HOLISTIC THERAPY ITEC CASE STUDY 1

1. TREATMENT CARD
CLIENT’S PROFILE:
V.A. is a 41 year old female, married with 21 year- old son, a graduating student of a
degree course in industrial engineering in her country of origin. She doesn’t have her
family with her. She works as a full time live-in carer in Cardiff. She stays with her
demented 93 year- old female patient in a 2 storey house with garden.
She has an active lifestyle. She sees to it that she walks at least 1 hour per day in the
morning or jumping exercises for 30 minutes in the garden as part of her regular
exercise regime.
She has no contraindications that require medical permission or restrict the treatment
therein. She last sought for GP advice last August 2010 because she noticed a lump
in her right wrist. Mrs V.A said that GP advised not to worry. The lump isn’t cancerous.
Though it will take time, the lump will somehow disappear.
She has a moderate ability to relax and have a regular sleeping pattern with 7 to 8
hours sleep. She has a regular meal. She usually have fruits and 2 slices of toast with
tea in the morning; fruits at lunch time and heavy meal at night. She takes at least 1
Litre of fruit juice in a week; 8 glasses of water per day, and a cup of decaffeinated
coffee. She gets protein mainly on chicken, beef, cheese, egg and milk. She is a non-
smoker and an occasional drinker (1-2 wine glasses)
She suffers from constipation but she considers herself very healthy. She never has
any muscular pain because she is relaxed at work which at the same time her home
as well. V.A finds it easy working on her patient because the old lady is independent
though she needs supervision. She only feels distressed due to financial needs of her
family and her extended family as well.
She has combination type of skin. Her stress level in general is 2 (1 – 10 where 10 is
worst and 1 is least).
She has signed a complete informed consent form and was made fully aware of the
treatment and its benefit and effects. She never had a proper massage therapy so
she feels excited about the session.
REASONS FOR TREATMENT:
V.A wanted to have the treatment for general relaxation and to know how proper
massage goes.
TREATMENT PLAN:
To promote relaxation by doing full body massage 60 minute per session for three
consecutive weeks using mainly effleurage, petrissage kneading and percussion. The
strokes will be light and slow for general relaxation giving emphasis on the abdominal
region to improve bowel movement.
These strokes will be performed to facilitate general circulation and lymphatic flow.
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2. Session 1 /Date: 17 February 2011
BEFORE THE SESSION:
The client feels excited about the massage and kept on asking about the benefits of
proper massage as she says. Though excitement is imperative, I can feel she is bit
anxious so I assured her that it is the same massage that she thinks that soothes and
relieved only that it is done with a training therapist. She was anxious if her
constipation will be resolved after the treatment.
Since the client was expecting a lot from a proper massage treatment, I explained to
her the rationale of draping, the ambiance of the room, up to the treatment strokes
before I let her sign the disclaimer form.
She said she don’t feel too distressed and rated her stress level only 2 (10 is worst and
1 is least)
DURING THE SESSION:
Full body massage with light strokes was performed with light percussive movement
for complete promotion of relaxation and physical and mental well being. Calming
massage music has been played. Grapeseed oil is used as massage medium.
Client asked for a firmer pressure on the upper and lower back. Even though she
doesn’t complain of pain or any discomfort on her back, I felt some muscle tightness
on the upper trapezius and erector muscles. The pressure applied is well enough to
relieve tension (“wow, that’s great) I also felt some knots and when I did circular
friction on the rhomboids and teres muscles, she said it was relieving as if something
has been pulled out from her arms. Though the client mentioned the lump on her
wrist which she was anxious about, I informed her that I was able to palpate any. The
hand muscles were smooth.
Client confirms relief while doing deep effleurage and requested more pressure.
The client was apprehensive when I unintentionally put pressure in the colon when I
reinforce palmar kneading. So I gradually, lighten my hands to make movement flow
smoothly and in rhythm. I spent extra time in doing the abdominal to improve bowel
movement.
AFTER THE SESSION:
The client said that she thought she was okay but she felt better after the session. I
asked the client to drink at least 2 glasses of water to aid her flash toxins and help the
bowel movement for better evacuation.
She said she feels stronger and lightened up. She said she is looking forward to the
next sessions and how she was wishing this session won’t end.
I reminded the client on the contra-actions of massage and she said she will definitely
be fine.
STRESS LEVEL:
The client said she is totally free from stress. If she can rate it negative 1 then she will
say so.
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3. HOME CARE INSTRUCTIONS:
1. Continue doing regular exercises
2. If within 24 hours muscle soreness is felt, hot bath or hot shower is good for
general relief.
3. Drink plenty of water to aid in bowel movement
4. Take bigger portion of foods rich in fibre to avoid constipation
5. When feeling bloated, try to rub abdominals in clockwise direction (this is the
movement of food in the colon)
REFLECTIVE PRACTICE:
I felt happy that client was satisfied and her expectations were met. I felt guilty when
I thought I hurt the client when I initially applied pressure in the abdominal upon
reinforcing palmar kneading. Next time, I will be more careful,
CLIENT’S SIGNATURE: VILMA APUADO
THERAPIST SIGNATURE: JULIE ANNE PENA
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4. Session 2 /Date: 24 February 2011
TREATMENT PLAN:
To promote relaxation by doing full body massage using classical massage
techniques for 60 minutes. Light strokes will be performed as a start with progression
on pressure to decrease tension on the erector muscles and upper trapezius and to
aid good general lymph and blood flow. Practical advices on maintaining good
lifestyle and diet will be suggested later on.
BEFORE THE SESSION:
The client felt relaxed and empowered after the last session. V.A said for the first time
she evacuated twice the next morning. She said she drunk more water but couldn’t
monitor her diet and include fibre-rich foods. She takes what is only available in the
fridge. She feels shy to request for extra food for her to be included in her old lady’s
shop list. But she tried to take more greens the previous week.
Though the client looks so vigorous and excited for the session, she rates her stress
level 5 (10 is worst and 1 is least). However, she said, physically she doesn’t feel any
discomfort. She said that the reason why she feels distressed was that her family were
in need of extra cash for the maintenance of the property she bought. Unfortunately,
her salary has been held due to technical problems in the banking system. She slept
late night and wakes up early because she was thinking about this matter and she
has to talk to her family with 8 hours time difference from UK. But generally, she said
she was fine.
I sanitized her feet and did the initial routine of draping.
DURING THE SESSION:
Full body massage with light strokes was performed with light percussive movement
for complete promotion of relaxation and physical and mental well being.
Pressure was progressively increased according to client’s tolerance to loosen tight
muscles of the back. I found that back muscles weren’t that tensed as in previous
session.
I left the player so no music has been played which I think is an important element in
providing much relaxing ambience. Grape seed oil is used as massage medium.
Client was sharing her emotional distress.
AFTER THE SESSION:
The client feels relaxed and more calm. She feels she can think more clearly now
because she felt she has just been freed from mental and emotional burdens. She
feels sleepy and requesting more extra time until the day ends.
STRESS LEVEL:
The client said her stress level is one and later on will be zero when she gets all the
sleep she needed
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5. HOME CARE INSTRUCTIONS:
1. Try to relax and listen to soft and mellow music to change ambiance
2. Continue doing regular exercises
3. Drink plenty of water to aid in bowel movement and flash toxins in the body.
4. Try to have foods rich in fibre to avoid constipation
5. When feeling bloated, try to rub abdominals in clockwise direction (this is the
movement of food in the colon)
6. Take a hot bath for general relaxation.
REFLECTIVE PRACTICE:
I spent extra more time in this session. I got carried away with the client’s stories and I
lost track of time. It could have been more relaxing for the client if she has avoided
talking while having the massage. I felt disappointed to myself because the session
wasn’t good enough for me without the music. It could have helped the client enjoy
the massage more.
Generally, I was impressed that despite the shortcomings, I met client’s needs and
somehow listening to her stories made me realise that as therapist, it is also a factor to
let the client feel that they are heard but therapist must not dwell on their burdens.
CLIENT’S SIGNATURE: VILMA APUADO
THERAPIST SIGNATURE: JULIE ANNE PENA
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6. Session 3 /Date: 03 March 2011
TREATMENT PLAN:
To promote relaxation by doing full body massage using classical massage
techniques for 60 minutes. Light strokes will be performed as a start with progression
on pressure according to client’s tolerance to aid good general lymph and blood
flow and for general relaxation. Practical advices on maintaining good lifestyle and
diet will be suggested later on.
BEFORE THE SESSION:
The client noticed that tough she still having constipation; she is more relaxed in
evacuating. The client was relieved and unloaded of burdens on the last treatment.
However, this week, she was expecting her period to come. She felt generalised
fatigue, heaviness in the chest and headache which she consider normal prior to her
menstrual period. She thinks that since she hasn’t tried having massage prior to her
period, this session will make her feel really better.
I explained to her that I will only apply light strokes since her muscles are tender.
Her stress level is 4 because of the discomfort brought about by her premenstrual
syndrome.
I sanitized her feet and did the initial routine of draping.
DURING THE SESSION:
Full body massage with light strokes was performed. Client wasn’t satisfied with light
strokes. She said deeper pressure is better for her. She finds it more relieving and
relaxing for her especially the effleurage using my fist. I gave the pressure tolerable to
her but with cautions.
Calming and soothing massage music was played. Scented sweet almond oil was
used as a massage medium which she provided.
AFTER THE SESSION:
Though the client still feels tenderness, generally she was much more relaxed and
feels lighter. She feels sad that the treatment session has been finished. Though the
client thinks that she isn’t so distressed in life, she should continue having a massage
treatment because it gives her lighter feeling and much energised mood.
STRESS LEVEL:
Despite the tenderness, the client said her stress level is one.
HOME CARE INSTRUCTIONS:
1. Continue to have a positive outlook in life and stay jolly.
2. Try to relax and listen to soft and mellow music to change ambiance
whenever felt emotionally and mentally distressed
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7. 3. Continue regular exercises
4. Drink plenty of water to aid in bowel movement and flash toxins in the body.
5. Try to have foods rich in fibre to avoid constipation
6. When feeling bloated, try to rub abdominals in clockwise direction (this is the
movement of food in the colon)
7. Take a hot bath for general relaxation.
REFLECTIVE PRACTICE:
I felt very proud that in the last session, client’s need has been met and i have given
my strength and shared my skill.
It was interesting that despite the discomfort hormonal changes causes the client, she
appreciated the treatment very much and considered it very soothing.
Generally, I was impressed that despite the shortcomings, I met the client’s needs.
EVALUATION / CONCLUSION:
V. A has benefited from the consecutive weekly massage. She is more aware now
that massage and water therapy aids in good bowel movement. The client tried to
take and follow advice and it is very delightful to see how improvements in health
could be made when they do so. The client was very thankful that she had a proper
massage as she calls it and she said she will continue to have it and will tell her friends
about her experience. She said she loved the proper massage (massage done by
training / trained therapist)
AFTER CARE ADVICE:
1. Try to relax as much as a possible whenever financial constraint comes along.
2. Take plenty of greens and water.
3. Take hot bath for general muscle relaxation.
4. Try to use ergonomics for postural purposes and proper usage of muscle
strength.
CLIENT’S SIGNATURE: VILMA APUADO
THERAPIST SIGNATURE: JULIE ANNE PENA
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