OSCE Exam

OSCE Exam Study Preparation

The Objectively Structured Clinical Evaluation (OSCE) is the clinical component of the College’s certification exams. This exam is designed to evaluate both the candidates’ knowledge and application of skill, and tests their ability to safely and effectively apply the principles and processes of massage therapy practice, within the context of multiple clinical scenarios in one of 7 test stations.

OSCE Exam Stations:

OSCE Exam Review for the Massage Board Exam

 OSCE Station 1: Remedial Exercise / Self Care

When studying for the OSCE exam, remember to master the stretches and the strengthening exercises (both isometric and isotonic) for all the muscle groups – or even better, specific muscles. (e.g. semitendinosus as opposed to hamstrings)

Strengthening:

Isometric Exercise:

Hold contractions for 5 seconds, 8-10 reps, 2-3 sets. 3-4 times a week.

(Have the patient take 30 seconds to 1 minute break between sets )

Isotonic Exercise:

10 – 12 reps., 3 sets >> once a day, 3 to 4 times a week.

( Have the patient take 30 seconds to 1 minute break between sets )

Stretching:

Hold each stretch for at least 30 seconds, breathe while you stretch, after 30 seconds, you may:

– move into a deeper stretch. hold again for 30 seconds

– take break ( 30 seconds to 1 minute break between sets ) then repeat stretch

* 2-3 sets, everyday

Important Notes:

As a Massage Therapist, it is important to remind the patient that:

  • Stretching and Strengthening exercises are to be stopped when pain is felt. Explain to the client the difference between a stretch sensation and a pain sensation if they are new to strengthening and stretching.
  • It is important to breathe while you stretch and strengthen.

To review the proper stretches for each muscle or muscle group, I found the following physiotherapy website. This website has short exercise video clips with narration which demonstrates typical exercises prescribed by physical therapists and massage therapists.

http://www.cyberpt.com/cptvidlist.asp (Note: you have to have Quicktime to view their videos (available for both Apple and Windows computers > download link: https://support.apple.com/kb/DL837). If you are uncomfortable downloading Quicktime, there are plenty of exercise videos on youtube.

It is important to teach the patient the proper way of targeting and stretching a specific muscle.

OSCE Exam Review for the Massage Board Exam

OSCE Station 2: Client Interview/ Patient Interview

Health professionals base their treatment plans from Subjective and Objective information. The Client interview part of the OSCE Exam for RMTs is to test your ability to gather as much subjective information from the client:

Purpose of Gathering Subjective Information:

– have a better understanding of the client’s presenting condition

– to devise an effective treatment plan.)

SUBJECTIVE INFORMATION:

During the first few months of Massage Therapy school, we all have learned LORDFICARAH which stands for Location, Onset, Referral, Duration, Frequency, Intensity, Character, Aggravating Factors, Relieving Factors and Alternative Healthcare and Health History. This is the easiest pattern to follow when obtaining subjective information from massage clients.

Location : Where the pain and tenderness is

Onset: When the pain started

Referral Pattern: Does the pain refer – the behavior of the referral (e.g. numbness, tingling, shooting, burning etc…)

Duration: How long the pain lasts

Frequency: Is the pain constant or does it come and go?

Intensity: The severity of the pain the client is experiencing at the moment and at certain times of the day, moment of injury etc. The client may describe the pain as Mild, Moderate, Severe OR you may suggest using a pain scale. 1-10/10.

Character: Characteristic of the pain ( dull, shooting, achy, etc…)

Aggravating Factors: What makes the pain worse?

Relieving Factors: What makes the pain decrease or go away?

Alternative Healthcare: Other health care provider that the client has seen in relation to the complaint. ( MD, Chiro, Physio, Naturopath etc…)

Health History: This information will come from the Health History Form that the client fills out when they come in for the first time.

SOAP Notes (Subjective Objective Assessment and Plan Notes) : To document the information you gather from your subjective interview, here is a review guide on how to write your SOAP Notes

Here is an example YouTube video that may help you with your Client interviewing skills:

OSCE Exam Review for the Massage Board Exam

OSCE Station 3: Assessment 1

Based on the examination handbook, in station 3, the candidate is expected to demonstrate their ability to perform specific assessment techniques (e.g. palpation, range of motion, neurological, orthopaedic testing, etc).

1. Orthopaedic Tests ( Special Tests)

To study how to perform specific orthopaedic testing ( 80+ special tests).Visit SPECIAL TESTS https://www.massagetherapyreference.com/special-tests/

 

2. Neurological Tests:

To test for nerve root damage, the corresponding dermatomes supplied by that nerve root may be tested for abnormal sensation and the myotomes may be tested for weakness. To test for sensitivity of a dermatome, a pinwheel, cotton ball, paper clip, the pads of the fingers or fingernails may be used. Ask the client for feedback.

Abnormal Sensations:

Hypoesthesia (decreased sensation), Hyperesthesia (excessive sensation), Anesthesia (loss of sensation), Paresthesia (numbness, tingling, burning sensation).

A. To study the cervical myotomes ( Neurological Test )

Cervical Myotomes

Cervical Myotomes Evaluation (test for relative strength and weakness):
C1-C2 Myotomes: Neck Flexion
C3 Myotomes : Lateral/ Side Neck Flexion
C4 Myotomes: Shoulder Elevation/ Shrugging shoulders
C5 Myotomes: Shoulder Abduction
C6 Myotomes: Elbow Flexion & Wrist Extension
C7 Myotomes: Elbow Extension & Wrist Flexion
C8 Myotomes:  Thumb Extension & Ulnar Deviation

 

B. To study for the myotomes of the rest of the body :

( note: the person doesn’t start showing the myotomes until 1:44. forward to 1:40 if you don’t want to see the long introduction.)

T1 Myotomes: Finger abduction
T2 – L1 Myotomes: Chest wall and abdominal muscles

L2, L3 Myotomes: Hip flexion
L3, L4 Myotomes: Knee extension
L4 Myotomes: Ankle dorsiflexion
L5 Myotomes: Big toe extension
L5, S1 Myotomes: Knee flexion
S1 Myotomes: Ankle plantarflexion
S2 Myotomes: Knee flexion

C. To study the dermatomes ( Neurological Test )

Full Body Dermatomes

3. Gross Anatomy , Landmarking, Palpation

It is important for a Massage Therapist to know Gross Anatomy, Bone Landmarks, the origins and insertions of all muscles especially the major muscles and the actions of those muscles. To study for these, watch the following videos:

Shoulder and Trapezius

Chest Region

Shoulder/ Arm Region

Forearm Flexors ( Anterior )

Forearm Extensors ( Posterior )

Leg Region

Gluteal Region

Thigh

Anterior Compartment

Posterior Compartment

Medial Compartment

Leg

Anterior Compartment

Posterior Compartment

Lateral Compartment

 

OSCE Exam Review for the Massage Board Exam

OSCE Station 4: Assessment 2

Based on the examination handbook, in station 4, the candidate is expected to conduct an assessment to determine the nature of the client’s presenting dysfunction.

Health professionals base their treatment plans from Subjective and Objective information. The Assessment 2 part of the OSCE Exam for RMTs is to test your ability to gather as much objective information from assessing the client:

Purpose of Gathering Objective Information:

– in order to have a better understanding of the client’s presenting condition, and come up with a clinical impression.

– in order to devise an effective treatment plan.

OBJECTIVE INFORMATION:

Steps: ( Assessment Protocol / Progression of Assessment ) – CLICK on each step for more information…

*** the following assessments are done after taking patient history and client interview ( Subjective information).

SOAP Notes (Subjective Objective Assessment and Plan Notes) : To document the information you gather from your objective assessment, here is a review guide on how to write your SOAP Notes

A. Visual Observation:

1. Postural Analysis/ Postural Assessment
2. Gait Assessment (if needed)

B. ROM ( Range of Motion ) Testing

C. Muscle Length and Strength Tests

D. Orthopaedic Assessment Tests including Neurological Tests ( Myotomes, Dermatomes )

E. Palpation

Performing Objective Examinations / Assessment:

Cervical Spine / Neck Exam:

 

Shoulder Exam:
This is the first ( of nine ) videos for shoulder examination. Find the succeeding videos on the person’s channel.

Hip and Groin Exam:
This is the first ( of seven ) videos for hip and groin examination. Find the succeeding videos on the person’s channel.

Knee Exam:
This is the first ( of 27 ) videos for shoulder examination. Find the succeeding videos on the person’s channel.

OSCE Exam Review for the Massage Board Exam

in Station 5, the candidate is expected to interact with the client to explain their treatment plan for initial and on-going treatment, and obtain informed consent.

Treatment Plans are formulated based on :

Subjective Information:

1. Client’s Health History

2. Client’s perspective of their presenting condition.

and, Objective Information:

3. Results of ROM testing, Orthopedic Testing, Neurological Testing, Postural Analysis

As registered Massage Therapists, we are required by law to get the patient’s Informed Consent.

** SOAP Notes (Subjective Objective Assessment and Plan Notes) : To document the information you gather from your subjective and objective assessment, and also your Massage Treatment plan here is a review guide on how to write your SOAP Notes for Massage Therapy

Informed Consent means the client understands and agrees to the Massage Therapist’s Treatment Plan.

Informed Consent or Consent To Treat Includes:

  1. Goal of treatment
  2. Positioning of the Client
  3. Draping
  4. Areas of the body treated and the reason for this
  5. The client will remove clothes according to their comfort once the massage therapist leaves the room
  6. Amount of pressure to be used and that it can be adjusted
  7. Risks of the Massage Treatment
  8. Potential Benefits of the Massage Treatment
  9. Treatment Modifications if needed
  10. Hydrotherapy, Stretching
  11. Contraindications
  12. Cost and Duration
  13. Does client need assistance getting on the table
  14. Any questions from the client
  15. Does Client consent to the treatment plan

Communicating the Massage Treatment Plan:

  • Therapist should learn how to communicate the treatment plan clearly in about 3 minutes.
  • Apart from it being required by law, the treatment plan will help make the client feel more relaxed and in control of the treatment. It is important that the patient understands what happens during the massage tretament and why.
  • Massage Therapist should consider the client’s knowledge and should refrain from using technical terms that the client does not understand.

Informed Consent / Consent to Treat Statement should include:

  1. Initial Treatment Plan. The Massage Therapist’s conclusion of what needs to be treated based on subjective and objective information.
  2. The positioning, pillowing and draping. The therapist needs to let the client know that they will have time to remove clothes according to their comfort, and position themselves accordingly between the sheets on the table, once the massage therapist leaves the room.
  3. The overview of how an actual massage is performed and how pressure is applied especially if it is a first time massage client. e.g techniques, passive stretch, hydrotherapy
  4. The Risks and Benefits of the massage treatment.
  5. That the therapist is open to modifying the treatment plan ( including massage techniques) before or during the massage.
  6. That the Client may stop the treatment at any time.
  7. Therapist should ask the client if they have any questions and answer them to the best of their knowledge.
  8. The therapist needs to ask the client if they consent to the treatment.

Also ;

  • Ongoing treatment plan, the frequency and duration and the perceived results of the ongoing treatment plan should also be included in the treatment consent.
e.g 30 minute treatments twice a week for 3 weeks then reassess…
  • The client should also be informed that Remedial Exercise and Self Care are to be given after the treatment.
  • The therapist should also remind the client to observe their bodies’ reaction to the massage treatments and inform you ( therapist ) about it the next time they come.
Credits: some information taken from the book Clinical Massage Therapy by Fiona Rattray and Linda Ludwig

OSCE Exam Review for the Massage Board Exam

OSCE Station 6: Treatment

In Station 6, the candidate is expected to perform a Focused Massage Therapy Treatment, given the presenting case history and assessment findings.

Review:

1. Massage Treatments By Condition

*** ( the above link does not include all conditions learned in class – check your notes and Rattray)

*** ( each case is different so it is important to read the case history and assessment findings from the stem. )

2. Massage Techniques

3. Principles of Massage

  • superficial, deep, superficial
  • general, specific, general
  • proximal, distal, proximal
  • peripheral, central, peripheral

OSCE Exam Review for the Massage Board Exam

OSCE Station 7: Technique

In Station 7, the candidate is expected to demonstrate their ability to perform specific massage therapy techniques on specific anatomical structures.

It would be good to practice all your massage therapy techniques with a classmate.

  • Study your Swedish Massage Techniques Here
  • Review Cross Fiber Frictions, Review Trigger Point Therapy
  • Review Joint Mobilizations and Joint Play
  • Review Passive Stretching
  • Review your gross anatomy so you will be able to easily palpate and find the structure they will ask you to Massage
  • Review all the massage techniques you studied in school and practice it with a partner.