| CDP Treatment of Lymphedema While all treatments for lymphedema should be tailored to the patient, CDP treatment includes at least two phases which are equivalent in all therapies. These two phases may need to be repeated after about 4-6 months. 1- Phase I decongestive: acute phase This usually takes two to four weeks of treatment, until a plateau of decongestion has been reached. For cases of simple lymphedema, it may take 5 to 25 sessions. 1- Patient education: contraindications, precautions, complications, self-bandaging, diet, etc. 2- Skin Care / skin precautions. 3- Hands-on modality: MLT / LDT (once or twice a day, possibly as often as 5 to 7 days a week in some clinics). 4- Medical compression: bandaging. 5- Psychological and stress management, if needed. Compliance: Home Maintenance Program: 1- Self-education of the patient. 2- Hygiene and precautions. 3- Self drainage, twice daily. 4- Self bandaging (facilitate with a "companion"). 5- Exercises under compression twice daily / breathing / moderate exercise. 6- Diet / weight loss if needed. Lymph Drainage: once or twice a day. Rest, then walk or exercise for 15-45 min. During the first phase of acute decompression the bandages are kept on the limb(s) at all times except during the LDT / MLT sessions. Note: Other Modalities That May Be Considered: - Elevation (early stages only) - Medication - Ultrasound - Laser - Heat/Microwaves - Cold - Pneumatic Pump compression - Electricity - Hyperbaric chambers - Mercury bath (rarely used anymore) 2- Phase II: Rehabilitation / Maintenance / Preservation Phase After the plateau of decompression, we can switch from bandages to compression garments during the day. The protocol is similar to that of phase I, but the home program maintenance is much more extensive. 1- MLT / LDT is replaced by self drainage twice daily. The therapist is seen much less often. 2- The bandages are replaced during the day by compression garments (sleeves or stockings) and/or other equipment (Reid sleeve, Legacy, etc.) 3- Phase III: Repetition of Acute Decongestion as in Phase I Phase I treatments may be repeated within 6 months (Kasseroller, 1998). ManageMENT of lymphedema, Non-operative Treatment, ISL Consensus document This International Society of Lymphology (ISL) Consensus Document is the current revision of the 1995 Document for the evaluation and management of peripheral lymphedema. It is based upon modifications suggested and published following the 1997 XVI International Congress of Lymphology (ICL) in Madrid, Spain, discussed at the 1999 XVII ICL in Chennai, India, considered at the 2000 (ISL) Executive Committee meeting in Hinterzarten, Germany, and derived from integration of discussions and written comments obtained during and following the 2001 XVIII ICL in Genoa, Italy as modified at the 2003 ISL Executive Committee meeting in Cordoba, Argentina. The document attempts to amalgamate the broad spectrum of protocols advocated worldwide for the diagnosis and treatment of peripheral lymphedema into a coordinated proclamation representing a "Consensus" of the international community. In the treatment of "classical" lymphedema of the limbs (that is, peripherallymphedema), improvement in swelling can usually be achieved by non-operative therapy. Because lymphedema is a chronic, generally incurable ailment, it requires, as do other chronic disorders, lifelong care and attention along with psychosocial support. The continued need for therapy does not mean a priori that treatment is unsatisfactory, although often it is less than ideal. For example, patients with diabetes mellitus continue to need drugs (insulin) or special diet (low calorie, low sugar) in order to maintain metabolic homeostasis. Similarly, patients with chronic venous insufficiency require lifelong external compression therapy to minimize edema, lipodermatosclerosis and skin ulceration. The compliance and commitment of the patient is also essential to an improved outcome. Failure to control lymphedema may lead to repeated infections (cellulitis/lymphangitis), progressive elephantine trophic changes in the skin, sometimes crippling invalidism and on rare occasions, the development of a highly lethal angiosarcoma (Stewart-Treves syndrome). Therapy of peripheral lymphedema is divided into conservative (non-operative) and operative methods. Applicable to both methods is an understanding that meticulous skin hygiene and care (cleansing, low pH lotions, emollients) is of utmost importance to the success of virtually all treatment approaches. Basic range of motion exercises of the extremities, especially combined with external limb compression, and limb elevation is also helpful to virtually all patients undergoing treatment. Non-operative Treatment Physical therapy Combined physical therapy (CPT) (also known as Complete or Complex Decongestive Therapy (CDT) or Complex Decongestive Physiotherapy (CDP) among others) is backed by longstanding experience and generally involves a two-stage treatment program that can be applied to both children and adults. The first phase consists of skin care, light manual massage (manual lymph drainage), range of motion exercise and compression typically applied with multi-layered bandage-wrapping. Phase 2 (initiated promptly after Phase 1) aims to conserve and optimize the results obtained in Phase 1. It consists of compression by a low-stretch elastic stocking or sleeve, skin care, continued "remedial" exercise, and repeated light massage as needed. Prerequisites of successful combined physiotherapy are the availability of physicians (i.e., clinical lymphologists), nurses, and therapists highly trained and educated in this method, acceptance of health insurers to underwrite the cost of treatment, and a biomaterials industry willing to provide high quality products. Compressive bandages, when applied incorrectly, can be harmful and/or useless. Accordingly, such multilayer wrapping should be carried out only by professionally trained personnel. Newer manufactured devices to assist in compression (i.e. pull on, velcro-assisted, quilted, etc.) may relieve some patients of the bandaging burden and perhaps facilitate compliance with the full treatment program. Some clinics find that patient self-care and risk reduction strategies help maintain edema reduction. CPT may also be of use for palliation as, for example, to control secondary lymphedema from tumor-blocked lymphatics. Treatment is typically performed in conjunction with chemo- or radiotherapy directed specifically at producing tumor regression. Theoretically, massage and mechanical compression could promote metastasis in this setting by mobilizing dormant tumor cells, although only diffuse carcinomatous infiltrates which have already spread to lymph collectors as tumor thrombi might be mobilized by such treatment. Because the long-term prognosis for such an advanced patient is already dismal, any reduction in morbid swelling is nonetheless decidedly palliative. Massage alone. Performed as an isolated technique, classical massage or effleurage usually has limited benefit. Moreover, if performed overly vigorously, massage may damage lymphatic vessels. From "Consensus Document of the International Society of Lymphology, The Diagnosis and Treatment of Peripheral Lymphedema, Lymphology, 2003 June, 36, (2): 84-91. Reproduced here by kind permission" |
| A Brief Glossary Over time schools used different names for CDP; however, all these terminology are pretty much equivalent. In this book we use the abbreviation CDP for simplicity. This letter Refers/May refer to: C "Combined" or "complex" D "Decongestive" P "Physiotherapy" or "physical therapy" T "Therapy" L "Lymphedema" or "lymphatic" Abbreviations CDP Complex Decongestive Physiotherapy (used by Medicare in Florida) CPDT Complex Physical Decongestive Therapy , Germany) CPT Complex Physical Therapy (Casley-Smith, Australia, 1980) CLT Complex Lymphatic Therapy (Casley-Smith, Australia) CDT Combined Decongestive Therapy (Vodder) LT Lymphedema Therapy LMT Lymphedema Multimodal Therapy General Principles of All Forms of CDP Lymphedema can present life-threatening medical complications; any treatment of lymphedema should be done in connection with of a licensed physician, using a multidisciplinary approach when possible. CDP is a conservative approach and is the treatment of choice for lymphedema. CDP often does not cure the lymphedema but seeks to restore the normal size and function of the limb. The sooner the patient receives treatment (even preventively, before the onset of lymphedema), the faster will be the response to the treatment. Cdp Treatment Problems - Scarcity of available information in the US. Conflicting scientific information. - Chronic nature of lymphedema: lymphedema is a condition that will generally worsen over time if left untreated.- Providers’, patients’ and insurance companies’ limited knowledge - Compliance and commitment of the patients is essential to success. Patients need to be well educated. - Bandaging and other medical external compression are sometimes difficult to accept as components of the treatment - Lymphedema usually requires lifelong care and psychological support. - Insurance companies are reluctant to reimburse CDP In the United States |
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| LYMPHLAND |
