Massage is probably the last thing that you would think of when looking for strategies to improve your immune system.
But a specific type of massage, Lymphatic or Lymphatic Drainage Massage (known as LDM), could do just that.
LDM's link to immune functions is clear enough that it is contra-indicated with those who have had an organ transplant. Transplant patients must take immune-suppressing medications for the rest of their lives, so anything that boosts immune function is not desired.
I will be writing about the research behind Lymphatic Massage and other issues, but more research needs to be done to show exactly how strong the connection is and what patients benefit the most. We need long-term studies done, with followup reports over the course of a decade (at least) not just a few months.
Showing posts with label massage therapy. Show all posts
Showing posts with label massage therapy. Show all posts
Thursday, June 25, 2009
Wednesday, December 24, 2008
Frozen Shoulder Syndrome Can Be Caused by the Way You Sleep
Having suffered from this condition myself, I can tell you firsthand how suddenly Frozen Shoulder can strike and how miserable it makes you feel. All you know is, you cannot lift your arm above your shoulder, and there is no comfortable position in which to lie down.
It took me some time before I finally tried to look up what was wrong with me. I found a Chinese medicine webpage that said it was often called Fifty Year Shoulder, because that was the age at which the condition usually struck. It recommended warming herbs in foods to improve circulation, and use of a heating pad.
OK, the heating pad helped somewhat, tho I cannot say the cinnamon et al helped any.
Finally I wound up at a massage therapist who was pretty good with trigger points. He began by releasing some trigger points or adhesions in the supraspinatus and infraspinatus. Those are two of the rotator cuff muscles, and they are located on the dorsal side of the shoulder blade. They help you lift the arm and roll the arm forward.
Rotator cuffs are not built to do heavy lifting; that is the job for the biceps and triceps and pecs. Rotator cuffs are meant to stabilize the shoulder joint. They help keep the shoulder down while the other muscles lift the elbow up with its payload.
So anyway, this was an improvement. Another session worked on stretching the tight pec muscles. That hurt, but I was so much better within the week. The therapist lifted my arm up and back as I lay on the massage table, and manually stretched the pec muscle by pushing away from the arm. Then she lay the arm across my chest and gently pushed toward the opposite shoulder.
You can pull your arm across your own chest, and hook the other arm around it to help press it towards your chest. Hold for a couple breaths, and allow the arm and shoulder to relax into it.
After three weeks of the onset of frozen shoulder, you can proceed with Post-Isometric Release techniques.
Stand or lie on your back, whichever you prefer. Raise the arm above you as far as your current range of motion allows. Push in the OPPOSITE direction; HOLD for 5 seconds and release. You should be able to move your arm a bit further than before. You may repeat the exercise at the new limit of your range of motion.
Repeat this series for every angle of movement for your arm. Up, to the side, across the chest, forward, back. Make circles with your arms, slowly, with your arms straight out at the side. Make the circles bigger.
Stand in a corner. Put your forearms on either wall, hands pointing up. Lean into the corner. You may feel a stretch in the pecs and in the upper back.
Lastly, hold your arms out to the side. Roll the shoulder forward so that your hands turn palm up. Rotate the arms back again. Roll both shoulders forward and back for a minute or two, then roll one shoulder forward while rolling the other one back. This helps correct the hunched shoulders that so many of us get from working at a computer all day.
Now, ask yourself how you lie in bed at night. Do you lie on your side, and do you let the shoulder flop forward? Ask yourself what you are training your muscles to do by your habitual ways of sitting, standing and lying.
Lying with the shoulders flopped forward is straining your supraspinatus and infraspinatus muscles because they are being stretched for too many hours. It also is training your pec muscles to shorten up in front. Eventually your shoulder will cry out, I can't do this anymore and cramp up into the Frozen Shoulder syndrome.
Lying in this position will also tend to hunch the back. And you are probably much too young to have a Dowager's Hump on your back.
So please, try to train yourself to lie on your back when you sleep.
Sweet dreams :) Laura
It took me some time before I finally tried to look up what was wrong with me. I found a Chinese medicine webpage that said it was often called Fifty Year Shoulder, because that was the age at which the condition usually struck. It recommended warming herbs in foods to improve circulation, and use of a heating pad.
OK, the heating pad helped somewhat, tho I cannot say the cinnamon et al helped any.
Finally I wound up at a massage therapist who was pretty good with trigger points. He began by releasing some trigger points or adhesions in the supraspinatus and infraspinatus. Those are two of the rotator cuff muscles, and they are located on the dorsal side of the shoulder blade. They help you lift the arm and roll the arm forward.
Rotator cuffs are not built to do heavy lifting; that is the job for the biceps and triceps and pecs. Rotator cuffs are meant to stabilize the shoulder joint. They help keep the shoulder down while the other muscles lift the elbow up with its payload.
So anyway, this was an improvement. Another session worked on stretching the tight pec muscles. That hurt, but I was so much better within the week. The therapist lifted my arm up and back as I lay on the massage table, and manually stretched the pec muscle by pushing away from the arm. Then she lay the arm across my chest and gently pushed toward the opposite shoulder.
You can pull your arm across your own chest, and hook the other arm around it to help press it towards your chest. Hold for a couple breaths, and allow the arm and shoulder to relax into it.
After three weeks of the onset of frozen shoulder, you can proceed with Post-Isometric Release techniques.
Stand or lie on your back, whichever you prefer. Raise the arm above you as far as your current range of motion allows. Push in the OPPOSITE direction; HOLD for 5 seconds and release. You should be able to move your arm a bit further than before. You may repeat the exercise at the new limit of your range of motion.
Repeat this series for every angle of movement for your arm. Up, to the side, across the chest, forward, back. Make circles with your arms, slowly, with your arms straight out at the side. Make the circles bigger.
Stand in a corner. Put your forearms on either wall, hands pointing up. Lean into the corner. You may feel a stretch in the pecs and in the upper back.
Lastly, hold your arms out to the side. Roll the shoulder forward so that your hands turn palm up. Rotate the arms back again. Roll both shoulders forward and back for a minute or two, then roll one shoulder forward while rolling the other one back. This helps correct the hunched shoulders that so many of us get from working at a computer all day.
Now, ask yourself how you lie in bed at night. Do you lie on your side, and do you let the shoulder flop forward? Ask yourself what you are training your muscles to do by your habitual ways of sitting, standing and lying.
Lying with the shoulders flopped forward is straining your supraspinatus and infraspinatus muscles because they are being stretched for too many hours. It also is training your pec muscles to shorten up in front. Eventually your shoulder will cry out, I can't do this anymore and cramp up into the Frozen Shoulder syndrome.
Lying in this position will also tend to hunch the back. And you are probably much too young to have a Dowager's Hump on your back.
So please, try to train yourself to lie on your back when you sleep.
Sweet dreams :) Laura
Saturday, August 23, 2008
Cerebral Palsy Patients and Massage
Cerebral palsy is an umbrella term covering several brain injuries that damaged different areas of the brain at various stages of development. It is divided into four groups or types based on symptoms, and can also be classified by at what age the child received the brain injury.
The four types are: Spastic cerebral palsy, Athetoid cerebral palsy, Ataxic cerebral palsy, and Mixed cerebral palsy. The spastic type is far more common than the others; it features muscles whose tonicity is so high that the antagonist muscles have “completely let go” to use Ruth Werner’s expression (Werner, 2002). Athetoid accounts for up to a third of cerebral palsy cases, and features very weak muscles and involuntary writhing movements. The Ataxic type exhibits chronic shaking and tremors with very poor balance. Some include a fifth type, Dystonic, which also involves involuntary twisting movements of trunk and extremities. Symptoms depend on whether the cerebral cortex, basal ganglia, or cerebellum is the most severely affected (Turkington, 2002).
Brain injuries can occur either prenatally, in birth trauma, or can be an acquired defect in early infancy. Prenatal diseases that can cause cerebral palsy include rubella, toxoplasmosis, hyperthyroidism, diabetes, Rh sensitization, toxic exposure, or abdominal trauma. Birth traumas include anoxia or asphyxia (where the oxygen supply is cut off), or head trauma as in a forceps delivery. Injuries in infancy include things like shaken baby syndrome, car accidents, infections like meningitis or encephalitis, and neoplasms (Werner, 2009). Cerebral palsy is also linked to fetal alcohol syndrome (UPI, 2007 and Gwinnell and Adamec, 2005). The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy. Yet another environmental cause is exposure to high levels of methyl mercury (thimerosal) (Turkington and Tzeel, 2004).
Diagnosis of cerebral palsy can be very tricky. Doctors often wait till after the child’s first birthday for the permanent appearance of specific motor problems. Most children are diagnosed by the age of 18 months. Strangely, X-rays or blood tests only exclude other brain diseases. Cerebral palsy is not a hereditary condition, and these tests will neither establish nor rule out a diagnosis of CP. Magnetic resonance imaging (MRI) and CAT scans are often ordered if a doctor suspects that the child has cerebral palsy, but these tests are better at catching cases of hydrocephalus and, as I said, are usually used to exclude other causes of delayed motor development. It is odd that “children with normal scans may have severe cerebral palsy, and children with clearly abnormal scans occasionally appear totally normal or have only mild physical evidence of cerebral palsy” (Turkington, 2002).
However one of the distinguishing characteristics is called the “scissors” gait. A gait that also occurs in cervical spondylosis, the scissors gait allows the knees and thighs to thump against each other or to cross in a cutting movement akin to that of a pair of shears. A trauma to the spinal cord can also cause this type of gait (Sayler, 2005).
Cerebral palsy is not a progressive disorder, but conventional medicine holds that it is not a curable condition, either. Milder cases can resolve themselves by the age of 7 (Werner, 2009). Treatment may include braces for weak limbs, extended occupational and physical therapy, or even surgical intervention to correct scoliosis or correct hip dislocations.
Fortunately, patients with cerebral palsy have been shown to respond very positively to massage therapy. Pioneer Sister Elizabeth Kenny was first developing her techniques when she treated a seven-year-old girl named Daphne Cregan. Miss Kenny applied her usual program of hot baths or packs, with muscle re-education and massage. The Australian child progressed from not even being able to sit up, to walking with a stick. Daphne later earned prizes in school, at St. Ursula’s, for art, composition, and spelling (Cohn, 1975).
A research study conducted by Maria Hernandez-Reif recruited volunteer licensed massage therapists to administer to cerebral palsy patients two days a week. Following 12 weeks of twice weekly massage therapy sessions (added to standard care), very young children with CP showed reduced spasticity and less overall and arm hypertonic (rigid) muscle tone. Range of motion scores for hip extension also improved. Few developmental measures improved for a control group given standard care plus being read to over the 12 weeks; this program only produced improved language and feeding scores. The additional reading sessions might have contributed to the improved language scores and might be encouraging news for parents who have children with CP who may want to add reading to their daily or nightly routine. In contrast, the children in the standard care/massage therapy group showed improved scores in cognition, fine and gross motor functioning, dressing and social skills (Hernandez-Reif, 2005).
Their treatment protocol follows:
The therapist started each session by cradling the child’s head and making small circular strokes on the scalp while making eye contact to orient the child to being touched. Subsequently, the therapist applied non-scented oil to his/her hands and massaged the child in the following sequence:
Head/face/scalp: (a) using flats of fingers, stroking forehead and temple area; (b) stroking cheekbones outwards toward temple; (c) massaging, using circular movements, under the chin, cheeks, jawline around the ears, back of neck and base of skull.
Shoulders/arms/hands: applying oil to the hands, (a) kneading shoulders, including scapula area, deltoids and pectoral muscles; (b) making hands like the letter ‘C’ and milking the arms from the shoulder to the wrist; (c) with hands turning opposite each other, twisting and wringing from the shoulder to the wrist and off the hand; (d) using thumb over thumb motion to massage the palm of the hand; (e) massaging and gently pulling each finger; (f) massaging the top of hand, including the wrist and areas in between fingers; (g) flexing and extending wrist and fingers; (h) rolling the arm from shoulder to wrist; and finishing by (h) using long milking strokes and smooth strokes from wrist to the shoulder.
Chest: (a) making small finger circles down and then up both sides of sternum; (b) making small lateral movements with fingertips under clavicles from sternum to shoulder, working both sides of chest simultaneously; (c) with one hand on each shoulder, squeezing whole deltoid area with entire hand, then lightly moving both shoulders back and forth to open up chest area (relaxing and repeating three times).
Hips: (a) without forcing joints since knees may not bend, holding the lower legs and moving both knees toward chest (relaxing and repeating three times); (b) repeating same step but alternating lower leg towards opposite shoulder (relaxing and repeating three times).
Legs and feet: applying oil to the hands, following procedure for arms and hands to one, then the other, leg and foot.
Back: (a) holding chest with fingers and thumbs on child’s back, applying small thumb circles down sides of spine from the neck to the tailbone and back up to the neck; (b) making soothing circular strokes around the tops of the shoulders; (c) using heel of hand, making circles around entire back, including shoulder blade and lower back areas; (d) making large full palm circles across entire back.
Conventional massage therapy works well but must be part of a course of long-term treatment. “The damage for a person who has CP does not begin in the muscle and connective tissues. Although this is where we feel the tightening of the connective tissue wrappings around muscles, the contractures themselves are simply a symptom-a complication of a problem deep in the brain. Therefore, if all we try to do is lengthen the muscles and stretch the fascia, we will run smack into a brick wall: either no progress will happed at all, or symptoms may even be temporarily exacerbated. Most people with CP get best results if bodywork focuses on indirectly affecting muscle tone through craniosacral work, gentle rocking, slow range of motion exercises, and manipulation of the arms and legs that engages the client in ways he or she doesn't automatically resist-this often means going with the direction of muscle shortening in order to disengage the reflex. Ultimately, the therapist will have to experiment with lots of different approaches, often accompanied by extremely supportive bolstering, in order to find what techniques allow their clients to relax and enjoy their massage (Werner, 2002). Patients are able to sleep through the night, and breathe more easily.
A specific type of massage therapy, craniosacral therapy, may also be helpful to patients with cerebral palsy. A system of therapy based on the idea that there is a rhythmic pressure and flow of cerebrospinal fluid between the cranium (skull) and sacrum (the base of the spine) that governs the way the craniosacral structures, including the brain, pituitary and pineal glands, spinal cord, and meninges, or membranes, function and maintain the body's well-being. Gentle hands-on "manipulation" of the skull, the spinal column, rib cage, and limbs is believed to restore the flow and maintain the body's well-being (Navarra, 2004).
Fortunately now cerebral palsy patients and their parents have several organizations and even a website to turn to for information and advice. They include: American Academy for Cerebral Palsy and Developmental Medicine, Gillette Children's Hospital, Ontario Foundation for Cerebral Palsy, United Cerebral Palsy Association, and Your Smile Web site.
Understanding of this condition has come a long way from an era when victims were thought to be mentally deficient. However, we are still a long way from erasing its effects or preventing most cases. Progress has been slow and new approaches come into general use only against resistance. Let’s hope that the new millennium has brought a greater openness to effective massage and other therapies.
SOURCES:
Cohn, Victor, Sister Kenny: The Woman Who Challenged the Doctors, University of Minnesota Press, 1975.
Gwinnell, Esther and Christine Adamec, Fetal alcohol syndrome (FAS), The Encyclopedia of Addictions and Addictive Behaviors, 2005.
Hernandez-Reif, Maria et al, Cerebral palsy symptoms in children decreased following massage therapy, Early Child Development and Care, 2005.
Navarra, Tova, Craniosacral therapy, The Encyclopedia of Complementary and Alternative Medicine, 2004.
Sayler, Mary Harwell, Gait, The Encyclopedia of the Muscle and Skeletal Systems and Disorders, 2005.
Turkington, Carol, Cerebral palsy (CP), The Encyclopedia of the Brain and Brain Disorders, Second Edition, 2002.
Turkington, Carol, and Albert Tzeel, Thimerosal, The Encyclopedia of Children's Health and Wellness, 2004.
United Press International, Diseases caused by fetal toxicity studied, 2007.
Werner, Ruth, A Massage Therapist’s Guide to Pathology, Lippincott Williams & Wilkins, 2009.
Werner, Ruth, Working with Clients Who Have Cerebral Palsy, Massage Today, Aug. 2002.
The four types are: Spastic cerebral palsy, Athetoid cerebral palsy, Ataxic cerebral palsy, and Mixed cerebral palsy. The spastic type is far more common than the others; it features muscles whose tonicity is so high that the antagonist muscles have “completely let go” to use Ruth Werner’s expression (Werner, 2002). Athetoid accounts for up to a third of cerebral palsy cases, and features very weak muscles and involuntary writhing movements. The Ataxic type exhibits chronic shaking and tremors with very poor balance. Some include a fifth type, Dystonic, which also involves involuntary twisting movements of trunk and extremities. Symptoms depend on whether the cerebral cortex, basal ganglia, or cerebellum is the most severely affected (Turkington, 2002).
Brain injuries can occur either prenatally, in birth trauma, or can be an acquired defect in early infancy. Prenatal diseases that can cause cerebral palsy include rubella, toxoplasmosis, hyperthyroidism, diabetes, Rh sensitization, toxic exposure, or abdominal trauma. Birth traumas include anoxia or asphyxia (where the oxygen supply is cut off), or head trauma as in a forceps delivery. Injuries in infancy include things like shaken baby syndrome, car accidents, infections like meningitis or encephalitis, and neoplasms (Werner, 2009). Cerebral palsy is also linked to fetal alcohol syndrome (UPI, 2007 and Gwinnell and Adamec, 2005). The majority of infants who survive severe shaking will have some form of neurological or mental disability, such as cerebral palsy. Yet another environmental cause is exposure to high levels of methyl mercury (thimerosal) (Turkington and Tzeel, 2004).
Diagnosis of cerebral palsy can be very tricky. Doctors often wait till after the child’s first birthday for the permanent appearance of specific motor problems. Most children are diagnosed by the age of 18 months. Strangely, X-rays or blood tests only exclude other brain diseases. Cerebral palsy is not a hereditary condition, and these tests will neither establish nor rule out a diagnosis of CP. Magnetic resonance imaging (MRI) and CAT scans are often ordered if a doctor suspects that the child has cerebral palsy, but these tests are better at catching cases of hydrocephalus and, as I said, are usually used to exclude other causes of delayed motor development. It is odd that “children with normal scans may have severe cerebral palsy, and children with clearly abnormal scans occasionally appear totally normal or have only mild physical evidence of cerebral palsy” (Turkington, 2002).
However one of the distinguishing characteristics is called the “scissors” gait. A gait that also occurs in cervical spondylosis, the scissors gait allows the knees and thighs to thump against each other or to cross in a cutting movement akin to that of a pair of shears. A trauma to the spinal cord can also cause this type of gait (Sayler, 2005).
Cerebral palsy is not a progressive disorder, but conventional medicine holds that it is not a curable condition, either. Milder cases can resolve themselves by the age of 7 (Werner, 2009). Treatment may include braces for weak limbs, extended occupational and physical therapy, or even surgical intervention to correct scoliosis or correct hip dislocations.
Fortunately, patients with cerebral palsy have been shown to respond very positively to massage therapy. Pioneer Sister Elizabeth Kenny was first developing her techniques when she treated a seven-year-old girl named Daphne Cregan. Miss Kenny applied her usual program of hot baths or packs, with muscle re-education and massage. The Australian child progressed from not even being able to sit up, to walking with a stick. Daphne later earned prizes in school, at St. Ursula’s, for art, composition, and spelling (Cohn, 1975).
A research study conducted by Maria Hernandez-Reif recruited volunteer licensed massage therapists to administer to cerebral palsy patients two days a week. Following 12 weeks of twice weekly massage therapy sessions (added to standard care), very young children with CP showed reduced spasticity and less overall and arm hypertonic (rigid) muscle tone. Range of motion scores for hip extension also improved. Few developmental measures improved for a control group given standard care plus being read to over the 12 weeks; this program only produced improved language and feeding scores. The additional reading sessions might have contributed to the improved language scores and might be encouraging news for parents who have children with CP who may want to add reading to their daily or nightly routine. In contrast, the children in the standard care/massage therapy group showed improved scores in cognition, fine and gross motor functioning, dressing and social skills (Hernandez-Reif, 2005).
Their treatment protocol follows:
The therapist started each session by cradling the child’s head and making small circular strokes on the scalp while making eye contact to orient the child to being touched. Subsequently, the therapist applied non-scented oil to his/her hands and massaged the child in the following sequence:
Head/face/scalp: (a) using flats of fingers, stroking forehead and temple area; (b) stroking cheekbones outwards toward temple; (c) massaging, using circular movements, under the chin, cheeks, jawline around the ears, back of neck and base of skull.
Shoulders/arms/hands: applying oil to the hands, (a) kneading shoulders, including scapula area, deltoids and pectoral muscles; (b) making hands like the letter ‘C’ and milking the arms from the shoulder to the wrist; (c) with hands turning opposite each other, twisting and wringing from the shoulder to the wrist and off the hand; (d) using thumb over thumb motion to massage the palm of the hand; (e) massaging and gently pulling each finger; (f) massaging the top of hand, including the wrist and areas in between fingers; (g) flexing and extending wrist and fingers; (h) rolling the arm from shoulder to wrist; and finishing by (h) using long milking strokes and smooth strokes from wrist to the shoulder.
Chest: (a) making small finger circles down and then up both sides of sternum; (b) making small lateral movements with fingertips under clavicles from sternum to shoulder, working both sides of chest simultaneously; (c) with one hand on each shoulder, squeezing whole deltoid area with entire hand, then lightly moving both shoulders back and forth to open up chest area (relaxing and repeating three times).
Hips: (a) without forcing joints since knees may not bend, holding the lower legs and moving both knees toward chest (relaxing and repeating three times); (b) repeating same step but alternating lower leg towards opposite shoulder (relaxing and repeating three times).
Legs and feet: applying oil to the hands, following procedure for arms and hands to one, then the other, leg and foot.
Back: (a) holding chest with fingers and thumbs on child’s back, applying small thumb circles down sides of spine from the neck to the tailbone and back up to the neck; (b) making soothing circular strokes around the tops of the shoulders; (c) using heel of hand, making circles around entire back, including shoulder blade and lower back areas; (d) making large full palm circles across entire back.
Conventional massage therapy works well but must be part of a course of long-term treatment. “The damage for a person who has CP does not begin in the muscle and connective tissues. Although this is where we feel the tightening of the connective tissue wrappings around muscles, the contractures themselves are simply a symptom-a complication of a problem deep in the brain. Therefore, if all we try to do is lengthen the muscles and stretch the fascia, we will run smack into a brick wall: either no progress will happed at all, or symptoms may even be temporarily exacerbated. Most people with CP get best results if bodywork focuses on indirectly affecting muscle tone through craniosacral work, gentle rocking, slow range of motion exercises, and manipulation of the arms and legs that engages the client in ways he or she doesn't automatically resist-this often means going with the direction of muscle shortening in order to disengage the reflex. Ultimately, the therapist will have to experiment with lots of different approaches, often accompanied by extremely supportive bolstering, in order to find what techniques allow their clients to relax and enjoy their massage (Werner, 2002). Patients are able to sleep through the night, and breathe more easily.
A specific type of massage therapy, craniosacral therapy, may also be helpful to patients with cerebral palsy. A system of therapy based on the idea that there is a rhythmic pressure and flow of cerebrospinal fluid between the cranium (skull) and sacrum (the base of the spine) that governs the way the craniosacral structures, including the brain, pituitary and pineal glands, spinal cord, and meninges, or membranes, function and maintain the body's well-being. Gentle hands-on "manipulation" of the skull, the spinal column, rib cage, and limbs is believed to restore the flow and maintain the body's well-being (Navarra, 2004).
Fortunately now cerebral palsy patients and their parents have several organizations and even a website to turn to for information and advice. They include: American Academy for Cerebral Palsy and Developmental Medicine, Gillette Children's Hospital, Ontario Foundation for Cerebral Palsy, United Cerebral Palsy Association, and Your Smile Web site.
Understanding of this condition has come a long way from an era when victims were thought to be mentally deficient. However, we are still a long way from erasing its effects or preventing most cases. Progress has been slow and new approaches come into general use only against resistance. Let’s hope that the new millennium has brought a greater openness to effective massage and other therapies.
SOURCES:
Cohn, Victor, Sister Kenny: The Woman Who Challenged the Doctors, University of Minnesota Press, 1975.
Gwinnell, Esther and Christine Adamec, Fetal alcohol syndrome (FAS), The Encyclopedia of Addictions and Addictive Behaviors, 2005.
Hernandez-Reif, Maria et al, Cerebral palsy symptoms in children decreased following massage therapy, Early Child Development and Care, 2005.
Navarra, Tova, Craniosacral therapy, The Encyclopedia of Complementary and Alternative Medicine, 2004.
Sayler, Mary Harwell, Gait, The Encyclopedia of the Muscle and Skeletal Systems and Disorders, 2005.
Turkington, Carol, Cerebral palsy (CP), The Encyclopedia of the Brain and Brain Disorders, Second Edition, 2002.
Turkington, Carol, and Albert Tzeel, Thimerosal, The Encyclopedia of Children's Health and Wellness, 2004.
United Press International, Diseases caused by fetal toxicity studied, 2007.
Werner, Ruth, A Massage Therapist’s Guide to Pathology, Lippincott Williams & Wilkins, 2009.
Werner, Ruth, Working with Clients Who Have Cerebral Palsy, Massage Today, Aug. 2002.
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