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Massage therapists often work with clients who have physical and mental disabilities, and they should be prepared to identify potential contraindications in order to best provide massage therapy to this population. Often, special needs clients may not disclose medical ailments or their need for accommodation until they arrive for the appointment, so it is up to massage therapists to be well educated about situations when it is, and when it is not appropriate to provide massage therapy services.Special NeedsThe term "special needs" is broad, and encompasses a large spectrum of minor to severe needs ranging from mobility assistance, to cognitive impairments, to clients with medical ailments. When special needs clients make an appointment for a massage therapy, they often (but sometimes do not) disclose that they have a physiological or mental impairment that may require special assistance. For massage therapists, it is best to be aware and prepared to work with clients who require additional attention and techniques to provide a quality massage while not compromising the client's health or safety.Educating YourselfHow would you work with special needs clients who require a wheelchair for mobility? How will you approach treatment with a client who has had a full skin graft on his or her back? How do you provide massage therapy to a client with a history of seizures? For many massage therapists, the answers to these questions are often guesses at best, and educating yourself about possible special-needs situations can help you become knowledge and prepare for any unforeseen needs and potential contraindications.For example, special needs clients with mobility issues may not be able to assume a supine or prone position on a conventional massage table to receive massage therapy. While a massage chair is a possible alternative, some clients may not want to / be able to move from their wheelchair and must be treated in a seated position. By being prepared with supportive pillows and bolsters, massage therapists can massage a client while they are in a comfortable position in their own chair. Be sure to educate your client about what you are doing during the massage therapy session, and why you are doing it. When working with special needs clients, ensuring their emotional and physical comfort should be one of your highest priorities.Another example is working with clients with visual or hearing impairments. How will you communicate with your client if it is difficult for them to see or hear you? For clients who are hearing impaired, massage therapists should always know to establish a set of mutually agreed upon hand signals, or have a piece of paper and pen prepared to write down questions or statements. Just because special needs clients may not be able to hear you is no reason to not attempt to communicate things during the massage therapy session like "are you too hot or too cold?" "Is the pressure ok?" "Are you ready to roll over?" As with hearing impairments, massage therapists should also be prepared to modify their method of communication with special needs clients who have visual impairments. Before you begin the massage, describe the room, assist the client to the table, and explain where everything is. Do not move anything once you have described the layout, as this can be disorienting to your client. During a massage therapy session, clearly describe everything you are about to do, and give the client a moment to give his or her consent.One more example is working with special needs clients who have medical conditions that may be ambiguous to the massage therapist. In school, massage therapists are educated about working with clients with autoimmune disorders, and communicative diseases. But what about clients with full-back skin grafts? What about a client who discloses that she occasionally has seizures? What about working with a terminally ill client? These special needs clients are examples of conditions that massage therapists will likely encounter during their practice, and each therapist should anticipate these concerns and prepare accordingly to provide quality massage therapy.Preparing Your Practice for Special Needs ClientsFor a standard massage therapy session, many massage therapists have a room set up with at least a table, a bolster, extra sheets, candles, and a headrest. But fewer massage therapists have a closet full of bolsters of various shapes (triangular, thin, thick, circular, flat), a massage chair to accommodate clients who cannot lie supine or prone, lights that can dim or brighten depending on a client's visual needs, or an erasable board to communicate with clients with hearing impairments.Physically preparing accessories and the layout of your room for a massage therapy session can increase the positive experience had by special needs clients exponentially. Additionally, massage therapists should consider how clients will even get to your massage room. Are the hallways in your practice large enough to accommodate clients of all sizes, and clients in wheelchairs? Is your practice ADA compliant with stairs and a ramp to the front door and a method of moving from one floor to another such as an elevator?Finally, are you advertising that your massage therapy practice is welcoming of special needs clients? By writing a sentence on your website such as "I am pleased to work with all clients, and request that you inform me of any special needs prior to making your appointment. I appreciate this extra time you give me to arrange your massage room, make a spot for any assistance animals, and prepare to provide you with a quality massage", massage therapists can let everyone know that they provide massage for special needs clients.Continuing EducationAs previously stated, "special needs" is a broad term and encompasses many medical, emotional, and physiological needs. There is a wealth of printed material about providing massage therapy to special needs clients, and these should be read by massage therapists to best prepare to accommodate all clients. Additionally, always understand that the client you are working with knows their condition better than anyone (including you). Ask them about prior massage treatments, and what did and did not work for them in the past. Always be mindful that they are above all people and clients with special needs - not a problem or a challenge to overcome.More massage schools are offering continuing education courses about accommodating special needs clients, and massage therapists often have the chance to learn about ADA compliance, medical contraindications, complementary therapies, medical massage, and much more. It is always a good idea to educate yourself to stay informed about best practices to serve all clients. Subscribe (if you do not already) to a trade journal or newsletter about special needs massage. Therapists should read articles on reputable message boards about accommodating special needs clients, and always be prepared to identify potential complications in order to give the best massage therapy possible. 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