resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Collaboration for a Cause
The Patient Protection and Affordable Care Act strongly encourages the formation of multidisciplinary practitioner teams called Patient Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
Monoculture of the Mind: Part II
Cases are built within boundaries. Such bounds may be a program, event, activity or individuals. In this instance, a medical case has boundaries that include clinical interactions that are comprised of history, signs, symptoms, diagnoses, treatment plans and treatments.
Epigenetics: The Western Science Supporting Essence
Since the days of Darwin, western medicine has touted that our genes were set in stone, that our genetics were our destiny. We were told that the diseases that ran in our family were likely coming to us as well.
Why DCs Need to Understand the Principles of "Inclusive Design"
In the past few columns, I've written about the negative effects of prolonged sitting at work. I've attempted to make the point that prolonged sitting (or prolonged standing) takes a toll on workers. Now let's discuss a related issue: the concept of "inclusive design."
Green Tea Catechins Lower PSA, Other Biomarkers in Men With Localized Prostate Cancer
A 2006 study (Cancer Research) was the first human investigation to show that green tea catechins (GTC) are highly effective in reversing premalignant prostate lesions (high-grade prostate intra-epithelial neoplasia), an established precursor to prostate cancer.
Successful Strategies in Integrating Acupuncture and Shiatsu in a Hospital Oncology Program
Colleagues from the Network of Researchers in Public Health in CAM recently published an article of interest to our Traditional Asian Medicine community.
Get That Shoulder to Move: Restoring Internal Rotation
How many times have you mobilized, performed ART, Graston, FAKTR and PIR, and stripped a patient's posterior capsule, yet on re-exam, discovered it was still blocked?
Resilience is the New Longevity
Sometimes we must enter a room through one door and not another, even though they both lead into the same space. I am talking now of the recent cachet with the concept of "resilience" regarding health, chronic pain and longevity.
What is a Discipline in Medicine?
In my now prolonged dialogue with physicians, one question emerges with enough regularity to deserve mention and naming: what is a discipline?
Are You Guilty of Paternalism in Your Approach to Patient Care?
Einstein is purported to have said, "When a man sits with a pretty girl for an hour, it seems like a minute. But let him sit on a hot stove for a minute and it's longer than any hour. That's relativity." In some way, everything is relative to one's point of view.
The Healing Properties of Light: An Interview With Researcher Anna Cocliovo
This interview is with Anna Cocliovo, a light researcher and Acupuncturist in Arizona. During my own research in light, I came across the article she published for the American Journal of Acupuncture and sought her out as a result.
Creating Child-Friendly Clinics with ABT
The Zurich Dojo was scattered with toy ducks, dolls, trains, exercise balls and teddy bears during my recent pediatric workshop.
News in Brief
Hamm Elected New President of the ACA; WFC / ACC 2014 Education Conference: Call for Papers; F4CP Recognizes Standard Process as $1 Million Supporter; Texas Chiro. College Begins Search for New President; League of Chiropractic Women Hosts Women's Success Summit.
AAAOM – Making Promises They Can't Keep
When the AAAOM first formed in 2007, their mission was clear: to support the profession through education, resources and legislative advocacy. The first years of the organization were filled with promise and hope.
One and Done: Keeping Patients From Vanishing After Just One Appointment
What happened to my 3:30 p.m. ROF? They may have rescheduled, but there are two common answers no one wants to hear: 1) "She called to cancel. I tried to get her to reschedule, but she refused." 2) "She no-showed.
Stress in the Modern Age: Impact on Homeostasis and What You Can Do (Part 1)
In 1926, Hans Selye first used the word stress in a biological context, referring to the nonspecific response of the body to any demand placed upon it.
Flexion-Intolerant Lower Back Pain (Pt. 3): Mobilization & Soft-Tissue Treatment
What is the biggest challenge to the chiropractor in treating discogenic pain? You have to completely reframe the purpose of your manipulation. It is rarely about unlocking a stuck segment at the disc involvement level; it is not about putting a joint back in alignment.
Steven Rosenblatt: Birthing A Cross-Cultural Acupuncture Profession
The existence of a cross-cultural acupuncture profession in the United States, one that is legalized, licensed, supported by formalized, academic training and inclusive of non-Asian practitioners, is an important part of the medical landscape in this country and is responsible for improving the lives of hundreds of thousands of Americans.
Chiropractic Prevents ADHD? Research Shows...
Now that I have your attention, let me tell you what the latest study actually states. As you may have noticed, research over the past few years has begun to reveal that acetaminophen (the primary ingredient in Tylenol) is not as safe as once thought.
AAAOM – The Beginning of the End (Part II)
In 2012, the AAAOM board members met in Chicago for their annual meeting. The goal was to come to a consensus on a long list of issues the AAAOM needed to work on including a functional board and budget.
Risk Factors for Heel Problems
Heel pain and gait disability are common occurrences in adults, often the result of thinning heel pads and a lifetime of exposure to heel-strike shock. One condition experienced by many people is plantar fasciitis.
April, 2005, Vol. 05, Issue 04
How Should We Teach Assessment?
By Whitney Lowe, LMT
Musculoskeletal disorders (MSDs) are some of the most commonly occurring causes of pain and disability in this country. They are treated by a wide variety of practitioners, and many people with them seek the care of someone other than a physician.Consequently, massage therapy is frequently used to address this wide array of pain and injury problems.
Proper treatment of any MSD begins with identifying the underlying problem. It is only then that we can determine if we should even be working on this client. If the practitioner has determined that a MSD exists for which massage treatment would be helpful, s/he must then determine which techniques or approaches to use with the client that should be helpful. The way to make this determination is through proper and accurate assessment.
Information may be gathered in many different forms, systems or structures yet they all have several elements in common. A thorough assessment includes detailed information from the client history, observable characteristics of the client and his/her condition, as well as specific methods of physical examination.
Some practitioners shy away from any organized framework for their assessment process, stating instead that intuition guides them. Others may state they do assessment solely through what they feel in their hands. While these are very important skills and may work well for basic relaxation massage approaches, they don't provide information necessary to make appropriate clinical decisions about treating MSDs. If I had an illness or injury and went to see a physician, I wouldn't want that doctor to evaluate me based on intuition or palpation alone. Likewise, many MSDs are complex and we must engage in a more comprehensive process when evaluating them.
There are some misconceptions about what assessment entails. Some feel it is just evaluating a client's range of motion. Evaluating range of motion is important, but you must know more than your client has a limitation in a certain motion, such as abduction of the shoulder. You must do what you can to find out why that limitation exists. Others state that assessment is mainly the use of special orthopedic tests like the Phalen's test for evaluating carpal tunnel syndrome. Memorization and use of various orthopedic tests is helpful, but only when used in their proper contexts. Simply memorizing these tests does not make you effective at assessment any more than memorizing the alphabet makes you a writer.
Assessment and Learning Theory
Learning theorists have developed classifications of how we learn that describe increasing levels of complexity. One of the most common classifications still used today is Bloom's Taxonomy of Educational Objectives, first published in the mid-1950s. In this classification, Bloom and his colleagues described six levels of increasing cognitive complexity: knowledge, comprehension, application, analysis, synthesis and evaluation.
The lowest levels, knowledge and comprehension, involve rote memorization. While memorization has its usefulness, it should not be the primary goal of our educational objectives. Unfortunately, most educational environments do not go past this level and assume that "learning" has occurred because an individual is able to achieve a specific score on a test that emphasizes rote memorization and, too often, little else.
The problem with this approach is that it doesn't reflect clinical reality at all. In the clinic room, the practitioner is faced with situations where memorization of facts still leaves you pondering as to what your client's primary complaint really is. In order to get past this point you must use the higher levels of the taxonomy - analysis, synthesis and evaluation. These abilities are developed through practical application of clinical reasoning activities in the learning process. Assessment is a complex procedure of clinical reasoning that has to use these higher cognitive functions in order to be even minimally effective.
Consequently, if we want to teach assessment skills in the way they will be eventually used in practice, we have to radically alter the way they are initially presented. In order to do this we have to get away from trying to have students find the "right" answer all the time. In many cases there isn't one "right" answer. There are several different paths and they each take us in different directions that may produce a good clinical reasoning process. Therefore, to accomplish this goal we must create educational activities that encourage a degree of cognitive uncertainty and encourage the practitioner to go through the reasoning process to figure a problem out. It is only through this kind of practice that these skills are developed.
So, when learning assessment, don't get stuck on trying to memorize a large group of special orthopedic tests or performing range-of-motion evaluations and call that your assessment. You must look at the entire picture of gathering information from the client's story and physical examination, process the importance of what you have found out, and construct a model for explaining your findings. When you can do this, you have moved into the higher levels of cognitive complexity, used advanced assessment strategies, and performed a much more thorough service in seeking care for your clients.
Click here for more information about Whitney Lowe, LMT.
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