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Experiential hands-on learning

Experiential hands-on learning: Ocean in a Jar (h/t Gwyn Jones) (#17/31)

Submitted by RST on Fri, 08/17/2012 - 22:19
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Field trip! We're going to Padilla Bay tomorrow for a shore walk. /happydance!

Source: http://nerrs.noaa.gov/Images/Reserves/PDB.jpg accessed 17 August 2012

 

Source: http://www.wwu.edu/huxley/spatial/nwwgis/maps/padillabay.gif accessed 17 August 2012

 

One of the things that's so interesting about Padilla Bay is that it is an estuarine environment--it's where fresh river water joins the salt water of Puget Sound, so it's a transition zone between freshwater and saltwater.

Life at that intersection reflects aspects of both the sources that make up that environment.

I'll post pictures of any interesting littoral plants and animals that we come across on our shore walk.

Gwyneth Jones, an oceanography instructor at Bellevue College, has lots of fun and educational links and resources on her science division webpage.

"Ocean in a Jar (for fun): creating scented bath salts that resemble the sea" is printed on the bottom half of that PDF page.

It's a fun opportunity to create gifts for your friends, family, and clients, as well as products you can use in a spa-oriented practice--and learn a little ocean science at the same time!

And it's especially topical ( ☺! ) since we MTs are so closely involved with the skin and effects of topical products such as oils and lotions. Last year in Journal Club, we looked at the life-and-death importance of oil massage for infants in the developing world to help their skin protect them against infections and body heat loss.

Earth sciences, biology, and social science, among others, meet in this exploration of making topical products for the skin.

 

UPDATE, 19 August 5:33 PM PDT: I've gotten feedback that the link to her page does not work for everyone. I tested it, and because it works from my machine, I am not sure what I can do to fix it. I wonder if the fact that it's a PDF document is breaking it somehow?

I've reproduced the relevant section from her page here, as well, so that if the document doesn't work for you, you don't miss out on her recipe.

Ocean in a Jar (for fun)

I enjoy making bath salts, scented oils, lotions, etc for my friends, family, and self. I realized recently that the base recipe I use for bath salts creates "seawater"! (Lower salinity, unless you use a vat of the stuff, but most of the key elements/ions are in there.) Martha Stewart showed viewers a very similar recipe when she was on Oprah recently (though let's not get into how I know that, ahem, and she didn't draw parallels with oceanography for some reason...). My concoction, below, is a combination of recipes from "Natural Beauty at Home", by Janice Cox, plus some trial and error. You can play around with the proportions to suit your preferences.

Epsom salts, 1 cup - magnesium sulfate (MgSO4 ·7H2O) - available (cheap) in drugstore aches-and-pains aisle

Kosher salt or coarse sea salt*, 1/4 cup - sodium chloride (NaCl)

* You can substitute baking soda (sodium bicarbonate, NaHCO3) and/or cornstarch (organic stuff), for some or all of the kosher/sea salt.

Optional:

Vegetable oil, about 1/8 cup - almond, coconut, avocado, walnut, olive... - If only oil spills were vege oils!

Food coloring, a few drops - the kind you can get in the grocery store baking aisle in little bottles

Essential oil, a few drops (I use the pure, natural ones) - lemon, rosemary, lavender, rose, mint, pine...

Mix the ingredients together well, by shaking in a jar with lid or in a Ziploc-type bag. It will take a couple minutes of shaking to distribute the oils and color well. I like using a bag so I can work out some of the colored lumps with my fingers.

To use, add about 1/4 cup to running bathwater. It will keep a month or so in a closed container. Not edible, so keep away from youngsters, pets, etc. With vegetable oil added, you can also use it as an exfoliating, moisturizing salt rub (my sister-in-law the kickboxer loves it this way): Add a little water to a handful of the salts and then rub on damp body skin in the shower; rinse with warm water. Don't use it as a rub if your skin is broken out or sensitive, and don't use it on your face (too irritating).

Enjoy! ☺ Gwyn

 

 

VERY IMPORTANT:

Remember, Epsom salts and essential oils are not edible, so keep this mixture stored in a safe place where children and animals can't accidentally poison themselves by eating it.

 

 

Reading the recipe is pretty straightforward. There are a couple of technical terms I'll note, but we don't need to wait until we get around to discussing the chemistry in order to use the recipe.

Salinity is the measurement of how salty a liquid is. The Earth's oceans are not equally salty everywhere; here's a map of how much they can vary from one region to another.

Source: http://upload.wikimedia.org/wikipedia/commons/f/f7/WOA05_sea-surf_SAL_AYool.png accessed 17 August 2012

 

By "elements/ions" she means the chemicals in different kinds of salt--there's the table salt (sodium chloride) that we're all familiar with, but there are many other kinds of salts as well.

Not all salts are edible, which is why there's a warning on the Epsom salts (magnesium sulfate).

We'll discuss the chemistry more later, but here at least, it looks like tomorrow will be a perfect day for going ahead with this activity in the meantime.

So I'm inviting you to take a little time to make some bath salts, following Jones' "Ocean in a Jar" recipe, and improvising with different oils that you like.

Have fun! If you hit on any combination you especially like, you're invited to share it with us in the comments.

Source: http://4.bp.blogspot.com/_aUURo8ALyhE/SrO3LbfZhzI/AAAAAAAAAEk/X8MNZ_jkIdI/s320/bath_salt.jpg accessed 17 August 2012

Delicious science: Making chocolate, by way of jawed fishes (#15/31)

Submitted by RST on Wed, 08/15/2012 - 17:22
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Gnathostomata is the group of vertebrates [back-boned animals] with jaws. The term derives from Greek γνάθος (gnathos) "jaw" + στόμα (stoma) "mouth". Gnathostome diversity comprises roughly 60,000 species, which accounts for 99% of all living vertebrates. In addition to opposing jaws, living gnathostomes also have teeth, paired appendages, and a horizontal semicircular canal of the inner ear, along with physiological and cellular anatomical characters such as the myelin sheathes of neurons. Another is an adaptive immune system that uses V(D)J recombination to create antigen recognition sites, rather than using genetic recombination in the Variable lymphocyte receptor gene.

The group is traditionally a superclass, broken into three top-level groupings: Chondrichthyes, or the cartilaginous fish [sharks and rays]; Placodermi, an extinct clade of armored fish; and Teleostomi, which includes the familiar classes of bony fish, birds, mammals, reptiles, and amphibians.

The Gnathostomata first appeared in the Ordovician period (about 450 million years ago) and became common in the Devonian period (about 360 million years ago).--Wikipedia, "Gnathostomata" accessed 15 August 2012

 

Fast-forward about 360 million years to France, where, as the story has it**, a young apprentice chocolate maker accidentally pours boiled cream into a batch of chocolate, provoking his master to fly into a fury, and to rebuke him for being a slack-jawed moron--a "ganache", since they were, of course, speaking French.

But the apprentice was redeemed--long after his abusive master has been forgotten, "ganache"--that versatile mixture of chocolate and cream--lives on in confections worldwide.

** Is this legend true? No idea, but it's a widely-told story in chocolatier circles, in any case.

 

The word "ganache" is rooted in the Greek γνάθος (gnathos) "jaw", and that's how fossilized jawed fishes are connected indirectly through a fluke of history to delicious chocolate treats.

 

How to make chocolate ganache

A good working ratio is 8 ounces of chocolate to a cup of heavy cream, but this isn't brain surgery, or even baking--chocolate is tolerant of variation, and you can use more chocolate/less cream to make it firmer if you like, or less chocolate/more cream to make it more liquid.

Before you start, you should decide what you want to use your ganache for.

You can frost a cake with it,

Source: http://upload.wikimedia.org/wikipedia/commons/0/06/Chocolate_cake_with_chocolate_frosting_topped_with_chocolate.jpg accessed 15 August 2012

 

or you can dip other things in it to serve as fillings (like this peanut-butter fudge),

Source: http://upload.wikimedia.org/wikipedia/commons/b/bc/PBfudge_ganache.jpg accessed 15 August 2012

 

or you can roll them into truffles and dust or dip them in combinations of chocolate and other toppings,

Source: http://upload.wikimedia.org/wikipedia/commons/7/7f/Truffles_with_nuts_and_chocolate_dusting_in_detail.jpg accessed 15 August 2012

 

 

or you can flavor the ganache and enclose it in hollow chocolate shells,

Source: The Chocolate Man, http://www.chocolateman.com/images/PRODUCT/medium/379.jpg accessed 15 August 2012

 

 

just to name a few of the things you can create.

 

 

For this introduction to ganache, let's just keep it simple and make a filling for hollow chocolate shells.

 

 

 

Hands-on experiential learning: Qualitative evaluation project--Interviewing people about what massage means to them

Submitted by RST on Sun, 05/06/2012 - 11:10
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Introduction

This exercise asks you to collect and record data about the personal and unique meanings that people take from massage.

The purpose is to give you the experience of conducting qualitative research on a very small scale, so that from it, you get a sense of how researchers design and carry out studies to investigate a particular research question.

We're going to use an ethnographic interview, which is a qualitative research method. It's a way of interviewing people, usually one-on-one, to find out basic facts about their lives, how they understand the world around them, and possibly such things as what meaning they derive from it.

 

Designing your project

The research design for this project is fairly straightforward:

Decide on 2 or 3 people whom you would like to interview to learn what they think about massage, and what their experience with massage is.

Decide on the setting where you would like to interview them--invite them to your place, drop by theirs, invite them out for coffee, or whatever other setting works well for you to ask questions and note down their answers.

Invite people to participate in your study. Two or three is enough for this, as it is really a demo more than it is an actual project.

Make sure that before you interview anyone, they have signed and given you a copy of the consent form later in this post.

Meet them for the interview, and record their answers to your questions.

Write up their answers to your questions, and--making sure you observe accepted practices of confidentiality--tell us in the comments below what you wanted to explore, what questions you asked in order to explore that, what their answers are, what you think their answers tell you about the meaning they take from massage, and anything else about the process that strikes you as worth mentioning.

 

Primum non nocere--First, do no harm.

 

Remember that, as a healthcare professional and as a researcher--even in an exercise as small-scale as this one--you have a responsibility and a duty above all to protect the identities of the people you interview.

Before you share information with the rest of us in the POEM community, make sure that you have removed or shielded any information that would help people to figure out the identity of the people you interview.

Perhaps the most obvious thing to do first is to make sure you don't use someone's real name. But by itself, that may not be enough to protect the identity of your participants.

Consider, for example, the following description:

"Mary", an MT originally from Alabama who now lives in the Seattle area, and who speaks Cambodian and works with refugee clients...

 

That description is specific enough for people who know me to figure out that "Mary" is really me; changing the name was not enough to hide that fact.

Consider changing the sex and age of your participants, as well as any other relevant demographic characteristics, that will protect their identity. In a context where it doesn't affect the meaning of the results, a 27-year-old man can become a 50-year-old woman, if necessary for the sake of protecting confidentiality in a research project.

Change details in the interviews that don't affect the meaning of the answers your participants provide. For example, with 1684 residents, Oshoto, WY is small enough that people from there might know each other well enough to recognize each other's stories. So if I interviewed someone who said something like "When I was growing up in Oshoto, ...", then I would either change the name of the town, or I would remove it altogether and just report the person said "When I was growing up, ...".

Although your sample size in this exercise is so small that this may not be practical here, for future projects you might combine two or more people into a composite character, whose identity can't be guessed because that single individual doesn't exist.

 

Does this changing of facts feel somehow deceptive--enough so that you're wondering about the ethics of it all? If you're new to qualitative research, and it does feel that way, then that's a good thing, because it means that you're integrating previous ethical principles with what you're learning now about research, and you're pushing at the boundaries of what you know.

You're right that integrity is at the core of research, and--although this can feel somewhat deceptive--this way of protecting your participants is squarely at the heart of research integrity.

First of all, you are doing it to protect your participants--they do not need to fear embarrassment, financial consequences, or worse, because they shared information with you. Your focus is on the information itself; nothing will happen to the participants as a result of giving you their answers to your questions.

Second, you will be faithful in the information you provide. You will not make up characters that do not exist at all, and you will not make up answers or information that someone did not share with you.

You are not changing the heart of the content of the answers. Changing someone's birthplace from Oshoto, WY to Pinson, AL, for example, or leaving it out entirely, is a detail that does not substantively change what massage means to that person, which is what this exercise is about.

On the other hand, to totally invent a person who you didn't really interview, and then to report an answer that you made up as being from that person--that would be a major ethical breach of integrity. But you're not doing anything like that here--in changing the details of real people who really exist, and who really gave you those answers you are reporting, you're nowhere near that ethical lapse.

 

Think about how you are going to invite your participants to talk to you. You want this to be about them, not about their trying to please you by telling you what they think you want to hear, so give some thought to your questions before you sit down with them for an interview.

Closed-ended questions, where the person being interviewed has a limited set of responses to choose from--"yes" or "no" questions, for example--tend not to be as good for this purpose as open-ended questions.

"Do you think massage benefits you?" does not encourage someone to open up to you as "Tell me about what you think massage does for people."

Decide on the questions you want to ask, and think about what you will do if the discussion goes in very different ways from what you expect. Think about what you will be reporting in future, and keep that in mind as you are deciding on the questions you will ask.

 

Carrying out your project

Informed consent

A core foundational principle of research is that the person you're interviewing should be participating willingly, and should understand why they are participating. If that willingness changes, they are free to stop participating at any time they want to.

This consent form is based on the one available at this link.

You can paste this consent form into a document, and print out two copies--one for your interview participant to keep for themselves, and one to sign and give to you to keep.

 

Participant's Agreement

I am aware that my participation in this interview is voluntary.

If, for any reason, at any time, I wish to stop the interview, I may do so without having to give an explanation.

I understand the intent and purpose of this research, and I understand that I will be asked about my understanding and experiences of massage.

I understand that I am free to expand on the topic or talk about related ideas.

I also understand that if there are any questions I would rather not answer or that I do not feel comfortable answering, then I have the choice of stopping the interview or moving on to the next question, whichever I prefer.

I understand that the information I provide will be used in a general way for a group online discussion of how people understand and experience massage, and that my identity will be kept confidential. Only the interviewer will know my identity; none of the other participants in the discussion of the answers to the interview questions will be aware of who I am.

I have been offered a copy of this consent form that I may keep for my own reference.

I have read the above form and, with the understanding that I can withdraw at any time and for whatever reason, I consent to participate in today's interview.



_________________________________                       ___________________
Participant's signature                                         Date
 

_________________________________
Interviewer's signature
 

 

 

 

Reporting on your project

In the comments to this story, please share your findings, and outline your evaluation of the interview.

Tell us how you approached the task, and what your key findings were.

In addition, think about the kinds of quantitative data you'd like to collect to boost your qualitative findings--what are your qualitative findings, what other processes do they point to, and how would you use quantative methods to investigate those processes?

 

Information sources on ethnographic interviewing

Design4Instruction: The Ethnographic Interview accessed 6 May 2012

Ethnomed: "Collecting Ethnographic Data: The Ethnographic Interview" accessed 6 May 2012

Johns Hopkins Bloomberg School of Public Health Center for Refugee and Disaster Response (CRDR) publication: Training in Qualitative Research Methods for Private Voluntary Organizations and Non-Governmental Organizations accessed 6 May 2012

Sakai Project article: "Ethnographic Interviews - Interviewing and Observing Users" accessed 6 May 2012

Wikipedia article "Ethnography" accessed 6 May 2012

 

 

 

Sue Shekut: Seeking feedback on massage research design

Submitted by RST on Sun, 03/25/2012 - 19:18
Posted in

The following is the same text that is contained in the 2 PDFs attached to this page.

This page is searchable text for finding from the POEM home page and for commenting on, but only the PDFs contain the correct and authoritative formatting of the document.

 

March 24, 2012

Fellow POEM Members,

I am submitting my research design, “Massage Therapy Modality Effect on Blood Pressure, Cortisol and Anxiety“ to POEM for feedback from POEM members and suggestions on how to best operationally define the different modalities of massage therapy for research.

My goals in submitting this particular research design to POEM are:

  1. To give other massage therapists (MTs) a template for writing similar studies.
  2. To find like-minded MTs that may want to contribute to this study/elements of this study and perhaps do the actual research.
  3. To show other MTs that writing research designs is not that hard, can be done by an MT, and follows a standard format.
  4. To make sure that the work I put in thus far does not just sit in my computer gathering "dust".

 

The design isn't the best ever, but it addresses some of the issues we all face in design research for massage therapy.

 

My specific questions to fellow POEM members are as follows:

  1. Is the operational definition I include of deep tissue, Swedish and sports massage clear enough for others to replicate? Is it accurate?
  2. Does a specific protocol for each modality need to be defined for the study design?
  3. Does a specific protocol for each modality need to be defined for MTs that provide massage to ensure objective application of the modalities for each research subject?
  4. Are these three modalities the best representation of diverse types of massage for studying effects of BP, cortisol and anxiety? Would including other modalities or breaking down deep tissue into trigger point work and mysofascial release provide more useful data?
  5. Does the study need to operationally define “light, moderate and firm” pressure or is the subjective appraisal of pressure by MTs giving the massage of each level of pressure sufficient? If not, how best to operationally define pressure levels? Who defines pressure levels? The MTs, each research subject?

 

Note that I wrote the bulk of this design in 2010 and had not yet read Christopher Moyer's study on cortisol and massage. However, since Moyer’s study was not an experimental study, but a meta-analysis of previous research, I believe that further experimental research on the effects of massage on cortisol levels is warranted.

I welcome comments, feedback and offers of collaboration for this research project. Even if no one ends up conducting this particular research project, I hope that by reading and reviewing my work, other MTs may be empowered to conduct their own research and further the evidence base of the massage profession.

Warmly,
Sue Shekut, Licensed Massage Therapist
Graduate student in Clinical Professional Psychology at Roosevelt University

 

Massage Therapy Modality Effect on Blood Pressure, Cortisol and Anxiety
Susan J. Shekut
Roosevelt University
© 2012, Sue Shekut

Abstract

Stress management is an important issue in the workplace and for the individual. Massage therapy has been shown to reduce depression and anxiety as well as to reduce levels of cortisol and reduce blood pressure (BP). Massage modality can moderate the effect of onset of BP reduction and may moderate the effect of onset of cortisol reduction as well as self-reported anxiety levels. There are a number of types of massage, but for this study, only deep tissue, sports massage and Swedish massage styles were examined as to their effect on the blood pressure, cortisol and anxiety levels of 90 participants. It is expected that Swedish massage will decrease BP, cortisol and self reported anxiety to the greatest degree immediately following the massage intervention and that deep tissue and sports massage will have greater effects on BP, cortisol and anxiety reduction two days post massage intervention.

Massage Therapy Modality Effect on Blood Pressure, Cortisol and Anxiety

Workplace stress has recently been indicated to be one of the major causes of some of the costliest, most time-robbing health problems for business. According to the 17th World Congress on Health and Safety at Work, 13.4 million working days are lost due to stress, anxiety, and depression (17th World Congress on Health and Safety at Work).

Traditional approaches to stress management include psychological interventions such as cognitive behavioral therapy, mediation, diaphragmatic breathing and similar self-directed techniques (David & McKay, 2008). However, there is a growing trend among consumers to seek massage therapy as a form of stress relief. In a consumer survey published by the American Massage Therapy Association (AMTA) in 2009 found that 32 percent of Americans said they got a massage for stress and/or relaxation in the last five years.

Some believe the mechanism of effect for massage therapy may be primarily psychological (Moyer, Rounds, & Hammum, 2004). Others believe massage has a physiological effect as well. Studies show that massage therapy can be effective for anxiety and depression as well as a host of clinical conditions (Rich, 2010). Additionally, current research findings has shown that a single session of massage therapy reduces state anxiety, blood pressure and heart rate, and multiple sessions of massage reduce delayed onset of pain (Moyer, et al., 2004). Other studies show that participants’ salivary cortisol levels decreased following massage therapy (Field, et all, 1997). Yet none of these studies tested whether a specific massage therapy modality was responsible for producing these affects.

The Touch Research Institute of Miami University, a noted research facility in the field of massage therapy, has conducted a number of studies demonstrating the physiological effects of massage therapy. One of their studies found that healthy adults that received 15-minute chair massages twice per week for five weeks had marked improvement in EEG patterns of alertness and frontal delta power increases, which suggests relaxation (Field, et al., 1996). The massage recipients also showed increased speed and accuracy on math computations, lower anxiety levels, as well as lowered salivary cortisol levels on the first day of treatment. However, BP levels were not tested at all in this study–only anxiety and cortisol levels were tested.

Corporate companies have been using massage therapy as a reward and stress intervention for the past 10-15 years (reference). A 1996 (Shulman & Jones) quasi-experimental field study found significant reductions in anxiety levels for massage recipients as measured by the State-Trait Anxiety Inventory Self-Assessment Questionnaire. Researchers found that residual effects of the massage continued after cessation of the massage intervention and that there was a trend for stress levels to be more greatly reduced for those massage recipients that worked more than 40 hours per week and had higher education levels. However, they did not test the effect of the intervention on BP levels, cortisol levels or participants’ anxiety levels in this study.

Fifteen-minute chair massages on healthcare workers at a major hospital decreased job stress, anxiety and depression as well as decreased in urinary cortisol (Field, Quintino, Henteleff, Wells-Kief, & Delvecchio-Fienerg, 1997). However, chair massages can include a variety of massage modalities depending on the training of the massage therapists providing the massage intervention. Neither the massage modality was addressed nor was the massage intervention operationally defined in this study. Participant BP levels were not investigated either.

Field and her colleagues reviewed various massage studies and overall found that massage therapy decreases cortisol levels and increases urinary serotonin and dopamine levels (Field, Hernandez-Reif, & Diego, 2005). While Field and colleagues claim that the reduction in cortisol suggests that massage had stress-alleviating effects and that increases in urinary serotonin and dopamine suggest that they help reduce depression and the effects of stress, there is no significant relationship between serotonin and dopamine secreted in the urine and the amount of these neurotransmitters in the brain. Research has shown that neurotransmitters do not cross the blood brain barrier. According to a recent study published in the Journal of Urology, urinary serotonin and urinary dopamine do not show levels of serotonin and dopamine that were previously in the central or peripheral nervous system. Urinary serotonin and urinary dopamine are synthesized in the kidneys, not in the central nervous system (Hinz, Stein, Trachte, & Uncini, 2010). Therefore, measuring urinary levels of neurotransmitters is not a definitive test to measure depression or anxiety nor to test the effects of massage therapy on depression or anxiety. However, testing salivary cortisol is an accepted method of testing the changes in unbound cortisol in participants, due to the validity of salivary cortisol reflecting the level of cortisol in the blood and the relative ease with which salivary cortisol may be obtained from participants. Habitual smokers tend to show blunted cortisol responses to psychological stress and therefore should not be included in studies that measure cortisol changes in response to stress effecting interventions (Kirschbaum & Hellhammer, 1993).

Since blood pressure tends to increase with stress and the sympathetic nervous system response, measuring blood pressure changes has been one method researchers use to examine physiological effects of massage (Smith, T. W., Birmingham, W., & Uchino, 2012; Cambron, Dexheimer, & Coe, 2006). This would suggest that measurements of changes in BP may be a good physiological measurement of anxiety levels to assess effects of massage therapy. In a preliminary study, 150 adults with “normal” BP (under 150/95) were given different types of massages to determine the effect on blood pressure. Overall blood pressure decreased for massage recipients of all types of massages. However, those that received Swedish massages had the greatest effect on BP reduction. Trigger point and sports massage styles tended to increase systolic BP. If both sports and trigger point therapy massage were used in one session, then both diastolic and systolic BP increased. However, these results were not statistically significant. Blood pressure was measured using an automatic cuff which may have resulted in less accurate readings but the study authors were not concerned with measuring actual BP changes, but the overall effect of the massages on BP. Another potential threat to internal validity of this study was that the massage therapy students conducting the massages self reported the style of techniques they used. Additionally, the study was a case study and not powered for multiple statistical tests. Future researchers were recommended to use manual BP cuffs and provide for tighter controls on the type of massages used (Cambron, Dexheimer, & Coe, 2006).

Recent studies examined the effects of the level of pressure of massages given to participants to determine if light, moderate pressure, or vibratory massage would have a greater effect on parasympathetic nervous system activity (Diego, Field, Sanders, & Hernandez-Reif, 2004). Massage recipients felt less anxiety following massage sessions no matter what pressure
was used. However, those that received moderate pressure massages reported the greatest decreases in self-reported stress. The moderate massage group showed a significant decrease in heart rate during the massage, which continued into the post massage session.

Field and a colleague followed up this study with research on the effect of moderate pressure massage on EKG readings to determine if a parasympathetic response was the result of moderate pressure massage (Diego, Field, , Sanders, . & Hernandez-Reif, 2004). Results indicated that participants that received the moderate pressure, 15-minute massage showed an increase in high frequency ratio components of heart rate variability. This suggested an increase in parasympathetic nervous system activity. The study contended that the mechanism for action in increasing parasympathetic response was the stimulation of pressure receptors in the skin (Diego & Field, 2009). While yielding useful data as to the effects of the level of pressure, neither of these latter two studies measured BP levels, cortisol levels, or participant anxiety, only the heart rate variability of participants.

Despite the growing volume of research on massage therapy, none of these studies compare modality (type) of massage given to changes in cortisol levels, changes in BP levels or changes in perceived anxiety levels. Since previous studies show that BP increases with massage that produces more painful responses (trigger point therapy, sports massage and deep tissue), it is expected that cortisol levels, a measure of the stress response, will respond similarly to BP on the types of massage interventions. Since psychological stress has been shown to increase cortisol levels, it is expected that self reported anxiety levels will correlate with levels of BP and cortisol.

Swedish massage (which tends to be a more moderate pressure style of massage), deep tissue massage and sports massage tend to be deeper pressure massage modalities (AMTAWashington, 2010). Massage recipients typically report feeling the most relaxing effects of a deep tissue or sports massage a few days after the massage session as the initial effects may include soreness and fatigue. These results would be assessed post massage and then 2 days after the massage session.

Hypothesis 1: Blood pressure levels will be negatively correlated with Swedish massage therapy immediately following the intervention.

Hypothesis 2: Blood pressure levels will be negatively correlated with deep tissue and sports massage two days post intervention.

Hypothesis 3: Salivary cortisol levels will be negatively correlated with Swedish massage therapy immediately following the intervention.

Hypothesis 4: Salivary cortisol levels will be negatively correlated with deep tissue and sports massage two days post intervention.

Hypothesis 5: Self reported anxiety levels will be negatively correlated with Swedish massage therapy immediately following the intervention.

Hypothesis 6: Self reported anxiety levels will be negatively correlated with deep tissue and sports massage two days post intervention.

Method

Participants

The sample would include approximately 90 participants from an large city in the Midwest. They would be recruited from the area via fliers sent to area offices as well as at nearby retail stores. It would be expected that participants would be fairly well educated, both male and female of middle to upper middle socioeconomic status, and be representative of a variety of races and demographics of this area.

Participants would be ages 25-55, of normal health, no hypertension or heart disease (BP under 140/90–the threshold for indicating hypertension), be nonsmokers, not be pregnant and have no history of severe mental illness (e.g., depression, bipolar, schizophrenia). Participants would be screened to ensure that they had previously received massages and have had positive experiences with massage, but had not received massages for at least 6 months prior to the study. Participants would be randomly assigned to Swedish, Deep Tissue. and Sports massage groups. Participants would be blind to the type of massage they are being given. A short questionnaire would be included with their two-day follow up anxiety test to assess whether they knew the type of massage they were given. Participants would be instructed to avoid salty foods between the massage intervention and the two-day follow up. Incentive to return for their two-day follow up would be the receipt of a gift certificate for a 30-minute massage (modality of their choice) to be completed at a later date.

BP Testing Procedures

BP would be measured via a manual BP cuff 5 minutes prior to massage intervention and 5 minutes after the intervention. At two day follow up the BP will again be measured. Recordings of Diastolic and Systolic BP would be made for both pre and posttests. Changes in BP for each participant would be recorded.

Cortisol Testing Procedures

Salivary cortisol testing procedure would be conducted in the following order: Premassage session salivary samples would be taken 3 minutes prior to massage; Post massage, another salivary sample would be taken 3 minutes prior to massage; Two days after the massage intervention, a salivary sample would also be taken.

Anxiety Testing Procedures

The State-Trait Anxiety Inventory Form (STAI) will be used to measure anxiety in participants. The STAI clearly differentiates between the temporary condition of "state anxiety" and the more general and long-standing quality of "trait anxiety." (Spielberger, 1994). Participants will be given the STAI 10 minutes prior to the massage, 10 minutes after the
massage and two days after the massage.

Massage Interventions

Massages would be provided by three Licensed Massage Therapists with at least five years of full-time work experience in massage therapy and with advanced training in the types of massage they are to perform (Swedish, deep tissue and sports massage).

Massage therapists would be instructed to provide either a 30-minute session of Swedish massage on the upper torso, a 30 minute session of deep tissue massage on the back (including infraspinatus, rhomboids, trapezius, erector and quadratus lumborum muscles), or a 30-minute session post-event Sports massage session on the upper torso. Each massage therapist would provide a different type of massage to different participants to avoid experimenter bias from influencing results. Massages would be provided in the same room in the same office to hold environmental differences constant.

Types of massage will be operationally defined per the definition provided by Milady’s Theory and Practice of Therapeutic Massage as follows (Beck, 1994).

Deep tissue message. “The term deep tissue massage refers to various regimens or massage styles that are directed toward the deeper tissue structures of the muscle and fascia…In most deep tissue massage techniques the aim is to affect the various layers of fascia that support muscle tissues and loosen bonds between layers of connective tissues” (Beck, 1994, p. 548).

Sports massage. “Sports massage refers to a method of massage especially designed to prepare an athlete for an upcoming event and to aid in the body’s regenerative and restorative capacities following a rigorous workout or competition. This is achieved through specialized manipulations that stimulate circulation of the blood and lymph. Some sports massage movements are designed to break down lesions and adhesions or reduce fatigue” (Beck, 1994, p.16).

Swedish message. “The Swedish system is based on the Western concepts of anatomy and physiology and employs the traditional manipulative techniques of effleurage, petrissage, vibration, friction and tapotement” (Beck, 1994, p. 15). All three types of massage would be administered using moderate and not light pressure based on previous study findings that moderate pressure massage stimulates parasympathetic NS activity more so than light pressure massage.

Anticipated Results

Based on results of previous research noted in this study, it is expected that recipients of Swedish massage will have the greatest reduction in both BP and cortisol levels immediately following the massage. However, we also expect to find that BP and cortisol levels will be reduced more for the deep tissue and sports massage group than the Swedish massage group two days after receiving the massage intervention. It is expected that recipients of Swedish massage will report the least anxiety immediately posttest and that the recipients of deep tissue and sports massage will report the least anxiety two days post test. Results will be analyzed using one-way ANOVA tests.

References

AMTA-Washington chapter (2010) Retrieved from: http://www.amtawa.org/index.php?src=gendocs&ref=Modalities&category=Reso...

Beck, M. (1994). Milady's theory and practice of therapeutic massage. (2nd ed.). Albany: 1994 Milady Publishing Company.

Calvert, R. N. (2010) A Brief History of Massage. Retrieved from: http://www.massagetherapy.com/media/experiencehistory.php

Cambron, J. A., Dexheimer, J. & Coe, P. (2006) Changes in blood pressure after various forms of therapeutic massage: A preliminary study. The Journal of Alternative and Complimentary Medicine, 12(1), 65-70.

Davis, M., Eshelman, E., & McKay, M. (2008). The relaxation and stress reduction workbook (6th ed.). Oakland, CA US: New Harbinger Publications.

Diego, M. A., & Field, T. (2009) Moderate pressure massage elicits a parasympathetic nervous system response, International Journal of Neuroscience, 119, 630-638.

Diego, A., Field, T., Sanders, C. & Hernandez-Reif, M. (2004). Massage therapy of moderate and light pressure and vibrator effects on EEG and heart rate. International Journal of Neuroscience, 114, 31-45.

Field, T., Hernandez-Reif, (FI?) & Diego, M. (2005) Cortisol decreases and serotonin and dopamine increase following massage therapy. International Journal Neuroscience, 115, 1397-1413.

Field, T., Diego, M. & Hernandez-Reif, M. (2010) Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience, 120, 381-385.

Field, T., Ironson, G., Scafidi, F., Nawrocki, T., Goncalves, A., Burman, I., Pickens, J., Fox, N., Schanberg, S., & Kuhn, C. (1996). Massage therapy reduces anxiety and enhances EEG pattern of alertness and math computations. International Journal of Neuroscience, 86, 197-205.

Field, Tiffany, Hernandez-Reif, M., Hart, S., Quintine, O., Droase, L. A., Field, T.,… & Schanberg, S. (1997) Effects of sexual abuse are lessened by massage therapy. Journal of Bodywork and Movement Therapies, 1(2), 65-69.

Field, T., Quintino, O., Henteleff, T., Wells-Kief L. & Delvecchio-Fienerg G. (1997). Job Stress reduction therapies. Alternative Therapies in Health and Medicine 3(4), 54-56.

Hinz, M., Stein, A., Trachte, G. & Uncini, T. (2010) Neurotransmitter testing of the urine, a comprehensive analysis. Journal of Urology, 2010(2), 177-183.

Kirschbaum, C. & Hellhammer, D., H. (1993) Salivary cortisol in psychoneuroendocrine research: Recent developments and applications. Psychoneuroendocrinology, 19(4), 313-333.

Kharrazian, D. (2009) Understanding the clinical relevance and non-validity of neurotransmitter testing. AlaimoChiropractic.com. Retrieved from: http://alaimochiropractic.com/urinaryneurotransmitter-testing-valid-or-h...

Moyer, C. A., Rounds, J, & Hannum, J. W. (2004). A meta-analysis of massage therapy research. Psychological Bulletin, 130(1). 3-18.

Ponce, A. N., Lorber, W., Paul, J. J., Esterlis, I., Barzvi, A., Allen, G. J., & Pescatello, L. S. (2008) Comparisons of varying dosages of relaxation in a corporate setting: Effects on stress reduction. International Journal of Stress Management 15(4), 396-407.

Rich, G. J. (2010). Massage therapy: Significance and relevance to professional practice. Professional Psychology: Research and Practice, 41(4). 325-332.

Schulman, K. R., & Jones, G. E. (1996) The effectiveness of massage therapy intervention on reducing anxiety in the workplace. Journal of Applied Behavioral Science, 32(2), 160-173.

Smith, T. W., Birmingham, W., & Uchino, B. N. (2012). Evaluative Threat and Ambulatory Blood Pressure: Cardiovascular Effects of Social Stress in Daily Experience. Health Psychology. Advance online publication. doi: 10.1037/a0026947

Spielberger, C. D., & Sydeman, S. J. (1994). State-Trait Anxiety Inventory and State-Trait Anger Expression Inventory. In M. Maruish, M. Maruish (Eds.) , The use of psychological testing for treatment planning and outcome assessment (pp. 292-321). Hillsdale, NJ England: Lawrence Erlbaum Associates, Inc.

Williams, A. (2005). Work-Related Stress Emerging as Major Global Occupational Health Hazard, National Safety Council press release. Retrieved from:http://www.nsc.org/Pages/Work-RelatedStressEmergingasMajorGlobalOccupationalHealthHazard.aspx

Experiential hands-on learning: The scope of military service's impact on us

Submitted by RST on Sun, 02/26/2012 - 11:18
Posted in

An exercise at the beginning of the workshop was a dramatic demonstration of how wide the effect of military service on human connections in American society is.

They asked first for anyone who had served in the military to stand and remain standing.

One of the participants stood up.

Then they asked participants to stand and remain standing if any of their family had served.

Several others and I stood up at this point.

Then they asked people to stand if any of their friends had served.

That question got the rest of the class on their feet.

These concentric circles (self, family, friends) radiated out until they touched everyone in the workshop, showing how much all of us have connections to people who have served in the military.

There is a dynamic tension between that scope of human connections, and the fact--often repeated throughout both workshops--that only 0.5% of people in US society participate in military service.

Just as in the workshop, we'll be coming back again to that fact, and the implications it has for us as individuals, citizens, and MTs.

Source: http://upload.wikimedia.org/wikipedia/commons/4/4a/Six_degrees_of_separa... accessed 26 February 2012

 

Spanish for MTs

Submitted by RST on Sun, 02/05/2012 - 12:25
Posted in

Rather than re-invent the wheel here, I'm going to point you to the introductory Spanish page of the MT who got the "Foreign Languages for MTs" section of POEM started, Donna Kopf.

Click this link for "Spanish for Massage Therapists: Part I" at "A Friend Who Kneads is a Friend Indeed!"

By extending yourself to speak even a little Spanish with clients who come for massage, you can make human connections with people from all over the Hispanophone (Spanish-speaking world)--the areas in blue on this map.
 

Source: http://upload.wikimedia.org/wikipedia/commons/6/6c/Map-Hispanophone_World.png accessed 5 February 2012

 

 

Realistically, you're not going to be able to fluently conduct an entire session in Spanish, unless you take a long time and a great deal of effort to study and practice the language.

But most Spanish-speakers are used to making all of the effort to communicate with English-speakers, at least in the larger US culture. By making the effort to go just a little way toward meeting them on their own ground, you are communicating human recognition, respect, and acceptance.

Even if you then have to switch to English for the rest of the session, or if you have to rely on the assistance of an interpreter, this small effort on your part can go a long way for your client to establishing security, respect, and trust.

 

cheers, to Donna Kopf!

French for MTs

Submitted by RST on Sun, 02/05/2012 - 12:25
Posted in

I've based this page on Donna Kopf's Spanish for Massage Therapists: Part 1.

 

By extending yourself to speak even a little French with clients who come for massage, you can make human connections with people from all over the Francophone (French-speaking world)--the areas in blue on this map.

Source: http://upload.wikimedia.org/wikipedia/commons/a/a5/French_official_language_world_map.svg accessed 5 February 2012

 

 

Realistically, you're not going to be able to fluently conduct an entire session in French, unless you take a long time and a great deal of effort to study and practice the language.

But most French-speakers are used to making all of the effort to communicate with English-speakers, at least in the larger US culture. By making the effort to go just a little way toward meeting them on their own ground, you are communicating human recognition, respect, and acceptance.

Even if you then have to switch to English for the rest of the session, or if you have to rely on the assistance of an interpreter, this small effort on your part can go a long way for your client to establishing security, respect, and trust.

 

The French language introduces a complication that Spanish does not pose--pronunciation in Spanish is almost totally consistent with the written language, while French words--like English ones--do not necessarily sound like they are written. In fact, they often sound so different that it is hard to make the connection between the written word and the spoken word.

I need to find a way to write out the pronunciations, and link to recordings of them, so that you can hear how they sound. Donna makes a good point:

Google Translate is a great thing. You can push a button and it will pronounce the word for you.

 

I tried it for the French words, and the Google Translate pronunciations sound excellent. 

Unfortunately, they don't provide a link to connect the words on this page directly to the Google Translate pronunciation, so that is currently an issue being addressed.

In the meantime, you can begin to familiarize yourself with French words, phrases, and sentences below, and the page will be truly usable once I've gotten the pronunciation guides sorted out.


 

Basic Phrases:

  • Hello. / Good morning. / Good afternoon.
    Bonjour.
     
  • Good evening.
    Bonsoir.
     
  • How are you?
    Comment allez-vous?
     
  • My name is _____.
    Je m'appelle _____.
     
  • Please excuse my French-language mistakes.
    Veuillez excuser mes fautes de français.
     
  • Thank you.
    Merci.
     
  • You are welcome. / My pleasure. / Don't mention it.
    Je vous en prie.
 
 
 
 
Intake Questions & Possible Responses
 
  • Yes
    Oui
     
  • No
    Non
     
  • Can I help you?
    Puis-je vous aider?
     
  • I need a massage.
    J'ai besoin d'un massage.
     
  • Half hour
    une demi-heure
     
  • Hour
    une heure
     
  • Hour & a half
    une heure et demie
     
  • Please complete this form.
    Veuillez remplir ce formulaire, s'il vous plaît.
     
  • Where do you have pain?
    Indiquez-moi où ça fait mal?
     
  • Head / Does your head hurt?
    à la tête / Avez-vous mal à la tête?
     
  • Neck / Does your neck hurt?
    au     cou / Avez-vous mal au cou?
     
  • Back / Does your back hurt?
    au dos / Avez-vous mal au dos?
     
  • Shoulder / Does your shoulder hurt?
    à l'épaule / Avez-vous mal à l'épaule?
     
  • Arm / Does your arm hurt?
    au     bras / Avez-vous mal au bras?
     
  • Elbow / Does your elbow hurt?
    au coude / Avez-vous mal au coude?
     
  • Hand / Does your hand hurt?
    à la main / Avez-vous mal à la main?
     
  • Abdomen / Does your abdomen hurt?
    à l'abdomen / Avez-vous mal à l'abdomen?
     
  • Hip / Does your hip hurt?
    à la hanche / Avez-vous mal à la hanche?
     
  • Knee / Does your knee hurt?
    au genou / Avez-vous mal au genou?
     
  • Leg / Does your leg hurt?
    à la jambe / Avez-vous mal à la jambe?
     
  • Feet / Does your foot hurt?
    au     pied / Avez-vous mal au pied?


     
  • For how long?
    Combien de temps?
     
  • days
    jours, journées
     
  • weeks
    semaines
     
  • months
    mois
     
  • years
    ans, années

     
  • Do you have any allergies?
    Avez-vous des allergies?
     
  • Drugs? / Do you have drug allergies?
    aux médicaments? / Avez-vous des allergies aux médicaments?
     
  • Food? / Do you have food allergies?
    alimentaires? / Avez-vous des allergies alimentaires?
     
  • Peanuts? / Are you allergic to peanuts?
    aux cacahuètes? / Avez-vous des allergies au cacahuètes?
     
  • Fragrance? / Are you allergic to fragrance?
    au parfum? / Avez-vous des allergies au parfum?
     
  • Pollen? / Are you allergic to pollen?
    au pollen? / Avez-vous des allergies aux pollen?
     
  • Seasonal? / Do you have seasonal allergies? 
    des allergies saisonnières? / Avez-vous des allergies saisonnières?
     
  • Cats? / Are you allergic to cats?
    aux chats? / Avez-vous des allergies aux chats?
     
  • Dogs? / Are you allergic to dogs?
    aux chiens? / Avez-vous des allergies aux chiens?
     
  • Are you pregnant?
  • Êtes-vous enceinte?
     
  • How many months?
    Combien de mois? 
     
  • 1
    un
     
  • 2
    deux
     
  • 3
    trois
     
  • 4
    quatre
     
  • 5
    cinq
     
  • 6
    six
     
  • 7
    sept
     
  • 8
    huit
     
  • 9
    neuf
     
  • 10
    dix
     
  • 11
    onze
     
  • 12
    douze
     
  • 13
    treize
     
  • 14
    quatorze
     
  • 15
    quinze
     
  • 16
    seize
     
  • 17
    dix-sept
     
  • 18
    dix-huit
     
  • 19
    dix-neuf
     
  • 20
    vingt

     
  • Who?
    Qui?
     
  • What?
    Qu'est ce que...?
     
  • When?
    Q    uand?
     
  • Where?
    Où    ?
     
  • Why?
    Pourquoi?
     
  • How?
    Comment?
     
  • How many?
    Combien de...?
 
 
 
 
 
 
I anticipate a fair amount of confusion in the beginning. If I do not understand a word they are saying I can ask that they write down a response so I may enter it into Google Translate. So the following phrase may be the most important:
 
  • Please write it down.
    Écrivez-le, s'il vous plaît.
 
 
 
cheers, to Donna Kopf!
 
 

Veterans Dinner and massage clinic prep: harvesting fruit for preserving

Submitted by RST on Sat, 10/22/2011 - 11:28
Posted in

Now that the date for the 2012 Veterans Dinner and massage clinic has been set, the preparation begins.

There is a great deal of work to get done behind the scenes to carry off such an event successfully, and we're getting started now.

There will be several "preserving parties" between now and then, where we make by hand the fruit preserves that we will be handing out as gifts to the veterans we are hosting. The preserving parties won't, in themselves, count for CE credit under Washington state law; they're just too far away from actual massage subject matter to justify that.

What they will do, however, is bring us together to have fun, to learn, and to create handmade gifts that will thank the veterans at the event for what they have endured, and to show our appreciation. So it's related, but the preserving parties themselves will not be part of the continuing education credits for Washington-state LMPs going into this event.

Although the Italian plums from the particular harvest shown here won't be part of the event themselves--this particular batch was donated, instead, to Northwest Harvest for Puget-Sound-area families that do not have enough food--this is how we always start with the preserving process.

Harvesting our own fruit for preserving to eat year-round as the autumn brings the growing season to a close is a gratifying reminder of how closely we are connected to the earth for our food.

 

Our friends Emma and George's Italian plum tree. For over a decade now, they've generously donated fruit from their garden to various causes, including Northwest Harvest and the Medicine Wheel Society at the University of Washington.

 

Interestingly, it can be harder to see the actual fruit when you're up on the ladder than it is to see it from the ground, so I keep Iain's ladder braced, and spot fruit to point out to him from my vantage point.

 

The end-of-season harvest yielded about 10 quarts of Italian plums. This batch went straight to the food bank, but we'll use other Italian plums, as well as other fruits, for gifts to hand out to the attendees at the Veterans Dinner and massage clinic.

 

cheers, to Emma Bartholomew and George Reilly!

Massage continuing education: Veterans' Dinner and massage clinic, Seattle, Saturday, 26 May 2012

Submitted by RST on Sat, 10/22/2011 - 09:00
Posted in

In the spirit of open-access educational materials, I am posting the materials for this real-life course here at POEM under the Class Materials menu on the bar above, as they are developed and become available.

The knowledge that I work to acquire and to provide to the students, and the new knowledge that emerges from their process of learning, questioning, and curious investigation of that foundation, belongs to the entire community of MT stakeholders, and so I plan to make it freely available here.

 

The open-access version does not offer actual CE credits, just access to all information from the course that can be recorded on a website for your own learning purposes.

This course meets the Washington state requirements for continuing education as outlined in WAC 246-830-475, accessible by clicking here.

WAC 246-830-475

Continuing education requirements.

  (1) To renew a license, licensed massage practitioners must complete twenty-four hours of continuing education every two years.

 

The clinic associated with the dinner itself will run 4 hours, from 9 AM to 1 PM. It will be the last event in a series of clinical session classes; the series will add up to more than 24 hours of continuing education, so there are several combinations of classes that the student can choose. Most, if not all, of these combinations will meet all the continuing education requirements for Washington state LMPs.

 

     (a) A minimum of eight hours must be direct supervised massage skills training; and

 

The clinic associated with the dinner will be the final session in a series of 4-hour massage clinics on weekends for veterans. I will directly supervise the LMPs attending the clinics.

If an LMP wants to complete Washington state CE requirements for two years mainly through clinic sessions, they can take as many as 5 veterans' clinic sessions (20 hours) toward that requirement.

The remaining 4 hours can be completed, if desired, by attending the following ethics session.

The open-access educational materials from these clinic sessions will include SOAP notes and minutes from the LMP debriefing after the session, as well as any other relevant information that emerges during the clinic session.

All educational materials from these sessions will be appropriately anonymized under HIPAA regulations to protect the privacy and confidentiality of the client, and under educational best practice standards to protect the identity of the LMP in any discussion that is posted to POEM.

 

     (b) A minimum of four hours must be in professional ethics, communication, and/or Washington state massage laws and regulations. Two of these hours must include professional roles and boundaries; and

 

A four-hour ethics class on applied ethics and communications issues in providing massage for a veteran population will be offered at least twice between 01 January and 26 May 2012.

The open-access educational materials from these sessions will be posted at POEM.

 

     (c) The remaining twelve hours may be met by meeting the requirements in subsection (2) of this section.

     (2) For the purposes of this chapter, continuing education is defined as any of the following activities that involve direct application of massage therapy knowledge, skills, and business practices:

     (a) Attendance at a local, state, national, or international continuing education program.

 

I don't know whether under Washington law this series of classes and clinic sessions counts as a local continuing education "program", but whether or not it does, it definitely counts as (f) Specialized training, below.


 

     (b) First aid, CPR, or emergency related classes.

 

N/A


 

     (c) Self study through the use of multimedia devices or the study of books, research materials, and/or other publications.

 

N/A

 

     (i) Multimedia devices. The required documentation for this activity is a letter or other documentation from the organization. A maximum of twelve hours is allowed per reporting period.

 

N/A
 

     (ii) Books, research materials, and/or other publications. The required documentation for this activity is a two-page synopsis of what was learned written by the licensee. A maximum of two hours is allowed per reporting period.

 

This will be an option for up to two hours of the series, if the student chooses that option.

If this option is chosen, the materials reviewed as well as the synopsis, anonymized to protect the identity of the LMP, will be posted as open-access educational materials at POEM.
 

     (d) Teaching a course for the first time, not to exceed eight hours.

 

N/A
 

     (e) Business and management courses not to exceed eight hours.

 

N/A
 

     (f) Specialized training. Training must be provided for a fee by an individual who has no less than three years of expertise in that area.

 

This is why the course in real life provides CE credits, and the online version at POEM does not.

I, as an individual, have far more than three years of expertise in the area of providing massage for people who have experienced trauma--thus meeting that criterion--but there will be no fee for access to the educational materials at POEM, and thus no Washington state CE credits for that version.

The real-life course charges fees at standard market rates for continuing education, and provides CE credits valid for the 24 hours in 2 years requirement outlined in Washington law.

 

     (g) Distance learning. Distance learning includes, but is not limited to, correspondence course, webinar, print, audio/video broadcasting, audio/video teleconferencing, computer aided instruction, e-learning/on-line-learning, or computer broadcasting/webcasting. A maximum of twelve hours is allowed per reporting period.

 

N/A

 


     (h) Active service on massage related boards or committees. A maximum of twelve hours is allowed per reporting period.

 

N/A

 

[Statutory Authority: RCW 18.108.025, 18.108.125, and 43.70.250. 09-11-016, § 246-830-475, filed 5/7/09, effective 6/7/09. Statutory Authority: RCW 18.108.025(1). 95-11-108, § 246-830-475, filed 5/23/95, effective 6/23/95; 94-13-181, § 246-830-475, filed 6/21/94, effective 7/22/94.]

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