Lymphedema Basics: Increasing Client Occupations
by: Candice D. Young E.d.S., COTA/L, CLT
Increasing independence in occupations is what occupational practitioners are known for. For many experienced clinicians, it is a daily routine recognized through experience through evidence-based practices. However, many clients suffer from diseases uncontrolled by either primary or secondary causes resulting in delayed healing or ongoing therapy services. The growing anxieties of past medical history, congenital conditions, or surgeries are not always straightforward nor understandable, and the complications may be unknown. Lymphedema could be lurking in the foreseeable future for many with no current cure and awaiting breakthrough treatments (Schaverien and Aldrich (2018).
Lymphedema is known to increase in prevalence in the United States, with little research to support and battle the lifelong diagnosis. There are two major causes of the disease, and it is categorized as primary or secondary lymphedema. Primary lymphedema is a congenital disability of the lymphatic system. It has no known cause, while secondary lymphedema is caused by irregular drainage of the lymph vessels resulting from injury, surgery, infections, and cancer. It is responsible for most cases in the United States (Curlett et al., 2020). Lymphedema causes swelling of the limb and can be visible anywhere in the body, unilateral or bilateral. The swelling can cause increased discomfort, decreased range of motion, pain, tightness, skin changes, increased risk for wounds, and, more importantly, lymphedema decreases activities of daily living (ADLs) and difficulty in instrumental activities daily living (IADLs). Lymphedema phases vary from no evident swelling; phase 0 to phase 3 elephantiasis; large capacity of lymph volume resulting in increased skin changes and discolorations (Blackman et al., 2020).
Practice of lymphedema treatment requires the lymphedema clinical specialist training; however best practices of complete decongestive therapy (CDT) are paired with manual lymph drainage (MLD), skincare, short-stretch bandaging, exercises, compression garments, and follow up visits (Kim et al., 2010) to maximize the reduction of lymph volume in the body (Sezgin Ozcan, 2018). While most clients become discouraged by treatment, the best results are accomplished between five and 15 days of consistent treatment sessions with at least 45 minutes of MLD (Keskin et al.; 2020). The extent of treatment and the phase of lymphedema varies with the length of sessions, compression, and follow-up care. The successful result leads to increase mobility, decreased pain, and a better quality of life for those who suffer from lymphedema (Sezgin Ozcan, 2018). A recent demonstration of the decrease in lymph volume for clients who received CDT in the upper extremity after having lymph node removed to prevent breast cancer spread was an average of 27% of their total volume taken with circumferential measurements. Moreover, the results increased their independence in activities of daily living and independent activities of living (Keskin et al.; 2020).
Currently there is no cure or operative treatments for clients with lymphedema and the lack knowledge of how to treat the disease increases the chances of exacerbations within clients (Schaverien and Aldrich (2018). Occupational therapy is a diverse field with diverse clients. OT practitioners take on the responsibility to help others increase occupations. Some treatment standards of lymphedema differ from client to client, but consistent CDT is critical. In addition, there is a need for more clinicians to understand the recovery process. As many health care providers support the recovery of lymphedema clients, Occupational therapy practitioners assist them.
References
Blackman, J., Dreiling, M., & Mutziger, A. (2020). Occupational Therapy Lymphedema Management and Its
Relationship to Quality of Life. Critically Appraised Topic 20, pp. 1-20. https://commons.und.edu/cat-papers/20
Curlett, H., Gallagher, A., & Shaver, A. (2020). Effectiveness of Complete Decongestive Therapy (CDT) as a Lifestyle Management Intervention for Adults with Secondary Lymphedema.
Keskin, D., Dalyan, M., Ünsal-Delialioğlu, S., & Düzlü-Öztürk, Ü. (2020). The results of the intensive phase of complete decongestive therapy and the determination of predictive factors for response to treatment in patients with breast cancer related lymphedema. Cancer reports (Hoboken, N.J.), 3(2), e1225. https://doi.org/10.1002/cnr2.1225
Kim, D. S., Sim, Y. J., Jeong, H. J., & Kim, G. C. (2010). Effect of active resistive exercise on breast cancer–related lymphedema: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(12), pp. 1844-1848. Retrieved from: https://www.archivespmr.org/article/S0003-9993(10)00770-7/fulltext
Sezgin Ozcan, D., Dalyan, M., Unsal Delialioglu, S., Duzlu, U., Polat, C. S., & Koseoglu, B. F. (2018). Complex decongestive therapy enhances upper limb functions in patients with breast cancer-related lymphedema. Lymphatic Research and Biology, 16(5), pp. 446-452. DOI: 10.1089/lrb.2017.0061
Schaverien, M. V., & Aldrich, M. B. (2018). New and Emerging Treatments for Lymphedema. Seminars in plastic surgery, 32(1), pp. 48–52. https://doi.org/10.1055/s-0038-1632403