LymphaTouch® As a Tool for Manual Lymph Drainage: A Therapist’s Perspective Karlie Kimball, Student in Occupational Therapy Faculty Advisor: Daniel Panchik, DSc., OTR/L, CLT-LANA   Pictures: Lymphatics- http://www.apsubiology.org/anatomy/2020/2020_Exam_Reviews/Exam_2/CH20_Gross_Anatomy_of_the_Lymphatic_System.htm LymphaTouch- https://www.lymphatouch.com/ Lymphedema, swelling due to impaired flow of lymph fluid, is a result of interrupted lymph circulation of the lymphatic system. This project aims to review and synthesize literature regarding the physiology of the lymphatic system, in particular, lymph flow, treatment of lymphedema involving the use of manual lymph drainage (MLD), and technology advances in the use of negative pressure in treatment and intervention in lymph flow. In addition to the literature review and synthesis, one certified lymphedema therapist was interviewed and asked to provide commentary on her experience using an advanced technology, the LymphaTouch®. Abstract LymphaTouch® was created in 2009 by developers in Finland Uses negative pressure and high-frequency vibrations to produce the effects of MLD Negative pressure is used to stimulate fluid flow and heal fibrotic tissues Pulls the tissue to increase lymph movement Moves the tissue vertically and horizontally in order to move the anchoring filaments that cause the lymph to remain static When these filaments are moved, endothelial cells open, causing lymph to be able to move Higher frequency vibrations stimulate the superficial layer of lymphatic system Lower frequency vibrations work to stimulate the deep layer of the lymphatic system LymphaTouch® and Negative Pressure Maureen McBeth, MPT, CLT-LANA was interviewed Clinician of lymphedema as well faculty at Norton School of Lymphatic Therapy Permission given to use her name Has been working with patients with lymphedema for 14 years and using LymphaTouch ® for 5 years Stated that using the device feels like “an extra pair of hands” when combined with MLD Difficult to compare MLD from LymphaTouch because they are so different. MLD calms the whole nervous system, but the device activates the lymphatic system and affects local tissues Can treat many different side effects from cancer treatment including lymphedema, cording, peripheral neuropathy, and other sensory deficiencies “LymphaTouch ® can help you adapt to all of those problems” Little research has been conducted to test the effect on cording, neuropathy, etc Challenges: after 5 years of usage, handle is cracked, but all challenges are related to mechanical design and durability, not the outcomes McBeth is working with the company to improve the overall design Contraindications: patients with sensitive skin or taking blood thinners may have a “cupping” effect Never had a patient with a negative response; does not cause pain Vuorinen et al. (2013) suggested similar outcomes Used in latency stage to see if the patient is having any subtle changes and help treat them early Iivarinen et al. (2013) suggested similar outcomes States that she believes it works best with cyclic pressure Iivarinen et al. (2016) suggested that continuous was better; more research should be conducted Clinical Commentary from Maureen McBeth, MPT, CLT-LANA LymphaTouch ® Literature The lymphatic system is a one-way system that transports lymph from the body cavities and interstitial spaces to the heart; plays large role in immune response (McLafferty et al., 2012) Lymph is watery fluid that carries clotting factors, fats, and proteins Lymphedema is a disruption of the lymphatic system causing accumulation of lymph Can be classified as primary or secondary (Buragadda et al., 2015) Lymphatic System and Lymphedema Authors Research and Findings Airakisinen, Vuorinen, and Raittila (2011) 18 patients treated; edema and perceived pain measured before and after treatment 20 minutes treatment sessions Patients with shoulder, neck, knee edema showed significant pain decrease; elbow edema a moderate decrease Suggests LymphaTouch® is a safe form of pain reduction Vuorinen, Ivarinen, Jurvelin, and Airaksinen (2013) 13 women with upper extremity lymphedema as a result of mastectomy LymphaTouch® group and MLD group 10 treatments lasting for 90 minutes Significant changes in tissue stiffness, degree of disability, limb volume Suggests LymphaTouch® is a positive and safe treatment that does not have adverse effects Iivarinen, Korhonen, Julkunen, and Jurvelin (2013) Looked at LymphaTouch® and its contributions to soft tissue changes Tested forearm while resting and while experiencing venous occlusion Found that LymphaTouch® can be used to diagnose and screen for changes in soft tissue in addition to lymphedema and other swelling conditions Iivarinen, Korhonen, & Jurvelin (2016) Looked at cyclic or continuous LymphaTouch® protocols 11 participants were placed into either cyclic or continuous protocols Cyclic: pressure varies to allow skin to move and then stop Continuous: continuous pressure Continuous pressure found to have more efficient fluid movement Found that negative pressure models can increase free movement of fluid Osborne and Newell (2015) Used two phases, subfascial and superficial, to reach both deep and superficial lymphatic systems Purpose was to move the lymph from the deep system to the superficial system Reduced inflammation, proteolytic activity, adipose tissue, and fibrosis Occupational therapy is necessary because lymphedema decreases quality of life, work and leisure participation, and impairs occupational engagement (Pergolotti et al., 2016) Complete Decongestive Therapy (CDT) is well recognized as an effective form of treating lymphedema CDT aims to reduce the swelling in the limbs to either a “normal” state or to a state where the size of the limb has stabilized (Quirion, 2009) Four steps within CDT Manual Lymph Drainage Uses light touch to move the lymph through altering lymph flow through normal healthy lymphatics and lymph node basins Compression bandaging Opens up lymphatic tracts and keeps them stimulated to prevent the accumulation of lymph Meticulous skin care Remedial exercises Treatment of Lymphedema A complete list of references is available upon request References Elizabethtown College Occupational Therapy Department Maureen McBeth, MPT, CLT-LANA Acknowledgements