Mechanical lymphatic drainage in the treatment of arm lymphedema
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Sep 17, 2009, 3:29:25 AM9/17/09
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Mechanical lymphatic drainage in the treatment of arm lymphedema
Date of Web Publication 9-Sep-2009
Newton Antonio Bordin1, Maria de Fatima Guerreiro Godoy2, Jose Maria
Pereira de Godoy3
1 Department, Medicine School in Sao Jose de Rio Preto-FAMERP, Brazil
2 Occupational Therapist, Brazil
3 Department of the Medicine School in Sao Jose do Rio Preto-FAMERP,
Brazil
Correspondence Address:
Jose Maria Pereira de Godoy
Department of the Medicine School in Sao Jose do Rio Preto-FAMERP
Brazil
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0019-509X.55556
Abstract
Exercising is one of the three cornerstones in the treatment of
lymphedema together with contention mechanisms and lymphatic drainage.
The aim of the current study was to evaluate a new method of mechanic
lymphatic drainage. Volumetric reductions were evaluated after passive
exercises in 25 patients with arm lymphedema resulting from breast
cancer treatment. Their ages ranged between 42 and 86 years old. All
patients were submitted to one-hour sessions using the RAGodoy®
electromechanical apparatus which performs from 15 to 25 elbow bending
and stretching exercises per minute. Volumetry, using the water
displacement technique, was performed before and after the sessions.
The paired t-test was employed for statistical analysis with an alpha
error of less than 5% being considered acceptable. The reduction in
volume was significant (P-value < 0.001) with a mean initial volume of
2026.4 and final volume of 1967.2 giving a mean loss of 59.2 mL. The
RAGodoy® apparatus was efficient to reduce the volume of
lymphedematous arms and is an option for the treatment of lymphedema.
Keywords: Apparatus, lymphatic drainage, lymphedema, treatment
Introduction
Lymphedema is characterized by an abnormal accumulation of fluids and
other substances in the tissue caused by a failure of the lymphatic
drainage system associated to an insufficiency of extralymphatic
proteolysis of the cellular interstice and mobilization of
macromolecules. [1],[2] There is no specific therapy for lymphedema
however an association of therapies, [3] including lymphatic drainage,
[4],[5],[6] myolymphokinetic exercises, [7],[8] stockings and
bandages, [9],[10],[11],[12] personal hygiene and care while
performing day-to-day activities, [13],[14] psychological support,
[15],[16] and drugs with a lymphokinetic action [17] is recommended.
Exercising is one of the three cornerstones in the treatment of
lymphedema together with contention mechanisms and lymphatic drainage.
However, there are few studies evaluating mechanical lymphatic
drainage of the arms. [18],[19]
The aim of the current study was to evaluate a new method of
mechanical lymphatic drainage utilizing the RAGodoy® apparatus.
Method
Volumetric reductions were evaluated after passive exercises in 25
patients with arm lymphedema resulting from breast cancer treatment.
Their ages ranged between 42 and 86 years old. The diagnosis of
lymphedema was clinical confirmed by lymphoscintigraphy and volumetry.
Lymphedema of the limbs was considered when the difference in volume
was more than 200 mL when compared with the contralateral arm.
Exclusion criteria were active infections and joint or neurologic
limitations. Patients from the Lymphedema Treatment Center were
selected according to the order of arrival and acceptance to
participate in the study. All patients were submitted to a one-hour
session using the RAGodoy® electromechanical apparatus which performs
from 15 to 25 elbow bending and stretching exercises per minute.
Volumetry was performed using the water displacement technique before
and after the one-hour session. The paired t-test was utilized for
statistical analysis with an alpha error of less than 5% being
considered acceptable.
The study was approved by the Research Ethics Committee of the
Institute of Biosciences, Languages and Exact Sciences (IBILCE) in São
José do Rio Preto, Brazil.
Results
The reduction in the volume was significant ( P -value < 0.001) with a
mean initial volume of 2026.4 and a final volume of 1967.2 giving an
average loss of 59.2 mL. Of the 25 evaluations there was a reduction
in 23 assessments and in only two there was an increase in volume.
[Table 1] shows the volumetric measurements before and after each
session.
» Discussion
The current study demonstrates a new option of mechanical lymphatic
drainage performed using a new apparatus specifically developed for
the treatment of arm lymphedema. This apparatus was developed taking
into account the venous and lymphatic return physiologies that utilize
contraction mechanisms within the muscles to produce lymphovenous
drainage. No apparatus has been reported in the literature with this
characteristic of lymphatic drainage for the arms. The authors
developed an apparatus with similar characteristics for the legs. [19],
[20],[21]
An association of therapies is suggested for the treatment of
lymphedema with this new approach being another option for arm
lymphedema.
The precautions related to the use of the apparatus are the velocity
and the time that each patient will tolerate exercising. Exercising
can be performed continuously or at intervals depending on the
patient. An increase of volume occurred in two patients during the
exercising, however these patients were reevaluated after other one-
hour sessions of exercises and they experienced a reduction in the
volume of the arm. Hence, appropriate guidance is important for
patients as they should not try to control the movements; they must be
performed passively by the apparatus. It is important that the
contraction mechanism drains more than the capacity of capillary
filtration. Thus, passive exercises are better in the treatment of
lymphedema because they demand a lower blood supply to the muscles and
hence less capillary filtration.
» References
1. Godoy JMP. Fisiopatologia do Sistema Linfático. In: Godoy JMP,
Belczak CEQ, Godoy MFG. Reabilitação Linfovenosa. Rio de Janeiro;
DiLivros: 2005. p. 37-41.
2. Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban
and Fischer: 2003. p. 233.
3. Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban
and Fischer: 2003. p. 280.
4. Godoy JMP, Godoy MFG. Manual lymph drainage: a new concept. J Vasc
Br March 2004;03:77-80.
5. Godoy JMP, Braile DM, Godoy MFG. A Thirty-month Follow-up of the
Use of a New Technique for Lymph Drainage in Six Patients. European
Journal Vascular Endovascular Surgery 2002;3:91-3.
6. Wittlinger H, Wittlinger G. Textbook of Dr. Vodder's Manual
Lymphatic Drainage. Brussels; HAUG: 1995. p. 124.
7. Pancheri MA. Tratamiento Miolinfokinético. In: Ciucci JL Linfedema
Del Miembro Superior. Postratamiento Del Cáncer De Mama. Buenos Aires:
Nayarit; 2004. p.110-22.
8. McKenzie DC, Kalda AL. Effect of Upper Extremity Exercise on
Secondary Lymphedema in Breast Câncer Patients: A Pilot Study. Journal
of Clinical Oncology 2003;21:463-6.
9. Artíbale MES, Godoy JMP, Godoy MFG, Braile DM. A new option for
compression in the treatment of lymphedema in children. J Vasc Br
2005;4:311-3.
10. Foldi M, Foldi E, Kubik S.Compression Therapy. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen: Urban
and Fischer; 2003. p. 528-88.
11. Thomas O' Donnell. Principles of Medical and Physical Treatment.
In: Browse SN, Burnand KG, Mortimer OS Disease of the Lymphatics.
London; Arnold: 2003. p.168.
12. GodoyJMP, Godoy MFG. Assessment of inelastic sleeves in patients
with upper limb lymphoedema. Indian Journal of Physiotherapy and
Occupational Therapy 2007;1:3-5.
13. Godoy JMP, Silva SH. Prevalence of cellulitis and erysipelas in
post-mastectomy patients after breast câncer. Arch Med Sci
2007;3:249-51.
14. Godoy MFG. Atividades de Vida Diária no Tratamento do Linfedema.
Lymphology 2002/03;35:213-5l.
15. Wilson RW, Hutson LM, Vanstry D. Comparison of 2 quality-of-life
questionnaires in women treated for breast cancer: The RAND 36-Item
Health Survey and the Functional Living Index-Cancer. Phys Ther
2005;85:851-60.
16. Critelli M, Lamuedra I. Tratamiento Psicológico. In: Ciucci JL
Linfedema Del Miembro Superior. Postratamiento Del Cáncer De Mama.
Buenos Aires:Nayarit, 2004. p. 143-50.
17. Ciucci JL, Ayguavella J. Tratamiento Farmacológico. In Ciucci JL
Linfedema del Miembro Superior. Buenos aires; Nayarit: 2004. p.
123-30.
18. Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation
of a novel alternative for maintenance therapy of breast cancer-
associated lymphedema. BMC Cancer 2006;6:84.
19. Godoy JMP, Godoy MFG. Desarrollo y evaluación de un aparato para
el drenaje de edemas. Angiología 2006;58:505-7.
20. Godoy JMP, Godoy MFG. New apparatus for mechanical lymph drainage
in association of therapies in threatment od lymphoedema. Acta Phlebol
2005;6:125-8.
21. de Godoy JM, Godoy Mde F. Development and evaluation of a new
apparatus for lymph drainage: preliminary results. Lymphology
2004;37:62-4.
Indian Journal of Cancer
http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2009;volume=46;issue=4;spage=337;epage=339;aulast=Bordin
Date of Web Publication 9-Sep-2009
Newton Antonio Bordin1, Maria de Fatima Guerreiro Godoy2, Jose Maria
Pereira de Godoy3
1 Department, Medicine School in Sao Jose de Rio Preto-FAMERP, Brazil
2 Occupational Therapist, Brazil
3 Department of the Medicine School in Sao Jose do Rio Preto-FAMERP,
Brazil
Correspondence Address:
Jose Maria Pereira de Godoy
Department of the Medicine School in Sao Jose do Rio Preto-FAMERP
Brazil
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/0019-509X.55556
Abstract
Exercising is one of the three cornerstones in the treatment of
lymphedema together with contention mechanisms and lymphatic drainage.
The aim of the current study was to evaluate a new method of mechanic
lymphatic drainage. Volumetric reductions were evaluated after passive
exercises in 25 patients with arm lymphedema resulting from breast
cancer treatment. Their ages ranged between 42 and 86 years old. All
patients were submitted to one-hour sessions using the RAGodoy®
electromechanical apparatus which performs from 15 to 25 elbow bending
and stretching exercises per minute. Volumetry, using the water
displacement technique, was performed before and after the sessions.
The paired t-test was employed for statistical analysis with an alpha
error of less than 5% being considered acceptable. The reduction in
volume was significant (P-value < 0.001) with a mean initial volume of
2026.4 and final volume of 1967.2 giving a mean loss of 59.2 mL. The
RAGodoy® apparatus was efficient to reduce the volume of
lymphedematous arms and is an option for the treatment of lymphedema.
Keywords: Apparatus, lymphatic drainage, lymphedema, treatment
Introduction
Lymphedema is characterized by an abnormal accumulation of fluids and
other substances in the tissue caused by a failure of the lymphatic
drainage system associated to an insufficiency of extralymphatic
proteolysis of the cellular interstice and mobilization of
macromolecules. [1],[2] There is no specific therapy for lymphedema
however an association of therapies, [3] including lymphatic drainage,
[4],[5],[6] myolymphokinetic exercises, [7],[8] stockings and
bandages, [9],[10],[11],[12] personal hygiene and care while
performing day-to-day activities, [13],[14] psychological support,
[15],[16] and drugs with a lymphokinetic action [17] is recommended.
Exercising is one of the three cornerstones in the treatment of
lymphedema together with contention mechanisms and lymphatic drainage.
However, there are few studies evaluating mechanical lymphatic
drainage of the arms. [18],[19]
The aim of the current study was to evaluate a new method of
mechanical lymphatic drainage utilizing the RAGodoy® apparatus.
Method
Volumetric reductions were evaluated after passive exercises in 25
patients with arm lymphedema resulting from breast cancer treatment.
Their ages ranged between 42 and 86 years old. The diagnosis of
lymphedema was clinical confirmed by lymphoscintigraphy and volumetry.
Lymphedema of the limbs was considered when the difference in volume
was more than 200 mL when compared with the contralateral arm.
Exclusion criteria were active infections and joint or neurologic
limitations. Patients from the Lymphedema Treatment Center were
selected according to the order of arrival and acceptance to
participate in the study. All patients were submitted to a one-hour
session using the RAGodoy® electromechanical apparatus which performs
from 15 to 25 elbow bending and stretching exercises per minute.
Volumetry was performed using the water displacement technique before
and after the one-hour session. The paired t-test was utilized for
statistical analysis with an alpha error of less than 5% being
considered acceptable.
The study was approved by the Research Ethics Committee of the
Institute of Biosciences, Languages and Exact Sciences (IBILCE) in São
José do Rio Preto, Brazil.
Results
The reduction in the volume was significant ( P -value < 0.001) with a
mean initial volume of 2026.4 and a final volume of 1967.2 giving an
average loss of 59.2 mL. Of the 25 evaluations there was a reduction
in 23 assessments and in only two there was an increase in volume.
[Table 1] shows the volumetric measurements before and after each
session.
» Discussion
The current study demonstrates a new option of mechanical lymphatic
drainage performed using a new apparatus specifically developed for
the treatment of arm lymphedema. This apparatus was developed taking
into account the venous and lymphatic return physiologies that utilize
contraction mechanisms within the muscles to produce lymphovenous
drainage. No apparatus has been reported in the literature with this
characteristic of lymphatic drainage for the arms. The authors
developed an apparatus with similar characteristics for the legs. [19],
[20],[21]
An association of therapies is suggested for the treatment of
lymphedema with this new approach being another option for arm
lymphedema.
The precautions related to the use of the apparatus are the velocity
and the time that each patient will tolerate exercising. Exercising
can be performed continuously or at intervals depending on the
patient. An increase of volume occurred in two patients during the
exercising, however these patients were reevaluated after other one-
hour sessions of exercises and they experienced a reduction in the
volume of the arm. Hence, appropriate guidance is important for
patients as they should not try to control the movements; they must be
performed passively by the apparatus. It is important that the
contraction mechanism drains more than the capacity of capillary
filtration. Thus, passive exercises are better in the treatment of
lymphedema because they demand a lower blood supply to the muscles and
hence less capillary filtration.
» References
1. Godoy JMP. Fisiopatologia do Sistema Linfático. In: Godoy JMP,
Belczak CEQ, Godoy MFG. Reabilitação Linfovenosa. Rio de Janeiro;
DiLivros: 2005. p. 37-41.
2. Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban
and Fischer: 2003. p. 233.
3. Foldi M, Foldi E, Kubik S.Lymphostatic Disease. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen; Urban
and Fischer: 2003. p. 280.
4. Godoy JMP, Godoy MFG. Manual lymph drainage: a new concept. J Vasc
Br March 2004;03:77-80.
5. Godoy JMP, Braile DM, Godoy MFG. A Thirty-month Follow-up of the
Use of a New Technique for Lymph Drainage in Six Patients. European
Journal Vascular Endovascular Surgery 2002;3:91-3.
6. Wittlinger H, Wittlinger G. Textbook of Dr. Vodder's Manual
Lymphatic Drainage. Brussels; HAUG: 1995. p. 124.
7. Pancheri MA. Tratamiento Miolinfokinético. In: Ciucci JL Linfedema
Del Miembro Superior. Postratamiento Del Cáncer De Mama. Buenos Aires:
Nayarit; 2004. p.110-22.
8. McKenzie DC, Kalda AL. Effect of Upper Extremity Exercise on
Secondary Lymphedema in Breast Câncer Patients: A Pilot Study. Journal
of Clinical Oncology 2003;21:463-6.
9. Artíbale MES, Godoy JMP, Godoy MFG, Braile DM. A new option for
compression in the treatment of lymphedema in children. J Vasc Br
2005;4:311-3.
10. Foldi M, Foldi E, Kubik S.Compression Therapy. In: Textbook of
Lymphology. For Physicians and Lymphedema Therapists. Munchen: Urban
and Fischer; 2003. p. 528-88.
11. Thomas O' Donnell. Principles of Medical and Physical Treatment.
In: Browse SN, Burnand KG, Mortimer OS Disease of the Lymphatics.
London; Arnold: 2003. p.168.
12. GodoyJMP, Godoy MFG. Assessment of inelastic sleeves in patients
with upper limb lymphoedema. Indian Journal of Physiotherapy and
Occupational Therapy 2007;1:3-5.
13. Godoy JMP, Silva SH. Prevalence of cellulitis and erysipelas in
post-mastectomy patients after breast câncer. Arch Med Sci
2007;3:249-51.
14. Godoy MFG. Atividades de Vida Diária no Tratamento do Linfedema.
Lymphology 2002/03;35:213-5l.
15. Wilson RW, Hutson LM, Vanstry D. Comparison of 2 quality-of-life
questionnaires in women treated for breast cancer: The RAND 36-Item
Health Survey and the Functional Living Index-Cancer. Phys Ther
2005;85:851-60.
16. Critelli M, Lamuedra I. Tratamiento Psicológico. In: Ciucci JL
Linfedema Del Miembro Superior. Postratamiento Del Cáncer De Mama.
Buenos Aires:Nayarit, 2004. p. 143-50.
17. Ciucci JL, Ayguavella J. Tratamiento Farmacológico. In Ciucci JL
Linfedema del Miembro Superior. Buenos aires; Nayarit: 2004. p.
123-30.
18. Wilburn O, Wilburn P, Rockson SG. A pilot, prospective evaluation
of a novel alternative for maintenance therapy of breast cancer-
associated lymphedema. BMC Cancer 2006;6:84.
19. Godoy JMP, Godoy MFG. Desarrollo y evaluación de un aparato para
el drenaje de edemas. Angiología 2006;58:505-7.
20. Godoy JMP, Godoy MFG. New apparatus for mechanical lymph drainage
in association of therapies in threatment od lymphoedema. Acta Phlebol
2005;6:125-8.
21. de Godoy JM, Godoy Mde F. Development and evaluation of a new
apparatus for lymph drainage: preliminary results. Lymphology
2004;37:62-4.
Indian Journal of Cancer
http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2009;volume=46;issue=4;spage=337;epage=339;aulast=Bordin
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