Massage Therapy Journal Fall 2024

54 • Massage Therapy Journal

AMTA Continuing Education

• Non-paralyzed areas can receive a regular massage, concentrating on muscular tension from compensatory movement patterns from the use of mobility aids. These areas are often found in the hands, arms, shoulders and neck and can be addressed effectively during massage. 40 Be sure to follow precautionary measures. thrombosis (DVT), or blood clots in the legs. • If the client has reduced bone density, decrease the amount of applied pressure and avoid forceful passive movements. Never use your body weight in the delivery of these movements. Deep manual pressure has been linked to adverse events. 41 • If the client has a DVT diagnosis, avoid the affected lower extremity (i.e., in the thigh and leg). Otherwise, look for signs and symptoms of DVT, including unilateral leg swelling, heat, redness or noticeable discoloration, and pain or tenderness. If these are present, avoid massage to the affected lower extremity. 42 Leg massage has been linked to adverse events. 43 • Edema may occur in the lower extremities from inactivity. This swelling can be reduced by massage. Be sure to elevate the affected limbs during the massage. • Some clients are at risk for decubitus ulcer formation. Decubitus ulcers, or decubiti, are injuries to the skin and underlying tissues from prolonged pressure and are usually found over bony projections. Decubitus ulcers are also called pressure sores or pressure ulcers . Decubiti are major threats to a person’s health. Areas at risk for decubitus ulcer formation are local contraindications, as the pressure from massage may contribute to tissue damage by promoting inflammatory reactions. 44,45 • At-risk areas for people who use a • If the client is inactive, there is a risk of reduced bone density and deep vein

• At-risk areas for people confined to bed are over the back of the head, shoulder blades, spine, elbows, tailbone, or buttocks and the heels. 46 • If the client has phantom limb pain associated with an amputation, massage the remaining limb and teach the client self-massage of the same areas. These methods were found to reduce pain and improve the quality of life in persons with lower limb amputations. 47,48 Be sure to avoid irritated areas or areas of broken skin if a prosthesis has caused friction wounds. Also, bring these areas to the attention of the client. Working With Clients With Visual Impairment Visual impairment is a decrease in the ability to see that cannot be corrected by usual means, such as eyeglasses, contact lenses or surgery. Impaired vision can be situational (such as trouble seeing only at night or in a bright environment), temporary (from an eye injury or from a surgical procedure) or permanent. Visual impairment also ranges in severity from low vision to complete or near-complete loss of vision. Normal vision or 20/20 vision refers to visual acuity, or the clarity or sharpness of vision. The first number of the fraction represents a standard testing distance of 20 feet (it is always 20 feet on a Snellen eye chart—countries on the metric system use the number 6 to represent 6 meters). The second number can change and represents a perceived distance. People with 20/20 vision can see the letters on an eye chart clearly from 20 feet away. People with 20/40 vision see the letters as if they are 40 feet away. In this scenario, letters on the 20/20 line of an eye chart appear blurry and difficult to read in people with 20/40 vision. 49 Organization defines low vision as visual acuity between 20/70 and 20/400. Blindness is defined as visual acuity worse than 20/400. 50, 51 Vision loss can be caused by a variety of things. It can be inherited or caused by an infection. There are different ways of describing a person’s vision loss. The World Health

Visual impairments affect people of all ages. They are more common among older age groups. The proportion of people aged 71 and older with visual impairments is 25 percent compared with six percent in people aged 18 and under.

wheelchair are over the shoulder blades, spine, buttocks and the backs of the arms and legs. 46

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