Professional Practice blog 7

What does it mean to be a massage therapist and a multi-disciplinary healthcare provider?
Victoria Walden
Due Date 30th October 2009

What does it mean to be a massage therapist?
As a massage therapist I believe that I have techniques and the qualifications to help improve the present status of clients that come to me with muscle pain or just for pure relaxation. Working within the scope of practice, that Massage New Zealand has produced I believe that I can help improve client’s quality of life.

As a multi-disciplinary practitioner alongside massage therapy is where I believe that I should become accustomed to other healthcare providers scope of practice that could aid in the recovery of any client that may come to me for treatment.

I feel as a multi-disciplinary practitioner you have to have an open mind to other means of treatment to help your client recover from any dysfunction that needs attending too.

McQuillan (2009), states that ‘Dialog is the key to working effectively as a multi-disciplinary practitioner:’

To achieve this is:
- Consensus
- Appreciation of difference
- Cross-fertilisation

- Consensus means a general or widespread agreement among all the members of a group. Between different means of treatment from different healthcare providers is where as a practitioners research has to come into play and showing evidence of treatment plans and how they can help the client. Through research and communication I believe that healthcare providers can produce a quality treatment plan for the client.

- Appreciation of difference means that every healthcare provider will have a different perspective on different treatments for clients therefore each practitioner needs to understand that everyone has different expertise.

- Cross-fertilisation means that each practitioner may have their expertise and through this you can work together and cross-fertilise ideas and treatment plans.

To provide a multi-disciplinary healthcare to each client from a massage therapist viewpoint will be hard and struggle to get other healthcare providers on board. This has a large affect on the C.A.M (Complimentary alternative medicines) as we have so much that we can provide to other healthcare professionals, who see that they are higher and more highly ranked in this department of care for clients. Recent research however has seen that C.A.M are becoming more recognised, World Health Organisation now recognises multi-disciplinary as a way for healthcare operators to work.

I believe as a massage therapist and part of the C.A.M we are slowly but surely making a mark in the healthcare provider’s profession. As a massage therapist, I feel it is our duty to inform clients of their options to request the second opinion of other healthcare providers. It is also our duty to respect and understand that there are other alternatives to treatment for each individual.

As a whole I believe that within any healthcare profession that multi-disciplinary practice should be set in place to provide that best suited care for any client who needs help. Communication is the key alongside consensus, appreciation of difference and also cross-fertilisation, from this I believe that it will take time and money, also the hierarchy within occupations will have to subside. If all is applied, the healthcare profession will reach new heights in applying care for clients.

References:

Class notes

McQuillan, D. Elluminate. Multi Disciplinary Practice. October 28th 2009. Professional Practice.

My own thoughts

How does reflective practice, supervision and the professional development policy, support professional practice?

Professional Practice:

Victoria Walden

Due Date: 23rd October

In a massage business a professional practice is what keeps your business successful and providing a high quality of service to each potential customer. I believe that within each business there should be reflective practice, supervision and a guild and also being involved with the professional development policy, this will show that you as a massage therapist uphold and support professional practice in your business. I believe that these three steps in your business will increase the status of your practice and improve the thinking, focus, and ideas that will continue to enhance you professional practice.

Reflective practice:

Using reflective practice within your business gives you the opportunity to improve not only with the present status of your business but also for yourself, in how you can improve your application within the business, massage, and also with client care. When using a reflective practice you can identify your strengths and weaknesses and how you can tackle them. I believe I could apply this in my business by:
- Writing a journal
- Feed-back forms from clients
- An comment box for clients who would like to remain unknown
- Writing comments to self, after treatment of each client, what worked and what could I have done better.
- Researching and asking about similar differences that others may have in common from other therapists.
From these few ideas I believe that I can obtain vital information and review what I can do to help improve the way that my business is run, from how each client is welcomed including phone calls, all the way to when they have come and gone back out the door. I know that this will improve the professional practice of any business.

Supervisor:

I believe having a supervisor is a vital aspect to the massage practice, within its professional practice. The position that the supervisor would take is to be a channel for your thoughts and also someone to bounce ideas off. The supervisor would also be there as a guild and someone to talk to if problems or issues come about within the practice that you cannot seem to find a solution. As a new massage therapist to the business I feel that I would need a supervisor within my first year as I no longer have the security of the lecturers or fellow students and have to deal with issues on my own. With a supervisor I can channel my thoughts and categories them into priorities to what is necessary at the time. My business therefore would not be cluttered with my thoughts and be scattered, instead it would be organised as my thinking process and also my worries would be out of my head, keeping it clear for the high quality of professional service that I would want to provide.
To establish a professional business you need to have someone to channel your thinking process and to keep your mind clear and concise.

To develop and improve your massage business you need to keep up with the latest things and the keep furthering and increasing your knowledge of the massage industry. With the professional development policy that is run through Massage New Zealand I believe as a massage therapist that it would be a great time to join and keep up to date. With joining MNZ you can further your education as a therapist and also be informed of workshops, gaining formal education. Massage New Zealand can offer so much to a young therapist in the industry: Latest knowledge, creditability, also giving your clients the comfort knowing that you are a trustworthy and professional practitioner. To have a professional practice being involved with a business, MNZ, is a step forward to becoming a successful therapist in the industry.

From what I have stated above I believe that it all relates and supports professional practice, they can improve the quality of the business at present and can maintain a high quality of service to each individual. These steps can enhance the ability to understand the industry and also your business in that industry. It can improve relations, ideas, quality, and the success of your practice in pleasing the potential customer and also you as a business owner.

References:

My own thoughts

Massage Industry and Government Policy in NZ

Massage Industry and Government Policy in NZ
Victoria Walden
Due 16th Oct (with week extention).

How can I as an individual massage therapist influence the development of government policy & laws that are supportive of the profession?

Within New Zealand our Government has certain policies and laws that are put in place to ensure the protection and safety of both parties involved. Massage therapy does not have laws specific to the profession and therefore there are massage therapists that are not qualified under NZQA or other education outlet. Through this anyone can massage and set up a business.
The laws that relate to massage therapy are as follows:

Privacy Act 1993
Health and Safety in Employment Regulations 1995
Consumer Guarantees Act 1993
Medicines Act 1981
Health and Disability Commissioner Act 1994
Health Practitioners Competency Assurance Act 2003
Injury Prevention, Rehabilitation and Compensation Act 2001
Local Body Requirements
Occupational Health and Safety requirements

From these laws they are a base outline as to what a massage therapist should abide by. These laws are unfortunately not specific to a massage therapist allowing a lot of variation to each therapist. Within New Zealand anyone can set up a business and apply massage to any customer that walks through their door. I believe that this approach to massage has to be rectified as there are different levels of experience and variation as to the extent of the education to some therapists.

I feel that the massage industry should be regulated. Yes there are therapists out there who have made their living as a professional massage therapist, without any educational certificates and have the same knowledge. I believe that there should be an allowance for people such as them, even a test that is national wide. From my perspective I see that some therapists can diminish the massage industry by their professionalism and through their practice, therefore regulation should be put into practice.

However as a new massage therapist to the industry I believe that there should be a one year integration into the business where I have read that you only really start learning when you being to apply your massage to the public.

With the dispute “massage regulation” I believe as a massage therapist myself there needs to be more information provided and also giving the opportunity to educate massage therapists without the correct knowledge if they agree.

There will always be public who dispute the regulation of therapists: Massage therapists without education, massage therapists who, not only supply massage, and also the public. From this the massage industry will always be split until there is more information provided to the public and also to other massage therapists, as in this industry the practice is evolving and improving in its techniques and application to the potential cliental.

I believe that the ways in which I could influence the minds of the public and try and convince, is that the education to a massage therapist is beneficial and essential to your help and safety of each client.

I could:

- Have my qualifications displayed on the wall where the clients will see it.
- Be registered under Massage New Zealand
- Provide clients with information that I have qualifications
- Provide clients with the information that some therapists do not have to qualifications as a massage therapist
- Communicate with Polytechnic where I studied, including teachers, students etc...
- Communicate with town district
- Get as many people behind the bill, this also involves the potential clients that will need massage for example: high advanced sporting athletes, doctors, hospitals, high profile businesses etc...

In conclusion I feel that the regulation of therapists should come into play and that everyone should back it. Myself as a therapist, I feel that each therapist should be allowed a year in the industry to learn and to get the experience of how the business is run and how to polish of techniques to provide the highest quality of service to each client. I feel that I need to understand and read more about how this industry is evolving and how we as a nation can improve the status at this present point where there are a lot of questions still unanswered.

References:

Class notes. (2008).

McQuillan, D. Elluminate. Understanding Legal Process .September the 23rd 2009. Professional Practice. Polytechnic Massage Therapy Diploma Course.

My own thoughts

New Zealand Legislation. (2009). Retrieved October, 17th, 2009 from http://www.legislation.govt.nz/

Sustainable Practice:

Sustainability: Blog 4
Victoria Walden
Due Date: 25th September 2009

Sustainable development is described by the Otago University Press as “Development that meets the needs of the present without compromising the ability of future generations to meet their own needs” (1987).

Sustainable massage practice involves three specific points:
- Environmental sustainability
- Social sustainability
- Economic sustainability
All three of these points interlink and relate to the theory and practical side of massage therapy.

Environmental sustainability:

Environmental sustainability is to do with the environment and how we are as a community, taking it for granted. Within the massage practice here are examples of how we are sometimes unsustainable: Example of this would be the amount of paper that is used, the amount of electricity used in the things such as laundry and the use of a motor car each day to get to and from work. As a massage therapist in my massage practice I believe that my business should try and improve our environmental sustainability, we can do this by:

- Biking to work
- Having adequate equipment (sheets)
- Using sheets as they dry more quickly
- Also using recycled paper or computer files for clients
- Timer on heating device in the business premises

I believe that as a practitioner it is also my occupation to spread the word about environmental sustainability and information to clients is another step in their recovery from injury or from something else. Information on 30mins and day “push play” can make a difference in a client’s daily routine.

Social sustainability:

Social sustainability relates to the quality of interaction between people, different parties, religions, trust. Within massage therapy social sustainability is a vital aspect to the communication, information and expansion of the business. Social sustainability is between clients ad their therapists and also other therapist’s interaction with each other and the interaction between the therapist, client and other health professionals.
Within my massage business I feel that social sustainability is a major aspect that should be addressed. Social sustainability has to do with communication and trust between all parties that relate to my massage practice. I feel that my business can do this by:

- Working with other therapists and healthcare professionals
- Looking after yourself
- Educating clients about improving their wellbeing
- Being aware of issues of environmental sustainability.

All of these points will improve my massage business as I feel that communication is the key to a successful business and consistent cliental. I can learn from other business and also learn from the clients in what they are looking for in a massage business, as they are my main target market.

Economic sustainability:

Economic sustainability basically means the financial performance of the operation of the business. For the massage therapist to build a credible reputation and to maintain the trust to exist between the therapist, client, and other health professionals the business needs to be economically viable. Economic sustainability is typically considered as actions which maintain economic capital for example financial performance, also taking environmental and social sustainability into consideration.
Within my massage business economic sustainability is another major point that must be addressed. Ways in which my massage practice can meet economic sustainability include:

- Setting fees and managing money
- Trigger point identifying target market to attract new clients and maintain existing clients
- Form relationships with interacting organisations: e.g. sports clubs, businesses, other health professionals and tourist orientated businesses.

For my massage business to maintain an economic sustainable business requires customers. The relationship between the therapist and client maintains both social and economically sustainable businesses. Basic economics relies on income (fees). Fees have to be set at acceptable levels... this also maintains the social sustainability of the business. Fees set too high are both economically and socially unacceptable therefore my business would research the other supplying business around the area to maintain a average price that is acceptable. Referrals from other associated businesses are also necessary in maintaining economic sustainability. This can be taken as broadly in include other health professionals, bank manager, accountant. My business will identify who my clients are and who is my target market; this will assist in the planning of the purchase of equipment. Equipment leads to environmental sustainability and the equipment needed is a direct outcome of which the target market will be, relating to social sustainability. Only the equipment necessary to meet the demands of my business needs to be purchased. Equipment that is not being used to its full application does not make economical sense.
In all I believe that my massage practice will do its best to keep a sustainable business, unfortunately this is not a perfect world and that the business will still rely on certain power sources, for example dryers, especially during the winter months. Also the fact that transport is necessary for me to get to work unless it is a fine day or public transport is available. Within my practice I do feel that that the three aspects of sustainability will be put into action and that it is a major topic in the community today.


References:
Class Notes 2008
McQuillan, D. Elluminate. Sustainable Practice. September the 23rd 2009. Professional Practice.
My own thoughts
The World Commission on Environmental and Development. (1987). Our Common Future, Oxford, New York: Oxford University Press.

Pyelonephritis

Pathology: Pyelonephritis
Victoria Walden
Due Date: 14th of September

Description:

Acute pyelonephritis (also known as acute infective tubulointerstitial nephritis) is a sudden inflammation caused by bacteria that primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. It’s one of the most common renal diseases. With treatment and continued follow-up care, the prognosis is good, and extensive permanent damage is rare.
(Springhouse, 2005)

Pyelonephritis is more common in females and can occur more when the immune system is down in any human body. This infection of the kidneys needs antibiotics as therapy, and treatment of any underlying causes to prevent recurrence.

Etiology:

The main cause of Pyelonephritis is when a kidney produces an infection that usually is caused by bacteria that has travelled to the kidney from an infection in the bladder, when the defences are broken down increasing bacteria flow.
- Women have more bladder infections than men because the distance to the bladder from skin, where bacteria normally live, is quite short and direct. Usually, however, the infection remains in the bladder.
- A women is more likely to develop pyelonephritis when she is pregnant. Peylonephtritis and other forms of urinary tract infection increase the risk of premature delivery.
- A man is more likely to develop the problem if his prostate is enlarged, a common condition after age 50. Both men and women are more likely to develop pyelonephtritis if they have any of the following conditions:

· An untreated urinary tract infection
· Diabetes
· Nerve problems that affect the bladder
· Kidney stones
· A bladder tumor
· Abnormal backflow of urine from the bladder to the kidneys, called vesicoureteral reflux
· An obstruction related to an abnormal development of the urinary tract

- Tests or procedures that involve the insertion of an instrument into the bladder also increase the risk of urinary tract infections and pyelonephtritis.
- Children sometimes develop pyelonephritis because of an abnormality in the bladder that allows urine there to flow backward (reflux) into the ureter, the connection between the kidney and bladder. This can lead to scarring of the kidney.
(About.com)

Through all of these the chances of this infection occurring are very high and can cause pain and further damage, also increasing reoccurrence.
Infections can also come from another part of the body, not just the bladder. Infections can come from the bloodstream. For example: A staphylococcal skin infection can spread to the kidneys through the bloodstream.
Also risk of producing this infection is increased in people with diabetes or with a weak immune system; this reduces their fight against infection.
Pyelonephritis is usually caused by bacteria, but it is rarely caused by tuberculosis, fungal infections, and viruses.
(Shankel, 2007)

Incidence:

Pyelonephritis occurs more commonly in females, probably because of a shorter urethra and the proximity of the urinary meatus to the vagina and the rectum — both conditions allow bacteria to reach the bladder more easily — and a lack of the antibacterial prostatic secretions produced in the male. Incidence increases with age and is higher in the following groups:
- Sexually active females: Intercourse increases the risk of bacterial contamination.
- Pregnant

females: About 5% develop asymptomatic bacteriuria; if untreated, about 40% develop pyelonephritis.
- Diabetics: Neurogenic bladder causes incomplete emptying and urinary stasis; glycosuria may support bacterial growth in the urine.
- Persons with other renal diseases: Compromised renal function aggravates susceptibility.
(Professional Guide to Diseases (Eighth Edition), 2005)

Acute pyelonephritis can occur at any age. In neonates it is 1.5 times more common in boys and tends to be associated with abnormalities of the renal tract. Uncircumcised boys tend to have a higher incidence than circumcised boys. Beyond that age girls have a 10-fold higher incidence. In adult life it reflects the incidence of urinary tract infection (UTI) in that it is much more common in young women. Over 65 the incidence in men rises to match that of women.
(Dr. Knott, 2009)

Signs & symptoms:

The two primary symptoms of pyelonephritis are pain in one flank, the area just beneath the lower ribs in the back, and fever. The pain can travel around the side toward the lower abdomen.
There can also be:
- Shaking chills
- Nausea & vomiting
- Urine maybe cloudly
- Urine can be tinged with blood
- Urine maybe unusually strong or foul-smelling
- Urinate more often
- Urinating maybe painful or uncomfortable.
(About.com)

Shankel says that one or both kidneys may be enlarged and painful, and doctors may find tenderness in the small of the back on the affected side. Sometimes also the muscles of the abdomen are tightly contracted. Spasms can occur when passing urine or kidney stones. If the ureters goes into spasms, people may experience intense pain.

In children, symptoms of a kidney infection often are difficult to recognise. In older generation, pyelonephritis may not cause any symptoms that seem to indicate a problem in the urinary tract. Instead the older generation may have delirium or an infection of the bloodstream (sepsis).
(Shankel, 2007).

Pyelonephritis can be sudden (acute) or long-term (chronic).
- Acute uncomplicated pyelonephritis is the sudden development of kidney inflammation.
- Chronic pyelonephritis is a long-standing infection that does not go away.
(About.com)

Indications and contraindications for massage therapy:

- Do not massage during acute phase
- Encourage the client to take the full course of antibiotics
- Avoid massaging the abdominal area until pain had subsided.
(Dr. Premkumar, 2000)

Risk factors:
- More common in women due to shortness of urethra
- Any kind of obstruction in the urinary tract predisposes to this infection
- Catheterization, pregnancy, loss of bladder control as in spinal, cord injuries, renal stones, birth defects of the urinary tract make a person more susceptible to infection.
(Dr. Premkumar, 2000)

Homecare exercises:

Prevention:
- Drink several glasses of water each day.
- If you are a women, wipe from front to back.
- Decrease the speed of bacteria during sex (urinate after sexual intercourse).
(About.com)

References:

About.com: Health topics A – Z. Retrieved September 13th, 2009 from http://adam.about.com/encyclopedia/infectiousdiseases/Kidney-infection-pyelonephritis.htm

Dr. Knott, L. (2009). Patient UK: Pyelonephritis. Retrieved September 13th, 2009 from http://www.patient.co.uk/doctor/Pyelonephritis.htm

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Schwartz, M, W. (2008). The 5-Mintue Pediatric Consult. Retrieved September 12th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/book-diseases-20a.htm

Shankel, S. (2007). Kidney Infection (Pyelonephritis). Retrieved September, 12th, 2009 from http://www.merck.com/mmhe/sec11/ch149/ch149d.html

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition). Retrieved September 12th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/book-diseases-7a.htm

Springhouse. (2005). Professional Guide to Diseases, (Eighth Edition): Prevalence and incidence of Pyelonephritis. Retrieved September 13th, 2009 from http://www.wrongdiagnosis.com/p/pyelonephritis/prevalence.htm

Wikipedia. (2009). Pyelonephritis. Retrieved September 12th, 2009 from http://enwikipedia.org/wiki/pyelonephritis

Professional Practice

Professional Practice: Ethics
Victoria Walden
Due date 14th of August

Reflect on ethical principles relevant to massage practice:

Within a Massage Practice ethical principles are put in place to ensure the emotional and mental safety of client and practitioner.

The core ethical concepts are:
- The therapeutic relationship
- Client-centred care
- Power differentials
- Transference
- Counter-transference

The therapeutic relationship:

Benjamin states that in a therapeutic relationship there is a power differential, also that each person in the relationship has a clear role, the environment is safe and that the time spent together between therapist and client is structured.

I feel this, sums up the difference between personal and therapeutic/professional relationship.

The relationship between client and therapist is also stated by Massage New Zealand in their “Code of Ethics”:

• A practitioner shall endeavour to serve the best interests of their clients at all times and
to provide the highest quality service possible.
• A practitioner shall at all times respect the confidence of their client, and diagnostic
finding acquired during consultation and/or treatment shall not be divulged to anyone
without the client’s consent, except when required by law or where failure to do so
would constitute a menace or danger to the client or another member of the community.
• A practitioner shall not enter into an intimate or sexual relationship with a patient whilst
the patient is under their care.

(Massage New Zealand, 2009).

This ethical principle/boundaries put in place for massage therapists gives an outline of the expectations that the massage therapist needs to obey by to conform with; Massage New Zealand’s standards and also to ensure the safety of the client and practitioner.

Client-centred care:

“Client-centred means that every action that the practitioner takes is in the service of the clients needs and not the practitioners needs” (Benjamin & Sohnen-Moe, 2003).

Client-centred care also means that the client must consent to any treatment before massage can begin. Through this step it gives the client a voice and the power to say ‘no’. This is an ethical principle that all practitioner take on board as the client at this stage is vulnerable and exposed when client as consented to massage the power changes from client to practitioner.

Power differential:

Within the massage practice there will be in most cases a power differential where the therapist holds the most power. This is because of the client allowing the practitioner into their space when sitting, lying down also not fully clothed. The client giving permission to the practitioner to massage shifts the power literally putting the safety and wellbeing of the client in their hands.

“To maintain an ethical practice, the person in power must regulary say “no” to something she could easily get and must instead choose to pay attention to the needs of the person with less power” (Benjamin & Sohnen-Moe, 2003).

The practitioner must maintain the respect and integrity of all clients’ boundaries when they are in a vulnerable state during massage practice.

Transference:

“Transference is the personalization of the professional relationship by the client” (Fritz, 2004).

Transference in a massage practice is where the client may demand more of the therapist’s time, bring them gifts, attempt to engage the professional in personal conversation, propose friendship or sexual activity or an expression of anger and blame towards the practitioner.

“Transference occurs when the client sees the therapist in a personal light instead of a professional manner” (Fritz, 2004).

The ethical principles have been put in place to stop this situation from occurring therefore in this case the practitioner needs to clearly state the professional relationship to reinforce the ethical boundaries. Also to refer client to the appropriate professional to help them.

Counter-transference is the opposite of transference where the practitioner has attached their personal feelings into the professional environment of their practice.

Ethical principles are put in place to limit this sort of inappropriate behaviour from client or practitioner.

Massage New Zealand has in place “Code of Ethics”, Established above and also sates professionalism, scope of practice/ appropriate techniques and image/advertising claims.

Each massage practice should take pride in their service, honesty, treatment, professionalism; respect for others and also for the practitioner themselves.

Obeying the ethical boundaries that have been enforced will improve the practice of a massage therapy business.

References:

Benjamin, B & Sohnen-Moe, C. (2003). The Ethics of Touch. (SMA Inc., Tucson, Ariz., 2003.)

Massage New Zealand. (2009). Code of Ethics. Retrieved, August, 13th, 2009, from http://massagenewzealand.org.nz/about-us/code-of-ethics/

McQuillan ,D. Elluminate August 12th,13th 2009. Professional Practice 2.

My Own Thoughts

Fritz, S. (2004). Mosby’s fundamentals of therapeutic massage, (3rd ed.). Missouri: Mosby.

Fibromyalgia

Pathology 2: Fibromyalgia
Victoria Walden
Due Date: 27/07/09

Description:

Fibromyalgia is a syndrome, with chronic pain disorder that affects the client physically, mentally and socially. The syndrome is characterised by chronic widespread pain, multiple tender points, abnormal pain processing, sleep disturbances, fatigue and often psychological distress (National Fibromyalgia Association 2009).

Tender points:
Tender point pain occurs in local sites, usually in the neck and shoulders. The pain then spreads out from these areas. The actual pain starts at the muscles. The joints are not affected. There are no lumps or nodes associated with these points of pain, and no signs of inflammation (swelling). People diagnosed with fibromyalgia feel pain in at least 11 to 18 specific tender points.

Widespread pain described as stiffness, burning, and aching. The pain also “radiates,” or spread, to nearby areas. Most patients report feeling some pain all the time. Many describe it as “exhausting.” The pain can vary depending on the time of day, weather changes, physical activity, and the presence of stressful situations. The pain is often more intense after disturbed sleep” (About.com: Health Topics A- Z).

Clients who suffer from this syndrome severely can be enormously debilitating and interfere with basic daily activities.
Females are more likely to be diagnosed with the syndrome than males.

“Fibromyositis (Fibro = Fiber; itis = inflammation) Also known as fibromyalgia, a group of conditions involving chronic inflammation of a muscle, its connective tissue coverings and tendons, and capsules of nearby joints. Symptoms are nonspecific and involve varying degrees of tenderness associated with specific trigger points, as well as fatigue and frequent awakening from sleep” (Marieb, Hoehn, 2007, p. 320).

Etiology:

“People with – experience pain from stimuli not normally perceived as painful, which is partially because of lowered pain thresholds and partially the result of central sensation involving an unbalanced autonomic nervous system response to physical, chemical and psychological stressors” (Salvo, 2008, p.139-40).

A notable imbalance in this syndrome is related to higher levels in the substance of P (neuroreceptor and neuromodulator associated with transmission of pain impulses to the central nervous system).
Fibromyalgia condition usually develops after phychologic trauma, local or general infections, medications, and excessive use of aspartame, as well as to physical trauma such as whiplash.

McCance and Huether talk about this in their book Pathophysiology – The Biologic Basis For Disease In Adults & Children 4th ed. They state that: "The etiology of Fibromyalgia has been debated for more than a century and that this syndrome cannot be caused by one single factor. There are different factors involved, for example: Flu like viral illness, chronic fatigue syndrome, HIV, Lyme disease, physical trauma, emotional trauma, also medications, especially steroid withdrawal. Fibromyalgia may overlap with myofascial pain syndromes; also rheumatic disease may coexist if not manifest with Fibromyalgia" (McCance & Huether, 2002. p.1399).

There are some clients that show signs of a genetic predisposition, with other family members also affected.

Incidence:

“A total of 2595 incident cases of fibromyalgia were identified between 1997 and 2002. Age-adjusted incidence rates were 6.88 cases per 1000 person-years for males and 11.8 cases per 1000 person-years for females. Females were 1.64 times (95% confidence interval=1.59 – 1.69) more likely than males to have fibromyalgia. Patients with fibromyalgia were 2.14 to 7.05 times more likely to have one or more of the following comorbid conditions: depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, and rheumatoid arthritis” (National Fibromyalgia Association 2009).

“The disorder has an increased frequency among women 20 to 50 years old. The prevalence of the disease has been estimated between 0.7% and 13% for women, and between 0.2% and 3.9% for men” (Fibromyalgia Support, 2009).


Signs & Symptoms:

· Chronic, widespread pain
· Fatigue
· Heightened pain in response to pressure
· Tingling of the skin
· Prolonged muscle spasms
· Weakness in the limbs
· Nerve pain
· Functional bowel disturbances
· Chronic sleep disturbances
· Impaired concentration
· Problems with short and long term memory
· Impaired speed of performance
· Inability to multi-task
· Cognitive (relating to thought processes) overload
· Diminished attention span
· Anxiety
· Depression
· Myofascial pain syndrome
· Headaches
· Localised pain (shoulders, neck, low back, hips, etc..)
(Wikipedia)
· Diarrhea
· Constipation
· Bloating
· Gas
· Urinary problems (burning while passing urine)
· According to the American College of Rheumatology, diagnosis is made if there is diffuse muscular pain along with 11 to 18 tender points described. (Dr. Premkumar, 2000, p.137)

“Other underlying ailments, such as chronic fatigue syndrome, irritable bowel syndrome, and rheumatoid arthritis, can also be present. New patients should be checked for these underlying conditions as well as fibromyalgia” (Fibromyalgia Support, 2009).

“Symptoms in Children. In general, children with fibromyalgia most often have sleep disorders and widespread pain” (About.com: Health Topics A –Z).

Fritz states: “Fibromyalgia is a condition characterized by aching and pain in the muscles, tendons, and joints all over the body but especially along the spine. Measurable changes in body chemistry and function occur in some people who have fibromyalgia, and these changes may be responsible for certain symptoms. However, fibromyalgia is not associated with muscle, nerve, or joint injury; inadequate muscle repair; or any serious bodily damage or disease. Also, people who have fibromyalgia are not at greater risk for any other musculoskeletal disease” (Fritz, 2004. p.610).

Indications and contraindications for massage therapy:

Recomended:
· Stress – reduction
· Regular physical activity such as walking, biking, swimming, or water aerobics (clients who are physically fit will experience less symptoms).
· Medication maybe used to reduce pain, improve sleep and combat depression (watch as a massage therapist as pain scale may change with client on pain killers).
· Application of moist heat and massage are proven beneficial in the management of pain and discomfort for this syndrome.

Massage:
· Massage should be tailored to each client, depending on how they are feeling at the time, as symptoms vary from day to day, also client maybe on pain killers.
· The pain of Fibromyalgia usually seems worse when a person is trying to relax and is less noticeable during busy activities or exercise (Fritz, 2004).
· Clients may request deep – pressure massage, this commonly provokes strong reactions for several days after treatment.
· Massage for stress reduction, removal of toxins, tenderpoint relief, break up adhesions (http://www.thebodyworker.com/, 1999-2009).
· Very slow increase in depth of massage strokes, from session to session, and carefully deactivation of trigger-points, are recommended.
· Address any other medical condition. (Salvo, 2008, p.141)

Yes: Detailed history from client every time as symptoms vary.
Yes: enquire about medications and be informed about the side effects of these medications.
Yes: full body relaxation massage of short duration.
Yes: gentle cross fiber friction over entire muscles, stretching and strokes such as effeurage are beneficial.
Yes: Hot packs on painful areas.
No: Massage may not be beneficial to all clients.
Do not use anything that will add to inflammation such as heat; Often over sensitive to touch. Refer to Naturopath and Acupuncturist for treatment if it is not working. Diet and Lifestyle changes are necessary (www.thebodyworker.com, 1999-2009).

“Massage has been shown to increase relaxation of muscles, decrease fatigue, decrease pain, produce sleep, decrease edema and increase mobility. It has been shown to increase communication, decrease depression and anxiety and produce a general increase in sense of well being. All these effects directly address the symptoms of fibromyalgia” (Dr. Premkumar, 2000, P.138).

Clients with Fibromyalgia are going to vary with pain, symptoms and tolerances. Therefore the therapist needs to adapt to each individual client with this syndrome to help improve their lifestyle.

References:

About.com: Health Topics A – Z. Retrieved July, 22nd, 2009, from http://adam.about.com/reports/fibromyalgia.htm

Buraun, M., & Simonson, S. (2007). Introducation to Massage Therapy 2nd ed. Lippincott: Williams & Wilkins.

Don L. Goldenberg, M., Carol Burckhardt, P., & Leslie Crofford, M. (2004). Management of Fibromyalgia Syndrome . Jama , 292:2388-2395.

Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.

Fibromyalgia Support. (2009). Causes, Symptoms and Signs of Fibromyalgia. Retrieved July, 22nd, 2009, from http://www.fibromyalgia-support.org/fibromyalgia-causes-symptoms-signs/fibromyalgia-causes-symptoms-signs.html

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby

Huether, S., & McCance, K. (2002). Pathophysiology: The Biologic Basis For Disease In Adults & Children (4th ed.).St. Louis, Missouri: Mosby, Inc.

National Fibromyalgia Association. (2009). Retrieved July, 20th, 2009, from http://www.fmaware.org/site/pageserver?pagename=fibromyalgia

Pathology for Massage Therapists. (1999-2009). Retrieved August, 6th, 2009, from http://www.thebodyworker.com/pathology-F.htm

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Wikipedia. Fibromyalgia. Retrieved July, 22nd, 2009, from http://en.wikipedia.org/wiki/fibromyalgia

The Treaty of Waitangi

Integrating Treaty framework and Hauora values into my practice as a massage therapist:
Due date: 17th of June 2009:
Professional practice:
Victoria Walden:

Article 1: Governance:
The massage therapists’ role in the relationship between client and therapist is to help the client in any way possible in keeping within the scope of practice. The treaty policy and legislation for health department applies to our practice so ensure health of each client. Being aware of the treaty is part of the massage therapy requirements, the code of ethics states: ‘Respect the client’s boundaries with regard to privacy, disclosure, emotional expression and beliefs’ (code of ethics, Massage NZ).

Article 2: Authority:
Within the scope of practice for massage therapists the client will be able to speak their mind as a right and have a say as to how their treatment will proceed. There will be a partnership between client and therapist to produce an outcome that both are happy with. This is accomplished by: ‘Maintain open communication throughout the massage session ensuring ongoing informed client consent, explaining rational for proposed massage’ (code of ethics, Massage NZ).

Article 3: Equity:
The quality of how people are treated should be of the highest respect and professionalism. Under the massage scope of practice each client should be treated the same and also accommodating for those of disabilities. Therefore access, and acceptance/respect of every client, no matter their disadvantage. The therapist should also respect and know when they should refer on; ‘Acknowledge the limitations of their skills and, when necessary refer clients to the appropriate qualified health care professions’ (code of ethics, Massage NZ).

Article 4: Respect:
Within the scope of massage practice the client’s wishes, culture, beliefs will be respected, also to what the client wants for their treatment.
The code of ethics states what the therapist should NOT do for example; ‘Endanger the physical, mental or emotional health, well-being or safety of a client’ (code of ethics, Massage NZ).

Hauora = well-being:
Hauora/well-being is a very vital part within the practice of massage therapy for the therapist and the client to reach the goal they are both happy with.
There are 4 parts to Hauora, Cultural beliefs, Thoughts and feelings, physical side and family (the social aspect); This is how they fit into my massage therapy scope of practice:

Cultural beliefs: The cultural beliefs of the therapist will be addressed and also of the client. With regards to the client, the therapist will have the respect for any cultural beliefs of any client and will do their best to understand and to accommodate their requests. From the therapist, some rituals are a belief to them and therefore a compromise is needed between therapist and client. Communication is the key.

Thoughts and feelings: The client’s thoughts and feelings will be freely welcomed in the company between client and therapist. The client should feel happy enough to communicate their ideas and thoughts about treatment plan and also how the process will unfold. Communication is vital to form a bond between client and therapist.

Physical side: From the client and therapist having a professional relationship the physical aspects of the client’s health and also what they want untouched or left alone physically will be established. This aspect of the scope of practice is very important making sure keeping within scope of a massage therapist, taking care of the client.

Family (social aspect): From the social aspect of the massage therapy scope of practice the information can be found from sports to old injuries, especially involving other health professionals in the investigation of the client’s reason for coming to the practice (with clients consent). Within the massage scope of practice, the therapists will respect the wishes of the client, therefore as a young child or teenager may want an adult or friend present in the session, a translator maybe necessary for clients who do not speak English or for cultural beliefs or other the family may be present or in another room close by.

Hauora and the framework of the treaty are vital pieces of information and that should be respected and understood by all massage therapists coming into the business, as the saying goes, treat people with the same respected that you would want them to treat you.

Reference:
Massage New Zealand. (2009). Retrieved June 16th 2009, from http://www.massagenewzealand.org.nz/
My own thoughts
Group thoughts from class 12th June 2009

Pathology

Pathology:
Conditions: Task 2 – Ankylosing Spondylitis
Victoria Walden
Due 18th May 2009

Description of Ankylosing Spondylitis:

Ankylosing means joining together or stiffening .
Spondylitis means inflammation of the vertebral bones of the spine.
Ankylosing spondylitis is a chronic, systemic, inflammatory arthritis leading to calcification and fusion (ankylosing) of the joints, usually the spine and scaroiliac joints (Salvo, S, G. 2008, p.132). This type of arthritis often runs in the family genes, also men are three times more likely to get this disease.
This disease is usually diagnosed in young adults with a peak onset between 20 and 30 years of age and can range from a mild to more severe disease in patients.

Etiology:

Ankylosing spondylitis is considered an autoimmune disease with the genetic basis (genetic basis means that is type of arthritis runs in the family genes, therefore if AS is common in a family, then it is more likely that in that family AS will occur)
With the disease this is the process of what occurs:
· Inflamed joints become infiltrated with inflammatory cells such as fibroblasts, repair begins.
· Collagen is laid down and organised into fibrous scar tissue.
· Tissues undergo the process of calcification and ossification (forming bone), leading to joint fusion and loss of flexibility.



Incidence:

One out of 10,000 people has Ankylosing spondylitis. It affects males more than females and usually is found between the ages of 20 and 40 (Springhouse, 2005).
It may develop in children younger than 10 years of age.

Signs and symptoms:

· This Disease affects the sacroiliac joints, intervertebral disk spaces and costo-vertebral joints commonly.
· It rarely affects the larger synovial joints e.g. hips, knees, shoulders.
· The spine becomes rigid and appears like bamboo, like in X-rays (Dr. Premkumar, K. 2000).
· Disease has exacerbations (can be made worse)and remissions (slight reduction of disease).
· Pain becomes worse when the body is at rest – pain reduces by mild activity.
· Patient complains of constant or irregular low back pain.
· Approximately 30% of this disease shows signs of systemic nature, such as fatigue, weight loss and low grade fever.
· 30% experience bowel inflammation with diarrhoea, eye inflammation and light sensitivity.
· Pain may radiate to the thigh area
· Through reduced movement of vertebral column the curvature of lumbar area is slowly lost.
· In the late stages of disease the spine becomes fixed.
· If costo-vertebral joints are fixed it can have an effect on lung volume.
· Kyphosis (hunchback) occurs when thoracic or cervical areas are affected and the weight of the head compresses the vertebral bodies therefore bends the spine forward, Head becomes hyperextended to maintain field of vision.



Indications and contraindications for massage therapy:

· Client should be positioned to what feels comfortable with plenty of support from pillows.
· Clients with Kyphosis need extra neck support.
· Pillow under knee can relieve tension on hamstrings, also cause pelvis to tilt backwards and straighten lumbar spine.
· From this disease Osteoparosis is common, which can lead to compression fractures
(Salvo, S, G. 2008, p.132).
· Ribcage expansion during inspiration is reduced if costo-vertebral joints are fused therefore client may experience breathing difficulties.
· AIM: Retain mobility of the joints, strengthen weak muscles and stretch tight muscles.
· YES: Gentle massage to the back and limbs.
· YES: Hot packs will help ease pain
· NO: Do not forcibly mobilize ankylosed joints.
· NO: No spinal manipulation
· NO: No deep pressure as osteoporosis is common.
· NO: Avoid massage to inflamed areas
· Advice client to sleep in supine position if possible
· Encourage client to do breathing exercises to regularly move the thorax (help breathing)
· MAJOR: Client maybe on painkillers therefore giving the wrong reading to pain scale.
· Address any other medical conditions e.g. osteoarthritis in treatment plan
· Physician consulted in clients with severe deformities.

References:

Dr. Premkumar, K. (2000). Pathology A to Z: A handbook for massage therapists, (2nd ed.). Canada: VanPub Books.

Professor, Dougadlas, M. (2005). Orphanet. Ankylosing spondylitis. May, 9th, 2009, from www.orpha.net/data/patho/GB/uk-Ankylosing-spondylitis.pdf

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists, (2nd ed.). Elsevier Health Science.

Wikipedia, Retrieved May, 9th, 2009 from http://en.wikipedia.org/wiki/ankylosing_spondylitis

Springhouse. (2005). Professional Guide to Diseases, (8th ed.). Lippincott: Williams & Wilkins.

Professional Practice

Professional Practice
Assessment Task 1 – Blog 1
Victoria Walden
Due 8th of May 2009

Does the scope of practice as defined by massage New Zealand fit within the legal requirements under the act: Healthcare Professional Competency Assurance Act 2003.

Yes, the scope of practice defined by Massage New Zealand does fit within the legal requirements under the Healthcare Professional Competency Assurance Act 2003. The reasoning why this scope of practice does fit is because of the way that Massage New Zealand has arranged their wording in their scope and also the professional way they approached this task.
With regards to Massage New Zealand they have incorporated the clinic competence and also the educational competence. As through learning the scope of practice will increase in each massage therapist as they continue with their study. From the clinic side of things the scope of practice in detail shows what the massage therapist is able to do and to achieve the best results from each client, as each client is not the same.

Example from the Certified massage therapy scope of practice:
· Delivery of relaxation massage according to the treatment plan which
could include the following massage strokes - effleurage, petrissage, deep
longitudinal, broad cross fibre, compression, vibration, tapotement.

Example from the Remedial massage therapist scope of practice:
· Clinical reasoning of the client condition presenting where information
gathered from history taking and physical assessment is assimilated to
produce an effective and relevant treatment plan.

I feel that the Healthcare Professional Competency Assurance Act (HPCA) is very strict as to what the massage therapist scope of practice is. Yet I feel in some way if Massage New Zealand does go under the HPCA that the flexibility of adapting to each client will be lost, there will be more restrictions to our practice and less freedom. Then again it could give more structure and credibility to the profession of massage therapists if Massage New Zealand did go under the act. Also massage would be under a government recognition giving massage therapists a more high profile name, as David quoted in the elluminate session of what a professional is:

“Professional – work ...requires the application of theories, principles and methods typically acquired through completion of a baccalaureate degree or higher or comparable experience; requires the consistent exercise of discretion and judgement in the research, analysis, interpretation and application of acquired theories, principles and methods to work product (West Virginia Interactive, 2008).”
(Elluminate, 2009).

From this quote it states that we do, do all of these things and more. The next step in the massage industry I feel is to get the positive go ahead from the government and HPCA can help with that.
Does our scope of practice as defined by MNZ accurately reflect our scope of practice?

I believe that Massage New Zealand’s scope of practice does accurately reflect our scope of practice because like the scope of practice we are striving to be professionals within massage therapy.
I believe that we all have our own approach to the scope of the massage industry but we all have to follow by the guild lines that Massage New Zealand has produced. Through these guild lines (scope of practice) we as massage therapists can apply any treatment within the scope and effectively produce a professional healthcare relationship with each client.


References:
Elluminate April 8, 2009.
Massage New Zealand. (2009). Retrieved May 7th 2009 from www.massagenewzealand.org.nz

Evaluation of Research Findings

Research Methods Assessment Task 1 - Blog 4 - Evaluation of Research Findings
Victoria Walden
Due Date 1st May 2009 (with extension)

Bodywork e-News. Unraveling the mysteries of Unwinding. (2008). Retrieved May, 8, 2009 from http://www.terrarosa.com.au/articles/Terra_News2a.pdf

‘Unravelling the mysteries of unwinding’, is an article of information referring to the techniques of Myofascial Release. Through reading this article I found that it had some good aspects and some less ones.

The first aspect that I liked about it was that the introduction explains the title of the article in the first two sentences. For Example, ‘The term “unwind” is in general used with a meaning to relax, become less tense, or take an ease. “Unwind your body” is a common phrase used to promote relaxation bodywork (Bodywork e-News, 2008). From these first two sentences the article has set up the article to inform the reader about relaxation of the body.

Another great aspect to this article is that it is well laid out and easy read. If a client is to receive Myofascial Release, this background information could set their mind at ease. The pictures and the explanation of what would occur during the session are simple and easily understood.

Unfortunately after reading the article a few times I still do not know whom the article is written for, as Simon also states in his blog (S, Marks, 2009).
My reasoning to this outcome is that the article is lacking in depth. It only brushes the surface of a lot of topics, therefore only giving enough information for someone to keep looking in other sources to acquire the full details of the article.

Another reason, which points the way to whom this article is written for, is contained in the remarks through the article stating where Myofascial Release is offered and that taking a seminar would be beneficial and helpful. To me in an article that was written to inform personal about the Myofascial techniques should not have marketing statements through the article. I would however accept the marketing comments at the end of the article, therefore giving the reader something to think about after reading the information and how myofascial release can help them.

This follows on to my next point, where arrangement of the article’s information is not in an order that flows. The article jumps from one topic to the next, not introducing or rounding up each topic. Therefore from this I found that someone who did not yet understand a little about the topic would find this article hard to follow.

My last comment to this article is that the article describes emotional release yet never goes into any depth about its effects from this treatment. For example in a paragraph with describes Dr. Frymann as mainly having developed the technique of unwinding, the article states that ‘unwinding was never intended nor used by her to provoke emotional release.’

From this I read that the client may have an emotional release from the treatment. Unfortunately it does not state what this means. Throughout the article from what I can tell, the author wants to inform the reader of the connection of the muscles with the mind as a way of increasing release from different areas of the body. I feel that emotional release is a major part of that, yet it is not fully explained in the article.

From this I find that the article has potential and could be beneficial for first time clients to read about the effects of Myofascial Release as well as helping the client to understand what is going on in their body.

References:

LoBiondo-Wood, G., Haber, J. & Krainovich-Miller, B. (2002). Critical Reading Strategies: Overview of the Research Process. Chapter 2 In LoBiondo-Wood, G. & Haber, J. (editors). Nursing research: Methods, critical appraisal, and utilization. 5th ed.). St Louis: Mosby. Retrieved May, 8, 2009 from http://www.richard.ingram.nhspeople.net/student/critintro.htm#lobi

Marks. S. (2009). Essay. Retrieved May, 8, 2009 from http://sjsteven.blogspot.com/2009/05/research-methods-blog-4.html


Bodywork e-News. Unraveling the mysteries of Unwinding. (2008). Retrieved May, 8, 2009 from http://www.terrarosa.com.au/articles/Terra_News2a.pdf

My Research Process

I have found through the research process so far, I have been in very foreign territory as I have found myself questioning everything I write down. The research process is a very complex way of researching and I for one have found it very difficult to understand especially the referencing of so many research resources like; articles, journals, text books, web site etc. The list goes on, as does my confusion as putting all of the resources information together does take time.

I found that asking questions is not a bad thing, and that no one is perfect. This helped me to understand the outlines that you must take to process the information that is provided in so many different forms.

· Looking at the research question provided, and reading it over a few times and looking up definitions that I don’t understand.
· Breaking up the research question into smaller parts and seeing if I can reword the question for my own understanding.
· Using the key words from the question, look up search engines using them.
· Reading articles using the key words to see if they jump out as it is quicker and more efficient.
· Using a brainstorm to decide order of writing.
· Using examples and comparing.
· Tying information all together.

Collaborative research:

Through the past few weeks my research has been involvement with my collaborative group task, where I am join by two other of my class peers and we come up with a research question/query that we have to research and prove fact of fiction.

We have taken different steps to come up with a decisive question/query. First we all went away and came up with different questions that we could research, we then came together and looked through the research questions that we came up with, disregarding questions that were too broad or not enough research material to help us in the research of that topic. We then broke down the question to which we were all interested in and also happy with. Our next step was to see if we were to do that topic that we had information that we could use. Then our last step in the process to getting the right question/query was to see if our lecturer agreed and to also help break it down again to make the topic we were about to research specific.

· Does massage support the rituals an athlete goes through before an event to address anxiety levels?

Next was the methodology which we had help from our lecture again and we came up with the idea of a questionnaire to receive good information for or topic question.

Again our group went away and came up with different questions that could be relevant to the topic. We then all met up and put together a few questions that could be possible to use. Then from the questions put together we will show our lecture getting her views on the topic.
We then have to look at the literature review so we all took two different physiological effects of massage on the human body and also to incorporate the fact that we are also seeing he anxiety levels of athletes.

Through this time this is what my collaborative group has come up with. I have found working with my peers on the topic a lot easier as I find that I sometimes get lost. It is great to be able to work with and learn from others in my class as I have learnt a lot from the way that they take the whole research process, also how they cope with it.
I find that research isn’t my speciality and that I do need to work on it. I am learning new skills and happy that I am able to apply them to my research.

Resourses:
Class notes.
My thoughts

Pathology: Tennis Elbow

Etiology:
Etiology of the tennis elbow includes the age of the client as people over the age of 30 years of age are more prone to incurring tennis elbow. Other causes of the diseases is repetitive action of the muscles involved in tennis elbow, for example playing tennis for a number of years, using the same muscles, tendons and ligaments day after day will eventually cause tennis elbow. Other causes are; tightness of grip, unskilled tennis players, force and flexibility of the forearm extensors. Also tennis elbow can be caused by a direct hit or a fall onto the elbow (Brad Walker 1999).

Pathogenesis:
Pathogenesis which is the affects after the disease or in this case the tennis elbow, is that with tennis elbow, small micro tears form in the tendons and muscles that are the control for such movements as swinging a tennis racket. From these tears they restrict movement and inflict pain, they also lead to the formation of scar tissue and calcium deposits therefore putting a lot of pressure on the muscles and nerves that can cut off blood flow to those areas (Brad Walker 1999).

Morphological:
Morphological is the anatomical changes that occur from the tennis elbow. Therefore the changes within the tennis elbow disease are the micro tears of the tendons and muscles used that was mentioned in the pathogenesis.

Histological:
Histological is the cellular and extra-cellular matrix changes when tennis elbow is present in the elbow. When tennis elbow is present, as said above, there are going to be micro tears in the tissues therefore as when there is an injury of the tissue there is usually bleeding at the site as the tear very likely would damage small blood vessels. This fluid includes blood and also chemicals that are released into the extracellular fluid (Marieb, E,. Hoehn, K, 2007), that accumulates at the damaged site which contains protein that turns into scar tissue. When there is an overload of scar tissue it will result in restriction of movement and also preventing the structure to return to its normal state, also increasing the risk of re-injury.

Epidemiology:
Incidence:
- Approximately 1% - 3% are diagnosed with “tennis elbow” each year (Joshi, D, 2008)

Prevalence:
- Estimated that 40% to 50% of all tennis players will incur tennis elbow at one point in their carrier (Marc. C, Levesque, MD, PhD, MD, 2007).
- “Between January 2004 and June, 2007, the number of Patients receiving a “tennis elbow” diagnosis has risen by 25% (Joshi, D, 2008).”



Reference:

Joshi, D,. (2008). Arthroscopic Treatment for Tennis Elbow: Report Shows Excellent Outcomes. Retrieved 26th of March 2009 from
www.pearldiverinc.com/pdp/index.php/eng/Market-and-Company-Data/Extremity-Reconstruction/Arthroscopic-Treatment-for-Tennis-Elbow-Report-Shows-Excellent-Outcomes

Marc. C, Levesque, MD, PhD, MD,. (2007). Arthritis and Tennis Elbow. Retrieved 24th of March 2009 from www.webmd.com/osteoarthritis/guide/tennis-elbow?

Marieb, E, N,. Hoehn, K,. (2007). Human Anatomy and Physiology. 7th edition.

Research – Wikipedia, the free encyclopedia (2009). Retrieved 24th of March 2009 from www.wikipedia.org/wiki/tennis_elbow

Vicenzino, B,. (2009). Lateral Epicondylalgia. Retrieved 24th of March 2009 from www.newmaster.it/spine2009/doc/report_vicenzino_20090206.pdf

Walker, B,. (1999). The Stretching Institute. Tennis Elbow: Guide to the treatment and prevention of tennis elbow. Retrieved 24th of March 2009 from www.thestretchinghandbook.com/archives/tennis-elbow.php

Information Quality

Collins Concise English Dictionary defines quality as “The degree of excellence which a thing possesses” (1978).
Information quality has a degree of excellence therefore is essential to the construction and critiquing of the research for any given topic.

Through research you can find information from a lot of different sources; library, internet, books, journals, articles etc. From this you then have to define what good and poor quality is.

How do you define the difference? How do you collect the correct data analysis to produce a comprehensive outcome for your research?

Alastair Smith (2005) has an idea that is an easy way to sort through the poor and good quality of resource information found through the internet.
He starts by looking at the scope including; breadth, depth, time and format. He then goes to the content; accuracy, authority, currency, uniqueness, links made to other resources and quality of writing. Alastair also looks at the graphic and multimedia design, purpose, for what audience, reviews, working ability; user friendly, required computing environment, searching browsability and organisation, interactivity, connectivity and cost.
Alastair’s analysis of internet quality of information is both precise and detailed.

Also Wendy Lazarus and Laurie Lipper (2003) also came up with a concept to identify what information is quality and what isn’t on the internet. They came up with a very different approach where they use a point system to define if the information is quality or not.
They split the evaluation into three sections. The first section is the baseline requirements, for example the author or sponsor being clearly identified. The second section is standards for low-barrier web sites which includes the literacy level of text. The third section is the requirements for high-quality web sites, which includes information quality, presentation etc.

Information these days comes from a lot of different sources and from these two sources it seems the internet is not so different from articles, books, journals etc.

Wikipedia referenced a journal that they found, that gives a precise outline of the dimensions to find and identify information quality (Wang & Strong, 1996).

1. Intrinsic IQ: Accuracy, objective, believability, reputation.
2. Contextual IQ: Relevancy, value-added, timeliness, completeness, amount of information.
3. Representational IQ: Interpretability, ease of understanding, concise representation, consistent representation.
4. Accessibility IQ: Accessibility, access security.

Through the sources found I established that they all have a similar way of finding the best quality of information. For example Alastair’s concept of finding quality information is to first read and then eliminating the requirements as they are established in the text. Wendy and Laurie found that their concept of a point system established what grade of quality the information was produced. Together they both used similar questions towards the text to achieve an efficient way to identify quality information.

Coming back to my questions asked before: How do you define the difference?

I have found reading through my references that you find the biggest difference in the first two minutes of looking at the resources provided. For example, where is the Author or sponsor clearly stated? When the resource was last updated? Are the first few lines easy to read and understand?

How do you collect the correct data analysis to produce a comprehensive outcome for your research topic?
Through my research, Wang & Strong’s concept has a basic outline that provides a guideline to find the correct data analysis for producing a comprehensive outcome. I repeat their concept again:
1. Intrinsic IQ: Accuracy, objective, believability, reputation.
2. Contextual IQ: Relevancy, value-added, timeliness, completeness, amount of information.
3. Representational IQ: Interpretability, ease of understanding, concise representation, consistent representation.
4. Accessibility IQ: Accessibility, access security.


References:

Information quality – Wikipedia, the free encyclopedia (2009) Retrieved March 18, 2009 from http://en.wikipedia.org/wiki/information_quality

Smith, A.G., (2005). Criteria for evaluation of Internet Resources, Retrieved March 18 2009 from www.vuw.ac.nz/staff/alastair_smith/evaln/index.htm

Lazarus, W., Lipper, L., (2003). The Children’s Partnership. Guidelines For Content Creation And Evaluation, Retrieved March 18 2009 from www.contentbank.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=6643

Collins, W,. Collins Cincise English Dictionary. (1978).

The Research Process

“The definition of Research process is. The ordered set of activities focused on the systematic collection of information using accepted methods of analysis as a basis for drawing conclusions and making recommendations” (Citied Mondofacto, education dictionary 2009).

Research Navigator.com states that there are several key steps involved in the research process. They begin with selecting a research topic, and the development of a tentative thesis, which is the argument that the research will defend. Next step was finding sources of supporting information and write notes from the information gathered through - books, journals, newspapers, web sites, interviews, etc. The next main step in the research process involved the writing of the paper. Using the notes previously noted , summaries, paraphrase, and incorporate quotes into a draft. The draft can be changed a few times before the final draft is complete. Next step was that you give credit to the sources used by producing a bibliography, or a list of sources. The final step was to edit the research document prior to submission.

Other sources I have found have a similar outlook on how the research process is defined for example Cambridge Rindge and Latin Research Guide uses a similar method but also incorporates writing a statement of purpose and then brainstorm questions about the focus topic. After that making a list of possible sources to produce research for the given topic. The University of Auckland adopt a simplified method when undertaking research which is broken down into 5 small steps, Step one is Defining your topic by clearly mapping out the concepts you want to research. Step two is selecting and using the best research resources, therefore using the internet, articles, books found at the local library. Step three is Locating the information you have identified, from the library or news article. Step four is evaluating resources, so printing out information and highlighting the more specific points also checking facts so that they are correct. Step five is documenting/citing your research, therefore stating at the end of you research writing a bibliography for the resources that you sourced your information from.

From the examples given of the research processes adopted by Research Navigator.com, Cambridge Rindge and Latin Research Guide and The University of Auckland, it can be seen that all three share similar characteristics when undertaking the research process. Their similarities were that they all had to have a focus topic, locating information and referencing research information found in the document. Although, they did have small differences for example, Auckland University had a more compacted process and was to the point, and Research Navigator.com had a complex and in-depth path to achieve the research process.

Therefore we ask the question why do we need to research, let alone use a research process?
Through Massage therapy and the medical world research is a very common aspect to the profession. Research process is important to the medical and health care part of our world also many, many more. Through researching different medical backgrounds we have now established a different insight to a lot of medical and health care professions. We have researched for how we can stop an infection all the way to how we can fix a broken leg. Research also can include the more spiritual side of medical care and healing of the hands.

I feel that the research process is necessary for the development of life in itself.

References:

Cambridge Rindge And Latin Research Guide. (2008). Basic Steps in the Research process. Retrieved March 4, 2009, from www.crlsresearchguide.org

Mondofacto. (2008). Research process. Retrieved March 4, 2009, from www.mondofacto.com/facts/dictionary?research+process

Research Navigator.com. (2009). Overview of the Research Process. Retrieved March 4, 2009, from www.researchnavigator.com/articles/research.asp?p=171027

The University of Auckland. (2009). The Research Process - step to success. Retrieved March 6, 2009, from www.library.auckland.ac.nz/instruct/research.htm

ABOUT ME

Hey my name is Victoria, I live in the South Island, I enjoy sports and activities, love my family and friends..... At the moment I am doing Massage Therapy and I enjoy this as I can help people enjoy life to the full, and make it that much more enjoyable by helping relieve discomfort.

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