Massage Final

1. Diagnosis and management of movement dysfunction.
2. Enhancement of physical and functional abilities.
3. Restoration, maintenance and promotion of optimal physical function.
4. Prevention of the onset, symptoms, progression of impairments, functional limitations and disabilities.

PT's can give examinations, evaluations, diagnoses and prognoses. PTA's can provide interventions under the supervision of a PT.

An individual who has impairments and functional limitations diagnosed by a PT and is receiving care.

An individual that has not been diagnosed but is seeking care.

-Developed by APTA (1992)
-Uses disablement model
-Describes PT roles
-Standardizes terminology
-Practice patterns
-Part I: patient/client management
-Part II: practice patterns
-Part III: tests used in practice

-Examination
-Evaluation
-Diagnoses
-Prognoses
-Intervention
-Outcomes

No universal definition:
-Absence of illness or disease
-A state of complete physical, mental and social well-being

Relates to behaviors and lifestyle patterns.

A persons own perceptions and evaluations of how he/she feels. Such a person may feel pain or weakness but a disease is not present.

Based upon a professional evaluation and reflects the highest state of medical knowledge which requires therapeutic intervention.

-Uniform communication over various disciplines and sectors
-Reporting of medical information
-Framework to review patient information / problems
-Reimbursement

1. Disease classification (ICD-9 to ICD-10) International Classification of Diseases.
2. Procedural Classifications or Codes (CPT - 4).
3. Reimbursement Classifications (DRG, CPT-4, HCPCS (Healthcare Common Procedure Coding System), RUGS(Resource Utilization Groups))

Various impacts of chronic and acute conditions on the functioning of specific body systems, on basic human performance, and on people's functioning in necessary, usual, expected, and personally desired roles in society.

-Nagi functional limitations model
-International Classification of Imapirment, Disability and Handicap (ICIDH)
-National Center for Medical Rehabilitation Model for Disablement (NCMRR)

-Active Pathology = Interruption or interference with normal processes
-Impairment = Anatomical, physiological mental, emotional abnormalities or loss
-Functional limitation = Limitation in performance at level of whole person
-Disability = Limitation in performance of socially defined roles

-Institute of Medicine in 1997 introduced to acknowledge role of rehabilitation in reversing disability process.
-Patient centered, considers what patient brings to the table
-Interventions become more comprehensive and holistic

-International Classification of Functioning, Disability and Health (ICF)
-Top-Down Model of neurological Rehabilitation

-Emphasis on health and functioning in society regardless of impairments.

3 levels include
-body structures and functions (i.e. fatigue, tremors, weakness)
-activity (i.e. cooking, ambulation, self care)
-participation (wife, mother, business owner)

The 4 areas are:
-Roles (from profile i.e. wife, cook, church member)
-Skills needed - what the patient needs to be independent in society (i.e. household ambulation, self care)
-Resources - what the patient brings to the table (skills, activities, abilities; i.e. cognitively intact, functional strength)
-Recovery - prognosis and outcomes (i.e. not expected to return to cook position)

1. Establishing roles that an individual needs or desires to perform.
2. Determining skills required to perform those roles.
3. Identifying resources needed to accomplish those skills.
4. Specifying the neural recovery process that will bring about the rehabilitation goals.

-Patient centered focus for planning intervention (not centered around diagnosis)
-Dual emphasis (view patient from both perspectives)
-Need evidence based practice linked to movement skills not disease prognosis.
-Outcome of therapy is skills

Refers to ongoing pathological/pathophysiological state.
Characterized by clusters of signs and symptoms.

Consequences of disease, pathological process or lesion. An alteration in anatomical, physiological or psychological structures or functions. Abnormality of structure or function.
Examples: decreased muscle strength, decreased range of motion

Occurs as the result of a restriction of the ability to perform a physical action, task or activity in a efficient, typically expected or competent manner. ALD's and IADL's
Examples: reaching for an object, grooming

Activities of Daily Living

Instrumental Activities of Daily Living

Inability to preform tasks, actions, activities related to self-care, home management or work. Cannot be overcome to maintain "normal" performance. Based on judgement that behaviors are inadequate.

Prevention of disease in susceptible population. Examples: vaccines, condoms, airbags, clean water.

Efforts to decrease duration of illness or severity of disease. Examples: screenings

Efforts to decrease disability and promote rehabilitation and restoration of function in patients with chronic and irreversible disease. Examples: acute hospitalization, outpatient services.

1. Patient / client history

2. Relevant systems review

3. Tests and measures

Making a clinical judgement based on data gathered.

A label encompassing a cluster of signs and symptoms.

Predicted optimal level of improvement and amount of time needed to reach that level.

Anticipated goals, expected outcomes, predicted level of improvement, specific interventions with duration and frequency.

Intended level of results of interventions. Includes changes in impairment, functional limitations and disabilities. Sort term or long term. Measurable and time limited.

Purposeful and skiled interaction of PT with patient.

Coordination: working together with all parties.
Communication: exchange of information
Documentation: entry into patient/client record identifying services provided
Patient/Client related instruction: informing, educating, training patients/clients and families etc.
Procedural Interventions: exercise, functional training, manual therapy, physical agents or modalities, airway clearing

Ending PT services when goals are reached

Ending PT services if patient declines, patient unable to participate, patient will no longer benefit from services.
*Results in discharge.

A series of interrelated components that enables clinician to carry out effective interventions. Attributes:
-adequate knowledge
-cognitive processing
-self-monitoring
-teaching skills
-communication

A problem-oriented apprach:
-State problem/impairment
-Develop a theory / hypothesis (diagnosis) as to why the problem exists
-Create treatment
-Re-evaluate theory

systematic manipulation of soft tissues

-psychological
-physiological
-mechanical
-psychoneuroimmunological
-reflexive

-changes in skin
-relaxation
-improves circulation
-affects immune system
-metabolic balance
-tissue pliability and mobility
-joint mobility and muscle flexibility
-reduces pain

Connective tissue becomes stiff and solid when is immobile due to trauma or disuse

intelligent touch
-temperature
-contour or bulk
-texture
-spasm
-mobility

-static contact
-superficial stroking
-fine vibration

-superficial effleurage
-superficial lymphatic drainage

-broad contact compression
-petrissage
-stripping
-specific compression

-Squeezing
-Wringing
-Picking up or C kneading
-Broad contact kneading / deep effleurage
-Specific kneading

-impaired connective tissue integrity
-impaired joint mobility
-impaired muscle integrity
-impaired muscle performance
-muscle spasm and abnormal resting tension
-pain
-postural malalignment
-impaired sensation
-swelling
-neurological dysfunction
-cardiopulmonary dysfunction
-psychoneuroimmunological

- least stimulating
- reduce anxiety
- induce sedation

Type of Stroke:
- gliding with minimal deformation
- light pressure 10 sec to 10 min
- unidirectional
Indications:
- change level of arousal
- pain reduction
- change muscle tension/tone
Contraindications:
- locally in areas of acute inflammation
-CABG

Type of stroke:
- vibration
- fast oscillating / tembling

Type of stroke:
- gliding with light centripetal pressure that deforms the subcutaneous tissue down to investing layer of fascia
Indications:
- lymphatic congestion / edema
- reflex sympathetic dystrophy
- decrease anxiety
-stimulate peristalsis
-reduce neuron exitability
Contraindications:
- CABG / cardiac problems
- Acute osteopedic injuries
- new scars
- infection
- kidney pathology

open up proximal to distal areas first, so you don't get a backup

- broad contact compression
- petrissage
- stripping
- specific compression

Type of stroke:
- nongliding over broad body surface
-pressure and release is perpendicular
Indications:
- assess quality
- circulatory effects
- CPR
- pulmonary rehab
Contraindications:
- hemophilia
- thrombus / DVT
- flail chest
- osteoporosis
- anticoagulants

Types:
- muscle squeezing
- wringing
- picking-up or c kneading
- deep effleurage
- specific kneading
Indications:
- effects on resting tension, extensibility, pain, immune function
- reduce anxiety, stress, depression
Contraindications:
- hemophilia
- thrombus / DVT
- flail chest
- osteoporosis
- anticoagulants

- no lubricant needed
- grip, lift squeeze
- pressure is light to moderate

- large segments
- whole hand
- gradual, rhythmical, no jerking movements

- one handed for smaller segments
- thumb is abducted and forms c shape

- small circular movements
- can use dorsal part of hand
- pressure light to heavy

- use finger tips, thumbs
- pressure light to moderate
- repetitive circles

Type of stroke:
- direction parallel
- light to heavy pressure
Indications:
- reduce trigger point activity
- restores length and strength
Contraindications:
- bleeding / clotting disorders
- osteoporosis
- wounds
- musculoskeletal inflammation

Type of stroke:
- use fingers
- light to heavy pressure
- perpendicular
Indications:
- trigger points
- local tenderness, referred pain
- sustained pressure softens, releases area
Contraindications:
- bleeding / clotting disorders
- osteoporosis
- wounds
- musculoskeletal inflammation

- skin rolling
- friction
- myofascial techniques

Type of stroke:
-grasp tissue b/t thumb and fingertips
-roll tissue over the surface = wavelike effect
- parallel or perpendicular
Indications:
-mobilizes scars
-lengthens fascial layers
-variation is fascia elasticity
Contraindications:
-hyperemia
-inflammation
-fragile skin
-pain tolerance

Type of stroke:
-repetitive, non gliding
-force directed across or parallel to fibers
Indications:
-ordered alignment of collagen
-increases extensibility of connective tissue
-strains/sprains
Contraindications:
-blood, venous disorders
-inflammation
-infection, wounds, frail skin
-osteoporosis

- pincemeat
- tapping
- hacking
- slapping
- clapping
- beating
- pounding

- great stimulating effect
- produces hyperemia
- pain relief with amputation or neuralgia

- rib fractures, post chest / spinal surgery
- bony prominences
- pulmonary issues
- unstable cardia issues
- hemorrhage
- abused patients