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PubMed2002

Physiotherapists' use of touch in inpatient settings.

BACKGROUND AND PURPOSE: Although touch is a basic element in the practice of physiotherapy, no research has been done to establish the type and purpose of practitioner touch in clinical settings. The purpose of the present study was to determine how physiotherapists use touch in inpatient acute and rehabilitation settings. METHOD: Fifteen physiotherapists with three or more years' experience were videotaped treating two to three patients. The participant physiotherapists reviewed a videotape of themselves and described the types of touch used and their intent behind each touch. Cross-case analysis was used to determine common themes in the descriptions. Mutually exclusive categories of touch were then refined, based on the cases. RESULTS: The most common types of touch used by physiotherapists included assistive touch, touch used to prepare the patient, touch to provide information, caring touch, touch to provide a therapeutic intervention, and touch used to perceive information. The physiotherapists also used 33 different combinations of touch, that is, a single touch used for more than one purpose. CONCLUSIONS: Inpatient physiotherapists clearly perform in a 'high touch' arena. Clinical experience was reported as the strongest factor in developing the physiotherapists' sensitivity to patient needs and their skill in using specific types of touch. Further research is needed concerning the way patients perceive and respond to the presence or absence of these various forms of practitioner touch.

Adolescent↗
PubMed2001

Fingertip touch improves postural stability in patients with peripheral neuropathy.

The purpose of this work was to determine whether fingertip touch on a stable surface could improve postural stability during stance in subjects with somatosensory loss in the feet from diabetic peripheral neuropathy. The contribution of fingertip touch to postural stability was determined by comparing postural sway in three touch conditions (light, heavy and none) in eight patients and eight healthy control subjects who stood on two surfaces (firm or foam) with eyes open or closed. In the light touch condition, fingertip touch provided only somatosensory information because subjects exerted less than 1 N of force with their fingertip to a force plate, mounted on a vertical support. In the heavy touch condition, mechanical support was available because subjects transmitted as much force to the force plate as they wished. In the no touch condition, subjects held the right forefinger above the force plate. Antero-posterior (AP) and medio-lateral (ML) root mean square (RMS) of center of pressure (CoP) sway and trunk velocity were larger in subjects with somatosensory loss than in control subjects, especially when standing on the foam surface. The effects of light and heavy touch were similar in the somatosensory loss and control groups. Fingertip somatosensory input through light touch attenuated both AP and ML trunk velocity as much as heavy touch. Light touch also reduced CoP sway compared to no touch, although the decrease in CoP sway was less effective than with heavy touch, particularly on the foam surface. The forces that were applied to the touch plate during light touch preceded movements of the CoP, lending support to the suggestion of a feedforward mechanism in which fingertip inputs trigger the activation of postural muscles for controlling body sway. These results have clinical implications for understanding how patients with peripheral neuropathy may benefit from a cane for postural stability in stance.

Aged↗
PubMed1978

Interpersonal touch among adults in cafeteria lines.

Previous studies have indicated that interpersonal touch decreases with age. In the present study 1012 pairs of college students and 212 pairs of elderly subjects were observed in cafeteria queues. Instances of touch were recorded along with sex, race, and body parts used to touch and touched. College students segregated themselves by race and sex just as the younger students had been observed to do in previous studies. Unlike all previous studies the elderly subjects did not segregate themselves by gender. For college students, touch was highest for female to male combinations; blacks were more likely to touch other blacks and least likely to touch whites. Touch was more likely among elderly subjects for female to female interactions than it was for college students, but there were no differences for the other gender combinations. In college students personal body areas were used to touch those of different gender while impersonal body areas were used to touch those of the same gender; personal body areas were more likely to be touched by others of the other gender. For elderly subjects there were no differences in frequencies with which personal or impersonal areas were involved in touch in relation to gender for either area used to touch or area touched.

Adult↗
PubMed2001

[Effects of touch on growth and mentality development in normal infants].

OBJECTIVE: To determine the effects of conducting Touch to infants upon their growth and mental development, sleeping and disease conditions, as well as the difference of effects of conducting Touch among infants of different month age. METHODS: 310 normal full-term infants aged 0-6 months were divided randomly into Touch group (n = 208) and control group (n = 102). Parents of Touch group were asked to conduct Touch to their infants 2-3 times/day, lasting 15-20 minutes every time, for at least 3 months. Intelligence tests were performed to infants of both groups at the beginning of the experiment and 6 months later (CDCC measurement table was employed). Data such as height, weight, circumferences of head and chest, sleeping, feeding and disease conditions etc. were recorded each month in a successive period of 6 months. Statistical analysis was conducted using SPSS 10.0. RESULTS: (1) The average score of mental development (MDI) was 7.4 higher, with a statistically significant difference, among the infants who began to receive touch within 3 months after birth than those infants with the same age in control group. The average score of psychomotor development index (PDI) was 5.8 higher, with a statistically significant difference, among the infants who began to receive touch within 3 months after birth than those infants with the same age in control group. Infants who began to receive touch within 3 months after birth slept remarkably better than those in control group did. No significant difference was found in scores of MDI and PDI and sleeping condition between infants who began to receive touch 3 months after birth and the infants with the same age in the control group. (2) Weight gain and growth in chest circumference in infants receiving touch within one month after birth were significantly better compared with the infants of the same age in the control group. There was no significant difference in values of height and head circumference between the two groups. There was no significant difference in values of height and head circumference between the two groups. (3) No significant difference in the incidence rates of acute respiratory infection and diarrhea disease was found between the touch group and control group. CONCLUSION: (1) Growth and mental development of infants can be improved by touch. Tthe earlier to conduct touch the better the effects. (2) Touch helps improve sleeping condition in infants.

Body Height↗
PubMed2003

Representations of pleasant and painful touch in the human orbitofrontal and cingulate cortices.

The cortical areas that represent affectively positive and negative aspects of touch were investigated using functional magnetic resonance imaging (fMRI) by comparing activations produced by pleasant touch, painful touch produced by a stylus, and neutral touch, to the left hand. It was found that regions of the orbitofrontal cortex were activated more by pleasant touch and by painful stimuli than by neutral touch and that different areas of the orbitofrontal cortex were activated by the pleasant and painful touches. The orbitofrontal cortex activation was related to the affective aspects of the touch, in that the somatosensory cortex (SI) was less activated by the pleasant and painful stimuli than by the neutral stimuli. This dissociation was highly significant for both the pleasant touch (P < 0.006) and for the painful stimulus (P < 0.02). Further, it was found that a rostral part of the anterior cingulate cortex was activated by the pleasant stimulus and that a more posterior and dorsal part was activated by the painful stimulus. Regions of the somatosensory cortex, including SI and part of SII in the mid-insula, were activated more by the neutral touch than by the pleasant and painful stimuli. Part of the posterior insula was activated only in the pain condition and different parts of the brainstem, including the central grey, were activated in the pain, pleasant and neutral touch conditions. The results provide evidence that different areas of the human orbitofrontal cortex are involved in representing both pleasant touch and pain, and that dissociable parts of the cingulate cortex are involved in representing pleasant touch and pain.

Adult↗
PubMed2004

Mother-Child touch patterns in infant feeding disorders: relation to maternal, child, and environmental factors.

OBJECTIVE: To examine mother and child's touch patterns in infant feeding disorders within a transactional framework. METHOD: Infants (aged 9-34 months) referred to a community-based clinic were diagnosed with feeding disorders (n = 20) or other primary disorder (n = 27) and were case matched with nonreferred controls (n = 47). Mother-child play and feeding were observed and the home environment was assessed. Microcoding detected touch patterns, response to partner's touch, and proximity at play. Relational behaviors were coded during feeding. RESULTS: Compared with infants with other primary disorder and case-matched controls, less maternal affectionate, proprioceptive, and unintentional touch was observed in those with feeding disorders. Children with feeding disorders displayed less affectionate touch, more negative touch, and more rejection of the mother's touch. More practical and rejecting maternal responses to the child's touch were observed, and children were positioned more often out of reach of the mothers' arms. Children with feeding disorders exhibited more withdrawal during feeding and the home environment was less optimal. Feeding efficacy was predicted by mother-child touch, reduced maternal depression and intrusiveness, easy infant temperament, and less child withdrawal, controlling for group membership. CONCLUSIONS: Proximity and touch are especially disturbed in feeding disorders, suggesting fundamental relationship difficulties. Mothers provide less touch that supports growth, and children demonstrate signs of touch aversion. Touch patterns may serve as risk indicators of potential growth failure.

Case-Control Studies↗
PubMedDate not supplied

The use and meaning of touch in caring for patients with cancer.

Although touch and touching are complex phenomena that constitute an important aspect of nursing practice, the ways in which nurses use touch are still poorly understood. In this study, patterns of nurse-patient touch were examined by analyzing videotapes of nurses caring for patients with cancer and audiotapes of unstructured interviews with patients and selected nurses. Using the techniques of qualitative ethology, five types of touch were identified and described: comforting, connecting, working, orienting, and social. These types of touch are comparable to the two major kinds of nurse-patient touch previously identified in the literature: task-related touch and affective touch. However, detailed, qualitative descriptions of the five types of touch, the variations in associated verbal and nonverbal behaviors, and the associated meanings provide more comprehensive descriptions than previously have been available. In particular, the use of connecting, orienting, and social touch have not been well-recognized or described in the literature. Awareness of the types and meanings of touch affords nurses the opportunity to increase the therapeutic value of touch as a nursing intervention.

Clinical Nursing Research↗
PubMedDate not supplied

Touch contamination of connection devices in peritoneal dialysis--a quantitative microbiologic analysis.

OBJECTIVE: To determine the level of bacterial contamination associated with touch contact of a connector set during peritoneal dialysis (PD). DESIGN: The experiment utilized a laboratory-based simulation of a bag exchange procedure. Deliberate touch contamination of the connector set spike was followed by quantitative recovery of micro-organisms from the connector and, in some cases, the dialysis bag. SUBJECTS: Patients undergoing PD were used as the "test" group. Departmental secretarial and laboratory staff served as the comparative control group. SETTING: The patients were voluntary subjects from a PD outpatients unit and were tested in their own homes. OUTCOME: The numbers of micro-organisms contaminating a connector set and entering the dialysis bag during a touch-contamination event were determined. Additionally we identified hand hygiene and, in particular, the care taken to dry the hands after washing as being highly relevant to microbial touch-contamination levels. Patient hand disinfection, as practised in most PD units, effectively reduced touch contamination to low levels. RESULTS: Touch contamination of a connector set with unprepared hands led to fewer than 100 micro-organisms translocating from fingers to the spike. If the hands were washed but not dried before touch contact was made, up to 4500 micro-organisms translocated to the connector set spike. Air-towel drying of washed hands before touch contact reduced the translocating numbers by 95%-99%. Hand disinfection, as routinely practiced by PD patients, reduced the bacterial numbers reaching the peritoneal cavity after touch contamination to <5. The range of micro-organisms isolated from the fingers of PD patients using hand disinfectants on a regular basis showed considerably more diversity than the control group. CONCLUSION: Hand care prior to bag exchange has a major effect on touch-contamination levels. Accidental touch contact of connecting devices by unprepared hands using a PD-bag exchange procedure leads to the translocation of 500 micro-organisms or fewer to the connector device. If the hands are wet at the time of contact the number translocating can be as high as 4500. Hand drying with an air towel before touch contact reduces the numbers translocating by 95%-99%. Hand disinfection procedures carried out prior to bag exchange minimizes touch-contamination levels.

Ambulatory Care↗
PubMed2004

The nature of touch in mothers experiencing maternity blues: the contribution of parity.

BACKGROUND: Maternal touch (MT) is an essential part of the initial contact between the mother and her newborn and has developmental effects on the child. MT is known to be reduced in postpartum depression (PPD). The nature of MT in mothers experiencing maternity blues and the effect of parity are still unknown. STUDY DESIGN: Seventy-five mothers were recruited from the ongoing series of deliveries. SUBJECTS: The participating mothers were observed during interaction with their newborns on the second-day postpartum. Touching behavior was scored on-line according to the Touch Scoring Instrument, which includes nine types of MT. Mothers were categorized as exhibiting maternal blues according to Stein's depression scale. OUTCOME MEASURE: Touch Scoring Instrument. RESULTS: Primiparous mothers with blues avoided all types of touch whereas multiparous mothers with blues provided firm touch and holding. All mothers with blues avoided proprioceptive touch. Multiparous mothers without maternal blues provided various types of touch including affectionate holding and matter-of-fact touch whereas primiparous mothers without blues mostly provided holding. CONCLUSIONS: Mothers with maternity blues on day 2 exhibited a pattern of MT similar to that known to characterize postpartum depression. Mothers without blues are able to provide developmental touch in a manner known to facilitate CNS stability and newborn adjustment to the extra-uterine world. Parity modulates the effect of maternity blues on MT and buffers the withdrawal effect of depression. Maternal touch could be used as a diagnostic tool for detection of mothers at risk in a timely manner. Touch interventions, which were previously demonstrated in PPD mothers, may be utilized in an earlier stage postpartum.

Adolescent↗
PubMed1993

An examination of touch between nurses and elderly patients in a continuing care setting in Northern Ireland.

The use of touch is an inherent part of nursing practice. This investigation examined the amount and type of touch received by elderly patients from nurses. It also attempted to assess elderly patients' perceptions of instrumental and expressive touch given by nurses. The Extended Model of Interpersonal Interaction formed the conceptual framework for the study. Non-participant observation and semi-structured interviews were the methods employed for data collection. Results tentatively suggest that most nurse-patient touch interactions in a care of the elderly ward are instrumental in nature. Expressive touches are predominantly given to body extremities. The gender of the nurse initiating touch and the part of the body touched influence the elderly patients' perception of the touch interaction. In particular, expressive touching behaviours by nurses that involve the leg, face and around the shoulders are perceived as uncomfortable. The only touching behaviour perceived as comfortable by all respondents was instrumental touching of the arm and shoulder by a female nurse. Elderly patients may misinterpret the goal or the motivation behind touch initiation by a nurse. Therefore, an awareness and a sensitivity towards elderly patients' needs and desires for tactile communication are required by nurses.

Aged↗
PubMed2001

The conceptual structure of physical touch in caring.

AIMS OF THE STUDY: This study was conducted to clarify and to conceptualize the phenomena of physical touch in caring. BACKGROUND: Physical touch occurs frequently in patient care situations and has specific meanings within the context of caring. However, the concept of physical touch in caring has not been well articulated in the literatures, although the phenomena of touch and physical touch have been studied in relation to comfort, sense of well-being and connectedness. DESIGN/METHOD: The Hybrid Model of concept development was applied to develop a conceptual structure of physical touch in caring, which included a field study carried out in Seoul, South Korea using in-depth interviews with 39 adult subjects consisting of health-care professionals, in-patients, and healthy persons. RESULTS/FINDINGS: The concept of physical touch in caring emerged as a complex phenomenon having meanings on several different dimensions which were encompassed several attributes and the conceptual structure of physical touch in caring centred around five aspects of goals for physical touch: promoting physical comfort, promoting emotional comfort, promoting mind-body comfort, performing social role, and sharing spirituality. CONCLUSIONS: Physical touch in caring as a concept having the dimensions of physical, emotional, social, and spiritual significance needs to be treated in a holistic way and it is possible to enrich the meanings and methods of physical touch in nursing so that its application may have effects that have positive impacts on patients' well-being and comfort.

Adult↗
PubMed2005

Stance stability with unilateral and bilateral light touch of an external stationary object.

Unilateral light fingertip touch of a stationary object has a significant stabilizing effect on postural sway during stance. The purpose of this study was to find out if this effect is enhanced by bilateral light touch of parallel stationary objects. The postural sway of 54 healthy subjects was tested in four stance conditions: no touch; unilateral left light touch of the left handle of a walker; unilateral right light touch of the right handle of the same walker; and bilateral light touch of the two handles. During testing, subjects stood blindfolded on two foam pads placed on the left and right force plates of the Tetrax balance system. Testing in each condition lasted 45 s and was executed twice in a random order. As expected, postural sway was significantly reduced by unilateral left or right light fingertip touch. It was significantly further decreased by bilateral light touch. In addition, light touch conditions were associated with a reduction in pressure fluctuations between the heel and forefoot of the same foot as well as those of the contralateral foot, with a concomitant increase in weight shift fluctuations between the two feet. The decrease in postural sway with bilateral light touch suggests cortical modulation of the bilateral touch inputs, with enhancement of the stabilizing response.

Adult↗