British Journal of Learning Disabilities Vol. 23 (1 995) 37

An Introduction to Aromatherapy for People with learning Disabilities

Jane Harrison, Aromatherapist/Massage Therapist, 5, West Pathway, Harborne, Birmingham and Judy Ruddle, Aromatherapist/Occupational Therapist, Community Support Team, Bankfields Court, Normanby,

Middlesborough, Cleveland.

Aromatherapy is the use of essential oils to promote health and well being and is being used increasingly with children and adults who have severe learning dis- abilities. Although well known for its relaxing, invig- orating and health promoting effects, its use can be further extended to provide sensory stimulation and to help develop communication through a trusting relationship. This article sets out to explore each of these areas and to describe how they have been used with people with severe learning disabilities.

History Although aromatherapy has only recently become

popular, the principles on which it is based have ancient origins. The earliest recorded uses of aromatic plants for medicinal purposes date back to Egyptian times. At this time, plants were being used both internally and externally for respiratory, skin and intestinal problems as well as for cosmetic purposes, most significantly for embalming.

By the middle ages recipes for spices and infused oils were being published. Together with these and home- made lavender bags, pomanders and other herbal sach- ets, aromatic plants were being used not only to enhance a person’s quality of life but also their chance of survival. It was found that glove makers and perfumers, who used the oils to mask body odour, rarely succumbed to any of the diseases of that time. This fact is attributed to the antibacterial properties of essential oils. The 18th and 19th centuries brought an increase in experiments to reproduce the therapeutic properties of essential oils synthetically and gradually medicines began to take the place of aromatic oils.

With the 20th century came a renewed interest in the use of essential oils and natural remedies. Gattfosse, a French chemist, discovered that many of the essential oils in his perfume products had better antiseptic properties than their chemical counterparts. Following an explosion in his laboratory, he burnt his hand badly

and in order to cool the area he plunged his hand into neat lavender oil. He discovered that his hand healed exceptionally quickly and with no scarring, which led him to further research the use of essential oils. It was Gattefosse who first coined the term ‘aromatherapie’ and in 1928 published the first modern book on the subject.

Other French scientists and physicians have continued this work including Valnet who became known for his use of essential oils to treat severe burns and battle injur- ies throughout World War I and later in the psychiatric hospitals. More recently Maury, a French biochemist who carried out research on essential oils, developed the massage techniques used in aromatherapy (Further reading: Tisserand, 1980; Davis, 1988; Price, 1983).

Today the properties of essential oils are being closely examined by both the medical and scientific community. Data is being gathered to support claims made regarding the physical and psychological effects of essential oils. As documented in The Lancet, Dec. 1980 the use of essen- tial oil of tea tree in the treatment of acne has now been established as a rival to benzol peroxide, yet with no side effects. Also, in Japan, Professor Shizuo Torii (1990) tested nineteen different essential oils and monitored brain wave patterns. He found that when the subject was presented with an invigorating oil, for example lemon, the brain wave pattern increased (as the reaction would be if someone was alert and concentrating) and when presented with a relaxing oil, for example marjoram, the brain wave pattern decreased (as the reaction would be if someone was calm and relaxed).

What is Aromatherapy? Aromatherapy is the controlled use of essential oils,

which are obtained from plants, to bring about balance and harmony to mind, body and spirit. Essential oils are natural, usually non-oily fragrant essences which are extracted from plants through a process of distillation. The oils are obtained from various parts of a plant; the flower (lavender), stem (lemongrass), leaf (eucalyptus,

38 - British Journal of Learning Disabilities Vol. 23 (1995)

geranium) or from the bark (cinnamon). Each oil is thought to have its own therapeutic effect on certain parts of the mind, and the body and its systems. Essen- tial oils have many different properties, including being antidepressant, bactericidal or sedative (Tisserand, 1980).

The oils can be used in a number of ways, either within massage (the oils being mixed with carrier oils, creams or lotions), for vaporisation (using burners or electric diffusers) or in water (the oils being placed in a bath or foot spa). For people with learning disabilities the use of aromatherapy and essential oils has more recently been extended to promote sensory awareness as well as to help develop communication through a trust- ing relationship. The use of aromatherapy can be intro- duced to people with learning disabilities in a variety of settings, including both day and residential services. Although a qualified aromatherapist can offer a depth of knowledge and experience in its use and application, anybody can introduce basic aromatherapy practice into the lives of people they support.

The Importance of Touch and Smell People with severe learning disabilities often have

additional physical and sensory impairment. Among people with an intellectual disability, 48% also have a sensory impairment of at least moderate severity and of these, 18% also have a dual sensory impairment (Harris, 1991). The information which we receive from our senses of sight, hearing, touch, taste and smell is vital to enable us to understand our environment. The use of aroma- therapy stimulates the senses of touch and smell, in particular, and for people with learning disabilities, this can provide more than just physical and mental well being, opening new avenues by which they can under- stand and make contact with their environment.

Touch Touch is a basic behavioural need, in much the same

way as breathing is a basic physical need (Montagu, 1986). For people with learning disabilities, touch may be experienced in mainly functional ways, for example, being assisted with dressing, bathing toileting or moving around. This form of touch may be perceived as being affirming and supportive but it may also be felt to be rough and manipulative. For people who have severe or profound learning disabilities, touch may be the clearest way they have of understanding the world and receiving information from the people around them.

The quality of touch which a person receives will often give clearer non-verbal cues as to the true feelings of the person offering touch than the accompanying verbal cues. The non-verbal messages we convey through touch and the quality of touch which a person receives are very important and can affect not only the quality of their relationship with others but also their own quality of life.

With aromatherapy and massage, massage can simply be seen as an extension of touch and the natural urge to rub something better. A parent will rub a child’s knee if they have fallen and hurt themselves. For people with learning disabilities, massage is recognised as being both an appropriate and valued way of offering touch. It need not be complicated to be effective and a simple hand massage can provide essential physical and emotional contact.

Smell The sense of smell is often considered to be one of the

least important senses, yet it is many times more sensi- tive than the sense of taste and can provide an important input into the way in which we perceive our environ- ment. The way smell can trigger physical responses such as hunger is well known and recognised. Supermarkets will pump ’freshly baked’ smells from their bakery to the entrance to encourage feelings of hunger, thereby sti- mulating their customers to buy more.

The sense of smell is perhaps just as closely linked to emotional feelings and memories. People often associate particular perfumes or tobaccos with certain people; similarly, different fragrances can remind people of events and places. Smell memories can be very powerful and sometimes a smell will evoke the memory of a pre- viously experienced emotion but the person will not remember the exact context. Smell receptors which lie at the top of the nostrils contain nerve cells which transmit impulses to the limbic system of the brain via olfactory nerves. the limbic system is both the smell and emotional centre of the brain, hence the strong association between the two.

Research undertaken at Warwick University suggests that people can learn to associate particular smells with different emotions (Van Toller & Dodd, 1988). This prin- ciple can be used to help people relax in different environments. For example, if a relaxing essential oils, such as lavender or marjoram, is used during a massage session when a person is feeling relaxed and calm, then vaporising the same oil at times when the person feels upset could, through smell association, help to calm them. This principle has been used successfully with people who have epilepsy, the smell of the essential oil ’reminding’ the nervous system of feelings of relaxation and, thereby, often averting a fit (Clouston, 1991).

For people with limited verbal communication, smell can provide a useful role in developing other forms of communication. For people with dual sensory impair- ment, different fragrances may be used to help them identify particular people or locate different places. Location smells may include pine for a bathroom, lemon for a kitchen and the person’s favourite perfume or essential oil in vaporisers, drawer liners or wooden balls to help them identify their own bedroom.

How Aromatherapy can be Used Many believe that the strength of aromatherapy lies

in the interrelation of the three elements of the essential oils, massage and the therapist/client relationship (Davis, 1988). For people with learning disabilities, the combination of this and the need to recognise the importance of touch and smell leads us to consider five different ways of introducing aromatherapy. These include the use of aromatherapy to invigorate and pro- mote activity and alertness, to facilitate relaxation and reduce stress, to stimulate sensory awareness, to facili- tate and encourage interaction and communication and to treat medical problems using natural substances (Sanderson & Ruddle, 1992).

British Journal of Learning Disabilities Vol. 23 (1995) . 39

Aromatherapy to Facilitate Relaxation and Reduce Stress

Aromatherapy is, perhaps, best known for its relaxing benefits and is becoming increasingly popular with people who want to reduce the stress in their lives and find time to unwind. For people with learning dis- abilities, these stresses may arise from an inability to communicate through the lack of choice in their every- day lives or from the challenges of new experiences and learning. Through direct chemical action, the association of particular oils with feelings of relaxation and the com- fort, support and reassurance provided through mass- age, aromatherapy can calm an anxious person, send a troubled person into a peaceful sleep and help reduce feelings and expressions of anger and frustration.

Aromatherapy in practice: Example one Clare has dual sensory impairment and severe learn-

ing disabilities. After living in a large hospital for many years, she was moved to a new home in another part of the country that was better able to provide the support she needed. It had been difficult to explain to Clare why she was leaving familiar surroundings and people for a completely strange environment. On arrival she seemed very upset, confused and frightened. She started pulling out her hair, crying and was unable to sleep at night. The staff were shown by an aromatherapist how to do hand and foot massage. They found Clare responded very well and would often fall asleep after a session of massage. Over time Clare began to settle into her new environment and became more relaxed in herself. The staff found that massage was an excellent way for them to make contact with Clare, reassure her and begin to develop a trusting relationship.

Aromatherapy to Invigorate and Promote Activity and Alertness

Claims that some essential oils uplift and invigorate tired minds and bodies have been made for centuries. Research carried out in Japan by Professor Torii has shown that when computer operators were exposed to the fragrance of lavender, errors were reduced by 20% and yet when they were exposed to the invigorating fragrance of lemon 54% fewer errors were made (Torii, 1990).

Aromatherapy in practice: Example two Shenvood House is a day service facility for people

with learning disabilities. Within the centre the activities carried out in the morning tended to be the more active or work orientated activities and the afternoons were geared more towards leisure pursuits. In the morning, in order to create a more physically and mentally energetic environment, the staff began to vaporise (using electric diffusers) the uplifting and invigorating oils of pep- permint, eucalyptus or lemon. These oils were used particularly in the areas where activity or concentration were required, for example, for those using the com- puters or during a keep fit class.

After several weeks of monitoring the use of aroma- therapy and asking clients about the different aromas and whether they felt any benefit from their use, staff

concluded that not only did people begin to recognise and enjoy the different aromas being used but also that they seemed to settle a lot quicker and work for longer periods of time.

Aromatherapy to Stimulate Sensory Awareness

For people with learning disabilities, learning may be limited due to physical limitations, lack of motivation or opportunity, and/or additional sensory impairments. Multisensory Massage can be used to help a person with severe learning disabilities to explore and experiment with different sensory experiences. Multisensory Mass- age incorporates the use of massage tools (for example, electric massager, body buddy, foot spa), as well as creams, lotions and massage oils fragranced with essen- tial oils to provide stimulation to the senses (Sanderson, Harrison & Price, 1991).

It is an activity that can be easily adapted to meet each individual’s needs. It can also be used in schools within the science programme of the National Curriculum, in Attainments la1 and la3, which involve reacting to sen- sory stimulation and showing interest in, and explor- ing materials.

Aromatherapy in practice: Example three Lilian is 25 years old. As well as requiring full assist-

ance with her mobility, Lilian is visually impaired. As a result she has had limited opportunity in the past to explore her environment. Multisensory Massage was introduced on a weekly basis and was incorporated into her foot massage which she was already receiving daily in order to improve the circulation in her feet.

The session began with Lilian using the foot spa for 10 minutes with essential oils of lavender and juniper added to the water in order to relax and warm her feet. Her feet were then gently rubbed dry using a warm towel and briefly massaged. Over time, using a variety of massage tools, for example, wooden massage rollers, electric massager and body mitts and toners, different sensations and textures were introduced. Prior to each different tool being used, it would first be offered to Lilian to feel and explore with her hands and face. Finally, the session would end with a foot massage using essential oils of lavender and juniper in grapeseed car- rier oil with the feet once more being wrapped in warm towels to keep them warm.

Aromatherapy to facilitate and encourage interaction and communication

Massage is often seen as being a passive activity but in Interactive Massage the emphasis is on developing a relationship through massage, encouraging the person’s ability and motivation to interact and communicate (Sanderson, Harrison & Price, 1991). The massage, there- fore, becomes a reciprocal and shared activity.

In their work with deaf-blind infants, McInnes & Treffry (1982) identified an ’Interactive Sequence’ that often occurs when people are introduced to new activi- ties. This sequence suggests that, although a person may initially be resistant to a new activity such as hand mass- age, if given the opportunity for repeated or extended experiences, they may begin to tolerate and then show

40 British Journal of Learning Disabilities Vol. 23 (1 995)

signs of enjoying the activity. Gradually the person may begin to respond in a more active or cooperate manner giving the therapist their hands or turning them over. Eventually, the person may start imitating the move- ments on their own or the therapist’s hand and finally initiate a massage session themselves, fetching the oils and indicating that they would like a massage. While it may take many months to see progress through all stages, the Interactive Sequence presents the therapist with recognisable stages from which progress can be identified.

Aromatherapy in practice: Example four Tom is a very hyperactive man whose concentration

rarely lasted more than a few seconds. The key worker decided to try using massage as a way of relaxing and making contact with him. She rubbed relaxing massage oil onto her hands and let him smell and touch her hands. At first Tom would stay fleetingly and then run away. The key worker never pulled him back but fre- quently offered her hands for him to explore. Occasion- ally, he would let her brush the back of his hands with hers before running off. Tom gradually learned to enjoy massage, letting her massage his hands more fully and then his back. Sometimes he would take his T shirt off and proffer his back or extend a hand and arm. Each time he had had enough she let him go. Over a period of time they slowly worked through the whole of the Interactive Sequence and, after six months, Tom knew where the oils were kept and would fetch them if he wanted a massage. He would sometimes lie for three-quarters of an hour indicating and proffering dif- ferent areas to be massaged. Gradually, as he became familiar with the massage movements, he would also sit alongside the key worker and massage another per- son’s hands imitating what had been done on his own. The relationship that Tom was able to develop through massage provided him with a firm foundation from which he could go onto enjoy other experiences and activities.

Aromatherapy to Treat Medical Problems Using Natural Substances

Many people today are now considering using comp- lementary therapies to treat minor health problems and to improve their health. Illnesses which are related to stress may be treated through the use of massage and relaxing essential oils and it is widely recognised that many other minor conditions respond to the use of aro- matherapy .

The correct selection and application of essential oils (by a qualified aromatherapist) can be used not only to relax and invigorate, but also to treat minor ailments.

Aromatherapy in practice: Example five Michael is 23 years old and has contractures of the

hands and wrists which result in them being perma- nently clenched in a fist. In hot weather he has problems with his skin due to sweating and as a result sores break out on his hands. To treat these sores lavender and tea tree essential oils were diluted and used to cleanse and speed up the healing process. This was accomplished by

firstly placing his hands in a bowl of warm water to help him relax his fists, tea tree oil being added to the water to act as a gentle antiseptic and lavender oil to encour- age the muscles to relax. His hands were then dried and gently massaged with lavender oil in a grapeseed carrier oil. This treatment was carried out on a daily basis and, after two weeks, his skin was completely healed. In order to maintain this good skin condition his hands are now bathed regularly with warm water and tea tree oil.

Conclusion Based on the principle of ‘ordinary lives for ordinary

people’ which is encompassed by the Five Accomplish- ments (OBrien, 1986), aromatherapy can be used to help develop and improve a person’s quality of life. When used mindfully and sensitively, it is an activity which encourages people with learning disabilities to make choices for themselves, for example, whether they would like a massage, which oils to use and for how long the session should last. It can offer another opportunity for the person to use and become a part of their local com- munity by using beauty salons, natural health clinics or visiting an aromatherapist in their own home. Through Multisensory nad Interactive Massage it can help the person to develop skills that will increase awareness of themselves and their environment and ultimately esta- blish relationships that are trusting and respectful. Aromatherapy can offer much to create the kind of sup- portive and stimulating environment in which the physi- cal, mental and emotional needs of the individual are met.

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