Lymphedema and Complete Decongestive Therapy: What Every Clinician Needs to Know – Barbara Ingram-Rice

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Lymphedema requires patients to commit to their wellbeing full time, but when the process becomes too difficult, self-care routines tend to fall away. This puts patients at risk of exacerbation, infection, and more. Over time, other health issues arise until suddenly they need assistance with maintaining their routines.

Not every therapist wants to be certified in Complete Decongestive Therapy, but every health care provider needs to know the basics, when and how to help, and when to refer out. In this recording, you’ll learn to recognize the signs and symptoms of lymphedema and explore complete decongestive therapy treatment plans, including assessment, massage, skin care, compression, exercise, and patient education.

1. Describe the lymphatic system and the flow patterns of lymph in the body
2. Outline the components of Complete Decongestive Therapy (CDT)
3. Apply Manual Lymphatic Drainage Massage (MLD) techniques for upper body
4. Demonstrate standard decongestive exercise protocols and exercises
5. Describe the best methods for donning/doffing compression garments
6. Evaluate how and when to refer patients to a certified lymphedema therapist

OVERVIEW OF THE ANATOMY AND PHYSIOLOGY OF THE LYMPHATIC SYSTEM

• Anatomy of the lymphatic system
• Understand the ways the lymphatic system may break down
• Differentiate between lymphedema, lipedema and acute edema due to an injury
• Discover what lymphatic watershed areas are

PATHOPHYSIOLOGY OF LYMPHEDEMA

• Stages of lymphedema
• Primary lymphedema
  • Congenital malformations
• Secondary lymphedema
  • Post cancer
  • Trauma
  • Venous complications

DIAGNOSTIC IMAGING

• Lymphoscintigraphy
• Xeroradiography
• CT scans

COMPLETE DECONGESTIVE THERAPY

• Assessment
• Manual lymphatic drainage massage
• Skin care
• Compression
  • Bandaging
  • Garments
  • Garment alternatives
  • Compression pumps
• Decongestive exercise
  • Standard exercises for UE and LE
• Patient education

LAB: MANUAL LYMPHATIC DRAINAGE PROTOCOL

BEST WAYS TO DONN/DOFF COMPRESSION STOCKINGS AND SLEEVES

• Upper extremity
• Lower extremity
• Bandaging alternatives

DECONGESTIVE EXERCISES

• Learn a fun exercise model that can be used for decongestive therapy as well as other patients
• Lab to practice the moves as led by the instructor

DIFFERENTIAL DIAGNOSES

• Lipedema
• Chronic venous insufficiency
• Venous-lymphostatic insufficiency
• Generalized edemas
• Edema during pregnancy
• Acute inflammation

INTERMITTENT PNEUMATIC COMPRESSION THERAPY

COMPLEX CASE STUDY UTILIZING CDT TECHNIQUES

• Initial assessment
• Inpatient intensive rehab
• Ongoing care