This is intended to be an enjoyable experience involving simple massaging touch of the hands and forearms. It is not intended to be massage therapy. Please ensure all appropriate safeguards are in place and if you have any concerns, seek advice before proceeding. Remember to seek agreement and consent in whatever way is appropriate before proceeding.

What you need

• A massage oil, cream or olive oil to prevent friction (check for allergies). If neither are suitable then talc may be used. Be sure to apply the talc to your own hands away from the person so that they do not breathe it in. Check that the person does not have an aversion to the smell of the product before using.  
• A towel to put under the person’s hands to help prevent the transfer of any cream/oil to clothes or furnishings so place it under the hand you are massaging. If the person has cold hands a warmed towel is comforting and can feel luxurious.  

Guidance and instructions

1. Check that there are no sores, bruises or rashes on the hands, wrists, or forearms. If there are, do not massage until they have cleared up. If a person has had a break or surgery in this area in the last 12 months, a skin condition or a condition that makes their bones brittle such as osteoporosis seek medical advice before massaging.  
2. Ensure that you are in a calm, relaxed state before you begin as feelings of tension or calmness can be transmitted through your touch. Before starting take a few slow deep breaths.
3. Communicate to the person about what is happening in the most appropriate way for them throughout. 
4. Ensure that the person is comfortably positioned and posturally supported as necessary. Also consider your own positioning, which should allow you to be comfortable and protect your own posture as much as possible.
5. Consider whether there are any changes to the environment that might improve the experience. For example, lighting, heating, noise and music.
6. Wash and dry your hands and theirs and carefully roll sleeves up to above the elbow if possible, so you have access to their hand and lower arm.   
7. If the person is able to indicate, ask them which hand they wish to be massaged first. You may support this by stroking down each of their arms and gently squeezing their hands and watching for which they give the most positive response.  
8. Keeping one of your hands in physical contact with their hand or arm can help to maintain connectedness and support their anticipation of the experience.
9. Whilst massaging continually look for feedback from the person, which strokes do they indicate they like or dislike?  How much pressure do they prefer? For some people light pressure feels tickly and uncomfortable whereas others may like it. Continue to do what they enjoy and move on from anything that they show they dislike. End the massage if the person shows that they do not like what you are doing. 
10. Warm the oil or cream in your hands and enable the person to smell it if they want to. If at any point there is friction between their skin and yours use more oil or cream.
11. Place your hands on the person’s hand you are starting with, slowly and gently. Hold still to give them time to sense and process the sensation of your touch. Observe their reactions to check that it is ok for you to proceed.
12. Apply the oil or cream over their hand and move up to the elbow using stroking movements. Pressure should only be applied in the direction blood flows when returning to the heart. So, gentle pressure can be used when moving in the direction from fingertips to the elbow but when moving back from the elbow to the hand you must not apply pressure. To maintain contact, slide your hands over their skin back to their hand and down to their fingers.
13. Cradling their hand with their palm down move your thumb in large circles around the back of their hand and continue in decreasing circles until you get to the centre of the back of their hand where you can hold your thumb still for a few seconds. Repeat as desired.
14. Using your thumb and first finger (pointing finger) gently squeeze the finger-web between their thumb and index finger for a few seconds. Repeat with each of their finger-webs.
15. With their hand remaining palm down make little circles with your thumb from their fingertip and gradually up and over their knuckles to their wrist. Slide back down to the fingertip. Repeat a few times with the little finger then slide from the wrist to the next finger. Do the same for the rest of the fingers and thumb. Spend some time massaging around the base of their thumb, using little circling motions and strokes with your thumb, before continuing up to their wrist.
16. If possible, turn their hand over to focus on their palm. Move your thumb in large circles around the palm and continue in decreasing circles until you get to the centre of the palm where you can hold your thumb still with gentle pressure for a few seconds. 
17. Massage the underside of their fingers (which are now facing up) from fingertips to their wrist, in the same way as you did with the back of the fingers.  
18. With both of your hands, gently hook one thumb between their little finger and third finger (wedding ring finger) hook your other thumb between their thumb and first finger. Slowly move your thumbs apart to open their palm and stretch their hand to the extent that it will comfortably and easily without forcing or pulling. Release gently. If the person does not have ‘normal’ range of movement, muscle tone/length in their fingers and wrists, it may not be possible to hook your thumbs between their little finger and third finger without causing discomfort, in which case skip this step.
19. For the last part of the massage focus on the forearm. With their hand palm down, cradle their wrist in both your hands. Place your thumbs on top of their wrist next to one another pointing up towards the elbow. Move your thumbs outwards, away from one another in circular motions around the wrist, and then continue these motions slowly up the arm to the elbow. Slide back and repeat a few more times.
20. Take a moment to hold their hand still before slowly placing it down to rest on the towel. 
21. Reposition yourself as necessary and repeat with their other hand.  
22. End by resting the second hand on the towel and communicating that the massage has finished.

What to observe, assess and record 

Consider observing and recording before, during and after:

• Facial expressions before, during and after the massage
• Muscle tone and posture, looking and feeling for signs of relaxation and tension and comfort and discomfort
• Changes in skin colour
• Breathing
• Levels of energy 
• Behaviours before and after the massage
• Effect on sleep
• Effect on appetite

Contributors

© Julia Barnes, MEd, Special Needs Teacher and postgraduate researcher in nurturing touch at the University of Birmingham

Dr Julie Calveley, BSc(Hons) Psychology, BSc(Hons) Nursing, Registered Learning Disabilities Nurse

Email: [email protected]

Created October 2020