Northern Virginia Community College, Annandale



HLT 220

Case Study # 3

NOTES:

* 70 Years old * Pain in lower back - hip-thigh (arthritis? failing joints?)

* Female * Macular degeneration

* Dowagers Hump * Slight dementia

* Swollen and stiff hands and knees * Constipation

* Flatulence * Medications- Xanax & Ultram

* Family history of arthritis

Below I have studied all of the obvious and stated conditions that currently exist in the patient. After studying the side notes, I concluded that the Xanax medication is to control the patients slight dementia, which may be causing the clients constipation and Flatulence. The Ultram may cause the client to have seizures. I am also under the assumption that the client suffers from either osteoporosis or osteoarthritis. I came to this conclusion because of the clients kyphosis, which can be caused by osteoporosis, and also because of the clients swollen and stiff joints and hip pain. The back/hip pain may also be caused by the clients obesity. The stiff joints and pain may be due to the failing/depletion of the clients bone density and joints. The massage techniques used vary, depending on the other existing pathologies.

1.) WHAT THERAPEUTIC ASSESSMENT QUESTIONS PERTINENT TO HER SPECIFIC CONDITIONS WOULD THE THERAPIST ASK IN THE PRE-MASSAGE INTERVIEW?

OBESITY-“Obesity is characterized by an abnormal increase in subcutaneous fat, primarily in visceral regions of the body”(Anderson 269).

* What is the clients current fitness/activity level?

* Are edema’s present? If so, what causes them?

* Is the client on any medication for their weight? *symptoms*

* Discuss patients tolerance for pain. If there is pain, where? How bad?

MACULAR DEGENERATION- “...Progressive deterioration of the retinal maculae” (Anderson 156).

* Is the client currently on any medication for this pathology? * symptoms*

* Is the client experiencing any pain? Where? Amount? Tolerance?

* Are the clients sensory organs effected? If so, how badly?

SLIGHT DEMENTIA- “A cognitive disorder... Characterized by personality disintegration, disorientation, and a general loss of cognitive abilities, including impairment of memory and abstract thinking” (Anderson 166).

* Is the client currently on medication for this pathology? *symptoms*

* Is the client experiencing any pain? Where? Amount? Tolerance?

* Are the clients sensory organs effected? If so, how badly?

DOWAGER’S HUMP (KYPHOSIS)- “Kyphosis is an exaggeration of the normal posterior thoracic curve” (Anderson 122).

* Does the client have any localized muscle tension or muscle spasms? Is it due to trauma? Overuse? Systemic disorder? Other?

* Does the client list or lean?

* Is the client currently taking any medications? *symptoms*

* Does the client use short, shuffling steps?

* Does the clients gait pattern waddle?

OSTEOPOROSIS-“Osteoporosis is characterized by decreased bone mass and increased susceptibility to fractures; 80% of people with osteoporosis are women” (Anderson 126-7).

OSTEOARTHRITIS-“Osteoarthritis is a chronic progressive erosion of the articular cartilage resulting from chronic inflammation” (Anderson 125).

* Is the client currently taking any medications? *symptoms*

* Does the client list or lean?

* Does the client use short, shuffling steps?

* Does the clients gait pattern waddle?

* Is there any crepitation? Where?

2.) IS MASSAGE INDICATED AND, IF SO, WHAT ADAPTIVE MEASURES SHOULD BE EMPLOYED?

OBESITY

* Use a compassionate attitude

* Reduce pressure in areas with large amounts of adipose tissue

* Avoid deep strokes

* If edema’s are present, elevate affected area

* Create a pain reference “guide”

* Lower the table or use a platform

* Use a sheet to provide patient with coverage

* Be prepared to massage client on floor

* Review symptoms of medication (constipation, nausea, disorientation, drowsiness, etc.)

MACULAR DEGENERATION

Depending on how visually impaired the client is you may need to explain everything verbally and maintain verbal feedback using a normal tone. The therapist may also need to use the “clock” reference with the patient while moving. Be sure to ask if the client needs assistance, do not assume.

SLIGHT DEMENTIA

* Obtain clearance

* Tailor massage to existing conditions

* If client is unable to speak ask the care giver about the clients vitality

* Shorter sessions may need to occur

* Develop a pain reference “guide”

DOWAGER’S HUMP (KYPHOSIS)

* Position the client for comfort

* Discuss pressure tolerance

* Do not overstretch spine

* If caused by osteoporosis use light massage

OSTEOPOROSIS/OSTEOARTHRITIS

* Avoid pressure over bones and joints

* Discuss pressure tolerance

* Limit or avoid joint mobilizations

* Avoid deep pressure, stretching

3.) WHAT OBSERVATIONS AND PALPATIONS SHOULD BE MADE DURING THE PRE-MASSAGE INTERVIEW AND DURING THE MASSAGE TREATMENT?

OBESITY

* Observe the patients body shape

* Is the patients weight effecting their walking?

* Is client limping to compensate for hip pain?

* Palpate to feel for the difference between muscle and adipose tissue

* Are there any bed sores or pitting edema’s due to sedentary lifestyle?

* Is the clients cognition normal?

* Any twitches or spasms in areas?

MACULAR DEGENERATION

* Are the clients movements impaired or graceful?

* Is the client focused and attentive?

* Are changes in sensory abilities present?

* Do mental abilities seem impaired?

SLIGHT DEMENTIA

* Are the clients movements impaired or graceful?

* Is the client focused and attentive?

* Are changes in sensory abilities present?

* Do mental abilities seem impaired?

DOWAGERS HUMP (KYPHOSIS)

* Are there any spinal deviations?

* Is bone structure bilaterally symmetrical in frontal, midsaggital, and horizontal planes?

* Are there any areas of generalized tension and excessive tone?

* Do muscles twitch involuntarily?

* Does client wince, jump, or verbalize when pressure is applied?

* Is there any crepitation when joints move?

OSTEOPOROSIS/OSTEOARTHRITIS

* Does client guard movement?

* Are there any areas of tension or excessive tone?

* Does client wince, jump, or verbalize when pressure is applied?

* Is there any crepitation when joints move?

* Are there any swollen areas of the body that are noticeable?

4.) WHAT MASSAGE TECHNIQUES SPECIFIC TO HER CONDITIONS SHOULD THE THERAPIST EMPLOY?

OBESITY

* Reduce pressure

* Avoid deep, powerful strokes

* If edema’s exist elevate and use lymphatic drainage techniques

* Use caution because of medications symptoms

* May need to move client to where they feel comfortable

MACULAR DEGENERATION

*There are no restrictions that relate to a client with macular degeneration. Massage the client with techniques relative and specific to other conditions.

SLIGHT DEMENTIA

* Full body massage to relax and soothe

* Use friction joint mobilizations and stretching (depending on other pathologies)

DOWAGERS HUMP (KYPHOSIS)

“Some relief can be gained by massage of the involved muscles (pectoralis major/minor, serratus anterior, rhomboids major/minor) using techniques such as deep gliding strokes, kneading, and deep friction” (Anderson 123).

OSTEOPOROSIS/OSTEOARTHRITIS

* Gliding strokes

* Light kneading

* Light vibration

* “...Superficial warming friction, within the client’s tolerance , which can warm and loosen surrounding tissue” (Anderson 125).

5.) WHAT POST MASSAGE INSTRUCTIONS WOULD THE THERAPIST BE LIKELY TO GIVE THIS CLIENT?

OBESITY

* Emphasize the importance of a healthy diet and exercise

MACULAR DEGENERATION

* The client should continue with massage to relax the body.

* Continue to use the clock reference if visually impaired.

SLIGHT DEMENTIA

* After continuous, short massage sessions and/or just a simple hand massage and calming music, “A decrease in the episodes of dysfunctional behavior was found in patients with dementia” (Anderson 358).

* Stress the importance that massage has on creating relaxation, and that relaxation has on dementia symptoms

DOWAGERS HUMP (KYPHOSIS)

* Avoid joint mobilizations, especially if hump is caused by osteoporosis or osteoarthritis

* Avoid deep pressure

OSTEOPOROSIS/OSTEOARTHRITIS

* Avoid joint mobilizations

* Avoid overuse of joints and achy areas

* Stress the importance of calcium in strengthening bones

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