[Fundamentals] Chpt 8 Lecture

Body Mechanics - Use of the body in a efficient and bio-mechanically correct way. (Careful, efficient  Dilerberate. Involves Leverage, Good Posture, Good Body Mechanics, Using the strongest and largest muscles.

Compressive Force - For us, it is forward, and down. For others it's Lifting and Upward. The difference between us and other professions is the direction of the force.

[Test]Best stance - Asymmetrical, front leg is relaxed, back leg is carrying the weight with knee-lock(Screw-Home) in the last 15 degrees of extension.
Men & Women Center of Gravity - Men is Above waistline, with their nose not passed their toes, Women is below the waistline, with their nose not passed their heels.

Balance Point - Pressure/Compressing forces are equal but in the opposite direction. (i.e. weight on back foot, and opposite hand on the persons body. The force on the hand will be equal to the force on the persons body.

Contact point - Where you initially contact your client however unlike the Balance point the forces don't need to be equal.

Petrissage - Lifting, Leaning back, and letting go.

Pressure - Force down in a 90 degree angle.
Counter-Pressure -Allows you to use more pressure without using more force.


4 Basic concepts for body mechanics:

• Weight Transfer - Shifting your center of gravity.
• Perpendicularity - Syncing straight into the tissue, perpendicular to the body. Straight in at 90 degree.
• Stacking the Joints - Everything is in line. Lining up the joints to apply pressure not bending or wearing your joints.
• Keeping the Back Straight - Core stability, keeping the core strong.

Improper Body Mechanics(Dysfunction and why they may be caused):

• Neck and Shoulders - Why would a MT have neck and shoulder problems? Not using body weight, muscling through the massage.
• Wrist and Hand - Using thumbs to much, not staying behind the stroke. (Make sure to always keep relaxed wrists and hands during the massage, tense hands can lead to shoulder problems.)
• Knees - Twisting/Hyper-extension.
• Ankles & Feet - Not in the Asymmetric stance staying locked, and not moving positions frequently.

Pressure: 

• Pressure in a large area is more intense, and pressure in a smaller area is less intense. (i.e. Palm on the surface of the leg is good, if you were to use your fingers it might be to much.

[Test]Drag:

Resistance to Glide. (use lotion to reduce drag.)

Duration and Speed.

• Specific application

• Short duration = 10 seconds
• Moderate duration = 30 seconds
• Long duration = 60 seconds

• Massage session

• Short duration = 5–15 minutes
• Moderate duration = 15–30 minutes
• Long duration = 45–60 minutes

• Speed

• Slow: beginning to end of application 10 seconds
• Moderate: beginning to end of application 5 seconds
• Fast: beginning to end of application 2 seconds

Skin:

• 7 layers: L1 - Skin Surface, L2 - Skin, L3 - Superficial Fascia, L4 - First Muscle Layer, F5 - Second Muscle Layer, L6 - Third Muscle Layer, L7 - Bone.

Equipment:

• Table height usually 1/2 of your height.

[A&P] Chpt 3 Lecture

Because he gave us a decent review of the test, I'm just going over his review at the end. Keep in mind that the questions may not add up to 25, but some of them may just be repeat.

1.) If you have a base pair that's sequence is A, T, C, C, G, A, T, what would it's pair look like?

• From what I understood there are certain types of nucleotides that are always seen together, Adenine always binds to Thymine(A, T) and Cytosine always binds to Guanine. (C,G).  Now with that in mind remember that these are pairs, not with each other, but what they are binded with. With that in mind the answer is: 

A, T, C, C, G, A, T.

v   v  v   v  v   v  v

T, A, G, G, C, T, A. 

Look at the above, A is to T, T is to A, so on and so forth, just remember the "A and T" and "C and G".

2.)Next 3 questions are similar to each other all you need to do is remember 3 different words; Hypo(Under) Hyper(Over) Iso(Same)

• If you have a Hypotonic solution(NaCl) and you put a bloodcell in this solution, what will happen to the blood cell? Hypo = Under, a Hypo Solution is a solution of low NaCl, meaning if you drop a blood cell in Hypotonic solution it will swell as water enters the cell from the surrounding dilute solution.
• Now, in the exact opposite case you have Hypertonic(High NaCl) what happens to the blood cell then? They lose water from their cytoplasm into the surrounding Hypertonic solution causing them to shrink
• Lastly, Iso(Same) what would happen? Not a damn thing. Isotonic means Same, Same NaCl inside, and out.

3.)What is the process that occurs when a white blood cell engulfs a microbe? Phagocytosis.

4.)The movement of water and solutes through a membrane as a result of hydro-static pressure, this is a form of? Filtration.

5.)Process in which cell membranes take in fluids? Pinocytosis.

6.)What is it when diffusion happens through a selectively permeable membrane? Osmosis.

7.)Know the forms of Active/Passive.

• Active movement(require energy) - Phagocytosis, Pinocytosis, Ion Pump.
• Passive movement - Diffusion, Osmosis/Dialysis, Filtration.

8.)What is the purpose of the flagella in the sperm cell? To Propel.

9.)What programs the Ribosome? Nucleolus.

10.)What is the hairlike part of the cell? Cilia.

11.)What control's most of the cells activity? Nucleus.

12.)What is in a cell, that's rod-shaped and is important in cell division? Centrioles

13.)What is the organelle that chemically processes molecules? Golgi Apparatus.

14.)What organelle has a digestive/suicide feature? Lysosome

15.)What is the organelle we refer to as "protein factory"? Ribosome.

16.)What is an important part of the cell membrane (about 100 years ago this was stated)? Act as a cell id tag.

17.)What stabilizes the cell membrane? Cholesterol molecules.

18.)What are the Plasma membranes receptors known as? Protein.

19.)What is the Plasma Membrane composed of? Phospholipids, Cholesterol, Protein, 

Please keep in mind this may not be everything on the test, and you will probably be a bit more familiar with tissues, and muscles, just in case.

[Fundamentals] Chpt 4 - Lecture [Partial]

Massage and Medical Terminology for Professional Record Keeping:

• How we communicate: [Box 4-1]

• Language - is made up of socially shared rules that include the following:

• Sounds and symbols that convey meaning.
• Word definitions - vocabulary.
• Ability to make new words.
• Agreed upon sequences of words used to communicate - grammar.

• Terminology - languages specific to a specialized knowledge [medical terminology]
• Taxonomy - The science of classification according to a pre-determined system.
• Nomenclature - A system of names; a vocabulary, is a system of names with explanations of their meaning; a classification is a systematic organization of things.

• Terminology Defined by MTBOK [Box 4-2]

• Big box i'm going to try and simplify for you guys.
• Assessment - The collection and interpretation of information provided by the client, the client's family and friends the massage practitioner and referring medical professionals 
• Body, Mind, and Spirit - The three primary, interrelated, interacting, and integrated layers that comprise a health, balanced and unified human being.
• Body work - A term the encompasses all the various forms of massage, movement, and other touch techniques 
• Client - A recipient of service, be it from a wellness or a health care professional, regardless of his or her health status. All patients are clients, but not all clients are patients.
• Clinical Massage - Massage therapy practice involving more extensive use of assessment and specific focused techniques and applications with the intention of achieving clinical treatment or functional outcomes and remediation of symptoms.
• Deep tissue - Tissues beneath the superficial structure being treated.
• Deep tissue work/massage - A generic term commonly used to describe a variety of techniques to address specific deep tissues and structures, regardless of the force or pressure exerted or the level of discomfort or pain experienced during of after the application
• Discipline - An area of study involving particular concepts, a specific vocabulary, and so on.
• Massage therapy equivalent or related terms - Terms htat mean the same thing as massage; they also include therapeutic, body massage, myotherapy, massotherapy, body rub, massage technology, body work, bodywork therapy, somatic therapy, or any deviation of these terms.
• Massage therapist equivalent or related terms - Terms that mean the same thing as massage practitioner, they also include massage technician, somatic massage therapist, or any of a bunch of different terms. 
• Mobilization - The process of making a fixed part movable for releasing stored substances as in restoring motion to a joint, freeing a organ, or making available substances held in reserve in the body, such as glycogen or fat.
• Modality - A method of application or the employment of any physical agents and devices.
• Physical agent - Tools or materials used in the application of therapeutic modalities. the consist of energy and materials applied to the client/patient to assist in the achievement of a persons therapeutic goals.
• Soft tissues - The skin, fascia, adipose tissue, muscles, ect. ect.
• Special tests - methods use to assess for the presence of and to determine the degree of a condition in a client/patient.
• Standards of care - Treatment guidelines developed by the profession for a given condition which identify appropriate treatment based on scientific evidence and clinical experience.
• Standards of practice - Standards for the practice of a profession that members of that profession or organization are expected to adopt.
• Supportive Environment - A environment in which the therapist provides support and loving kindness within clear and appropriate boundaries.
• Technique - A procedure or skill used in massage therapy including; Compression, Friction, Gliding/stroking, Holding, Kneading, Lifting, Movement and mobilization, Percussion, Vibration.
• Therapeutic process - The capacity of the musculoskeletal system to self correct, come into balance and achieve equilibrium through the skillful normalization of tissue tone by a massage therapist.
• Treatment planning - The documented process of determining a treatment plan to address the therapeutic goals of the client/patient.
• Wellness -  The condition of optimum physical, emotional, intellectual, spiritual, social, and vocational well-being.

Several Test questions in this section!!

[Terms]

[M - Myo - Muscles - Fibromyalgia]

[U - Nephr - Kidney - Polynephritis]

[R - Pulm - Lungs - Pulmonary]

[D - Gastro/colo - Stomach - Gastritis/ Colonospy]

[E - Adreno - Gland - Endocrine]

[R - Gyn - Female - Gynecologist]

[S - Osteo - Bone - Osteoporosis]

[I - Perma - Skin - Dermis]

[N - Necro - Nerve - Neuropathy]

[C - Cardio - Heart - Cardiovascular]

[H - Hemo - Blood - Hemotoma]

[Abbreviations]

[Epi = Over: Epidermis]

[Dis = Separation: Dislocation]

[Dys = Bad, Abnormal, Difficult: Dysphagia(Difficulty swallowing)]

[Hypo = Under: Hypoglycemia]

[Ante = Before, Forward: Antecubital]

[Hemi = Half: Hemiplegia]

[Ology = Study of: Pathology]

[Itis = Inflammation: Tendonitious]

[Rrhage = Excessive flow: hemorrhage]

[Positional Terms]:

Erect, Prone, Anatomical, Supine, Laterally Recumbent.

[Directional Terms]:

Dorsal/Posterior, Ventral/Anterior, Superior, Inferior, Superficial, Deep, Proximal, Distal, Intermediate, Medial, Lateral.

[Planes]:

Transverse, Frontal/Coronal, Sagittal

[Levels of structure]:

Chemical, Cellular, Tissues, Organs, Organ Systems, Organism.

[Tissues]:
Tissues are a collection of specialized cells that perform a special function.

• Epithelial Tissue - Made with cells that intertwine with each other, forms the coverings that align various parts of the body including the surface of the skin.

Types of Muscle Tissue.

• Connective Tissue - Tissue that connects, supports, binds, or separates other tissues or organs, typically having relatively few cells embedded in an amorphous matrix, often with collagen or other fibers, and including cartilaginous, fatty, and elastic tissues
• Muscle Tissue - Made of bundles of elongated cells it is the main component of the muscles attached to the skeleton.
• Nerve Tissue - Composed of tangles of neurons, forms the brain the spinal cord and the nerves. 

[Cavities]:

Cranial, Spinal, Thoracic(Super-Mediastinum, Pericardial, and Pleural) Diaphragm, Abdominal, Abdominopelvic, Pelvic. [Primary: Dorsal, Ventral]

[Spine]:

7 cervical vertebrae (upper neck)

12 thoracis vertebrae (middle back)

5 lumbar vertebrae (lower back)

5 sternum(fused) vertebrae (lower-er back)

2-3 coccyx(fused) vertebrae (butt)

[Skeletal System]:

206 bones, the bones of the skull, thorax and the spine form the "Axial skeletal". Protect the vital organs, Everything attached is considered the "Appendicular skeleton".

[Bone]:

Bone is a dense connective tissue composed primarily of calcium and phosphate.

[Joints]:

Joints are places where bones come together, where limbs are attached and where the motion if the skeletal system occurs

• Synarthrodial - Not movable.(joints in your head)
• Amphiarthrodial - Slightly movable (chest, pelvic area)
• Diathrodial - Most movable/freely movable (fingers hips and shoulders.)

Types of movements:

• Flexion - Movement that reduces the angle of a joint.
• Extension - Movement that increases the angle of a joint.
• Abduction - Movement away from the midline.
• Adduction - Movement toward the midline.
• Pronation - Turning of palm downward.
• Supination - Turning of palm upward.
• Eversion - Turning of the sole of the foot away from the midline.
• Inversion - Turning of the sole of the foot inward.
• Planter flexion - Movement of the planter surface of the sole of the foot downward.
• Dorsiflexion - Movement of the top or dorsal surface of the foot toward the shin
• Rotation - Rolling to the side.
• Circumduction - Moving in a cone; the ability to move the limb in a circular manner.
• Protraction - Thrusting a part of the body forward.
• Retraction - Pulling a part of the body backward.
• Elevation - Raising a part of the body.
• Depression - Lowering a part of the body.
• Opposition - Place one part of the body opposite another, as in placing the tip of the thumb opposite the tips of the fingers.

[Cartilage]:

The skeletal system includes two types of cartilage. Hyaline cartilage, which is very elastic, cushiony, and slippery, makes up the articular surfaces at the joints; the cartilage between the ribs and at the nose, larynx and trachea; and the fetal skeleton. Hyaline means "glass" the other type is "White fibrocartilage", which is elastic, flexible, and tough, is interarticular fibrocartilage found in joints such as the knee.

[Ligaments]

Attach bone to bone. Ligaments are pliable, flexible and tough.

[Skeletal Muscle]

Each skeletal muscle has sections, a origin where it begins, a insertion, where it attaches to (usually a mobile structure). and a muscle belly. Muscles create the potential for motion by creating a pulling force. Joints allow motion to occur. 

Smooth muscle involuntary wave-like contraction in the digestive tract = Remember peristalsis. 

Cardiac Muscle is also involuntary.

and Skeletal muscle is voluntary.

[3 types of actions]:

concentric, eccentric, isometric

• Concentric, Eccentric -  a form of isotonic actions. Isotonic contraction happens when movement meaning the proximal end is brought to the distal end, or the insertion is move to the origin. (Muscle contracting) Concentric - Muscle Contracts. Eccentric - Muscle Lengthens.
• Isometric - Tension put on the muscle but no contraction or movement occur. (pushing against a wall.)

Nervous System on wednesday [rest of the lecture]

[Fundamentals] Chpt 6 - Full

Indications and Contraindications

• Indication - A condition for which an approach would be beneficial.
• Contraindication - A condition for which an approach would be harmful. there are 3 types of contraindications.

• General - No massage techniques may be performed.
• Regional - Particular areas must be avoided.
• Application with Caution - A condition that requires the massage therapist to adapt the massage techniques so the client's safety is maintained.

• [Example of Indication and Contraindications] A diabetic patient has blood sugar over 200, it would be an indication to give them insulin to lower their blood sugar, However if their blood sugar is 70, it would be a contraindication to give them insulin to lower it.   

Indications for Massage

• Objective - Results that can be seen.
• Subjective - Results that are assumed from effective based on experience.

• The Effects of massage are both physical(Objective) and mental(Subjective).
• [Example of Objective and Subjective] If a patient says they think they have a fever and you can see they are sweating and flushed, that is Objective. If a patient says they have a headache, you can not see any signs, therefor it is Subjective.

• Anatomic benefits can be measured Objectively.
• Biochemic benefits can be measured Objectively and Subjectively.
• Physiologic benefits can be measured Subjectively.

Approaches to care

When considering approaches to care there are several ways of going about it, how do you decide which and why? Firstly, lets address the 3 approaches you can take, these are; Therapeutic change, Condition management, and Palliative care. 

• Therapeutic change

• This change process requires client energy and resource expenditure. Resources required; Support systems, Motivation, Information, Finances.
• Practitioner needs include knowledge and skills, careful assessment protocol, and professional support.
• Therapeutic change might be unrealistic at a particular time or under set of circumstances, Condition management or Palliative care can be offered instead. 

• Example of Therapeutic change - because athletes are looking to improve their physical qualities to compete massage could improve their flexibility allowing them to push off more efficiently and run faster.

• Condition management

• Support for clients unable to undergo therapeutic change process for various reasons; Chronic health condition. Life circumstances that create chronic stress, A situation for which change is not viable, Need to postpone time frame for change.
• Accounts for the largest client base for therapeutic massage.
• Benefits: Manages existing physical compensation patterns, Can slow the progression of chronic conditions, Can prevent a situation from becoming worse, Offers emotional support for stress symptoms.

• Example of Condition management - Construction worker with repetitive pain in hands, show the client how to manage the symptoms.

• Palliative care

• Uses of palliative care include; Meeting pleasure needs, coping with chronic pain, making the transition from life to death.
• Can reduce pain, but not necessarily suffering. (suffering can be mental and spiritual.)

• Examples of Palliative care - Day spa customers: Massage services are not part of a cohesive treatment plan, usually do it as a one-time experience, not possible to provide any true therapeutic change or condition management benefits because there is no time for proper assessment.

Pathology, Health, and Therapeutic Massage.

• Pathology - is the study of disease. To practice safely, massage practitioners need a basic understanding of pathologic processes:

• Referring appropriately, recognizing contraindicating symptoms, recognize general types of disorders, specific signs and symptoms, and the development of disease processes, and understanding possible interactions between massage and medications.

• Health - optimal functioning with freedom from disease or abnormal processes. Factors that can influence health are:

• Inherited(Genetics) and constitutional traits, Lifestyle(diet, exercise, rest, stress level.),Beliefs and attitudes, self-esteem, loving relationships. Authentic personality and freedom from self-hindering patterns.

• Dysfunction - the in-between state of "not-healthy" and "not-sick".

• Effective approaches to dysfunction include mind/body medicine, stress management, and prevention methods. Active pathologic processes often require more aggressive treatment.

• Peak performance - maximum conditioning or functioning to a particular action. (physical or mental, energy consuming or stressful)

• During Peak performance your body does not hold back energy expenditure. Injury, Depletion and Illness can result if you do not give the body enough time to recover. 

• Disease - occurs when homeostasis cannot be returned to normal easily.

• In "Acute" cases of disease homeostasis can be returned to normal quickly, however in "Chronic" cases the body's homeostasis may never be restored and compensation is developed because of it. (Compensation is the process of counterbalancing a defect in body structure or function. (You limp on your left leg because your right leg has been injured.)) Further details in "Development of Pathologic Conditions"

• Functioning limits - The body has anatomic and physiologic functioning limits, the heart can only beat so fast, the endocrine can only secrete a maximum amount of hormones. 

• The body can only perform at an extent, when this is reached the body signals this by pain, fatigue or strain. However when the extraordinary events can push the body's functioning limits. Normally the body will never allow us to push past our limits, showing you signs of fatigue or pain before we can reach those limits, but in rare circumstances events may happen that will make the body push far beyond those limits and allow us to be super human for a short duration. (Mother lifting a van to save her child.)
• On the other hand " Dysfunction" results when the reserve runs low because restorative mechanisms are unable to function effectively, or when the body begins to "limit" function in an attempt to maintain higher energy reserves.
• Many massage professionals will serve people at the beginning of dysfunctional patterns; ie when the client does not feel their best, but are not sick. After dysfunction has set in, an intervention should be applied at the point where ROM limits were first observed.

• Development of Pathologic conditions - 

• Illness occurs when a body process breaks down, it also tends to indicate cautions and general contraindications.
• Injury occurs when tissue is damaged.
• Types of massage for injury can help edema, pain, circulation, approximation, and scar tissue formation.
• Healing taxes the body's reserves, our goal as the practitioner is to help the body supply healing so that it may heal faster, we do this by relieving stress, a relaxing the body. If a body is high on stress and cannot relax your body will heal a lot more slowly than it would without stress.

• If we cannot help the client with injury massage or illness massage we need to refer them to a professional that can help them.

• Signs - objective abnormalities than can be seen or measured by someone other than the patient.
• Symptoms - Subjective abnormalities felt only by the patient.
• Syndromes - Groups of Signs and Symptoms usually from a common cause.
• Acute Diseases - developed signs and symptoms quickly but only last for a short duration.
• Chronic Diseases - Opposite of acute, signs and symptoms may developed slowly and last a long duration, possibly until death.
• Communicable Diseases - can be transmitted from one person to another.
• Homeostasis - relevant constancy of the body's internal environment. 
• Compensation - a process of counterbalancing a defect in structure or function.
• Risk Factors - predisposing conditions that make a disease or injury more likely to happen; Genetic or inherited traits, Age-related or biologic factors, Lifestyle, Environment, Preexisting or primary conditions, Stress.
• General Adaptation Syndrome(GAS) - three stage response to harmful stimuli; Alarm("Fight or Flight"), Resistance reaction, Exhaustion. (Prolonged or excessive "Fight or Flight" response can disrupt normal functioning throughout the body.
• Generalized Stress Conditions -  The hypothalamus acts on the interior pituitary gland to cause the release of adrenocorticotropic hormone (ACTH) this stimulates the adrenal cortex to secrete glucocorticoid. while this is happening the sympathetic division of the autonomic nervous system(ANS) i stimulated by the adrenal medulla, resulting in the release of epinephrines and norepinephrines to assist with the body in responding to the stressful stimulus.

 Pathologic Conditions and Indications for Massage.

• Inflammatory Response - Processes that minimize tissue injury to promote healing

• Active, important part of the healing process, the primary signs are; Heat, Redness, Swelling, and Pain. Occurs in response to injury and may also accompany  specific immune system reactions. Sometimes the inflammatory response can be more intense or prolonged than desired, and can be suppressed by antihistamines or antiinflammatories.
•  Heat and Redness - Histamine, Prostaglandins, and kinens are associated with inflammation. Dilated blood vessels increase blood volume and bring WBCs.
• Swelling and Pain - Edema results in increased permeability of vessel walls. Increased pressure triggers pain receptors. Inflammatory exudate is the fluid that accumulates.
• Extent of Inflammation - Local(on your hand or arm.) Systemic(Allergic reaction-full body response) Chronic Inflammatory Disease(Hepatitis, RA).
• [How Massage can benefit prolonged Inflammation; it activates the body's natural antiinflammatory agents, triggers completion of process, involves lymphatic flow to dilute and remove irritant.]

• Indications for Inflammatory Response

• Tissue Repair - Combination of two processes; Regeneration with similar cells, and Replacement with fibous connective tissue(Scar Tissue).
• Healing Process Goals -  Promote regeneration, minimize replacement. Slow the formation of scar tissue. Keep scar tissue that does not form pliable.
•  Therapeutic Inflammation creates a controlled, localized area of inflammation to jump-start the healing processes. The types of therapeutic inflammation include: Deep friction, Connective tissue stretching, Moxibustion(burning the skin), and Acupuncture.
• Contraindications - Suppressed Healing mechanisms, Conditions of impaired repair and restorative functions (unless carefully monitored), Use of antiinflammatory medications.

Pain

• Pain is a very important mechanism to understand, it's a complex, private, and abstract experience. Managing pain can be a major challenge, it can affect us in many different ways; Physiologic, Psychologic and Social Aspects. The Practitioner needs to recognize that the clients pain is what they say it is, and exists when the client says it does.
•  There are four processes involved in pain sensations; 

• Pain transduction - Noxious stimuli lead to electrical activity in pain receptors.
• Pain transmission -  Pain impulses travel through PNS(Parasympathetic Nervous Systom) and CNS(Central Nervous System).
• Pain modulation - neural activity can influence pain transmission at the spinal cord, also involves activity in primary afferent pain receptors.
•  Pain perception - subjective experience.

• Fast Pain - Local and specific, Sensation on the surface, Prickling, Sharp, Electrical.
• Slow pain -  More Diffuse(spread out), Felt in deeper tissues, Burning, throbbing, aching, usually associated with tissue damage.
• Utility of pain sensations - Cue us to protect ourselves from further hurt, Initiate a search for medical assistance, Help pinpoint underlying cause.
•  Nociceptors(Ends of dendrites) - 

•  These are found in almost every body tissue, respond to any type of stimuli, and adapt slightly, or not at all.

•  Pain transmission to cerebral cortex

• Neospinothalamic tract - carries type A(fast pain) nociceptors to the thalamus.
•  Paleospinothalamic tract - carries type C(slow, chronic pain) nociceptors to the brainstem.

• Influences on perception of pain

• Emotional interpretation -  Hypothalamus and limbic structures.
• Rational interpretation - Frontal cortex 
• CNS Mechanisms
• Neurotransmitters and neuromodulators(substance P, acetylcholine, norepinephrine, epinephrine, dopamine, serotonin)
•  Endorphines

• The pain threshold is the point at which a stimulus is perceived as painful. This Varies somewhat among individuals. Perceptual dominance, some pain overshadows other pain; can be activated by massage that “hurts good”.
• Pain tolerance is the duration or intensity of pain endured before relief is sought. This varies widely among individuals  

• Origins of pain

• Somatic - from stimulation of skin, skeletal muscle, joints, tendons, and fascia.
• Visceral - from stimulation of internal organs  

• The Cortex accurately locates origin of most somatic and some visceral pain.

• Acute pain - A disease, symptom, or a temporary treatment aspect.

• Warning signal that arouses sympathetic nervous system. Temporary, sudden onset, localized. Client is often able to describe it. Arouses sympathetic ANS.

• Chronic pain - persists or recurs for indefinite periods, usually longer than 6 months.

• Major health problem for many, Obscure onset(Hidden, or concealed), Character and quality can change. Anxiety, sleep disturbances, depression common,  Multidisciplinary approach to treatment.

• Intractable pain - Is persistent with treatment or without demonstrable disease.

• Intractable pain poses the greatest challenge to health care providers. Massage provides temporary relief through distraction.

• Phantom pain - Can occur after an amputation.

• Pain or other sensations seem to originate from amputated extremity, Brain misinterprets stimuli from proximal portions of sensory nerves.

• Referred pain - felt far from its origin.

• Visceral pain and deep somatic pain can refer, A diagnosis must be obtained from a physician.

• Sources of information for assessment:

• Subjective information from the client, Direct observation of verbal and nonverbal information, Gender and, cultural differences in expression

• Sympathetic responses to acute pain:

• Decreased ROM, Muscle guarding, Trigger points, Areas of increased or decreased sensitivity

 Impingement Syndrome

• Two types of nerve impingement:

• Compression - pressure on a nerve by a bony structure.
• Entrapment - pressure on a nerve by soft tissue. 

• Impingement classified by the plexus affected.  

• The Cervical plexus - includes the phrenic nerve and the ventral branches of four upper cervical nerves.

• Symptoms - headaches, neck pain, breathing difficulties, and pain sensations in neck, ear, and shoulder (transmitted by cutaneous branches of nerves.)
• Origins of pressure - include suboccipital and the sternocleidomastoid muscles, and shortened connective tissues at cranial base.

• The Brachial plexus - situated in the neck and axilla.

• Symptoms - pain in the shoulder, chest, arm, wrist, and hand, and thoracic outlet syndrome.
• Origins of pressure - include scalenes, pectoralis minor, subclavius, and arm muscles.

• Lumbar plexus

• Symptoms - pain in lower back, belt area, lower abdomen, genitals, thigh, and medial lower leg.
• Origins of pressure - can include quadratus lumborum, psoas, and lumbar dorsal fascia.

•  The Sacral plexus - sciatic nerve and serves the pelvic structure, buttocks, and lower limb.

• Symptoms - gluteal, genital, leg, and foot pain
• Origin of sciatic pressure - include piriformis muscle and ligaments of the sacroiliac joint  

• Massage can reduce pressure on nerves:

• Soften and stretch connective tissue, normalize muscle tension patterns, restore normal resting length to shortened muscles.

Psychological Dysfunctions

• Science has validated the mind/body link in terms of health and disease. Many risk factors for the development physical(body) pathologic conditions are mentally(mind) influenced.
• Major types of mental health dysfunctions - Trauma, Posttraumatic stress disorder, Pain and fatigue syndromes, Anxiety and depressive disorders, Stress-related illness.

• Massage can physically influence mental state through compassionate touch. Soothing ANS Hyper and Hypo Activity, Managing pain, normalizing breathing patterns, providing support for returning the body to normal homeostasis.
• 
  

Tumors and Cancer

• Tumors - benign (usually localized and slow-growing) or malignant (can metastasize).

• Detection of Cancer - Point out abnormalities or changes, suggest medical evaluation.
• Cancer not always a contraindication - Massage can support immune function as part of comprehensive treatment program, it's important not to overtax the body's systems.

 Medications

• Massage and medications can interact synergistically or antagonistically to; 
  stimulate a body process, 
  inhibit a body process, or 
  replace a body function.

[A&P] Chpt 2 - Key Terms

Biochemistry - Devoted to studying the chemical aspects of life.
Matter - Anything that occupies space and has mass.
Molecules - Molecules are particles of matter that are composed of one or more smaller units called Atoms.
Atoms - Basic units of matter.
Proton - Subatomic particle with a positive charge.
Neutron - Subatomic particle with no charge.
Electron - Subatomic particle with a negative charge.
Nucleus - The core of an atom, composed of positively charged protons and uncharged neutrons.
Atomic Number - Number of protons in an atom.
Atomic Mass - Number of protons and neutrons in an atom.
Orbital - Certain limits away from the atom that electrons dart around in.
Energy Levels - Limited region surrounding the nucleus of an atom at a certain distance containing electrons; also know as "Shell"
Elements - Pure substances, composed of only one type of atom.
Compounds - Substance whose molecules have more than one element in them.
Ionic Bond - Chemical bond formed by the positive-negative attraction between 2 ions.
Dissociate - When a compound breaks apart in solution.
Electrolytes - Substance that ionizes(dissociates to form ions) in solution, rending the substance capable of conducting an electric current.
Covalent Bond - Bond formed when 2 atoms share their electron.
Hydrogen Bond - A weak "bond" formed by hydrogen elements. (like 2 molecules of a water, the hydrogen is attracted to the oxygen of another water molecule, much like magnets to the fridge, they are together but not hard to separate like a Covalent Bond is.)
Organic - Compounds that are composed of molecules that contain Carbon-Carbon C-C.(Helium, Carbon Dioxide.)
Inorganic - Compounds that lack carbon and hydrogen atoms.
Solvent - Substance in which other substances are dissolved.
Solute - Substance that dissolves into another substance.
Aqueous Solution - When water is the solvent for a mixture (blend of 2 or more kinds of molecules), the mixture is called an aqueous solution. (salt into water)
Dehydration Synthesis - Reactants combine only after two hydrogen (H) atoms and an oxygen (O) atom are removed.
Hydrolysis - disrupts the bonds in large molecules, causing them to be broken down into smaller molecules. (opposite of dehydration synthesis)
Adenosine Triphosphate - breaks apart in muscle cells (into ADP) to yield energy needed for muscle contraction.
Chemical Equation - Chemist use this to represent a chemical reaction.
Buffers - chemicals in blood that maintain pH.
Carbohydrate - (carbon and water) Organic compounds containing hydrogen, carbon, and oxygen, in certain specific proportions.
Monosaccharide - basic unit of carbohydrate molecules.
Disaccharide - Molecule made up of 2 saccharide units.
Glycogen - Polysaccharide made up of a chain of glucose.
Lipids - fats and oils, fats when are solid at room temperature, and  oils such as corn oil.
Triglycerides - lipid molecules formed by a glycerol unit joined to three fatty acids.
Phospholipids - Phosphate containing fats molecule found in cell membrane.
Cholesterol - a steroid lipid.
Peptide Bonds - covalent bonds linking amino acids within a protein molecule.
Enzymes - a functional protein acting as a biochemical catalyst, allowing chemical actions to take place in a suitable time-frame.
Lock-and-Key - Each Enzyme has a shape that fits the specific molecules it works on as a key fits a specific lock.
Nucleotides - basic building blocks of nucleic acids are called nucleotides.

[Fundamentals] Power Points [2,3,5,6]

Chapter 2 Power Points (Tassa)
Chapter 3 Power Points (Tassa)
Chapter 5 Power Points (Rick)
Chapter 6 Power Points (Rick)

[A&P] Chpt 2 - Lecture

These are just my notes from the lecture, by the time Tassa's 3 hour lecture ended my recorder was dead on batteries. So this is all the notes I was able to copy down as he was literally flip flopping them, lol. So what i'll do is incorporate from the book where my notes are spotty.

  Matter is anything that occupies space and has mass. In the body most chemicals are in the form of Molecules. Molecules are particles of matter that composed of one of more smaller units called Atoms. There are 109 types of Atoms. A substance made up from one kind of atom is an Element. A atom is the smallest part of an Element that still has the properties of that Element.

  There are 3 types of subatomic particles that make up an Atom:

• Protons - These particles have a positive charge (+).
• Neutron - These particles have no charge. (Think neutral.)
• Electron - These particles have a negative charge. (-)

  The Neutron's and the Proton's are located in the middle of an atom called the "Nucleus".

• Atomic mass: Number of Proton's & Neutron's in the Atom.
• Atomic number: Number of Proton's in the Atom.

  Negatively charged Electron's surround the nucleus at a distance. In a electrically neutral atom, there is one electron for ever proton. (1 - 1 = neutral) Electron's dart about in the atom's Orbitals. 

• Orbitals - Atom's 1st Orbital can hold 2 electron's, the 2nd Orbital can hold 4 electron's, and the 3rd orbital can hold 8 electrons.

Orbital's are arranged by Energy Level's(EL) depending on their distance from the nucleus.

• Elements - one type of atom.
• Molecule - Two or more atom's together.
• Compound - Made of molecules.\

  Now, what happens when a Atom has a uneven number of electrons in their orbital? Well they become unstable, when this happens it seeks another atom to bond with.

• Chemical bonds:
• Chemical bonds are formed  when atoms are "unstable" they seek other atoms to bond with because their orbital is not "full". All but a hand-full of atoms have room for more electrons in their outer most energy level. (Noble gases.)

• Ionic Bonds - Ions formed when an atom gains or loses electrons in its outer energy level to become stable.

• Positive-Ions - Lost it's electrons.
• Negative-Ions - Has gained electrons.

 This is all for the lecture now, I'll continue after work tomorrow.

[Fundamentals] Chpt 6 - Key terms

Indication - approach would be beneficial for healthy enhancement.
Contraindication - approach that could be harmful.

• Avoidance's:
• General Avoidance - No massage techniques may be used.
• Regional Avoidance - A particular area is avoided.
• Caution - Client safety is maintained.

Objective - Results can be measured my the therapist.

Subjective - Results are assumed by the client/patient.

Therapeutic change - Beneficial alteration in the clients physical, mental, and spiritual stats that results from a therapeutic massage process.

Condition management - The use of massage methods to support clients who are not able to undergo a Therapeutic change but want to live life to the fullest.

Palliative care - Attempts to relieve or reduce the intensity of uncomfortable symptoms, does not try to produce a cure.

Suffering - an overall impairment in the quality of life.

Pathology - The study of disease.

Trauma - An abrupt shock or injury to the body or psyche.

Medications - Substances prescribed to stimulate or inhibit a body process or replace a chemical in the body

Health - Optimal functioning with freedom from disease or abnormal processes.

Dysfunction - In between states of not healthy, but also not sick.\

Peak Performance - Maximum conditioning and functioning in a particular action.

Homeostasis - Relative constancy of the bodies internal environment.

Acute - A term that describes a condition in which the signs and symptoms develop quickly last a short duration and then disappear.

Chronic - A term that describes disease that develops slowly and lasts for a long time, sometimes for life.

Signs - Objective abnormalities that can be seen or measured by someone other than the patient.

Symptoms - Subjective abnormalities felt only by the patient.

Syndrome - Group of different signs and symptoms usually arising from a common cause.

Communicable diseases - disease that can be transferred from one person to another.

Inflammatory response - A combination of processes that attempts to minimize injury to tissues and promote healing.(characterized by pain, heat, redness, and swelling.)

Referred pain - pain felt in an area other than the source of the pain.

Pain spasm pain cycle - Steady contraction of muscles which causes ischemia and stimulates pain receptors and muscles, the pain in turn initiates more spasms.

Impimgement syndromes - Conditions that involve pathologic pressure on nerves and vessels. 2 types compression and entrapment.

Synergistic - The interaction of medication and massage to stimulate the same process of effects.

Antagonistic - When a massage produces the opposite effect sought.

Benign tumors - Tumor remains localized with in the tissue from which it arose and does not undergo malignant changes.(Benign tumors usually grow slowly)

Malignant tumors - Type of tumor that tends to spread to other regions of the body. (Cancer)

Metastasis - Migration of cancer cells.

Endangerment site - Any area of the body where nerves and blood vessels surface close to the skin and are not well protected by muscle or connective tissue; therefore Deep sustained pressure into these areas can damage these vessels and nerves.(i.e. The kidney area is included because the kidneys are loosely suspended and fat and connective tissue. Heavy pounding is contraindicated in that area.)

Referral - Client is sent to a health care professional for diagnoses and treatment of disease.

[Fundamentals] Chpt 2 - Lecture

6 Professional Criteria's (Need to know)

• Specialized body of knowledge.
• Extensive training.
• Orientation towards others
• A commonly accepted code of ethics/practice.
• Legal recognition through certification of licensure.
• A professional association.

Certification vs. Licensure

• Certification:

• Voluntary credential
• Requires education and examination organization approval.

• Licensure:

• Government regulated, permits the practice of a profession.

Professional Tracks:

• Health and Wellness: Spa's (stress reduction, pampering services, cosmetics, and relaxation.)
• Medical, Clinical, and Rehabilitation: Working under the supervision of a licensed professional (i.e. A doctor, physical therapist, chiropractor)
• Sports and Fitness:  This can cover both wellness or medical. (based on issues related to the environments that supports exercise and sports performance.)

Educational Categories:

• Academic majors-Formal programs of study designed to impart knowledge and skills that represent the accumulated knowledge base in a subject area. (comprehensive and theoretical).
• Career majors-Formal programs of study designed to impart knowledge and skills that represent the relevant accumulated knowledge within the content of occupation-specific job requirements.(less theory, more application narrower focus than Academic majors.)

• Vocational career majors-consist of formal programs of study that impart the knowledge and skills required for semi skilled, skilled, technical, and paraprofessional occupations that typically require education below baccalaureate  level
• Nonvocational career majors-consist of formal programs of study that impart the knowledge and skills required for technical and professional occupations that typically require education at the baccalaureate level or higher.

 Therapeutic Massage(What, Where, and How):

• What - The scientific art and system of assessment, systematic, and manual application of a technique.
• Where - The superficial soft tissue of the skin, muscles, tendons, ligaments, and fascia as well.
• How - By means of hand, foot, knee, arm, elbow, and forearm.

Effects of Massage:

• Mechanical - Stimulation of a specific area in the body that with a specific technique that as a immediate result on at area such as Friction, rubbing out adhesions, increasing circulation, getting blood to the area.
• Reflexive - Stimulation to one area of the body that has a impact on a nearby organ or the whole body as a whole massage in general is reflexive.
• Both - Massage that includes both of the above techniques.

Approaches to Massage Therapy(Multiple Test Questions Must know):

• Asian - Asian Massage came from traditional Chinese medicine and concepts, and other Asian modalities. The effects of compressive manipulations and stretches that focus on specific areas of the body elicit responses of the nervous, circulatory, and muscular systems and affect the energetic flows in the clients body.(grounded in ancient concepts, stood the test of time.)
• Structural and Postural Integration - This technique focus's more on the connective and tissue structure to influence posture and biomechanics. The approach is systematic and effective. (grounded in the fundamentals of physiology and biomechanics. requires extensive training.)
• Neuromuscular - Created by many Doctors this technique is still taught by one of the originators today (Leon Chaitow) Many technqiues are similar to those performed in Rolfing, Asian methods, and Swedish massage and gymnastics. This technique is a nervous and reflexive method. Connective tissue is affected as well. The common threads running through all the styles are the basic concepts of activation of the toner receptor mechanism, reflex arc stimulation, positional receptors, and applications of stretching and lengthening.
• Manual Lymphatic Drainage - Created by Emil Vodder, this technique stimulates the flow of lymphatic fluid via mechanical and reflexive techniques. (sometimes called systemic massage)
• Energetic (Biofield) - based on ancient concepts of body energy patterns, this method uses near touch or light touch to initiate reflexive responses, often highly effective.
• Craniosacral and Myofascial - Created by William Sutherland and expanded upon by John Upledger, and John Barnes, Method focused on mechanical and reflexive connective tissue functions(tiny movement of the cranium and dura). Both light and deep touch are used depending on the method.
• Applied Kinesiology - Created by George Goodheart, this approach blends many techniques but works primarily with the reflexive mechanisms. A muscle testing technique is used to evaluate similiar to a biofeedback mechanism. Some of the techniques use Asian meridians and acupressure; others rely on osteopathic reflex mechanisms that seem to correspond with Chinese acupuncture points.
• Integrated Approaches - This includes; Infant massage, Sports massage, Animal/Equine massage, on-site or seated massage, prenatal massage, geriatric massage, massage for abuse survivors, Russian massage. This type of massage incorporates many different massages from many different cultures. Founders and teachers of Integrated massage include every massage professional that has developed a unique massage for a specific person.

Therapeutic Massage Tree:

• Although massage encompasses a wide diversity in its uses and applications, all forms of therapeutic massage methods stem from the same roots. (Body, Mind, Spirit.)

Scope of Practice(what can we do):

• Knowledge base a practice parameters of a profession.
• Includes an assessment, treatment planning, and treatment through the manipulation of soft tissue, circulatory fluids, and energy fields of those effecting and benefiting all of the body's systems.
• (Relaxation, Stress Reduction, Enhancing over all Well-being. Improving posture, facilitating circulation, balancing energy, relieve pain and discomfort, repair and prevent injury, and rehabilitation.)
• Wellness - Spa, Massage franchise, Independent massage practice.
• Health care - Sports and fitness, Clinical, Medical, or Rehabilitation settings.
• Entry Level Massage:

•  Encompasses a range of massage services for wellness and pleasure practice.
•  Considered massage specialty which requires additional education and experience.
•  Career Development:

• Employee Pathway(Franchise) - Fast becoming the largest employer of massage therapists. Reliable pay, No hassles of owning your own business, good way to gain experience.
•  Independent Massage Practice - Complex due to varied structured options, career development, be very motivated, responsible for marketing and own taxes. 
• Independent Contractor - Establish contracts with a medical office, or spa offices.
• Massage Clinic - Your own franchise.

• Sports and Fitness - Covers a very broad spectrum of massage, from Wellness massage to Medical massage based on issues related to whatever the environment is that supports exercise and sports performance. 
• Entry Level Practice(Clinical, Medical, Rehabilitating, Wellness) - Popular as a primary avenue for massage practice. Growing Rapidly.
• 3 Realms of functioning.

• Normal - Seeking massage for Wellness, relaxation, no health care supervision is required.
• Dysfunctional, complex, athletic patterns - Person may be injured or have a history of illness. Requires usually over 1000 hours of practice in order to deal with more complex injuries. Supervision may be required pending on the functional level of the client(i.e. extent of the injury, how long ago it happened).

•  Illness and Trauma - Working with a healthcare professional (MD, PT, CPD) with a patient that had severe trauma or illness (I.e. Heart attack, or terminally ill) you need a medical release form in order to work with this patient, altering your techniques to fit the client's needs. You need medical supervision (medical script).

• Occupational Definitions and Scopes of Practice(Box 2-6):

•  Respect the scope of practice for other professionals. Refer your clients to someone who has more extensive training or knowledge in a medical field that you cannot assist with. (Refer if you do not know what is wrong with a client.)
• Acupuncture - Traditional Chinese concept medicine.
• Athletic Training - For performance. 
• Chiropractor - Joint Manipulation. 
• Cosmetology - External health and beauty of nails, skin and hair.(beautification)
• Dentistry - Teeth, Alveolar processes, gums, jaws, dependent tissues.
• Esthetics - clean and beautify the skin.
• Medicine - Diagnose disease, aliment, defect, complaint, or other physical or mental conditions.
• Naturopathy - Herbology, homeopathy, acupuncture, manipulation, hydrotherapy, massage, exercise, and psychological methods.
• Nursing - People who are experiencing changes in the normal health process or who require assistance in the maintenance of health and prevention of management of illness.
• Osteopathic Medicine - Musculoskeletal system with and other body systems
• Physical Therapy - Therapeutic exercises with or without devices, to prevent, correct or alleviate a physical or mental ability.
• Podiatric Medicine - is the examination, diagnosis, and treatment of abnormal nails and superficial excrescences on human feet.
• Psychology - Treatment of mental or emotional disorders, disabilities, and behavioral adjustment problems.

•  Personal Limits:

• Type and extent of personal education.
• Personal biases. 
• Life experiences.
• Personal interests.
• Physical limitation, size and endurance levels.

• Clients ability to adapt:

• Ability to adapt to certain internal and external stressors.

• Effective or Good Ability to Adapt.:

•  Good health function normally, able to conduct satisfying work, copes with stressors well, very flexible.
• Massage Goals - Maintain and enhance health and well-being.

• Ineffective or Moderate and Strained Ability to Adapt: 

•  Stressed or always chronically ill, functions with effort, beginning to break down or burnout needs intervention to cope with stressors.
• Massage Goals - (Via the book): Because massage temporarily takes the edge off of physical discomfort and reduces the strain of stress response, this allows people to perform better under stress, making it more tolerable. People tend to be less motivated to change if their stress or current circumstances seem tolerable. massage intervention may not be the best way to go about helping with person. Tassa said they may require intervention to cope with stressors (ie mental/psychological intervention) 

• Poor Ability or Inability to Adapt:

•  May be terminally ill or injured hope is lost, ability to function is lost and they require comprehensive intervention. 
• Massage Goals - Massage must be used carefully and supervised by a medical professional, and if massage is appropriate than it would be called palliative care(hospis for massage) this will not change or enhance the condition at all, it's pretty much to make the patient relax and reduce stress.

• Ethical Principles:

• Ethical principles help you in resolving ethical dilemmas and problem solving approaches.
• Respect - esteem and regard for clients, other professionals and yourself. 
• Client Autonomy - Self determination, give client the right to decide and the right to submit to sufficient information make a decision.
• Veracity - The right to be objective truth.
• Proportionality - The benefit must outweigh the burden on the treatment. 
• Nonmaleficence - Do no harm.
• Beneficence  - Treatment should contribute to the clients well-being.
• Confidentiality - respect for privacy and information.
• Justice - equality.  
• Standards of practice - Provides specific guidelines and the rules that form a concrete professional structure. Directs quality care and provides a means of measuring the quality of care.  

• Informed Consent: 

• Protection process for your clients.
• Requires that the client understands what will occur, that they participate voluntarily and that they can be competent to give consent .
• Guardians must provide consent for minors unable to do so. (under 18 needs parents consent)
• Discussions leading to consent and clarify ethical gray areas, Ask open ended questions that require a detailed response from your client. (How does that make you feel, is it dull or sharp, does it radiate to another area or is it stationary.)
• Consent could be both verbal or written. 
• In all cases the Therapist is responsible for obtaining informed consent. 

• Test Question:  

•  Which one of  these 4 is not able to give informed consent?

• Pregnant lady in her 3rd trimester, exhausted moody and emotional.
• An 84 year old widow with 5 speeding tickets.
• A guy with a car accident and he can communicate only through his computerized keyboard.
• Severely depressed woman on medication and her husband wants to cheer her up.  (No she can not.) 

•  Client needs to know the following before giving proper consent:

• Goals of the Therapeutic program.
• The service you are providing.
• Behavior expected of the client.
• The Risks and Benefits.
• Practitioner's qualifications.
• Financial considerations.
• Length of Therapy.
• Confidentiality Limitations.
• Levels of mandatory reporting practices.

Intake Procedures: 

• Needs assessment, based on medical history and physical assessment.
• Use this assessment to devise a initial treatment plan.
• Initial Treatment Plan:

• States the goals, duration of the session, how many sessions needed, costs, and chosen intervention.
• Establishes objective progress measurements for identifying what goals have been reached. 

• Give client written policy statement information such as a brochure, indicating the following:

• Type of Service
• Training and experience.
• Appointment policies
• Expectations
• Fees(Be specific)
• Statements of sexual appropriateness
• Recourse policy

• Confidentiality:

• Respect for your clients private information.
• A clients information is private and it belongs to the client (HIPAA: Health Insurance Portability and Accountability Act.)
• You can not discuss a clients information with anyone but the client without written consent.

• Boundaries:

• Test Question (possibly 2) on Right of Refusal. KNOW THIS.

• Right of Refusal:
• Professional -  This is a right that both the practitioner and the client have. You have the right to refer or deny the client service, if a just and reasonable cause exists.(Done through disclosure, as long as you acknowledge and inform the client of the situation that interferes with the professional relationship.)  
• Client - The same right goes to the client, if they do not feel you are doing good enough, or your a smoker, or your a female/male, and they are a male/female and do not wish to be massaged by the opposite sex they can deny you. (if this does happen you can either not charge or reduce their rate.)    

• Personal Boundaries: 

• Define yours by honestly looking at your feels, fears, frustrations, prejudices, biases, personal, and moral value systems.   
• Your personal boundaries are within an arms length of someone's space.  
• You need to be invited into your clients space, so you do not invade them.  
• Provide guidelines for professional boundaries. (Physical or emotional space in the therapeutic relationship.)

• Client's Boundaries:

• First you must find out what their boundaries are. (some people who have had an abusive past may not be able to define their own personal boundaries because they've never been given the opportunity.)
• Keep an eye on your patients facial expressions and body language as well when you are determining your clients boundaries. 
• If this is their first massage, you need to be more aware of their boundaries.

• Defuses feelings of sexual arousal:

• Recognizing your arousal and interrupting what your doing.
• Be aware of your own psychological state.
• Adjust the intent of the session to stimulate a more sympathetic outcome.(change the lighting, music, use a different stroke, conversation, and position.)
• You have be able to educate your client, explaining the feelings in a professional manner using clinical terminology. (para-sympathetic reaction to your touch may stimulate the client.)

• Transference: (Will be on test possibly 4 times.)

•  Client's personalization of the professional relationship. [Could be in the form of them demanding more time after the session. providing more massage. They can give you personal gifts. May express anger and blame you for not being able to aid you with their condition. Also have unrealistic expectations. or want to be your friend.]

• Counter-Transference:

• Professionals inability to separate the therapeutic relationship from personal feelings. [I.e. You get angry because your client isn't reaching the goals you set for them.  Unable to say no, "client wants you to spend more time on an area, you are unable to say no."]
• Also this could be practicing techniques that only you like to give or receive. [I.E. you enjoy deep tissue massage, that means everyone you massage is getting deep tissue massage. Or you don't like your feet touched therefore you aren't going to touch anyone's feet.]
•  Not counter-transference - If you are grieving from the loss of your best friend it is not count-transference.

• Dual(or multiple) rolls:

• When the scopes of practice overlap, and you are a Massage therapist Esthetician and cosmetologist, you can tell a client and use things that would benefit their condition. [I.E you can use ahoba oil on their scalp to relieve dandruff or relieving the scalp.]

• Appropriate body language

• When you initiate your client sessions begin with a handshake, then invite that person into your space, you also wait for them to welcome you into their space. Cultural challenges may exist. 

• Reciprocity 

• The right of exchange of privileges between governing bodies. [find what other laws and regulations are in the states you want to practice in.]

• Self-Reflection

• Dealing with suspected ethical or illegal behavior, self-reflect before initiating a consultation of actions, motives should be based on genuine concern for the fellow professional client and the good of the profession not on the personal values of moral beliefs.
• Talk with someone involved in the community in which you want to get involved in. 

[Fundamentals] Chpt 2 - Key Terms

• Counter-transference : Inability on the part of the professional to separate the therapeutic relationship from personal feelings and expectations for the client; it is personalization of the professional relationship by the professional.
• Dual Role : when scopes of practice overlap (i.e. one professional provides support in more than one area of expertise) or the personal and professional relationship overlap.
• Ethics : the science or study of morals values and principles.
• Ethical behavior : right and correct conduct based on moral and cultural standards as defined by the society in which we live
• Ethical decision making : the application of ethical principles and professional skills to determine appropriate behavior, and resolve ethical dilemmas
• Informed consent : a consumer protection process; it requires that clients be informed of the steps of treatment, that they are participation be voluntary, and that they be competent to give consent. Informed consent is also an educational process that allows clients to make knowledgeable decisions about whether to receive a massage.
• Mentoring : A professional relationship in which an individual with experience and skill beyond those of the person being mentored provides support encouragement and career expertise.
• Peer Support : Interaction among those with similar skill an experience to encourage and maintain appropriate professional practice
• Principles : basic truths or rules of conduct; they are generalizations that are accepted as true and that can be used as a basis for ethical conduct.
• Scope of practice : knowledge base and practice parameters of a profession.
• Standards of practice : Principles that serve as specific guidelines for directing professional ethical practice and quality care, including a structure for a evaluating the quality of care they are an attempt to define the parameters of quality care.
• Standard of care : a assessment and treatment process that a clinician (massage therapist) should follow for a certain type of clinical circumstance performed at the level at which similarly qualified practitioner's manage the clients care under the same or similar circumstances
• Supervision : involves a person who oversees others and their professional behavior. The supervisor may be from a different discipline(i.e. nurse) or maybe a massage therapist who has more skill and experience than those supervised. supervisors usually are in a position of authority, they are actively involved in such areas as development and approval of treatment plans, review of clarity scheduling discipline and teaching.
• Therapeutic Relationship : created by the inter-personal structure and professional boundaries between professionals and their clients.
• Transference : The  personalization of the professional relationship by the client.
• Code of ethics : an agree upon set of behaviors developed to promote high standards of practice.
• Evidence based practice(EBP) : "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
• Mandatory ethics : ethical behavior that is motivated only by compliance with the law.
• Aspirational ethics : ethical behavior motivated by a professionals desire to provide the highest possible benefit an welfare of the client.
• Needs assessment: history taking using a clients information form a physical assessment using an assessment form. the information is evaluated to develop a care plan
• Initial treatment plan : a plan that states therapeutic goals, the duration of the sessions, and the number of appointments necessary to meet the agreed goals costs the general classification of intervention to be used an the objective progress measurement to be used to identify attainment of goals
• Confidentiality : Respect for the privacy of information.
• Right of refusal : the right of either the client or the professional to stop the massage session.
• Power differential : A term that describes the difference in knowledge and skills between the client and the professional; it exists because one is placed in the position of controlling the situation.
• Clinical reasoning : form of critical thinking that targets a specific therapeutic practice.
• Reflective listening :  the ability to restate information in a way that indicates the listener has received and understood the message.
• Active listening : clarifying a feeling attached to a message but not adding to or changing the message.
• Conflict : An expressed struggle between at least 2 interdependent parties who perceive incompatible goals scarce resources and/or interference from the other party in achieving their goals.
• Defensive climate : an atmosphere characteristic of competition that inhibits the mutual trust required for effective conflict management.
• Supportive climate : a collaborative environment that leads to mutual trust into an atmosphere conducive to managing 
• Credentials : a designation earned by completing a process that verifies a certain level of expertise in a given skill.
• Reciprocity : the exchange of privileges between governing bodies.