CONNECTIONSFall 2011 Issue ISSN 1916-1042

The Magazine for Natural Health Practitioners

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Fall 2011 Issue

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CONTENTSBoard Highlights

My Lymphatic Journey…

NATURAL HEALTH CARE – a Right in Switzerland

NHPC Complaints Resolution ProcessSummary of Arbitrators Decision and Sanction Committee Decision

Generating Clients on a Tight Budget

Bonnie Prudden: Inspiring Health at Every Age

Perspectives for the Professions

The Effect of Reflexology on the Autonomic Nervous System in Healthy Adults: A Feasability Study

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CONNECTIONS

Copy PolicyReproduction in part ispermitted with creditacknowledging NHPC asthe original source, notingdate of issue and originalauthor. Copyright materialsaccepted for publicationremains with the author.However, NHPC may freelyreproduce them in print,electronic, or other forms.

Editorial PolicyThe magazine welcomesarticles on any topic relatedto health and wellness. Allsubmitted articles mustinclude the author’s name.The editors reserve the rightto edit articles for clarity,length, and to correct factualinaccuracies. The opinions expressed by the authors of published articles or adver-tisements are not necessarily those of the NHPC, and do not imply endorsement by the NHPC Board.

Return Undeliverable Canadian Addresses to:

Natural Health Practitioners6th Floor, 10339- 124 StreetEdmonton, AB T5N 3W1www.nhpcanada.org

Canadian Publications Mail ProductSales Agreement No. 40024947

Board of Directors

PresidentDon Himmelman

Vice-PresidentMichelle Huszar

SecretaryMichelle Blanchard

TreasurerKim MacEachran

DirectorsMichelle BlanchardJeff LazoPaul BuffelStephanie Nunez - Braatz

Administration

ExecutiveColleen MacDougall, CAEExecutive Director & Registrar

Doug BakerAssistant Executive Director Henriette DouziechExecutive Assistant

Complaints & PrivacyCathy SveenComplaints Director & Privacy Officer Jan BagotComplaints Administrator

Communications, Marketing & Public RelationsClaire AshtonCommunications Director Nadine NoseworthySenior Coordinator : eMedia and Advertising Jasmine BischoffMarketing Communications Coordinator

Membership, Credentialing & ResearchRoberta PalynchukManager Lucy LavineMembership Coordinator Lynda AckerMembership Coordinator (RenewingMembers) Noelle Goff-KurlanderQuality Assurance Coordinator Sarah KayMembership Coordinator (New Members) Jenn VasquezContinued CompetencyProgram Coordinator EducationErica JonesSenior Coordinator Jamal GabrielEducation & Events Assistant

Finance & AdministrationSuzanne OlsonManager Finance & Administration Mora MooreAssistant Manager Finance & Administration

CONTACT INFORMATI ON

To send us your article or for more information about the magazine, please contact us at:Natural Health Practitioners of Canada (NHPC)

Sixth Floor, 10339 - 124 StreetEdmonton, Alberta T5N 3W1Toll free 1 888 711 7701Tel. 780 484 2010Fax. 780 484 3605e-mail growingtogether@nhpcanada.orgwebsite www.nhpcanada.org

5Summer 2011

As summer moves towards fall, there is much in transition, in accordance

to this age old cycle. What is true of the environment around us and within our lives is also mirrored, to a degree, within the NHPC. At the NHPC office new staff have been hired and trained, serving the needs of our growing organization. Meanwhile your volunteer Board of Directors are transitioning into their various roles, including myself. While admittedly more comfortable contributing in a background capacity, in this final year of being on the Board I accepted the challenge to step up to be President. As someone used to living in a quiet hemlock forest in Nova Scotia, far from the centre of anything, this feels like a bit of a leap. So far, though, the demands have been minimal. The pace definitely will pick up once fall indeed arrives.

Connection CafesSpeaking of the fall, the next round of in person Connection Cafes will be launched in October, beginning in the Maritimes. These Cafes are excellent opportunities to meet with your Board members and ask questions up close and personal, while networking with members from your region. We, the Board, really value your input and take what we have learned back to our meetings. Dates and registration for the Connections Cafe nearest you can be found online through the members section of the NHPC website.

Insurance AdvocacyThe first portion of the two-part National Health Knowledge Dialogue (NHKD) survey was run successfully and the data is being collected. This first survey focused on Practitioners while the second, to be launched very soon, focuses on Patients. The analyzed data from these surveys will be used in the NHPC’s advocacy work with the government and the health insurance industry. Thank you to those practitioners who took the trouble to participate.

Sister organizations in countries around the world will also be running this survey, creating a global picture of the value of

natural health practices. It is exciting to note that this initiative, which has never been done before in such a coordinated fashion, was initiated by your NHPC.

MTAA LawsuitOn a more serious note, by now many of you are aware that your NHPC Board of Directors has initiated a legal suit against the Massage Therapy Association of Alberta (MTAA). This unprecedented decision arose when it came to our attention that for a number of months the MTAA had been communicating very serious allegations about your NHPC. These allegations were presented within their own organization and publicly on the MTAA website, they were communicated to government and insurance agencies in a number of different provincial jurisdictions. As a result, the reputation of the NHPC and that of our fellow NHPC members has been harmed. This legal action seeks a full and complete retraction and

apology by the MTAA and a distribution of that retraction and apology to all individuals and parties that were exposed to the false and malicious statements. We, your Board and the NHPC office, are working hard to rectify this situation. Feel free to contact the NHPC office or myself should you have any questions or concerns about this matter.

While transitions can be challenging at times, in unexpected ways, they are workable and they carry the potential to be some of our most rewarding experiences. I’m often reminded of this as my fellow Board members and I work to advocate on your behalf locally, provincially, nationally and internationally so that all may benefit from the advancement of natural health.

Board HighlightsDon Himmelman, President

6 Summer 2011

It has been my joy to be working with NHPC since the beginning of July. I have been overwhelmed by the warm welcome and tremendous support from staff and members since my

arrival. I look forward to supporting NHPC members by working collaboratively with the amazing NHPC team in Edmonton.

I am also looking forward to being at the Connections Cafes this fall. Come out and join us for some networking and learning. I am especially excited to be meeting with, and learning from, our credentialed schools in conjunction with these events.

There is always plenty going on and I would love to have your contribution on anything we are doing. Feel free to stop in the office and join me for a chat and a cup of tea or, if you are in the far reaches of the country, don’t hesitate to give me a call on the NHPC toll free line or send me an email. I’d love to hear from you.

Take Care and Be Well!

Bobbi Membership & Credentialling Manager

Member Services News Renewal Season

If you did not renew your membership in May of 2011, chances are you are due to renew this fall. Watch your mailbox (and inbox) for notification that your membership is due for renewal. Renewals will be accepted online, by fax, by mail and in the office beginning September 12.

If you are due to renew this fall, your membership, including your NHPC membership number and all insurance policies included with your membership, will expire on October 31. Please ensure your renewal form and payment are at the NHPC office before that date!

Massage Therapy Competency Assessment Process – MTCAP

NHPC developed MTCAP last year to address the need to recognize the training, knowledge and skills of massage therapists through review and evaluation of competencies gained through prior learning, clinical experience and continued education. It is designed to determine if a massage therapist has developed the competency equivalency of 2200 hours of training through the course of their career.

Programs, such as MTCAP, are consistently used in the health professions in a variety of grandfathering, Prior Learning and Assessment and Recognition (PLAR) programs and/or equivalency processes to evaluate the skills and knowledge of practitioners and professionals. Some of these initiatives include

the Massage Therapy Association of Alberta’s 2200-Hour Education Equivalency Process, the College of Midwives of British Columbia’s PLAR for internationally educated applicants and the Canadian Society of Medical Laboratory Science’s PLAR.

NHPC is proud to continue to provide opportunities for success and excellence of practice for our members by offering our MTCAP program for Canadian massage therapists.

Continued Competency Program

As Natural Health Practitioners, it is important that we all continue to grow and learn within our profession. The more we know, the better care we can give our clients.

NHPC requires that all members meet a standard of continued competency through seeking to grow and learn. As was outlined in the last issue of Connections, we are moving to an audit system for our Continued Competency Program, so please ensure that you keep copies of all certificates and document all learning activities that you participate in for at least five years. You will be asked to submit documentation when your “number” comes up.

From taking a course, to attending a Connections Café, to reading this issue of Connections; every opportunity to learn and grow counts! For information on how to fulfill your CCP requirements, please visit the NHPC website and check out the CCP Video Tutorial.

Program Credentialing

There is another cycle of program credentialing starting this fall. If you have a program that you would like to have recognized by NHPC, please submit it by the end of September for consideration at the December board meeting. Contact me (Bobbi/Roberta) directly for assistance with your application.

Toronto Police Service

Those of you in Toronto will be happy to hear that NHPC is being registered with the Toronto Police Service Police Reference Check Program. Once we have been registered with this program, applying for a criminal record check with a vulnerable sector search will be much easier on all practitioners applying for membership with NHPC. Our registration should be complete shortly.

A big thank you going out to the members who brought this issue to my attention!

Contact Member Services Staff memberservices@nhpcanada.org

Jenn Vasquez CCP and MTCAP CoordinatorLynda Acker Membership Renewals CoordinatorRoberta Palynchuk Membership and Credentials ManagerSarah Kay New Membership Coordinator

Membership News and Updates

7Summer 2011

Manual lymphatic drainage (MLD) was not a subject that I knew anything about

when I attended the first class as part of my remedial massage diploma in 2002. Little did I know where it would lead me.

After the first class I was not convinced this particular subject had anything to offer me but at the behest of the teacher, with whom I had an affinity, I returned to finish the classes. By the end of the sixteen-week course I had learned enough to understand that although this therapy is extremely light to the touch and delivered in a slow manner, the effects are profound. I also saw that there was very few therapists’ performing lymph drainage as part of the modalities they offered and so I felt that it was something that would make me stand out in the ‘massage crowd’.

Upon entering my into my own practice I started to offer MLD to my clients, many of whom were prime candidates for this type of treatment. The results were amazing so I started to document the effects over the course of many months. Around the same time I was asked to teach MLD at Victoria University and because I was enjoying delivering the treatment and seeing the results I took up the position. As my confidence grew through the application of this treatment I began to see more and more clients that just wanted to receive MLD treatment in my clinic. I also noticed that my teaching style was changing in direct reference to the results that I was able to see before my eyes.

As I was delivering this treatment daily I began noticing the effects it was having on my body. There were many times when I felt that the way I was taught the technique was not in the biomechanical ‘best interests’ of my body. Often my posture was compromised and hands were placed in awkward positions to deliver the treatment.

Gradually I started to change my stances around the table and to understand that delivering an effective and complete experience for my client meant that I must be completely comfortable in the delivery. As a result of this my technique changed and I started to move my whole body with each movement. I called this performing MLD from the “ground up”, being at home in my body so that my fluidity and ease of technique not only meant a better treatment for my client but also a more comfortable work environment for me. The way that I was doing MLD meant that what was happening with my hands on the clients’ body was the combined result of full body movement and rhythm, the hands being the END result of the movements of my body. This

idea became the cornerstone of my teaching, based on the ideals of self-care and excellent technique. It was not only enjoyable it also worked. This was seen time and time again in my classes where there would be a student with a particular pathology who would volunteer to be my model for a particular sequence. Many students were breast cancer survivors, had knee or ankle trauma or other soft tissue issues such as primary or secondary lymphoedema. Almost every time I worked on them there was both a subjective and objective improvement in their condition, often to the amazement

of not only them but other members of the class as well. It was these instant results, which enabled students to understand that even though this touch is superficial in comparison to what they are used to delivering in their remedial treatments, it is elegant, efficient, and profound when used to treat indicated pathologies. MLD massage goes where remedial cannot, swollen areas, both acute and chronic, and the paradox of this treatment is that such a superficial technique has such a deep and lasting impact upon the client. Over the years I have had many emails and calls form students thrilled with the results they were getting for their clients, and also very happy with the relaxing effects it had on their own bodies.

Within my own practice there have been numerous stand out occasions where using MLD has changed the nature of my clients understanding of massage for the better. Three different ones come to mind.

The first one is the case of a thirty-five year old woman who had been suffering from Chronic Fatigue Syndrome (Myalgic Encephalomyelitis) for ten years. She had been confined to bed for the previous five years. At her worst she was hooked up to both a cathode and drip to feed her. She was on copious amounts of medications, which kept changing as she was experimenting with all different combinations of drugs to assist her to get through her days. The most she was ever able to stay awake was three hours at a time. When we first started to work together I would visit her in her home twice a week. I started with very short relaxation massages coupled with small sequences of MLD to assist her to move fluid through her body, which due to immobility had built up, in some areas dramatically. The most marked effect of the early MLD sessions was her increased ability to deal with the constant pain she was suffering, the parasympathetic nervous systems response was immediate and her relaxation greatly improved. She looked forward to our sessions simply from the

My Lymphatic Journey...Michelle Yaffe-Vassallo

8 Summer 2011

point of easing her pain with a drug free alternative. Another side effect/benefit was an increased removal of toxins from her system, in her words “After an MLD I feel like crap, but the next day I feel amazing”. Further to this her sleeping improved, her sinuses cleared and over the course of four years her immune system became stronger so that each winter the numerous ills and chills of the season became fewer. I still treat her on a weekly basis and even though her CFS/ME situation is slow to improve she says she could not do without her weekly MLD sessions.

The second client underwent mastectomies, bilaterally, at different times. I did not meet her until she had had the first breast removed due to breast cancer. She had heard about MLD through a friend and as she was having some post-surgical oedema she decided to give it a try. She brought her husband along to the session so that he could learn about the therapy and deliver some of the more simple strokes to ease her pain between treatments. It was a revelation to her. Immediately post session she reported that there was an overall feeling of lightness in her arm that had been absent since the operation. Also her pain was eased and she noticed that she had increased range of motion and pain free movement in both the arm and hand. Within four years breast cancer had developed in her other breast, which also had to be removed. Her husband called me and asked if I would go and visit her in the hospital to perform some MLD on the post-operative area. I went and did a simplified version of MLD the day after the operation while the translucent bandaging and drainage tube were still in place. Many things came of that session, not only was I was able to ease my client’s pain and discomfort but I was also, through my touch able to help ease her mental anguish in regards to loosing her other breast. Although it was confronting as a therapist to be invited into treatment so soon after surgery, it was rewarding and empowering in that once again I was humbled and delighted to see that this seemingly superficial technique could have such life changing effects for people.

The third occurred on route to teach MLD in Canada in 2009. On that particular night there were many returning Canadians who had been competing in the masters games in Sydney. One lady who had been playing soccer had severely injured her knee and done extensive soft tissue damage by falling directly onto it. At the time she had kept playing but when the game ended her knee had started to resemble a soccer ball. On the flight home it had stared to ache and swell considerably more and things were not looking good with pain and discomfort increasing by the hour. Another member of her team and I were talking at the back of the plane and we got around to discussing the reason for my trip to Canada. He explained her situation and asked if I would consider treating her. After we had torn her track pants to get them above her knee I proceeded to perform the MLD leg and groin sequence hourly throughout the remaining fourteen hours of the flight and the reduction in fluid volume and pain was remarkable. She even offered to come and be my MLD model when I was teaching in Calgary!

I have also been asked to teach in prestigious Australian Rules football clubs, the latest being Carlton. To me this suggests that the benefits of MLD have become more recognised in the mainstream community through more practicing therapists, better public education and favourable media coverage. My job at this elite club was to instruct the ‘on field runners’, trainers and massage therapist in MLD techniques. The value of these for sports is that often when a player has sustained an injury on the field or court regular massage is contraindicated, normally RICE protocol is followed. The beauty of MLD is that along with RICE it can be applied immediately upon the player being removed from danger. Not only does it assist in keeping the swelling at a manageable level it also clears the injured tissue of debris, enhancing the tissue regeneration process by helping keep the injured area as healthy as possible hastening the healing time and allowing players to return to he game much sooner.

9Summer 2011

Manual Lymph Drainage

Manual Lymphatic Drainage (MLD) is a highly specialized technique that can be used to treat many injuries and pathologies. It can be performed as a preventative technique that bolsters our bodies’ ability to rejuvenate and resist all types of stress.

MLD not only stimulates the vital functions of the skin, tissues and internal organs, but also serves to eliminate cellular waste and stimulate the parasympathetic relaxation response inhibiting muscle tonus and pain.

By the end of this two-day course, you’ll possess the ability to understand and perform a full lymphatic drainage with confidence and skill.

Where: Winnipeg, MB Where: Edmonton, AB

When: September 17 & 18, 2011 When: September 20 & 21, 2011

Cost: $480 + tax Cost: $480 + tax

Seated Massage

Introduction to seated massage is a 1-day course that will introduce you to and instruct you in performing a fifteen minute seated massage over clothes. It will also act as an introduction to the remedial massage diplomas corporate massage elective. You will be taught to perform a seated massage with a view to efficient and safe body use including a range of dynamic exercises and stretches to help you prepare to deliver the massage. Possible pitfalls of performing seated massage will be examined, as will relevant workplace pathologies, and how to treat them in the corporate environment. We will also look at how to safely manage the workspace that you will be in and various elements that will make it easier to do your job.

Where: Calgary, ABWhen: September 23, 2011Cost: $300 + tax $480 + tax when BUNDLED with Self Care for Massage Therapist Visit the Centre for Learning at www.nhpcanada.org for more info.

Self care for Massage Therapists

Performing massage can be draining. As therapists, we’ve all been there. Ever wanted to learn ways to protect yourself and maintain your practice for the long haul? Recent research suggests that the working lifespan of massage therapists in the industry is around two years. Another survey states that 80% of people who start in bodywork drop out after two years. Two of the main reasons cited for this are that hands (particularly thumbs) give out and many therapists belatedly realize they don’t have the physical stamina to do the work.

Where: Calgary, ABWhen: September 24, 2011Cost: $300 + tax $480 + tax when BUNDLED with Self Care for Massage Therapist Visit the Centre for Learning at www.nhpcanada.org for more info.

Centre for Learning

WORKSHOPS with Michelle Yaffe-Vassallo

REGISTER ONLINE in the Centre for Learning at www.nhpcanada.org

www.nhpcanada.org

There have been many such experiences in the course of my practice and this in turn has made me a better teacher of this therapy. Students attend my classes because they have some curiosity or interest in this modality, and as far as I am concerned it is my job to nurture that interest and create a fun, dynamic and engaging learning experience. Through the provision of theory and technique I provide the key for students to walk through the door and follow their own journey with this wonderful therapy. I am able to share ‘real life’ practice stories, which adds validity to the teaching. We discuss situations in their practice and clinics and how MLD may be able to help their clients. And at the end of the day as manual body workers and therapists we do what we do because of a desire to help our clients to achieve their fullest potential and that is what makes our careers as massage therapists so rewarding and fulfilling.

Michelle Yaffe-Vassallo is the Director of Rhythm Massage Development, Michelle, studied her Diploma of Remedial Massage at Victoria University, graduating valedictorian of her year. She came to massage as a career change and quickly found her place, not only treating clients in her own clinic, but also as an educator of various remedial subjects at Victoria University. She specializes in Manual Lymphatic Drainage(MLD); self care for massage therapists and research literacy.

Space is limited. Reserve today at 1-888-300-7685

Thepractice-buildingroadmap8 week webinar series

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Fall Season webinar start dates: October 10th and November 18th

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Eligible for NHPC Continued Credits

10 Summer 2011

In June of this year I had the privilege of extending the friendship of our association to Switzerland. Switzerland is the first county in the western world to recognize Complementary

and Alternative Medicine (CAM) as part of their constitution. It is inspiring to see that others have gone on to be successful in just what we are trying to achieve, greater recognition for Natural Health Practitioners.

In 2009, 67% of the Swiss electorate voted, through referendum, for five CAM therapies to be covered by that countries health insurance. The government will recognize these five CAM therapies until 2017, at which time each therapy will be examined for efficacy, cost-effectiveness, and suitability.

The referendum that brought on this phenomenal change to the Swiss constitution is largely thanks to Walter Studeli, and the referendum was just the beginning of the advocacy work for CAM that he continues with on a daily basis. He says that “To have the constitution is only the first step, now we have to adapt the legislation. But quite often the problem we have now is not the laws; it’s the execution of the laws done by civil servants. So, you really have to be present to find out what’s going on. You must have influence, talk with the people, have a broad network… We will continue to work, as this is an ongoing process. “

When I was in Switzerland, I first met with Dr. Yvonne Gilli, who is a member of the Swiss National Party and M.P. for the Swiss Government.. Dr. Gilli gave me a tour of her practice, which is in an integrated clinic. It was interesting to see that even though there is now integration between allopathic medicine and Natural Health Care, allopathic healthcare is still the primary form of healthcare in Switzerland. This is surprising, especially considering that most Swiss citizens are raised in a culture where

Natural Health Care is placed first, as there is great respect for traditional forms of healthcare that have been passed down from generation to generation. For the most part, Natural Health Care is understood culturally within Swiss citizens.

Cecile Cassini represents a foundation of associations, which in many ways mirrors our own association. It represents 28 Natural Health modalities like Massage Therapy, Polarity Therapy, Rebalancing, Rolfing, and Shiatsu. Right now, Cecile is advocating for all 28 modalities to be regulated on a standards basis by the Swiss government.

The majority of the people practicing in these 28 modalities receive insurance coverage from their insurance company programs. Similarly to our own healthcare system, in Switzerland, there are two insurance platforms: there is primary healthcare that the Swiss government pays for, and there is secondary healthcare. However, in Switzerland all 28 modalities are recognized, whereas in Canada insurance companies only recognize predominantly massage therapy.

When I went into pharmacies in Switzerland, I cheerfully noticed that the shelves were predominately lined with complementary medicines, with a visibly limited inventory of allopathic medicine. When I spoke with the druggists in these stores, they were proponents of CAM as a first intervention, and recommend trying CAM first before trying pharmaceutical drugs for many conditions. That probably has much to do with the fact that Swiss people grow up knowing the importance of CAM. I couldn’t help but think forward to the day when Canada’s pharmacies will follow suit, even though I know we have a long way to go before we can realize that dream.

Perhaps the most uplifting thing to see on my trip was my visit to an integrative hospital just outside of Zurich. In this hospital, Natural Health Care is a primary focus used to treat patients. Allopathic medicine is still available, but it is part of the Natural Health Care methods system of healthcare. I met with several doctors there who have chosen to work in this hospital because of its approach to whole body healing and providing patients the opportunity to really heal themselves with a strong natural health approach to healing.

Lukas Rist, the CEO of the hospital, tells me that they are constantly working with the doctors in the hospital on research papers and projects to continue to show the outcomes and efficacy of a Natural Health hospital. This is really important because this kind of research will serve to support natural health in Canada. I look forward to collaborating with Rist and reading his research papers.

NATURAL HEALTH CARE – a Right in SwitzerlandColleen MacDougall, NHPC Executive Director

*CAM and Natural Health Care are used interchangeably in this article

Left to right: Christian Vogel, Colleen MacDougall, Cecile Cassini

11Summer 2011

Looking to the Swiss people, I know we can learn from them that CAM is not something Canada should be afraid of. If we can show the Canadian people, government, and insurance industry the efficacy of CAM and point to Switzerland as a reference point, we

can convince them of the importance of natural health practices being integrated into our current healthcare system. Those I met in Switzerland were warm and eager to share their success with our association. I can’t wait to see our collaborative work.

One of many pharmacy shelves stocked with natural health products

The integrative hospital

E-mail : robert@massageessentials.ca

12 Summer 2011

NHPC Complaints Resolution Process Summary of Arbitrators Decision and Sanction Committee DecisionCathy Sveen, NHPC Complaints Director

A complaint by a client regarding an Alberta Natural Health Practitioner

related to crossing of boundaries of a sexual nature and practicing beyond their scope of practice was reviewed through the NHPCA COMPLAINTS RESOLUTION process. Following an investigation into the complaint, a decision was made by the Executive Director to refer the complaint to arbitration.

The Arbitrator found that the allegations that the Natural Health Practitioner performed Thai massage without having the appropriate competency set to perform the treatment; and inappropriately touched or massaged a client’s breast and/or nipples in a sexual manner and without informed consent were proven.

The arbitrator found that these actions were contrary to #6, #15 and #22 of the NHPCA Code of Ethics, was detrimental to the best interests of the public, harmed the standing of the profession generally, and displayed a lack of knowledge, skill, and judgment in the practice of massage therapy,” attempts at sexual exploitation of a patient is a serious breach of professional conduct and shows failure in judgment and skill as a practitioner”.

The arbitrator held that multiple sections of the NHPCA Code of Ethics were violated: Competency, Integrity, and Responsibility to prevent “ Harm to our Clients”. The decision of the arbitrator was then referred onto to the Sanction Committee of the NHPCA Board of Directors.

The Sanction Committee of the NHPCA Board of Directors determined at a Sanction Hearing that the appropriate sanction in this instance is:

• Aten(10)monthsuspensionofthepractitioner’smembershipfrom the date of the Committee decision;

• At the end of the suspension period, the practitioner canapply for reinstatement as an Associate or Regular Member provided the following conditions are meet:

The practitioner provides an undertaking to the NHPCA that they will only provide services within the scope of their competencies, as recognized by the NHPCA;

The practitioner will demonstrate that they have successfully completed course work in the following subject areas. The

course(s) to be approved by the Executive Director and at the practitioner’s expense;

- Professionalism - Informed consent - Boundaries - Ethics

The practitioner shall provide a written report to the Executive Director within 30 days following the completion of the required course(s) indicating how their conduct, as disclosed in the arbitration, falls short of the standards set out in the NHPCA Code of Ethics, specifically Codes #6, #15, #22 and what they have learned.

The provisions regarding eligibility for membership as an Associate or Regular Member, as set out in the Bylaws, shall also otherwise apply to the practitioner’s application for reinstatement.

• Intheeventthatthepractitionerappliesforandisapprovedfor registration as a Regular Member, their practice shall be subject to the following conditions:

o The practitioner shall be prohibited from providing breast massage.

Classified Listings

To advertise, contact Nadine: 888-711-7701 or nnoseworthy@nhpcanada.org

For additional listings, please visit www.nhpcanada.org

Part Time Massage Therapist Edmonton, AB

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Our family of practitioners integrates science based education with heart-full compassion, warmth and humor. If you feel that you would be a compliment to our team of alternative health practitioners, please contact:

Sheryl Watson:

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Sacred Diva Healing Centre, 10830 124 street,

Edmonton, AB T5M 0H3. www.sacreddiva.ca

13Summer 2011

Generating Clients on a Tight BudgetJackie McKay

If you are looking to fill your holistic practice you are going to have to increase your number of clients, and to do that, you need more leads or prospects. For many business owners,

generating leads feels like a painful struggle, but it doesn’t have to be. In fact, it can be easy and fun. Following are five painless ways to generate leads.

1 – Ask for a referral

This is the easiest way to get new clients and it won’t cost you a penny. Yet so many therapists just don’t think of asking their client’s for referrals. If your client’s love you, know you and trust you – it’s more than likely they would be happy to refer to you and they more than likely know others who need your help – especially if they have friends who are just like them (sports enthusiasts, moms, stressed out executives, etc.)

After you’ve finished treating your client, let them know that you are building your practice and ask them if they can think of someone they know who might be able to use your services. Ask them to keep you in mind when they speak to them next. Let them know you offer “referral” incentives. Make sure to follow up with a gift!

2 – Attend a weekly networking event

You never know who you will meet at a networking event, or what kinds of connections you might make. When you meet people be the person who asks the questions. Listen well. Be curious. They will eventually come around to asking about you. Remember that even if your ideal clients aren’t swarming the room, the guy who’s dressed casually and talks too much, just may be the doorway to your ideal clients.

3 – Book speaking engagements or hold an information workshop or teleseminar.

Where do your ideal clients hang out? Get in front of them and speak to them or volunteer quick tasters of your services. If your ideal clients are sports enthusiasts, offer to speak to sports organizations in your city or surrounding areas. Go fish where the fish are!

4 – Send a warm letter

Contact previous clients and send an email or snail mail letter thanking them for their business. Let them know what is new and inform them of who you treat exactly and that you are expanding your practice and you are ready to accept new clients. Ask them to keep you in mind if they can think of someone who is your ideal client.

5 – Approach a JV for an opportunity

Joint ventures are a wonderful opportunity to create a win-win situation for everyone, but often take a dash of creativity to find and execute. They’re fun and can be very, very profitable. This is why you need to keep your ears and mind open whenever you go

to networking events and meetings.

Think of ways you can bring value to possible JV partners and how they help your clients. For example, if you’re a massage therapist you might approach your local gym and offer to give a talk on the benefits of using massage while on an exercise program. You could send your own clients to the fitness facility whenever you hear of someone who is looking to get back into shape. Essentially, you swap leads. In turn, they might promote you in their facility or on their website and receive your services free in return for a specific number of referrals or sales.

6 – Publish a newsletter and commit to doing it regularly

People love to forward emails they think the recipient would like. A weekly newsletter with timely, high content and personable information is an ideal way to keep in touch with current clients and attract new ones. The newsletter doesn’t have to be long, but it does need to contain information that is relevant to your ideal client.

As you’re writing your newsletter, remember to write about topics that speak to your client’s struggles make sure to give them lots of value and offer a solution. Gear your newsletter to alleviating their pain and enhancing their pleasure. Encourage them to forward it to their friends and family.

Your Assignment:

Set up a system to generate leads so that your ideal client will find you. As you continue, your leads will increase, and you’ll be able to pick and choose your clients. The key is focus, consistency and incorporating marketing into your daily routine.

If you would like some 1:1 support developing your own marketing “system” that attracts lots of yummy clients, check out the Soul-Inspired Coaching programs. The Soul-Inspired Prosperous Practice Coaching programs can show you exactly how you can fill your practice and attract new clients to your business each month. And, you could do this in a “step-by- step” format, without being selly or icky, but just by being you. How would that make a difference in your life? I created this one-of-a-kind program to personally walk you through the same secrets I used (and continue to use daily) to attract my own ideal clients to my current coaching practice each month. Wanna learn more? Get in touch with me for a free exploratory session to see if I can help. Contact me at info@healerswhoprosper.com and go to www.HealersWhoProsper.com to get your Free Checklist – 141 To Fill Your Practice.

Until then, go heal your peeps!

Jackie McKay teaches natural health practitioners the “heart-centered” HOW TO of busting through entrepreneurial fears and making a name for themselves in their healing business.

14 Summer 2011

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15Summer 2011

It seems Bonnie Prudden, age 97, holds the key to

perfect health at any age. Her secret, a combination of physical fitness and Bonnie Prudden Myotherapy™, has kept her healthy and active over the span of her own lifetime, proving that if you take time to care for yourself, you can age gracefully, never losing your vitality or spirit. In 2006, she was the first person to ever be inducted into the Massage Hall of Fame, and also holds a Lifetime Achievement award from the President’s Council on Physical Fitness.

If you remember the 1950’s, Bonnie Prudden was a household name to you. You may have read one of her books, watched her syndicated television show, sported her exercise fashion line, read one of her many articles in Sports Illustrated, and at the very least you heard about her conversations with American President Eisenhower which lead to The Report That Shocked the President, which showed that American children were alarmingly out of shape, the least fit children in the world.

If you were born later, much of what you remember about physical fitness in grade-school is thanks to her. Because of Prudden, many people from all walks of life began finding time for exercise in their schedule. Born into an era that didn’t understand the importance of physical fitness, Prudden taught people how to take care of themselves through exercise. Even now, at the age of 97, she continues to inspire people to make time for exercise in their day. How could you not be inspired, when Prudden herself is still active, healthy, and full of energy at the age of 97?

If you work in natural health, you may have heard of myotherapy. Bonnie Prudden Myotherapy™ is one of the 66 modalities recognized by the Natural Health Practitioners of Canada, and boasts a 95% success rate in curing muscular pain. Learning from Dr. Janet Travell’s method of trigger point injection therapy, Prudden developed her own method of trigger point therapy that is non-invasive and can even be practiced at home without doctor supervision. This method relies on the power of your

hands and elbows to relive pain and discomfort from your life. Certified Bonnie Prudden Myotherapists receive 1,300 hours of schooling and are required to report back every two years for an additional thirty-five hours of continuing education hours. There are a few Canadians recognized as practicing Bonnie Prudden Myotherapy™, but most of Prudden’s students are practicing in the United States, coming from her own myotherpy school in Tuscan, Arizona.

All her life, Prudden has been full of energy, ready to take on her next adventure.

She tells us that her energetic spark was ignited as early as when she was an infant, and that as young as two years old, she “was climbing out [her] window into the night”, searching for adventure. Her mother didn’t know what to do with her overactive daughter, and enrolled her in ballet the same year in an attempt to exhaust her. This might have exhausted her enough to stop sneaking out of her window in the middle of the night, but Prudden began to blaze trails in the fitness world as she grew up. As a young women she danced on Broadway and became one of the top female mountain climbers in the world.

When Prudden was 23 she was in a bad skiing accident and fractured her pelvis in four places. To make matters worse, her doctor told her that she would never dance, climb, or ski again, and would never be able to have children. To most this would be considered a major setback, but it seems Prudden took it on as a challenge. When asked what she was thinking after her doctor gave her such a negative diagnosis, she said “what I was really thinking was up yours.” She did go on to prove her doctor wrong, continuing to be active all her life and giving birth to two children. She now serves as an inspiration for anyone living with pain and physical injury. With the right care, you can and will achieve pain free existence again.

Prudden’s method to pain free existence is a combination of physical fitness and Bonnie Prudden Myotherapy™. She believes that you cannot have one without the other, and has even included an exercise regimen with her myotherapy training. She believes that stress is a major precurser for chronic pain, telling us “you have to know that if you have any injury, real injury in your life, that it stays there and can come back again when you have stress in your life. Suddenly, you have a backache, or shoulder pain, or something else... then you can’t understand why you have a backache, you’ve never had a backache before. [But] you’ve never done any exercise before [either].” Prudden’s method seems simple enough, maintain an active lifestyle to keep your

Bonnie Prudden: Inspiring Health at Every AgeNHPC Staff

16 Summer 2011

body strong, and when do you encounter unavoidable pain from injury, treat yourself with Bonnie Prudden Myotherapy™ to release pressure from those trigger points that are causing the pain to surface.

If you’re interested in trying Bonnie Prudden Myotherapy™ on yourself or loved ones, you can start by picking up a copy of Prudden’s book, Pain Erasure the Bonnie Prudden Way, which was first published in 1980 and is on the New York Times Bestseller list. This book walks you through Prudden’s techniques in simple terms using charts, pictures, and diagrams, that are easy to understand. Plus, because Prudden believes her therapy cannot be complete without physical fitness, she dedicates the later part of the book to showing people how to begin an exercise regime. If you’ve never exercised before, or if you are recovering from physical injury that makes

exercise difficult, this section will help you on your way to becoming physically fit.

Every year, Bonnie Prudden celebrates her birthday by doing a somersault into her backyard pool, and her 97th birthday was no exception. If that isn’t proof enough that her methods to pain free existence work, I can only encourage you to try them out for yourself. With a little determination and self care, it seems that anyone can recover from injury and live a long and healthy life.

More information about Bonnie Prudden Myotherapy™ can be found at www.bonnieprudden.com

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17Summer 2011

1

PersPectives Professionsfor the

By field law’s Professional regulatory grouP

Issue 10, summer 2011

Joint SubmiSSionS on Sanction: the hearing tribunal’S role

ayla akgungor

Once a hearing tribunal has made a finding of unprofessional conduct, it is common practice in many professions for the hearing tribunal to be presented with a joint submission on sanction. A joint submission on sanction sets out a penalty (or penalties), which both the investigated member and the College have agreed constitutes a reasonable and appropriate response to the unprofessional conduct.

A hearing tribunal always retains the discretion to accept or reject a joint submission on sanction. Generally speaking, the principle of deference will apply and the hearing tribunal should accept the joint submission on sanction unless it is of the view that the penalty is unfit, unreasonable or is contrary to the public interest.

The principle of deference recognizes that joint submissions on sanction are often the outcome of an extended period of negotiations and discussions where the parties have addressed their minds to the issue of appropriate penalties. In doing so, the parties have streamlined the hearing process and saved time and resources. Accordingly, the parties’ efforts in arriving at a joint submission on sanction should not be disregarded unless there are good and cogent reasons for doing so. Recent decisions of the courts have emphasized the importance of this approach.

In Rault v. Law Society (Saskatchewan), 2009 SKCA 81, the College and the investigated member made a joint submission that a lawyer be permitted to resign in the face of discipline. The hearing tribunal instead ordered that the lawyer be disbarred and be ineligible to apply for reinstatement for five years. The Court of Appeal

reversed the sanction decision finding that the principles applied in criminal law with respect to joint submissions on sentencing should also be applied to professional disciplinary matters. The Court noted that there are good public policy reasons for the principle of deference to joint submissions and concluded that if the hearing tribunal was of the view that the joint submission sanction was inappropriate, it had a duty to give good or cogent reasons on why the proposed sanctions were inappropriate; not within the range of appropriate sanctions; unfit or unreasonable; or contrary to the public interest.

similarly, in Pankiw v. Chiropractors’ Association (Saskatchewan), 2009 SKQB 268, the hearing tribunal rejected a joint submission on sanction and imposed different penalties on the investigated member. The court overturned the sanctions imposed by the hearing tribunal on the basis that it had not put its mind to or concluded that the joint submission was unfit, unreasonable or not in the public interest. The court then imposed the penalties set out in the original joint submission on sanction. The court noted that joint submissions are to be encouraged not ignored. If they are ignored, lengthy discipline hearings and increased costs to be borne initially by members of the profession and perhaps ultimately by the public they serve will result.

In practice, if members of a hearing tribunal are concerned that a joint submission on sanction is unfit, unreasonable or not in the public interest, they should make their specific concerns known to the parties and provide them with an opportunity to make further submissions, either

Continued on Page 4...

1

PersPectives Professionsfor the

By field law’s Professional regulatory grouP

Issue 10, summer 2011

Joint SubmiSSionS on Sanction: the hearing tribunal’S role

ayla akgungor

Once a hearing tribunal has made a finding of unprofessional conduct, it is common practice in many professions for the hearing tribunal to be presented with a joint submission on sanction. A joint submission on sanction sets out a penalty (or penalties), which both the investigated member and the College have agreed constitutes a reasonable and appropriate response to the unprofessional conduct.

A hearing tribunal always retains the discretion to accept or reject a joint submission on sanction. Generally speaking, the principle of deference will apply and the hearing tribunal should accept the joint submission on sanction unless it is of the view that the penalty is unfit, unreasonable or is contrary to the public interest.

The principle of deference recognizes that joint submissions on sanction are often the outcome of an extended period of negotiations and discussions where the parties have addressed their minds to the issue of appropriate penalties. In doing so, the parties have streamlined the hearing process and saved time and resources. Accordingly, the parties’ efforts in arriving at a joint submission on sanction should not be disregarded unless there are good and cogent reasons for doing so. Recent decisions of the courts have emphasized the importance of this approach.

In Rault v. Law Society (Saskatchewan), 2009 SKCA 81, the College and the investigated member made a joint submission that a lawyer be permitted to resign in the face of discipline. The hearing tribunal instead ordered that the lawyer be disbarred and be ineligible to apply for reinstatement for five years. The Court of Appeal

reversed the sanction decision finding that the principles applied in criminal law with respect to joint submissions on sentencing should also be applied to professional disciplinary matters. The Court noted that there are good public policy reasons for the principle of deference to joint submissions and concluded that if the hearing tribunal was of the view that the joint submission sanction was inappropriate, it had a duty to give good or cogent reasons on why the proposed sanctions were inappropriate; not within the range of appropriate sanctions; unfit or unreasonable; or contrary to the public interest.

similarly, in Pankiw v. Chiropractors’ Association (Saskatchewan), 2009 SKQB 268, the hearing tribunal rejected a joint submission on sanction and imposed different penalties on the investigated member. The court overturned the sanctions imposed by the hearing tribunal on the basis that it had not put its mind to or concluded that the joint submission was unfit, unreasonable or not in the public interest. The court then imposed the penalties set out in the original joint submission on sanction. The court noted that joint submissions are to be encouraged not ignored. If they are ignored, lengthy discipline hearings and increased costs to be borne initially by members of the profession and perhaps ultimately by the public they serve will result.

In practice, if members of a hearing tribunal are concerned that a joint submission on sanction is unfit, unreasonable or not in the public interest, they should make their specific concerns known to the parties and provide them with an opportunity to make further submissions, either

Continued on Page 4...

Once a hearing tribunal has made a finding of unprofessional conduct, it is common practice in many professions for the

hearing tribunal to be presented with a joint submission on sanction. A joint submission on sanction sets out a penalty (or penalties), which both the investigated member and the College have agreed constitutes a reasonable and appropriate response to the unprofessional conduct.

A hearing tribunal always retains the discretion to accept or reject a joint submission on sanction. Generally speaking, the principle of deference will apply and the hearing tribunal should accept the joint submission on sanction unless it is of the view that the penalty is unfit, unreasonable or is contrary to the public interest.

The principle of deference recognizes that joint submissions on sanction are often the outcome of an extended period of negotiations and discussions where the parties have addressed their minds to the issue of appropriate penalties. In doing so, the parties have streamlined the hearing process and saved time and resources. Accordingly, the parties’ efforts in arriving at a joint submission on sanction should not be disregarded unless there are good and cogent reasons for doing so. Recent decisions of the courts have emphasized the importance of this approach.

In Rault v. Law Society (Saskatchewan), 2009 SKCA 81, the College and the investigated member made a joint submission that a lawyer be permitted to resign in the face of discipline. The hearing tribunal instead ordered that the lawyer be disbarred and be ineligible to apply for reinstatement for five years. The Court of Appeal reversed the sanction decision finding that the

principles applied in criminal law with respect to joint submissions on sentencing should also be applied to professional disciplinary matters. The Court noted that there are good public policy reasons for the principle of deference to joint submissions and concluded that if the hearing tribunal was of the view that the joint submission sanction was inappropriate, it had a duty to give good or cogent reasons on why the proposed sanctions were inappropriate; not within the range of appropriate sanctions; unfit or unreasonable; or contrary to the public interest.

Similarly, in Pankiw v. Chiropractors’ Association (Saskatchewan), 2009 SKQB 268, the hearing tribunal rejected a joint submission on sanction and imposed different penalties on the investigated member. The court overturned the sanctions imposed by the hearing tribunal on the basis that it had not put its mind to or concluded that the joint submission was unfit, unreasonable or not in the public interest. The court then imposed the penalties set out in the original joint submission on sanction. The court noted that joint submissions are to be encouraged not ignored. If they are ignored, lengthy discipline hearings and increased costs to be borne initially by members of the profession and perhaps ultimately by the public they serve will result.

In practice, if members of a hearing tribunal are concerned that a joint submission on sanction is unfit, unreasonable or not in the public interest, they should make their specific concerns known to the parties and provide them with an opportunity to make further submissions, either orally before the hearing tribunal or by way of written submissions. Only after the instigated

JOINT SUBMISSIONS ON SANCTION: THE HEARING TRIBUNAL’S ROLE

18 Summer 2011

RECENT CASES OF INTEREST TO REGULATORS

member and the College have provided their comments on the hearing tribunal’s concerns with the joint submission should the hearing tribunal proceed with making its ultimate decision on sanction.

Indeed, as the case of Visconti v. College of Physicians & Surgeons (Alberta), 2009 ABQB 742 demonstrates, this practice should be followed at any point where the hearing tribunal is considering varying from the penalties proposed by the parties whether or not the penalties were proposed by joint sanction. In Visconti, the legislation provided for an Investigating Committee to make recommendations to the Council of the College with respect to sanctions. Council imposed sanctions over and above those recommended by the Investigating Committee. Even though

there was no joint submission on sanction in this case, the Court held that the investigated member should have been advised that Council was considering a higher penalty and been given the opportunity to make submissions.

While it remains up to hearing tribunals to determine whether they will accept joint admissions on sanction, they must be mindful of the public policy reasons for encouraging joint submissions on sanction. In cases where hearing tribunals choose to deviate from joint submissions, they must be prepared to set out in their written decisions cogent and well-developed reasons for why the sanction proposed by the parties was unfit, unreasonable, not in the public interest or not within the range of appropriate penalties for the unprofessional conduct in question. s

Reasonable Apprehension of BiasLim v. Association of Professional Engineers of Ontario, 2011 ONSC 106

A complaint against an engineer was referred to a discipline hearing. The Manager of Legal and Regulatory Affairs, who was the support staff who assisted the discipline tribunal in its duties, engaged in correspondence with the parties to try to set a date for the hearing. Counsel for the member indicated he had not received full disclosure and therefore the proposed dates would not work, but proposed some alternative dates. The Manager sent a response by e-mail indicating that the Chair of the Tribunal had an obligation to the public to proceed expeditiously, and that if assertions were made regarding the lack of availability for a hearing, evidence would have to be provided to support the assertions. Further correspondence was exchanged between the Manager and both counsel, in which the Manager warned that threats and intimidation would not be tolerated. The Manager threatened to report member’s counsel to the Law Society, and demanded an apology from counsel. Counsel for the Association wrote stating that she also thought the Manager’s communication was inappropriate. The member then made an application for further disclosure and also argued that there was a reasonable apprehension

of bias. The Manager sought to be added as a party to the application. The member hearing the application refused to grant the Manager party status. The Chair of the Tribunal subsequently overturned the decision, and decided to add the Manager of the Tribunal as a party, without granting the parties an opportunity to make submissions. The member sought a stay of the hearing on the basis of reasonable apprehension of bias. The Court granted the stay and permanently quashed the proceedings.

Commentary: Tribunal staff, such as the Hearings Director or persons acting in an administrative capacity to assist discipline tribunals in carrying out their functions must not usurp the function of the discipline tribunal. Tribunal staff can act as a conduit between the parties and the discipline committee, but should refrain from making any decisions on behalf of the discipline committee, or appearing as if they are controlling the process. Staff members acting in this capacity should ensure that (a) they do not communicate with the parties unless they have directions to do so from the tribunal or the Chair (b) they clearly indicate to the parties that the correspondence is being sent on behalf of the tribunal and (c) the tone and content of the communications does not give rise to a reasonable apprehension of bias.

2

recent caSeS of intereSt to regulatorS

katrina haymond

reasonable apprehension of biasLim v. Association of Professional Engineers of Ontario, 2011 ONsC 106

A complaint against an engineer was referred to a discipline hearing. The Manager of Legal and Regulatory Affairs, who was the support staff who assisted the discipline tribunal in its duties, engaged in correspondence with the parties to try to set a date for the hearing. Counsel for the member indicated he had not received full disclosure and therefore the proposed dates would not work, but proposed some alternative dates. The Manager sent a response by e-mail indicating that the Chair of the Tribunal had an obligation to the public to proceed expeditiously, and that if assertions were made regarding the lack of availability for a hearing, evidence would have to be provided to support the assertions. Further correspondence was exchanged between the Manager and both counsel, in which the Manager warned that threats and intimidation would not be tolerated. The Manager threatened to report member’s counsel to the Law Society, and demanded an apology from counsel. Counsel for the Association wrote stating that she also thought the Manager’s communication was inappropriate. The member then made an application for further disclosure and also argued that there was a reasonable apprehension of bias. The Manager sought to be added as a party to the application. The member hearing the application refused to grant the Manager party status. The Chair of the Tribunal subsequently overturned the decision, and decided to add the Manager of the Tribunal as a party, without granting the parties an opportunity to make submissions. The member sought a stay of the hearing on the basis of reasonable apprehension of bias. The Court granted the stay and permanently quashed the proceedings.

Commentary: Tribunal staff, such as the Hearings Director or persons acting in an administrative capacity to assist discipline tribunals in carrying out their functions must not usurp the function of the discipline tribunal. Tribunal staff can act as a conduit between the parties and the discipline committee, but should

refrain from making any decisions on behalf of the discipline committee, or appearing as if they are controlling the process. Staff members acting in this capacity should ensure that (a) they do not communicate with the parties unless they have directions to do so from the tribunal or the Chair (b) they clearly indicate to the parties that the correspondence is being sent on behalf of the tribunal and (c) the tone and content of the communications does not give rise to a reasonable apprehension of bias.

overlapping JurisdictionNowoselsky v. College of Social Workers Appeal Panel (Alberta), 2011 ABCA 58

A social worker was found guilty of a number of allegations, including several boundary violations with clients. The social worker appealed to Council, which upheld the findings, and then to the Court of Appeal. The social worker raised a number of grounds of appeal, including that the same conduct was being dealt with by the employer and was the subject of a grievance pursuant to the governing collective agreement. The social worker argued that he was facing “double jeopardy” and the Hearing Tribunal should not have proceeded in these circumstances. The Court of Appeal rejected this argument, confirming that in matters of this nature, the employer could address the conduct via the mechanisms in the collective agreement, and the College could address the conduct under the HPA.

Commentary: The fact that the employer is addressing the subject matter of a complaint in the employment context does not deprive the regulatory body of jurisdiction to process the complaint under its own governing jurisdiction. Both the employer and the regulatory may have a legitimate interest in addressing the conduct.

new evidenceBarrington v. Institute of Chartered Accountants (Ontario), 2011 CarswellOnt 3623

Four accountants who worked at Deloitte were involved in conducting an audit approving the financial statements of a large company.

19Summer 2011

Overlapping JuristictionNowoselsky v. College of Social Workers Appeal Panel (Alberta), 2011 ABCA 58

A social worker was found guilty of a number of allegations, including several boundary violations with clients. The social worker appealed to Council, which upheld the findings, and then to the Court of Appeal. The social worker raised a number of grounds of appeal, including that the same conduct was being dealt with by the employer and was the subject of a grievance pursuant to the governing collective agreement. The social worker argued that he was facing “double jeopardy” and the Hearing Tribunal should not have proceeded in these circumstances. The Court of Appeal rejected this argument, confirming that in matters of this nature, the employer could address the conduct via the mechanisms in the collective agreement, and the College could address the conduct under the HPA.

Commentary: The fact that the employer is addressing the subject matter of a complaint in the employment context does not deprive the regulatory body of jurisdiction to process the complaint under its own governing jurisdiction. Both the employer and the regulatory may have a legitimate interest in addressing the conduct.

New EvidenceBarrington v. Institute of Chartered Accountants (Ontario), 2011 Carswell Ont 3623

Four accountants who worked at Deloitte were involved in conducting an audit approving the financial statements of a large company. Under new management, serious financial irregularities were discovered in the company’s books. Complaints were made against the four senior accountants who were involved in the audit. The complaints alleged that they failed to adhere to accounting and auditing standards. After a lengthy discipline hearing, the accountants were found guilty of several allegations. The Notice of Hearing alleged that the accountants failed to comply with generally accepted accounting standards (GAAP) and generally accepted auditing standards (GAAS) and gave multiple particulars relating to those charges. During the course of the hearing, evidence came to light that had not been disclosed to the Institute during its investigation relating to a dispute that the four accountants had with the company. The dispute related to an inappropriate agreement that the company had entered into that was affecting the validity of their financial statements. Although the company advised the accountants that it would cancel the agreement, the company failed to do so. The Discipline Committee found three of the accountants guilty of the specific allegations in the Notice of Hearing, concluding in part that their failure to follow up regarding the cancellation of the side agreement was a breach of the GAAP. They were ordered to pay a large fine and the costs of the hearing.

The members appealed to the appeal tribunal, which upheld the decision of the Discipline Committee. The accountants sought judicial review, on the basis that there was a breach of fairness. The court granted the application for judicial review in part, quashing some of the findings, and overturning the costs order.

The members appealed the findings to the Court of Appeal, and the Institute cross-appealed. The members raised several grounds of appeal, including that they had inadequate notice of the allegations and that the Discipline Committee failed to provide adequate reasons. The Court of Appeal considered whether there was a breach of fairness, given that the Notice of Hearing and the particulars referenced therein did not specifically refer to the side agreement that was referenced and material to the Discipline Committee’s decision.

The Court of Appeal held that there was no breach of fairness to the members, given that the side agreement was evidence that had not specifically been disclosed to the investigators prior to the hearing. It was raised by the accountants themselves during the hearing, and should have been anticipated by them given that they knew at least one witness would be testifying on the issue. Moreover, it did not change the essential elements of the charges, which were whether or not there was a breach of GAAP and GAAS. Just because the prosecutor had a different theory of the case did not prohibit the Discipline Committee from considering the new evidence, since there are potentially different “routes to liability.”

Commentary: Where new evidence arises during the course of a hearing that is relevant to the charges, consideration of that evidence will not always result in a breach of fairness. If the member knew of the evidence, and the evidence is relevant to the allegations in issue, the discipline tribunal may be able to rely upon it notwithstanding the lack of specific notice. However, the specific statutory provisions need to be considered. Many statutes have a specific provision that allows a discipline tribunal to consider new evidence that arises in the course of a hearing, provided that notice is given and/or an adjournment is granted. If new evidence does arise, in order to avoid allegations of a breach of fairness, the hearing can be adjourned so that the member can respond to the new evidence. Each situation should be carefully assessed to determine the best course of action. s

4

These articles should not be interpreted as providing legal advice. Consult your legal adviser before acting on any of the information contained in them. Questions, comments,

suggestions and address updates are most appreciated and should be directed to:

Katrina Haymond in Edmonton 780-423-9584Lisa Gaunt in Calgary 403-260-8525

rePrintS Professional organizations may reprint articles in their own newsletters provided credit is given for the articles to Field Law’s Professional Regulatory Group and the individual

author. Please send us a copy of the newsletter with the article.

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PersPectives for the Professions

orally before the hearing tribunal or by way of written submissions. Only after the investigated member and the College have provided their comments on the hearing tribunal’s concerns with the joint submission should the hearing tribunal proceed with making its ultimate decision on sanction.

Indeed, as the case of Visconti v. College of Physicians & Surgeons (Alberta), 2009 ABQB 742 demonstrates, this practice should be followed at any point where the hearing tribunal is considering varying from the penalties proposed by the parties whether or not the penalties were proposed by joint sanction. In Visconti, the legislation provided for an Investigating Committee to make recommendations to the Council of the College with respect to sanctions. Council imposed sanctions over and above those recommended by the Investigating Committee. Even though there was no joint submission on sanction in this case, the Court held that the investigated member should have been advised that Council was considering a higher penalty and been given the opportunity to make submissions.

While it remains up to hearing tribunals to determine whether they will accept joint submissions on sanction, they must be mindful of the public policy reasons for encouraging joint submissions on sanction. In cases where hearing tribunals choose to deviate from joint submissions, they must be prepared to set out in their written decisions cogent and well-developed reasons for why the sanction proposed by the parties was unfit, unreasonable, not in the public interest or not within the range of appropriate penalties for the unprofessional conduct in question.

training dVd for hearing tribunals is now available!Over the past year, the lawyers at Field LLP had the opportunity to work on an important and groundbreaking project with the Alberta Federation of Regulated Health Professions (AFRHP). The project resulted in the production of a training DVD that will provide members of Hearing Tribunals under the HPA with an overview of the discipline process under the HPA and an introduction to some key concepts that members need to be aware of. The DVD, called “Hearing Tribunal Essentials” provides an overview of basic administrative law principles, the professional conduct process, contested and uncontested hearings, key evidentiary rules, assessing credibility of witnesses, imposing sanctions, and preparing reasons. The DVD also

includes a number of interesting demonstrations designed to give new members a realistic snapshot of the hearing process.

We appreciated the opportunity to collaborate on this exciting project with the Steering Committee of the AFRHP’s Complaints Process Working Group, which included Kathy Hilsenteger (ACDMTT), Sharlene Standing (CLPNA) and Dr. Richard Spelliscy (CAP). If you want to obtain a copy of the DVD, you can order it online at www.afrhp.org.

While the DVD provides general training, we anticipate that many Colleges will still want individualized training for their tribunals. Our Professional Regulatory Group will continue to provide individualized and advanced training upon request. Please contact Katrina Haymond at 423-9584 for more information.

Joint SubmissionsContinued from Page 1...

20 Summer 2011

A Step to Better HeAltH, AcAdemie de mASSAge Scientifique, AcAdemy of clASSicAl orientAl ScienceS, AcAdemy of mASSAge & ortHotHerApy, AcAdemy of reflexology - HAve feet Will trAvel, AcAdemy of SomAtic HeAling ArtS, AcAd-emy of trAditionAl cHineSe medicine, Active HeAltH group, Active releASe tecHnique, AfricAn toucH, AHern'S ScHool of mASSAge, AlBerni vAlley tHerApeuticS, AlBertA AromAtHerApy inStitute, AlBertA inStitute of mASSAge, AlBertA mASSAge trAining, AlexAnder tecHnique, AlexAndriAn inStitute, Algonquin college of Applied ArtS & tecHnology, Allgemeinic KrAnKenHAuS WAndSBeK, AlliAnce deS mASSotHerApeuteS du queBec, AmAtSu trAining ScHool ltd., AmBi-Antz, AmericAn inStitute of mASSAge tHerApy, AmericAn polArity tHerApy ASSociAtion, Arc inStitute, ArcHWAyS HeAling college, AromAtHerApy WHoliStic centre, AromAticA, Art of conSciouS toucH BodyWorK, ASiA-pAcific AromA-tHerApy ltd., ASSociAtion deS mASSotHerApeuteS du queBec, ASSociAtion of mASSAge & BodyWorK profeSSionAlS, ASton pAtterning ASSociAtion, AtlAntic college of tHerApeutic mASSAge, AuStrAlASiAn college of nAturAl tHerApieS, AuStrAliAn college of nAturAl medicine, AuStrAliAn government, AuStrAliAn inStitute of Applied ScienceS, AuStrAliAn inStitute of HoliStic medicine, BAlneA inStitute - ScHool of complimentAry tHerApieS, BAltimore ScHool of mASSAge, BAncroft ScHool of mASSAge tHerApy, BAnning mASSAge ScHool, BArBArA BrennAn ScHool of HeAling, BeAr foot reflexology & trAditionAl tHAi mASSAge, Beijing univerSity of cHineSe medicine, BelAruSSiAn HeAltH vitAl centre, Bellevue mASSAge ScHool, Blue Heron AcAdemy of HeAling ArtS And ScienceS, Body intelligence trAining, Body-mind connection, BodytAlK internAtionAl, Bonnie prudden myotHerApiStS, Boulder ScHool of mASSAge tHer-Apy, BoWen college, BoWenWorK cAnAdA regiStry, BoWtecH, BriAn utting ScHool of mASSAge, BritiSH columBiA inStitute of HoliStic StudieS, cAlgAry college of HoliStic HeAltH And clinicS, cAlgAry college of trAditionAl cHineSe medicine And Acupuncture, cAlming tHe oceAn, cAnAdiAn AcAdemy of nAturAl tHerApy, cAnAdiAn AcupreSSure college, cAnAdiAn ASSociAtion of SpeciAlized KineSiology, cAnAdiAn college of HeAltH ScienceS & tecHnology, cAnAdiAn college of mASSAge & HydrotHerApy, cAnAdiAn college of mASSAge & WellneSS, cAnAdiAn college of Science And tecHnology, cAnAdiAn college of SHiAtSu tHerApy, cAnAdiAn educAtion centre of Beijing univerSity of cHineSe medicine, cAnAdiAn HellerWorK ASSociAtion, cAnAdiAn inStitute of AlternAtive medicine, cAnAdiAn inStitute of Bio-field tHerApy, cAnAdiAn inStitute of nAturAl HeAltH And HeAling, cAnAdiAn inStitute of trAditionAl cHineSe medicine, cAnA-diAn inStitute of WellneSS And SpA educAtion, cAnAdiAn nAtionAl ScHool of AromAtHerApy, cAnAdiAn ortHotHerApy college, cAnAdiAn pilAteS ASSociAtion, cAnAdiAn reflexology ScHool, cAnAdiAn ScHool of tHAi mASSAge, cAnAdiAn ScHool of trAditionAl tHAi tHerApy, cAnAdiAn Society of teAcHerS of tHe AlexAnder tecHnique, cAnAdiAn tHerApeutic college, cAnAdiAn trAger ASSociAtion, cAnBerrA inStitute of tecHnology, cAnterBury college, cAreer cAnAdA college, cAroline A. oWen, cArrington college, cASAromA WellneSS centre, cAScAdiA centre, cAyce/ reilly ScHool of mASSotHerApy, cdi college, centenniAl college of Applied ArtS & tecHnology (WArden WoodS cAmpuS), centre de mASSotHerApie de queBec, cHAngcHun univerSity of cHineSe medicine, cHengdu univerSity of trAditionAl cHineSe medicine, cHiAng mAi SKill development centre, cHinA inStitute of Sport Science, cHoice college, cHongqing college of trAditionAl cHineSe medicine, circle of life, ScHool of tHAi mASSAge And HeAltH, clASSicAl KineSiology inStitute, cleArHeArt BodyWorK ScHool, college And clinic of complementAry medicine, godelmAn, college BoreAl, college of internAtionAl HoliStic StudieS, college of mASSAge tHerApiStS of ontArio, college of mASSAge tHerApy of BritiSH columBiA, college of medicAl intuition, college of nAturAl HeAling ArtS, college of nAturAl HeAltH cHoiceS, college of tHe nortH AtlAntic, college pAuline gAgnon medecine AlternAtive, colorAdo inStitute of mASSAge tHerApy, comeniouS univerSity in BrAtiSlAvA, commiSSion on mASSAge tHerApy AccreditAtion, compucollege, connecticut centre for mASSAge tHerApy, core inStitute ScHool of mASSAge tHerApy, crAniAl tHerApy centre, cv ScHool of continuing mASSAge educAtion, dAHAn inStitute of mASSAge StudieS, dAndong diet Service tecHnology ScHool, d'Arcy lAne inStitute, deSert reSortS ScHool of SomAtHerApy, diAnne miller ScHool of pilAteS, dominion college of remediAl mASSAge, dr. vodder ScHool, eASt-WeSt college of HeAling ArtS, ecole de mASSAge profeSSionnel, ecole de mASSAge profeSSionnel, ecole de mASSo-nAturo-KineSie, edmonton college of SWediSH relAxAtion mASSAge, edmonton puBlic ScHoolS, educAting HAndS ScHool of mASSAge, educAtionAl KineSiology foundAtion, elegAnce ScHool of eStHeticS, elmcreSt college of Applied HeAltH ScienceS, empreSS Bridge college KineSiology college, energy medicine pArtnerSHipS, eSAlen inStitute, europeAn ScHool of SHiAtSu, evA HuSer ScHool, excellence in reflexology, felden-KrAiS, firSt AffiliAted HoSpitAl of guAngxi trAditionAl cHineSe medicAl univerSity, firSt cAnAdiAn coSmeticiAn And HAir deSign AcAdemy, five elementS inStitute of trAditionAl cHineSe medicine, foldiScHule gmBH, footHillS college of mASSAge tHerApy, from WitHin WellneSS centre, gAnSu college of trAditionAl cHineSe medicine, gold coASt trAining AcAdemy BurleigH HeAdS cAmpuS, golden needle Acupuncture, golden SciSSorS BeAuty & mASSAge ScHool, good ScentS ScHool, grAnt mAceWAn univerSity ,grAnt mAceWAn univerSity, guAngxi trAditionAl cHineSe medicAl univerSity, guAngzHou univerSity of trAditionAl cHineSe medicine, guijeK inStitut queBecoiS pour lA SAnte inte-grAle, guild for StructurAl integrAtion, HAle olA - A plAce of HeAling, HAndS on tHerApy ScHool of mASSAge, HAnne mArquArdt ScHool, HArBin SHengruntAng HeAltH tecHnology vocAtionAl trAining ScHool, HeAling BodyWorK centre, HeAling co-op of SASKAtoon ltd., HeAling HAndS center, HeAling HAndS cHAir mASSAge, HeAling ScentS HoliStic clinic, HeAling toucH internAtionAl, HeAling your Soul mASSAge & WellneSS, HeAltH cAre AcupreSSure, HeAltH centre "dAr" BulgAriA, HeArtWood inStitute, HeilongjiAng inStitute of trAditionAl cHineSe medicine, HellerWorK internAtionAl, HenAn trAditionAl cHineSe medicine univerSity, HoliStic unconventionAl medicine ScHool of nortHern collAge,, HoloS univerSity grAduAte SeminAry, Hu Bei college of trAditionAl cHineSe medicine, HuA xiA Acupuncture And HerB college of cAnAdA, Hui zHou xu lAn BeAuty And HAir SKill trAining ScHool, Hurley/oSBorn prActitio-ner'S ASSociAtion, ict KiKKAWA college, ict nortHumBerlAnd college, imKo Apleidingen AmerSfoort, in toucH trAining, inStitute for HumAniStic energy tHerApy, inStitute for tHerApeutic toucH, inStitute of AromAtHerApy, inStitute of Scientific medicAl intuition, inStitute of tHAi mASSAge, inStitute of trAditionAl HerBAl medicine And AromAtHerApy, integrAtive yogA tHerApy, internAtionAl AcAdemy of eStHeticS, internAtionAl AcAdemy of mASSAge, internAtionAl AcAdemy of nAturAl HeAltH ScienceS, internAtionAl certified AromAtHerApy inStitute, internAtionAl council for AquAtic tHerApy And reHABilitAtion, internAtionAl inStitute of reflexology, internAtionAl loving toucH foundAtion, internAtionAl orgAnizAtion for SHAntAlA mASSAge, internAtionAl profeSSionAl ScHool of BodyWorK, internAtionAl ScHool of mASSAge tHerApy, internAtionAl ScHool of SHiAtSu, internAtionAl SivAnAndA yogA vedAntA centre, inter-nAtionAl tHerApy exAminAtion council, internAtionAl trAining mASSAge, intuition By deSign, irene'S myomASSology inStitute, iSrAel AcAdemy of mASSAge, ivAno-frAnKivSK'S regionAl committee of tHe red croSS Society, jApAn SHi-AtSu college, jiAngxi univerSity of trAditionAl cHineSe medicine, jin SHin do foundAtion, joHn BArneS myofASciAl releASe treAtment center, journey WitHin HoliStic Study And retreAt centre, joyeSSence AromAtHerApy centre, KA-runA college, Kine-concept inStitute, KineSiology college of cAnAdA, KoKoro do jo ,KootenAy ScHool of reBAlAncing, KripAlu center for yogA And HeAltH, KripAlu center for yogA And HeAltH, KundAlini reSeArcH inStitute, KyBAlion BfS fur mASSAge und pHySiotHerApie, lAKelAnd college, lAmBton college, lAngArA college, lAStone tHerApy ,lAyden'S HerBAl And tHerApy centre, le centre pSycHo-corporel, letHBridge college, leyline centre for SpirituAl prActice, liAoling province city of fuSHun fu KAng yuAn mASSAge trAining ScHool, liAoning college of trAditionAl cHineSe medicine, lindSey HopKinS tecHnicAl educAtion centre, living eArtH ScHool of nAturAl tHerApieS, lomilomi SomAtic HeAling centre inc., lotuS centre, lotuS pAlm ScHool, louiSiAnA inStitute of mASSAge tHerApy, lympHologic mediziniScHe WeiterBildungS gmBH, m.H. vicArS ScHool of mASSAge tHerApy , mAKAmi college, mAnitoBA mAS-SAge And reflexology ASSociAtion (mmrA), mArcHAnd inStitute of Sport And deep tiSSue mASSAge, mASSAge- BAeder- und eleKtrotHerApieScHule, mASSAge tHerApy college of cAnAdA, mASSAge tHerApy college of mAnitoBA, mASSAge tHerApy inStitute (SoutH AfricA), mASSAge tHerApy inStitute of colorAdo, mASSAge-ScHule WormS/inStitute for pHySiotHerApy And mASSAge tHerApy, mASter yogA AcAdemy, mASterS college of HoliStic StudieS, mAui ScHool of tHerApeutic mASSAge, mcKAy mASSAge & HydrotHerApy progrAm, medicAl ScHool qindAo univerSity, medicine HAt college, medix ScHool, melBourne college of nAturAl medicine, meridiAn centre, metro community college, mettA in motion, micHigAn ScHool of myomASSology, milne inStitute, miniStry of puBlic HeAltH of uKrAine, miSSiSSAugA ScHool of AromAtHerApy, moldovA repuBlicAn centre of medicAl SociAl reHABilitAtion, moreAu inStitute of nAturAl HeAling, morquito rAncH AromAtHerApy, moScoW regionAl StAte inStitute, motHer And BABy WellneSS, mount royAl univerSity, myotHerApy college of utAH - ScHool of mASSAge tHerApy And BodyWorK, myotHerApy in-Stitute of mASSAge, nAnjing univerSity of trAditionAl cHineSe medicine, nAtionAl AcAdemy of mASSAge tHerApy And HeAling ScienceS, nAtionAl certificAtion BoArd for tHerApeutic mASSAge And BodyWorK, nAtionAl HoliStic inStitute, nAtionAl inStitute of mASSotHerApy, nAture cAre college, nAture'S WAy HerBAl HeAltH inStitute, nevAdA cAreer AcAdemy, neW center for WHoliStic HeAltH educAtion And reSeArcH, neW center for WHoliStic HeAltH educAtion And reSeArcH, neW mexico AcAdemy of HeAling ArtS, neW mexico ScHool of nAturAl tHerApeuticS, neW yorK college of HeAltH profeSSionS, neWfoundlAnd And lABrAdor mASSAge tHerApiStS' BoArd, nortHern ArizonA mASSAge tHerA-py inStitute, nortHern inStitute of mASSAge tHerApy, nortHern inStitute of mASSAge tHerApy (englAnd), nortHWeSt HellerWorK, nortHWeStern ScHool of mASSAge, nortHWeStern ScHool of mASSAge, nortHWeStern ScHool of mASSAge, nortHWeStern ScHool of mASSAge, nuAd Bo rArn inStitute of tHAi mASSAge, oceAn BotAnicAlS eSSentiAl oilS, oceAn Stone tHerApy, oceAn Stone tHerApy, oHASHi inStitute, oKAnAgAn vAlley college of mASSAge tHerApy, old medicine HoSpitAl ScHool of tHAi mASSAge, onSen internAtionAl, ontArio college of HeAltH & tecHnology, ontArio college of reflexology, ortHoBionomy ASSociAtion of cAnAdA, ortHopAedic inStitute, pAcific inStitute of Aro-mAtHerApy, pAcific inStitute of reflexology, pAlAcKy univerSity, fAculty of pHySicAl culture, pcu college of HoliStic medicine, peng jiu ling qi gong HeAltH centre, pHillipS ScHool of mASSAge, pHuSSApA tHAi mASSAge ScHool, pHySicAlmind inStitute, pHySiologic inStitute, pHySiotHerApy ScHool, poleStAr pilAteS, polyvAlente pierre-dupuy, prAirie mASSAge, profeSSionAl inStitute of mASSAge And fitneSS, profeSSionAl inStitute of mASSAge tHerApy, profeS-SionAl inStitute of mASSAge tHerApy (cAlgAry cAmpuS), protege ScHool, pyrAmid yogA centre, quAntum toucH, quinteSSence AromAticS, rAinStAr univerSity, reflexology ASSociAtion of cAnAdA, reHABilitAtionS und AuSBildungSSte-Atte feur mASSAge, reidmAn internAtionAl college for complementAry medicine, reidmAn internAtionAl college for complementAry medicine, relAx - u, relAx StAtion ScHool of mASSAge tHerApy, relAx to tHe mAx, remington college, rocKy mountAin AcAdemy, rocKy mountAin HoliStic centre, rolf inStitute, rolfing guild, roSen inStitute, royAl AcupreSSure Society ScHool & clinic, royAl AeStHetic tHerApy internAtionAl college, royAl inStitute of Science And mAnAgement, ruSSiAn militAry medicAl AcAdemy, SAcred divA HeAling centre for Women, SAcredASiA ScHool of Ancient tHAi mASSAge, SASKAtcHeWAn inStitute of Applied ScienceS And tecHnology, SASKAtcHeWAn SHiAtSu tHerApiStS ASSociAtion, SASKAtoon SHiAtSu centre, SAult college of Applied ArtS & tecHnology, ScHool of HeAltH ScienceS, ScentS of comfort, ScHool for pHySicAl tHerApy At tHe BAltic SeA clinic, ScHool of effective reflexology, ScHool of HeAling ArtS, ScHool of mASSAge tHerApy And AdvAnced trigger point, ScHool of SpA tHerApieS, ScottiSH ScHool of profeSSionAl mASSAge, ScuolA di eSteticA modernA, SeAted AcupreSSure tHerApy trAining, SHAndong univerSity of tcm, SHAngHAi univerSity of tcm, SHAnxi trAditionAl cHineSe medicine college, SHeridAn college inStitute of tecHnology & AdvAnced leArning, SHiAtSu AcAdemy of toKyo, SHiAtSu ScHool freiBurg, SHiAtSu ScHool of cAnAdA, Sir SAnford fleming college, SmitH mountAin lAKe inStitute of HigHer HeAling,SnoWlion center ScHool, SomAticS inStitute ScHool of mASSAge, SoutH AuStrAliAn HeAltH educAtion centre, SoutHern AlBertA inStitute of mASSAge, SoutHern cAliforniA univerSity of HeAltH ScienceS, SoutHWind jAde, SpA lunA, Spectrum centre ScHool of mASSAge, Sprott-SHAW community college, St. joHn neuromuSculAr pAin relief inStitute, StAte vocAtionAl ScHool for pHySiotHerApy At WurzBurg univerSity, Still point yogA ScHool, Stone tHerApy ScHool, Stott internAtionAl certificAtion centre, Stott'S pilAteS, SunriSe trAditionAl tHAi mASSAge, SunSHine mASSAge ScHool, SutHerlAnd-cHAn ScHool, SWediSH inStitute - college of HeAltH ScienceS, tAoye trAditionAl cHineSe medicine And mASSAge inStitute, tHAi mASSAge ScHool of tHAilAnd, tHAi mASSAge toronto ScHool And mASSAge centre, tHAi mASSAge trAining centre, tHAi trAditionAl medicine development centre, tiAnjin mASSAge tHerApiSt ScHool, tiltAn college, toKyo HeAltH inStitute, toronto ScHool of BuSineSS, toronto ScHool of tHAi mASSAge, toucH of grAy, toucHpoint inStitute of reflex-ology And KineStHeticS, trAger cAnAdA, trAining in poWer, trAnSformAtionAl ArtS college, tri-StAr pAcific internAtionAl leArning And development centre, ulmKolleg - germAny, uncommon ScentS, univerSAl college of leArning, univerSAl college of reflexology, univerSity of WeSt BoHemiA - pilSen college, upledger inStitute, uS cAreer inStitute, utAH college of mASSAge tHerApy, utopiA AcAdemy, vAncouver reflexology centre, vAncouver ScHool of BodyWorK And mASSAge, volgogrAdSKiy medicAl univerSity, WAt pHo trAditionAl medicAl ScHool, Wellington college of remediAl mASSAge tHerApy, WellpArK college of nAturAl tHerApieS, WellSpringS college of mASSAge tHer-Apy And eStHeticS, WeSt coASt college of mASSAge tHerApy, WeSt coASt college of mASSAge tHerApy (neW WeStminSter cAmpuS), WeSt coASt inStitute of AromAtHerApy inc., WeSt coASt KineSiologyinStitute,WeSt SicHuAn vocA-tionAl ScHool, WeStern college of remediAl mASSAge,WeStern inStitute of AromAtHerApy, WeStervelt college, WHiStler ScHool of mASSAge And SpA ServiceS, WHiStler tHerApeutic centre, WHite river ScHool of mASSAge, Wild roSe college of nAturAl HeAling, WindSong ScHool of HeAling, World of AromAtHerApy, WuHAn inStitute of pHySicAl educAtion, yogA AlliAnce (uS), yogA ASSociAtion of AlBertA, yogA in tHe rocKieS, yogA Studio college of cAnAdA,

yogAdotcAlm, zcd - odenSe/odenSe zonecollege, zeemAnS, zen SHiAtSu clinic And ScHool, zenergy BodyWorK And WellneSS, zHAn jiAng SHen mei occupAtion And tecH. ScHool.

NHPC RECOGNIZES MORE THAN

500 PROGRAMS INTERNATIONALLYand the list keeps growing.

21Summer 2011

Subhead Makami College: One of Over 500 School Programs Recognized by the NHPC

When the Pavkovic family opened Makami College in Edmonton, Alberta, in 2001, they were united by their simple desire to help people achieve their dreams.

When asked how Makami got off the ground, Marija Pavkovic-Tovossi, Managing Director of Makami says, “It just fit. We had a lot of professionals that we networked with like chiropractors, physiotherapists, and massage therapists that had been working in the industry for over 20 years. We just went to all of them, and it just happened. We were able to work together, doors opened, and we were able to create something that is really changing people’s lives. We like to see people get educated in order to change the lives of their families.”

All four members of the Packovic family are heavily involved with the day-to-day operations at Makami College. Ljubica is the Director of Operations and Department Head for the Massage Therapy program, her husband Dragan is the Finance Director and Construction Manager, their daughter Marija is the Managing Director, and their son Vladimir is the Marketing Director.

Ljubica Pavkovic has a nursing background in Yugoslavia. She is also a Massage Therapist, Holistic Practitioner, and holds certification in numerous specializations in energy work and massage therapy. Speaking with her daughter Marija, it is clear

that Ljubica’s thirst for knowledge combined with her love of teaching and strong belief in inclusivity has led to her being “a big inspiration to the students, because they see where she’s come from and what she’s achieved.”

The Pavkovic family had overcome their own challenges before realizing their dreams and starting their family business. When they first moved to Canada from former Yugoslavia in 1987 none of them spoke any English, and because of that they faced immense difficulty in getting settled here. Makami College, which started as a small school with only 12 students in their first year, has grown to having 30 employees and more than 350 students enrolled last year. Against all odds, the Pavkovic family was able to overcome language and cultural barriers to create a successful business in Canada.

They now encourage others to do the same by training them to be Massage Therapists with solid business skills. Because they know first-hand how difficult it can be to solidify a new career, the Pavkovic family has designed the Makami program to be as inclusive as possible regardless of a students limitations. “One of our part time students one time was a blind man, and he is an amazing Massage Therapist, but he’s blind. So no other school would even take him in, but we had a special instructor work with him through the whole process. And now he is an amazing therapist. I think we try to give everybody a chance and an opportunity, because if this is their dream then we want to help them achieve it.”

Makami College is on NHPC’s list of over 500 recognized school programs. For more information about this school, visit www.makamicollege.com

Are you an NHPC Recognized Program? Want to see your school program featured in the next issue of Connections? Contact Jasmine by email; Jbischoff@nhpcanada.org or by phoning 1-888-711-7701 ext. 230

left to right: Vladimir Pavkovic, Marija Pavkovic-Tovissi, Dragan Pavkovic, Ljubica Pavkovic

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22 Summer 2011

CONTINUING EDUCATION

http://conted.mtroyal.ca/healthhumanservice

Information: 403.440.6867 or cehealth@mtroyal.ca

Reveal a new you

Addiction Studies

Body Talk Access

Bowen Therapy

Energy Therapy

Feng Shui

Healing Touch

Massage Therapy

Medical Terminology

Mindfulness-Based Stress Reduction

Personal Fitness Trainer

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23Summer 201132 ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 Reflexology and the Autonomic Nervous System

C. M. hughes, phD,isalecturerintheSchoolofHealthSciences,UniversityofUlster,NorthernIreland,UnitedKingdom.s. Krirsnakriengkrai, phD,isalecturerintheDepartmentofPhysiotherapy,FacultyofHealthScience,SrinakharinwirotUniversity,Bangkok,Thailand.s. Kumar, MD, Mphil,isalecturerintheDepartmentofCommunityMedicine,TeerthankarMahaveerMedicalCollege&ResearchCentre,Moradabad,UttarPradesh,India.s. M. McDonough, phD,isaprofessorattheHealthandRehabilitationSciencesResearchInstitute,SchoolofHealthSciences,UniversityofUlster.

Correspondingauthor:C.M.Hughes,PhDE-mailaddress:CM.Hughes@ulster.ac.uk

Reflexology is an ancient treatment based on the the-ory that all the body structures are interlinked with specific reflex points on the hands and feet.1,2 The purpose of treatment is to normalize the body’s function, break down tension, alleviate stress, and

improve nerve function and blood supply throughout the body.3,4

Evidence suggests that reflexology has an effect on physio-logical outcomes. Frankel found that reflexology increased sinus arrhythmia, indicating a higher synchronization between heart rate (HR) and respiration, and reduced baroreceptor reflex sensi-tivity5; therefore, reflexology helps patients maintain blood pres-sure (BP) homeostasis by creating changes in autonomic outflow. zhen et al found that reflexology stimulation could increase the complexity of HR variability signal, indicating an increase the vagal activity.6

When people are under stress, autonomic nervous system (ANS) disturbances are induced, which consist of suppressed vagal and/or enhanced sympathetic functions. The observed effects of reflexology on the ANS therefore may help explain why reflexology has been shown to reduce anxiety and stress in cancer patients,7 women with depression,8 dementia patients,9 and in the working population.10

Mental stress may be induced under experimental condi-tions, provoking sympathoexcitatory responses following emo-tional or behavioral challenges.11 The Stroop color word test12,13 and a mental arithmetic test14,15 have been widely used as tools for

TheEffectofReflexologyontheAutonomicNervousSysteminHealthyAdults:AFeasibilityStudy

C. M. Hughes, PhD; S. krirsnakriengkrai, PhD; S. kumar, MD, MPhil; S. M. McDonough, PhD

original research

Background• Reflexology has been shown to reduce anxiety and stress in various populations. The mechanism by which this occurs may be in modulating autonomic nervous system (ANS) function; however; there is limited evidence available in the area. PrimaryStudyObjective• The aim of the study was to inves-tigate the feasibility of using an experimental model to deter-mine the physiological effect of reflexology on stress.Methods/Design• A feasibility study to assess an experimen-tal study design to compare the effect of reflexology and control interventions on heart rate (HR) and blood pressure (BP) fol-lowing mental stress tests. Setting• The Health and Rehabilitation Science Research Institute at the University of Ulster, Northern Ireland, United kingdom.Participants• Twenty-six healthy volunteers. Intervention• Mental stress was induced before and after inter-vention. Participants in the reflexology group received 20 min-utes of reflexology, and the control group received 20 minutes of relaxation with a therapist holding each participant’s feet. Primary OutcomeMeasures • The outcome measures, HR

and BP, were measured throughout mental stress testing, intervention, and a second period of mental stress testing fol-lowing intervention.Results• The study design was considered feasible. There were significant reductions in systolic blood pressure (SBP) (22%; P= .03) and in diastolic blood pressure (DBP) (26%; P= .01) during mental stress following reflexology compared to the stress period prior to intervention. In contrast, there was a 10% reduc-tion in SBP (P = .03) but a 5% increase in DBP (P= .67) during the period of mental stress following the control intervention compared to results obtained during mental stress prior to this intervention. However, there were no significant differences between reflexology and control groups. Conclusion • This study has demonstrated the feasibility of conducting an experimental study on the effect of reflexology in stress using BP as the primary outcome measure. Results from such a study would address the lack of high-quality evidence for the physiological effects of reflexology. (AlternTherHealthMed. 2011;17(3):32-37.)

32 ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 Reflexology and the Autonomic Nervous System

C. M. hughes, phD,isalecturerintheSchoolofHealthSciences,UniversityofUlster,NorthernIreland,UnitedKingdom.s. Krirsnakriengkrai, phD,isalecturerintheDepartmentofPhysiotherapy,FacultyofHealthScience,SrinakharinwirotUniversity,Bangkok,Thailand.s. Kumar, MD, Mphil,isalecturerintheDepartmentofCommunityMedicine,TeerthankarMahaveerMedicalCollege&ResearchCentre,Moradabad,UttarPradesh,India.s. M. McDonough, phD,isaprofessorattheHealthandRehabilitationSciencesResearchInstitute,SchoolofHealthSciences,UniversityofUlster.

Correspondingauthor:C.M.Hughes,PhDE-mailaddress:CM.Hughes@ulster.ac.uk

Reflexology is an ancient treatment based on the the-ory that all the body structures are interlinked with specific reflex points on the hands and feet.1,2 The purpose of treatment is to normalize the body’s function, break down tension, alleviate stress, and

improve nerve function and blood supply throughout the body.3,4

Evidence suggests that reflexology has an effect on physio-logical outcomes. Frankel found that reflexology increased sinus arrhythmia, indicating a higher synchronization between heart rate (HR) and respiration, and reduced baroreceptor reflex sensi-tivity5; therefore, reflexology helps patients maintain blood pres-sure (BP) homeostasis by creating changes in autonomic outflow. zhen et al found that reflexology stimulation could increase the complexity of HR variability signal, indicating an increase the vagal activity.6

When people are under stress, autonomic nervous system (ANS) disturbances are induced, which consist of suppressed vagal and/or enhanced sympathetic functions. The observed effects of reflexology on the ANS therefore may help explain why reflexology has been shown to reduce anxiety and stress in cancer patients,7 women with depression,8 dementia patients,9 and in the working population.10

Mental stress may be induced under experimental condi-tions, provoking sympathoexcitatory responses following emo-tional or behavioral challenges.11 The Stroop color word test12,13 and a mental arithmetic test14,15 have been widely used as tools for

TheEffectofReflexologyontheAutonomicNervousSysteminHealthyAdults:AFeasibilityStudy

C. M. Hughes, PhD; S. krirsnakriengkrai, PhD; S. kumar, MD, MPhil; S. M. McDonough, PhD

original research

Background• Reflexology has been shown to reduce anxiety and stress in various populations. The mechanism by which this occurs may be in modulating autonomic nervous system (ANS) function; however; there is limited evidence available in the area. PrimaryStudyObjective• The aim of the study was to inves-tigate the feasibility of using an experimental model to deter-mine the physiological effect of reflexology on stress.Methods/Design• A feasibility study to assess an experimen-tal study design to compare the effect of reflexology and control interventions on heart rate (HR) and blood pressure (BP) fol-lowing mental stress tests. Setting• The Health and Rehabilitation Science Research Institute at the University of Ulster, Northern Ireland, United kingdom.Participants• Twenty-six healthy volunteers. Intervention• Mental stress was induced before and after inter-vention. Participants in the reflexology group received 20 min-utes of reflexology, and the control group received 20 minutes of relaxation with a therapist holding each participant’s feet. Primary OutcomeMeasures • The outcome measures, HR

and BP, were measured throughout mental stress testing, intervention, and a second period of mental stress testing fol-lowing intervention.Results• The study design was considered feasible. There were significant reductions in systolic blood pressure (SBP) (22%; P= .03) and in diastolic blood pressure (DBP) (26%; P= .01) during mental stress following reflexology compared to the stress period prior to intervention. In contrast, there was a 10% reduc-tion in SBP (P = .03) but a 5% increase in DBP (P= .67) during the period of mental stress following the control intervention compared to results obtained during mental stress prior to this intervention. However, there were no significant differences between reflexology and control groups. Conclusion • This study has demonstrated the feasibility of conducting an experimental study on the effect of reflexology in stress using BP as the primary outcome measure. Results from such a study would address the lack of high-quality evidence for the physiological effects of reflexology. (AlternTherHealthMed. 2011;17(3):32-37.)

32 ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 Reflexology and the Autonomic Nervous System

C. M. hughes, phD,isalecturerintheSchoolofHealthSciences,UniversityofUlster,NorthernIreland,UnitedKingdom.s. Krirsnakriengkrai, phD,isalecturerintheDepartmentofPhysiotherapy,FacultyofHealthScience,SrinakharinwirotUniversity,Bangkok,Thailand.s. Kumar, MD, Mphil,isalecturerintheDepartmentofCommunityMedicine,TeerthankarMahaveerMedicalCollege&ResearchCentre,Moradabad,UttarPradesh,India.s. M. McDonough, phD,isaprofessorattheHealthandRehabilitationSciencesResearchInstitute,SchoolofHealthSciences,UniversityofUlster.

Correspondingauthor:C.M.Hughes,PhDE-mailaddress:CM.Hughes@ulster.ac.uk

Reflexology is an ancient treatment based on the the-ory that all the body structures are interlinked with specific reflex points on the hands and feet.1,2 The purpose of treatment is to normalize the body’s function, break down tension, alleviate stress, and

improve nerve function and blood supply throughout the body.3,4

Evidence suggests that reflexology has an effect on physio-logical outcomes. Frankel found that reflexology increased sinus arrhythmia, indicating a higher synchronization between heart rate (HR) and respiration, and reduced baroreceptor reflex sensi-tivity5; therefore, reflexology helps patients maintain blood pres-sure (BP) homeostasis by creating changes in autonomic outflow. zhen et al found that reflexology stimulation could increase the complexity of HR variability signal, indicating an increase the vagal activity.6

When people are under stress, autonomic nervous system (ANS) disturbances are induced, which consist of suppressed vagal and/or enhanced sympathetic functions. The observed effects of reflexology on the ANS therefore may help explain why reflexology has been shown to reduce anxiety and stress in cancer patients,7 women with depression,8 dementia patients,9 and in the working population.10

Mental stress may be induced under experimental condi-tions, provoking sympathoexcitatory responses following emo-tional or behavioral challenges.11 The Stroop color word test12,13 and a mental arithmetic test14,15 have been widely used as tools for

TheEffectofReflexologyontheAutonomicNervousSysteminHealthyAdults:AFeasibilityStudy

C. M. Hughes, PhD; S. krirsnakriengkrai, PhD; S. kumar, MD, MPhil; S. M. McDonough, PhD

original research

Background• Reflexology has been shown to reduce anxiety and stress in various populations. The mechanism by which this occurs may be in modulating autonomic nervous system (ANS) function; however; there is limited evidence available in the area. PrimaryStudyObjective• The aim of the study was to inves-tigate the feasibility of using an experimental model to deter-mine the physiological effect of reflexology on stress.Methods/Design• A feasibility study to assess an experimen-tal study design to compare the effect of reflexology and control interventions on heart rate (HR) and blood pressure (BP) fol-lowing mental stress tests. Setting• The Health and Rehabilitation Science Research Institute at the University of Ulster, Northern Ireland, United kingdom.Participants• Twenty-six healthy volunteers. Intervention• Mental stress was induced before and after inter-vention. Participants in the reflexology group received 20 min-utes of reflexology, and the control group received 20 minutes of relaxation with a therapist holding each participant’s feet. Primary OutcomeMeasures • The outcome measures, HR

and BP, were measured throughout mental stress testing, intervention, and a second period of mental stress testing fol-lowing intervention.Results• The study design was considered feasible. There were significant reductions in systolic blood pressure (SBP) (22%; P= .03) and in diastolic blood pressure (DBP) (26%; P= .01) during mental stress following reflexology compared to the stress period prior to intervention. In contrast, there was a 10% reduc-tion in SBP (P = .03) but a 5% increase in DBP (P= .67) during the period of mental stress following the control intervention compared to results obtained during mental stress prior to this intervention. However, there were no significant differences between reflexology and control groups. Conclusion • This study has demonstrated the feasibility of conducting an experimental study on the effect of reflexology in stress using BP as the primary outcome measure. Results from such a study would address the lack of high-quality evidence for the physiological effects of reflexology. (AlternTherHealthMed. 2011;17(3):32-37.)

24 Summer 2011ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 33

inducing these ANS responses. These studies have shown that HR and BP increase using experimental mental stress models to levels similar to those observed during a moderate walking task16,17 but below those associated with hypertensive risk. These experimental models therefore may be used to simulate patho-logical stress.

The aim of the current study was to investigate the feasibility of using an experimental model to determine the physiological effect of reflexology on stress using mental stress tests in healthy adults to induce ANS function. The feasibility of patient recruit-ment and retention, logistics of intervention, outcome measure sensitivity, and appropriateness of the control intervention for such a study design was carried out. These data also will provide the basis of a power analysis to determine numbers for a future trial.

MATERIALSANDMETHODSParticipants

This study was approved by the Research Ethics Committee of the University of Ulster. Healthy adults aged between 18 and 45 years were recruited from within the university through e-mail announcements and advertisements. Participants were excluded if they had previously received reflexology or had any condition that might interfere with the outcome measurements such as vascular, lymphatic, or skin conditions; diabetes; pregnancy; use of a cardiac pacemaker; or current drug therapy to treat hyper-tension. Potential participants were informed about the experi-mental procedure and asked to give written informed consent. The number of participants required for this study was calculat-ed using power analysis from a similar study of acupuncture,18 as there were no similar studies on reflexology in the literature. The sample size from power analysis was 10 per group. The current study recruited 25 participants who were randomly allocated into either the reflexology group or control group using comput-er-generated numbers and sealed opaque envelopes. An indepen-dent researcher who was otherwise uninvolved in the trial performed randomization. Participants were asked to abstain from smoking and drinking caffeine or alcohol for at least 6 hours prior to testing and to refrain from eating or performing strenuous exercise during the preceding 2 hours.

InterventionsThe reflexology group received stimulation to reflex points

associated with the organs that would be expected to induce a physiological response in the ANS. These points included the reflex area for the peripheral nervous system, including the ANS, which is responsible for the regulation of HR and BP; the central nervous system, the brain and spinal cord, as these areas regulate ANS function; the solar plexus, which within the theory of reflex-ology will calm and relax the entire nervous system; the heart, as direct reflexology stimulation to this point may affect the organ (left foot only); the kidney, due to its role in the control of BP; and the endocrine reflex points such as the pituitary, thyroid, and adrenal gland points, as the hormones released from these glands aid in the regulation of HR and BP. These points were

selected using appropriate published charts and textbooks.2,19 Pressure was applied to each of these points for 30 seconds at a time on each of the feet for a total of 20 minutes. The reflexology intervention using grape-seed base oil was performed by one of two qualified reflexologists with more than 10 years’ experience.

The control group did not receive reflexology stimulation; the reflexologists simply rested each participant’s heels in the palms of their hands for 20 minutes. The purpose of this inter-vention was to control for the effects of relaxation, touch, and patient-therapist interaction. All interventions were carried out in the same room.

MentalStressProcedureTwo mental stress tests were employed to induce ANS

parameters within the participants; these were the Stroop color word test and a mental arithmetic test. A pilot study carried out prior to this experimental study indicated that both of these tests increased HR and BP to a similar degree and could therefore be used interchangeably. The experimental procedure required two periods of induced stress to the ANS and therefore two separate stress tests were used to reduce the possibility of accommodation. The participant determined the order in which the stress tests were applied by randomly selecting one of two envelopes that contained the names of the two tests. The test that the participant selected was used as the first stress test during the experiment.

The Stroop color word test consisted of presenting color-naming words, with each word printed in a color different from its meaning; for example, the word red was printed in blue ink. To perform the task, the participant had to say the names of the color of the ink, not the color designated by the word.20 The men-tal arithmetic test was a verbal serial subtraction. The partici-pants were instructed to verbally subtract 13 serially from 1079 for 4 minutes.15 During the mental stress, the sound from a met-ronome beating at 2 Hz (120 bpm) was used as a distraction15 and to increase stress.21 As sympathetic responses to mental stress testing are strongly influenced by perception of task difficulty,22 each volunteer was asked to assess each mental stress test, using a standard 5-point scale: not stressful, somewhat stressful, stressful, very stressful, or very very stressful.

OutcomeMeasurementsHR, systolic blood pressure (SBP), and diastolic blood pres-

sure (DBP) were measured noninvasively using an automatic upper arm blood pressure monitor (Omron M5-I, Gaiam Ltd, Louisville, Colorado). All outcomes were measured every minute at baseline and during interventions and mental stress tests (Figure 1).

ExperimentalProceduresParticipants were asked to lie in the supine position. The

blood pressure cuff was applied to the upper arm, and HR and BP were recorded every minute throughout the experimental period. After 5 minutes of baseline measurement, the participant took part in a mental stress test (color word test or mental arith-metic) for 4 minutes, followed by a 10-minute recovery period.

Reflexology and the Autonomic Nervous System

25Summer 201134 ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 Reflexology and the Autonomic Nervous System

The intervention was then carried out for 20 minutes according to group allocation. A second baseline was measured for 5 min-utes after the intervention period, followed by a different mental stress test (color word test or mental arithmetic) for 4 minutes and another 5-minute recovery period (Figure 1).18 The investiga-tors who carried out the mental stress testing and who measured the outcomes were blinded to treatment allocation.

BlindingStatusFor blinding purposes, all participants were informed that

they would receive one of two different forms of complementary intervention. After completion of the experiment, all partici-pants were asked to guess which interventions they received to check for blinding status. The blinding index for each group was calculated using the method demonstrated by Bang et al.23 Confidence interval (CI) of a proportion was calculated accord-ing to the method described by Newcombe,24 which was available online at http://faculty.vassar.edu/lowry/prop1.html.

DataAnalysisEach outcome measurement was analyzed using Statistical

Package for Social Sciences (SPSS) version 11.5 for Windows (SPSS, Chicago, Illinois). Data were checked for a normal distri-bution using kolmogorov-Smirnov test. Baseline values were averaged from the values of minute 4 and minute 5 at resting baseline. Data were analyzed for differences from preceding baseline, during intervention, and during the two periods of mental stress testing. Analyses of variance with repeated mea-sures were used to compare treatment effects and time and post hoc comparisons, using Tukey’s Honestly Significant Difference test, were used for significant between-group and within-group comparisons. The level of significance was set at 0.05.

RESULTSCharacteristicsofSubjects

Twenty-six healthy volunteers responded to the advertise-ments and e-mail recruitment. One of them was excluded due to previous exposure to reflexology. Twenty-five participants were randomly allocated into two groups. Seven males and six females with a mean age of 27.08 ± 6.32 years were allocated to the reflex-ology group. Six males and six females with a mean age of 26.76

± 5.53 years were allocated to the control group. There was no significant difference in demographics between the groups (P> .05). There were no dropouts during the study, and no adverse effects were reported.

ExperimentalProfilesofAllOutcomesDuring the 4-minute periods of mental stress, HR, SBP, and

DBP were significantly increased (P < .05) relative to the baseline (average of baseline minute 4 and minute 5). This increase was greater during the first phase of mental stress testing than the second phase of mental stress testing that occurred after the intervention. The profile for DBP obtained at each minute throughout the experiment is shown in Figure 2. Profiles for HR and SBP were similar.

ComparisonoftheEffectsofReflexologyandControlonResponsestoMentalStress

The second baseline period was lower than the first base-line; therefore, comparison of the effects of reflexology and con-trol on responses to mental stress was analyzed using the change in HR and BP from the preceding baseline (average values at minute 4 and minute 5 baseline). The average changes in HR and BP over the 4 minutes of induced stress from preceding baseline are shown in Table 1. There were significant reductions in SBP (22%; P = .03) and in DBP (26%; P = .01) during mental stress following reflexology compared to the stress period prior to intervention. In contrast, there was a 10% reduction in SBP (P = .03) but a 5% increase in DBP (P = .67) during the period of mental stress following the control intervention compared to results obtained during mental stress prior to this intervention. However, there were no significant differences between reflexol-ogy and control groups.

Participants’PerceptionofTaskDifficultyofMentalStressThere were no significant differences in perceived difficulty

between the two mental stress tasks or between the reflexology and control groups as to the perceived difficulty within each stress task. The perceived difficulty values (mean ± SD) were 1.23 ± 0.6 (reflexology group) and 1.25 ± 0.97 (control group) for the color word test and 1.92 ± 1.19 (reflexology group) and 1.25 ± 0.97 (control group) for the mental arithmetic test.

Mental MentalBaseline Stress Recovery Intervention Baseline Stress Recovery

5 min 4 min 10 min 20 min 5 min 4 min 5 min

Color word test or mental arithmetic

Color word test or mental arithmetic

1. Reflexology to the ANS-related points2. Control-touch

HR and BP continuously recorded every minute

FIGURE 1 Experimental ProtocolAbbreviations: ANS, autonomic nervous system; HR, heart rate; BP, blood pressure.

26 Summer 2011ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 35Reflexology and the Autonomic Nervous System

BlindingEfficiencyMost of the participants allocated to receive reflexology

treatment (53.8%) said “don’t know” when asked which experi-mental group they were in, while most of the participants in the control group (66.7%) guessed “control” (Table 2). The blinding index was 0.15 (95% CI, 0.03-0.46) for the reflexology group and 0.5 (95% CI, 0.22-0.78) for the control group.

PowerAnalysisThe current data were used to calculate the numbers required

to detect significant differences for DBP between groups. Using a within-group standard deviation of 7.1, a minimum difference between groups of 2.6, alpha of 0.05, and power at 90%, a total of 180 participants per group would be required to detect significant changes between groups.

TABLE 1 Average Increase in Heart Rate and Blood Pressure During 4-minute Stress Test

Intervention OutcomesAverageIncreaseFromBaseline

%ChangePreinterventiontoPostintervention 95%CI

Reflexology HR (BPM) Preintervention 10.79

Postintervention 8.54 20.8% decrease –1.2%-42.9%

SBP (mmHg) Preintervention 9.81

Postintervention 7.62 22.3% decrease –0.3%-45%

DBP (mmHg) Preintervention 8.31

Postintervention 6.16 25.9% decrease 2.1%-49.7%

Control HR (BPM) Preintervention 11.40

Postintervention 9.15 19.9% decrease –2.8%-42.3%

SBP (mmHg) Preintervention 8.58

Postintervention 7.75 9.7% decrease –7.1%-26.4%

DBP (mmHg) Preintervention 8.96

Postintervention 9.44 5.4% increase 7.4%-18.1%

The % change in HR and BP during the stress test following intervention as compared to the stress test prior to intervention is shown along with confidence intervals.Abbreviations: CI, confidence interval; HR, heart rate; BPM, beats per minute; SBP, systolic blood pressure; DBP, diastolic blood pressure.

*

*

**

*

* * *

*

*

* *

***

Stress

Control

Stress

ReflexologyDBP90

85

80

75

70

65

60

Reflexologyres

t3

rest1

rest5

stress

2str

ess4

recov2

recov4

recov6

recov8

recov10cam2cam4cam6cam8

cam10cam12cam14

cam16cam18cam20

rest2

rest4

stress

1str

ess3

recov1

recov3

recov5

Time (min)

FIGURE 2 Profiles of Diastolic Blood Pressure Responses to Mental Stress and Reflexology or Control Intervention *Significant difference from baseline (average of min 4 and 5) at P < .05

27Summer 201136 ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 Reflexology and the Autonomic Nervous System

DISCUSSIONResults from this study indicate that a larger trial would

require 180 participants in each arm in order to have the required power to demonstrate significant changes in DBP in participants under stress following reflexology. This study also demonstrated the feasibility of conducting a methodologically rigorous control-led study under experimental conditions using healthy volun-teers. Recruitment was successful as the required numbers were randomized into the study. HR, SBP, and DBP increased signifi-cantly from baseline during both of the mental stress indicating that these tests are appropriate to use under experimental condi-tions. In addition, all participants self-reported the level of per-ceived task difficulty using the standard 5-point scale. There was no difference between reflexology and control group, which con-firmed that the perceived task difficulty did not influence the results between groups.

The blinding index was calculated from the method demon-strated by Bang et al,23 which was scaled to an interval of –1 to 1, 1 being complete lack of blinding, 0 being consistent with perfect blinding, and –1 indicating opposite guessing which may be relat-ed to unblinding. From the results, the blinding index of the reflex-ology group was 0.15 (95% CI, 0.03-0.46) and the control was 0.5 (95% CI, 0.22-0.78), indicating that the blinding may not have been completely successful for the control intervention. It is difficult to define what an appropriate comparable intervention for reflexolo-gy studies would be. Many studies have demonstrated that sham interventions produced some effect. Frankel used foot massage for a comparable intervention to reflexology and found that there were no significant differences between reflexology and foot mas-sage because the foot massage also induced some therapeutic effects.5 Hughes et al in a trial comparing reflexology and foot mas-sage on pain in people with multiple sclerosis also found signifi-cant pain reduction in both group.25 It was suggested by this group that sham foot massage might also stimulate the reflex points asso-ciated with reflexology and therefore have some therapeutic effect.

In a review of studies published on reflexology, kunz and kunz discuss the problem of finding an appropriate control for reflexology trials.26 The authors report 14 studies comparing reflex-ology to a sham reflexology treatment (use of nonrelated points) and 11 studies comparing reflexology and foot massage for various conditions. The results of these trials were mixed, leading to the general conclusion that foot massage is not a reliable control pro-cedure for reflexology. Therefore for the present study, the control intervention used a simple touch on the participants’ heels, which

did not stimulate and reflex points. This form of control was suc-cessful, because although there was some unblinding in this group, the intervention did not attenuate HR and DBP responses during mental stress. The study therefore effectively controlled for thera-pist interaction and touch without the stimulation of reflex points.

Reflexology moderated BP as the increase in BP observed dur-ing the first period of stress testing was significantly reduced by 22% to 25% in this group, whereas a small reduction in SBP (10%) and an increase of 5% in DBP were observed in the control group. Similar results were reported by McVicar et al, who with a sample size of 52 demonstrated reductions in SBP and pulse rate following reflexology.27 However, as with the present study, McVicar et al did not find any differences between intervention and control groups. In McVicar’s study, participants received reflexology for 60 min-utes. In the current experimental study, the effect of 20 minutes of reflexology intervention was investigated. This methodology was based on a previously published study by Middlekauff et al, who demonstrated reduced BP following 20 minutes of acupuncture.18 It may be that a longer treatment period in our experimental design would produce stronger results and should therefore be considered in any future investigation. Indeed, reflexologists stress the importance of treating a patient holistically with a full treat-ment rather than limiting an intervention to specific points for a specific condition.28 kunz and kunz suggest that frequency and duration of treatment may vary from condition to condition.26 They reference multiple studies that demonstrate a reduction in pain or anxiety following one short reflexology session; however, evidence suggests that other reflexology treatments (such as for asthma control or cholesterol reduction) require daily sessions of 40 to 50 minutes over several days to demonstrate any effect. In addition, the pressure or intensity of the treatment may be a fac-tor.26 The McVicar study researchers applied only a light pressure,27 as this group had previously demonstrated effectiveness of a light pressure within a cancer patient population. It may be that a mod-erate pressure is required for optimal stimulation of reflex points, although there is no robust evidence to support this.26

Reflexology has been shown to reduce anxiety and stress in various populations.7-10 The mechanism by which this occurs may be in modulating ANS function.5,6,27 The current study demon-strates the feasibility of conducting experimental studies in the area and indicates that BP may be modulated by reflexology; how-ever, further fully powered trials using suggested modifications to the protocol such as longer treatment time are required to confirm these findings.

TABLE 2 Blinding Index of Reflexology and Control Group

Assignment

Response

Total BI 95%CIComplementarymedicine Control Don’tknow

Reflexology 4 (30.8%) 2 (15.4%) 7 (53.8%) 13 (100%) 0.15 0.03-0.46

Control 2 (16.7%) 8 (66.7%) 2 (16.7%) 12 (100%) 0.5 0.22-0.78

Total 6 10 9 25

Abbreviations: BI, blinding index; CI, confidence interval.

28 Summer 2011ALTERNATIVE THERAPIES, may/jun 2011, VOL. 17, NO. 3 37Reflexology and the Autonomic Nervous System

CONCLUSIONThis study has demonstrated the feasibility of conducting

an experimental study on the effect of reflexology in stress using BP as the primary outcome measure. Results from such a study would address the lack of high-quality evidence for the physio-logical effects of reflexology.

AcknowledgmentsWe gratefully acknowledge Dr Jongbae Park for his guidance on the protocol for this study.

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16. Graham RC, Smith NM, White CM. The reliability and validity of the physiological cost index in healthy subjects while walking on 2 different tracks. ArchPhysMedRehabil. 2005;86(10):2041-2046.

17. Bhambhani Y, Maikala R. Gender differences during treadmill walking with graded loads: biomechanical and physiological comparisons. EurJApplPhysiol. 2000;81(1-2):75-83.

18. Middlekauff HR, Yu JL, Hui k. Acupuncture effects on reflex responses to mental stress in humans. AmJPhysiolRegulIntegrCompPhysiol. 2001;280(5):R1462-R1468.

19. Norman L, Cowan T. TheReflexologyHandbook:ACompleteGuide. Bath, England: Bath CPI; 1988.

20. Stroop JR. Studies of interference in serial verbal reactions. JExpPsychol. 1935;18:643-662. 21. Ross AE, Flaa A, Høieggen A, Reims H, Eide Ik, kjeldsen SE. Gender specific sympa-

thetic and hemorrheological responses to mental stress in healthy young subjects. ScandCardiovascJ. 2001;35(5):307-312.

22. Callister R, Suwarno NO, Seals DR. Sympathetic activity is influenced by task difficulty and stress perception during mental challenge in human. JPhysiol. 1992 Aug;454:373-387.

23. Bang H, Ni L, Davis CE. Assessment of blinding in clinical trials. ControlClinTrials. 2004;25(2):143-156.

24. Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. StatMed. 1998;17(8):857-872.

25. Hughes CM, Smyth S, Lowe-Strong AS. Reflexology for the treatment of pain in people with multiple sclerosis: a double-blind randomised sham-controlled clinical trial. MultScler. 2009;15(11):1329-1338.

26. kunz B, kunz k. Evidence-BasedReflexology forHealthProfessionalsandResearchers[e-book].London, Uk: Dorling kindersley; 2009. Available from: kindle books. Accessed August 21, 2009.

27. McVicar AJ, Greenwood CR, Fewell F, D’Arcy V, Chandrasekharan S, Alldridge LC. Evaluation of anxiety, salivary cortisol and melatonin secretion following reflexology treatment: a pilot study in healthy individuals. Complement Ther Clin Pract. 2007;13(3):137-145.

28. Quinn F, Baxter GD, Hughes CM. Complementary therapies in the management of low back pain: a survey of reflexologists. ComplementTherMed. 2007;16(1):9-14.

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29Summer 2011

What is self-care?Part 2 of 2(continued from Summer 2011 issue)Julie Barlow Professor of Health Psychology, Coventry University

Effectiveness of the CDSMC

In the US, randomised controlled trials (RCT) have found the CDSMC to be effective in improving self-efficacy, use of self-management techniques, improving physical and psychological health status, and reducing health care utilisation among participants with arthritis, lung disease, heart disease and stroke (Lorig et al. 1999). Griffiths, Foster, Ramsay et al. (2007) reviewed four UK randomised controlled trials (RCTs) examining the effectiveness of the CDSMC (Kennedy, Reeves, Bower et al. 2007; Griffiths, Motlib, Azad et al. 2005) and the related Arthritis Self-management Programme (ASMP) (Buszewicz, Rait, Griffin et al. 2006; Barlow, Turner, & Wright 2000). The ASMP is very similar to the CDSMC but has a focus on arthritis. Griffiths et al. found that self-efficacy improved in all studies, psychological distress improved in three studies (Kennedy et al. 2007; Buszewicz et al. 2006; Barlow et al. 2000) and generic quality of life improved in one study (Kennedy et al. 2007) based on intent-to-treat analysis. However, effect sizes were small to moderate and healthcare utilisation remained unchanged. The review focused on a limited range of outcomes and thus did not report effectiveness for outcomes such as positive affect (Barlow et al. 2000), energy (Kennedy et al. 2007), exercise and relaxation (Kennedy et al. 2007, Barlow et al. 2000), cognitive symptom management (Barlow et al. 2000; Kennedy et al. 2007) and communication skills (Barlow et al. 2000). The study by Kennedy, Reeves, Bower et al., (2007) was a national evaluation of the CDSMC which also assessed cost-effectiveness showing that the intervention produced a small reduction in costs. The authors report that valuing a quality adjusted life year at £20,000 results in a 70% probability of the CDSMC being effective leading to the conclusions that the CDSMC may be a cost-effective alternative to usual care (Richardson, Kennedy, Reeves et al., 2007). A related paper by Reeves, Kennedy, Fullwood et al., (2008) focused on predicting who benefited from the CDSMC, and showed that participants with lower self-efficacy and health-related quality of life at baseline had more positive outcomes as did younger participants who benefited much more than their older counterparts. The authors conclude that the CDSMC will have positive outcomes in a wide variety of people although it may be particularly beneficial for younger people and those lacking in confidence or not coping well with their LTHC.

Two RCTs examined the effectiveness of the CDSMC focusing on specific target groups (i.e. Myocardial Infarction (MI) patients and people with multiple sclerosis). A RCT of the CDSMC (Barlow, Turner, Edwards & Gilchrist, 2009), focused on people with Multiple Sclerosis (MS) and recruited nationally. The

CDSMC was open to anyone with a LTHC, thus, participants with MS learned alongside participants with conditions such as asthma, diabetes or heart disease. Results showed that at 4-months, the CDSMC was effective in terms of self-efficacy and depression and although effect sizes were small, these improvements were maintained at 12-months. The study was designed to examine the characteristics of people with MS who had expressed an interest in the Course and received information about it but then decided not to attend. This group of ‘informed non-attenders’ were invited to take part in the study and formed a Comparison Group. Compared to the Intervention Group, the ‘informed non-attenders’ had longer disease duration, were less anxious, experienced less psychological impact, and fatigue at baseline. A nested qualitative study based on interviews (Barlow, Turner & Edwards, 2009) revealed that MS participants compared themselves to other CDSMC attendees with similar symptoms (but not necessarily the same diagnosis) and drew inspiration and hope from those perceived to be coping well. Thus, the use of social comparisons across and within diagnostic groupings can be beneficial, suggesting that generic self-management interventions do not compromise the opportunity for making relevant informative comparisons. Participants learned new self-care techniques, such as goal setting, that were catalysts for mastering new skills. Achieving small, realistic goals enhanced self-efficacy and led to feelings of empowerment and positive outlook. As in earlier studies, the self-care competencies gained by participants were generalised to other situations not directly connected to MS, such as parenting, social activities and work. Equally, although participants felt more in control of their MS, many reported that they had not learned any new information or skills; rather the benefits of the CDSMC were viewed in terms of reinforcing and honing existing competencies to further improve quality of life. Importantly, participants had learned to manage illness around their lives as opposed to managing their lives around their illness.

The effectiveness of the CDSMC for MI patients was examined in a RCT (n = 192, mean age 65.9 years and a median duration of one year since the first MI) (Barlow, Turner & Gilchrist, 2009). This study may be of particular interest to readers of this chapter given that all participants had completed Cardiac Rehabilitation within the previous two years. The CDSMC was run specifically for the MI patients and was delivered by two lay tutors who themselves had experienced an MI. Analysis revealed no statistically significant differences between the groups although a pattern of small improvements among the Intervention Group on self-efficacy, anxiety, depression and cognitive symptom management was observed. It should be noted that this sample

30 Summer 2011

comprised mainly men (72%) and duration since the first MI was relatively short (i.e. median of one year), which contrasts with most other studies of lay led self-management where the majority of participants are women and mean disease duration tends to be ten years or more. In addition, participants in this study were relatively high in self-efficacy and self-management competencies at the start of the study as may be expected among MI patients who have recently completed cardiac rehabilitation. Interviews with a sub-sample of intervention group participants showed that they perceived an overlap between the CDSMC and cardiac rehabilitation particularly around diet and exercise. However, they viewed cardiac rehabilitation as being more about instruction whereas the CDSMC was more about discussion, mutual support, and goal setting.

‘Well, the rehab is different really because the rehab is mainly exercising. The self-management course is the fact that, basically you’re coming back to setting yourself a goal to do and get on with it.’

‘The self-management course was better because you got to talk to people about their problems. At the cardiac rehab, it was nurses standing in front talking about things’.

‘The action planning [on the CDSMC] made me get up and do some exercise. I was going to ride my exercise bike which I’ve never got round to using. And I set myself a plan to do 5 minutes a day on that. And now I go out and for a walk ... and I have joined an exercise class.’

Participants positively reappraised their situation as being ‘more manageable’ and believed that ‘there is life after a heart attack’. Some were ‘coping better’ after the CDSMC as they now realised that they were not on their own. A few participants felt that that had not ‘improved or got worse in terms of MI-related problems’ but nonetheless they felt ‘a bit more positive.’ It appears that there are few additional benefits from CDSMC attendance for this target group who had recently completed cardiac rehabilitation and had comparatively short disease duration. Interestingly, the proportion of women (28%) in this study was greater than the proportion of women attending cardiac rehabilitation, which is reported to be 11-20% of those eligible (Barber, Stommel, Kroll et al., 2001). This suggests that shifting the focus from rehabilitation to self-care may be more attractive to women.

Further examples of self-care approaches with a community perspective

This section provides some examples of other approaches to community self-care remaining with the topic of heart disease as an exemplar. The Heart Manual is a facilitated, home-based, 6-week programme for post-MI patients and is set in a cognitive-behavioural framework. The programme comprises written materials, a workbook to record progress and 2 audio tapes. Topics covered include simple exercises, pacing activities, advice about risk factors and lifestyle change, relaxation, stress management and vignettes of patients’’ experiences. Trained healthcare professionals work with patients and their carers over the course of the programme. A RCT showed that the incidence of clinical anxiety was reduced by 50% in the Heart Manual group compared to a control group who received standard care, information about MI and lifestyle change, and informal counselling (Lewin, Robertson, Cay et al. 1992). Patients who were clinically anxious or depressed at discharge from hospital showed the greatest improvement. In addition, there was a reduction in GP visits in the following 12 months and a reduction in admission to hospital in the first 6 months following discharge. A later study by Linden, (1995) reported similar findings although sample size was small. A comparison between the Heart Manual and hospital-based CR showed no clinically or statistically significant differences (Jolly, Taylor, Lip et al. 2007). However, Heart Manual participants who failed to adhere to exercise attributed their lack of motivation to difficulties in exercising on their own at home suggesting that some form of group support may have been beneficial. Further

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manuals have been developed for Coronary Artery Disease and Revascularisation (see The Heart Manual, http://www.theheartmanual.com).

Increasing and maintaining physical activity levels is one important aspect of self-care included in Cardiac Rehabilitation (CR). Following CR, maintenance of physical activity over time, can be difficult. A range of interventions have been designed and tested to help participants maintain physical activity over time. Cognitive interventions are based on techniques such as self-efficacy enhancement, management of barriers to physical activity and problem solving. Behavioural interventions are based on self-monitoring, prompting, goal setting and feedback and some interventions use a combination of cognitive and behavioural techniques. A systematic review of such interventions following CR found that whereas cognitive interventions showed inconsistent findings, behavioural and combination interventions had consistent outcomes and positive findings.

Increasingly, electronic technology is being incorporated in to self-care interventions. Such technology enables virtual on-line communities to be formed with the aim of providing group support in a similar manner to the face-to-face, group-based approach discussed above (i.e. the CDSMC). The impact of adding on-line community features to an internet -mediated walking program was examined among people who were overweight or had coronary artery disease or type II diabetes (Richardson , Buis, Janney et al. 2010). An RCT showed that although there was no difference in terms of increased daily step count, participant attrition was reduced among the on-line group. In addition, participants with low baseline social support made greater use of the on-line features than those with high baseline social support. An alternative use of technology is where data is transmitted via telephone lines thus enabling electronic communication between individuals in their own homes and their clinical team (i.e. telehealth). The influence of telehealth on self-management was examined among patients with heart failure (Dansky, Vasey & Bowles 2008). An RCT found that self-management behaviours were predicted by confidence and that participants using video-based telehealth demonstrated greater gains in confidence compared with control participants who received routine home visits only.

Further examples of self-care in rehabilitation can be found in other chapters of this Encyclopedia covering conditions such as asthma, chronic obstructive pulmonary disease, fibromyalgia, and myalgic encephalomyelitis/chronic fatigue syndrome.

Conclusions

The terms ‘self-care’ and ‘self-management’ tend to be used interchangeably. Self-care has been used to refer to specific rehabilitation strategies such as a particular exercise regime for a specific condition. However, broader definitions of self-care include not only management of symptoms and treatment but also management of psychosocial consequences and lifestyle changes. There is an increasing range of interventions being developed to enhance self-care using cognitive, behavioural, or cognitive-behavioural frameworks. Given the importance of social support for encouraging and maintaining behaviour change, many interventions involve group support either in face-to-face group settings or via on-line communities. The advent of generic courses, such as the CDSMC, provides an additional resource for those people who require additional support or further guidance in techniques such as goal setting, communication with family and healthcare professionals or managing psychosocial consequences of their conditions.

References

The following References are from the “What is Self Care” article found on pages 13, 14, 15:

Bandura A. 1977. Social learning theory. Englewood Cliffs (NJ): Prentice-Hall.

Barber K, Stommel M, Kroll J, et al. 2001. Cardiac rehabilitation for community-based patients with myocardial infarction: Factors predicting discharge recommendations and participation. Journal of Clinical Epidemiology 54:1025-30.

Barlow J. 2001. How to use education as an intervention in osteoarthritis. Best Practice & Research Clinical Rheumatology 15(4):545-58.

Barlow JH, Edwards R, Turner AP. 2009. The experience of attending a lay-led, chronic disease self-management programme from the perspective of participants with Multiple Sclerosis. Psychology & Health 24(10):1167-1181.

Barlow JH, Turner AP, Edwards R, Gilchrist M. 2009. A randomised controlled trial of lay-led self-management for people with multiple sclerosis including a comparison with those who chose not to attend the intervention. Patient Education & Counseling 77:81-89. doi 10.1016/j.pec.2009.02.

Barlow JH, Turner AP, Gilchrist M. 2009. A randomised controlled trial of lay-led self-management for Myocardial Infarction patients who have completed cardiac rehabilitation. European Journal of Cardiovascular Nursing 8:293-301. doi 10.1016/j.ejcnurse.2009.02.002.

Barlow JH, Turner AP, Wright CC. 2000. A randomised controlled study of the Arthritis Self-Management Programme in the UK. Health Education Research 15(6):665-680.

Benz Scott LA, Ben-or K, Allen JK. 2002. Why are women missing from outpatient cardiac rehabilitation programmes? A review of multi-level factors affecting referral, enrolment and completion. Journal of Women’s Health 11:772-91.

32 Summer 2011

Bush D, Ziegelstein R, Tayback M, Richter D, Stevens S, Zahalsky H, Fauerbach J 2001. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. American Journal of Cardiology 88:337-341.

Buszewicz M, Rait G, Griffin M, Nazareth I, Patel A, Atkinson A, Barlow J & Haines A. 2006. Self management of arthritis in primary care: randomised controlled trial. BMJ 333(7574):879.

Bradley LA. 1989. Adherence with treatment regimens among adult rheumatoid arthritis patients: current status and future directions. Arthritis Care and Research 2(3):S33-39.

Chase JA. 2011. Systematic Review of Physical Activity Intervention Studies After Cardiac Rehabilitation. Journal of Cardiovascular Nursing. [Epub ahead of print]

Clark NM, Becker MH, Janz NK, Lorig K, Roakowski W, Anderson L. 1991. Self-management of chronic disease by older adults: A review and questions for research. Journal of Aging and Health 3(1):3-27.

Coates VE, Boore JR. 1996. Knowledge and diabetes self-management. Patient Education and Counseling 29:99-108.

Damen S, Mortelmans D, Van-Hove E. 2000. Self-help groups in Belgium: their place in the care network. Sociology of Health & Illness 22(3):331-348.

Dansky KH, Vasey J, Bowles K. 2008. Use of telehealth by older adults to manage heart failure. Research in Gerontological Nursing 1(1):25-32. doi: 10.3928/19404921-20080101-01.

Department of Health. 2005. Self-Care – A Real Choice. DH: London. Online: http://www.dh.gov.uk/SelfCare.

Department of Health. 2005. Supporting people with long term conditions: An NHS and social care model to support local innovation and integration. DH: London.

Deyo RA. 1982. Compliance with therapeutic regimens in arthritis: issues, current status, and a future agenda. Seminars in Arthritis and Rheumatism 12(2):233-244.

Dickens C, McGowan L, Clark-Carter, D, Creed F. 2002. Depression in rheumatoid arthritis: a systematic review of the literature with meta-analysis. Psychosomatic Medicine 64(1):52-60.

Gibson P, Powell H, Coughlan J, et al. 2002. Limited (information only) patient education programs for adults with asthma. Cochrane Database of Systematic Reviews CD001005.

Griffiths C, Foster G, Ramsay J, Eldridge S & Taylor S. 2007. How effective are expert patient (lay led) education programmes for chronic disease? BMJ, 334, 1254-1256.

Griffiths C, Motlib J, Azad A, Ramsay J, Eldridge S, Khanem R, Munni R, Garrett M, Barlow J, Turner A, Feder G. 2005. Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease: A randomised controlled trial. British Journal of General Practice 55:831-837.

Janssens A, van Doorn P, de Boer J, van der Meche F, Passchier J and Hintzen R. 2003. Impact of recently diagnosed multiple sclerosis on quality of life, anxiety and depression of patients and partners. Acta Neurologica Scandinavica 108:389-395.

Jolly K, Taylor R, Lip GY, Greenfield S, Raftery J, Mant J, Lane D, Jones M, Lee KW, Stevens A. 2007. The Birmingham Rehabilitation Uptake Maximisation

Study (BRUM). Home-based compared with hospital-based cardiac rehabilitation in a multi-ethnic population: cost-effectiveness and patient adherence. Health Technology Assessment 11(35):1-118.

Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Richardson G, Gardner C, Gately C, Rogers A. 2007. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. Journal of Epidemiology and Community Health 61(3):254-61.

Lewin B, Robertson IH, Cay EL, Irving JB, Campbell M. 1992. Effects of self-help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services. Lancet 25;3398800.:1036-40.

Linden B. 1995. Evaluation of a home-based rehabilitation programme for patients recovering from acute myocardial infarction. Intensive and Critical Care Nursing 11(1):10-9.

Lorig K, Holman H. 1993. Arthritis self-management studies: a twelve-year review. Health Education Quarterly 20(1):17-28.

Lorig K, Holman H. 2003. Self-management Education: History, definition, outcomes and mechanisms. Annals of Behavioral Medicine 26(1):1-7.

Lorig K, Sobel D, Stewart A, Brown B, Bandura A, Ritter P, Gonzalez V, Laurent D, Holman H. 1999. Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial. Medical Care 37(1)5-14.

Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. 2007. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370(9590):851-858.

National Health & Hospitals Reform Commission Final Report: A Healthier Future for All Australians. June 2009.

Patten SB, Beck CA, Williams JV, Barbui C, Metz LM. 2003. Major depression in multiple sclerosis: a population-based perspective. Neurology 61, 1524-7.

Reeves D, Kennedy A, Fullwood C, Bower P, Gardner C, Gately C, Lee V. 2008. Predicting who will benefit from an Expert Patients Programme self-management course. British Journal of General Practice 58(548):198-203.

Richardson CR, Buis LR, Janney AW, Goodrich DE, Sen A, Hess ML, Mehari KS, Fortlage LA, Resnick PJ, Zikmund-Fisher BJ, Strecher VJ, Piette JD. 2010. An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial. Journal of Medical Internet Research 12(4):e71.

Richardson G, Kennedy A, Reeves D, Bower P, Lee V, Middleton E, Gardner C, Gately C, Rogers A. 2008. Cost effectiveness of the Expert Patient Programme (EPP) for patients with chronic conditions. Journal of Epidemiology and Community Health 62:361-367.

Sheeran P, Abraham C. 1995. The Health Belief Model. In: M Connor, P Norman, editors. Predicting Health Behaviour. United Kingdom: Open University Press. p. 23-61.

Van Hecke A, Grypdonck M, Defloor T. 2009. A review of why patients with leg ulcers do not adhere to treatment. Journal of Clinical Nursing 18(3):337-49.

Wallston KA. 1992. Hocus-Pocus, the focus isn’t strictly on locus: Rotter’s social learning theory modified for health. Cognitive Theory and Research 16(2):183-199.

World Health Organisation. 2009. Self-care in the Context of Primary Health Care. Report of the Regional Consultation, Bangkok, Thailand.

33Summer 2011

Course Listings

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34 Summer 2011

BACK to BASICS – Anatomy, Physiology, & Chemistry

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35Summer 2011

Rejuvenating Face Massage Course

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36 Summer 2011

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Through the Canadian Centre of Indian Head Massage with Debbie Boehlen. Courses are ongoing throughout Canada. This weekend course will teach you all you need to be able to provide a wonderfully relaxing Indian Head Massage treatment for your clients, friends and family. Certification is available. This course is eligible for Continued Competence Credits with the NHPC, and approved for CEUs/CECs with RAC and numerous other Provincial Associations and Governing Bodies in your province. Please check our website for details. For course dates and locations please contact Debbie or visit our website: www.indianheadmassagecanada.com Tel: 905.714.0298 email: debb@bell.net

Infant Massage Training (34 hours)

Dates: October 8 & 9, 2011 (Edmonton) Investment: $390 +gst Location: Canadian College of Massage & Wellness West Edmonton at Wellness Within Register: www.wellnesscollege.ca 780-489-7799 (Edmonton area) 1-877-489-7799 (Toll-free) Description: Canadian College of Massage & Wellness offers a unique and exciting Infant Massage class. Help mom, help baby. Gain invaluable knowledge for all parents. In this 2-day training you will learn how to teach Infant Massage classes and offer individual sessions to Parents, including:

• Benefits • Contraindications and Guidelines • Infant Massage Techniques and Parent Routines

o Colic, Digestion & Teething o Common Childhood Discomforts o Massage and Stages of Growth o Hydrotherapy Techniques

• Attachment Parenting • Addressing Parent Concerns and Questions • Developing and Promoting your Class

*This course has been approved for CEUs as a Specialization course by the NHPC!

Jade Stone Massage

Two Day

Workshop

With Shelley Willis

By Southwind Retreat and Spa

Experience the ancient healing power of Jade Stone Massage. The new Hot Stone massage treatment; Jade massage is a therapeutic and lucrative addition to your treatments. Jade Stone Benefits *Promotes relaxation & vitality while releasing toxins and inflammation *Fewer stones with alternating temperatures for deeper results *Jade Stones are heated or chilled non-porous for easy cleaning Workshop schedule visit www.southwindjade.com Private workshops please inquire To Register contact Shelley “the jade diva” 1-877-545-4433 / 250-390-0185 jadediva@shaw.ca NHPC Credentialed for Massage Therapists, Accredited CEU'S & CCC Shelley Killeen is an educator of Jade Stone Massage offering workshops, distributor of Southwind Jade Massage Stones and owner/operator of Southwind Retreat & Spa located on Vancouver Island.

37Summer 2011

Maternal Massage Training (34 hours)

Dates: November 12 & 13, 2011 (Edmonton) Investment: $390 +gst

Location: Canadian College of Massage & Wellness West Edmonton at Wellness Within Register: www.wellnesscollege.ca 780-489-7799 (Edmonton area) 1-877-489-7799 (Toll-free) Description: Canadian College of Massage & Wellness brings you a comprehensive course on Pre & Postnatal Massage for Massage Therapists. In this 2-day intensive training you will gain practical & hands-on knowledge in the following: • Benefits of Maternal and Postpartum Massage • Contraindications and Guidelines to Maternal Massage • Special Circumstances • Emotional and Physical aspects of Pregnancy and Postpartum • Positioning, Supports and Materials • Techniques and the Stages of Pregnancy • Labour Massage • Postpartum Massage

After the weekend course, 10 practicum massages are required. *This course has been approved for CEUs as a Specialization by NHPC & MTAA!

Advanced Muscle Therapy Seminars

Cheryl Stephenson RMT, MSc., BPE Red Deer, AB Are you looking for continuing education seminars that will increase your confidence and competence as a therapeutic massage professional? This advanced technique seminar series is value packed with the practical skills you require to excel at your profession. Included is:

• An integrative treatment approach that employs a variety of protocols including trigger point, active release, myofascial release, and muscle energy techniques.

• A comprehensive manual with illustrations and detailed technique descriptions.

Oct 21, 2011 Introduction to Therapeutic Techniques Oct 22, 23 Advanced Techniques for Low Back & Hip Nov 19, 20 Advanced Techniques for Neck & Upper Back

Dec 4 Pilates for Therapists Jan 14, 15, 2012 Advanced Techniques for Shoulder/Rotator Cuff

Feb 4,5,6 Pelvic/Lumbar Dysfunction & Correction

Mar 17,18 Advanced Techniques: TopicTBA

Apr 21,22,23 Cervical & Thoracic Dysfunction and Correction

• Advanced Technique seminars present an integrative treatment approach employing Trigger Point, Active Release, Myofascial Release, and PNF stretching techniques. • Dysfunction and Correction seminars employ Muscle Energy Technique (Onsen) protocols designed to correct spinal imbalances details @ www.perfectbalanceseminars.com contact Cheryl@perfectbalanceseminars.com (403) 877-6058

38 Summer 2011

Reiki Divine Energy Program

with Master Teacher Wayne RMT, RM, MHA, IS2, BA Rel

As an holistic non-religious healing modality, Reiki focuses on conducting Divine healing energy (Chi/Ki) into a client thereby increasing the level of their own natural healing energy. This energy is used to heal any issue on the physical, mental, emotional, and/or spiritual levels. Other therapeutic modalities become "energized" and more effective. The therapist becomes truly holistic by offering a complete approach to healing. All parties are blessed and feel an angelic peace afterward. Students are qualified to apply Reiki therapy. Level completion certificates (5 credits) are given at the end of each of four levels. What:………Divine Reiki Program (ongoing) Class form: Group or Individual (custom times) -In person or long distance. Who:……….Master Teacher Wayne RMT, RM, When:……...Ongoing -starting November 1, 2009 Where:…….Suite 205 5831 57St. Red Deer, Alberta (T4N 2L5) Time:………10:00 a.m. - 3:00 p.m. Tuition…..…$125.00 per level -cash Contact: Wayne at (403)347-0928 www.divinelightreikiandhealth.com Divine.Light.Health@gmail.com

Stability Ball Training

From Gaia Adventures

Stability ball exercise is one of the most effective means to rehab your patients. It’s easy, for every body type, and fun to use. Learn the very latest advancements and techniques in stability ball training during my upcoming workshops. Stability Ball Training is coming October 28, 29 in Vancouver, Nov 12, 13 in Winnipeg and Nov 26, 27 in Edmonton (14 Primary Credits MTAM, MTAA, MTABC, NHPC) Advanced Ball Training on October 30 in Vancouver, Nov 14 in Winnipeg, and Nov 28 in Edmonton (7 Primary Credits MTAM, MTAA, MTABC, NHPC) Go to http:www/gaiaadventures.com/bodyball.html for information and to register online. In these hands-on, fast-paced sessions, you’ll learn about "Core Activation Assessment and Training Techniques", functional kinetics with the ball and how to use the stability ball to rehab shoulders, back and correct posture.

2 –day Active Isolated

Stretching (AIS)

Stretch-for-Life’s Active Isolated Stretching, The Mattes Method 2 – day seminars will teach you how to expertly assist your clients’ active stretching movements.

Active Isolated Stretching is a rehabilitative form of active and assisted stretching techniques that will help you reach optimal flexibility, improve ROM and correct postural imbalances. Register today – classes fill up quickly!

Upcoming courses in BC and Alberta: Kamloops: January 14 & 15 (Sat/Sun) Canmore: January 25 & 26 (Wed/Thurs) Cranbrook: February 18 & 19 (Sat/Sun) Edmonton: February 22 & 23 (Wed/Thurs) Calgary: March 10 & 11 (Sat/Sun) Red Deer: March 24 & 25 (Sat/Sun) Nanaimo: April 14 & 15 (Sat/Sun) Kelowna: May 16 & 17 (Sat/Sun) Course Fee: $430.00 (includes course manual)

To register visit www.stretch-for-life.com

denise@stretch-for-life.com

NHPC credits = 10 MTAA credits = 18 CMTBC credits = 14 MTAS credits = 16 MTAM credits = 16

39Summer 2011

Active Isolated

Stretching (AIS)

Instructor:

Paul John Elliott, LMT, Certified AIS Instructor, Advanced

AIS Practitioner

Active Isolated Stretching: the Mattes Method (AIS) is a cutting edge method of stretching used by today’s massage therapists, personal trainers, athletic therapists and fitness professionals.

Working with the body’s natural physiological makeup, this method of stretching improves circulation and increases fascial elasticity, which helps eliminate physical pain and improve human performance.

AIS is an outstanding modality for improving posture, eliminating abnormal curvatures as well as restoring proper body alignment and eliminating physical pain.

This 3-day course will empower you with stretching and myofascial protocols that will compliment your current techniques and strategies.

Upcoming Dates: Calgary – ADVANCED AIS. May 27, 28 and 29 Location: 400-7330 Fisher St. S.E. T2H 2H8. Requires one Level 1 course certificate. Register at: http://stretchingcanada.com/event/seminar/advanced-ais

Regina – Level 1 AIS 3-day. June 3, 4 and 5 Location: Holiday Inn Express and Suites Regina, Sk S4S 3R6. Register at: http://stretchingcanada.com/event/seminar/regina-3-day

Langley –Level 1 AIS 3-day August 19, 20 and 21 Location: Langley Sportsplex Suite 3. Register: Paul Turner at 3-peaks Kinesiology:1-778-298-3757 - threepeaks@shaw.ca Langley – ADVANCED AIS 3-day August 19, 20 and 21 Location: Langley Sportsplex Suite 3. Register: Paul Turner at 3-peaks Kinesiology:1-778-298-3757 - threepeaks@shaw.ca

Structural Myofascial Therapy (SMFT)

Course Developer:

BetsyAnn Baron

Level 1: Connecting with Fascia Taught by course developer BetsyAnn Baron Kelowna, BC: Sept 30-Oct 2, 2011 Montreal, QC: Nov 4-6, 2011 (taught in French) Edmonton, AB: Nov 18-20, 2011 Early Registration Cost: $525 (reg $625) - Register more than 30 days Credits: NHPC = 15 Learn how to help your clients experience rejuvenation of injured tissue, increase in their range of motion, deeper and easier breathing, improvement in posture, decrease of chronic pain and so much more. We will focus on: 1. Myofascial full body protocol including anatomy/physiology 2. Postural Somatic Awareness (PSA) - a fantastic, subjective evaluation tool for you, the therapist, as well as for your clients 3. Working within these 3 paradigms: palliative, corrective, integrative Level 2: Creating Specificity Kelowna, BC: Feb 17-19, 2012 Montreal, QC: Mar. 9-11, 2012 (taught in French) Edmonton, AB: Mar. 23-25, 2012 Level 3: Delving Deeper Kelowna, BC: Apr. 27-29, 2012 Montreal, QC: May 11-13, 2012 (taught in French) Edmonton, AB: June 1-3, 2012 For more information or to register contact: BetsyAnn Baron 514-577-5355 education@baronbodyworks.ca

40 Summer 2011

Back to Back Traditional Study Retreats

on the Southeast Coast of India

From Calming the Ocean in combination with

The Healing Hands Center & Wudang Wen Wu

Tui Na Massage and Healing Qi Gong December 23 - 31, 2011 Must Register by November 15, 2011 Healing Qi Gong creates internal strength for a longer and healthier life, increasing overall power; Tui Na Massage techniques focus on joint mobility for better circulation, which helps the body naturally heal itself while loosening constrictive adhesions. Honorary Doctor of Qi Gong David Wei creates a beautiful harmony between these healing practices for effective, comprehensive treatments with priceless hand maintenance exercises. 8 - 12 Students $1,799 13 - 16 Students $1,699 Ancient Thai Massage, Yoga & Self-Healing January 2 - 14, 2012 Must Register by November 30, 2011

• Training provided by a Master of Ancient Thai Massage since 1990

• Detoxify yourself physically, then emotionally with simple exercises

• Strengthen your body and mind through daily strengthening yoga sets

• During the two weeks you'll go through incredible life changing experiences

• Awaken your healing energy through guided meditations and self-attunements

• Learn the only form of Ancient Thai Massage that flows physically and energetically

The Ancient Massage, Ancient Stretches and Ancient Healing of Doctor Jivaka Kumarabhacca are a powerful combination that will benefit any massage practitioner. To find this combination of traditional practices in a single curriculum is rare. 8 - 12 Students $2,099 13 - 16 Students $1,999 Prices in Canadian Dollars, Based on double occupancy, add $350 for single occupancy (includes taxes, tuition, accommodation, 3 meals/day, transportation to and from the Chennai airport) Held at Cocoland, a resort in the middle of a coconut plantation three minutes from the beach. Kristian Olsvik 780-701-9993 www.calmingtheocean.com info@calmingtheocean.com

STONE THERAPY SCHOOL

Course developer: NINA GART

Level 1

Hot & Cold Stone Massage 3-day certification course

The Original Stone Therapy Training Level I - Massage with Hot & Cold Stones 3-day intensive, instructional, hands-on course Credits: NHPC – 15 Pick up a stone from anywhere, look deep inside… for captured within is the power to heal… 2011 schedule:

AB Calgary: Sep 30 – Oct 2 Edmonton: Nov 4 – 6 Grande Prairie: Nov 18 – 20

SK Saskatoon: Oct 17 - 19 Regina: Dec 2 - 4

BC Vancouver: Oct 8 - 10 Nanaimo: Sep 16 - 18 Victoria: Sep 19 – 21

Main focus of the course is SAFETY: . In depth Stone Therapy Procedures . Bio Mechanics . Safety principals in Stone Therapy . Stones used, their qualities and care for stones . Thermatherapy principles . Indications, contraindications, benefits and so much more Stone Therapy School offers courses since 1999 for massage therapists, energy and SPA professionals. Ongoing classes in AB, SK, BC CEUs: NHPC – 15, MTAA – 25, MTAS – 21, CMTBC – 21 To register: NINA GART 604-459-8646 nina@stonetherapyschool.com www.stonetherapyschool.com

41Summer 2011

Unwind the Belly

with Chi Nei Tsang

Workshops

Learn to Unwind The Belly with Chi Nei Tsang Workshops – www.unwindthebelly.ca Chi Nei Tsang (chee-nayt-song) is traditional Oriental Visceral bodywork. The three pillars of CNT are breath work, applied qigong, and skilled gentle touch - all three are addressed in each exhilarating two day module. Learn to work the body core without fear. In Level 1A we learn the fundamentals necessary to do a safe powerful abdominal bodywork session. Our primary focus is to open the channels of elimination – the Metal organs - the skin, the lungs, and the large intestine. We free the diaphragm & expand & relax the breath, and learn to open the 9 Wind Gates. We root & ground with Earth Qigong, and build our life force (qi or chi), from the marrow out, with Bone Breathing. In Level 1B we become more assured and specific with the ancient abdominal touch techniques. We learn powerful ways to work with and balance the Earth and Wood internal organs of the body. Our anatomical knowledge grows. We learn to maintain our own health (& transform toxic energy) with the Microcosmic Orbit and the Six Healing Sounds Unwind the Belly with Chi Nei Tsang The Fundamentals:

Part 1 - The Basics: Metal Organs (no prerequisite): • 16-17 September 2011, Edmonton, AB (at the Providence Renewal Centre)

Part 2 - Wood And Earth Organs (prerequisite: Fundamentals Pt 1): • 18-19 September 2011, Edmonton, AB (at the Providence Renewal Centre)

Global Body Attitude (prerequisite: Fundamentals Pt 1 & 2): Part 1 - Fire Organs & Chasing Specific Winds

• 25-26 November 2011, Edmonton, AB (at the Providence Renewal Centre)

Part 2 – Water Organs & Balancing Meridians • 27-28 November 2011, Edmonton, AB (at the Providence Renewal Centre)

Visceral Anatomy: An East/ West Perspective • Dates TBA, December 2011, Vancouver, BC,

Qigong & Discharging for Healthcare Practitioners (no prerequisite):

• Dates & Location TBA Instructor: Peter TS Melnychuk, LMT Certified CNT Instructor (since 2004) & Adv. Practitioner, CNT Institute (Oakland, CA) Visceral Manipulation Practitioner & Certified Teaching Assistant (Barral Institute) Online Info & Registration: detailed course descriptions & fees at www.unwindthebelly.ca Contact & Registration: Laurelle at 780.428.5572 or info@unwindthebelly.ca

Please specify which class(es) you are interested in.

WHOLISTIC NUTRITION Correspondence Program

LIVING ENERGY Natural

Health Studies

A 2-year-plus program designed for people who want to get a solid, working under-standing of nutrition and how it relates to health and wellness, also for people wanting to further their career in the natural health field. This is an ongoing program, and students can start at any time. Level 1, Level 2, and Level 3 are totally via correspondence; Level 4 (advanced nutrition) is a detailed hands-on five-day program. COST: Levels 1-3 $750 each (plus GST) Level 4 $800 (plus GST) ** Cost of course includes workbook, administration fees, tutorial support, and one exam for each level. A discount is available if Levels 1-3 are purchased at the same time. This program has affiliations with a number of organizations and colleges including Canadian Association of Natural Nutritional Practitioners (CANNP). For detailed information contact Living Energy/Dr. Radka Ruzicka HD(RHom), NNCP at (780) 892-3006 (local call from Edmonton), visit our website www.livingenergy.ca

42 Summer 2011

Need space?NHPC’s Knowledge Center is taking bookings now.

For more information:

call 1 888 711 7701 or email jgabriel@nhpcanada.org

The Knowledge Center features:• Affordable rates• Member discounts• 1600 square feet• Large windows overlooking downtown Edmonton• Kitchenette• Massage tables, projector, catering, desks & chairs available

10% MEMBER DISCOUNT

ON BOOKINGS

15% ADVERTISITNGDISCOUNT

43Summer 2011

I AM NHPC

One of the great benefits of being a member of the NHPC is the association’s insurance program.

No other professional liability insurance policy specific to your profession offers an occurrence form policy with limits of $3,000,000 each claim and $4,000,000 per policy period per individual.

ADDITIONAL BENEFITS• Instantrecognitionbymostinsurance

companies across Canada

• Instant recognition as a competent professional

• Massage Therapy Competency Assessment Process • A prior learning assessment process for ‘2200

hour’ competency equivalency recognition by the insurance industry

• Facilitates massage therapists moving into regulated environments

• Does not apply to Regulated MT Provinces

Visit www.nhpcanada.org or call 1-888-711-7701 for more information.

Halifax, Nova ScotiaOctober 24

Toronto, OntarioOctober 25

Winnipeg, ManitobaOctober 26

Saskatoon, SaskatchewanNovember 14

Regina, SaskatchewanNovember 15

Calgary, AlbertaNovember 16

Edmonton, AlbertaNovember 17

Vancouver, British ColumbiaDecember 5

Kelowna, British ColumbiaDecember 6

Lethbridge, AlbertaDecember 7

The NHPC invites members to attend a Connections Café in a city near you.

Connect with like minded healthcare professionals for a powerful evening of networking and conversation.

Together we can strengthen our natural health community.

Join us. Online registration opens mid September at nhpcanada.org or call 1•888•711•7701 for more information.

natural health practitioners of canada associationassociation des praticiens de la santé naturelle du canada

2011FALLSCHEDULE

FREE REGISTRATION

7 - 9 pm

Locations TBA

Refreshments & Snacks Provided

Halifax, Nova ScotiaOctober 24

Toronto, OntarioOctober 25

Winnipeg, ManitobaOctober 26

Saskatoon, SaskatchewanNovember 14

Regina, SaskatchewanNovember 15

Calgary, AlbertaNovember 16

Edmonton, AlbertaNovember 17

Vancouver, British ColumbiaDecember 5

Kelowna, British ColumbiaDecember 6

Lethbridge, AlbertaDecember 7

The NHPC invites members to attend a Connections Café in a city near you.

Connect with like minded healthcare professionals for a powerful evening of networking and conversation.

Together we can strengthen our natural health community.

Join us. Online registration opens mid September at nhpcanada.org or call 1•888•711•7701 for more information.

natural health practitioners of canada associationassociation des praticiens de la santé naturelle du canada

2011FALLSCHEDULE

FREE REGISTRATION

7 - 9 pm

Locations TBA

Refreshments & Snacks Provided