Published Articles
Title: “Pneumatic compression devices for in-home management of lymphedema: two case reports”
Authors: Samantha Cannon
Publication: Cases Journal. March 23, 2009
Abstract: The two patients in this case series had experienced long-term difficulty controlling lymphedema at home. Both patients had used numerous home therapies, including older-generation intermittent pneumatic compression devices, without success. The Flexitouch® system, an advanced pneumatic device, was prescribed to assist them with in-home efforts by providing therapy to their affected limbs in addition to the lower trunk area for the patient with lymphedema of the lower extremity; and the trunk, chest wall, and shoulder areas for the patient with lymphedema of the upper extremity. Both patients achieved successful home maintenance of lymphedema, as judged by limb volume, clinical observations, and subjective patient impressions, after incorporating the Flexitouch® system. Neither patient experienced the deleterious effects (worsening genital edema; fibrotic cuff development) that they had experienced with the older-generation intermittent pneumatic compression devices they had previously used. Incorporating the Flexitouch® system as part of maintenance may improve success for lymphedema patients who have previously struggled with in-home management.
http://www.casesjournal.com/casesjournal/article/view/6625/2420
Title: “Reduction of Complications and Associated Costs with Flexitouch® Therapy for Lymphedema”
Authors: Tina Hammond
Publication: The Open Rehabilitation Journal, Volume 2
Abstract: Lymphedema is a chronic condition requiring multiple clinic visits over several weeks for costly treatment and education by a trained therapist, followed by lifelong in-home self-care. The self-care regimen can be physically and psychologically demanding and inadequate treatment can lead to progression of the lymphedema and serious complications. The patient described in this report was diligent with a home care program yet experienced difficulty controlling her lymphedema independently, necessitating a return to skilled therapy for repeated treatments. This case study describes the impact that an advanced pneumatic device, the Flexitouch® system, had on the costs of treatment and quality of life for a patient with lymphedema. Substantial long- and short-term cost reductions and quality-of-life gains may have been realized as the patient achieved successful maintenance of a home care program without any lymphedema-related complications or infections requiring hospitalization, antibiotic therapy, or in-clinic lymphedema therapy.
Title: "Lymphedema: Role of Truncal Clearance as a Therapy Component"
Authors: Harvey N. Mayrovitz, PhD, Dawn Brown-Cross, PT, EdD, CLT Nova Southeastern University Barbara L. Mayrovitz, RN, BA Home Health Service Alison H. Golla, MA, OTR/L, CLT Tactile Systems Technology, Inc.
Publication: Home Health Care Management Practice OnlineFirst. Feb 27, 2009
Abstract: Lymphedema is increasingly being seen in patients receiving home health care and throughout the general population. Substantial risks of complications are associated with failure to recognize its presence, worsening of the condition and the use of inadequate or incomplete therapy. Therapeutic truncal clearance as a component of therapy is universally accepted by professional therapists as being essential, but often rejected by third-party payers. This therapeutic component is based on sound physiological principles, but there has not been, nor will there likely be, peer-reviewed testing because it is deemed unethical to subject patients to therapy without its use. We believe that if the physiological basis for this therapy were more widely understood, its absolute need would be better recognized. Thus, our goal is to describe those lymphatic system features that directly impact lymphedema development and complications emphasizing the role of and scientific basis for truncal clearance as an essential treatment component.
http://hhc.sagepub.com/cgi/rapidpdf/1084822309331484?ijkey=b8Uanao8/ZwCk&keytype=ref&siteid=sphhc
Title: “Can Truncal Edema Be Treated With Pneumatic Compression”
Authors: Tina Hammond, PTA, CLT-LANA, was
Publication: National Lymphedema Network’s LymphLink, Volume 21, Number 2
Conclusion: This patient received CDT with utilization of an advanced programmable PCD during the in-clinic and home maintenance phases to treat her truncal and lower extremity lymphedema. For the past two years, the patient has continued to effectively control her lymphedema utilizing the advanced PCD in addition to exercise and daily garment wear. She modifies her treatment regime as needed with supplemental device programs used to target specific areas. These options are available using the programmable components of the PCD. She has required no additional in-clinic treatment for complications of lymphedema.
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Title: “Overcoming Barriers in the Management of Lower Extremity Lymphedema Utilizing Advanced Pneumatic Therapy”
Authors: Tina Hammond, PTA, CLT-LANA, and Alison H. Golla, OTR/L, CLT was
Publication: The Open Rehabilitation Journal, Volume 2
Abstract: Lymphedema often requires intensive, costly treatment which initiates in the clinic and is eventually self-administered by the patient at home. In-clinic Complete Decongestive Therapy aims to reduce limb volume, improve mobility, and reduce the risk of infection. Maintaining these clinical gains requires that the patient continues the treatments at home. Self-administering these treatments, however, can prove difficult, leading to loss of the therapeutic gains achieved during the in-clinic phase, especially when clinicians must moderate the recommendations to adapt to a patient's physical limitations and/or the demands of one's social and work obligations. Adding an advanced pneumatic therapy device in the home may assist with overcoming barriers associated with the complex requirements of self-administered lymphedema care. By providing a consistent, passive treatment option, patients may be better able to maintain the clinical progress achieved during in-clinic therapy. The purpose of this retrospective case review was to assess whether adding such a device to the at-home treatment regimen made a difference in the patient's ability to manage lymphedema independently. This case study follows a patient with primary bilateral lower extremity lymphedema from initial in-clinic therapy through to her two year follow-up visit. Barriers to lymphedema management faced by this patient are identified, the clinical reasoning for the various treatment options tried is provided and the subsequent functional outcomes are presented. The case study suggests that the Flexitouch® system offers promise as an adjunct to in-home treatment for patients whose lymphedema has proven challenging to control.
http://bentham.org/open/torehj/openaccess2.htm
Title: “The Standard of Care for Lymphedema: Current Concepts and Physiological Considerations”
Authors: Harvey N. Mayrovitz, PhD
Publication: Lymphatic Research and Biology, Volume 7, Number 2
Abstract: The standard of care for lymphedema encompasses risk reduction, early detection, Phase-I Complete Decongestive Therapy in a clinical setting, and Phase-II Self Management at home. This review discusses these lymphedema treatment components, including relevant physiological aspects that form the basis of treatment and an understanding of which are critical to successful outcomes. Phase-I therapy includes manual lymphatic drainage (MLD), short-stretch compression bandaging, decongestive exercise, skin care, and sometimes intermittent pneumatic compression (IPC). Home management includes many of the same elements, with adaptations for home treatment. Significant to the success of Phase-I and Phase-II care is effective bandaging and lymphatic drainage treatment via manual (MLD) or automated (IPC) processes. Truncal clearance plays a key role in facilitating lymphatic drainage from affected limbs by achieving effective pressure gradients, reducing lymphatic network resistance, and stimulating lymphatic contractility. The transition from Phase-I to Phase-2 presents challenges to patients and clinicians. Poor patient compliance with time-consuming technique dependent-home care regimens contribute to losing gains achieved in the clinic. Ineffective treatment results in complications, including increased pain, reduced range of motion and mobility, increased risk of infection, and other physical and psychological sequelae. The use of an advanced programmable IPC device for lymphedema treatment may support successful home management by addressing some of the home treatment barriers. Device selection requires careful consideration of the mode of action and device functionality. An advanced programmable device that provides truncal and proximal clearance and low applied pressure represents the current choice for such in-home devices.
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Title: “Psycho-Social Impact of Lymphedema”
Authors: Sheila H. Ridner, BSN, MSHSA, MSN, PhD, ACNP
Publication: Lymphatic Research and Biology, Volume 7, Number 2
Abstract: Patients with lymphedema experience multiple psycho-social problems. Healthcare professionals who deal with patients who have venous disease, lymphatic malformations, or secondary lymphedema are uniquely positioned to help address psycho-social issues in these patients. To address these concerns in practice settings, it is necessary to become familiar with the lymphatic system and to approach patients with compassion based upon an understanding of the difficulties and frustrations they may be experiencing. Caregivers must learn to recognize that these problems exist, assess patients for these problems, and assist them in obtaining needed services.
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Title: “The Unique Biology of Lymphatic Edema”
Authors: Stanley G. Rockson, MD
Publication: Lymphatic Research and Biology, Volume 7, Number 2
Abstract: Sadly, the subject of lymphatic vascular insufficiency continues to engender relative neglect by health care professionals, which represents a source of frustration and fear among patients. A re-consideration of the unique, complex biology of lymphatic vascular disorders has the capacity both to reinvigorate interest and facilitate the implementation of the correct, existing treatment interventions for individuals affected by these disease states.
While most of this complex lymphatic biology remains somewhat elusive, growing insights into the molecular mechanisms of lymphatic development and repair have been instructive. Present and future considerations in lymphedema diagnosis and management must acknowledge the unique tissue biology of this disorder. Many changes are unique to the lymphatic mechanisms of chronic edema. The profound stimulus to collagen deposition in the integument seems to be unique to chronic lymphatic edema, although this biology remains largely unexplicated. Several lines of evidence also suggest that lymphatic function has a unique and important influence upon adipose biology. Molecular investigation of murine models of human acquired lymphedema are beginning to shed light on these processes. Such focused mechanistic, approaches to the study of lymphedema and other lymphatic diseases are vital, as we attempt to expand our insights into the complex biology of lymphedema and its potential responsiveness to pharmacologic control and molecular intervention, prevention, and reversal.
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Title: “Contractile Physiology of Lymphatic Edema”
Authors: David C. Zawieja, PhD
Publication: Lymphatic Research and Biology, Volume 7, Number 2
Abstract: The lymphatic system has important roles in body fluid regulation, macromolecular homeostasis, lipid absorption, and immune function. To accomplish these roles, lymphatics must move fluid and its other contents (macromolecules, lipids/chylomicra, immune cells) from the interstitium through the lymphatics, across the nodes, and into the great veins. Thus, the principal task of the lymphatic vascular system is transport. The body must impart energy to the lymph via pumping mechanisms to propel it along the lymphatic network and use pumps and valves to generate lymph flow and prevent its backflow. The lymphatic system utilizes both extrinsic pumps, which rely on the cyclical compression and expansion of lymphatics by surrounding tissue forces, and intrinsic pumps, which rely on the intrinsic rapid/phasic contractions of lymphatic muscle. The intrinsic lymph pump function can be modulated by neural, humoral, and physical factors. Generally, increased lymph pressure/stretch of the muscular lymphatics activates the intrinsic lymph pump, while increased lymph flow/shear in the muscular lymphatics can either activate or inhibit the intrinsic lymph pump depending on the pattern and magnitude of the flow. To regulate lymph transport, lymphatic pumping and resistance must be controlled. A better understanding of these mechanisms could provide the basis for the development of better diagnostic and treatment modalities for lymphatic dysfunction
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Title: "Using a Programmable Pneumatic Device with Truncal Therapy to Facilitate Wound Healing: A Case Series"
Authors: Caren Betz, PT
Publication: Ostomy Wound Management, volume 55, 2009, 55(3)
Abstract: Chronic, recurring limb ulcers require a comprehensive approach that addresses the wound pathology, vascular status, and swelling. Although studies have shown that compression, especially high compression, is more effective than dressings alone, evidence to support one particular method of compression is limited. A sequential intermittent pneumatic compression (IPC) device was evaluated in four patients (two men, two women, age range 47 to 59 years) with nonhealing (history of 1 to 6 months) venous insufficiency (n = 2), postsurgical complication (n = 1), and radiation burn (n = 1) wounds and minimal to extensive clinically observable edema. All patients received standard wound care (debridement and/or appropriate dressings). Wounds were protected with an anti-shear wound dressing during pneumatic treatment. Each week, the various wounds and limb girths decreased until the site healed or limb volume normalized for that individual; 100% of the wounds healed. One patient, who had minimally observable edema, also responded positively when IPC was added to his standard wound care regimen. The pneumatic system was well tolerated in all patients. The results obtained suggest that combining appropriate standard wound care with this IPC treatment may facilitate closure of chronic, nonhealing wounds. Additional studies are needed to ascertain the effectiveness and cost-effectiveness of this treatment modality.
http://o-wm.com/content/using-a-programmable-pneumatic-device-with-truncal-therapy-facilitate-wound-healing-a-case-s