Teaching Pathology from the

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• Teaching Pathology from the
• Ruth Werner
• President, Massage Therapy Foundation
• Author, A Massage Therapists Guide to Pathology
• Recipient, 2005 Teacher of the Year Award
• Wernerworkshops_at_ruthwerner.com

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Why Develop Curriculum on Pathology?

• Required by
• COMTA, other accrediting agencies
• Some state licensing boards
• NCBTMB

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Why Teach Pathology?

• Public Safety Why do people get massage?
• AMTA 2012 Massage Profession Research Report says
  of the 18 of US adults who got massage in 2011
• 44 for medical reasons
• 30 for stress
• 12 for pampering

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Why Get Massage?, cont.

• So about 74 for health and/or wellness
• 37.9 million people had a massage in 2011
• 170,500,000 sessions delivered
• (about 4.5 sessions per person)

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Massage Locations
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More Massage Locations

• 1 each (about 400,000) in
• Workplace
• Student clinic
• Hospital
• Alternative therapy clinic

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Massage Therapy in Policy

• ACA mandates a place for integrative medicine for
  health and wellness
• NCCAM
• Recognizes massage as part of integrative
  medicine
• Requires that IM licensed providers be
  research-literate
• It is our job to prepare MTs to be ready to take
  part in this new/ continuing reality

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So

• About 400,000 people get massage in a student
  clinic (under our care) each year
• Massage is being used as health care more than as
  self-indulgence including in spa and resort
  settings
• Are we educating students to be health care
  providers?

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What Goes in a Pathology Curriculum?

• Understanding what issues impact choices for
  bodywork and safety
• Critical thinking the answer is always it
  depends our students must determine what it
  depends on
• Palpatory and visual signs of caution
• Medications (new field, under-studied)
• Skills to get more information (research
  literacy!)

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Finding More Information

• Print resources about MT and Pathology
• Werner
• Salvo
• Premkumar
• Wible, Persad (MT and pharmacology)

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Finding More Information

• Electronic Resources About MT and Pathology
• In general look for .gov, .edu rather than .com
• Beware of advertisements hiding as good
  information
• Wikipedia can be a good starting place, but not a
  good ending place
• Medscape.com, emedicine.com
• Mayo.com
• NIH.gov
• Subheads for type of condition
• CDC.gov
• Scholar.google.com edits out most commercial
  sites

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Finding More Information

• Trade Journals
• Massage Therapy Journal
• Massage and Bodywork
• Massage Magazine
• Massage Today
• They all have columns on pathology and research,
  with the added benefit that they are more current
  than textbooks and written by MTs

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Beyond Objectives all the way to IMPACT

• critical thinking
• Weigh risks and benefits to make choices for a
  safe and effective session and treatment
  strategy
• Communication
• Be able to have an informed conversation with the
  client and his/her health care team
• Which systems are affected
• What is the prognosis
• What are common treatment options
• Where does massage fit/ what does the research
  say?

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Troubleshooting Pathology Classes

• What doesnt work
• It feels dark and hopeless
• It doesnt seem pertinent
• Its just a big information dump
• Its too technical
• Its too personal
• Its too hard to fit in between courses after
  AP, before student clinic
• Taught by multiple people
• Taught by non-MTs, who have no sense of context
• Its too hard to discern what to cover and what
  to let go

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How Do We Teach Pathology Well?

• Pathology teachers need to
• Focus as much (or more) on the bodys capacity
  for healing as we do on the process of illness
  this frames a context for bodywork as a
  therapeutic intervention, working to create an
  environment conducive to positive change
• Discuss people who live with conditions with
  respect and appreciation
• (Humor has a place here too)
• Instill the fact that life is an open-book test
• NO ONE can remember it all (including the
  teacher)
• Plus which, information changes
• Thats why you need to be able to look stuff up!
• Remember what it felt like to be overwhelmed with
  information

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In the Delivery

• Review pertinent AP (this is building the house
  of cards)
• Discuss what happens when certain cards
  (functions) are removed (interrupted)

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For Each Topic

• Cover at least
• Definition
• Etiology (briefly!)
• Signs and symptoms
• Conclude from that information
• Massage benefits
• Massage risks
• How to maximize benefits, minimize risks

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In the Best of All Possible Worlds Add

• What does the research say about massage and ___?

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This gets us to

• critical thinking
• Weigh risks and benefits to make choices for a
  safe and effective session and treatment
  strategy
• Communication
• Be able to have an informed conversation with the
  client and his/her health care team
• Which systems are affected
• What is the prognosis
• What are common treatment options
• Where does massage fit/ what does the research
  say?

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Herpes Simplex

• Viral infection leading to painful blisters on
  the skin
• Oral, genital, other
• Type 1 v. Type 2 no longer a significant issue
• Incidence
• Who knows?
• Genital herpes 60?
• Oral herpes 80?

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Herpes Simplex, cont.

• Primary and recurrent herpes
• Virus is never expelled
• Communicability
• Virus is stable on surfaces outside a host
• Can spread from one part of the body to another
• Can spread during prodromic stage

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Herpes Simplex, cont.

• Types of herpes
• Oral
• Genital
• Whitlow
• Gladiatorum
• Others
• Signs and symptoms
• Tingly, itchy during prodromic stage
• Painful blisters on a red base
• Scabbing after acute phase (less contagious)

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Herpes Simplex, cont.

• Complications
• Secondary infection
• Increased risk of contracting, spreading HIV/AIDS
• Vaginally delivered babies
• Treatment
• Antivirals to shorten episode (not prevent)
• Research
• Nothing on humans with herpes about massage
  therapy

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Herpes Simplex, cont.

• Massage?
• Risks? (How to eliminate them?)
• Benefits? (How to maximize them?)
• Reschedule during outbreaks, prodromic stage
• Avoid hands?
• Isolate linens if exposed
• Be careful of spreading from therapist to client!

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Strategizing Classroom Content

• Prioritize
• Discuss the most common conditions
• Cardiovascular disease
• Arterial side hypertension, atherosclerosis, etc
• Venous side DVT, PE
• Types of cancer
• Skin, lung, colorectal, breast, prostate
• Regional issues
• WNV, Lyme, etc

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Prioritizing, continued

• Discuss the conditions most influenced by touch
• Contagious conditions
• (especially of the skin demystify these!)
• Public health issues
• HIV/AIDS, hepatitis, TB
• Fluid management diseases
• Kidney and liver dysfunction
• Diabetes
• Musculoskeletal conditions
• Coordinate with other courses

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Use Lots of Tools!

• The emphasis is on interaction with the material
• Draw pictures
• Use videos
• Invite visitors
• Assign projects

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You cant cover everything so

• Empower students to get their own information
  they should be able to provide the basic things
  you cover in class
• Homework has a place here too ensure that
  students are interacting with content NOT covered
  in class time.

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Student Projects in Pathology

• Focus on critical thinking and communication
  skills
• Assign a research paper
• on a students choice of topic
• on your choice of topic
• (beware of plagiarism it is a difficult issue)
• Assign a spoken presentation
• Warning students are not teachers. These can be
  boring to sit through, and may turn off the rest
  of the class
• Interview someone who lives with a condition
• This can also spill over into a research literacy
  project
• Find an article on the topic (or you can provide
  one)
• Critique it
• Describe how to apply findings in practice

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Thank You!