Chapter 1 Principles of Outcome Based Massage OutcomeBased

Objectives At the end of this presentation you will have the information needed to: • Describe the goals and components of Outcome-Based Massage • Describe the relationship between Outcome-Based Massage clinical decision-making, evidence-based practice, and therapeutic relationship • Identify the components of the structure, process, and outcomes of clinical care. • Describe and distinguish among outcomes for medical massage, wellness massage, and whole systems massage • Identify when it is appropriate to establish different types of outcomes for clients Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Outcome-Based Massage (OBM) is a systematic treatment approach in which therapists provide massage interventions with the goal of achieving specified outcomes that are tailored to address each client’s unique needs, presenting issues and preferences Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Components of Outcome-Based Massage has three key components: • Outcome-Based Massage clinical decision-making, • evidence-based practice, and • therapeutic relationship Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Components of Outcome-Based Massage Copyright © 2014 Wolters Kluwer Health | Lippincott Williams &

Outcome-Based Massage • Guided by the concept of Intelligent Touch • Based on models of functioning, disability and health and wellness models • Classifies massage techniques on the basis of the tissue layer they treat • Uses a systematic clinical decision-making process Uses massage techniques to achieve specific treatment outcomes • Selects massage techniques based on evidence • Modifies interventions to address the client’s needs Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Outcomes for Massage • Outcomes: the results of a single intervention or multiple interventions in plan of care • Three steps to determine the appropriate treatment outcomes for a client. • 1. Understand the potential therapeutic effects of massage and the evidence • 2. Identify which of the client’s body structures and functions she can appropriately treat with massage techniques. • 3. Determine whether she is treating the client’s impairments or providing a wellness intervention. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Therapeutic Effects of Massage Techniques Copyright © 2014 Wolters Kluwer Health | Lippincott Williams

Body Structures and Functions • Body structures: the various anatomical structures and systems of the body • Body functions: the physiological functions of those anatomical systems • Impairment: any loss or abnormality of the client’s body structures or functions that occur as a result of the pathophysiology of a medical condition • Massage techniques are more appropriate for some body structures and functions than others. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Body Structures and Functions for Massage: Musculoskeletal • Adhesions/scarring • Impaired connective tissue integrity • Impaired joint mobility • Impaired muscle integrity • Abnormal muscle-resting tension and muscle spasm • Postural malalignment • Swelling: Edema, joint effusion, Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Body Structures and Functions for Massage : Multisystem, Neurological, Energetic • Multisystem • Impaired sensation secondary to entrapment neuropathy or nerve root compression • Pain • Neurological • Abnormal neuromuscular tone: Spasticity, rigidity, clonus • Energetic • Less than optimal biomagnetic field pattern • Reduced energy flow Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Body Structures and Functions for Massage : Cardiovascular, Pulmonary, CNS • Cardiovascular • Decreased arterial supply • Decreased venous return • Increased blood pressure • Swelling: lymphoedema • Pulmonary • Impaired airway clearance • Dyspnea • Decreased rib cage mobility (other than bony abnormality) • Central Nervous System • Reduced mental focus • Failure to thrive in high-risk infants • Lethargy Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Body Structures and Functions for Massage: Psychoneuroimmunological, GI • Psychoneuroimmunological • Stress • Depression • Altered body image • Immune suppression • Altered patterns of sleep • Gastrointestinal immobility secondary to sedentary status Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Interventions for Wellness Versus the Treatment of Impairments • The primary distinction is whether or not the focus of treatment is on an impairment in the client’s body structure or function. • Wellness interventions: not concerned with addressing the client’s impairments. • The treatment of impairments: aim is to reduce the impairments associated with medical conditions. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Impairments: Health • Health: a dynamic process that encompasses multiple domains, including the individual’s physical, emotional, social, and intellectual dimensions. In addition, some definitions of health address the individual’s ability to fulfill her social roles and respond to environmental stressors Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Impairments: The International Classification of Functioning, Disability and Health Copyright © 2014

Massage for Impairments: The International Classification of Functioning, Disability and Health • The model represents the individual at three levels: body structures and functions, activity, and participation. • Body structures: • Body functions • Activity: the individual’s execution of a task or action in an ideal situation • Participation: the individual’s involvement in a life situation, or his ability to execute a task within his environment • Individual’s medical condition and personal and environmental factors affect all three levels of functioning concurrently. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Impairments: Outcomes • Which outcomes are relevant for the client’s needs and the intent of the intervention? • A list of impairments in body structures and functions and outcomes that revolve around the treatment of impairments, recovery, and the prevention of secondary impairments Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Impairments: Outcomes • Impairments Body Structures and Functions Amenable to Treatment with Massage and Related Outcomes Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Wellness: Wellness • Wellness: encompassing both a balance of “mind, body and spirit” and an individuals’ self-perception of their well-being, which is distinct from their state of “health. ” • A person can have a high level of wellness, even though he has a medical condition that leaves him with sub-optimal health • For example, people who are living with chronic illnesses, disabilities or, medical conditions associated with age are still capable of experiencing high levels of wellness. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Wellness: Wellness Interactions Model © 2007 LWW Copyright © 2014 Wolters Kluwer

Massage for Wellness: Wellness Interactions Model • Spirit: that part of a person’s non-physical being that embodies her drive to transcend the physical world • Body and brain structures and functions: those body structures and functions that are free of impairments -grade zero • Activity capacity: as in ICF • Ability to participate in society: as in ICF Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Wellness: Wellness Interactions Model • Wellness behaviors: – personal factors that play a central role in wellness, – e. g. self-nurturance, healthy lifestyles, readiness for change, and perceived health. • Environmental factors: – facilitators and barriers to wellness that the individual encounters in her social setting. – e. g. social attitudes, available wellness services, education, and the individual’s financial status Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Wellness: Outcomes • Absence of impairments that stem from a medical condition • A list of relevant body structures and functions and associated outcomes for wellness. • Outcomes are directed at optimizing the client’s body structures and functions. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Massage for Wellness: Outcomes • Domains, Definitions, and Sample Outcomes for Wellness and Whole

References • The references for the material in this Power. Point presentation are found in Chapter 1: Principles of Outcome-Based Massage Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins