ABMP: Special Populations

Clients Over 55

Terminology

Aging - The physical process of growing older. In that process, every body system is affected—the epidermis of the skin becomes thinner and less elastic, cardiac output decreases and blood pressure increases as arteriosclerosis often develops. Strength decline, due to loss of muscle cells, comes with a decrease of general mobility; there is slower nerve conduction, decreased circulation and lymph flow, decreased immunity, loss of flexibility, degenerative changes to joints as bone mass decreases, and impaired lung capacity, among others.

Alzheimer's Disease - A progressive degenerative disorder of the brain involving the death of neural tissue that leads to loss of memory, deterioration of thinking and language skills, and pronounced behavioral changes.

Benefits of massage for older adults - Massage for older adults demonstrates many positive benefits including increased appetite, improved local circulation to the skin, improved digestion and elimination, increased flexibility, improved immune function, reduced muscle tension, pain reduction, improved skin condition, improved sleep quality, and decreased stress. Massage also provides a means of social contact for people who may be dealing with the loss of lifelong friends or a spouse, or feelings of isolation resulting from decreased mobility.

Decubitus ulcers - A type of ulcer caused by impaired circulation to the skin that appears as an open wound that is vulnerable to infection. They are commonly called bedsores and are locally contraindicated.

Dementia - A group of symptoms caused by the gradual death of brain cells resulting in the loss of mental ability severe enough to interfere with normal activities of daily living. It leads to memory impairment, loss of reasoning and planning ability, and marked changes in behavior. The most common cause is Alzheimer's disease but a variety of other conditions, including head trauma, are also causes.

Frail - A state of physical and/or mental delicacy or weakness that interferes with the ability to independently perform activities of daily living.

Level of vitality in older adults - A state of physical and/or mental delicacy or weakness that interferes with the ability to independently perform activities of daily living.

Massage cautions for older adults - A massage for an older adult will be based on the individual client's level of vitality and health. Healthy, robust, older adults should receive the same type of massage as any middle-aged client. Clients who are frail and in a weakened condition will require massage adaptations. Use a thorough health history intake process to gather a complete picture of the client's health. Obtain a physician's release for older adults who demonstrate decreased physiological or psychological function due to aging. Typically, frail clients cannot tolerate long sessions and do better with shorter timeframes. Also, be ready to assist an older client at all times before, during, and after the session by helping them exit or enter a car, open a heavy entrance door, or get on and off the massage table.

Older adult - The term preferred by health-care providers to describe patients/clients who are 60 years of age and older. The term has replaced the use of the terms "senior citizen" and "geriatric," because these terms have negative connotations for many people. The term "elderly" is sometimes used to indicate a person of advancing age who is frail.

Orthostatic Hypotension - The sudden drop in blood pressure an older adult might experience upon moving from a reclining position to a seated or standing position; also called postural hypotension. Position the client in a seated position for the last 5 minutes of the session if orthostatic hypotension is an issue.

Parkinson's Disease - A progressive neurologic disease caused by degeneration of the brain's basal ganglia and low production of the neurotransmitter dopamine. It is characterized by an inexpressive face, tremors, slow movements, a gait with shortened steps, postural changes, difficulty with balance, decreased coordination, and muscle weakness.

Stroke/ Cerebrovascular accident (CVA) - A condition that results in a loss of brain function due to a disturbance in the blood supply to the brain, most often caused by a blockage (e.g., blood clot) or internal hemorrhage. As a result, the affected area of the brain cannot function normally, which may result in an inability to move one or more limbs on one side of the body, failure to understand or formulate speech, or a visual impairment.

Vigor - A state of physical and mental strength, energy, and force.

Vitality - The condition of being alive; the characteristic, principle, or force that distinguishes living things from nonliving things.

Practice Quiz

1. You begin working with an 82-year-old client who is moderately frail, has significant hearing loss, and prefers to have her primary caregiver present for her session. Which of the following statements is accurate regarding client communication during the intake process?

a. When a client's hearing prevents communication, it is best to determine she is too vulnerable to receive message

b. It is important to speak directly to the client even if her caregiver is offering input during the client intake process

c. The most significant details of the massage session should be communicated directly to the caregiver rather than the client

d. Since the client can't hear well, it is best to communicate in writing

2. As people age, the body experiences:

a. increased circulation and lymph flow

b. the same level of circulation and lymph flow

c. erratic levels of circulation and lymph flow

d. decreased circulation and lymph flow

3. When interacting with older adults remember to:

a. Obtain a health history form, but avoid a health intake interview if the client has hearing loss

b. Speak to attending family members if the client seems too frail to answer health questions easily

c. Face the client and speak clearly, as many older adults experience some hearing loss

d. Obtain a health history form and physician's release but avoid a health intake interview if the client seem too frail to answer health questions easily

4. As people age, arteriosclerosis:

a. often decreases

b. often develops

c. often disappears

d. often causes scar tissue

5. As people age, lean body mass and strength:

a. become erratic with good/ bad days

b. remain stable unless hormonal imbalances are present

c. decline due to loss and atrophy of muscle cells

d. increase due to increased myocell production

6. All of the following are benefits of massage for older adults, EXCEPT:

a. decreased pain

b. increased flexibility

c. increased sleep quality

d. decreased osteoporosis

7. Orthostatic hypotension is caused by:

a. moving from a seated or standing position to a reclining position

b. deep massage work on frail blood vessels

c. moving from a reclining position to a seated or standing position

d. deep massage work on arthritic joints

8. In older adults, functional changes in the gastrointestinal system lead to:

a. decreased circulation and lymph flow

b. decreased elasticity and tone in fascial skin

c. digestive and elimination issues

d. decreased lung capacity and vital function

9. As people age, cardiac output:

a. remains stable

b. increases

c. becomes erratic

d. decreases

10. When providing massage to older adults, it is important to remember that:

a. Most older adults do not require modification or adaptations to massage application

b. Every older adult experiences health-related conditions that require the massage be adapted so that it is lighter and less vigorous

c. Most older adults are on medications that require significant adaptations in the massage application

d. Every older adult is unique and the depth and vigor of the massage is based on the client's individual level of health and vitality

11. One way to prevent safety issues caused by orthostatic hypotension is to:

a. position the client in a supine position for the last 5 minutes of the session

b. position the client in a seated position for the last 5 minutes of the session

c. position the client in a side-lying position for the last 5 minutes of the session

d. position the client in a prone position for the last 5 minutes of the session

12. As people age, the epidermis of the skin is affected, leading to:

a. thinner, more fragile skin

b. adhered muscle fibers

c. tougher, denser skin

d. increased scar tissue production

13. In older adults, lung capacity:

a. decreases

b. remains stable

c. becomes erratic

d. increases

14. As people age, general mobility:

a. decreases

b. increases

c. becomes unstable

d. remains stable

15. If the client's skin is frail and delicate, avoid techniques like:

a. effleurage strokes

b. facial massage

c. myofascial release

d. relaxation massage

Practice Quiz answer key

1. B

2. D

3. C

4. B

5. C

6. D

7. C

8. C

9. D

10. D

11. B

12. A

13. A

14. A

15. C

Clients who are Obese

Terminology

Adipose Tissue - Body fat; a loose connective tissue composed mostly of adipocytes. Its main role is to store energy in the form of lipids, to cushion structures, and to insulate the body. Practitioners must be cautious when working with areas where adipose deposits are particularly excessive because this tissue tends to be highly vascular and may be prone to bruising. For this reason, when providing massage to clients who are obese, avoid pushing through adipose tissue to access muscle.

Back pain (related to obesity) - The experience of pain in the low-back region is related to many conditions including pathologies of the bony spine, discs between the vertebrae, and ligaments around the spine and discs, as well as regional inflammation, spinal cord and nerve conditions, muscular conditions, and conditions of the pelvis or abdominal area. Back pain is one of the top 10 conditions associated with obesity.

Benefits of massage for obesity - Definition

Massage benefits people who are obese by helping them overcome common challenges related to the physical and psychological stresses that accompany this condition by reducing muscle soreness, joint pain, fascial restrictions, and hypertonicities, and by addressing postural shifts that occur with extra body mass. Massage supports improved breathing and sleep patterns and helps reduce stress. Clients also benefit psychologically from the social contact provided by massage.

Body composition - The ratio of fat to lean body mass. It is calculated based on the weight and height of an individual and is commonly determined using a body mass index.

Body fat - The amount of adipose tissue in an individual body; the percentage of a person's body that is not composed of water, muscle, bone, and vital organs.

Body mass index - A key for relating weight to height in order to determine if a person is a healthy weight. The formula measures a person's weight in kilograms, divided by his or her height in meters squared.

Cancerous diseases (related to obesity) - A group of diseases (e.g., skin cancer, liver cancer, etc.) caused by normal cells mutating and replicating uncontrollably. Obesity increases a person's risk to develop cancer.

Coronary artery disease (related to obesity) - A condition where one or more arteries that supply blood to the heart are impeded or blocked. The primary cause is atherosclerosis. Symptoms include chest pain, angina pectoris, heart attack, and sudden death. Coronary artery disease is one of the top 10 pathologies associated with obesity.

Diabetes mellitus (related to obesity) - Commonly called type 2 diabetes, this condition develops when the pancreas no longer produces enough insulin, or cells stop responding to the insulin that is produced. Glucose in the blood can't be absorbed into the cells of the body, eventually causing serious health complications if not treated and managed. Type 2 diabetes is one of the top 10 pathologies associated with obesity.

Gallstones (related to obesity) - A solid, crystal deposit that forms in the gallbladder. It can migrate to other parts of the digestive tract and cause severe pain with life-threatening complications. Gallstones are one of the top 10 pathologies associated with obesity.

Genetic predisposition - Inherited tendencies or inclinations that make a person more susceptible to health problems.

High cholesterol (related to obesity) - When the combination of low-density lipoprotein (LDL) "bad" cholesterol and high-density lipoprotein (HDL) "good" cholesterol exceeds 200 mg/dl. Risk factors include a family history, obesity, alcoholism, lack of regular exercise, the intake of high-cholesterol foods, and a high-fat, high-calorie diet. High cholesterol is associated with a number of health conditions including coronary artery disease, heart attack, and stroke. High cholesterol is one of the top 10 pathologies associated with obesity.

Hypertension (related to obesity) - A technical term for high blood pressure, hypertension is the top pathology related to obesity, according to the National Institutes for Health. Normal blood pressure is less than 120 systolic and less than 80 diastolic. High normal (pre-hypertension) is 120–139 systolic and 80–89 diastolic. Hypertension stage 1 is 140–159 systolic and 90–99 diastolic. Hypertension stage 2 is 160 or higher systolic and 100 or higher diastolic. High blood pressure is a factor in the development of many different diseases and conditions including damage to arteries, aneurysm, coronary artery disease, heart failure, transient ischemic attack, stroke, dementia, kidney failure, and many others.

Infertility (related to obesity) - Diminished or absent ability to conceive and bear offspring. A couple is considered to be experiencing infertility if conception has not occurred after 12 months of sexual activity without the use of contraception. It has many causes and may be related to factors in the male, female, or both. Infertility is one of the top 10 pathologies associated with obesity.

Lean body mass - The mass of the body without fat; the percentage of a person's body composed of water, muscle, bone, and vital organs.

Leg conditions (related to obesity) - Increased strain on the leg veins related to obesity may cause fluid retention, swelling of the ankles and feet, the rupture of superficial capillaries (capillaritis), and varicose veins.

Lifestyle - The set of habits and customs unique to a person that lend consistency to activities, behaviors, manners of coping, motivation, and thought processes, and define the way in which he or she lives including diet, level of physical activity, substance use (e.g., tobacco or alcohol), and social and personal interactions.

Massage cautions for clients who are obese - Conduct a thorough health history intake, as obesity is often a contributing factor to many other health conditions that may make massage adaptations necessary, or may completely contraindicate massage. Obtain a physician's release in the event of recent weight loss surgery. Practitioners must be cautious when working with areas where adipose deposits are particularly excessive because this tissue tends to be highly vascular and may be prone to bruising. For this reason, when providing massage to clients who are obese, avoid pushing through adipose tissue to access muscle. Also, avoid deep work over any folds of excess skin that may occur if a client has lost a significant amount of weight.

Obese - According to body mass index and the National Institutes for Health, a person is obese if he or she has a BMI of 30 or higher. For example, a person who is 5' 5" and weighs 180 or more pounds is considered obese. A BMI of 25-29.9 is considered overweight.

Obesity - The condition of being obese; an excessive amount of body fat in relation to lean body mass.

Obesity causes - A number of factors contribute to the occurrence of obesity including genetic predisposition, lifestyle choices, environmental factors such as access to safe places to walk or be active, access to healthy foods, social factors, cultural factors, conditions like hypothyroidism, and side effects from some prescription drugs.

Obesity impact on life - Obesity impacts lifestyle and can lead to lowered self-esteem, depression, and significantly diminished quality of life. Overweight and obese adults generally use CAM therapies (including massage) less than normal-weight adults. This may be because they are reluctant to expose themselves and feel vulnerable to prejudice and criticism.

Overweight - According to body mass index and the National Institutes for Health, a person is overweight if he or she has a BMI of 25–29.9. For example, a person who is 5' 5" and weighs 150–174 pounds is considered overweight.

Skin conditions (related to obesity) - Obesity causes many skin conditions. Stretching of the skin may result in stretch marks (striae), while retained moisture in body folds encourages the growth of bacteria and fungi, leading to skin rashes and potential breakdown of the tissue. Decubitus ulcers, commonly called bedsores, occur due to impaired circulation. Hormonal changes cause acanthosis nigricans, which are darkened areas of the neck and body folds.

Weight loss surgery - Procedures performed on people who are obese to support weight loss; technically called bariatric surgery. For example, the size of the stomach may be decreased with partial removal, or with a gastric band; the small intestine might be re-routed to bypass part of the stomach; etc.

Practice Quiz

1. According to research, a significant factor that contributes to obesity is:

a. a history of participation in higher education

b. a history of being underweight as a child

c. the level of access a person has to safe places to exercise

d. a history of osteoporosis

2. The ethical massage of clients who are obese includes:

a. Seeking to provide a meaningful massage experience that supports the client in achieving his/her goals

b. A discussion of the dangers of being overweight and the impact of obesity on joints and muscles

c. Suggestions of supplements that support the client's nutritional needs

d. A referral to a nutritionist to help the client get bacj on track with weight loss

3. According to research, overweight and obese adults generally use CAM therapies (including massage):

a. about the same as normal-weight adults

b. significantly more than normal-weight adults

c. significantly less that normal-weight adults

d. slightly more than normal-weight adults

4. Practitioners must be cautious when working with areas where adipose deposits are particularly excessive because:

a. this tissue tends to be highly vascular and may be prone to tissue tearing

b. this tissue tends to lack circulation and so fluids may pool in the tissue

c. this tissue tends to be highly vascular and may be prone to bruising

d. this tissue tends to lack circulation and can be overstimulated

5. According to research, a significant factor that contributes to obesity is:

a. the level of access a person has to healthy food

b. the use of blood-thinning medications

c. a history of participation in higher education

d. a history of cancer

6. When providing massage to clients who are obese:

a. use a predominance of tapotement strokes to better access muscle

b. pull adipose tissue away to one side to access muscle

c. push through adipose tissue to access muscle

d. avoid pushing through adipose tissue to access muscle

7. A client who is obese might seek out massage to address:

a. varicose veins

b. high cholesterol

c. body mass index

d. low-back pain

8. A thorough health history and client interview process is especially necessary when working with a client who is obese because:

a. Obese clients almost always have diminished bone density, which makes them susceptible to bone breaks during massage

b. Obesity is often a contributing factor to many other health conditions that require massage adaptations

c. Obese clients tend to be older adults who suffer from age-related conditions

d. Obese clients almost always have diabetes in addition to being overweight

9. If the size of the client poses positioning challenges on a massage table (e.g., the table is too narrow, etc.), practitioners often:

a. position the client on a massage table in the supine position, but not ask the client to turn over during the session

b. determine that the client is contraindicated for massage

c. position the client on a massage table in the prone position, but not ask the client to turn over during the session

d. position the client on a mat situated on the floor

10. If a client has a history of significant weight loss, and skin folds that hang loosely are present, the practitioner should:

a. avoid deep pressure or techniques that might "pinch" the folds

b. use deep work, including petrissage, directly on the folds to stimulate skin tightening

c. use skin-rolling techniques across the folds to support local circulation

d. avoid gentle strokes that do not stimulate the folds, as they may feel irritating to the clients

11. The mass of the body without fat is referred to as:

a. fixed body mass

b. optimal body mass

c. lean body mass

d. original body mass

12. According to research, a significant factor that contributes to obesity is:

a. history of being underweight as a child

b. history of cancer

c. lifestyle choices

d. use of blood-thinning medications

13. With a body mass index of 25–29.9, a person is:

a. at a healthy weight

b. obese

c. below weight

d. overweight

14. To maintain good body mechanics when working on clients who are obese, the practitioner should:

a. raise the table height to gain additional height leverage

b. maintain the same table height, but watch for the tendency to bend at the waist while working

c. lower the table height to gain additional height leverage

d. maintain the same table height, but watch for the tendency to side-flex the neck while working

15. A client who is obese might seek out massage to address:

a. skin health related to acne or breakouts

b. foot conditions due to an inability to trim or file toenails

c. diminished bone density due to the stress of excess weight on the skeletal system

d. sore joints due to the stress of excess weight on the skeletal system

Practice Quiz Answer Key

1. C

2. A

3. C

4. C

5. A

6. D

7. D

8. B

9. D

10. A

11. C

12. D

13. D

14. C

15. D

Clients who are Children

Terminology

Adolescence - A transitional stage of physical and psychological human development that generally occurs during the period from puberty to legal adulthood.

Behavioral cues (infants) - The behaviors that tell a parent or practitioner what a baby needs. Cues that indicate a baby is content and interested in interaction include normal skin color, arms and legs that are flexed or tucked, hand touching the face, hand to the mouth or in the mouth, sucking, eye contact, smiling, and regular breathing rate. Cues that indicate a baby is stressed or getting too much stimulation include hiccupping, yawning, sneezing, frowning, looking away, squirming, frantic or disorganized activity, arms and legs pushing away, arms and legs limp and floppy, and skin color changes.

Benefits of massage for infants - When infants receive massage, the bonding between baby and caregivers increase, digestion is improved, neurological development is supported, respiration slows and deepens, sensory and motor nerves are stimulated, sensory awareness is increased, sleep quality is improved, stress indicators are decreased, and vocalization is increased.

Cautions for infant massage - Cautions for infant massage (that ranges from 5–15 minutes) include misreading a baby's behavioral cues and providing too much stimulation, or providing massage too close to when a baby has been fed (wait 45 minutes after feeding before providing massage). Do not use regular massage lubricant on infants; use cold-pressed natural food oils to prevent babies from getting sick when they place their hands in their mouths. If the baby has signs of nausea, vomiting, or diarrhea, he or she is contraindicated for massage.

Child (biological) - A human between the stages of birth and puberty.

Child (legal) - A minor; a person younger than the age of majority (under 18 years of age).

Cold-pressed natural food oils - The type of oil used as the lubricant for infant massage. Babies often place their hands in their mouths and could get sick from exposure to the synthetic dyes, fragrances, and chemicals in many massage lubricants.

Infant - A human from the time of birth up to one year of age.

Legal guardian - A person who has the legal authority (and the corresponding duty) to care for the personal and property interests of another person, called a ward. Guardians are usually used in three situations: guardianship for a minor, an incapacitated adult or elderly person, and for developmentally disabled adults.

Locomotion (child development) - The first movements an infant makes on his/her own including "creeping" (pushing self around on the stomach), "scooting" (crawling on one leg and dragging the other), or combinations of rolling, rocking, and squirming. Between 6–8 months of development, infants progress to hands-and-knees crawling. Some babies skip crawling and progress directly to walking.

Tactile stimulation (child development) - The activation of sensory receptors in the skin by touch. History and research shows that tactile stimulation is essential for child development. In the early 20th century, children in orphanages in America and Europe died in alarming numbers from touch deprivation. Those that did survive experienced delayed bone growth, low weight, suppressed immunity, poor coordination, general apathy, and decreased mental function. Touch is essential for life, proper development, and good health.

Tiffany Field (research on preterm infants) - Tiffany Field is a researcher who has extensively studied the benefits of massage for preterm infants at the Touch Research Institute. Her research shows that massage stimulates growth, aids digestion, positively affects sympathetic and adrenocortical function, aids sleep, and decreases fussing, crying, and behaviors related to stress such as hiccupping.

Toddler - A human between the ages of 1 year and 3 years of age.

Vocalization (child development) - The early sounds made by infants and toddlers as they develop speech including babbling, cooing, or sounds like "ba" and "ma." Increased positive vocalization is a behavioral cue for contentment and relaxation, as opposed to crying sounds.

Practice Quiz

1. Wait to provide massage after a child has been fed for:

a. at least 45 minutes

b. 10-15 minutes

c. 15-25 minutes

d. 1-2 hours

2. If the infant is deeply asleep:

a. use warm hydrotherapy to open the session

b. use massage strokes that deepen the sleep state

c. it is not the right time for massage

d. use massage strokes that stimulate the infant until he/she wakes up

3. Ways to reduce the stimulation an infant experiences during a session include all of the following EXCEPT:

a. wait to proceed

b. use quiet voices and continue to talk gently to the infant

c. turn up the lights so the infant doesn't feel like he/ she is in the dark

d. turn off the music

4. Massage is contraindicated for an infant who is:

a. making eye contact

b. vocalizing and reaching toward a parent

c. asleep

d. vocalizing and reaching toward a practitioner

5. A caution in infant massage is that a practitioner or parent might:

a. overload the cardiovascular system and cause heart arrythmias

b. be overly cautious and provide only light work to the infant's muscles

c. create muscular imbalances that lead to postural dysfunction in later years

d. misread an infant's behavioral cues and provide too much stimulation

6. Infants who receive massage:

a. experience enhanced digestion

b. experience enhanced brain size

c. experience better flexibility throughout life

d. experience reduced muscle hypertonicity

7. Infants who receive massage:

a. demonstrate increased vocalization, which aids speech development

b. experience enhanced brain size

c. demonstrate the ability to walk sooner than infants who don't receive massage

d. demonstrate the ability to stand sooner than infants who don't receive massage

8. Infant massage sessions last:

a. an hour, just alike a massage for an adult

b. 20-35 minutes, so long as the client is engaged

c. 5-15 minutes, so long as the client is engaged

d. 40-50 minutes, so long as the client is engaged

9. If the infant is vomiting, then:

a. place the infant on his/her tummy during the session

b. use gentle rocking strokes

c. massage is contraindicated

d. use cool hydrotherapy on the tummy

10. Because children are not of legal age:

a. the parent or guardian must walk the child into the building and out of the building to prevent liability concerns of kidnapping

b. the parent or legal guardian must remain for the first 5 minutes of the session and return 5 minutes before the end of the session

c. they must have a parent or legal guardian present during the entire session

d. the must have a parent or legal guardian sign a release before the parent/guardian leaves the child

11. If the infant has signs of nausea, then:

a. use gentle rocking strokes

b. massage is contraindicated

c. use warm hydrotherapy

d. use gentle gliding strokes

12. Infants signal they are receptive to massage by:

a. breaking eye contact

b. arching the back

c. kicking and jerking the arms and legs

d. smiling and making eye contact

13. Infants signal they are receptive to massage by:

a. arching the back

b. crying and making eye contact

c. vocalizations and reaching toward the parent

d. flaring the fingers and toes

14. A practitioner's role during an infant massage session is to:

a. provide the parents an opportunity to run errands while keeping the child safely engaged for an hour

b. provide work that will not overstimulate the infant and keep hm/her awake

c. educate parents about behavioral cues that indicate the child is receptive to massage

d. prove work that correctly addresses infant muscular tension

15. Infants who receive massage:

a. receive the tactile stimulation they need for bone health

b. experience better posture throughout life

c. experience better flexibility throughout life

d. experience improved sleep quality

16. The massage lubricant that is always used for infants is:

a. oil combination with lavender or mandarin fragrance

b. warming massage gels

c. cold-pressed natural food oils

d. cooling massage gels

Practice Quiz Answer Key

1. A

2. C

3. C

4. C

5. D

6. A

7. A

8. C

9. C

10. C

11. B

12. D

13. C

14. C

15. D

16. C

Clients who are Pregnant

Terminology

Benefits of massage for pregnant clients - Benefits of massage during pregnancy include decreased anxiety, improved blood and lymph circulation, reduced depression, decreased fatigue, reduced headache pain, improved immunity, improved sleep, reduced joint pain and stiffness, reduced muscle pain and soreness, improved skin conditions, reduced stress, and more.

Blood clots (pregnancy) - A substance (e.g., air bubble, globules of fat, bone chips, chemicals from illegal drugs, amniotic fluid, etc.) combined with blood, or blood that has been converted from a liquid to a solid state. A thrombus is a blood clot that is stationary within a vessel. A potentially life-threatening embolus is a blood clot that travels through the bloodstream and then lodges in the blood vessel, blocking the flow of blood. When a woman is pregnant, she is more likely to develop blood clots because of pregnancy hormones and because the growing uterus places pressure on the veins in her pelvis. The iliac, great saphenous, and femoral veins accessible in the medial thigh are more prone to develop blood clots during pregnancy. For this reason, caution is used when providing massage in this region.

Cautions for pregnancy massage - Every woman's experience of pregnancy is unique. Because complications related to pregnancy can occur for a variety of reasons, it is important to conduct a thorough health history intake to rule out contraindications. Obtain a physician's release if you have any doubts about the appropriateness of massage for the client. Gentle abdominal massage is acceptable, but moderate to deep work is contraindicated. Use caution when massaging the medial thigh because the iliac, great saphenous, and femoral veins are more prone to develop blood clots during pregnancy. Techniques from myofascial approaches are avoided during pregnancy, and range of motion techniques are only applied gently and slowly because of the presence of relaxin in the mother's body. Avoid areas with varicose veins and watch for signs and symptoms that contraindicate massage.

Cesarian delivery (C-section) - Surgery to deliver a baby through the mother's abdomen when vaginal birth is considered less safe than a cesarean birth.

Conception - The process of becoming pregnant through the union of the male sperm and female ovum (fertilization producing a zygote) followed by implantation in the womb and the resulting entity (embryo).

Eclampsia - A serious and life-threatening form of pregnancy-related hypertension characterized by seizure, coma, hypertension, proteinuria (the excess of serum proteins in the urine), and edema.

Embryo pregnancy - The pre-fetal product of conception, from implantation through week 8 of development.

Epidural - A general term used to describe the injection of drugs into the epidural space (the outer most part of the spinal canal) that results in a loss of sensation that eliminates the pain of childbirth.

Fetus - An unborn offspring, from the embryo stage (the end of week 8 after conception) when major structures have formed until birth.

First Trimester - The first of three divisions during pregnancy (roughly 3 months each), in which different phases of fetal development take place. The first trimester is a time of basic cell differentiation. Common changes that occur in a pregnant woman's body during the first trimester include increased blood volume, increased body temperature, increased heart rate, increased metabolism, increased urination frequency, increased uterus size, the presence of relaxing at week 10, and hormonal changes that can cause headaches, fatigue, nausea, constipation, mood swings, smell and taste sensitivity, and possible vomiting.

Gestational diabetes - A condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy, especially during their third trimester. It is caused when insulin receptors do not function properly.

High-risk pregnancy - A pregnancy that puts the mother or the developing fetus at higher-than-normal risk for complications. Factors that lead to high-risk pregnancy include old or young maternal age, a mother that is overweight or underweight, a history of problems with other pregnancies, multiple fetuses (e.g., twins), and pre-existing health conditions including HIV/AIDS, heart disease, hypertension, kidney disorders, autoimmune disorders, sexually transmitted diseases, diabetes, or cancer. Some pregnancies become high risk with the development of preeclampsia, eclampsia, gestational diabetes, or as result of tests that indicate the fetus is abnormal.

Positioning pregnant clients - During the first trimester, use supine, prone, side-lying, and semireclined positions. During the second trimester, use supine, side-lying, and semireclined positions. From the late second trimester through the third trimester, use side-lying and semireclined positions.

Preeclampsia - A disorder that occurs during pregnancy characterized by high blood pressure and proteinuria (the excess of serum proteins in the urine). If left untreated, preeclampsia can develop into eclampsia and be life-threatening.

Pregnancy - The state of carrying a developing embryo or fetus within the female body. Pregnancy lasts approximately 9 months, measured from the date of a woman's last menstrual period, and is divided into three timeframes called trimesters, each roughly 3 months long.

Prenatal - Occurring or existing before birth.

Relaxin - A hormone produced during pregnancy that facilitates the birth process by causing a softening of the cervix and the pubic symphysis. Its presence causes the production of collagen to decrease and promotes collagen breakdown. It also plays a role in the timing of delivery by inhibiting contractions of the uterus until labor.

Second trimester - The second of three divisions during pregnancy (roughly 3 months each), in which different phases of fetal development take place. The second trimester is a period of rapid growth and maturation of body systems. Common changes that occur in a pregnant woman's body during the second trimester include baby movement felt toward the end of the trimester, back pain, tender and swollen breasts, more shallow breathing as the diaphragm moves upward, the separation of the linea alba, muscle cramping, organ displacement to accommodate the growing fetus, an expanding pelvis, postural changes, the appearance of stretch marks, increased weight, and edema in the legs, ankles, and feet.

Signs and symptoms that contraindicate massage for pregnant women - Massage contraindications for pregnant women include any condition that normally contraindicates massage, as well as abdominal cramps, abdominal pain, back pain with vaginal bleeding, decreased fetal movement over a 24-hour period, diarrhea, high-risk pregnancy, morning sickness that includes nausea and vomiting, severe swelling or pitting edema in the extremities, severe pain anywhere in the body, uterine contractions, or vaginal bleeding.

Third Trimester - The last of three divisions during pregnancy (roughly 3 months each), in which different phases of fetal development take place. The third trimester is a period in which body systems are completed, fat accumulates under the baby's skin, and the fetus moves into position for birth. The third trimester ends with birth. Common changes that occur in a pregnant woman's body during the third trimester include carpal tunnel syndrome, varicose veins, hemorrhoids, heartburn, insomnia, increased pregnancy posture (causing tension to muscles and joints and making walking and bending over difficult), shortness of breath as the uterus moves up into the rib cage, edema in the lower extremities, and increased pressure on nerves, blood vessels, and internal organs as the baby grows to term.

Vaginal birth - Birth of a fetus through the vagina.

Varicose veins - A vein that is distended, enlarged, and/or twisted near the surface of the skin, most commonly found in the legs. They are caused by weakened valves and veins and exacerbated by being overweight, pregnant, or having a job where you must stand for long periods of time, thereby increasing the pressure on your leg veins. As the uterus grows during pregnancy, it places pressure on the inferior vena cava which, leads to varicose veins.

Zygote - The one-celled organism resulting from a fertilized female egg (ovum). Zygotes undergo a 2-week period between fertilization and implantation of rapid cell division before they become an embryo.

Practice Quiz

1. When a pregnant woman in the late second or third trimester is positioned in this manner, the weight of the fetus could impinge on the abdominal aorta and inferior vena cava:

a. side-lying

b. prone

c. supine

d. seated

2. Myofascial release massage or connective tissue techniques for clients who are pregnant are:

a. avoided due to the presence of relaxin in the client's body

b. locally contraindicated when providing abdominal massage

c. encouraged due to the presence of relaxin in the client's body

d. locally encouraged, especially for abdominal massage

3. One change that a woman's body goes through in the third trimester is:

a. pregnancy posture increases difficulty walking and bending over

b. heart rate and blood volume increases

c. linea alba begins to separate

d. relaxin present at week 10

4. Pre-existing health concerns such as high blood pressure, kidney disorders, or autoimmune disorders:

a. usually don't influence a pregnancy

b. indicate massage as condition management for pregnancy

c. are factors in HNR pregnancy

d. are factors in high-risk pregnancy

5. If a pregnant client arrives at your clinic and complains of back pain, massage:

a. is contraindicated

b. of the back is a local contraindication

c. requires a physician's release

d. is indicated

6. Relaxin causes:

a. the production of scar tissue that forms the linea alba

b. the production of elastin to decrease and elastin breakdown to increase

c. the production of lymph proteins and the accumulation of fluids in the tissue

d. the production of collagen to decrease and collagen breakdown to increase

7. If the client had a normal vaginal birth:

a. vaginal bleeding is normal for 2 weeks after delivery and is not a contraindication

b. vaginal bleeding is not normal after delivery and is an absolute contraindication

c. Vaginal bleeding could be abnormal and always requires a physician's release

d. Vaginal bleeding indicates a local contraindication and the back, gluteal muscles, and thighs should not be massaged

8. If a pregnant client arrives at your clinic and complains of neck tension and headache pain, massage:

a. requires a physician's release

b. of the neck is a local contraindication

c. is contraindicated

d. is indicated

9. Aromatherapy for clients who are pregnant:

a. is always contraindicated

b. is avoided if the practitioner does not have specialized training in aromatherapy

c. is contraindicated during the first two trimesters

d. is indicated so long as appropriate oils like basil, clary sage, and thyme are used

10. One change that a woman's body goes through in second trimester is:

a. relaxin present at week 10

b. the linea alba begins to separate

c. blood pressure drops

d. vomiting

11. If the client had a C-section birth, massage can only be provided in these positions for eight weeks after delivery:

a. prone and supine positions

b. prone and side-lying positions

c. side-lying and supine positions

d. seated position only

12. If the client received an epidural for pain relief during delivery:

a. avoid the injection area for 8 hours after the procedure

b. the entire back and gluteal region are contraindicated for two weeks post-delivery

c. massage is contraindicated for two weeks post-delivery

d. avoid the injection area for 72 hours after the procedure

13. One change that a woman's body goes through in the third trimester is:

a. baby movement felt toward the end of the trimester

b. hormonal changes cause fatigue, nausea, and smell sensitivity

c. body temperature increases

d. carpal tunnel syndrome may develop

14. If a pregnant client arrives at your clinic and complains of abdominal cramps, massage:

a. is contraindicated

b. is indicated

c. in the abdominal area is a local contraindication

d. requires a physician's release

15. If a pregnant client arrives at your clinic and complains of back pain and light vaginal bleeding, massage:

a. is indicated

b. is contraindicated

c. of the back is a local contraindication

d. requires a physician's release

16. As the uterus grows during pregnancy, it places pressure on the inferior vena cava, leading to:

a. difficulty breathing

b. varicose veins

c. axillary artery blood clots

d. low-back pain

17. One change that a woman's body goes through in the first trimester is:

a. edema may be present in the legs, ankles, and feet

b. baby movement felt toward the end of the trimester

c. breathing becomes more shallow as the diaphragm moves upward

d. hormonal changes cause fatigue, nausea, and smell sensitivity

18. Caution is used when massaging the medial thigh when clients are pregnant because:

a. the iliac, great saphenous, and femoral veins accessible in the medial thigh are more prone to develop blood clots during pregnancy

b. the brachial, redial and cephalic veins accessible in the medial thigh are more prone to bruising during pregnancy

c. the iliac, great saphenous, and femoral veins accessible in the medial thigh are more prone to bruising during pregnancy

d. the brachial, radial, and cephalic veins accessible in the medial thigh are more prone to develop blood clots during pregnancy

19. Relaxin is:

a. a hormone produced during pregnancy that causes edema in the lower legs, ankles, and feet

b. a hormone produced during pregnancy that causes arm and shoulder pain

c. a hormone produced during pregnancy that causes carpal tunnel syndrome

d. a hormone produced during pregnancy that causes the cervix and pubic symphysis to soften and lengthen

Practice Quiz Answer Key

1. C

2. A

3. A

4. D

5. D

6. D

7. A

8. D

9. B

10. B

11. C

12. D

13. D

14. A

15. B

16. B

17. D

18. A

19. D

Clients who are Athletes

Terminology

Amateur athletes - People who take part in sports for fitness, enjoyment, or as part of nonprofessional or collegiate activities.

Athletes - People who are physically active and train to participate in sports.

Cautions for massage of athletes - Cautions and contraindications for athletes are the same as for regular massage. However, the practitioner will want to watch for weather-related exposure (e.g., heat exhaustion, heat stroke, hypothermia, frostnip, and frostbite) and for injury that occurs during an event that may require first aid related to acute inflammation (e.g., the application of ice and elevation, etc.).

Delayed-onset muscle soreness (DOMS) - Muscle pain, soreness, and stiffness felt 12–48 hours after exercise and believed to be the result of muscle tissue breakdown (ruptures in the sarcolemma) from physical exertion.

Environmental conditions (sporting events) - Weather, the topography at the event (surface features or landscape), altitude, time changes, travel to out-of-town events, and factors like pollution, traffic, and noise all influence the athlete's ability to perform, avoid injury, and recover optimally from the event.

Event massage - A category of sports massage in which the massage is applied on the day, and at the location, of a sporting event.

Frostbite - A condition that results from cold exposure where the tissue freezes, occurring on the hands, feet, nose, cheeks, and ears. Superficial frostbite causes sensations of burning, numbness, tingling, itching, and cold. Tissue can be permanently lost from frostbite.

Frostnip - A condition that results from cold exposure where the ears, nose, cheeks, chin, fingers, and toes may turn white, and the surface of the skin may form ice crystals. The skin may feel numb, tingly, or itchy.

Heat exhaustion - A form of hyperthermia characterized by pale or splotchy skin that may feel cool and clammy to touch, heavy sweating, shallow and rapid breathing, weakness, fatigue, and possible fainting, as well as headaches, dizziness, nausea, muscle cramping, and chills.

Heat stroke - A life-threatening form of hyperthermia characterized by red, flushed skin that is hot and dry to the touch; a strong, rapid heartbeat; and rapid, shallow, or deep breathing; as well as irritability or confusion, headaches, dizziness, and nausea.

Hyperthermia - A general term for a number of heat-related symptoms associated with illness caused by prolonged exposure to the sun or inadequate replacement of fluids lost through perspiration causing dehydration.

Hypothermia - A life-threatening condition that occurs when the core temperature of the body falls below 96 degrees F because the body has been exposed to cold or wet conditions for a prolonged period of time. Symptoms include pronounced shivering, numbness, a feeling of cold throughout the body, inability to move quickly, dizziness, and confusion.

Intra-event massage - Massage provided to the athlete between heats or innings, at half time, or between different events at a match or meet. Benefits include reduced muscle tension that resulted from the first event, and improved muscle recovery before the next event. The pace is brisk and the techniques (the same as for pre-event massage) are delivered with light-to-moderate pressure.

Maintenance massage - The regular massages the athlete receives between sporting events, and while in training, to aid in muscle recovery and reduce the risk of injury.

Post-event massage - Massage provided to the athlete after all athletic efforts have concluded and usually within 2 hours of the last effort. Benefits include reduced muscle tension, improved muscle recovery, decreased occurrence of delayed-onset muscle soreness, improved next-day range of motion and flexibility, decreased muscle cramping, and reduced stress. The pace and strokes are soothing and relaxing and may include the use of lubricant. A variety of strokes might be used, but tapotement is avoided because it can be too stimulating and trigger muscle cramping.

Pre-event massage - Massage provided to the athlete from 1 day to 2 hours before the athlete's event as part of the athlete's warm-up preparations. Benefits include increased local circulation to the primary muscles used in the particular sport, decreased muscle tension, warming of muscles and connective tissue, increased flexibility, and improved mental attitude and concentration. The massage is usually brisk, of short duration (approximately 20 minutes or less), and provided over clothing without the use of lubricant. Slow, relaxing techniques are avoided. Common techniques include rhythmic compression, petrissage, superficial friction, passive joint movement, gentle stretching, and tapotement with light to moderate pressure.

Professional athletes - People who make their living by participating in sports.

Promotional event massage - Massage provided at a sporting event, where the athletes are not clients of the practitioner, for the purposes of promoting the massage business.

Treatment massage - Massage given to an athlete as part of the rehabilitation process when he or she has sustained an injury.

Practice Quiz

1. Amateur athletes are:

a. people who take part in sports for fitness, fun, or as part of nonprofessional or collegiate activities

b. people who make their living in sports

c. people who work with athletes but who don't play sports themselves

d. people who are reimbursed for their athletic efforts

2. A massage used to help the athlete prepare for optimal performance and delivered at a mountain bike competition is called:

a. maintenance massage

b. training massage

c. event massage

d. treatment massage

3. Massage delivered at a sporting event where the athletes are not currently your clients is called:

a. pre-event massage

b. intra-event massage

c. promotional event massage

d. new client treatment massage

4. Muscle pain, soreness, and stiffness felt 12–48 hours after exercise is called:

a. immediate-onset muscle soreness

b. delayed-onset muscle soreness

c. pre-event muscle soreness

d. intra-event muscle soreness

5. Hyperthermia may occur during sporting events where:

a. the athlete is exposed to high altitude for prolonged periods of time

b. the athlete is exposed to heat and sun for prolonged periods of time

c. the athlete is inactive for long periods of time between events and stiffens up

d. the athlete is exposed to cold or wet weather for prolonged periods of time

6. Mountaineers, skiers, and ice skaters are probably more prone to this condition than other athletes:

a. frostnip

b. cryogenics

c. hyperthermia

d. delayed-onset muscle soreness

7. Professional athletes are:

a. people who make their living in sports

b. people who play sports but also have jobs in sports-related retail careers

c. people who take part in sports for fitness and fun

d. people who work with athletes but who don't play sports themselves

8. Slow, overly-relaxing techniques that might sedate the athlete and send the body into rest and recovery mode are avoided during:

a. treatment massage

b. maintenance massage

c. pre-event massage

d. training massage

9. A pre-event massage is usually provided to an athlete:

a. 10 minutes before the start of the event

b. once a week for 6 weeks following an event

c. between 1 day and 2 hours before the start of the event

d. directly after the athlete has performed in the event

10. Hypothermia may occur during sporting events where:

a. the athlete is inactive for long periods of time between events and stiffens up

b. the athlete is exposed to cold or wet weather for prolonged periods of time

c. the athlete is exposed to heat and sun for prolonged periods of time

d. the athlete is exposed to high altitude for prolonged periods of time

11. A condition related to cold temperatures characterized by whiteness of the skin and the formation of ice crystals on the skin's surface is:

a. frostnip

b. hyperthermia

c. hypothermia

d. frostbite

12. One benefit of pre-event massage for athletes is:

a. improved water consumption between events

b. improved mental attitude and concentration

c. improved appetite after the event

d. improved relaxation and sleepiness before the event

13. A massage provided after a first athletic effort to decrease muscular tension before a second athletic effort is called:

a. treatment massage

b. intra-event massage

c. post-event massage

d. maintenance massage

14. Massage therapists who provide sports massage at events should be able to recognize the signs and symptoms of:

a. skin cancer and obesity

b. pregnancy and osteoporosis

c. hyperthermia and hypothermia

d. diabetes and fibromyalgia

15. Pre-event massage would include:

a. proprioceptive techniques

b. tapotement

c. aggressive stretching

d. slow effleurage

Practice Quiz Answer Key

1. A

2. C

3. C

4. B

5. B

6. A

7. A

8. C

9. C

10. B

11. A

12. B

13. B

14. C

15. B

Clients at the End of Life

Terminology

Active phase of dying - The final phase of the dying process, as defined by the Hospice Patients Alliance, which is characterized by an unresponsive state, severe agitation, hallucinations or pronounced personality changes, abnormal breathing patterns, difficulty speaking or swallowing food or liquids, and decreased urine output. The body may be held in a rigid and unchanging position, and the jaw may drop or be held in a sideways position.

Cautions for massage for end-of-life care - So long as strokes are gentle and soothing, there are few absolute contraindications for massage delivered during end-of-life care. Massage is typically provided in the client's home, a hospice, or a hospital room, so adaptability to these new environments and the ability to work around monitors and machines is important.

End-of-life care - Care provided to a person nearing death (due to natural causes or terminal illness) that is provided to manage symptoms and give comfort after treatment to cure or fight a disease ends.

Massage for end-of-life care - Techniques are very gentle and calming, with slow strokes on the arms and hands, holding at the base of the neck, and other strokes as appropriate to promote relaxation, comfort, and offer support.

Phases of approaching death - The Hospice Patients Alliance descriptions for two phases (preactive phase and active phase) and their related signs and symptoms that indicate death is near.

Preactive phase of dying - The first phase of the dying process, as defined by the Hospice Patients Alliance, which begins approximately 2 weeks before death. It is characterized by increased restlessness and confusion, a withdrawal from social activities, increased periods of sleep, reduced food and liquid intake, periods of breathing pauses, changes positions often, and difficulty healing from wounds.

Terminal illness - A disease that is considered ultimately incurable and likely to cause death within a short period of time (typically a life expectancy of 6 months or less). An illness is considered terminal when there are no standard therapies to eliminate it from the body or cure it.

Practice Quiz

1. If a person is restless and changes position often, he or she is probably in the:

a. active phase of dying

b. inactive phase of dying

c. post-active phase of dying

d. preactive phase of dying

2. One goal of end-of-life care (Palliative care) is to:

a. make the person as comfortable as possible

b. reduce muscular adhesions

c. reduce muscular tension

d. maintain all available range of motion

3. Terminal illness is:

a. a condition that responds well to aggressive medications

b. a disease that is considered ultimately incurable and likely to cause death within 5 years

c. a disease that is considered ultimately incurable and likely to cause death within a short period of time

d. a condition that responds well to massage and other complimentary therapies

4. During the preactive phase of dying, a person:

a. demonstrates reduced food and liquid consumption

b. demonstrates an unresponsive state

c. demonstrates the inability to speak

d. demonstrates pronounced personality changes

5. Holding strokes at the base of the neck during end-of-life care are:

a. contraindicated as too sedating for the client

b. indicated to calm and relax the client

c. never used during the active phase of dying

d. never used during the preactive phase of dying

6. Care provided to a person nearing death (due to natural causes or terminal illness) is:

a. terminal care

b. therapeutic care

c. condition management

d. end-of-life care

7. The second phase of approaching death is called:

a. the preactive phase of dying

b. the active phase of dying

c. the post-active phase of dying

d. the inactive phase of dying

8. If a person keeps his or her mouth open for breathing, but is unable to speak, he/she is probably in the:

a. preactive phase of dying

b. inactive phase of dying

c. active phase of dying

d. post-active phase of dying

9. The first phase of approaching death is called:

a. the post-active phase of dying

b. the preactive phase of dying

c. the active phase of dying

d .the inactive phase of dying

10. A person's extremities may feel very cold and turn bluish or purple during:

a. the post-active phase of dying

b. the active phase of dying

c. the preaactive phase of dying

d. the inactive phase of dying

11. During the preactive phase of dying, a person:

a. is unable to swallow food or liquids

b. develops edema in the extremities and has difficulty healing from infections

c. demonstrates severe agitation, including hallucinations

d. is unable to speak

12. During the active phase of dying, a person might:

a. develop edema in the extremities

b. demonstrate abnormal breathing patterns including long pauses in breathing

c. demonstrate increased hunger and thirst

d. demonstrate decreased hunger

13. During the active phase of dying, a person:

a. may develop edema in the extremities

b. may demonstrate increased hunger and thirst

c. may be completely unresponsive

d. may demonstrate increased hunger

14. The preactive phase of dying:

a. begins approximately 6 months before death

b. begins approximately 2 weeks before death

c. beings approximately 2 days before death

d. begins approximately 1 week before death

15. Massage during end-of-life care is typically provided in:

a. in the ICU

b. in a massage clinic

c. at a wellness center

d. a client's home

Practice Quiz Answer Key

1. D

2. A

3. C

4. A

5. B

6. D

7. B

8. C

9. B

10. B

11. B

12. B

13. C

14.B

15. D

Clients with Disabilities

Terminology

Assertive (or adaptive) technology - An accepted term for devices and societal or personal modifications that help people with disabilities overcome impairments and broaden the accessibility of places and things. Examples include wheelchairs, prosthetics, accessible keyboards, speech-recognition software, etc.

Autism spectrum disorders - A general term for a group of complex developmental cognitive disorders, including Asperger's syndrome, Rett syndrome, and childhood disintegrative disorder.

Balance disorder - Feelings of unsteadiness in association with sensations like spinning, floating, or feelings of wooziness associated with some physical disabilities related to the vestibular system.

Developmental delay - A temporary intellectual disability that results because of illness or trauma in childhood that disappears as a child grows up.

Developmental disability - An intellectual disability that describes lifelong disabilities caused by mental or physical impairments that manifested before age 18.

Disability (medical) - A functional impairment caused by an accident, trauma, genetics, or disease that may limit a person's mobility, hearing, vision, speech, or mental function.

Hearing impairment - A disability where there is a loss of the ability to detect or perceive some or all sound frequencies, or when the clear perception of sound is diminished.

Impairment - A problem in body structure or function that impacts a person's ability to execute a task or take an action.

Intellectual (or cognitive) disability - Any disability that affects mental processes, ranging from mild to severe and present from birth or acquired later in life. The term, "mental retardation" is still in use but is currently being replaced by "mild," "moderate," "severe," or "profound intellectual disability."

Learning disabilities - Neurological impairments that affect the brain's ability to receive, process, store, and respond to information. They include difficulties with reading, writing, spelling, math, listening, and using language, and can be mild to severe.

Massage for intellectual and mental health disabilities - Considerations and specialized training to provide massage for people with intellectual disabilities include working with communication related to intellectual disabilities, working appropriately with guardians and caregivers, understanding how to rule out contraindications from a health history intake, and choosing appropriate techniques based on the client's level of health, vitality, and intellectual capacity to integrate and benefit from massage work. Be prepared to adapt massage techniques and session goals moment-by-moment based on the client's response to massage.

Massage for physical disabilities - Considerations and specialized training to provide massage for people with physical disabilities include reducing access challenges to the massage environment, assisting clients with balance disorders, treating wheelchairs and other mobility devices as part of a person's body space, understanding how to rule out contraindications from a health history intake, working around medical equipment, working with paralysis, working with limb amputations, managing client needs or disinterest in assistance, working with communication related to speech impairments, choosing appropriate techniques based on the client's level of health and vitality, and knowing methods to transfer clients on and off the massage table if appropriate.

Massage for sensory disabilities - Considerations and specialized training to provide massage for people with sensory disabilities include reducing access challenges to the massage environment, managing client needs or disinterest in assistance, working with communication related to hearing impairments or visual impairments, managing the client's personal items in situations of visual impairments, treating service dogs appropriately, understanding how to rule out contraindications from a health history intake, and choosing appropriate techniques based on the client's level of health and vitality.

Massage for health disabilities - Functional impairments caused by mental health disorders that interfere with or limit one or more major life activities.

Mental health disorders - Mental, behavioral, or emotional patterns associated with subjective distress that are not part of normal development or culture arising from a number of factors that might be biological (e.g., disordered brain chemistry), psychological (e.g., temperament and coping style), or social (e.g., a history of abuse or bullying).

Paralysis - The loss of muscle function in one or more muscles often caused by damage to the spinal cord. Paraplegia is the impairment of motor and sensory function of the lower extremities, while quadriplegia is the partial or total loss of function in both the upper and lower extremities and the torso.

People-first language - A form of disability etiquette that aims to diminish the subconscious dehumanization that can occur when discussing people with disabilities. It puts the person before the disability and helps to decrease the discrimination people with disabilities experience in society by raising awareness and understanding.

Physical disability - A term that refers to a number of disabilities that affect the muscular, skeletal, nervous, respiratory, and cardiovascular systems. Causes of physical disabilities are congenital, injury-related, amputations, or a disease such as muscular dystrophy and others.

Sensory disabilities - A disability that involves impairment of any of the five senses, although the inability to smell or taste is often not considered a disability.

Visual impairment - A disability where there is a loss of visual capacity. The terms "blind," "legally blind," "low vision," and "partially sighted" are used to describe degrees of visual impairment.

Practice Quiz

1. A lifelong disability caused by mental or physical impairments that manifested before the age of 18 is called:

a. congenital disability

b. mental health disability

c. developmental delay

d. developmental disability

2. People-first language:

a. places the person before the disability

b. ignores that a person has a disability

c. places the person equal to the disability

d. places the person after the disability

3. Assertive devices like wheelchairs, artificial limbs, braces, and canes might be used by people with:

a. sensory disabilities

b. physical disabilities

c. mental disabilities

d. intellectual disabilities

4. The preferred expression in people-first language is:

a. a handicapped child

b. child with a disability

c. functionally impaired child

d. disabled child

5. If a client is using a wheelchair, the therapist should:

a. avoid leaning on the wheelchair and invading a person's personal space

b. push the wheelchair for the client so that the client doesn't need to ask for help

c. push the wheelchair out of the session room once the client is on the table

d. lean on the wheelchair to demonstrate friendliness

6. The preferred expression in people-first language is:

a. crippled person

b. uses a wheelchair

c. confined to a wheelchair

d. physically disabled person

7. The goal of people-first language is to:

a. raise awareness and understanding

b. recognize that people can overcome their disabilities

c. ignore that a person has a disability

d. recognize that people are equal to their disabilities

8. In a medical sense, a functional impairment might indicate:

a. limits to a person's diet

b. limits to a person's genetics

c. limits to a person's sight

d. limits to a person's liquid intake

9. A hearing impairment is considered a:

a. intellectual disability

b. mental health disability

c. sensory disability

d. congenital disability

10. When working with clients with disabilities, it is appropriate to:

a. take hold of a person with a visual impairment and guide him/her physically

b. pet a service dog and give it water and a treat

c. make every effort to assist the client without making reference to the disability or without asking the client first

d. ask the client directly and respectfully what type of assistance he/she might need

11. One cause of functional impairments related to medical disability is:

a. liver issues

b. high cortisol

c. disease

d. food allergies

12. When working with clients with disabilities, it is appropriate to:

a. place a hand on the shoulder of a client with a hearing impairment to get his/her attention

b. place the personal items of a person with a visual impairment (like clothing) out of the way and in a safe place

c. speak directly to an interpreter when conducting the health intake for a person with a hearing impairment if you have difficulty communicating

d. speak in a loud voice to a person with a visual impairment to get his/her attention

13. In a medical sense, a functional impairment might indicate:

a. limits to a person's mental capacity

b. food allergies

c. liver issues

d. dietary restrictions

14. Devices that help people with disabilities overcome impairments and broaden the accessibility of places or things are called:

a. assertive (or adaptive) technology

b. people-first technology

c. handicapped parking

d. handicapped hotel room

15. In a medical sense, the term "disability"means:

a. work impairment

b. functional impairment

c. stress-related condition

d. social disadvantage

16. A visual impairment is considered a:

a. sensory disability

b. intellectual disability

c. congenital disability

d. mental health disability

17. The loss of function in one or more muscles is called:

a. autism

b. prosthesis

c. neuralgia

d. paralysis

18. One cause of functional impairments related to medical disability is:

a. genetics

b. low thyroid

c. high cortisol

d. high estrogen

Practice Quiz Answer Key

1. D

2. A

3. B

4. B

5. A

6. B

7. A

8. C

9. C

10. D

11. C

12. A

13. A

14. A

15. B

16. A

17. D

18. A