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Clinical Advances Heading

Using pneumatic compression in lymphedema treatment By Karen Ashforth

Pneumatic compression is experiencing a resurgence in popularity as a treatment for lymphedema, both as a means of accelerating the in-clinic treatment phase, as well as for home care.

Photo: Karen Ashforth

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n the past, classically trained lymphedema therapists were cautious about adopting pneumatic compression as a modality. This is despite the fact that pneumatic compression has been shown to be equivalent in efficacy to professionally applied manual lymph drainage (MLD)1, offering better maintenance control than self-applied massage2, and an effective adjunctive modality when combined with other treatments3. In addition, for many years pneumatic compression appliances were available for extremities only, and did not provide treatment for torso edema. However, this limitation has long since been overcome due to development of specialized appliances that treat the torso as well as the extremities, along with multimodal treatment cycles that can vary the patterns of massage. Pneumatic compression has once again become an important treatment component for lymphedema. It is important to remember that although pneumatic compression can perform a similar decongestive function, it is not a substitute for hands-on massage. A machine, no matter how sophisticated, cannot replace the hands and eyes of a trained lymphedema therapist. Sometimes very specific manual techniques and drainage patterns are required; for example, in treating a patient with an irregularly shaped breast. However,

Calibrated gradient pump and torso – arm appliance. the automated and replicable action of pneumatic compression has the advantage of being more cost-effective than professional MLD, and more efficient than self-applied massage. Pneumatic compression decongests swollen arms, legs, and torso areas by applying massage and compression. A console supplies air at calibrated pressure to an appliance, which is worn around the treated body part. The appliance contains air chambers, which inflate and deflate in

Karen Ashforth MS, OTR, CHT, CLT-LANA has practiced occupational therapy for 34 years, specializing in treatment of lymphedema for 11 years. She is board certified in both hand therapy and lymphedema therapy and has presented and published lymphedema research internationally. She directs a hospital based outpatient lymphedema clinic in Santa Cruz, California.

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one or more specific patterns, creating a directional compressive movement that decongests edematous areas. Types of systems There are a wide variety of pneumatic compression systems, from basic three or four chamber units that are limited to treating arms or legs, to more complex combinations, which can treat extremities and trunk. Systems are classified by the ability to set the pressure across the entire appliance (sequential pump) or in individual sections on the appliance (calibrated gradient pump). The arms and legs are a major focus of lymphedema treatment. If edema is limited to these areas, an extremity-only appliance is usually sufficient and has the advantage of being lower-profile and easier to comply with than a torso or truncal appliance system. Spring 2015

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Pathways Spring 2015  
Pathways Spring 2015