The Continuum of Touch
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Transcript of The Continuum of Touch
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The Continuum of TouchThe Continuum of Touch
From prebirth
Infancy
Adulthood and Old age
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-- perhaps the first form of medicineperhaps the first form of medicine
- described in ancient texts in China, described in ancient texts in China, India & EgyptIndia & Egypt
- described by Hippocrates in 400 BCdescribed by Hippocrates in 400 BC
- touch is considered a form of therapy in touch is considered a form of therapy in many parts of the worldmany parts of the world
History of Touch History of Touch
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ShiatsuReflexology
Touch TherapyTouch Therapy
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MassageMassage TherapiesTherapies
Ayuverdic Massage
Thai Massage
Infant Massage
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Kangaroo Care
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Kangaroo CareKangaroo Care
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Infant Infant
Co-sleepingCo-sleeping
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DoulaDoula
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Mailman CenterMailman Center
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Touch Research InstitutesTouch Research Institutes
• Established in 1992 by Dr. Tiffany Field with a grant from Johnson & Johnson.
• The TRI was the first center in the world devoted solely to the study of touch and its application in science and medicine.
www.JJPI.comwww.JJPI.com
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To date, we have conducted over 100To date, we have conducted over 100 scientific scientific studies on touch therapy effects and we have studies on touch therapy effects and we have established two other TRIs (Philippines, Paris).established two other TRIs (Philippines, Paris).
www.miami.edu/touch-research
www.JJPI.comwww.JJPI.com
Touch Research InstitutesTouch Research Institutes
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Continuum of Touch Continuum of Touch
FromFrom PregnancyPregnancy ….. …..
toto LaborLabor
….. ….. to Infancyto Infancy
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Pregnancy Massage
Field, Hernandez-Reif, Hart, et al., (1999), Field, Hernandez-Reif, Hart, et al., (1999), J of Psychosomatic Obstetr GynJ of Psychosomatic Obstetr Gyn
Field, Diego, Dieter, Hernandez-Reif, et al., (2004), Field, Diego, Dieter, Hernandez-Reif, et al., (2004), Infant Behavior & Dev.Infant Behavior & Dev.
Field, Hernandez-Reif, Diego, et al,. (2004), Field, Hernandez-Reif, Diego, et al,. (2004), J of Psychosomatic Obst GynJ of Psychosomatic Obst Gyn
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Progressive Muscle Progressive Muscle
Relaxation (PMR)Relaxation (PMR)
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Study DesignStudy Design
• two 20-minute sessions per weektwo 20-minute sessions per week of Pregnancy Massage or PMRof Pregnancy Massage or PMR
for 5 weeks starting in 2for 5 weeks starting in 2ndnd
• focus on the head, neck, back, focus on the head, neck, back, arms, legs, and facearms, legs, and face
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Pregnancy Pregnancy AnxietyAnxiety
0
10
20
30
40
50
Massage Relaxation
PrePost
* *
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Pregnancy Pregnancy Back PainBack Pain
1
2
3
4
5
Massage Relaxation
*
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PregnancyPregnancyDisturbed SleepDisturbed Sleep
0
12
24
36
48
Massage Relaxation
*
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PregnancyPregnancySupplemental Sleep (Naps)Supplemental Sleep (Naps)
0
10
20
30
40
Massage Relaxation
*
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Birth OutcomesBirth Outcomes
0
30
60
90
120
150
OCS PNF
MassageRelaxation
**
**
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Pregnancy Pregnancy Depressed MoodDepressed Mood
0
1
2
3
Massage Relaxation
PrePost
*
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Pregnancy and Pregnancy and Depressed MoodDepressed Mood
10-30% of women are 10-30% of women are
depresseddepressed during pregnancy during pregnancy
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Pregnancy Depression Pregnancy Depression on Maternal Cortisolon Maternal Cortisol
100
200
300
400
Depressed Non-Depressed
Prenatal Cortisol
ng/m
g
**
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Prematurity and Prematurity and Depressed PregnancyDepressed Pregnancy
0%
20%
40%
60%
80%
100%
Depressed Non-Depressed
Prematurity
Per
cen
t of
Gro
up
> 37< 37
*
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Low Birthweight andLow Birthweight andDepressed PregnancyDepressed Pregnancy
0%
20%
40%
60%
80%
100%
Depressed Non-Depressed
Low Birth Weight
Per
cen
t of
Gro
up
> 2500g< 2500g
*
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Dieter, Field, Hernandez-Reif, et al., (2002).
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Prenatal DepressionPrenatal Depression Effects on Neonate Effects on Neonate
100
200
300
400
500
600
Depressed Non-Depressed
Neonatal Cortisol
ng/m
g
100
200
300
400
Depressed Non-Depressed
Prenatal Cortisol
ng/m
g**
**
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Prenatal DepressionPrenatal Depression
0
10
20
30
40
50
60
Depressed Non-Depressed
Neonatal Indeterminate Sleep
Per
cent
Tim
e**
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Prenatal DepressionPrenatal Depression
-0.2
-0.15
-0.1
-0.05
0
0.05
Depressed Non-Depressed
Mothers
Fro
ntal
EE
Asy
mm
etry
-0.1
-0.05
0
0.05
Depressed Non-Depressed
InfantsF
ront
al E
E A
sym
met
ry
F3F3 F4F4
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Depressed Pregnancy Depressed Pregnancy Effects Include:Effects Include:
For mothersFor mothers::
- Elevated cortisol (stress hormone)Elevated cortisol (stress hormone)
- Greater chance of having a preterm Greater chance of having a preterm baby baby
- Greater chance of having a lowbirth Greater chance of having a lowbirth weight babyweight baby
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Depressed Pregnancy Depressed Pregnancy Effects Include:Effects Include:
For fetusFor fetus::
- - Greater fetal activityGreater fetal activity
For infantsFor infants::
- - Elevated cortisol & greater chance of Elevated cortisol & greater chance of being born preterm or low birthweightbeing born preterm or low birthweight
- Greater Indeterminate sleepGreater Indeterminate sleep- Greater relative right frontal EEG Greater relative right frontal EEG
activationactivation
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Partners Massaging Partners Massaging Depressed Pregnant WomenDepressed Pregnant Women
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Demographics
• N = 84 depressed pregnant women
• Mean age = 28.8 (SD = 5.7)
• Mean g.a.= 22.9 wks at recruitment
• 46% Caucasian, 39% Hispanic, 12% African American and 3% Asian
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Pre-Post Test DesignPre-Post Test DesignRecruited from Ob Gyn clinics in 2nd semester &
assigned to Massage, PMR group or control .
Massage Therapy (by partner)
• Two 20 min. massages per week for 16 weeks at home.
PMR
• Two 20 min. relaxation exercise sessions per week for 16 weeks.
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Maternal Maternal Cortisol Change (ng/ml)Cortisol Change (ng/ml)
-76
-16
6
-80
-70
-60
-50
-40
-30
-20
-10
0
10
*-5
Massage PMR ControlMassage PMR Control
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Obstetric ComplicationsObstetric Complications(higher score is optimal)(higher score is optimal)
91
78
102
0
25
50
75
100
Massage Relaxation Control
**
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Mothers’ Mothers’ AnxietyAnxiety
0
10
20
30
40
50
Massage Relaxation Control
PrePost**
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Mothers’ depressionMothers’ depression
0
10
20
30
Massage Relaxation Control
PrePost
**
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Infant Depressed SymptomsOn Brazelton Neonatal
Assessment Scale (BNBAS)
0
1
2
3
4
5
6
Massage Relaxation Control
**
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Overall ConclusionsOverall ConclusionsPregnancy massagePregnancy massage is a safe and effective intervention for is a safe and effective intervention fordepressed and non-depressed mothers:depressed and non-depressed mothers:
stress hormones (cortisol)anxiety and depressed mood disturbed sleepObstetric complications and postnatal complications, hence improving neonatal outcomes, including reducing the incidence of prematurity.
**These data also highlight the efficacy of using a **These data also highlight the efficacy of using a significant other to deliver the massage intervention.significant other to deliver the massage intervention.
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Touch Therapies during LaborTouch Therapies during Labor
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Continuum of Touch Touch therapies during Labor –
Doula - companion woman who stays in touch with the laboring mother (stroking, holding, speaking to her).
Studies from the 1980s by Klaus & Kennell revealed that 127 of 128 non-industrial societies included a woman present with the mother-to-be during labor.
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Doula vs No Doula
0
10
20
30
40
50
60
70
80
Complications
DoulaNo Doula
0
5
10
15
20
Medication
DoulaNon Doula
Klaus et al, 1986 (Study on 417 laboring women in Guatemala)
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Doula vs No Doula
02468
101214161820
C-Section
DoulaNo Doula
0
2
4
6
8
10
12
14
Labor Hrs.
DoulaNon Doula
Klaus et al, 1986 (Study on 417 laboring women in Guatemala)
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Benefits of a Doula Present at the Birth of a Child (Stein, Kennell &
Fulcher, 2004)
• 50% reduction in C-sections50% reduction in C-sections
• 40% reduction in use of forceps40% reduction in use of forceps
• 60% reduction60% reduction in epidural in epidural analgesiaanalgesia
• 25% decrease in labor length25% decrease in labor length
0
10
20
30
C-Section
Father Fa + Doula
23%23%
14%14%
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Labor Massage by PartnerLabor Massage by Partner
Field, Hernandez-Reif. et al., (1997). J of Psychosom Ob Gyn.
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Labor MassageLabor Massage
Conducted by Conducted by partner partner every hour for 5 hoursevery hour for 5 hours.
20-min sequence consisting of stroking20-min sequence consisting of stroking for 5-5-min each of the following regions: min each of the following regions:
1) head, 2) neck, shoulders and back, 1) head, 2) neck, shoulders and back,
3) hands and arms and 4) legs and feet.3) hands and arms and 4) legs and feet.
Control groupControl group who did other activities who did other activities (breathing exercises), but no massage.(breathing exercises), but no massage.
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Labor Massage Labor Massage (MOOD 1(MOOD 1stst session) session)
0
2
4
6
8
10
12
14
16
Massage Control
PrePost
**
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Labor Massage Labor Massage (Pain 1(Pain 1stst session) session)
0
1
2
3
4
5
Massage Control
PrePost
**
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No. of Hours in LaborNo. of Hours in Labor
0
4
8
12
Massage Control
**
8.58.5 11.311.3
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Post LaborPost Labor DepressionDepression
0
4
8
12
16
20
Massage Control
**
15.415.4 19.819.8
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Skin-to-Skin (Kangaroo care)
• KC - consists of holding the infant (in diaper) against the bare KC - consists of holding the infant (in diaper) against the bare chest with an over-covering.chest with an over-covering.
• This practice started in Bogota Colombia by Drs. Rey and This practice started in Bogota Colombia by Drs. Rey and Martinez in the 1970s, because of overcrowding in their Martinez in the 1970s, because of overcrowding in their NICU, NICU, few resources and high mortality and infection rate.few resources and high mortality and infection rate.
• KC was introduced to the mother (benefit of access to KC was introduced to the mother (benefit of access to breastfeeding) who did KC for 24/7 and later to the fathersbreastfeeding) who did KC for 24/7 and later to the fathers
• Can begin in the delivery or recovery room between 30-40 min Can begin in the delivery or recovery room between 30-40 min postbirth to help stabilize the infant or can begin earlier.postbirth to help stabilize the infant or can begin earlier.
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Research Benefits of KC
• Thermal synchrony – maternal temperature regulates infant’s temperature
• Regulate heart rate and respiration
• More deep sleep
• Fewer days in incubators
• Greater weight gain and earlier discharge.
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Preterm Infant Preterm Infant Massage TherapyMassage Therapy
•Can be started as soon as Can be started as soon as preterm infant is stablepreterm infant is stable
•Can be taught to parents Can be taught to parents or performed by nurseor performed by nurse
•Takes 15 minutes and Takes 15 minutes and involves rubbing & flexion involves rubbing & flexion and extension of limbs and extension of limbs (kinesthetics)(kinesthetics)
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Introduction
Premature infants receiving massage therapy:– Have shorter hospital stays
– Show a 21-47% greater increase in weight gain
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GI ActivityFood Absorption Hormone Release
Vagal Activity
Pressure/ Bar Receptor Stimulation
Weight Gain
Massage Therapy
Proposed mechanism for the effects of massage therapy in stimulating preterm infant weight gain
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Method (Participants)48 Medically stable premature infants assigned to48 Medically stable premature infants assigned to
• Massage therapy (n=16)Massage therapy (n=16)• SHAM massage therapy (n=16)SHAM massage therapy (n=16)• Standard care control group (n=16)Standard care control group (n=16)
Group assignment based on a random stratification Group assignment based on a random stratification procedure designed to ensure equivalence across procedure designed to ensure equivalence across groups on the following variables:groups on the following variables:
(a)(a) Gestational age (± 2 wks)Gestational age (± 2 wks)(b)(b) Birthweight (± 150 g)Birthweight (± 150 g)(c)(c) Gender Gender (d)(d) Days in the NICUDays in the NICU(e)(e) Study entry weightStudy entry weight
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Method (Procedure)
Massage Therapy: Massage Therapy:
Baby on stomach: 1Baby on stomach: 1stst & last 5-min. & last 5-min. Rubbing the head, shoulders, back, Rubbing the head, shoulders, back, legs and armslegs and arms
Baby on back: 5 min of flexion and Baby on back: 5 min of flexion and extension of the arms and legs and extension of the arms and legs and
SHAM massage:SHAM massage: • Identical to the massage therapy Identical to the massage therapy
procedure exception that the procedure exception that the lightlightpressure rubbing pressure rubbing was used.was used.
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Weight Gain (gms p/day)
0
5
10
15
20
Groups
ControlMassageShamLinear (Control)
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Pre During Post
3.0
3.5
4.0
4.5
Control Massage SHAM
Pre During Post
Pre During Post
Vagal Activity
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Gastric MotilityGastric Motility
Pre During Post
6.0
7.0
8.0
Gas
tric
Mo
tili
ty (
2-4c
pm
EG
G)
Control Massage SHAM
Pre During Post
Pre During Post
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• Has been replicated in Taiwan, Philippines,Israel, and China
• Nurses and parents can be trained to conduct the therapy and has been shown to reduce mothers’ depression.
• Simple to do, safe and reduces hospital costs because of earlier discharge.
Preterm Infant Massage Effects
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Fathers’ Massaging BabiesFathers’ Massaging Babies
• 32 fathers (M age = 33) and their
infants (R: 3-14 mo) were studied.
• Predominantly middle class
• ½ were taught to do infant massage
and the other half were on a wait-list
Cullen, Field, Escalona & Hartshorn (2000). Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & CareEarly Child Dev. & Care
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Fathers’ Massaging BabiesFathers’ Massaging Babies
3
3.2
3.4
3.6
3.8
4
Massage Control
Express Warmth Accept
Cullen, Field, Escalona & Hartshorn (2000). Cullen, Field, Escalona & Hartshorn (2000). Early Child Dev. & CareEarly Child Dev. & Care
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Fathers’ Massaging BabiesFathers’ Massaging Babies
0
10
20
30
40
50
Massage Control
1st dayLast day
Caregiving Score (feeding, cleaning, playing, etc)Caregiving Score (feeding, cleaning, playing, etc)
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Touch can Span Across the Ages
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