1. Megan Davis, Kristin Hamrick, Bret Ramsey, Briana Ulanowski
In patients with lymphedema, are alternative or traditional treatments more effective at removing fluid from the extremities?
Megan Davis, Kristin Hamrick, Bret Ramsey, Briana Ulanowski

2. Objective Define lymphedema Describe traditional treatment
Describe and discuss multiple alternative treatments.
Discuss results, conclusion, and clinical significance.

3. Lymphedema Lymphatic System Lymphedema Progression Stage 0 Stage 1
Sanitation System
Waste Disposal
Fluid Check
One-way system
Lymphedema
Progression
Stage 0
Stage 1
Stage 2
Stage 3
Bodies immune system defender.
In that it transports and drains excess fluids, proteins, and cellular debris from the interstitial spaces that are not reabsorbed by venous system.
Maintains proper fluid balance
Drains into the venous system does not go the other direction like that of the heart.

4. Complete Decongestive Therapy
Systematic Order of Treatment (Lasinski 2012)
Manual Lymphatic Draining
Compression
Systematic Literature Review
complete decongestive therapy is effective and has a positive impact on quality of life in patients with varying severities of lymphedema continued compression of the affected area is required to maintain treatment results.

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6. Complete Decongestive Therapy
Systematic Order of Treatment
Manual Lymphatic Draining
Compression
Exercise
Proper Self-Care

7. Why use alternate techniques? (Rodrick et al 2013)
Qualifications
Time
Money
Resources
Reimbursement
Compliance

8. Alternative Treatments
Kinesio Tex Tape
Tsai et al 2009
Morris et al 2013
Rodrick et al 2013
Acupuncture & Moxibustion
Wanchai et al 2012
Low-level laser therapy

9. Kinesio Tex Tape
Compression bandage used in CDT replaced with Kinesio Tex Tape
Mimics skin
Aid systems
Provide mechanical support
Lift skin from tissue beneath
Releases pressure
Thickness and Flexibility
Muscle and Lymphatic Systems
Without restricting movement
Provides space for lymphatic fluid movement

10. Kinesio Tex Tap Literature
Patients with unilateral breast-cancer lymphedema for at least 3 months (Tsai et al 2009)
N=41 randomly assigned
CDT or Modified with Kinesio Tex Tape
Systematic Review of the Literature (Morris et al 2013)
Includes Tsai et al Support Care Cancer 2009
No significant differences between groups for outcome measures [including side effects]
KTT is no more effective than usual care SSB [ in breast cancer related lymphedema outcomes]
KTT had increased wound development than SSB
SSB is more cost effective over an extended treatment period

11. Literature (Cont.) Systematic Review Literature (Rodrick et al 2013)
Better after 1 month treatment
Unaware of long-term management with tape
Likely to be effective with CDT
Article
Tsai et al 2009
Morris et al 2013
Rodrick et al 2013
Significant Findings
None

12. Acupuncture & Moxibustion
Traditional Chinese Medicines
Acupuncture
Moxibustion
Side Effects
Preventative Measure
Treatment for patients that acquired lymphedema
Fine, solid, stainless steel needle inserted under skin for stimulation
Body stimulation using heat from the smoldering herb mugwort
Bruising, bleeding, pain and fatigue

13. Wanchai et al 2012 Systematic Review of 4 Studies Significant Findings
Decrease hardness and swelling
Increase Body Temperature
Significant Findings
Measure Yourself Medical Outcome Profile
SF-36 bodily pain and vitality subscales
ROM, degree of lymphedema
30% Reduction lymphedema by circumference

14. Rodrick et al 2013 Acupuncture stimulate anatomical locations on skin
Pressure or needle with/without electrical stimulation
Significant Findings
Increased shoulder ROM
Improved altered sensory issues
Less density perceived

15. Low-Level Laser Therapy
Softening scar tissue by increasing
Lymphatic motoricity, Lymphangiogenesis, macrophage activity
Unblock lymphatic system
Not associated with CDT

16. Rodrick et al 2013 Likely to be effective Limb-volume reduction
Shoulder mobility
Grip strength
Self-reported symptoms
1) Independent of compression and CDT
2) Pain, function, QOL, and softening tissue

17. Conclusion Most effective treatment
Complete Decongestive Therapy
More literature on alternative treatments is needed.

18. References
Lasinski BB. Complete decongestive therapy for treatment of lymphedema. Seminars in oncology nursing. 2013;29(1):20–7. doi: /j.soncn
Morris D, Jones D, Ryan H, Ryan CG. The clinical effects of Kinesio® Tex taping: A systematic review. Physiotherapy theory and practice. 2013;29(4):259–70. doi: /
Rodrick JR, Poage E, Wanchai A, Stewart BR, Cormier JN, Armer JM. Complementary, Alternative, and Other Non-Complete Decongestive Therapy (CDT) Treatment Methods in the Management of Lymphedema: A Systematic Search and Review. PM & R : the journal of injury, function, and rehabilitation doi: /j.pmrj
Tsai H-J, Hung H-C, Yang J-L, Huang C-S, Tsauo J-Y. Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2009;17(11):1353–60. doi: /s
Wanchai A, Armer JM, Stewart BR. Complementary and alternative medicine and lymphedema. Seminars in oncology nursing. 2013;29(1):41–9. doi: /j.soncn