Guide Palpation and Assessment Skills

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So, determination of the needs of the tissues, and of the person, are paramount. Whether the objective is mobilisation of a joint; restoration of joint play or range of motion; release of tense, shortened structures; enhanced circulation to, or drainage of, needy tissues; toning of weak or inhibited musculature; deactivation of trigger points, or other pain modulating initiative, or any of a range of other bodywork approaches, it is axiomatic that there should be in place an adequate degree of awareness of the nature and current level of dysfunction, as well as an ability to compare this current state with whatever is conceived of as normal, before treatment commences.

Palpation and Assessment Skills: Assessment Through Touch - Leon Chaitow - Google книги

Whatever the system of treatment, any local findings muscle, joint, etc. As discussed in the Preface to the first edition of this book, in , this ability is often spoken of as an intuitive approach. Intuition in this sense is not a vague esoteric phenomenon, but rather a demonstration of knowing in action Schon in which apparently spontaneous therapeutic skills emerge from a background of deep understanding and refined actions, acquired by diligent practice. Clearly much such evaluation can now be performed using technology. Patients can be photographed, videod, scanned, X-rayed and in a multitude of other ways investigated as to the current state of their structures, functions and dysfunctions.

Biotechnology is advancing by leaps and bounds, and tools and equipment, previously only available in hospital and major clinic settings, are increasingly available to the individual practitioner and therapist, to assist in the clinical application of such methods. So is the ancient art of palpation becoming redundant? Are assessments involving subjective judgement, old-fashioned and inaccurate? In recent years the value of palpation has been challenged, with research studies suggesting that reproducible results cannot always be demonstrated when the accuracy of palpation is tested.

The reliability of palpation performed by individuals, as well as the degree of agreement between experts palpating the same patient, or tissues, is increasingly questioned. These issues, as well as the suggested remedies for individuals as well as for teaching and training organisations, are explored in Chapter 2.

The truth is that as with the acquisition of any skill there are a number of variables that can determine whether the outcome is a skilled individual or not. These variables include:.

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This book contains a distillation of the methods and thoughts of hundreds of wonderfully skilled individuals, from diverse therapeutic backgrounds. The commonality that emerges is that despite the doubts expressed as to the value of palpation see Chapter 2 , there is no equivalent in technology to replace what can be gleaned from truly skilful hands-on touch and assessment methods. You are recommended to work through the book, chapter by chapter, exercise by exercise more than once , recording your findings and refining your skills. This is as relevant to the student as to the person currently in active practice, for we should never cease striving for even better subtlety of palpatory literacy.

Academy of Applied Osteopathy Yearbook, pp. Many experts advise discovering how hard you can press on your own closed eyeball before discomfort starts, as a means of learning just how lightly to press. Other advice includes keeping an eye on the degree of blanching of the nailbed, to ensure uniformity of pressure. This is particularly important in the evaluation mode of neuromuscular technique see Chapter 5. When we palpate more deeply or apply digital pressure to a tender point in order to ascertain its status Does it hurt?

For example, when assessing people with the symptoms of fibromyalgia, the criteria for a diagnosis depend upon 11 of 18 designated sites testing as positive i. If it takes more than 4kg of pressure to produce pain, the point does not count in the tally. The question then is, how does a person learn to apply 4kg of pressure, and no more?

It has been shown that, using a simple technology such as bathroom scales , physical therapy students could be taught to accurately produce specific degrees of pressure on request. Students were tested applying posteroanterior pressure force to lumbar tissues. After training, using bathroom scales to evaluate pressure levels, the students showed significantly reduced error, both immediately after training as well as a month later Keating et al Without a measuring device such as an algometer there would be no accurate means of achieving, or measuring, a standardised degree of pressure application.

“Princess and the pea” – an assessment tool for palpation skills in postgraduate education

An algometer is a hand-held, springloaded, rubber-tipped, pressure-measuring device, which offers a means of achieving standardised pressure application. Using an algometer, sufficient pressure to produce pain is applied to palpated or preselected points, at a precise 90 angle to the skin. The measurement is taken when pain is reported. Baldry referring to research by Fischer discusses algometer use he calls it a pressure threshold meter and suggests it should be employed to measure the degree of pressure required to produce symptoms, before and after deactivation of a trigger point, for when this is successful, the pressure threshold over the trigger point increases by about 4kg Baldry , Fischer Valuable as it is in research and in training pressure sensitivity, use of an algometer is not really practical in everyday clinical work.

It is, however, an important tool in research, as an objective measurement of a change in the degree of pressure required to produce symptoms. It also helps a practitioner to train themselves to apply a standardised degree of pressure when treating and to know how hard they are pressing. This is an objective base which is calculated from the patients subjective pain reports, when pressure is applied to test points.

The calculation of the MPI determines the average degree of pressure required to evoke pain in a trigger or tender point. Using an algometer, pressure is applied to each of the points being tested which could be the 18 fibromyalgia test points or, more logically, a selection of active trigger points identified by standard palpation.

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Pressure is applied, using the algometer, at a precise 90 angle to the skin, sufficient to produce pain, with the pressure measurement being taken when this is reported. The values are recorded and then averaged, producing a number which is the MPI. This allows comparison at a later stage to see whether the trigger point requires greater pressure to produce pain, indicating that it is less active, or the same or less pressure, indicating that it has not changed or is more sensitive.

Objective palpatory literacy It is axiomatic that practitioners who use their hands to manipulate soft or bony structures should be able, accurately and relatively swiftly, to feel, assess and judge the state of a wide range of physiological and pathological conditions and parameters, relating not only to the tissues with which they are in touch but others associated with these, perhaps lying at greater depth.

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The information a practitioner needs to gather will vary according to the therapeutic approach; it might be the range of motion and the feel of joint play, the relative weakness or tightness in muscles, the amount of induration, oedema or fibrosis in soft tissues, identification of regions in which reflex activity is operating or even differences in the quality of perceived energy variations in regions of the body.

Karel Lewit sums up a major problem in learning to palpate: Palpation is the basis of our diagnostic techniques [and yet] it is extremely difficult to describe exactly, in words, the information palpation provides. We will try, nevertheless, to do just this, with the help of numerous experts from a variety of disciplines, all the while keeping in mind the words of Viola Frymann : Palpation cannot be learned by reading or listening; it can only be learned by palpation.

Much of this book comprises descriptions of various forms of palpation, highlighting different ways in which this may be best achieved, along with numerous examples of exercises which can help in the development of perceptive exploratory skills. Of course, what we make of the information we derive from palpation will depend upon how it fits into a larger diagnostic picture, which needs to be built up from case history taking and other forms of assessment.

Such interpretation is naturally essential in order for treatment to have any direction; palpation is anything but an end in itself. However, interpretation of the information derived from palpation is not a major purpose of this text; the main purpose is learning to palpate.

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This concentration on the process of learning to palpate is not because interpretation of information is regarded as being of only secondary importance for it is not but because to have ventured too far into that realm would have expanded the text to an unmanageable size. For example, in Chapter 3, which deals with the assessment of skin tone elasticity, we will discover how to make an accurate assessment of local or general areas in which there is a relative loss of the skins ability to stretch due to reflex activity.

The section therefore deals with the art of palpation of these particular tissues in terms of this particular characteristic elasticity, adherence. What the finding of local skin tightness may actually mean in terms of pathological or physiological responses, and what to do about it, will also be touched on in terms of the opinion of various experts, but it is not possible to give a comprehensive survey of all possible opinions on the topic.

In other words, the individual practitioner will have to fit the acquired information into their own belief system and use it in accordance with their own therapeutic methodology. The aim of the book is to help in identifying what is under our hands. We can equate palpation with learning to make sense of some other form of information, say that relating to music. It is possible to learn to read music, to understand its structure, the theory of harmony, tones and chords and even something of the application of such knowledge to different forms of composition.

However, this would not enable us to play an instrument. The instrument that therapists play is the human body and the development of palpatory literacy allows us to read that body. One of osteopathys major figures, Frederick Mitchell Jr , makes a different comparison when he equates the learning of palpatory literacy with that of visual literacy. Visual literacy is developed in visual experiences, and the exercise of visual perceptions in making judgments. Visual judgments and perceptions may be qualitative, or quantitative, or both.

Although the objectives in training the diagnostic senses do not include aesthetic considerations, aesthetic experiences probably are developmental in terms of visual literacy. In making aesthetic value judgments one must be able to discriminate between straight lines and crooked lines, perfect circles and distorted circles To evaluate the level of sensory literacy, one may also test for specific sensory skills in a testing situation. In later chapters I will suggest ways in which this can be done. Assumptions and paradoxes The assumption is made that the reader has at least a basic knowledge of anatomy and physiology, and, ideally, of pathology.

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It is. It is all too easy for practitioners even those with wide experience to feel what they want to feel or what they expect to feel. A relative degree of detachment from the process of assessment is therefore helpful, if not essential. An open mind is also vital to the task of learning palpatory literacy; those practitioners with the greatest degree of rigidity in terms of their training and the system of therapy they follow often have the hardest time in allowing themselves to sense new feelings and become aware of new sensations. Those with the most open, eclectic approaches massage therapists are a prime example usually find it easiest to trust their senses and feelings.

This paradox can only be resolved by highly trained professionals becoming more intuitive and open, trusting that they really are sensing very subtle sensations as they open themselves to developing the delicate skills necessary for many palpatory methods. At the same time, many less well-trained professionals may need to accept the necessity of adding layers of knowledge to their intuitive and nurturing talents. Unless a practitioner is able to read with the hands the information which abounds in all soft tissues and is also able to relate this to the problems of the patient as well as to a good deal of other diagnostic information much potentially vital data will be missed.

No one in the osteopathic field has done more to stress the importance of sound palpatory skills than Viola Frymann and we will be learning from a number of her observations as we progress through the text. She summed up the focusing of these skills, and the importance of making sense of them, when she said Frymann : The first step in the process of palpation is detection, the second step is amplification, and the third step must therefore be interpretation. The interpretation of the observations made by palpation is the key which makes the study of the structure and function of tissues meaningful.

Nevertheless it is like the first visit to a foreign country.