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Chapter 2 Treatment Planning Mosby’s PATHOLOGY for Massage Therapists Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
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2 2 Lesson 2.1 Objectives Discuss the importance of a treatment plan. Compare and contrast subjective versus objective data. Design a client intake form. Discuss important elements of a client interview.
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3 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 3 Lesson 2.1 Objectives (cont'd.) Identify assessment domains of the PPALM method. Discuss several ways to assess client pain. Contrast and compare acute pain with chronic pain.
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4 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 4 Introduction Treatment Plan – Actions to resolve health issues identified during client assessment Assessment – Process of appraising a client’s condition Based on subjective reporting and objective findings
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5 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 5 Assessment Purpose of assessment: Appraise client’s heath Identify conditions requiring precautions or treatment modifications Aspects of assessment: Client intake form Interview Physical assessments
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6 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 6 Assessment Subjective data — information learned from the client Objective data — information that is measurable and quantitative Palpation — touching with purpose and intent
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7 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 7 Client Intake Form Personal and contact information Health and medical information Emergency contact person Regular physician or health care provider Date the information is recorded
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8 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Client Intake Form (cont’d.)
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9 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 9 Client Intake Form (cont’d.) Presenting the intake form: Greet client Escort client to a quiet area with adequate lighting Present form, clipboard, and writing pen Obtain important forms (prescriptions, referrals, clearance) Obtain client signature
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10 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 10 Interview Purpose of interview: Helps the therapist screen for contraindications or realize the need for adaptive measures Gives the therapist a chance to gather details needed to provide better service, such as Primary purpose for session Primary purpose for session Client’s personal preferences Client’s personal preferences
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11 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 11 Interview (cont’d.) Interview process: Greet client by name Introduce yourself Review information on intake form Be sure form is complete, dated, and signed Organize interview; highlight health and individual issues (e.g. PPALM method) Conclude interview From Salvo S: Massage therapy: principles and practice, ed. 2, Philadelphia, 2003, Saunders.
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12 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 12 Interview Sit facing the client at eye level Begin with a brief orientation Use open- and closed-ended questions Open-ended questions offer little restriction when answering Close-ended questions require a “yes” or “no” response
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13 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 13 Interview Listen carefully and use reflective questions Take notes sparingly Use silence This gives client time to talk, giving therapist greater understanding of client Signal your interest
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14 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 14 PPALM PPALM stands for the first letter of five assessment domains From Salvo S: Massage therapy: principles and practice, ed. 3, St. Louis, 2007, Saunders.
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15 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 15 PPALM (cont’d.) Five steps of treatment planning: Ask client questions using the PPALM format Collect data Appraise and synthesize data; integrate data with one’s own clinical expertise Discuss plan with client Implement plan
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16 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 16 PPALM (cont’d.) Purpose of session Identify client’s reason for session Discuss client’s past experience with massage therapy If client is a minor, obtain permission from: Child’s parent or Child’s parent or Child’s legal guardian Child’s legal guardian
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17 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 17 PPALM (cont’d.) Pain Ask about pain Is it related to injury or illness? How is it being treated? Pain can be acute (began abruptly) or chronic (developed slowly)
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18 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 18 PPALM (cont’d.) Fig. 2-4 from Salvo SG: Massage therapy: principles and practice, ed 3, 2007, St. Louis, Saunders; Fig. 2-5 from Hockenberry MJ: Wong’s nursing care of infants and children, ed 8, 2007, St. Louis, Mosby. Assess pain using OPPQRST and pain scales
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19 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 19 PPALM (cont’d.) Allergies and skin conditions Inquire about allergies to ingredients in massage lubricants Use hypoallergenic products when needed Ask client about skin conditions Lifestyle and vocation Factors include occupation, leisure or sports activities, physical exercise, stress level, and nutrition
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20 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 20 PPALM (cont’d.) Medical history Inquire about the client’s heath status If a disease is present, ask how long the client has had the condition, how it is managed, current symptoms, and any activity limitations If a client’s symptoms are unstable, obtain medical clearance before massage Ask about medication use and their purpose
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21 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 21 Lesson 2.2 Objectives Describe the importance of screening clients for contraindications. List items included in a treatment plan. Discuss postmassage communication. Design treatment plans for subsequent sessions.
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22 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 22 Screening Clients for Contraindications Ruling out contraindications is our duty and obligation Most conditions require only slight adjustments Elevating the upper body or avoiding an area Reducing pressure or session time Sometimes, massage is postponed
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23 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 23 Contraindications (cont’d.) Contraindication – Presence of disease or condition so a particular client cannot be treated in the usual manner Absolute – Massage is inappropriate, not advised, and may be harmful Local – Massage can be administered while avoiding infected/inflamed area or area in question
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24 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 24 Formulating a Treatment Plan Based on: Client health intake form Interview Other assessments, such as soft tissue palpation Take into account a client’s financial and time restraints
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25 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 25 Formulating a Treatment Plan (cont’d.) Includes: Techniques and areas to include or avoid Recommendations for self-care Duration, frequency, and length of treatments Reassessment Referrals
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26 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 26 Formulating a Treatment Plan (cont’d.) Includes (cont’d.): Whether client needs assistance Use of special support or bolstering devices Use of adjunctive therapies Suggested reading material
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27 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 27 Communication After Treatment Client evaluation of massage Ask client to evaluate massage Modify plan for future sessions if needed Discuss client education and homework assignments
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28 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 28 Subsequent Sessions Review PPALM notes Update plan based on progress toward client’s goals In general, the initial treatment period consists of frequent sessions, tapering off as symptoms subside Ask about symptoms and tailor treatment based on client symptoms that day
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