Chapter 2 Treatment Planning Mosby’s PATHOLOGY for Massage Therapists Copyright © 2010, 2006 by...

Chapter 2Chapter 2

Treatment PlanningTreatment Planning

Mosby’s PATHOLOGYfor Massage Therapists

Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2Copyright © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

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Lesson 2.1 ObjectivesLesson 2.1 Objectives

Discuss the importance of a treatment plan.Discuss the importance of a treatment plan. Compare and contrast subjective versus Compare and contrast subjective versus

objective data.objective data. Design a client intake form.Design a client intake form. Discuss important elements of a client interview.Discuss important elements of a client interview.


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Lesson 2.1 Objectives Lesson 2.1 Objectives (cont'd.)(cont'd.)

Identify assessment domains of the PPALM Identify assessment domains of the PPALM method.method.

Discuss several ways to assess client pain.Discuss several ways to assess client pain. Contrast and compare acute pain with chronic Contrast and compare acute pain with chronic

pain.pain.


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IntroductionIntroduction

Treatment Plan – Actions to resolve health Treatment Plan – Actions to resolve health issues identified during client assessment issues identified during client assessment

Assessment – Process of appraising a client’s Assessment – Process of appraising a client’s conditioncondition Based on subjective reporting and objective findingsBased on subjective reporting and objective findings


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AssessmentAssessment

Purpose of assessment:Purpose of assessment: Appraise client’s heathAppraise client’s heath Identify conditions requiring precautions or Identify conditions requiring precautions or

treatment modificationstreatment modifications

Aspects ofAspects of assessment:assessment: Client intake formClient intake form InterviewInterview Physical assessmentsPhysical assessments


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AssessmentAssessment

Subjective data Subjective data — information learned from — information learned from the clientthe client

Objective data Objective data — information that is — information that is measurable and quantitative measurable and quantitative

Palpation — touching with purpose and intentPalpation — touching with purpose and intent


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Client Intake FormClient Intake Form

Personal and contact informationPersonal and contact information Health and medical informationHealth and medical information Emergency contact personEmergency contact person Regular physician or health care providerRegular physician or health care provider Date the information is recordedDate the information is recorded


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Client Intake Form Client Intake Form (cont’d.)(cont’d.)


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Client Intake Form Client Intake Form (cont’d.)(cont’d.)

Presenting the intake form:Presenting the intake form: Greet clientGreet client Escort client to a quiet area with adequate lightingEscort client to a quiet area with adequate lighting Present form, clipboard, and writing penPresent form, clipboard, and writing pen Obtain important forms (prescriptions, referrals, Obtain important forms (prescriptions, referrals,

clearance)clearance) Obtain client signatureObtain client signature


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InterviewInterview

Purpose of interview:Purpose of interview: Helps the therapist screen for contraindications or Helps the therapist screen for contraindications or

realize the need for adaptive measuresrealize the need for adaptive measures Gives the therapist a chance to gather details needed Gives the therapist a chance to gather details needed

to provide better service, such asto provide better service, such as• Primary purpose for sessionPrimary purpose for session

• Client’s personal preferencesClient’s personal preferences


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Interview Interview (cont’d.)(cont’d.)

Interview process:Interview process: Greet client by nameGreet client by name Introduce yourselfIntroduce yourself Review information on intake Review information on intake

form form Be sure form is complete, Be sure form is complete,

dated, and signeddated, and signed Organize interview; highlight Organize interview; highlight

health and individual issues health and individual issues (e.g. PPALM method)(e.g. PPALM method)

Conclude interviewConclude interview

From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, ed. 2, Philadelphia, 2003, Saunders. ed. 2, Philadelphia, 2003, Saunders.


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InterviewInterview

Sit facing the client at eye levelSit facing the client at eye level Begin with a brief orientationBegin with a brief orientation Use open- and closed-ended questionsUse open- and closed-ended questions

Open-ended questions offer little restriction when Open-ended questions offer little restriction when answeringanswering

Close-ended questions require a “yes” or “no” Close-ended questions require a “yes” or “no” responseresponse


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InterviewInterview

Listen carefully and use reflective questionsListen carefully and use reflective questions Take notes sparinglyTake notes sparingly Use silenceUse silence

This gives client time to talk, giving therapist This gives client time to talk, giving therapist greater understanding of clientgreater understanding of client

Signal your interest Signal your interest


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PPALMPPALM PPALM stands for the first letter of five PPALM stands for the first letter of five

assessment domainsassessment domains

From Salvo S: From Salvo S: Massage therapy: principles and practice,Massage therapy: principles and practice, ed. 3, St. Louis, 2007, Saunders. ed. 3, St. Louis, 2007, Saunders.


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PPALM PPALM (cont’d.)(cont’d.)

Five steps of treatment planning:Five steps of treatment planning: Ask client questions using the PPALM formatAsk client questions using the PPALM format Collect dataCollect data Appraise and synthesize data; integrate data with Appraise and synthesize data; integrate data with

one’s own clinical expertiseone’s own clinical expertise Discuss plan with clientDiscuss plan with client Implement planImplement plan


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Purpose of sessionPurpose of session Identify client’s reason for sessionIdentify client’s reason for session Discuss client’s past experience with massage Discuss client’s past experience with massage

therapytherapy If client is a minor, obtain permission from:If client is a minor, obtain permission from:

• Child’s parent or Child’s parent or • Child’s legal guardianChild’s legal guardian


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PPALMPPALM (cont’d.)(cont’d.)

PainPain Ask about painAsk about pain Is it related to injury or illness?Is it related to injury or illness? How is it being treated?How is it being treated? Pain can be acute (began abruptly) or chronic Pain can be acute (began abruptly) or chronic

(developed slowly)(developed slowly)


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Fig. 2-4 from Salvo SG: Fig. 2-4 from Salvo SG: Massage therapy: principles and practice, Massage therapy: principles and practice, ed 3, 2007, St. Louis, Saunders; ed 3, 2007, St. Louis, Saunders; Fig. 2-5 from Hockenberry MJ: Fig. 2-5 from Hockenberry MJ: Wong’s nursing care of infants and children, Wong’s nursing care of infants and children, ed 8, 2007, St. Louis, Mosby.ed 8, 2007, St. Louis, Mosby.

Assess pain using OPPQRST and pain Assess pain using OPPQRST and pain scalesscales


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Allergies and skin conditionsAllergies and skin conditions Inquire about allergies to ingredients in massage Inquire about allergies to ingredients in massage

lubricantslubricants Use hypoallergenic products when neededUse hypoallergenic products when needed Ask client about skin conditionsAsk client about skin conditions

Lifestyle and vocationLifestyle and vocation Factors include occupation, leisure or sports activities, Factors include occupation, leisure or sports activities,

physical exercise, stress level, and nutritionphysical exercise, stress level, and nutrition


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Medical history Medical history Inquire about the client’s heath statusInquire about the client’s heath status If a disease is present, ask how long the client has had If a disease is present, ask how long the client has had

the condition, how it is managed, current symptoms, the condition, how it is managed, current symptoms, and any activity limitationsand any activity limitations

If a client’s symptoms are unstable, obtain medical If a client’s symptoms are unstable, obtain medical clearance before massageclearance before massage

Ask about medication use and their purposeAsk about medication use and their purpose


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Lesson 2.2 ObjectivesLesson 2.2 Objectives

Describe the importance of screening clients for Describe the importance of screening clients for contraindications.contraindications.

List items included in a treatment plan.List items included in a treatment plan. Discuss postmassage communication.Discuss postmassage communication. Design treatment plans for subsequent Design treatment plans for subsequent

sessions.sessions.


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Screening Clients for Screening Clients for ContraindicationsContraindications

Ruling out contraindications is our duty and Ruling out contraindications is our duty and obligationobligation

Most conditions require only slight adjustmentsMost conditions require only slight adjustments Elevating the upper body or avoiding an areaElevating the upper body or avoiding an area Reducing pressure or session timeReducing pressure or session time

Sometimes, massage is postponedSometimes, massage is postponed


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Contraindications Contraindications (cont’d.)(cont’d.)

Contraindication – Presence of disease or Contraindication – Presence of disease or condition so a particular client cannot be condition so a particular client cannot be treated in the usual manner treated in the usual manner Absolute – Massage is inappropriate, not advised, Absolute – Massage is inappropriate, not advised,

and may be harmfuland may be harmful Local – Massage can be administered while Local – Massage can be administered while

avoiding infected/inflamed area or area in questionavoiding infected/inflamed area or area in question


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Formulating a Treatment PlanFormulating a Treatment Plan

Based on:Based on: Client health intake formClient health intake form InterviewInterview Other assessments, such as soft tissue palpationOther assessments, such as soft tissue palpation

Take into account a client’s financial and time Take into account a client’s financial and time restraintsrestraints


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Formulating a Treatment PlanFormulating a Treatment Plan(cont’d.)(cont’d.)

Includes:Includes: Techniques and areas to include or avoidTechniques and areas to include or avoid Recommendations for self-careRecommendations for self-care Duration, frequency, and length of treatmentsDuration, frequency, and length of treatments ReassessmentReassessment ReferralsReferrals


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Formulating a Treatment PlanFormulating a Treatment Plan(cont’d.)(cont’d.)

Includes (cont’d.):Includes (cont’d.): Whether client needs assistanceWhether client needs assistance Use of special support or bolstering devicesUse of special support or bolstering devices Use of adjunctive therapiesUse of adjunctive therapies Suggested reading materialSuggested reading material


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Communication After TreatmentCommunication After Treatment

Client evaluation of massageClient evaluation of massage Ask client to evaluate massageAsk client to evaluate massage Modify plan for future sessions if neededModify plan for future sessions if needed Discuss client education and homework Discuss client education and homework

assignmentsassignments


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Subsequent SessionsSubsequent Sessions

Review PPALM notesReview PPALM notes Update plan based on progress toward client’s Update plan based on progress toward client’s

goalsgoals In general, the initial treatment period consists of In general, the initial treatment period consists of

frequent sessions, tapering off as symptoms subsidefrequent sessions, tapering off as symptoms subside

Ask about symptoms and tailor treatment based Ask about symptoms and tailor treatment based on client symptoms that dayon client symptoms that day

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