MCQ - PP
Area of triangle skin between first and 2nd toes; supplied by what nerve?
Deep pernoneal
Another name for atrial septic defect is:
"hole in the heart" or defective foramen oval.
Competence and Accountability is directly linked to the Social Contract
"to serve and protect the well-being and best interests of their clients" Massage therapists must be competent and held accountable to provide these services
Veggies and fruit good source of c, d, carbs, but not
(B12) NOT GOOD source
Example of specific petrissage
(stripping) why pk isnt a specific..i dunno
What type of strain does the deltoid ligament protect the ankle against
Eversion / Valgus
Anterior Longitudinal ligament limits what?
Extension & reinforces front of annulus fibrosis
Protrusion:
posterior disc bulge without rupture of the annulus fibrosus
semilunar valve located where?
at the connections between the pulmonary artery and the right ventricle, and the aorta and the left ventricle.
A(n) _____ molecule is the primary source for energy in metabolism.
atp
the lumbar superior articular facets face
backwards, medially & are generally concave;
All of the following are common skin disorders resulting from allergies, bacterial, viral, or fungal infections except: Psoriasis Impetigo Contact dermatitis Basal cell carcinoma
basal cell carcinoma
subcutaneous prepatellar bursa lies
between the skin of the knee and the patella, permitting movement of the skin
The cause of numbness and tingling in the arm and lateral three and one-half digits
carpal tunnel syndrome
Washing with an antimicrobial - containing product that kills or inhibits the growth of microorganisms is referred to as
chemical removal.
One of the most significant ways health care professionals protect client vulnerabilities and demonstrate respect is by maintaining
client confidentiality. It is also a legal requirement of the RHPA
Pain on the anterolateral aspect of the leg is highly suggestive of
l4 disc problems
pain radiating to the posterior aspect leg and of the foot suggests the
l5 disc problems
as you palpate both malleolus ; which sits mor distally
lateral malleolus
What is the common attachment site shared by teres major and latissimus dorsi?
lesser tubercle of humersu
Which of the following types of protection should a massage therapist have? A. Brass knuckles B. Liability insurance C. Life insurance D. Retirement fund
liability insurance. This is the minimal insurance needed to protect against incidents of injury on your premises or during massage. Small business insurance is also a smart choice if you happen to have a successful massage practice that included workers other than just yourself.
A fourth ligament of the hip that is sometimes injured is the _________________________________which provides a physical attachment of the head of the femur to the acetabulum
ligamentum teres
In the upper-right quadrant we have what organs?
liver and gallbladdere
Asking your prone partner to hold their arms out in front of them like superman is a good way to contract which part of the trapezius?
lower traps
head of talus can be located between which two bony landmarks
medial malleolus and navicular tubercle
Obers test: what do you move
move thigh into extension; ext rot. And adduction
laws pertaining to home operation business is federal provincial or municipal
municipal
nerve innervating anterior arm
musculocutaneous nerve
Gst registration requirement;:
must earn 30,000 that year.
disc injuries can result in pressure on the spinal cord itself (upper lumbar spine) leading to a
myelopathy, pressure on the cauda equina leading to cauda equina syndrome (saddle anesthesia, bowel/bladder dysfunction), or pressure on the nerve roots (most common)
basic building block of nervous system
neuron
is a dual relationship misconduct?
not necessarily;can be low risk, medium risk or high risk. High risk dual relationships (such as dating) WILL RISK YOUR LISENCE as they are also gross violations of your promise to society as a therapist.
In the lumbar spine, the nerve roots exit through relatively large
ntervertebral foramina, & as in the thoracic spine, each one is named for the vertebrae above it. For example, the L4 nerve root exits between the L4 & L5 vertebrae
emotional boundaries
o I don't date clients o An erection is a normal physiological change in circulation and may occur. While I understand it is not a sexual response, let me know if you would prefer to change to a prone position or have an additional blanket
The main ligaments of the lumbar spine are the same as those in the lower cervical & thoracic spine (excluding the ribs). These ligaments include:
o anterior & posterior longitudinal ligaments, o ligamentum flavum, o supraspinous & interspinous ligaments, & o the intertransverse ligaments.
In order to acquire this massage therapists must be enrolled in a formal training program which includes: Admission requirements set by the College The completion of a competency-based education program (ie: the Massage Therapy Competency Standards Document) As a regulated healthcare professional, this is not enough
once in practice massage therapists must maintain their level of competency - this is done through the professions Quality Assurance program
Pinching the fingers together highlights which muscle in the wrist?
palmaris longus
Carpal tunnel syndrome involves inflammation of the flexor retinaculum, with pressure on the median nerve and loss of conduction. This is a description of: Functional limitation, impairment, pathophysiology, or disability?
pathophysiology
Which muscle is involved in the adduction of the leg when standing at attention
pectineus
The membrane that surrounds and protects the heart is called the:
pericardium
incubation
period from the initial entrance of the organisms to the time when 1st signs and symptoms appear 2-3 days (flu) wks-mths (Hep B) yrs (HIV)
The endocrine system contains?
pituitary adrenal and thyroid glands
cmto takes care of;
policy and guidelines for profession cert. exams rmt info. public register Quality assurance program public education media relations profession education publications complaints and discipline matters
Which of the following are objective measures in assessment? posture medications strength pain levels
posture and strength
Client vulnerability is further compounded because: Clients often wear very little clothing during treatment Therapists sometimes touch intimate parts of their bodies When we touch our clients physical bodies we also touch all of them; body, mind, heart and soul A term to describe these imbalances is
power differential.
All clients regardless of age or gender who receive Massage Therapy are entitled to a complete explanation of the proposed treatment including:
prediction of both frequency and duration of treatments, proposed draping and positioning, risks and benefits, alternatives to treatment or draping, and right of refusal throughout the care plan.
what is most commonly affected bursa in bursitis
prepatellar bursa
What muscle is antagonist to both biceps brachii and supinator?
pronator teres
some of the details in MTA include but not limited to :
prov. exams advertising records; how long we keep (10 years; or 10+ past minors 18th) council mtgs prof. misconduct quality assurance ceu credits peer assesments
patella seems to disappear when the knee is flexed; it sinks between 2 landmarks
proximal tibia and femoral condyles
STRONG MUSCLES that affect the hip
psoas, illiacus, piriformis; quadratus lumborum
The structure that carries deoxygenated blood to the lungs is:
pulmonary artery
oxygenated blood to heart via
pulmonary vein
Which of the following will not help you in smart business planning? A. Setting goals B. Purchasing a one year supply of massage oils C. Creating a business plan D. Creating a mission statement
purchasing massage oil for one year
What should you do if you receive a tip? A. Put it in your pocket and forget about it B. Record it for tax purposes C. Refuse to accept it D. Offer it to charity
record it for tax purposes
who owns the clients files?
records you record regarding your clients are first and foremost the property of your client. It is your job to safeguard them, but if a client requests, you must provide them a copy of your notes.
convalescent stage
recovery, felling better # of organisms are declining still contagious!
Which muscle attaches onto the cartilage of ribs five through seven
rectus abdominus
Healthcare professions are committed to the direct benefit of their clients and only secondarily to making a profit. Massage therapy is not just a healthcare profession it is a
regulated healthcare profession
Cleaning:
removes debris, utilizing plain soaps or detergents
Look over cross section, case control, cohort study, correlational (research)
research shit
what three tendons form pes anserinus tendon
sartorius, gracilis and semitendonosis
There are two types of breaches of Confidentiality:
Deliberate and Intentional Breaches: A therapist knows the information in question is confidential and knowingly and deliberately reveals it Inadvertent and Unintentional Breaches: A therapist, through carelessness or thoughtlessness reveals confidential information about a client
what is critical before each and every treatment
Full and informed consent
Px that derive secondary gain by exhibiting a severe derangement of locomotion are examples of what gait?
Functional inhibition gait.
Toe-Off In the toe-off phase, the foot prepares the leave the ground - heel first, toes last.
Hamstring muscles - extends the leg at the hip. Quadriceps femoris - maintains the extended position of the knee. Posterior compartment of the leg - plantarflexes the ankle. The prime movers include gastrocnemius, soleus and tibialis posterior.
As important as confidentiality is in health care it is not an absolute as required by law can refer to a subpoena or reporting abuse of a minor There are also two key exceptions:
Harm to self Harm to others
Legal guidance regarding consent comes from the
Health Care consent Act (HCCA).
First sign of osteoarthritis:
FRACTURE OF BONE
Posterior Longitudinal limits what?
Flexion & reinforces back of annulus fibrosis
The College's Quality Assurance program monitors the practice of the profession by:
Sets continuing education requirements Reviews standards and expectations and adherence to current and best practice standards
Which landmark is located proximal to the medial epicondyle of the femur, and the tendon of what muscle.
adductor tubercle /adductor magnus
The duty of confidentiality continues even
after the client stops seeing or being treated by the therapist. It is mandatory to provide information on your collection, use and disclosure policies
Disinfection:
alcohols 60 - 90%, boiling for 20 minutes. NOTE: Debris may not necessarily be removed, but the surface will be disinfected.
gate control theory
asserts that non-painful input closes the "gates" to painful input, which prevents pain sensation from traveling to the central nervous system. Therefore, stimulation by non-noxious input is able to suppress pain.
Head of fibula is the attachment site for
biceps femoris, soleus, fibular collateral ligament
Where does the blood flow from the right atrium?
bicuspid valve
abdominal aorta terminates where;
bifurcating into the right and left common iliac arteries
A therapists duty of confidentiality extends beyond what a client tells them,
but also what they observe and conclude in the clinical setting. It covers all medical records, and includes verbal or electronic dialogue with staff.
what cervical level is hyoid
c5
what cervical level is the cricoid at?
c6
What exactly is a conflict of interest
can be defined as a situation in which a person in a position of trust and authority allows their personal or private interests to interfere with their client's best interest. Conflict of interest scenarios can impede our ability to be competent and accountable. They can do this by affecting and influencing our professional judgement
The therapist's choice of techniques is an example of: structure of care process of care outcomes of care functions of care
process of care
Spodylosis
refers to a degeneration of the intervertebral disc
tumor is where when associated with myansthenia gravis
thymus gland
Massage can result in circulatory changes due to the involuntary reflex responses of the:
ANS system
MALARIA CI'S:
DONT MASSAGE ABDOMEN. (look up why)
The structure located between the small and large intestine is the:
ilieocecal valve
acute stage of infectious disease
maximum symptoms most contagious often cancel their appt
Common flexor tendon attaches to this bony landmark.
medial epicondyle of humerus
antigen found on type B blood
B antigens
proptosis
bulging eye
Available energy form carbohydrates is
4.0?
Dorsiflex rom
0-20 degrees
Express or Implied Consent is
where it is reasonably assumed the client consents to an action. For example, making an appointment and showing up expresses desire to be interviewed, assessed and receive treatment.
Massage Therapy Act (MTA) is
where we go for the finite details of how to do our job. Not the how to of techniques, but the how to's of conduct and business. Most importantly, title protection and scope are found in the MTA. The document itself is divided into sections of content, the first of which is exams.
diploplia
double vision
Abnormally fast HR, when BPM is >100
tachycardia
The production of too much insulin is typical of:
type 2 diabetes
Consider the following as you begin to develop your practice routine in class and student clinic
1. Avoid sharing personal information with clients 2. Don't flirt with clients 3. Avoid expressing physical affection for clients 4. Don't be casual with clients 5. Manage time effectively 6. Set financial boundaries 7. Appear and present like a health professional (class discussion - what will your clinic look be once registered?)
Two major categories of Boundary Violations:
1. Gross Violations: Breaches of the professional promise not to engage in sexual contact with clients 2. Dual Relationships: The blending of a professional (therapeutic) relationship with another potentially incompatible relationship
FOUR STAGES OF infectious disease
1. Incubation 2. prodromal Stage 3. Acute Stage 4. Convalescent stage
Gross Violations - fall into three categories:
1. Sexual Intercourse 2. Sexual Touching 3. Sexual Behaviour / Remarks Any of these are met with the same Zero tolerance policy and are grounds for removal from the profession.
lumbar ext rom
20 to 35 deg
With a correctly positioned and intact disc, the lumbar facet joints carry approximately
20-25% of the axial load. If degeneration occurs this load may reach up to 70%.
60 hour course; how many CEUs
30
How many ceu's for a 60 hour course?
30 CEUs
RMT'S MUST ACUTALLY HAVE how much time massaging, teaching or supervising in three years?
500 HOURS OF MASSAGE TIME EVERY 3 YEARS. (supervising and teaching wont count now as part) NEW
how many hours to keep rmt status
500 hands on massage in 3 years; teaching, supervision not included (new)
Linens should be washed at
75.1 degrees Celsius to provide the most effective means of destroying microorganisms** FOR HOW LONG.
antigen found on type A RBC's
A antigens
A trigger point is
A hyperirritable spot in the soft tissue that often exhibits a predictable referral pain pattern
Definition of a Therapeutic Relationship
A relationship which exists between two people; one being a therapist and the other a client, for the sole and expressed purpose of serving the health and well-being of the client
Definition of a Therapeutic Relationship
A relationship which exists between two people; one being a therapist and the other a client, for the sole and expressed purpose of serving the health and wellbeing of the client
Rickets (bone deformities) in children is caused by:
A severe or prolonged deficiency of Vitamin D
What is the definition of Client Vulnerability?
A state in which a person is susceptible to injury or harm
case control study
A study that compares patients who have a disease or outcome of interest (cases) with patients who do not have the disease or outcome (controls), and looks back retrospectively to compare how frequently the exposure to a risk factor is present in each group to determine the relationship between the risk factor
A member must practice 500 hours of direct client care within scope, in the province, in a three year period to maintain their license requirements once registered.
A therapist can be on inactive for an indefinite period of time. In times where a therapist goes inactive (i.e. for 15 months) they may be required to complete a refresher course before reentering the profession. Note - if you are on inactive, you CANNOT practice.
Swing phase:
Accounts for 40% of the cycle. It can be divided into the leg lift and swing phases
Stance phase:
Accounts for 60% of the gait cycle. It can be divided into the heel strike, support and toe-off phases.
What hormone increases reabsorbtion of Na+ and K+ at collecting duct?
Aldosterone
Not all complaints need to proceed to the Discipline Committee sometimes they can be resolved internally through;
Alternative Dispute Resolution (ADR): Informal resolution (mediation) which involves the complainant, the person making the complaint and a third party.
Explore alternatives for action
An alternative for action is a possible resolution to the problem A possible resolution is one we can justify or support with good reasons Generate at least _____ possible resolutions
We do this by practicing Informed Consent
An ongoing process of communication between a therapist and a client which results in the client providing the therapist with their agreement or authorization to a specific treatment plan This must occur before each and every treatment Consent must be recorded on each treatment note
Competence can be defined in two ways
As the ability to perform tasks and roles As a set of personal capabilities or characteristics, the most essential of these being capacity
Deficiency of _______leads to pernicious anemia
B12
Combating conflict of interest scenarios:
Be aware Be honest if a conflict or potential conflict exists Abstain from decision making by removing yourself from the scenario
Practicing after school before license will get you in trouble...with what??
Behaving badly and unethically, and MAY delay her application of certification
CCT
CONSENT TO TREAT'; RMT's require both written and verbal consent. Written in the waiver, and written ourselves on our treatment notes after verbally reviewing the treatment plan for that treatment. Every treatment. This often is written in short form
The four structures that can cause nerve compression or impingement for thoracic outlet syndrome (TOS) are
Cervical rib, ant. Scalene, costoclavicular, and pectoralis minor
Federal requirements
Charter of Rights and Freedoms The Personal Information Protection and Electronic Documents Act (PIPEDA) Ontario health information custodians collecting, using or disclosing personal health information within Ontario are no longer subject to the federal Personal Information Protection and Electronics Documents Act (PIPEDA) because PHIPA is considered substantially similar to the federal act.
Make a decision and implement the decision
Choose a resolution Support your decision by demonstrating why the resolution you have chosen is the best possible resolution for this situation Implement your decision
Informed Consent requires the client to have :
Competent choice Voluntary consent Adequate, relevant understood information
Health Care Consent Act (HCCA) Since it has "health" and "consent" in the name, we can logically assume it will relate to heath care, health information and consent guidelines.
Consent must be given VOLUNTARILY and the client MUST Be INFORMED of the treatment, including risks, benefits and side effects. It must be RELATED TO TREATMENT, and NOT TO BE OBTAINED through fraudulent promises by the therapist not misrepresent what will occur in treatment and afterwards. Clients must have time to grasp the concepts, and ASK QUESTIONS having every question answered to their satisfaction by the therapist. Alternative to treatment and consequences of not having treatment must be outlined as well.
Not a symptom of shock;
ELEVATED blood pressure
Substitute decision makers What if a client is not capable? "Substitute decision-maker" means a person who is and is often a family member.
Example Do they understand they may hurt more tomorrow, might bruise, might be light headed or dizzy? Some treatments may be more complex than others, such as addressing a long time scar with frictions or fascial work. Consent has nothing to do with age. It is about the capacity to understand the information. You can presume a person is capable, unless they prove to you otherwise,
Sterilization:
Exposure to steam at high temperatures (autoclave) NOTE: May not remove debris, but the surface will be sterilized.
Mandatory Reporting - The duty to Report Mandatory reporting is outlines as an obligation for all RHPA practitioners against all RHPA practitioners as one of the ways we can promise to keep the public safe in the hands of health care providers Not all issues need to be reported. If a client reports to you they disliked a therapists dress code, aromatherapy product work or fee schedule, these are not mandatory reports. Pull up case histories of misconduct trial. Drive home the point for whatever reason sometimes there are bad decisions being made. It is our obligation to report therapists who
Financially abuse Sexually abuse Emotional abuse Physically abuse their clients
Heel-Strike In the heel-strike stage, the foot hits the ground heel first. There are three muscles/muscle sets involved, each acting at a different joint:
Gluteus maximus - acts on the hip to decelerate the lower limb. Quadriceps femoris - keeps the leg extended at the knee and hip. Anterior compartment of the leg - maintains the ankle dorsiflexion, positioning the heel for the strike.
Model for Ethical Decision-Making - Seven Steps
Identify the ethical issue or dilemma 2. Consider the relevant ethical standard(s) and legal requirements 3. Apply the tests of: justice, publicity and universality 4. Consultation 5. Explore alternatives for action 6. Assess your proposed resolutions 7. Make a decision and implement the decision
If your client has a moderate anterior pelvic tilt what three muscles would be shortened?
Iliacus, psoas major and rectus femoris
Leg Lift Once the foot has left the ground, the lower limb is raised in preparation for the swing stage.
Iliopsoas and rectus femoris - flexes the lower limb at the hip, driving the knee forwards. Hamstring muscles - flexes the lower limb at the knee joint. Anterior compartment of the leg - dorsiflexes the ankle.
Swing In the swing phase, the raised leg is propelled forward. This is where the forward motion of the walk occurs.
Iliopsoas and rectus femoris - keep the hip flexed, resisting gravity as it tries to pull the leg down. Quadriceps femoris - extends the knee, positioning the foot for landing. Anterior compartment of the leg - maintains ankle dorsiflexion so that the heel is in place for landing. Next, the heel hits the ground, and the whole cycle repeats.
Establishing and maintaining a Therapeutic Relationship:
In order to keep the Therapeutic Relationship professional we need to establish professional boundaries It is always the therapist's responsibility to establish, advise of and hold boundaries. When clients challenge these boundaries, it is the therapist's job to reaffirm expected behavior
RMTAO TAKES CARE OF;
Influencing and communicating change conference and seminars liability insurance optional group benefit package publications networking media relations public referral promotional materials job search assistance
Treatment of Sensitive Areas
Information Sharing and Consent Involving Treatment for Conditions of the Chest Wall Musculature, Breast Tissue, Inner Thigh and Gluteal Region
One of the easiest ways to determined if we are in a conflict of interest or potential conflict of interest scenario is to test yourself with the following questions.
Is this situation likely to interfere, or appear to interfere, with the independent and objective judgement that I must show as a regulated healthcare professional in performing my duties? Would others (clients, the public or peers) trust my judgement if they knew I was participating in this situation?
take home points about the RHPA
It is broad, and includes all regulated professions in health care in the province with a focus on openness, consumer choice and quality care. Some primary functions include safeguarding against and defining abuse, the colleges duty to investigate all complaints, provisions of care for abused clients. It outlines mandatory reporting, whistle-blowing and established fines for holding out. It gives all the governing colleges shape and definition. It is a piece of paper. Our colleges are the people who give it life.
iliofemoral ligament A. (Y ligament of Bigelow): is considered to be the strongest ligament in the body.
It is positioned to prevent excessive extension & plays a significant role in stabilizing & maintaining an upright posture at the hip, while also limiting anterior translation
Registered Massage Therapists must possess a certain level of competence in terms of:
Knowledge Skills Attributes Ethics
where is the most common site for vertebral problems in lumbar spine and why?
L5-S1 because this level bears more weight than any other vertebral level.
Neurolgia carry out phagocytosis of microbes to protect the CNS from disease.
Microglia
name of a Synergist that eliminates an unwanted action caused by mm crossing more than one joint.
Neutralizing synergist
Establishing and maintaining a Therapeutic Relationship:such as; Develop policies to support your boundaries
No show or cancelation policies Policies about respect for self and others in this wellness space Policies about referral, and responsibility for self (home care compliance, etc)
All associate massage therapists who work here and who come in contact with your personal information are aware of the sensitive nature of the information you choose to disclose and are aware of the measures taken to safeguard your privacy and of the regulations that require such actions. Below, we have outlined what our office is doing to ensure that
Only necessary information is collected about you; We only share information with your consent; Storage, retention and destruction of your personal information complies with existing legislation, and privacy protection protocols; Our privacy protocols comply with privacy legislation, standards of our regulatory body, the College of Massage Therapists of Ontario, and the law.
Informed consent refers to the ethical and legal right of the client to decide what healthcare services she or she will utilize. .
Part of our obligation is to inform the client of risks, side effects benefits and alternatives to treatment, empowering their decision making
Quality Assurance Program consists of: Periodic assessments of therapists strengths and deficiencies (ie: self-assessment)
Participation in professional development activities (ie: CEU's Continuing Education Unit) Maintenance of professional competence is a lifelong process Although the profession sets requirements and standards for continuing education, success depends on two additional factors: A system for ensuring that continuing education standards are adhered to The sincere motivation and commitment of The Profession's Scope of Practice
What is the origin of the teres major?
Posterior aspect of the inferior angle of the scapula
What does PAF stand for?
Pre-approved Framework Guideline (for WAD 1 and WAD 2)
The role of a Standards of Practice Document:
Provides a clear and comprehensive outline of what is expected and required of practitioners for assuring the delivery of quality patient care Sets goals in terms of outcomes that can be achieved and evaluated in massage therapy curriculum Outlines the accountability mechanisms to be utilized by the College for resolving issues regarding practitioners or between practitioners and clients Provides the public with a benchmark with which to assess the quality of care received
Integrity in the therapeutic practice can be seen as: -
Providing a house call for a home bound client, or referring them to a mobile provider if you cannot - Reading more about a pathology or contributing your time and skills to a charitable walk to support further research in that area or participating in research in this area yourself - Speaking with peers in other fields who are ``experts`` in that pathology to build your knowledge and expand your professional resources
Informed Consent is facilitated by
Providing information to clients in a way that they can understand Providing information in simple non-technical language Practicing communication skills and facilitative body language Asking the client questions, and listening; asking them to repeat key points in their own words Providing information and seeking consent only within the scope of massage therapy We also respect our clients by safeguarding their rights to privacy and confidentiality
Principle II - Responsible Caring Meaning:
Providing sensitive, compassionate and empathetic quality massage therapy.
Provincial requirements include PHIPA, now replacing PIPEDA for health care professionals. Personal Health Information Protection Act (2004) PHIPA
Purpose of guide Date enacted PHIPA applies Who Obligations put on health information custodians by PHIPA Who ensures PHIPA is enforced? What recurring problems have been addressed by PHIPA
Support After the heel strike stage, the leading leg hits the ground, and the muscles work to cope with the force passing through the leg. This is known as the support stage.
Quadriceps femoris - keeps the leg extended, accepting the weight of the body. Foot inverters and everters - contract in a balanced manner to stabilise the foot. Gluteus minimus, medius and tensor fascia lata - abducts the lower limb. This keeps the pelvis level by counteracting the imbalance created from having most of the body-weight on one leg.
Which two muscles attach to the xiphoid process?
Rectus abdominis/tranversus abdominis
In acute conditions it is best to do all of the following except? a. Reduce pain and decrease sympathetic nervous system firing b. Treat any compensating structures and maintain local circulation c. Reduce or remove protective muscle spasms d. Reduce inflammation and edema
Reduce or remove protective muscle spasms
Regulatory requirements
Regulated Health Professions Act, Health Care Consent Act, Massage Therapy Act, College of Massage Therapists of Ontario
Developing research and massage therapy as evidence based practice
Research is a critical part of building the body of knowledge of massage therapy Research enables therapists to actually improve instead of just maintain skills Massage therapists can use research findings to inform their decisions, actions and treatment of clients
The primary muscles involved in torticollis are:
SCM, scalens, and trapezius (upper fibers
A conflict of interest can affect massage therapists in clinical practice, education, administration, research and regulation, and can take many forms
Self dealing - getting a family member a job through a clinical relationship Accepting benefits - accepting a case of liquor for an instructor requiring students to purchase tables through that supplier Influence peddling - accepting free equipment from a supplier in exchange for official supplier status in the professional association, for which the RMT is vice president Using your employers' property for private advantage - stealing supplies from work or school Using confidential information - a RMT who sits on the regulatory board uses confidential information to assist in the recruitment agenda of a friend who operates a school Outside employment - an instructor at a school accepts a job at a competing school teaching night classes
Standards for Education and Training
Setting standards for admission into massage therapy training institutions Setting standards for knowledge, skills and attitudes that need to be acquired during a recognized massage therapy training program Setting standards for ongoing practitioner competence Establishment of Codes of Ethics and Standards of Practice document
A number of mechanisms are used to demonstrate accountability to society
Standards for Education and Training Research for evidence based practice Quality Assurance ADR and Discipline
During a massage a client makes repeated sexual suggestions. What actions should be taken?
Stop immediately and politely explain to the client that the massage is over
Sympathetic nerves arise from what spinal cord segments:
T1-L2
Regulated Health Professions Act (RHPA) Each health profession in Ontario is regulated by two statues; the RHPA and its own act (i.e. for RMT's the Massage Therapy Act).
THis Act engulfs all regulated health practitioners, outlines prohibited acts, how misconduct shall be handled, the structure of the colleges, and other crucial points that give us the directions we need to understand our roles together as the health team that the public relays on. The focus of the RHPA is openness, consumer choice and quality care.
what governing body; ie federal, CMTO, provincial, or municipal has a say regarding homebased business?
TOWN OR MUNICIPALITY
Apply the tests of: justice, publicity and universality
Test of Justice: Test of Publicity: Test of Universality:
Alternative Dispute Resolution (ADR) and Discipline of Members Regulated healthcare professionals must have bodies (committees) organized amongst themselves for dealing with disciplining their members
The Inquires, Complaints and Reports Committee (ICRC): sees all complaints and screens all member-specific concerns that arise from other sources, including mandatory reports. Discipline Committee: Conducts a hearing
Accountability for Standards
The Massage Therapist must comply with any requirement as defined in any existing legislation related to the performance of the therapist's job. The Massage Therapist is only held accountable to meet a Standard if he/she is the person who has performed the task
DISINFECTION: Definition:
The _inactivation of disease-producing microorganisms_. Disinfection usually involves chemicals, heat or ultraviolet light. Levels of chemicals disinfection change with the type of product used.
CLEANING: Definition:
The _physical_ removal of foreign material, e.g. dust, soil, organic material such as blood, secretions, excretions and microorganisms. The terms "decontamination" and "sanitation" may be used for this process in certain settings. Cleaning reduces or eliminates the reservoirs of potential pathogenic organisms. Cleaning agents are the most common chemicals used in housekeeping activity.
Competence to perform Tasks and Roles
The ability to perform the responsibilities required of professionals to the standard necessary for safe, effective and ethical practice
The Therapeutic Relationship exists in the broader context of the Social Contract:
The client agrees to reveal personal information to the therapist and the therapist in turn agrees to hold in confidence this information (unless otherwise required by law)
STERILIZATION: Definition: .
The destruction of all forms of microbial life including bacteria, viruses, spores and fungi. Items must be cleaned thoroughly before effective sterilization can take place
Professional Ethics:
The ethical values and principles that govern the practice of massage therapists
Competence in Capacity to Practice
The mental ability to practice and perform the tasks and roles assigned to the practitioner as a healthcare professional (This area is very rare for RMT's to run into conflict with. An example could be Alzheimer's, where they forget their training, standards etc.)
Definition of Professional Boundaries
The physical and emotional limits that are appropriate in the therapeutic setting Physical boundaries can be easier (more tangible) than emotion limit setting o I will close the door before you will begin to change for treatment o Your will be draped to "here" when we treat your arm
Scope of Practice
The practice of Massage Therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissue and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain. (Massage Therapy Act, 1991)
cohort study
The study groups follow a group of people who do not have the disease for a period of time and see who develops the disease (new incidence). The cohort cannot therefore be defined as a group of people who already have the disease. ... They enable a wide range of exposure-disease associations to be studied.
We respect our clients by respecting their autonomy:
Their right to make choices and decisions about their health care
Dual Relationships can take many forms, such as:
Therapist who becomes a Teacher when you begin school Bartering for Goods and Services Providing therapy for relatives and friends Socializing outside of treatment Being emotionally or sexually intimate with a client
Massage Therapists have entered into a Social Contract:
Therapists agree to serve and protect the well-being and best interests of their clients first and foremost. Society agrees to provide the profession with the autonomy to govern itself and with the privileges and status afforded regulated healthcare professions This relationship is based on mutual respect and trust.
Dual Relationships - are also forms of conflict of interest A conflict of interest must be declared to third party payees such as insurance companies, motor vehicle claims or Workman's Safety Insurance Board WSIB.
They may feel you are unable to be impartial in your assessments and decline to reimburse your client (or you depending on how you have arranged payment) for the treatments. It is better to ask first in this case, as they WILL retroactively demand the full balance of payment back if the conflict of interest is discovered later on.
What is the definition of harm? What does that look like in an actual case, and what does it mean?
Though we do not counsel the ability to refer appropriately and know when to breech confidentiality is part of the job. "Harm" as it is referred to here is extreme bodily harm, rather than off handed sarcasm without reasonable likelihood of harmful follow through. A client should always be encouraged to seek help themselves, rather than acting behind their backs in any way
Principle IV - Responsibility to Society Meaning:
To be accountable to society and conduct ourselves in a manner that fosters and promotes high ethical standards.
Principle III - Integrity in Relationships Meaning
To practice with integrity, honesty and diligence in our professional relationships with ourselves, our clients, our professional colleagues and society.
Professional Commitment:
To serve the health, well-being and best interests of their clients, first and foremost at all times
Principle I -Respect For Persons Meaning:
To value the dignity and worth of all persons regardless of age, race, culture, creed, sexual identity, gender, ability and/or health status. Respect For Persons Meaning: To value the dignity and worth of all persons regardless of age, race, culture, creed, sexual identity, gender, ability and/or health status.
We protect our client's vulnerability by:
Treating them equally and fairly Not discriminating against them based on culture, ethnicity, age, able ness, sexual orientation, religion etc. Making our services available and accessible to them
When would you refuse a client for massage?
Uncontrolled hypertension
We demonstrate Respect for Persons when:
We maintain the therapeutic relationship We ensure our clients provide informed consent We protect our client's right to privacy and confidentiality
we must remember that although we are accountable to society we also possess a certain degree of personal and professional autonomy
We make our own individual decisions and choices We have rights as well as responsibilities Setting limits to our services Receiving appropriate remuneration for our work Ensuring that we are treated with respect by our clients
Legitimate process and purpose for collecting patient information
We must always ensure the questions we ask our client are relevant to their care, rather than our own needs
Consider the relevant ethical standard's and legal requirements Ask ourselves the following questions
What does our Standards of Practice have to say about this situation? Are there any applicable legal requirements? What does our Code of Ethics have to say about this situation? What do General Ethical Principles have to say about this situation?
Consultation Ask ourselves the following questions:
What is the most current professional thinking on this issue/dilemma? What would my profession expect of me in this situation? Consult with a colleague Consult with the College
Transference
When the client projects unto the therapist old feelings or attitudes that they had about significant people in their past (often parental figures)
Counter-Transference:
When the therapist projects unto the client old feelings or attitudes that they had about significant people in their past
Assess your proposed resolutions
________________________ for each of the alternatives for action you have generated
Spondylolisthesis
a forward displacement of one vertebra over another
correlation study
a quantitative method of research in which you have 2 or more quantitative variables from the same group of subjects, & you are trying to determine if there is a relationship (or covariation) between the 2 variables (a similarity between them, not a difference between their means)
Look up difference between ethical dilemma and ethical situation (ethical dilemma):
a situation poses a question of right or wrong where we have conflict of values
spasm
an involuntary, sustained contraction of a muscle
What is the triangular shaped muscle that is a weak elbow extensor located lateral to the olecranon process?
anconeus
phagocytes
are cells that protect the body by ingesting harmful foreign particles, bacteria, and dead or dying cells. Their name comes from the Greek phagein, "to eat" or "devour", and "-cyte", the suffix in biology denoting "cell",
Consent is not valid if the client has been
coerced, mislead or uninformed of consequences to getting or not getting treatment, or if their questions have not been answered.
What hydro to do for bursitis:
cold compress
What hydro to do for gout is appropriate;
cold donut or cool foot bath.
What is another term for the superior surface of the scapula where the biceps attach
corocoid process
frontal and parietal suture
coronal
Know the sutures: ie: frontal/parietal =
coronal suture
What tract sends info to cranial nerves:
corticobulbar tract
Which hormones play a key role in regulating long term stress?
cortisol, hGH, and thyroid hormone
Josey the RMT enjoys when Samantha comes in for treatment. Samantha is like the Grandmother she always wanted. Warm, supportive...Josey can tell Samantha anything, and Samantha always has positive words of support and guidance. The roles for therapist and client have become altered and Samantha's needs are not the focus for Josey, she instead is counting on receiving support, rather than being the supportive nurturer in the scenario; what is this
counter transference example
strabismus
crossed eyes
Spondylolysis
defect in the pars, or the arch of the vertebrae
ligament that anchors spinal cord horizontally
denticulate ligament
Ligament that anchors spinal cord horizontally:
denticulate ligaments
During which phase of clinical reasoning does the emphasis on education for home maintenance and self care increase?
discharge phase
ptosis
drooping eyelid
prodromal stage
early signs and symptoms malaise- not feeling well, headache, fever, upset stomach
Lymphatic drainage technique reduces:
edema and pain
what is not a sign of shock
elevated blood pressure
This substance is released in response to pain in order to control it.
endorphins
Taking an advanced taping course or any other ceu to:
ensure we remain competent.
A set of moral ideals that shape a person's or group's behavior can be defined as what? A. Ethics B. Philosophy C. Laws D. Human rights
ethics
sella turcica is located where
ethmoid bone
Ligamentum Flavum Supraspinous Interspinous all limit what motion
excessive flexion
pubofemoral will help prevent what
extension of hip
which muscle is not in the anterior compartment of the leg; tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis longus, fibularis tertius.
fibularis longus
ACTIONS of biceps femoris;
flex leg at knee joint extend thigh at hip; lat rotate flexed knee.
medial and lateral rotation of knee can only happen in what position
flexed
A hole in the septum between the heart's two upper chambers is called an atrial septal defect or
foramen ovale defect
Any change of information such as address, name or location must be submitted to the governing body within
fourteen (14) days of it taking effect
If a client is taking anti-inflammatories or blood thinners, it is contraindicated to perform: Rhythmic techniques Trigger point therapy Friction techniques Effleurage
frictions
Which of the following is an inexpensive way help to boost your business? A. Television commercial B. Highway billboard C. Gift cards D. Rent a small shop
gift cards
Confidentiality Statement
giving information about a client to any person except as required or allowed by law or except to facilitate diagnosis or treatment of a client is considered to be professional misconduct under the Professional Misconduct Regulations
selenium
has antioxidant properties and may help protect cells from damage. Most people get enough of this essential mineral from foods
If an athlete is showing symptoms of staggering, is incoherent, and not sweating, what could this indicate?
heat stroke
what part of gait affected by antalgic gait
heel strike
what does the iliolumbar ligament do
helps stabilize L5 with the ilium & to prevent anterior displacement of L5.
______, or a reduced amount of oxygen in the ischemic tissue, might damage the muscle cell membrane
hypoxia
what ligament is considered to be the strongest ligament in the body?
iliofemoral ligament (prevents excessive extension and limits anterior rotation
An important ligament unique to the lumbar spine & pelvis is the________________________ , which connects the transverse process of L5 to the posterior ilium.
iliolumbar ligament
To locate lateral epicondyle of femur you must palpate deep to what structure
iliotibial tract
The hip, already a stable articulation because of its bony configuration, & support from strong muscles, is further supported by 3 strong ligaments
ilitofemoral pubofemoral ishiofemoral
Tax records should ideally be kept for how long? A. 10 years B. 1 year C. Indefinitely D. 5 years
indefinately
how would you passively position the foot to shorten the surrounding tissue of the medial malleolar groove.
invert the foot
A prolonged deficiency in _______ may cause an enlarged thyroid or weight gain.
iodine
weakest of the 3 strong ligaments in the acetabulofemoral joint.
ishiofemoral ligament
IS THERE an age limit to consent?
it has nothing to do with age, it is based on mental capacity to understand risks and side affects relating to treatment or lack of treatment. Also, consent is not valid if the client is mentally unable to understand the information being presented.
The best way we can ensure we maintain the trust and confidence of the public is by acting with integrity when performing our responsibilities and obligation. Integrity includes ;
sincerity, honesty, respect, responsibility and diligence. Not just when it`s convenient, when we agree, will make us money or derive benefit in some way, but consistently, even when it`s ill-timed or awkward. When we act with integrity, we recognize and honor the best part of humanity. Good will, sincere intent and genuine caring for those entrusted to our care
What would you concentrate on doing with a client that has scoliosis?
strengthen weak muscles and stretch shortened muscles
Injured bursae to knee....located anterior to patella:
subcutaneous prepatelar bursa
What muscle increases external rotation:
subscapularis and teres major
what is the name of the veins that carry blood back to the heart
superior and inferior vena cava
bone that articulates with the tibia and fibula
talus
All mm: (masseter, lat and med pterygoid) movement moves mandible except:
temporalis mm
Hip pain tends to be in the groin & anterior thigh, although it may be referred to
the knee (usually medial side). The hip can later be ruled out in the examination by the absence of a capsular pattern.
LUMBAR Facet joint & disc articulations are considered to be what?
the motion segments of the lumbar spine.
Ontarians with Disabilities Act (ODA) 2005
the new law, Ontarians with Disabilities Act (ODA), demands a higher standard of accessibility. This goes beyond the accessible washrooms one might bring to mind. Have you considered the needs outside of physical impairment? What about mental impairment? What about mood disorders like anxiety. Did you know service animals are more than just dogs?
What muscle would you have your client contract if they get a cramp in their gastrocnemius?
tibialis anterior
which tendon could you follow along the dorsal surface of the ankle to locate the medial cunieform
tibialis anterior tendon
The muscle that is an antagonist to both actions of the tibialis anterior is
tibialis posterior
how would you passively position the foot to best locate the trochlea of the talus
to best locate the trochlea of the talus invert and plantar flex
cross section study
transversal study, prevalence study) is a type of observational study that analyzes data collected from a population, or a representative subset, at a specific point in time
Mechanical effects of massage are caused by compression, tension, shearing or bending tissues. True or False?
true
Hand washing is the single most important procedure for preventing nosocomial infections (Nosocomial = acquired or occurring in a hospital). Hand washing is defined as a
vigorous, brief rubbing together of all surfaces of lathered hands. Followed by rinsing under a stream of water. Although various products are available, hand washing can be classified simply by weather plain soap or detergents (in bar, granular, leaflet, or liquid form) suspends microorganisms and allows them to be rinsed off; this process is often referred to as mechanical removal.
