Lec 4. Sequencing And Sop.Tp.Pdf

Standards of Practice & Creating Sequences Learning Outcomes By the end of this lecture you will be able to:  Discuss the importance of Standards of Practice (SOP) and how they shape our work as therapists.  Incorporate the five outcome-based steps in creating a cohesive massage sequenc...

Standards of Practice & Creating Sequences Learning Outcomes By the end of this lecture you will be able to:  Discuss the importance of Standards of Practice (SOP) and how they shape our work as therapists.  Incorporate the five outcome-based steps in creating a cohesive massage sequence.  Discuss various strategies that would ensure desired outcomes are met in creating full body wellness treatments. Standards of Practice  CMTO  CMTO Standards of Practice 2022  Establish expectations (of the RMT)  Guide your practice  To protect the public  RMTs are obligated to ensure they comply with the SOP  Set the minimum requirement for performance  Provide the fewest prescriptive requirements while still protecting the public  Dynamic living document Standards of Practice Stakeholders:  Therapists  Discipline  Educators hearings  Registration  Fitness to practice  Complaint  Quality assurance investigation  Client relations  The public Massage Sequencing Creating meaningful sequences:  A massage sequence refers to a structured, outcome-based series or succession of massage techniques that compose an intervention or some part there of.  How is a sequence different from a routine?  Sequences are highly structured in timing and technique/consistent with principles of design Steps in Creating a Sequence 1. Summarize clinical findings/outcomes 2. Select techniques 3. Specify scope and duration 4. Choose a gen technique 5. Sequence according to principles Massage Sequencing 1. Summarize ct expectations and clinical finding  clinical outcomes 2. What are the impairments (Δ body structure/function)…link these to your choice of technique (modality). Examples:  To  edema use MLD  To  systemic sedation use superficial stroking Think Pair Share Use 5 mins Using OBM Table 1-4 Choose one impairment and link it to a technique (or modality) that you could use to meet the related outcome. Massage Sequencing 3. Specify scope and duration  Scope refers to the amount of the body to be treated Scope is further broken down into regional and full-body sequences. A region is considered to be any large contiguous area.  Duration refers to available time Massage Sequencing  Factors determining whether an intervention should be regional or full-body include: Condition being treated (type(s) of impairment) Consider severity, complexity, acuity of health condition Chosen techniques (and level of competency) Consider which areas are commonly treated together Available time (See OBM Table13-2) What are other time-based considerations? You are creating a sequence to increase arousal. Your best choice of techniques would be? A. Static contact B. Deep effleurage C. Fast light hacking D. Slow rhythmical beating Think/Pair/Share Describe/discuss reasons why you would design different sequences of massage techniques for two clients who have similar health conditions. Massage Sequencing 4. Choose a framing (general) technique  Engages tissue  Provides a snapshot of tissue presentation  “…act as a powerful palpation tool, serving to frame and connect other techniques… impart a sense of structure…provides the ‘broth’ of the application.” Technique Components Let’s talk about techniques…  Contact surface – the portion of the clinician’s hand or arm that is used to execute the stroke.  Pressure (of technique) – the amount of force per unit area of contact surface that the clinician applies.  Engage(s) – to enter into contact with. In OBM a tissue is said to be engaged if it is “significantly” deformed during application.  Direction – the way in which the applied force moves. Technique Components  Amplitude/length – indicates the size of the area the technique is to cover.  Rate – indicates how fast the technique is applied.  Duration – indicates how long the technique would be applied for.  Integrades (with) – to merge well with another technique. Technique Components  Combines (with) – technique can be performed simultaneously with another similar technique.  Context – how this technique might best be used in a sequence. Massage Sequencing 5. Sequence according to principles  Movement from principle to principle and from technique to technique should be a smooth seamless continuous flow.  General – Specific – General  Can you list all the techniques with the taxonomy of most to least general? See OBM p. 371  Use general techniques first and last Sequencing According to Principles  Superficial – Deep – Superficial  Myth = deep work is good work  Starting superficially allows the clinician to:  Introduce their touch  Allows their hands to palpate in a more sensitive and relaxed position  Listen or “see” the body as it unwinds or releases Sequencing According to Principles  Principles related to enhancing fluid return  Proximal – Distal – Proximal  Pressure may be centrifugal and your starting point distal, if your primary intent is not to affect local circulation.  Factors affecting movement of fluid include:  Direction of pressure that is centripetal, i.e. movement of fluid toward the heart (blood) or lymph nodes (lymph)  Don’t forget about your old friend gravity  Technique being applied proximally moving distally with applied centripetal pressure…this creates a proximal reservoir into which distal fluid can be moved and will maximize pliability of proximal muscle – an example would be? Sequencing According to Principles  Periphery – Center – Periphery  When addressing circumscribed areas of local pathology, e.g. inflammation, techniques should be applied from periphery to center (centrifugally). This allows gradual palpation into areas of tenderness and altered responses. Which of the following is a principle of massage sequencing? A. Specific/General/Specific B. Superficial/Deep/Superficial C. Centrifugal/centripetal/ centrifugal D. Slow rate techniques prior to faster rate techniques Which of the following massage principles speaks to the application of pressure? A. Proximal/distal/ proximal B. General/specific/ general C. Periphery/centre/ periphery D. Superficial/deep/ superficial True or False. Superficial effleurage combines well with specific compression. A. True B. False Moving from effleurage to palmar kneading to thumb kneading then back to a series of broader techniques speaks to which principle? A. G/S/G B. S/D/S C. P/D/P D. P/C/P Other Considerations  Treatment to unaffected then affected  Treatment to agonist, antagonist and synergist groups  How might focus to one muscle affect the integrity or performance of another?  Be aware of:  Balance within the myofascial system  Positional shifts in related body systems  Possible undesirable responses, e.g. a crisis in healing Sometimes slowly is the fastest way in getting to where you want to go. Other Considerations  Intensity and duration of chosen technique will (usually) vary in direct proportion to the specificity and depth of treatment.  Ensure treatment to the contralateral side, related areas of the axial skeleton or to compensatory muscles (or groups).  Sequencing According to Principles Further Considerations: Rhythm  Overall delivery of manipulations Should be predictable for the client Think smooth transitions Continuity when changing pressure or techniques Other Techniques/Modalities  The inclusion of hydrotherapy, mobilizations, passive or PNF stretching and/or therapeutic exercise should be considered prior to developing a treatment sequence to ensure seamless inclusion. Full Body Wellness Strategies Be sure to review these…you don’t necessarily need to memorize them but they should make sense to you  See Key Points 13-2  See Table 13-4 Review Questions Use the following & create a few of your own in preparation for related exams:  Consider the technique of Superficial Stroking – discuss the three SOP components and how they relate to this technique?  What is the relationship between the specificity of a technique and the depth at which it is applied?  Why is the consideration of time so important when creating sequences? Review Questions  List three different specific & general techniques.  Some techniques are neither general or specific, which ones are they and why do they fall in the ‘grey’ zone?  What techniques do percussive techniques integrate cohesively with?  List two approaches to maximizing a client’s relaxation experience. References  Andrade, 2023, Outcome-Based Massage, Lippincott Williams & Wilkins, New York, Ch. 13  Be sure to check out the related info on the CMTO website