MODERN REHABILITATION PROGRAMS
IN PHYSIOBALNEOTHERAPY OF
LYMPHEDEMA OF LOWER EXTREMITIES.
Apkhanova T.V., Badtieva V. A.
Federal State Institution «Russian Scientific Center
of Rehabilitation Medicine and Health Resort
Science of the Ministry of Health and Social
Development», Moscow, Russia.
*In
the general structure of a
vascular pathology lymphedema
of lower extremities occupies
about 8-10 %.
*lymphedema suffer about
120 million persons in the
World.(World Health
Organization,2002).
*In Moscow every tenth patient
addressing for the specialised
help to phlebologist, suffers a
lymphatic odema of extremity.
The problems for patients with Lymphedema:
-A FEELING OF HEAVINESS
-COSMETIC DEFORMITY
-SLIGHT DISCOMFORT
-REPEATED EPISODES OF INFECTION (CELLULITIS AND
LYMPHANGITIS)
- MALIGNANT DEGENERATION (STEWART-TREVES
SYNDROME)
-THICKENING OF THE SKIN
-HARDENING OF THE LIMB
-LEAKAGE OF LYMPH
-MASSIVE SWELLING (ELEPHANTIASIS)
*THESE CONDITIONS CONSIDERABLY DECREASE THE
QUALITY OF A LIFE.
Etiological classification of Lymphedema
Primary lymphedema:
•
hypoplasia lymphatics and
lymph nodes
• hyperplasia lymphatics
• aplasia lymphatics and
lymph nodes
•
•
•
•
•
•
•
•
Secondary lymphedema:
damage or removal of regional
lymph nodes through surgery
Radiation of regional lymph
nodes
infection
after traumas or tumor
invasion or compression.
vein stripping, peripheral
vascular surgery (arterial
reconstruction)
liposaction
burns, burn scar excision
insect bites
Treatment of Lymphedema of lower
extremities
Conservative therapy:
• recommendations about
change of a way of life
• skin care
• medicamentous treatment
(benzopyrones, antibiotics,
and antifungal antibiotics)
• compression by a lowstretch elastic stocking
• Сomplex physiotherapy
• pneumocompression
Operative treatment:
• Microsurgery
• Surgical resection
• Liposuction
*PHYSIOTHERAPEUTIC TREATMENT
OF LYMPHEDEMA OF LOWER
EXTREMITIES TAKES LEADING
POSITIONS IN LYMPHEDEMA
TREATMENT
(2009 Consensus Document of the
International Society of Lymphology).
CLINICAL CLASSIFICATION OF
LYMPHEDEMA
(SAVCHENKO T.V., POKROVSKY A.V.,
2004)
I stages –latent or subclinical edema
II stage - permanent (constant) edema
III stage - increase edema with subdermal
fibrosis
IV stage - elephantiasis
Actions of various physical factors
• stimulation of a lymphatic drainage
(strengthening methods to stimulate lymph
flow dynamics and lymphangion activity)
• acceleration lymph transport
• stimulation extralymphatic factors of lymph
circulation (a muscular pump of a shin)
• restriction lymph formation
• normalisation of processes of microvascular
circulation
The primary goals of Complex
Decongestive Physiotherapy (CDT):
1. decrease edema
2. increase lymph drainage from the
congested areas
3. reduce subdermal fibrosis
4. improve the skin condition
5. enhance patient’s functional status
In Center clinic we have developed and use
rehabilitation programs with the following
methods:
•
•
•
•
•
•
•
magnetic stimulation,
magnetic laser therapy,
pulse matrix laser therapy,
cryotherapy,
pneumocompression,
balneotherapy (mineral baths and black mud),
thalassotherapy (algotherapy with cold
seaweed application).
Complex Decongestive Therapy
(on method Foeldi M.)
• at 1 stage - a skin care, Manual Lymph
Drainage (MLD) and bandaging of the limb by
bandage of a short stretching, daily, physical
exercises.
• At 2 stage - (MLD) 2-3 times a week are
carried out, elastic support garment with the
high compression ( 4 classes of the
compression), made on individual measures of
the patient to order («MEDI», Germany).
Patient with
Lymphedema III stage
(Savchenko T.V.,
Pokrovsky A.V.'s
classification, 2004)
At the I stage of Lymphedema
• recommendations about change of a way of
life
• the elastic compression
• courses of medicamentous therapy once a year
(mainly in summer)
• preventive and medical rehabilitation programs
(magnetic stimulation, a pneumocompression,
magnetic laser therapy, pulse matrix laser
therapy, balneotherapy, thalassotherapy),
At the II stage of Lymphedema
• recommendations about change of a way of life,
• compression therapy,
• courses of medicamentous treatment are spent 2
times a year.
• medical rehabilitation programs (a
pneumocompression, magnetic laser therapy,
pulse matrix laser therapy, magnetic stimulation,
cryotherapy, balneotherapy, thalassotherapy,
Manual Lymph Drainage and bandaging of the
limb) are spent 2 times a year.
At the III stage of Lymphedema
• to change of a way of life,
• compression therapy,
• Medical rehabilitation programs (a pneumocompression, magnetic laser therapy, magnetic
stimulation, pulse laser therapy, cryotherapy,
balneotherapy, thalassotherapy, Manual Lymph
Drainage and bandaging of the limb) are spent 2-3
times a year.
• Medicamentous treatment is spent by courses for 4-6
months and includes preventive appointment of the
prolonged antibiotics for prevention of relapses of an
erysipelatous inflammation.
At the IV stage of Lymphedema
• patients accept surgical treatment with
carrying out of conservative preoperative
preparation and postoperative
rehabilitation with use specified
physiotherapeutic and medicamentous
means.
Patiens with IV stage of Lymphedema
Patient with secondary Lymphedema II stage
(Savchenko T.V., Pokrovsky A.V.'s classification,
2004)
For treatment
After treatment
DEVELOPMENT PHYSIBALNEOTHERAPY
OF LYMPHEDEMA IN RUSSIA
Absence profile the special Lymphological
centres in Russia is compensated by an existing
wide network of branches of regenerative
medicine and Health Resort establishments.
At stages of regenerative and Health Resort
treatment patients with Lymphedema can spend
effective complex not medicamentous therapy
with application of a wide spectrum
physiobalneotherapeutic methods.
Conclusion
• Creation of modern rehabilitation
programs of regenerative treatment of
patients with Lymphedema has allowed to
raise considerably efficiency of
conservative Lymphedema treatment and
to create necessary base for development
in Russia a physiotherapeutic direction in
treatment Lymphedema of lower
extremities.