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Walton, Medical Conditions and Massage Therapy: A Decision Tree ApproachLesson PlansChapter 10 - Nervous System Conditions

Goals of the Lesson: Cognitive: Students will be able to explain common massage principles to use when working with nervous system conditions. Using Decision Trees, they will be able to construct appropriate massage plans for common nervous system conditions. Using narrative information from the text and outside resources, students will be able to build Decision Trees for common nervous system conditions. Affective: N/AMotor:N/A

Learning Objectives:The lesson plan for each objective starts on the page shown below.

Objective #

Objective Pages and Features

10-1 Explain why the following principles are commonly used with nervous system conditions: the Previous Massage Principle, the Where You Start Isn’t Always Where You End Up Principle, the Sensation Principle, and the Sensation Loss, Injury Prone Principle.

143

10-2 Describe the four main types of multiple sclerosis; describe the common signs, symptoms, complications, and treatments for multiple sclerosis.

143-145; Figure 10-1; Table 10-2

10-3 List the interview questions to ask a client with MS, and explain the corresponding massage therapy guidelines.

145-149; Fig 10-2 (Decision Tree); Table 10-1; TJ (online)

10-4 Summarize the status of research on massage and MS, and the possible benefits of massage for people with MS.

149

10-5 Describe the common signs, symptoms, complications, and treatments for Parkinson disease. 149-150; ; Figure 10-3; Table 10-2

10-6 List the interview questions to ask a client with Parkinson disease, and explain the corresponding massage therapy guidelines.

150-151; Figure 10-4 (Decision

Copyright © 2011 Wolters Kluwer | Lippincott Williams & Wilkins Page 1

Selected Key Terms

• Multiple sclerosis (MS)• Paresthesia• Spasticity• Ataxia• Neuropathic• Antiseizure medication • Muscle relaxant• Tricyclic antidepressant (TCA) • Parkinson disease (PD)• Tremor• Bradykinesia• Dopamine• Stroke (cerebrovascular accident)• Ischemic stroke• Thrombotic stroke• Embolic stroke• Hemorrhagic stroke• Transient ischemic attack (TIA)• Hemiplegia• Hemiparesis• Fall risk• Depression• Major depressive disorder• Dysthymia• Bipolar disorder• Postpartum depression• Seasonal affective disorder (SAD)• Antidepressant• Selective serotonin reuptake inhibgitors

(SSRIs)• Serotonin and norepinephrine reuptake

inhibitors (SNRIs)• Norepinephrine and dopamine reuptake

inhibitors (NDRIs)• Monoamine oxidase inhibitors (MAOIs)• Peripheral neuropathy• Cerebral palsy (CP)• Spastic hemiplegia/diplegia/quadriplegia• Paralysis• Intrathecal

Medical Conditions and Massage Therapy: a Decision Tree ApproachChapter 10 – Nervous System Conditions

Tree); Figure 10-5; Table 10-1

10-7 Summarize the status of research on massage and Parkinson disease, and the possible benefits of massage for people with Parkinson disease.

151-152

10-8 Describe the types of stroke; describe the common signs, symptoms, complications, and treatments for stroke (cerebrovascular accident).

153-156; Figure 10-6; Figure 10-7.

10-9 List the interview questions to ask a client with a stroke history or risk, and explain the corresponding massage therapy guidelines.

156-159; Figure 10-8 (Decision Tree); Figure 10-9; TJ 10-1; TJ (2 online)

10-10 Summarize the status of research on massage and stroke, and the possible benefits of massage for people with a stroke history.

159-160

10-11 Describe the types of depression; describe the common signs, symptoms, complications, and treatments for depression.

160-164

10-12 List the interview questions to ask a client with depression, and explain the corresponding massage therapy guidelines.

164-168; Figure 10-10 (Decision Tree);

10-13 Summarize the status of research on massage and depression, and the possible benefits of massage for people with depression.

168-169; TJ 10-2; TJ 10-3.

10-14 Describe the causes of peripheral neuropathy; describe the common signs, symptoms, complications, and treatments for peripheral neuropathy.

169

10-15 List the interview questions to ask a client with peripheral neuropathy, and explain the corresponding massage therapy guidelines.

170-171; Figure 10-11 (Decision Tree); Table 10-1

10-16 Summarize the status of research on massage and peripheral neuropathy, and the possible benefits of massage for peripheral neuropathy.

171-172



10-17 Describe types of cerebral palsy; describe the common signs, symptoms, complications, and treatments for cerebral palsy.

(online)

10-18 List the interview questions to ask a client with cerebral palsy, and explain the corresponding massage therapy guidelines.

(online, including 1 Decision Tree); Table 10-1

10-19 Summarize the status of research on massage and cerebral palsy, and the possible benefits of massage for cerebral palsy.

(online, including 1 online TJ)

10-20 Build a Decision Tree for each of the following conditions: anxiety, addiction (chemical dependency), alcohol intoxication, Bell palsy, brain tumor (primary)/metastatic brain disease (secondary), carpal tunnel syndrome, dementia/Alzheimer disease, encephalitis, cluster headache, migraine headache, tension headache, meningitis, polio/postpolio syndrome, reflex sympathetic dystrophy (complex regional pain syndrome), seizures/seizure disorders, spina bifida, spinal cord injury (SCI), and trigeminal neuralgia (tic doloreux).

172-182 (Conditions in Brief)

You Will Need:Gather the following materials and teaching aids for the following lessons:10-20: Printouts of blank Decision Trees, available online at http://thePoint.lww.com/Walton


http://thePoint.lww.com/Walton


Objective 10-1.Explain why the following principles are commonly used with nervous system conditions: the Previous Massage Principle, the Where You Start Isn’t Always Where You End Up Principle, the Sensation Principle, and the Sensation Loss, Injury Prone Principle.

Lecture OutlineFigures, Tables, and Features

Resources andIn-Class Activities

Outside AssignmentsEvaluation Instructor’s Notes

Content Text page

PPt slide

The Previous Massage Principle is commonly used in nervous system conditions because the massage therapist is often working in unpredictable territory. A client’s previous massage history can help guide the session.

The Where You Start Isn’t Always Where You End Up Principle is commonly used in nervous system conditions because the massage therapist is often working in unknown territory. By starting conservatively with a client and monitoring the response to massage over time, a therapist can learn how the client’s nervous system condition responds to massage, and the therapist may be able to work more strongly over time.

The Sensation Principle and the Sensation Loss, Injury Prone Principles are sometimes used because sensation is often compromised in nervous system conditions.

143 N/A FiguresN/A

TablesN/A

BoxesPrinciple Box, page 150(Previous Massage Principle)Principle Box, page 157(Where You Start Isn’t Always Where You End Up Principle) Principle Box, Page 170(Sensation Principle)Principle Box, Page 171(Sensation Loss, Injury Prone Principle)

Other FeaturesN/A

ResourcesN/A

Related ChaptersChapter 3, Principles of Massage Contraindications

In-Class ActivitiesExercise: Ask the students to identify medical conditions in which sensation is compromised. Which areas of the body tend to be involved?

MaterialsN/A

Outside AssignmentsAsk students to reflect on the Previous Massage Principle. Suppose you have a new client with a nervous system condition and a long history of massage therapy. What kind of information about the previous massage would help you plan the current session? What questions should you ask the client in order to get this information?

In using the Where You Start Isn’t Always Where You End Up Principle, it’s important to monitor a client over time. If you had a new client with a nervous system condition, what kind of questions would you ask at each session to determine whether stronger or gentler work is advised at each time?

EvaluationN/A

Legend: TJ: Therapist’s Journal. PPt: PowerPoint.



Objective 10-2.Describe the four main types of multiple sclerosis; describe the common signs, symptoms, complications, and treatments for multiple sclerosis.




Content Text page

PPt slide

Multiple Sclerosis♦ Background (Signs and

Symptoms; Complications; Treatment)

143-145

N/A FiguresFigure 10-1. Progression of symptoms and disability in MS.

TablesTable 10-1. Medications for Symptom Relief in Nervous System Conditions.

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Review Figure 10-1 on page 144, the disease patterns of MS. Ask students to reflect on what it can be like to live with a progressive disease. Discuss other diseases with relapsing patterns, and any experiences they know about of living with symptoms or other challenges that come and go. What can we draw on from our own experiences in life to understand and be present for our clients with MS?

MaterialsN/A

Outside Assignments N/A

Evaluation

Self-Test Questions, p. 182




Objective 10-3.List the interview questions to ask a client with MS, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Multiple Sclerosis♦ Interview Questions♦ Massage Therapy Guidelines

145-149

N/A FiguresFigure 10-2. A Decision Tree for MS.


BoxesN/A

Other FeaturesTherapist’s Journal (online): “Cool Down the Waiting Room.”

ResourcesN/A

Related ChaptersChapter 3, Principles of Massage Contraindications;Discussion of corticosteroid medication in Chapter 21;Discussion of chemotherapy side effects (similar to mitoxantrone) in Chapter 20

In-Class ActivitiesExercise: Using these two sections of the book, have students diagram each interview question about MS and link it to one or more massage therapy guidelines.

MaterialsN/A

Outside AssignmentsN/A

Evaluation





Objective 10-4.Summarize the status of research on massage and MS, and the possible benefits of massage for people with MS.




Content Text page

PPt slide

Multiple Sclerosis♦ Massage Research♦ Possible Massage Benefits

149 N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersChapter 6, Massage Research in Massage Practice

In-Class ActivitiesExercise: While little research is available testing outcomes of massage in MS, studies suggest that people with MS are using CAM therapies and, in particular, massage. Discuss possible reasons why clients with MS are seeking massage.

MaterialsN/A

Outside AssignmentsHave students review the signs and symptoms of MS, and the possible massage benefits, then make a case for the direction of future research on massage and MS.

Evaluation





Objective 10-5.Describe the common signs, symptoms, complications, and treatments for Parkinson disease.




Content Text page

PPt slide

Parkinson Disease (PD)♦ Background (Signs and


149-150

N/A FiguresFigure 10-3. Lack of facial expression in PD.

TablesTable 10-2. Medications for Parkinson Disease.

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Parkinson disease can create a “mask-like” facial expression that can appear flat, angry, or hostile. Ask students to consider what it might be like to have one’s facial expressions be out of control in this way.

MaterialsN/A


EvaluationSelf-Test Questions, p. 182




Objective 10-6.List the interview questions to ask a client with Parkinson disease, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Parkinson Disease♦ Interview Questions♦ Massage Therapy Guidelines

150-151

N/A FiguresFigure 10-4. A Decision Tree for Parkinson Disease.Figure 10-5. Parkinson disease: selected clinical features and massage therapy guidelines.


BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersChapter 3, Principles of Massage Contraindications

In-Class ActivitiesExercise: Using these sections of the book, have students diagram each interview question about PD and link it to one or more massage therapy guidelines.

MaterialsN/A


Evaluation

Self-Test Questions, p.182




Objective 10-7.Summarize the status of research on massage and Parkinson disease, and the possible benefits of massage for people with Parkinson disease.




Content Text page

PPt slide

Parkinson Disease♦ Massage Research♦ Possible Massage Benefits

151-152

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersChapter 6, Massage Research in Massage Practice

In-Class ActivitiesExercise: While little research is available testing outcomes of massage in people with PD, one of the larger studies (36 subjects) investigated neuromuscular therapy. Discuss the merits of continuing research on NMT and PD, vs. more research on less structured “relaxation massage” in people with PD.

MaterialsN/A


Evaluation





Objective 10-8.Describe the types of stroke; describe the common signs, symptoms, complications, and treatments for stroke (cerebrovascular accident).




Content Text page

PPt slide

Stroke (Cerebrovascular Accident)♦ Background (Signs and


153-156

N/A FiguresFigure 10-6. Comparison of ischemic and hemorrhagic stroke.Figure 10-7. Hemiplegia in stroke.

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersDiscussion of related cardiovascular disease and treatment (especially atherosclerosis, thrombosis, embolism, aneurysm, and atrial fibrillation) in Chapter 11.

In-Class ActivitiesExercise: Ask students to review the mnemonic, “FAST” and discuss the corresponding signs of stroke and follow-up.Why is it so important to record the time of symptom/sign onset?

MaterialsN/A


Evaluation





Objective 10-9.List the interview questions to ask a client with a stroke history or risk, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Stroke (Cerebrovascular Accident)♦ Interview Questions♦ Massage Therapy Guidelines

156-159

N/A FiguresFigure 10-8. A Decision Tree for stroke.Figure 10-9. Stroke: Selected clinical features and massage adjustments to consider.

TablesN/A

BoxesN/A

Other FeaturesTherapist’s Journal 10-1. Gentle Handling after a Severe Stroke.

Two additional Therapist’s Journals online: 1. Massage After a Mild Stroke.2. Warning Leaks.

ResourcesN/A

Related ChaptersRelated cardiovascular disease discussed in Chapter 11

In-Class ActivitiesExercise: Discuss the close relationship of the nervous system and cardiovascular system in stroke. Which precautions from Chapter 11(Cardiovascular System Conditinos) are necessary to follow in most people with a stroke history, and why?Exercise: Review “Warning Leaks,” the therapist’s journal online. Ask students to role play themselves in the therapist’s situation and how they might strongly or vehemently encourage a medical referral in a client with those symptoms.

MaterialsN/A

Outside AssignmentsAsk students to review and discuss the range of possible reasons for pressure adaptations in a clients with stroke histories. Which pressure restrictions are in force at a given site? Which are general/overall pressure restrictions?

Evaluation





Objective 10-10.Summarize the status of research on massage and stroke, and the possible benefits of massage for people with a stroke history.




Content Text page

PPt slide

Stroke (Cerebrovascular Accident)♦ Massage Research♦ Possible Massage Benefits

159-160

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Discuss the study by Mok and Woo in 2004. Review why the study cannot be used as proof of massage benefit. How would students tinker with the design of the study to explore whether Swedish massage could benefit stroke patients? Encourage them to think about massage modality, length of session, speed, sample size, and other possible control conditions.

MaterialsN/A


Evaluation





Objective 10-11.Describe the types of depression; describe the common signs, symptoms, complications, and treatments for depression.




Content Text page

PPt slide

Depression♦ Background (Signs and


160-164

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Discuss the different types of depression. Compare and contrast in terms of onset and prevalence.

MaterialsN/A

Outside AssignmentsTask students to do a short report on antidepressant medications: compare the mechanisms of action, side effects, and when each class entered the market. Which are used as first-line therapy?

EvaluationSelf-Test Questions, p. 182




Objective 10-12.List the interview questions to ask a client with depression, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Depression♦ Interview Questions♦ Massage Therapy Guidelines

164-168

N/A FiguresFigure 10-6. A Decision Tree for depression.

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Review the interview questions about depression. Recognizing that depression can be a very sensitive topic, have students discuss whether they would re-word any questions to be more sensitive or nuanced, or whether they would re-phrase any to correspond to their own personal style of interviewing.

MaterialsN/A


Evaluation





Objective 10-13.List the interview questions to ask a client with depression, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Depression♦ Massage Research♦ Possible Massage Benefits

168-169

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesTherapist’s Journal 10-2. Keeping Company with a Client with Depression.

Therapist’s Journal 10-3. Touch after Trauma.

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Review the massage research on depression presented in this text. What are the shortcomings in available clinical trials? Look at the meta-analysis published by Moyer et al. in 2004.Ask students to speculate on the length and frequency of massage sessions that might be necessary for it to help with depression. Exercise: Review the two therapist’s journals in this section. What does each story suggest about massage and depression? Be as specific as possible about the benefit. MaterialsN/A

Outside AssignmentsHave students do a literature search at PubMed or Clinicaltrials.gov for research on massage and depression since the publication of this book, and write up their findings. Do any of the available studies focus on clinical depression, or do they simply look at depression or depressed mood in other populations?

Evaluation

Self-Test Questions, p. ##




Objective 10-14.Describe the causes of peripheral neuropathy; describe the common signs, symptoms, complications, and treatments for peripheral neuropathy.




Content Text page

PPt slide

Peripheral neuropathy♦ Background (Signs,

Symptoms, Complications, and Treatment)

169 N/A FiguresN/A


BoxesN/A

Other Features

ResourcesN/A

Related ChaptersDiscussion of opioid analgesics in Chapter 21.

In-Class ActivitiesN/A

MaterialsN/A

Outside Assignments

Evaluation





Objective 10-15.List the interview questions to ask a client with peripheral neuropathy, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Peripheral Neuropathy♦ Interview Questions♦ Massage Therapy Guidelines

170-171

N/A FiguresFigure 10-11 A Decision Tree for peripheral neuropathy.


BoxesN/A

Other FeaturesTherapist’s Journal 10-4. Stretching the Rules for Neuropathy.

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Discuss the Sensation Principle, and the rationale for stepping outside of it for a client with neuropathy. Ask students to identify the conditions under which they would be comfortable using deeper pressures on an area of neuropathy, as the author of Therapist’s Journal 10-4 did. What questions would they need to ask a client in order to do so, and why wouldn’t it be advisable with a single time or one-time client?

MaterialsN/A


Evaluation





Objective 10-16.Summarize the status of research on massage and peripheral neuropathy, and the possible benefits of massage for peripheral neuropathy.




Content Text page

PPt slide

Peripheral Neuropathy♦ Massage Research♦ Possible Massage Benefits

171-172

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Research on massage and neuropathy suggests that people are using massage for neuropathy, but there is little or no evidence on its efficacy. Ask students to design a study testing the effectiveness of massage for neuropathy. How long would the sessions need to be, and how frequent? What pressures should be used? Anything else that is important to mention in the massage protocol?

MaterialsN/A


Evaluation





Objective 10-17.Describe the types of cerebral palsy; describe the common signs, symptoms, complications, and treatments for cerebral palsy.




Content Text page

PPt slide

Cerebral Palsy♦ Background (Signs and

Symptoms, Complications, and Treatment)

ONLINE

N/A FiguresFigure 1. Intrathecal baclofen therapy. (ONLINE) Figure 2. A Decision Tree for cerebral palsy. (ONLINE)


BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersChapter 10, Nervous System Conditions (in text)

In-Class ActivitiesExercise: Discuss the treatments for CP. in terms of the goals of each treatment. Which treatments target pain, and which are used for spasticity? Review Table 10-1 in text for the common side effects of medications.

MaterialsN/A

Outside AssignmentsHave students go online and learn from a reputable source such as www.cerebralpalsysource.com about the main types of CP and the treatments. They can write up a short report, comparing and contrasting the features of CP.

Evaluation

N/A



http://www.cerebralpalsysource.com/

http://www.cerebralpalsysource.com/


Objective 10-18.List the interview questions to ask a client with cerebral palsy, and explain the corresponding massage therapy guidelines.




Content Text page

PPt slide

Cerebral Palsy (CP)♦ Interview Questions♦ Massage Therapy Guidelines

ONLINE

N/A FiguresFigure 1. Intrathecal baclofen therapy. (ONLINE) Figure 2. A Decision Tree for Cerebral Palsy. (ONLINE)


BoxesN/A

Other FeaturesN/A

ResourcesN/A


In-Class ActivitiesExercise: Discuss the best massage approaches to use in areas of spasticity. This is a good time to review the best pressures, and to reinforce the principles to follow in the case of spasticity. Ask students to develop a list of questions to ask the client at each session to determine the best pressure for that day’s session.

MaterialsN/A


Evaluation

N/A




Objective 10-19.Summarize the status of research on massage and cerebral palsy, and the possible benefits of massage for cerebral palsy.




Content Text page

PPt slide

Massage Research Possible Massage Benefits

ONLINE

N/A FiguresN/A

TablesN/A

BoxesN/A

Other FeaturesN/A

ResourcesN/A


In-Class ActivitiesExercise: The research on massage and CP provides no evidence of benefit for this population, yet massage therapists might still build a theory for it being effective, and more research might support it. Read the Therapist’s Journal, “Hope and a Holistic Approach to CP.” Ask students to identify the massage elements and other factors that seemed to help this client. Which of these factors seem to be well within the massage therapist scope of practice? Which require additional training?

MaterialsN/A


Evaluation

N/A




Objective 10-20.Build a Decision Tree for each of the following conditions: anxiety, addiction (chemical dependency), alcohol intoxication, Bell palsy, brain tumor (primary)/metastatic brain disease (secondary), carpal tunnel syndrome, dementia/Alzheimer disease, encephalitis, cluster headache, migraine headache, tension headache, meningitis, polio/postpolio syndrome, reflex sympathetic dystrophy (complex regional pain syndrome), seizures/seizure disorders, spina bifida, spinal cord injury (SCI), and trigeminal neuralgia (tic doloreux).




Content Text page

PPt slide

Other Nervous System Conditions in Brief

172-182

N/A FiguresN/A

TablesOther Nervous System Conditions in Brief, pages 172-182.

BoxesN/A

Other FeaturesN/A

ResourcesN/A

Related ChaptersN/A

In-Class ActivitiesExercise: Together in class, complete a Decision Tree for Spinal Cord Injury, using the information from the Conditions in Brief Table.

MaterialsN/A

Outside AssignmentsHave students choose one or two conditions from the Conditions in Brief Table. On their own, they can sort the information into a Decision Tree Format, using one of the blank trees available online. If the information in Conditions in Brief does not complete a Decision Tree, students can look up additional information on the condition using other pathology texts, or online resources such as www.mayoclinic.com or www.myclevelandclinic.com. They can indicate on the tree (perhaps using different colored fonts or other notation) which information was derived from which sources.

Evaluation

N/A



http://www.myclevelandclinic.com/

http://www.mayoclinic.com/

Documents

Walton, Medical Conditions and Massage Therapy: A Decision ...downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/... · Walton, Medical Conditions and Massage Therapy: