Chapter II Head to Toe Assessment A. General appearance The client is healthy and he has an upright posture.

He is well groomed with a height of approximately 59.2 cm and has a weight of 158.75 lbs. His temperature is 36.8 C, blood pressure of 100/70 mmHg, respiratory rate of 18 cycles per minute and pulse rate of 85 beats per minute. B. Mental status The client is conscious and cooperative. He is well oriented and actively participated on our therapies since day 1 until the last. He speaks clearly and he uses English and Tagalog words as his means of communication. C. Skin He has a fair complexion, slightly smooth skin, and has a black, evenly distributed hair. He also has scabies on his both feet due to insect bites. D. Nails The client has thick nails with a convex-shaped nail plates and pinkish nail bed color. His capillary refill is within the normal range of 2-3 seconds. E. Head and Face His head is proportionate to his body size, white and smooth scalp and has fine hair condition and dont have any lesions. His facial movement is also symmetrical. F. Eyes His eyes were symmetrically aligned and in normal condition. His eyebrows were evenly distributed. His eyelids and eyelashes are symmetrically aligned. His has a normal and frequent blink response. His eyeballs are symmetrical. He has a pinkish conjunctiva and has white sclera. His pupils are equal in size and his lacrimal apparatus is moist. G. Ears The color of his ears is the same with his facial color and is symmetrically aligned. Its texture and elasticity is not tender. His pinna recoils when it is folded. The external canal has no cerumen upon inspection and he has no difficulty in hearing acuity. H. Nose His nose is symmetrical and the same color with his facial tone. Both noses are patent, and his sinuses are not tender. Also his nasal cavity is moist and his septum is intact and is located at the midline. I. Mouth

The client has a purplish lips. His tongue is positioned in midline. It is smooth and pinkish in color. J. Neck His neck muscles are equal in size. His lymph nodes are not palpable and his trachea is in the midline. No lesions seen. K. Breast and Axilla His breasts are symmetrical and his nipples and areola are brown in color. L. Chest and Lungs He has a symmetrical chest shape. He has symmetrical lung expansion. He has a regular breathing pattern. He has a regular breathing with no adventitious sound heard upon auscultation. M. Abdomen His abdomen has no lesions and has a rounded contour with a symmetric movement. Normal bowel sound heard upon auscultation. His bladder is distended. N. Upper Extremities The clients muscle strength is equal on both extremities. His muscle tone is normal. No lesion found. His peripheral pulses are palpable and there are no deformities. O. Lower Extremities The muscle strength is equal. His muscle tone is normal. No lesion found, his peripheral pulses are palpable and there are no deformities.

PSYCHOTHERAPIES

Psychotherapy is a general term that is used to describe the process of treating psychological disorders and mental distress. During this process, a trained psychotherapist helps the client tackle a specific or general problem such as a particular mental illness or a source of life stress.

Psychotherapy is a general term for treating mental health problems by talking with a psychiatrist, psychologist or other mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts and behaviors. Psychotherapy helps you learn how to take control of your life and respond to challenging situations with healthy coping skills. There are many specific types of psychotherapy, each with its own approach. The type of psychotherapy that's right for you depends on your individual situation. Psychotherapy is also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.

Music Therapy

Definition
Music therapy is a technique of complementary medicine that uses music prescribed in a skilled manner by trained therapists. Programs are designed to help patients overcome physical, emotional, intellectual, and social challenges. Applications range from improving the well being of geriatric patients in nursing homes to lowering the stress level and pain of women in labor. Music therapy is used in many settings, including schools, rehabilitation centers, hospitals, hospice, nursing homes, community centers, and sometimes even in the home.

Purpose
Music can be beneficial for anyone. Although it can be used therapeutically for people who have physical, emotional, social, or cognitive deficits, even those who are healthy can use music to relax, reduce stress, improve mood, or to accompany exercise. There are no potentially harmful or toxic effects. Music therapists help their patients achieve a number of goals through music, including improvement of communication, academic strengths, attention span, and motor skills. They may also assist with behavioral therapy and pain management. Physical effects Brain function physically changes in response to music. The rhythm can guide the body into breathing in slower, deeper patterns that have a calming effect. Heart rate and blood pressure are also responsive to the types of music that are listened to. The speed of the heartbeat tends to speed or slow depending on the volume and speed of the auditory stimulus. Louder and faster noises tend to raise both heart rate and blood pressure; slower, softer, and more regular tones produce the opposite result. Music can also relieve muscle tension and improve motor skills. It is often used to help rebuild physical patterning skills in rehabilitation clinics. Levels of endorphins, natural pain relievers, are increased while listening to music, and levels of stress hormones are decreased. This latter effect may partially explain the ability of music to improve immune function. A 1993 study at Michigan State

University showed that even 15 minutes of exposure to music could increase interleukin-1 levels, a consequence which also heightens immunity. Mental effects Depending on the type and style of sound, music can either sharpen mental acuity or assist in relaxation. Memory and learning can be enhanced, and this used with good results in children with learning disabilities. This effect may also be partially due to increased concentration that many people have while listening to music. Better productivity is another outcome of an improved ability to concentrate. The term "Mozart effect" was coined after a study showed that college students performed better on math problems when listening to classical music. Emotional effects The ability of music to influence human emotion is well known, and is used extensively by moviemakers. A variety of musical moods may be used to create feelings of calmness, tension, excitement, or romance. Lullabies have long been popular for soothing babies to sleep. Music can also be used to express emotion nonverbally, which can be a very valuable therapeutic tool in some settings.

Description
Origins Music has been used throughout human history to express and affect human emotion. In biblical accounts, King Saul was reportedly soothed by David's harp music, and the ancient Greeks expressed thoughts about music having healing effects as well. Many cultures are steeped in musical traditions. It can change mood, have stimulant or sedative effects, and alter physiologic processes such as heart rate and breathing. The apparent health benefits of music to patients in Veterans Administration hospitals following World War II lead to it being studied and formalized as a complementary healing practice. Musicians were hired to continue working in the hospitals. Degrees in music therapy became available in the late 1940s, and in 1950, the first professional association of music therapists was formed in the United States. The National Association of Music Therapy merged with the American Association of Music Therapy in 1998 to become the American Music Therapy Association. Goals Music is used to form a relationship with the patient. The music therapist sets goals on an individual basis, depending on the reasons for treatment, and selects specific activities and exercises to help the patient progress. Objectives may include development of communication, cognitive, motor, emotional, and social skills. Some of the techniques used to achieve this are singing, listening, instrumental music, composition, creative movement, guided imagery, and other methods as appropriate. Other disciplines may be integrated as well, such as dance, art, and psychology. Patients may develop musical abilities as a result of therapy, but this is not a major concern. The primary aim is to improve the patient's ability to function. Techniques Learning to play an instrument is an excellent musical activity to develop motor skills in individuals with developmental delays, brain injuries, or other motor impairment. It is also an exercise in impulse control and group cooperation. Creative movement is another activity that can help to improve coordination, as well as strength, balance, and gait. Improvisation facilitates the nonverbal expression of emotion. It encourages socialization and communication about feelings as well. Singing develops articulation, rhythm, and breath control. Remembering lyrics and melody is an exercise in sequencing for stroke victims and others who may be intellectually impaired. Composition of words and music is one avenue available to assist the patient in working through fears and negative feelings. Listening is an excellent way to practice attending and remembering. It may also make the patient aware of memories and emotions that need to be acknowledged and perhaps talked about. Singing and discussion is a similar method, which is used with some patient populations to encourage dialogue. Guided Imagery and Music (GIM) is a very popular technique developed by music therapist Helen Bonny. Listening to music is used as a path to invoke emotions, picture, and symbols from the patient. This is a bridge to the exploration and expression of feelings.

Dance therapy
Dance/movement therapy, or dance therapy is the psychotherapeutic use of movement [2] and dance for emotional, cognitive, social, behavioral and physical conditions. As a form of expressive therapy, DMT is founded on the basis that movement and emotion are directly [3] [4] related. The ultimate purpose of DMT is to find a healthy balance and sense of wholeness.

Definition
Dance therapy is a type of psychotherapy that uses movement to further the social, cognitive, emotional, and physical development of the individual. Dance therapists work with people who have many kinds of emotional problems, intellectual deficits, and life-threatening illnesses. They are employed in psychiatric hospitals, day care centers, mental health centers, prisons, special schools, and private practice. They work with people of all ages in both group and individual therapy. Some also engage in research. Dance therapists try to help people develop communication skills, a positive self-image, and emotional stability.

Origins
Dance therapy began as a profession in the 1940s with the work of Marian Chace. A modern dancer, she began teaching dance after ending her career with the Denishawn Dance Company in 1930. In her classes, she noticed that some of her students were more interested in the emotions they expressed while dancing (loneliness, shyness, fear, etc.) than the mechanics of the moves. She began encouraging them by emphasizing more freedom of movement rather than technique. In time, doctors in the community started sending her patients. They included antisocial children, people with movement problems, and those with psychiatric illnesses. Eventually, Chace became part of the staff of the Red Cross at St. Elizabeth's Hospital. She was the first dance therapist employed in a formal position by the federal government. Chace worked with the emotionally troubled patients at St. Elizabeth's and tried to get them to reach out to others through dance. Some of them were schizophrenics and others were former servicemen suffering from posttraumatic stress disorder. Success for these patients meant being able to participate with their class in moving to rhythmic music. "This rhythmic action in unison with others results in a feeling of well-being, relaxation, and good fellowship," Chace said once. Chace eventually studied at the Washington School of Psychiatry and began making treatment decisions about her patients along with other members of the St. Elizabeth's medical team. Her work attracted many followers, and the first dance therapy interns began learning and teaching dance therapy at St. Elizabeth's in the 1950s.

Other dancers also began using dance therapy in the 1940s to help people feel more comfortable with themselves and their bodies. These dancers included Trudi Schoop and Mary Whitehouse. Whitehouse later became a Jungian analyst and an influential member of the dance therapy community. She developed a process called "movement in-depth," an extension of her understanding of dance, movement, and depth psychology. She helped found the contemporary movement practice called "authentic movement." In this type of movement, founded on the principles of Jungian analysis, patients dance out their feelings about an internal image, often one that can help them understand their past or their current life struggles. One of Whitehead's students, Jane Adler, furthered Whitehead's work in authentic movement by establishing the Mary Starks Whitehouse Institute in 1981. In 1966, dance therapy became formally organized and recognized when the American Dance Therapy Association (ADTA) was formed.

Benefits
Dance therapy can be helpful to a wide range of patientsrom psychiatric patients to those with cancer to lonely elderly people. Dance therapy is often an easy way for a person to express emotions, even when his or her experience is so traumatic he or she can't talk about it. It is frequently used with rape victims and survivors of sexual abuse and incest. It can also help people with physical deficits improve their self-esteem and learn balance and coordination. Dance therapists also work with people who have chronic illnesses and life-threatening diseases to help them deal with pain, fear of death, and changes in their body image. Many people with such illnesses find dance therapy classes to be a way to relax, get away from their pain and emotional difficulties for a while, and express feelings about taboo subjects (such as impending death). Dance therapy is suitable even for people who are not accomplished dancers, and may even be good for those who are clumsy on the dance floor. The emphasis in dance therapy is on free movement, not restrictive steps, and expressing one's true emotions. Children who cannot master difficult dances or can't sit still for traditional psychotherapy often benefit from free-flowing dance therapy. Even older people who cannot move well or are confined to wheelchairs can participate in dance therapy. All they need to do is move in some way to the rhythm of the music. Dance therapy can be useful in a one-on-one situation, where the therapist works with only one patient to provide a safe place to express emotions. Group classes can help provide emotional support, enhanced communication skills, and appropriate physical boundaries (a skill that is vital for sexual abuse victims).

Description
There are currently more than 1,200 dance therapists in 46 states in the United Sates and in 29 foreign countries. Like other mental health professionals, they use a wide range of techniques to

help their patients. Some of the major "schools of thought" in dance therapy include the Freudian approach, Jungian technique, and object relations orientation. Many therapists, however, do not ascribe to just one school, but use techniques from various types of dance therapy. The authentic movement technique is derived from the Jungian method of analysis in which people work with recurring images in their thoughts or dreams to derive meaning in their life. Instead of asking the patient to dance out certain emotions, the therapist instructs the patient to move when he or she feels "the inner impulse." The moves are directed by the patient and the therapist is a noncritical witness to the movement. The moves are supposed to emerge from a deep level within the patient. In Freudian technique, dance therapists work with patients to uncover feelings hidden deep in the subconscious by expressing those feelings through dance. In object relations technique, the therapist often helps the patient examine problems in his or her life by considering the primary initial relationship with the parents. Emotions are expressed in a concrete, physical way. For instance, a patient would work out his fears of abandonment by repeatedly coming close to and dancing at a distance from the therapist. Dance therapists sometimes use other types of therapy along with dance, such as art or drama. Therapists also discuss what happens during a dancing session by spending time in "talk therapy." Dance therapists use visualizations during sessions, too. For example, the therapist might instruct patients to imagine they are on a beautiful, peaceful beach as they dance. In one frequently used technique, the therapist mirrors the movements of the patient as he or she expresses important emotions. This is especially powerful in private one-on-one therapy. It is thought that this device provides a sense of safety and validates the patient's emotions. The underlying premise of dance therapy is that when people dance, they are expressing highly significant emotions. A fist thrust out in anger into the air or a head bent in shame has deep significance to a dance therapist. Through dance therapy, the theory goes, patients are able to more easily express painful, frightening emotions, and can progress from there. After experiencing dance therapy, they can talk about their feelings more freely and tear down the barriers they have erected between themselves and other people. The hope is that eventually they can go on to live more psychologically healthy lives.

Play therapy

Play therapy is a treatment modality in which the therapist engages in play with the child. Its use has been documented in a variety of settings and with a variety of diagnoses. Treating within the context of play brings the therapist and the therapy to the level of the child. By way of an introduction to this approach, a case is presented of a sixyear-old boy with oppositional defiant disorder. The presentation focuses on the events

and interactions of a typical session with an established patient. The primary issues of the session are aggression, self worth, and self efficacy. These themes manifest themselves through the content of the childs play and narration of his actions. The therapist then reflects these back to the child while gently encouraging the child toward more positive play. Though the example is one of nondirective play therapy, a wide range of variation exists under the heading of play therapy.