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Aromatherapy used on a Stroke Rehabilitation Unit

by Paula Mullins(more info)

listed in aromatherapy, originally published in issue 99 - May 2004

Introduction

How did it start?

Long before the days of drugs and laboratory-developed beauty creams, people turned to the village herbalist, the person who specialized in grinding, brewing, and mixing leaves, flowers, and fruits of plants which grew wild. Plant oils were one of the numerous discoveries brought to Europe by the crusaders in the middle ages. This science was developed in the 20th century by the French chemist, Rene-Maurie Gattefosse, who coined the term Aromatherapy in 1937 and is said to be the father of modern Aromatherapy. In the 1900s he used lavender oil to treat a burn on his hand, noticed how quickly it healed and began to look further into the therapeutic qualities of oils. Aromatherapy has become one of the fastest growing natural healing arts in this country. It has also rapidly gained respect from orthodox medical practitioners. Aromatherapy is increasingly being used in gyms, health and beauty clinics and extending to hospitals, hospices and surgeries. The sale of Aromatherapy oils has increased over the years. Essential oils are on sale in chemists, high street shops and supermarkets. The essential oils are found in toiletries, skin care products and in everyday products, and are enjoying success and growth.

How does it work?

Because the odoriferous molecules of an essential oils are extremely volatile, they diffuse through the skin in the same way as other gases. They have the ability to penetrate right into the deep layers of the skin and travel to various organs, glands and tissues of the body. When they have passed through the epidermis they seep into the small capillaries in the dermis and are carried all around the body. When inhaled, essential oil particles are taken directly to the roof of the nose, where information about the aromas, via the olfactory bulb are forwarded to the area of the brain associated with smell.

What are essential oils made from?

Depending on the species of plant, essential oils are extracted from petals, leaves, roots, buds, twigs, wood bark, resin or fruit. In a few cases every part of the plant growing above the ground is used. There are several ways of obtaining the oil, the most common being steam distillation. Expression is confined to the citrus oil family. The oils are extracted by machine out of the rind, onto a sponge. When the sponge is saturated, the oil is squeezed out of it, into a vat.

Perceived benefits of aromatherapy
Most essential oils are antiseptic
bergamot blackpepper
cinnamon eucalyptus
ginger juniper
lavender lemon
lemongrass lime
tea tree violet
rosemary sandalwood
ylang ylang niaouli
patchouli pine
marjoram  
Some are effective at fighting viral
and fungal infection
calendula eucalyptus
lime myrrh
patchouli tea tree
Some oils are antiinflammatory
bergamot cajuput
chamomile eucalyptus
geranium ginger
lavender marjoram
niaouli peppermint
rosemary  
Certain essential oils increase circulation  and are said to assist cell regeneration
chamomile cypress
geranium marjoram
peppermint rose
Some essential oils are relaxing
rose rosemary
violet ylang ylang
chamomile clary sage
ginger geranium
grapefruit jasmine
melissa lavender lemongrass
neroli patchouli
petitgrain sandalwood
While others are stimulating
blackpepper cajuput
cinnamon eucalyptus
geranium peppermint
lemongrass niaouli
pine rosemary
tea tree thyme

Contra indications

Essential oils are powerful and should be used with care. In using the oils on the ward, caution is taken when treating people with the following conditions:

Heart disease and high blood pressure:

Barker mentions that no evidence of any oil used will make an existing circulatory problem worse when relaxing and calming oils are used.[1] When treating hypertension, Barker states that the main group of essential oils considered should decrease the peripheral resistance by dilation of peripheral blood vessels and in return will reduce venous return and systematic blood pressure.[2]

Epilepsy: Davis states that there is a number of essential oils which can provoke an epileptic type fit in people who
are susceptible.[3] For this reason it is extremely important to be certain that a person does not suffer from epilepsy before beginning any treatment.

Elderly Care: Bensoulah states that a low dilution blend of 1-2 % must be used, as older skin tends to be thin, dry and very absorptive.[4] Also it is prudent to keep the dosage low, as substances are metabolized more slowly as we age, and especially if taking long term medication.

Deep Vein Thrombosis: Rankin Box 2001 states that feet, legs or trunk should never be massaged.[5] A very light hand or face massage will not increase circulation enough to move emboli and may reduce patients' anxiety.

Diabetes: There is no evidence to show that aromatherapy is contraindicated in the case of diabetes. Be aware of hypoglycaemia. Diabetics have a slow healing rate and heavy pressure might cause bruising. The skin of a diabetic is easily torn or broken. Should this happen, the person might get a diabetic ulcer. It is possible to release too many toxins for the system to cope with and this can make the diabetic feel ill.

Risk Factors.

Most essential oils used need to be diluted in a carrier oil or, as it is sometimes called, 'base oil'. Grapeseed and sweet almond are the best general-purpose carrier oils. You should know what you are taking – in other words, find out the Latin (genus and species) name, which is the only name that differentiates one form of the oil from another. Oils called eucalyptus, for example, could be from one of several different plants.

Lis Balchin states that essential oils should not be taken internally unless prescribed by a medically qualified practitioner.[6] Aromatherapy practitioners in Europe, but not UK, have to be medically qualified.

Consent to Treatment

Norton mentions that if a patient consents to a course of health care or indeed complementary therapies, he or she should have sufficient information on which to make both an informed and considered choice.[7] Information regarding the likely outcome and inherent risks should be provided in a form that is understandable and relevant for the individual. Informed consent is an ethical and legal issue that must be addressed, as patients cannot make informed decision about proposed therapies unless the potential benefits, possible harms and the therapy itself are explained and discussed. The Department of Health Guidance (Dec 2000) is helping to provide clarity with regards to consent.[8] Guy's and St Thomas' Hospital NHS Trust have re-edited its consent policy to ensure that patients are fully informed with regard to their treatment of care. Competent adults can give a verbal consent to be treated after a short explanation is given about the treatment itself.

Role Function of Aromatherapy on a Stroke Unit

Completed records are kept in the form of proformas and completed for all patients on the unit. They contain information about important matters of clinical diagnosis, patch testing, and reasons for not treating a patient. Aromatherapy massage treatment may be contraindicated or may need to be considerably moderated due to the patient's condition. Patients' notes are evaluated on the ward in order to gain background information for each patient and to help rule out any contraindications for the treatment. Information would be noted on the patient's proforma. Prior to treatment, patients are patch tested with the recommended essential oils used for the aromatherapy massage treatment. This is to ensure that patients do not have an allergy to the essential oils used. The outcome of this procedure is documented on their proforma. Patients are treated on a regular basis and the record of each treatment session is documented and kept with the patient proformas. The patient's record of treatment is then evaluated when the patient has been discharged from the ward so that this information is at hand for research and evaluation data. An aromatherapy care plan is written and each treatment session is documented and kept in the patient's care plan folder at their bedside. Green labels with 'aromatherapy patient' are placed on the patient's drug charts for those who are having treatment. When patients are discharged from the ward an evaluation is written up on the treatment that they receive. Verbal consent is received from the patients before the treatment begins. If a competent adult patient refuses treatment this is clearly documented on the patient's records. If the patient is not suitable for treatment this is also clearly documented.

Environment Issues

Air fresheners/room sprays with essential oils are blended in water in spray bottles.

Lavender bags are made up with lavender essential oil added and used to help patients to relax and aid sleep especially at night when requested. A selection of bubble bath blends with essential oils are blended for the staff to use in the patients baths and wash basins to help the patient to feel relaxed. A blend of tea tree essential oil and water is used in a mouthwash.

Education

A current literature folder is held by the aromatherapist and contains mostly up to date, research-based articles relating to complementary therapies. Fact sheets are given to patients' relatives, giving information on aromatherapy and the use of essential oils for use at home after the patient is discharged. Teaching sessions are given to patients' relatives for them to continue treatment. A handout on the technique is given and other relevant information. A blend of essential oils is provided.

Potential Benefits.

  • Induces a state of relaxation;
  • Relaxes tight and tense muscles;
  • May induce natural sleep;
  • Stimulates blood lymph circulation which increased the supply of oxygen and elimination of toxins;
  • Reduces tension;
  • Relieves pain in general and in specific areas;
  • Acceptable way of giving and receiving TLC;
  • Reduces swelling in limbs;
  • Relieves tightness in the limbs;
  • Returned sensation.

Case Studies: Speech and Language Referrals.

Case Study One

An 86-year-old gentleman came in with a left middle cerebral artery infract and a right sided weakness. He was also non-insulin dependent diabetic mellitus (NIDDM).

Before the treatment: This gentleman had a nasal gastric tube in situ. He was unable to swallow and he had a haematoma in his mouth. Assessment by a speech and language therapist showed that he held the bolus in his mouth with effortful swallow and there was change in voice quality – therefore he aspirated. There was repetitive tongue pumping movement, which led to facial grimaces. There was laryngeal bobbing as the patient attempted to trigger swallow. When swallow was triggered, he had good laryngeal movement.

Treatment: The patient received 10 aromatherapy face massage treatments with lavender/ mandarin essential oil blended in a carrier oil to help desensitize around the patients lips/mouth. Particular attention was paid especially around the lower chin and lips for each treatment. Also the speech and language therapist cleaned the patient's mouth with 1 drop of tea tree essential oil in a glass of water.

After the treatment: The patients face was not flaccid. He had increased tone in his cheeks and under the chin/tongue. He had good laryngeal elevation, strong swallow and no residue in the mouth. On discharge he was eating a soft diet and drinking thin fluids.

Case Study Two

An 88-year-old lady came in with a left cerebral infarct and a right sided weakness. She was unable to communicate verbally. She also had a neglect to the right side, had suffered a previous stroke in the past and was identified to have had hypertension.

Before the Treatment: This patient's right aspect of the mouth drooped downwards with continual dribbling/drooling when at rest. The position of her lips was asymmetrical. The position of her jaw hung widely open and was severely affected. There was no attempt to reposition. She had no tongue co ordination so she could not speak and took nil by mouth. She was flaccid in the facial area.

Treatment: The patient received 8 regular face massage treatments with lavender/mandarin essential oil in a carrier oil blend. The aim/objective of the treatment was to help tone the muscles in the face and to stimulate sensitivity in the facial area. Particular attention was given to the lips, chin and cheeks for stimulation when receiving the face massage. A massage was also given under the chin to help stimulate the flaccid tongue. Tea tree essential oil was used to stimulate the tongue, which had no movement. By the 3rd treatment this patient could move her tongue very slightly with some exercises. She managed to swallow some water and thickened juice. There was no more dribbling and she managed to keep her lips closed as much as possible. By the 7th treatment the patient was able to drink fluids much better and her swallowing had improved.

After the treatment: The patient had no dribbling/drooling. She closed her lips together when swallowing and dabbed her mouth when necessary to clear any excessive spillage from her lips.

Case Study Three

This 49-year-old lady came in after collapsing in the USA with a left cerebral infarct and right sided weakness. The lady had dysphasia and in 1986 she also had a myocardial infarction.

Before the treatment: This patient received 11 aromatherapy massage treatment with lavender/mandarin essential oil blend. The aim/objective of the face massage treatment was to help increase the tone on the right side of the face. There was flaccidity in both cheeks, slight tightness at the base of the tongue, and on the left side under the chin. By the 5th treatment, there were great improvements. The face muscles had good tone, in both cheeks and base of the tongue and neck area. The patient could manage to say a few words. By the 8th treatment, the tone in the cheeks felt much better and not as flaccid.

After the treatment: The patient could speak using more intelligible, spontaneous words, though she continued to be severely dyspraxic.

Case Studies: Physiotherapy Referrals

Case Study One

A 51-year-old gentleman came in with a left sided weakness, slurred speech, TIA X4, increased cholesterol, bipolar disorder and increased blood pressure.

Aims/objectives: This patient had a very flaccid arm/hand. The aim/objective of the treatment was to help increase the tone in the flaccid arm/hand.

Treatment: The patient received 16 aromatherapy massage treatments to his stroke arm/hand. At the beginning, there was tightness in the arm/hand with some clawing of the fingers. The patient could move his thumb and first finger slightly. By the 3rd treatment he had some movement in the thumb, and very slight flexion and extension of the fingers. By the 6th treatment, the patient could flex and extend the thumb, could flex his fingers into a fist but had to pull his whole hand back to extend the fingers. By the 9th treatment, the patient could count on his fingers including the little finger. By the 13th treatment there was swelling in the hand. By the 14th treatment, the hand swelling had slightly reduced. He also had some tone in the arm/hand.

After the treatment: The swelling had gone down. The patient had his arm/hand in a splint at night to help keep his fingers from tightening up by the morning. There was good improvement in the arm/hand and the patient found that the massage had helped to loosen the tightness in the arm/hand.

Case Study Two

A 69-year-old gentleman collapsed with a left sided weakness and right-sided stroke.

Aims and objectives: This gentleman had swelling and tenderness in the wrist. The aim/objective of the treatment was to help reduce any swelling in the wrist and encourage stretching of the fingers.

Treatment: This patient received 13 aromatherapy massage treatments to his arm/hand with a cream base only. At the beginning the arm/hand was very tender and painful in the fingers and wrist. By the 8th treatment, there was no swelling and the knuckles in the hand had improved. By the 12th treatment, there was a slight grip in the hand, though there was no actual movement. There was some tightness in the fingers with slight clawing.

After the treatment: There were good improvements in the arm/hand though the arm/hand was painful. The thumb and the little finger were a little more supple, although the patient found the little finger painful. He also found that the treatment had helped ease the pain in the arm/hand.

Case Study Three

A 64-year-old lady came in with a right CVA, left sided weakness, increased blood pressure and a gastric ulcer.

Aims and objectives: This lady had flaccidity in the arm/hands with some return movement. The aim/objective of the treatment was to help increase the tone in the arm/hand and improve the movement.

Treatment: This patient received 5 aromatherapy massage treatments to her arm/hand: Two with lavender/lemongrass, one with lavender/mandarin, two with lavender/geranium, all blended in a carrier oil. The first treatment showed flaccidity in the arm/hand. There was some movement in the hand especially the fingers, thumb and little finger. A lavender bag was made up for the patient to inhale from, for relaxation. The patient had psoriasis on both hands. By the 2nd treatment, all the fingers could move slightly and some hand exercises were given. The psoriasis improved on the hand. By the 3rd treatment, the patient could open and close her hand into a fist though not fully, and had a good grip in the hand.

After the treatment: There were great improvements. The patient could flex and extend her hand into a fist. She could count on the 1st 2nd and 3rd finger except the little finger with her thumb. With her hand flat, palm faced down on the table, the patient could open and close her fingers slightly, and she could move the thumb slightly. Some stretching exercises were given during her treatments.

Conclusion

Harvey states that most NHS buyers and doctors want to see solid clinical research based evidence that a therapy works before allocating funds or referring patients.[9] Unfortunately, research into complementary therapies tends to be scattered internationally and does not get into the journals doctors read. It falls short of the rigid standards set by the favoured research framework, the Randomized Controlled Clinical Trial. There is a great need to develop the field of practical aromatherapy. There is an even greater need for research into the potential and positive benefits of aromatherapy to patients. This should be embraced and not discussed lightly.

References

1. Barker A. Aromatherapy and Heart Attack. Aromatherapy Quarterly. 48: 13-17. 1996.
2. Barker A. Aromatherapy and Hypertension. Aromatherapy Quarterly. Winter. p. 23-26. 1994.
3. Davis P. Aromatherapy an A-Z. The CW Daniel Company Ltd. 1998.
4. Brett H. Aromatherapy in the Care of Older People. Nursing Times. 96: 33: 56-57. 1999.
5. Rankin Box D. Massage The Nurses Handbook of Complementary Therapies. Baillier Tindell. Chapter 26. 2001.
6. Lis Balchim M. Aromatherapy for Pain Relief. Pain Concern UK. P. 12-15. 1998.
7. Norton L. Complementary Therapies in Practice: The Ethical Issues. Journal of Clinical Nursing. 4: 343-348. 1995.
8. Dept of Health. Key Points in Consent. The Law in England. 2000
9. Harvey E. The Natural Health Service: Complementary Therapies in the NHS. Here's Health. 1998.

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About Paula Mullins

Paula Mullins Dip ArTh MThCert Dip A/P Dip Ref ITEC CertEd works at Guy's and St Thomas' Hospital NHS Trust as an Aromatherapist, Reflexologist and Researcher. This post developed over a period of time commencing in October 1996 as a part-time position. It is now a full position on the Acute Stroke Rehabilitation Unit. She can be contacted on paulamullins@tiscali.co.uk


  • Neroli


    Cajuput


    Petitgrain


    Bergamot


    Eucalyptus

     

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