Nervous System

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During the premassage interview, the massage therapist should ask the client about the items listed here to assess the client’s nervous system. â— If the client is experiencing changes in sensory abilities or impairment in mental abilities, these symptoms could indicate a neurological problem or the aftermath of an injury. More information is needed. â— The cause of fatigue, depression, insomnia, or anxiety could be a mental and/or emotional condition. Tingling or shooting pain could indicate nerve entrapment or nerve compression. â— If the pain is continuous for the client, what should the therapist do? The therapist should ask the client to acquire a medical diagnosis and clearance for massage from the client’s health care provider. â— If the client is taking medications for mood and/or mental disorders, the side effects of these medications should be taken into account before performing massage on the client. During the premassage interview, the massage therapist should observe the client. â— If the client does not move with grace and balance, further test are needed to determine whether the client is suffering from a nervous disorder. â— Involuntary movements are often an indication of a neurological disorder or a problem with a medication. â— Shallow and rapid breathing can indicate stress or anxiety. One of the most important consequences for massage therapists to keep in mind is that medications for mood disorders depress sensory information entering the nervous system. This means the massage therapist must adjust the client’s massage so that it is not overly aggressive since the client will not be able to provide accurate feedback about pressure. When should massage therapists announce their presence? Therapists should announce their presence when they enter a room occupied by a visually impaired client. If the client is not also hearing impaired, it is important to remember to speak in a normal tone of voice to avoid offending the client. â— When assisting visually impaired clients in moving from one area to another, therapists should be careful to give clear and specific directions and stand just in front or to the left of the client. Sensations of numbness, coldness, tingling, or itching might also be accompanied by loss of motor control. What massage techniques can be useful in maintaining mobility for clients with Alzheimer’s disease? Passive joint mobilizations, stretching, and applying friction around the joints are all useful techniques. When does carpal tunnel syndrome occur? Carpal tunnel syndrome occurs when the size of the carpal tunnel (where the transverse carpal ligament connects across the carpal bones) decreases or the inflamed tendons increase in size. â— If the carpal tunnel syndrome is chronic, how can edema be reduced? Edema can be reduced by elevating the limb and using centripetal gliding strokes or lymphatic draining techniques. What can cause the conjunctiva of the eye to become inflamed? Inflammation of the conjunctiva can be caused by any of the following: bacterial infections, viral infections, allergies, or environmental factors such as debris. â— Why is massage contraindicated? Massage is contraindicated because this is often a contagious disease. What causes the elevated pressure in the eye? The elevated pressure is due to an obstruction of the outflow of aqueous humor from the eye. The elevated pressure causes defects in vision. â— Massage therapists should also avoid the eyes of clients who have glaucoma when doing a facial massage to avoid putting undue pressure on sensitive eyes. After obtaining clearance from the client’s health care provider, what are the goals of massage therapy for clients with Guillain-Barre syndrome? The goals of massage therapy are to prevent muscle contractures and increase the tone of flaccid muscles. To achieve these goals, the following massage techniques can be useful: passive joint mobilizations, stretching, and applying friction around joints. Once the client has completely healed and clearance has been obtained from the client’s health care provider, massage can begin. Huntington’s chorea is a debilitating disorder that requires medical supervision during massage. The massage therapist must rely heavily on the client to indicate comfort of position, pressure, and technique. What massage techniques can be useful for clients with Huntington’s chorea? Gentle, gliding strokes can help the client to relax. The massage therapist should also be conscious that clients who use wheelchairs can develop pressure sores; these should be avoided when performing massage, and the client’s caregiver should be notified. Lou Gehrig’s disease (amyotrophic lateral sclerosis) is a debilitating disorder that requires medical supervision during massage. The massage therapist must rely heavily on the client to indicate comfort of position, pressure, and technique. What massage techniques can be useful for clients with Lou Gehrig’s disease? Gentle, gliding strokes can help the client to relax. The massage therapist should also be aware that the client might not be able to get on the massage table, which means that the therapist should be prepared to perform massage while the client is in the wheelchair. Why is massage contraindicated for clients who have meningitis? Massage is contraindicated because meningitis is often a contagious disease, and meningitis can be life threatening. Massage during remission can lessen exacerbations, relax the client, decrease tone in rigid muscles, and prevent stiffness and contractures. However, the client should be thoroughly evaluated before each massage since the client’s symptoms can vary significantly from day to day. If clearance has been obtained from the client’s health care provider, what massage techniques can be useful for clients with myasthenia gravis? Gliding strokes, gentle kneading, passive joint mobilizations, and stretching can be helpful. Clients suffering from nerve compression benefit most from massages focused on relieving tension in the muscles. If clearance has been obtained from the client’s health care provider, what massage techniques are useful for clients with nerve compression? Gentle kneading and gliding strokes are most useful. However, massage therapists should avoid applying pressure to vertebral disks. Clients suffering from nerve entrapment benefit most from massages focused on relieving tension in the muscles. The massage therapist can work deeply, but briefly, to release the tissues responsible for entrapment; overworking the affected area can cause further trauma. Clients suffering from neuropathy should be referred to their health care providers for diagnosis and treatment. Massage should not be performed until the cause of neuropathy has been determined. What can the clients who have Bell’s palsy do on their own to alleviate symptoms? Clients can massage their own faces two or three times a day to maintain muscle tone. The massage therapist and client might need to develop a code to use for communication if the client cannot speak. â— What massage techniques can be helpful for clients with cerebral palsy? Light strokes and gentle kneading can help reduce spasms and involuntary movements. Passive stretching and joint mobilizations can help to prevent muscle contractures. What event often causes Erb’s palsy? Birth trauma is often the cause of Erb’s palsy. The injury of the upper brachial plexus causes paralysis in the arm. Massage is acceptable for clients with paraplegia. However, massage therapists should be aware that the longer the client has been inactive, the weaker the client’s bones and muscles will be. The massage therapist should also keep in mind that, when massaging legs or arms that have little or no sensation, light pressure must be used. Only enough pressure should be applied to increase circulation but not enough to cause bruising or discomfort. For clients with paralysis, sometimes only the motor neurons have been damaged (leaving the client immobile), but sensory damage might also have taken place. Sensory damage can occur to varying degrees, so it is important for the therapist to determine the extent of any sensory damage and compensate accordingly. The goal of massage therapy for clients with Parkinson’s disease should be to reduce rigidity. What massage techniques are useful for clients with Parkinson’s disease? Gentle gliding strokes and kneading during the massage followed by passive movements of joints after the massage can be helpful. Lighter massage is preferred as the client’s skin might be dry and fragile. â— What massage techniques can be useful for patients with poliomyelitis? Kneading can help to reduce contractures; passive joint mobilizations can help retain joint mobility; and cross-fiber friction over joints and atrophied muscles can help loosen adhesions. The massage therapist should keep in mind that the loss of motor function is irreversible and be aware of the possible presence of pressure sores on clients who wear braces or use crutches. Massage therapy is contraindicated for clients with rabies because rabies is infectious and life threatening. The client might not be able to provide active feedback, so massages should only consist of gently gliding over the affected area. The massage should be tailored to meet the specific needs of the client since the symptoms can vary significantly from treatment to treatment. â— Are passive joint mobilizations useful in this case? If clearance for massage has been obtained from the client’s health care provider, and the symptoms are not severe, then passive joint mobilizations can help increase joint mobility for clients with reflex sympathetic dystrophy. Massage therapists should assess and record the motor and sensory function of clients with sciatica before each massage treatment. What should a massage therapist do if a seizure occurs during the massage treatment? The therapist should try to place the client on his or her side and provide light immobilization to prevent the client from falling off the table. The therapist should only call 911 if the seizure lasts more than 5 minutes. In less severe cases of spina bifida, clients can benefit from general massage. However, local massage in the lumbosacral area is prohibited. â— If the form of spina bifida that the client has involves neurological complications, how should the massage therapist proceed? In these more severe cases, the massage therapist must gain clearance from a health care provider before proceeding. If significant paralysis has resulted from the spinal cord injury, then the therapist might have to perform the massage while the client is in a wheelchair. In general, the massage considerations for clients with spinal cord injuries are the same as the considerations for clients who are paralyzed. If clearance has been obtained from the client’s health care provider, what massage techniques can be helpful for a client who has had a stroke? Massage strokes should be slow, superficial, soothing, and rhythmic. Deep pressure should be avoided. Joint mobilizations within the client’s tolerance can be helpful. Compression or entrapment of the neurovascular bundle can be caused by any of the following: a cervical rib, tight scalene muscles, a depressed clavicle, or a tight pectoralis minor muscle. If the pain is severe, then local massage is contraindicated, but general massage is permitted if clearance has been obtained from the client’s health care provider. What massage techniques should be used for a general massage in this case? Light gliding strokes can be helpful as long as they are within the client’s tolerance. The massage therapist should obtain the name and phone number of a contact person and the client’s health care provider in case a panic attack occurs during massage treatment. Which phase of bipolar disorder is likely to cause more trouble for massage therapists? The manic phase of bipolar disorder is more likely to cause trouble for the massage therapist since the client could be hyperactive, have trouble concentrating, and have extreme emotional outbursts. Should massage therapy sessions be scheduled to coincide with times when the client has lots of energy or when the client has very little energy? Massage treatments can be scheduled during either. Massage can help the client relax during high-energy times, and massage can help rejuvenate the client during low-energy times. Massage therapy can be part of the recovery process for clients with addictions because it helps to relieve stress during periods of chemical withdrawals. â— Why should deep pressure be avoided? Deep pressure should be avoided during the early stages of withdrawal because it could intensify the release of toxins into the body. Massage can be performed on clients with insomnia as long as the cause of the insomnia is not a condition for which massage therapy is contraindicated. For clients with vertigo and hyperesthesia, clearance from the client’s health care provider is required before massage can be performed.

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