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.
Wednesday, August 12, 2009
Sunday, July 26, 2009
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
Tuesday, June 16, 2009
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
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
Sunday, May 10, 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.
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.
Thursday, May 7, 2009
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
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
Wednesday, May 6, 2009
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
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
Thursday, April 2, 2009
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
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
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