Cautions and Recommendations to Therapists Asthma bronchial Obtain a detailed history specifically the triggers that bring on an attack.

k. If there is a history of allergy, ensure that the client is not allergic to the oil or other potential allergens in the clinic. It may be advisable for the client to have the required medications close at hand during the massage. A whole body relaxation massage helps to reduce bronchospasm. The client should be positioned as comfortably as possible. Most often this is a half-lying position with pillows supporting the knees, head, and arms. Work at relaxing the neck muscles of the shoulder girdle Concentrate on relaxing and massaging the abdominal, intercostals, pectorals, latissimus dorsi, sternocleidomastoid, and scalene muscles. Massage the muscles of posture these clients tend to develop kyphosis. Vibration can also be employed over the chest to loosen the thick mucous plugs. A disposable sputum mug with disinfectant may have to be provided. Ensure that the mug is disposed of in a leak-proof bag. Deep breathing exercises are very beneficial to open up the alveoli. Ask client to take short inspirations and expire slowly through the mouth four or five times. The expiration should be complete but not forced. Consider keeping brochures from your local Asthma Research Council on remedial relaxation and mobility exercises for these clients. The frequency of massage can be varied according the clients needs. A relaxation massage scheduled once a week has been found to be beneficial. Atelectasis Increase humidity and warmth of room before massaging these clients as it helps to loosen thick and plugged mucous. There should be proper air circulation and filtration in the clinic. The aim is to reduce the symptoms and help with the drainage of the excess mucous by dislodging them from the walls of the bronchi and to increase the mobility of the thorax. If the client has breathing difficulties, s/he will feel most comfortable in a half-lying position with support beneath the knees, arms, and head. For those with no breathing difficulties, other positions may be used. Since the basal regions of the lungs are most affected, position the client with the head end lower than the rest of the body either by using pillows under the abdomen to raise it or tilting the table with the foot end higher than the head end. Let the client relax for about ten minutes in this position before massage. Encourage clients to breathe deeply with slow and full expiration throughout the massage. Steam inhalation at this point helps loosen the thick sputum, if present. Do a whole body relaxation massage and use vigourous chest clapping, hacking and vibrations for 10 to 20 minutes. You may have to provide a sputum mug with disinfectant for the client. Use proper precautions while handling and disposing the mug and contents. Massage the tired respiratory muscles and the accessory muscles that are used for respiration. This should include the pectorals, the latissimus dorsi, trapezius, sternocleidomastoid and scalene muscles. These clients are very prone to respiratory infection. Do not massage if you have any form of respiratory infection. Schedule these clients for a time when they are unlikely to come in contact with others with infection. Encourage client to loose weight if obese, and stop smoking, if a smoker.

Bronchitis The aim is to reduce the symptoms and help with the drainage of the excess mucous by dislodging them from the walls of the bronchi and to help with the mobility of the thorax. Proper air circulation and filtration in the clinic helps these clients. Higher humidity and warmth also helps with the drainage of mucous. Since the basal regions of the lungs are most affected, position the client with the head end lower than the rest of the body either by using pillows under the abdomen to raise it or tilting the table with the foot end higher than the head end. Let the client relax for about ten minutes in this position before massage. Steam inhalation at this point helps loosen the thick sputum. Do a whole body relaxation massage and use vigourous chest clapping, hacking, and vibrations for 10 to 20 minutes. You may have to provide a sputum mug with disinfectant for the client. (Use proper precautions while handling and disposing the mug and contents). Massage the tired respiratory muscles and the accessory muscles that are used for respiration. This should include the pectorals, the latissimus dorsi, the trapezius, sternocleidomastoid and scalene muscles. Encourage clients to breathe deeply with slow and full expiration throughout the massage treatment. These clients are very prone to respiratory infection so massage should be avoided if the Therapist has even a mild form of respiratory infection. Schedule these clients for a time when they are unlikely to come in contact with others with infection. Encourage client to stop smoking if smokers. Cancer Lung Encourage clients to stop smoking if smokers. Keep brochures on dangers of smoking in your clinic. Have addresses and telephone numbers of local Quit Smoking Clinics handy. In general, the benefit of massage in reducing stress levels in these individuals is undisputed. However, massage may help spread the cancer to other regions especially if it has already spread to lymph nodes or other neighbouring structures. Consult Physician as to the stage of disease in invidivual clients. If a client is on radiation therapy, avoid massaging the skin over radiation areas. Clients on chemotherapy are more prone to any type of infection. Avoid massaging such individuals if you have even a mild form of any infection. Ensure that such clients are scheduled at a time when they are unlikely to come in contact with other infected individuals. Cystic Fibrosis The aim should be to help drain the viscid mucous from the lungs and to increase blood flow and venous/lymphatic drainage in the fatigued respiratory muscles. Before treatment, increase the humidity and warmth in the clinic. This helps to loosen the thick mucous. Steam inhalation is very beneficial. If possible, position the client with the head end lower than the leg to use the effect of gravity on drainage. However, the client may be most comfortable in a half-lying position a position that does not restrict breathing. Support the flexed knee, flexed and slightly abducted arm and the neck with pillows. Massage the respiratory muscles and back using broad strokes. The intercostals may be stretched by placing the fingers (2 nd-3rd or 2nd 4th fingers) in the intercostal spaces and rhythmically applying inward pressure during expiration. Use repetitive vibratory strokes on the chest. Cupping, tapping and hacking strokes should be used all

over the chest to loosen the thick mucous. A cup may have to be provided for the sputum. Handle the container with gloves and ensure that the cup and the contents are disposed in a leak-proof bag. If not too uncomfortable, change the position of the client to facilitate drainage through the different bronchi. These clients are prone to respiratory infections. Ensure that they do not come in contact with any form of infection in the clinic. The susceptibility to the infection increases the risk of tuberculosis in these clients. Ensure that you are not put at risk inadvertently. You may have to check with the Physician regarding infectivity of the client if TB has been diagnosed. Refer client to local support groups and for genetic counselling. Emphysema The aim is to reduce the symptoms, help with the mobility of the thorax and facilitate drainage of mucous by dislodging them from the walls of the bronchi. Proper air circulation and filtration in the clinic helps these clients. Higher humidity and warmth also helps with the drainage of mucous. The client may be more comfortable seated or in a half-lying position. Let the client relax for about ten minutes in this position before massage. Steam inhalation at this point helps loosen the thick sputum, if present. Do a whole body relaxation massage and use vigourous chest clapping, hacking and vibrations for 10 to 20 minutes. You may have to provide a sputum mug with disinfectant for the client. (Use proper precautions while handling and disposing the mug and contents). Massage the tired respiratory muscles and the accessory muscles that are used for respiration. This should include the pectorals, the latissimus dorsi, trapiezius, sternocleidomastoid and scalene muscles. The intercostal muscles may be stretched using two fingers in the intercostal space and applying pressure downward during expiration. Encourage clients to breathe deeply with slow and full expiration throughout the massage treatment. These clients are very prone to respiratory infection so massage should be avoided if the Therapist has even a mild form of respiratory infection. Schedule these clients for a time when they are unlikely to come in contact with others with infection. Encourage client to stop smoking of smokers. Influenza Be informed about outbreaks of influenza in your area. It may be wise to have annual inoculations of flu vaccines (not advisable if pregnant) at the start of the flu season i. in late autumn. Do not massage clients with influenza until they have fully recovered. Therapists with influenza should not massage clients until all symptoms have disappeared. Proper disposal of tissues, hand washing, covering mouth while sneezing or coughing are simple techniques that can prevent the spread of disease. Pleural Effusion Consult Physician regarding cause of effusion. If due to infection do not massage till treated completely. If due to tuberculosis follow precautions given under tuberculosis. The aim is to help with the absorption of fluid, prevent adhesions, prevent permanent changes in posture and help ventilation. Avoid areas of drainage tube if it is in place. These clients have a tendency to develop scoliosis. The shoulder is lower and the hip

higher on the affected side as compared to the normal side, so the postural muscles should be addressed while massaging. The treatments should be short not more than fifteen minutes with more time spent to massage the arms, shoulder girdles and back. In chronic pleural effusion, massage with the client lying on the side with the normal side on the table helps to expand the affected lungs. Ask client to push against your hand that is placed on the affected side, while breathing in;. Deep breathing exercises are also helpful. The intercostal muscles can be stretched by using two fingers in the intercostal space and pressing inwards during expiration. Work in conjunction with Physiotherapist. Pleurisy Encourage the client to breath deeply. Since it may be due to bacterial infection, massage should not be done under the cause has been identified. If due to other causes, a full body relaxation massage may be done with focus on the shoulder, back, and arms. Encourage the client to get bed rest. Pneumoconiosis Silicosis These clients are prone to respiratory infections. Schedule them at a time when they are unlikely to be exposed to other clients who may have respiratory infection. Do not massage them when you have a respiratory infection. There is a high incidence of tuberculosis in people with silicosis. Ensure that it is not so with the client you are treating. Encourage the client to stop smoking, if smoker, as it speeds up the progress of the disease. Do a whole body relaxation massage using hacking, clapping, and vibration strokes over the chest. The latter helps to drain secretions better. Steam inhalation before start of the treatment may be beneficial. Keep room at higher humidity and warmth. Pulmonary Edema Clearance from the treating Physician has to be obtained. A gentle massage of short duration may be given in a seated position with a focus on the tired respiratory muscles with an aim to relax and calm the individual. Pulmonary Embolism NEVER massage vigourously, the legs of individuals with moderate to severe varicose veins, or those who have been immobilised for a long time, or those pregnant. Vigourous massage in individuals who are predisposed may result in dislodgment of thrombi already formed. Those clients with a previous history of emboli are likely to be on anti-coagulant therapy and are prone to bleed easily. Do not use excess pressure while massaging these individuals. Early mobilisation after surgery helps avoid thrombi and emboli formation. Encourage clients in plaster casts or those advised prolonged bed rest to passively or actively move joints that are not immobilised. Sinusitis Local application of heat helps relieve pain. Encourage clients to complete the full course of antibiotics that have been prescribed. Steam inhalation also helps relieve the congestion. Accupressure and acupuncture are forms of treatment that have been found to be beneficial.

Tuberculosis Lung In general, tuberculosis is not infectious from 2 4 weeks after start of adequate treatment with antitubercular drugs. Do not massage unless sure that the client is no longer infective. Consult Physician regarding infectivity of individuals. Be cautious while treating clients with history of prolonged cough (more than 3 weeks), weight loss, fatigue and low grade fever. Refer such clients to a Physician before you treat. Massage Therapists should periodically get screened for tuberculosis by skin tests. Keep track of the epidemiology of tuberculosis in your area. If exposed to tuberculosis inadvertently, consult Physician immediately and watch for results of skin testing and take preventative treatment. Ensure that the local exhaust and general ventilation of the clinic is functioning properly.

Test for Chapter Nineteen

Name___________________________ Date 15 March Jasons Birthday 2005 system consists of two anatomical areas: the

1. The

respiratory

____________________________________________________________ which _________________________________________________________________ _ and the ______________________________________________________ where_____________________________________________________________ _____ (just tell me what the particular structures DO with their time) 2. What does surfactant do? 3. Atmospheric pressure is lower than the air pressure in my lungs. I am (inhaling/exhaling) 4. What is the term used to refer to the ability of lungs to expand? __________________________________________ 5. Tell me about hypoxic drive.

6. Why is alveolar air different from atmospheric air? 7. What can the presence of extra fluid do to the lung? 8. When is hmoglobin molecule fully saturated? 9. What is the rate established as upnea? 10. What is a painless, firm, fibrotic enlargement at the end of a digit?

Test for Chapter Nineteen

Name___________________________ Date 15 March Jasons Birthday 2005

11. The respiratory system consists of two anatomical areas: the Upper respiratory tract which conducts air between the atmosphere and the lungs and the lower where gas exchange takes place. 12. What does surfactant do? it reduces surface tension, facilitating inspiration and keeping it all from collapsing during expiration 13. Atmospheric pressure is lower than the air pressure in my lungs. I am (inspiring/expiring) 14. What is the term used to refer to the ability of lungs to expand? Compliance 15. Tell me about hypoxic drive. People with chronic lung disease have become used to lower amounts of oxygen, so they need a greater amount of CO2 in the air to trigger expiration. They need to remain slightly hypoxic rather than be given extra oxygen. 16. Why is alveolar air different from atmospheric air? Alveolar has been filtered and moistened, old air is never totally expired from the lungs, et cetera. 17. What can the presence of extra fluid do to the lung? it can impede blood flrow through the pulmonary capillaries and increase surface tension in the alveoli, restricting expansion of the lung 18. When is hmoglobin molecule fully saturated? When all four hme molecules have taken up oxygen 19. What is the rate established as upnea? 10 to 18 inhalations per minute 20. What is a painless, firm, fibrotic enlargement at the end of a digit? Clubbing