Client Assessment and Treatment Flashcards

A client presents with a history of deep vein thrombosis (DVT) that was diagnosed and treated 6 months ago. She has been cleared by her physician for massage but reports occasional unilateral calf aching. Which approach is MOST appropriate for the affected limb?

Answer: Use light, non-compressive touch to the affected limb while avoiding deep or frictional techniques

Even with physician clearance after resolved DVT, residual vascular changes and risk of post-thrombotic syndrome warrant a conservative approach. Light, non-compressive touch avoids mechanical disruption of fragile vessel walls. Distal-to-proximal effleurage (B) is contraindicated for DVT history because it increases venous pressure and can dislodge any residual thrombus. Full normal treatment (D) ignores the nuanced risk profile. Complete avoidance (A) is overly restrictive given physician clearance.

During intake, a client discloses she is 10 weeks pregnant, has a history of two prior miscarriages, and is under high-stress conditions at work. She requests deep abdominal work for bloating. Your BEST course of action is to:

Answer: Postpone abdominal massage and offer alternative comfort techniques while recommending OB/GYN consultation

First trimester with a history of multiple miscarriages represents elevated risk, particularly with added psychosocial stressors. Postponing abdominal work and recommending OB/GYN consultation is the most clinically prudent action. Gentle circular strokes (B) still introduces unnecessary risk without clearance. Declining all massage (A) is overly restrictive. Requiring written clearance for all massage (D) may be appropriate in some clinical settings but is not the single best answer here — the priority is deferring the specific requested technique while providing safe alternatives.

A therapist is performing a SOAP note and records: 'Client appears anxious and reports work-related stress causing neck tension. ROM limited to 40° left rotation. Suboccipital release and SCM cross-fiber friction performed. Client reported reduced tension post-session.' Which portion of this note contains information that should NOT be documented in the Objective section?

Answer: Client appears anxious and reports work-related stress

The Objective section should contain measurable, observable, or verifiable clinical findings — such as ROM measurements, techniques applied, and physiological outcomes. 'Client appears anxious and reports work-related stress' is a subjective observation and client-reported history, which belongs in the Subjective section. Documenting it under Objective conflates the therapist's interpretation with measurable data, which undermines clinical accuracy and legal defensibility of the record.

A new client with type 1 diabetes reports well-controlled blood glucose levels and takes insulin via pump. Midway through a 90-minute session, he becomes diaphoretic, mildly confused, and reports feeling 'shaky.' The therapist's FIRST priority should be:

Answer: Stop the session, offer a fast-acting glucose source such as juice or glucose tablets, and monitor the client

The client is showing classic signs of hypoglycemia (shakiness, diaphoresis, confusion). The immediate intervention is to stop massage — which lowers blood glucose further via increased circulation and insulin uptake — and provide a fast-acting carbohydrate source. Emergency services (A) are warranted only if the client loses consciousness or symptoms do not resolve. Continuing massage (C) is dangerous as it exacerbates hypoglycemia. Checking the pump (D) delays life-saving intervention and is outside the therapist's scope.

A client with fibromyalgia reports that her rheumatologist recommended massage but that previous sessions always caused a 24–48 hour post-massage flare of pain and fatigue. Which treatment modification is MOST supported by current evidence-informed practice for this population?

Answer: Limit session length to 30 minutes using only superficial, non-compressive techniques and increase intensity only if well-tolerated over multiple sessions

Fibromyalgia involves central sensitization, meaning the nervous system is in a hyperreactive state. Post-massage flares after standard sessions indicate the client's threshold is low. Evidence supports starting with shorter, gentler sessions — particularly gentle Swedish or myofascial techniques — and gradually titrating pressure and duration based on client response. Deep tissue/trigger point work (B) typically exacerbates central sensitization. Avoiding all massage during flares (C) is overly restrictive — mild, gentle work is often beneficial. Tapotement (D) is contraindicated as it further stimulates an already hyperactive nervous system.

A client signed a HIPAA-compliant release form authorizing her massage therapist to share treatment notes with her primary care physician. Three months later, the client verbally requests that the therapist also share the notes with her chiropractor. What is the CORRECT procedure?

Answer: The therapist must obtain a new written authorization specifically naming the chiropractor before releasing any records

Under HIPAA, a valid authorization to disclose protected health information (PHI) must specifically identify each recipient. A release naming the primary care physician does not extend to other providers, even if they are in the same professional category. Verbal requests from clients do not satisfy HIPAA's written authorization requirement. The therapist must obtain a new, written authorization that specifically names the chiropractor, describes the information to be disclosed, and includes an expiration date or event. Contacting the physician (D) is irrelevant — that provider has no authority over the client's records sharing decisions.