[libribook.com] Traumatic Scar Tissue Management 1st Edition
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
- Page 564 and 565: Physiological ResponseAs discussed
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- Page 568 and 569: Stress Response and Stress Hormones
- Page 570 and 571: dissociation and inner shakiness) (
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- Page 581 and 582: Psychological Stress and Wound Heal
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- Page 601 and 602: ASD symptoms include (DSM-V 2013):
- Page 603 and 604: Box 7.1Why do medical events potent
- Page 605 and 606: Rehabilitation and reintegrationThi
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- Page 625 and 626: Given the impact of trauma on the b
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- Page 629 and 630: The Massage Therapist and TraumaThe
- Page 631 and 632: Bordoni B, Zanier E (2014) Skin, fa
- Page 633 and 634: Foex (2013) Surgical Tutor UK Avail
- Page 635 and 636: Kutner JS, Smith MC, Corbin L et al
- Page 637 and 638: Schmidt NB, Richey JA, Zvolensky MJ
- Page 639 and 640: CHAPTER 8Communication and the ther
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- Page 649 and 650: BoundariesOver the course of our li
- Page 651 and 652: Box 8.1Aside from obvious sexually
- Page 653 and 654: Box 8.2Eight principles that guide
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- Page 663 and 664: SummarySeveral pieces of informatio
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