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Introduction to Lymphedema Part 2. Possible Effects of Lymphedema. Damage of interstitium Valvular insufficiency Occlusion of lymph vessel Fibrous area limiting function of lymph system Decreased muscle pump function Inflammatory processes of lymph node Sclerosis of arteries and veins

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Introduction to Lymphedema Part 2


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possible effects of lymphedema
Possible Effects of Lymphedema

Damage of interstitium

Valvular insufficiency

Occlusion of lymph vessel

Fibrous area limiting function of lymph system

Decreased muscle pump function

Inflammatory processes of lymph node

Sclerosis of arteries and veins

Tissue changes

Changes in Lymph Transport

what is cdt
What is CDT

CDT= Complete Decongestive Therapy

Manual Lymph Drainage

Compression Bandaging

Remedial Exercise

Skin and Nail Care

Instructions in Self-Care

slide4
MLD

MLD=Manual Lymphatic Drainage

Improves lymph circulation and production

Re-routes the lymph flow around blocked areas

Special techniques of MLD help break down fibrous tissues

Promotes relaxation: dim lights, music

MLD sessions last between 30 – 60 minutes

compression bandaging
Compression Bandaging

Reduces ultrafiltration rate

Improves efficiency of muscle and joint pumps

Prevents re-acummulation of evacuated lymph fluid

Helps reduce fibrosis of tissues

Wear bandages all night during stage I

Bandaging sessions can last approximately between 30 and 60 minutes

remedial exercises
Remedial Exercises

Gentle active strengthening (may slowly progress)

Gentle stretching (may slowly progress)

Low intensity

Diaphragmatic breathing

Improves muscle pump, lymph vessel activity, and lymphatic return

Done with bandages (or compression) in place

skin and nail care
Skin and Nail Care
  • To help prevent and eliminate bacterial and fungal growth
    • Use PH balanced lotion
    • Work with physician if other topical agents are needed
  • To reduce risk of infection
    • Avoid nicks and cuts
    • Clean all injuries immediately
    • Avoid extreme temperatures
    • Learn signs of infection and when to contact the physician
instructions in self care
Instructions in Self Care

Skin and nail care

Infection prevention

Self massage

Self bandaging

Compression garments

Exercises

When to contact MD or PT: increase in swelling

phase 1 phase 2 of cdt
Phase 1 & Phase 2 of CDT

Phase 1 (Treatment Phase)

Phase 2 (maintenance)

MLD

Skin and nail care

Compression Bandaging

Ordering compression garment=end of phase 1

Exercises: gradually add more

Self Care Training: manual lymph drainage, wear schedule for garments, exercises

MLD as needed

Skin and nail care

Compression Garment during the day

Bandaging at night

Exercises

lymphedema banadaging
LymphedemaBanadaging
  • A multi-layered bandaging system
  • Creates compression
    • Increase reabsorption
    • Decrease ultrafiltration
  • Uses short stretch bandages
short stretch bandages
Short Stretch Bandages

Contain no elastic threads

Stretches to only 50%

Pure cotton

Like a soft cast: no soft spots

working pressure vs resting pressure
Working Pressure Vs. Resting Pressure

Working Pressure

Resting Pressure

Does not yield to fluid refilling

Constriction generated by elastic thread

Can cause tourniquet effect, soft tissue damage, or loss of sensation

methods of compression bandaging application
Methods of Compression Bandaging Application

Apply graduated widths of compression bandages

Each bandage should be applied from distal to proximal

Use uniform spacing and tension

Use lotion prior to application

bandaging products
Bandaging Products
  • Tricofix/ Tg- Tubular Gauze stockinette
    • Can use as a chip bag of foam for high compression area, fold over at end
  • Artiflex/Cellona synthetic cotton padding bandages
    • Malleolus, skin folds
  • Other padding
  • Elastomull/ Transelast Classic gauze
    • Fingers and toes, wrap to get toes softened up
  • Isoband/Idealbinde short stretch cotton bandages
    • Not for compression really, just padding still
  • Comprilan/ Rosidal K short stretch cotton bandages
    • 6-10cm for decreasing compression, tape not hook.
objectives and considerations for use of foam
Objectives and Considerations for use of Foam

Improved comfort

Even pressure distribution

Increase protection for skin over bony prominences

Custom tailored pressure for odd shapes and sizes of areas

Caution for allergic reaction

Aggressive response where foam overlaps

care and maintenance of bandages
Care and Maintenance of Bandages

Washing

Drying

Re-rolling

Re-ordering

exercise tips
Exercise Tips

Work with Physician

Use compression

Maintain hydration

Monitor environmental temperatures

May need to adapt exercises to patient

Need to “ease into” intensity of exercise

Don’t wear tight or restrictive clothing

Start exercises twice a day for 15 minutes each session

upper extremity remededial exercises
Upper Extremity Remededial Exercises
  • Abdominal Breathing
  • Head isolations
  • Shoulder rolls and shrugs
  • Arm Exercises
    • Hand isolations
    • Climb the ladder
    • Swimming
    • Canoeing/ Stick exercises
    • Softball exercises
lower extremity remedial exercises
Lower Extremity Remedial Exercises
  • Abdominal Breathing
  • Foot and Leg Exercises
    • Toe Clenches and abduction
    • Ankle Curls and rotation
    • Riding the bike
    • Heel slides
    • Resist knee flexion in supine
    • Bridging and knee to chest
  • Walking
billing for lymphedema services
Billing for Lymphedema Services
  • Use Good documentation language
    • MLD vs massage
    • Bandaging vs wrapping
  • Forms to keep
    • Education
    • Volumetric
    • Photos
    • Daily notes
billing cont
Billing (cont)
  • Bill for
    • Eval
    • Re-eval
    • Ther ex
    • Functional activities
    • Manual therapy
    • Orthotic fitting training (Jobst measurements)
  • G Codes
    • Bill under “Other”
compression garments
Compression Garments

Ready made or custom