Chapter 2 Treatment Planning Mosby’s PATHOLOGY for Massage Therapists Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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.

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.

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

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

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

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

8 Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 8 Client Intake Form (cont’d.)

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

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

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.

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

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

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.

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

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

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)

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

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

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

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.

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

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

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

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

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

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

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