The Use of Integrative Diagnostics for Applied Psychosynthesis on a Patient with Cerebral Vascular Accident
Author: Michele S. Jang P.T.; I.M.P,C.
Abstract: This article illustrates the benefits of Psychosynthesis work. This case study focuses on a 76 year old woman who suffered a Cerebral Vascular Accident. Upon evaluation, the woman complained of right-sided weakness and left wrist pain due to carpal tunnel syndrome. The woman presented with expressive aphasia and dysarthria. Function was limited, especially of the right upper extremity. The woman was treated for one hour with Integrative Manual Therapy focusing on Integrative Diagnostics for Applied Psychosynthesis. After treatment was completed, there was significant improvement observed in transfers as well as a decrease in aphasia.
Key Words: Psychosynthesis, Cerebral Vascular Accident (CVA), Carpal Tunnel
History
The patient is a seventy-six year old woman who suffered a cerebral vascular accident (CVA) on August 2, 1999. Her chief complaints are of right-sided weakness, dysarthria, expressive aphasia and left wrist pain due to carpal tunnel syndrome. Prior to the CVA, the client worked as a full-time licensed nurse practitioner, a job which she was not able to return to following the CVA. The client currently lives alone, and she has been deteriorating functionally. She reports falling approximately once every two weeks. Her last fall was September 30, 2000, during which she reports fracturing her right elbow, which was placed in a sling, but not casted. She was no longer using the sling at the time of this treatment. Carpal tunnel-like pain in her left hand affects her ability to use this side to assist in balancing.
Along with her worsening balance, the patient reports increasing difficulty with fine-motor tasks such as dressing and feeding due to right hemiparesis. Her right hand is her dominant side. She has relied on her left hand to help, but sparingly, as its use is limited by the aforementioned carpal tunnel-like pain. The patient also expressed great frustration at her inability to talk and make her needs known due to her dysarthria and expressive aphasia. Along with her history of a cerebral vascular accident, the patient also has a history of hypertension and surgery to relieve right carpal tunnel pain in 1994. She is scheduled for left carpal tunnel surgery in the future.
Examination
The patient was treated once six months ago prior to our session. During this second treatment (which was 2 hours in length), the patient was re-evaluated the first hour and treated the second. As pertinent to this case study, the following are some highlighted points observed during the reassessment:
1. minimal assistance to transition onto and off the treatment table
2. minimal assistance for adjusting herself on the treatment table
3. decreased fine motor control with slow opposition on the right
4. decreased coordination of the right upper extremity with hypertonicity and spasticity of the shoulder in flexion and abduction
5. with her head supported by pillows in supine, the client exhibited great difficulty bringing her right hand to her mouth to simulate self-feeding -- often missing her mouth and being successful on the 5th attempt.
Other observations include yellowish facial pallor and a soft, weak voice quality which I found difficult to decipher at times.
Treatment
Based upon her Myofascial Mapping (1,2,3), the Integrative Manual Therapy_ technique of Integrative Diagnostics for Applied Psychosynthesis (IDAP) (2) was used. IDAP is a technique which employs Neurofascial Process (3) - a system of hand placements with anatomic imagery. IDAP is a tool used to explore emotional, cognitive, spiritual /other energies that are stored in one’s body and that can impair health and the ability to function. Several ages were determined to be significant.
During the one hour of treatment using IDAP, the client revealed that she had an extremely difficult childhood being physically abused by her father. She remembered several situations in which she had been beaten.
Outcome
After the IDAP treatment session, the patient and I noted the following changes:
1. no assistance was required to adjust herself on the table and off of it
2. able to simulate self-feeding using her right upper extremity successfully and with 100 percent accuracy in 5 attempts with no apparent patterning as exhibited prior to treatment
3. less expressive aphasia with greater vocalization
4. facial pallor no longer appeared yellow, but pinkish.
The patient expressed a sense of greater well-being and was amazed at how much the memories of her abusive childhood affected her.
Discussion
A follow-up conversation with the patient’s daughter revealed that the patient had reverted back to her pre-treatment presentation after one week. From this study, it is apparent that one hour of IDAP created a change for the better in this patient as demonstrated by her improvement in transfers, table mobility, upper extremity coordination and control, voice projection, expressive aphasia and facial pallor. Her treatment plan calls for an additional three hours of IDAP (four hours total, including the hour documented in this report), which has not yet been completed. One can only guess how the patient will change after the additional three hours of IDAP and if these changes will stay. A future case study may be in order.
References