Stoke

Stroke is the second single largest killer in New Zealand with more than 2000 people every year, (NZ Heart and Stroke Foundation, 2007).

Etiology:

According to the Heart and Stroke Foundation a stroke is defined as a sudden loss of brain function; a stroke occurs when brain cells die from oxygen deprivation, oxygen deprivation occurs if blood flow to the brain is blocked by a clot or vessels are damaged, without oxygen brain cells cannot function.

There are two types of Stroke:

Hemorrhagic: A Hemorrhagic stroke occurs when the blood vessels in the brain burst due to high blood pressure, artherosclerosis and congenital malformation. A burst vessel causes bleeding into the brain and increased blood flow into the damaged vessel, blood build up increases pressure in the brain damaging nerve cells and collapsing smaller blood cells.
Ischemic: Occurs when blood flow through the crucial blood vessels is blocked by a blood clot or plaque.


Pathogenesis (Signs and Symptoms):
The human brain is divided into regions. Each region controls different movements, senses, or intellectual functions (Fritz, 2004). Therefore, the effects of a stroke depend on which region of the brain is damaged. Fatigue will be an effect of any stroke, and different types of stroke can also cause similar damage.

The effects of a stroke depending on where the damage has occurred to the brain can vary for each patient.

Physical effects include: Weakness, paralysis, movement limitations, pain, fatigue and interruptions to sleeping patterns.
Strokes can also severely effect patients emotionally: Anxiety and depression are a common repercussion of a stroke.
Thinking, speech and memory difficulties can effect the patient mentally.

The American Stroke Association has identified several stroke warning signs. Someone having a stroke may not experience all of the warning signs and warning signs can come and go. Symptoms of stroke depend on the type and which area of the brain is effected. Signs of ischemic stroke usually occur suddenly, and signs of hemorrhagic stroke usually develop gradually (Chandrasoma & Taylor, 1997, p.929).

Symptoms of a stroke include:

• Immediate numbness or weakness of the face, arm, or leg, especially on one side of the body.
• Immediate confusion, difficulty speaking or understanding.
• Difficulty seeing in one or both eyes suddenly.
• Sudden difficulty walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.
• Paralysis on one side of the body.
• Speech problems may occur as a result of ischemic stroke.
  

Complications that may develop gradually as a result of immobility caused by stroke include the following:

• Blood clots.
• Bedsores.
• Fibrosis of connective tissue resulting in decreased mobility.
• Malnutrition.
• Pneumonia.
• Urinary tract infections.

Treatment :

Treatment for strokes usually involves Rehabilitation which includes physical therapy, speech therapy, and occupational therapy. Physical therapy involves using exercise and other physical means (e.g., massage, heat) to help patients regain the use of their arms and legs and prevent muscle stiffness in patients with permanent paralysis.
Your aim as a massage therapist should be to: help relax, ease pain, and comfort the person who has had a stroke with Massage. Massage therapy can also help to increase circulation to areas that are in need of more nutrients and blood flow and massage can also promote the release of endorphins that can help in pain control.

Treatment indications and contradictions for massage.

Aim:

• Prevent joint stiffness.
• Promote relaxation.
• Reduce pain.
• Decrease muscle spasticity.
  

Massage Guidelines:

• Massage strokes should be slow, soothing, and superficial.
• Joint mobilisations and passive stretching should be done within clients’ tolerance and not forced.
• The first few treatments should be brief (30mins max), a couple of times a week so you don’t tire the patient.
• Make sure the client is well supported and comfortable through out the session.
• Deep pressure massage is not recommended, due to pain relief they may not have an adequate pain tolerance.
• Check-in with their physician about their treatment.
• Refer to appropriate health care practitioners for diet and lifestyle modifications and treatment of underlying conditions .i.e. blood pressure, quit smoking, nutrition.
• May be on blood thinner medications.

Cause and prevention are often closely linked. A combination of factors that have been present or developing for a long period of time can contribute to a stroke. If someone has two or more of the risk factors below, stroke risk can be dramatically increased.

Controllable stroke risk factors:

• Check blood pressure
• Stop smoking
• Exercise regularly
• Limit alcohol intake
• Eat a healthy diet and reduce salt intake
• Lower cholesterol
• Control weight

Anyone who is high risk you should encourage to see their doctor, who will usually assess each risk factor for stroke (and heart disease) before deciding on necessary treatments.

Prevalence: Approximately 70% of ischemic stroke patients are able to regain their independence and 10% recover almost completely. Approximately 25% of patients die as a result of the stroke. The location of a hemorrhagic stroke is an important factor in the outcome, and this type generally has a worse prognosis than ischemic stroke.
More than 30% of stroke patients require assistance with daily living and approximately 15% require care in an assisted-living facility (e.g. nursing home, rehabilitation centre). Approximately 20% of stroke patients require help walking (e.g., cane, walker) and as many as 33% suffer from depression.

Incidence: Stroke affects all ages. In New Zealand each year, 40 stroke victims will be children and nearly 2,000 (a quarter of all strokes) will be under retirement age.

References:

Carlson, S. (2006). Massage for Stroke Patients. Retrieved August, 2nd 2009, from http://massagetherapy.suite101.com/article.cfm/massage_for_stroke_patients

Dr. Premkumar, K. (1959). Pathology A to Z: A handbook for massage therapists (2nd Ed.). Canada: VanPub Books.

Frtiz, S. (2004). Mosby’s Fundamentals of Therapeutic massage (3rd Ed.). Missouri: Mosby.

New Zealand Stroke Foundation Inc, (2007). Retrieved August, 7th 2009, from www.stroke.org.nz

Salvo, S, G. (2008). Mosby’s Pathology for Massage Therapists (2nd Ed.). Elsevier Health Science.

Chandrasome, P, Taylor, C R (1997). Concise Pathology. Michigan: Appleton & Lange.

Treaty of Waitangi.

Explain the meaning of title articles of the treaty of Waitangi, their historical context and their significance to health practice in New Zealand.

The Treaty of Waitangi 1840The English version of the treaty was broken up into three articles in relation to who had sovereignty, property rights and protection from the queen, signing this version authorized English to take away all rights from Maori because their version was translated to give Maori the impression that the queen would become second to the chiefs power (rangitiratanga) granting Maori the same rights as British citizens, giving them protection from the arriving farmers/sealers and settlers.

Principles of the Treaty.
Protection/Partnership and Participation, Governance, Authority, Equity and Respect incorporated into a Massage practice.

As a therapist I have to ensure my key responsibility is to the client and understanding my role as a massage therapist to treat with respect and privacy while dealing with their health and well-being. Although this I feel is common sense and persistent with all clients. Authority is specified in equal measures to both client and therapist, written consent does not take away the right for unequal partnership and by creating a treatment programme with the clients input it will certify meeting their individual needs and the programmes effectiveness with overall greater results long term. To obtain equity within your practise each clientele should be treated as an individual and their healthcare programme should be tailored to their pain / expectations or injuries. Being respectful of client needs and beliefs including respecting their privacy and previous treatment from other professionals they have sought before you. Information can be sought by opening pathways of communication to allow your client to relax in your work environment, therefore if you do not understand certain elements to ones religion/ culture or beliefs, ask respectively.


Hauora = Health “your breath that’s the source of your life”.

Mason Durie’s replica of health promotion is founded on the Southern Cross constellation. The six stars represent key values of total health.

Healthy lifestyles- Improve the well-being and health of the client.

Cultural identity - Client is able to freely express their concerns and beliefs without judgement, and support of a family member is welcome.

Environment- Providing a space that is culturally sensitive and supports different cultures and has the total health of the client within focus.

Society- Participation with their treatment is encouraged and sought after.

Leadership- Management of oneself to maintain a healthy lifestyle.

Autonomy- Control and self governance of their jointly created care plan.




References:

Bachelor of Midwifery/Diploma in Massage Therapy; Treaty Workshop. May 18th 2009.

Durie,M.(1998). Whaiora: Maori health development(pp.69-74). Auckland, New Zealand: Oxford University Press.

My Own Thoughts.

Pathology Report on Rheumatoid Arthritis.



Rheumatoid Arthritis (RA) is a chronic systematic disease believed to be related to an antigen-antibody reaction that effects the joints of the body leaving them crippled and disfigured. The use of massage can be an important part of the prevention strategy of dealing with RA, which is considered the most severe type of joint inflammatory disease. (Donald W. Scheumann).


Etiology:
The Etiology of rheumatoid Arthritis is not fully understood, evidence however points towards a complex interaction between environmental (e.g. viral infections) and genetic factors. Risk factors believed to increase your chance of RA are:
- Female have a 2-3 times greater chance of developing RA than men.
- Positive family history of RA.
- Older age.
- Smoking.


Pathogenesis (Signs and Symptoms):
Early stage Rheumatoid Arthritis patients initially experience symptoms at just one location or a few widely spread sites, surfacing over weeks to months with signs of weakness or fatigue in the joint common. Joints more commonly effected by Rheumatoid Arthritis are those with a high ratio of synovium: articular cartilage. RA usually effects joints both sides equally and common joints are the wrists, metacarpals, interphalangeals, knees, ankles and toes, (Harris ED) but RA can also effect the hips, shoulders, cervical spine, TMJ, and sometimes small bones of the larynx causing hoarseness or narrowing of the airways. Rheumatoid joints are typically tingly, tender to the touch, and warm. Some patients complain of "puffy" hands resulting from increased blood flow to inflamed areas.


Treatment:
Once existence of RA has been confirmed your goals of treatment should be to:
- Reduce pain
- Limit inflammation
- Halt joint damage
- Improve function


RA is characterised by periods of painful, inflammatory flare-ups (acute phase) and remission (sub-acute phase).

ACUTE PHASE

Massage Caution:
- Massage is best avoided in its acute (flare) phase. RA is an inflammatory condition caused by agents in the circulatory system, anything that increases circulation also increases the risk that the disease may spread to other joints in the body. Massage is therefore contradicted during these flare-ups.

SUB-ACUTE PHASE
Massage is significant in the sub-acute remission stages of RA to encourage local circulation to improve mobility and aid the relaxation of muscle tissue to reduce stress that soft tissue surrounding the joints can trigger (Fritz, S.). During remission chronic pain presents both from physiological and psychological causes, the physiological from weight bearing on the effected joints and the psychological due to stress, anxiety and depression experienced after loss of normal function therefore massage is useful to clients for reduction of pain and stress management. (Charles C. Tuchtan…etc).

Massage Caution:
- Clients may be taking analgesic or anti-inflammatory medication that reduces sensitivity and masks pain. (Premkumar, K.).
- Surrounding muscles and tendons become stressed and tight from chronic pain making joints become stiff rather than inflamed.


Prevalence:
World wide Rheumatoid effects about 1% of the world’s population.

Incidence:
- Worldwide the annual incidence of RA is approximately 3 cases per 10,000
- 2-3 times greater chance of having rheumatoid arthritis if you are female with its most pronounced in patients under the age of 50 years old.
- About 1 in 10 RA patients will experience severe joint damage due to cartilage and bone decay, if left untreated permanent disfigurement can result.
- 10-20% of RA patients the disease goes into remission in the early stages or never develops beyond a mild case.
- Onset may be at any age, most often between 35 yr and 50 yrs of age.



References:

1) Charles C. Tuchtan, Vicki M. Tuchtan, David Stelfox. (2003). Foundations of Massage. (2nd Edition). (Pg 153). Australia: Elsevier Australia. 2)Donald W. Scheumann. (2006). The Balanced Body. (3rd Edition). (Pg 105). Philadelphia: Lippincott Williams & Wilkins.
3)Fritz, S. (2005). Sports & exercise massage. Missouri: Mosby.
4)Harris ED (2005). Clinical features of rheumatoid arthritis. Harris ED, Kelley WN. Kelley's Textbook of rheumatology. (7th Edition). Philadelphia: WB Saunders.
5)Premkumar, K. (2000). Pathology A to Z – A handbook for massage therapists (2nd Edition). Philadelphia: Lippincott Williams & Wilkins.
6)Saag KG, Cerhan JR, Kolluri S. (1997) Cigarette smoking and rheumatoid arthritis severity.

Pathology of the Tennis Elbow

Etiology- “cause of disease”
Tennis elbow is caused by chronic stress on tissues of the forearm extensor muscles attaching to the elbow. Many different causes include:

• improper backhand stroke


• weak shoulder and wrist muscles


• using a too tightly strung or too short tennis racket


• hitting the ball off centre on the racket or hitting heavy, wet balls


• overuse of hand tools


• heavy lifting


• occupations that require strenuous or repetitive forearm movement
  

Also known as Lateral epicondylitis, tennis elbow is extremely common in today's active society. (Medscape, 2009).

Pathogenesis – “what happens from that disease?”
Sandy Fritz explains that pain and tenderness to the elbow is felt when gripping or rotating the wrist and forearms which is common at the start. Stress is then created at the muscle origin which evidently causes microscopic tears that lead to the inflammation of several structures of the elbow including muscles, tendons, bursa, and periosteum. Pain is felt when gripping or rotating the wrist and forearm.




Morphological / Histological – “Changes within the tissues”
The early Morphological and Histological damage consists of small tears in the connective tissue that hold the extensor muscles to the bone, tissue become prone to repeated tearing and become irritated which causes inflammation and swelling. The consequential pressure is capable of cutting off the blood flow and even pinching the radial nerve that controls the arm and hand.


Epidemiology
Incidence
The annual incidence of tennis elbow in general practice is 4-7 cases per 1000 patients, with a peak in patients 35-54 years of age. The peak incidence is between 40 and 50 years of age. (Tidy, 2007).
The risk of overuse injury is increased 2-3 times in players who play more than 2 hours per week and 2-4 times in players older than 40 years. (Medscape, 1994 – 2009)

Prevalence Roetert (1995) noted lateral epicondylitis effects 40-50% of recreational tennis players.

References.

Medscape (1994 – 2009). Etiology of Tennis Elbow. Retrieved March 29th 2009 from http://emedicine.medscape.com/article.

Premkumar,K. (2000).Pathology A to Z- a Handbook for massage Therapists.(2nd edition). Canada; VanPub Books.

Roetert, E. (1995). The biomechanics of tennis elbow: An integrated approach. Clinics in Sports Medicine vol 14 pg 47-57.

Tidy, Dr C. (2007). Epidemiology of the tennis elbow. Retrieved March 30th 2009 from http://www.patient.co.uk/

Introduction to the research process.

The research process generally follows a scientific method that requires identifying a problem then developing a hypothesis or set of questions you would like to answer, this being the basis of your research. This blog describes and expands each step of the research process from start to finish and explains why they are important in developing a simple idea.

The layout for a research paper includes a statement question at the start of the paper, (your hypothesis), then broken up into precise paragraphs of your findings from your research. This would lead into your last paragraph being your conclusion where you summarise all findings and ultimately answer your hypothesis. All academic research papers require that all resources and authors be cited in a reference page at the end.

Initially, you need to discover a knowledge gap, research problem or an idea you think still needs to be explored. By using methods like brainstorming and mind mapping you effectively narrow the idea down to a single hypothesis, stating what will be researched and explaining the purpose of gaining value and significance to enhance your field of interest. The success of all research is about finding an answer to your question or hypothesis; whether it is proved right or wrong - it is still an answer. “Without a question, research has no focus, drive or purpose” (J Hammel, 2009).

The next step is to locate a high level of quality literature significant to your hypothesis this will find out what authenticated researchers and scholars have already discovered and documented about the subject matter. These resources will identify key concepts and further examine what is known about your chosen area of research. Ultimately your final review of the chosen literature will highlight the significant theories and should contain some scientific basis for their research.

Next step is to use Methodology, because during the research process there are set procedures and stages which need to be followed in the same order to keep your research process systematic, and to ensure you get the most truthful outcome. Research is an organised and planned process. By having structure or methods, to which it is focused and restricted to a specific scope, research is a valuable tool for any massage therapist.





















References.


Introduction to Research, (F. Molloy, personal communication, March 2nd, 2009).

The Research Process, J Hammel, personal communication, March 4th, 2009).

Hi im Kath, i am currently living in Timaru at the moment

and studying Massage Therapy in Dunedin. I like doing anything to do with snow water or speed.


I currently have a small clinic in Timaru and work at a local pub while studying that keeps me busy.