Assessment and more


What is personal professionalism? Personal professionalism is maintained when the therapist appears knowledgeable, skilled, self-aware, focused, calm, confident, and prepared. —What is client precaution knowledge? Client precaution knowledge is acquired when the therapist becomes familiar with and records the special needs and concerns of the client through objective and subjective assessment. —A professional environment is one that is safe and comfortable for the client. —Information classified as subjective data is based on the client’s perspective. Information from the client is subjective because the client is the one experiencing the symptoms. —Is a symptom part of the subjective data or the objective data? It is part of the subjective data since it is something noticed and reported by the client. —Information classified as objective data is based on measurable and quantitative data collected by the therapist. This data is primarily collected through observation and palpation. —Documentation is crucial for the therapist to maintain information about the care and needs of individual clients, but it is also legal evidence of performed treatments. —The client health intake form is filled out by the client. —The RAP form and session charting are filled out by the therapist. The information on the RAP form is a combination of objective data gathered by the therapist and subjective data from the client on the client’s condition. Session charting records the effectiveness of the treatment techniques used and any revisions to the plan. —The client health intake form is filled out by the client and contains personal contact information, health and medical history information, and an informed consent form. —Health and medical information can be gathered using open-ended questions that allow the client to fill in all of the information or using a list of conditions that the client can check off. —The informed consent form records the client’s authorization for professional services. It should include the therapist’s credentials, modalities used, potential benefits and undesirable effects, and professional and ethical responsibility. The treatment protocol begins with greeting the client and having the client fill out a health intake form. The therapist then conducts a premassage assessment where objective assessments are made of the client’s health and recorded on a RAP form. —If massage treatment is not contraindicated, then the therapist formulates a treatment plan and performs the massage treatment. While performing the massage treatment, the therapist continues to make objective assessments of the client’s condition. After the massage, the therapist documents the treatment and engages in postmassage communication with the client. —The massage therapist asks the client questions that are relevant to massage therapy in the premassage interview. —To avoid increasing the absorption rate of the medication, the therapist needs to know whether the client has recently received an injection or uses a transdermal patch. —Surgical mesh implants should only be massaged with gentle pressure to avoid disrupting the tissue-mesh relationship. —Heat or ice should not be used over implanted devices. The massage environment might need to be adjusted to accommodate clients with allergies. —Deep pressure should be avoided if the client bruises easily. —If medications or inhalers are being used by the client, then they should be nearby in case they are needed. Also, clients with diabetes should have sugar available in case it is needed. —Sleeping positions, contact lenses, sleep apnea, and gastrointestinal discomfort can dictate the client’s preferred body position(s). —If the client is prone to seizures, the therapist needs to know how to identify and deal with them. —The causes of fatigue, depression, insomnia, or anxiety need to be ascertained so that the massage therapy can be adjusted accordingly. —The causes of frequent or persistent headaches need to be ascertained so that the massage therapy can be adjusted accordingly. —The causes of numbness/tingling/pins and needles need to be ascertained so that the massage therapy can be adjusted accordingly. —Special adjustments need to be made for clients who are pregnant. —The therapist must accommodate client sensitivity to cold, heat, or pressure. —Additional stress reduction techniques might be useful if the client is under stress. —Frequent or painful urination might indicate the presence of a urinary infection, kidney stone, or bladder infection. —Massage should be avoided if the physical trauma is less than 72 hours old. Pain can be assessed using what five guidelines? Pain can be assessed using the following guidelines: (1) location, (2) onset and duration, (3) intensity, (4) quality, and (5) what actions and/or substances make it better or worse. —The scale in the diagram shows the levels of intensity of pain. —Take into account any self-treatment in which the client is engaging. If the client is doing any exercises assigned by other healthcare providers, do not add any other activities. Reduction of caffeine and sugar intake might help reduce pain. What is fascial mobility? Fascial mobility is a measure of how easily the skin glides when it is moved over the underlying structures. The three areas of skin assessment include skin color, condition, and pigmentation. The skin temperature can also be checked to see whether the client has a fever or local inflammation. —What two conditions are displayed in the images on the slide? The image on the right is of a person afflicted with edema. The cause of the edema must be ascertained and clearance for therapy might be required from the client’s physician. The image on the left is of a person afflicted with ischemia, a deficiency in blood flow to an area of the body. The cause needs to be ascertained. What is the respiration rate of a normal adult? It is about 16 breaths (1 inhale and 1 exhale) per minute. —Diaphragmatic breathing occurs when the client’s breathing is abdominal, and costal breathing occurs when the client’s breathing is shallow. —The therapist should also observe any respiratory-related sounds (wheezing, rattling, crackling, etc.) as well as the client’s breathing patterns (mouth breather, nose breather, shortness of breath, etc.). The client’s body structure can be assessed using the horizontal and vertical landmarks shown on the slide. —Name the anterior landmarks in the horizontal/
transverse plane that should be symmetric on both sides of the body and equidistant from the ground. Ears, eyes, the top of the acromioclavicular joints, the anterior superior iliac spines, the top of the trochanters, the top of the patellae, the top of the fibular heads, and the top of the medial malleoli. The therapist should note any deviations in symmetry. If the skin is difficult to move over the underlying structures, then that indicates restrictions or adhesions of superficial fascia. What massage techniques could be used to address these restrictions? Myofascial release techniques such as torquing, pin and glide, deep gliding, and skin rolling might be used to address these issues. Muscles can be assessed using palpation. The therapist should note any local tenderness and spasms, trigger points, increased tone, fibrosis, and flaccidity and atrophy. —
What can cause referred pain? Trigger points can cause referred pain and involuntary muscle twitches. Trigger points can be treated using ischemic compression. —Rebound tenderness can indicate conditions such as peritonitis or appendicitis, which would require the client to seek immediate medical attention. Flaccidity can be helped by exercise. The therapist should observe the client’s gait for signs of listing, leaning, shuffling steps, torquing, dragging feet, waddling, limping, compensating, and abnormal pointing of feet. —Movement should also be assessed by evaluating the client’s joint range of motion (ROM). ROM tests the state of the joints and surrounding muscles. Any sounds of crepitation should be noted. —Active ROM is done by first demonstrating the movement for the client and then observing and palpating while the client performs the movement, stopping at the point of discomfort. Active assisted ROM is done by observing and palpating the client while assisting the client in performing the movement correctly (as long as the movement does not hurt the client too much). —Active resisted ROM is done by observing and palpating the client while applying resistance to the movement. —Passive ROM is done by observing and palpating the client while moving the client’s joint through the movements without any assistance from the client. Any abnormal end feel should be noted (hard or soft). What does the presence of swollen lymph nodes indicate? Swollen lymph nodes indicate possible local or systemic infection or a cancerous enlargement. Massage might be contraindicated if the swelling is due to an infection. —Refer the client to the client’s health care provider if any superficial or deep masses are found so that they can be evaluated. —If a hard mass is felt in the region of the descending or sigmoid colon, it can be assumed to be a stool, and the area should be avoided. A treatment plan should incorporate all of the information gathered about the client. After integrating the information, the massage therapist should use critical thinking skills, knowledge of anatomy and physiology, massage therapy skills, and understanding of the effectiveness of the available techniques to determine what will work best for the client. What do short-term goals involve? They involve using specific modalities to decrease discomfort in specific areas by the end of the session. —What do long-term goals involve? Long-term goals focus on restoring normal function to the client. —Both short- and long-term goals should be simple and realistic. The therapist should discuss the options with the client to come up with a workable treatment plan. What are some possible adjunctive therapies? Aroma therapy and hydrotherapy are examples of adjunctive therapies. —The treatment plan should be treated as a malleable instrument that should change as the client’s needs and concerns change. It is important to record any changes to the plan during session charting. —Why are self-care activities important? They can empower the client to take control of his or her own health and play an active part in the healing process. The end of each massage session includes the evaluation of the session’s effectiveness by the client. Reevaluation of the treatment plan might be necessary if the client is not experiencing success with the treatments. —Client education and any homework assignments for the client should be discussed where appropriate. What are some examples of these? Client education might include suggestions for lifestyle modifications such as methods of stress management or ways to increase water consumption. Client homework might include strength-building exercises or stretches.

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