a session with a burn survivor who had traumatic scarringdecades old, upon a release of a thick scar band, the patient experienced amemory of being 7 years old in the Huber Tank at the burn unit, some 40 yearsin the past. The sights, smells and feelings of that experience were replicated, asif she were in the tank in the present day.Autonomic discharge may also occur in tandem with somatic memory, and beexpressed in the form of autonomic phenomena, such as fasciculation, tremor,shaking, nystagmus, tears, skin color changes, sweating, clamminess, laughing,crying and emotions like anger, aggression or irritation.Such responses may cause a client to feel surprised, vulnerable and confused.The conversation we have with the client during such an experience can be ofvalue to their therapeutic process. Conversely, if not well navigated the client

not only does the brain carry memories but that cells and neuropeptides hold and

transport memories throughout the entire body. According to Levine (1997),

memories are not literal recordings of events but rather a complex of images that

are influenced by arousal, emotional context, and prior experience. Levine

asserts that psychological wounds are reversible and that healing comes when

physical and mental release occurs.

Intense emotions at the time of trauma initiate the long-term conditional

response to reminders (triggers) of the event, which are associated with both

chronic alterations in physiological stress response and dissociative disturbances.

Animal research suggests that intense emotional memories are processed outside

of the hippocampus mediated memory system and are difficult to extinguish (van

der Kolk et al. 1997, van der Kolk 2014).

The individual’s perception of the danger, the force of collision, reactive lesions,

pain and other alarm sensations, all combine to create the preserved, intense,

information. The stored information may get triggered, resulting in reactions

such as fear, panic, syncope (partial or complete loss of consciousness), and

somatization – a tendency to experience and communicate psychological distress

in the form of physical symptoms.

MT may spark a somatic response or implicit tissue memory. Unexplained or

atypical responses relate to the client’s trauma history memories (e.g. recall of

the traumatic event, the moment of injury, consequent surgeries or other

lifesaving interventions) rather than to the MT intervention or technique

(Andrade 2013, Fitch 2014).

For example: during a session with a burn survivor who had traumatic scarring

decades old, upon a release of a thick scar band, the patient experienced a

memory of being 7 years old in the Huber Tank at the burn unit, some 40 years

in the past. The sights, smells and feelings of that experience were replicated, as

if she were in the tank in the present day.

Autonomic discharge may also occur in tandem with somatic memory, and be

expressed in the form of autonomic phenomena, such as fasciculation, tremor,

shaking, nystagmus, tears, skin color changes, sweating, clamminess, laughing,

crying and emotions like anger, aggression or irritation.

Such responses may cause a client to feel surprised, vulnerable and confused.

The conversation we have with the client during such an experience can be of

value to their therapeutic process. Conversely, if not well navigated the client

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