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Lymphedema is a chronic medical condition caused by an abnormal accumulation of protein-rich lymphatic fluid in the extra-vascular (interstitial) space, causing recurrent or progressive swelling associated with physical, psychosocial, and occupational performance complaints (Ramos, O'Donnell, & Knight, 1999; Woods, Tobin, & Mortimer, 1995). Lymphedema onset is associated with a variety of medical diagnoses including venous disease, infection, and oncological, orthopedic and congenital issues. Occupational therapy services are indicated to assist clients to concurrently address integration of lymphedema self-management techniques into daily living and any occupational performance complaints associated with lymphedema onset. Occupational therapists can enhance their professional practice by pursuing continuing education opportunities to develop specialized clinical skills in lymphedema assessment and treatment.
This article will discuss various issues facing the client with lymphedema, and the role of the occupational therapist in dealing with those issues. It will also briefly describe complete decongestive therapy (CDT), a widely accepted treatment protocol, which integrates client self-management as a key component of treatment interventions (Executive Committee of International Society of Lymphology, 2009).
Reduced independence
Chronic lymphedema may contribute to clients developing physical impairments including mobility restrictions and orthopedic or soft tissue issues. Impaired client strength, endurance, dexterity, and mobility may contribute to functional performance complaints (Crane, 2009; Helms, Kuhn, Moser, Remmel, & Kreienberg, 2009). Physical complaints may impede our clients' ability to complete lymphedema selfmanagement strategies including: ability to don and doff graduated compression garments, routine self-bandaging, and skin care. The occupational therapist's skill in activity analysis will facilitate addressing these challenges by introducing adaptive strategies, equipment and biomechanical education to promote client independence. The occupational therapist's ability to successfully address these functional issues may be the difference between our clients' success in managing their lymphedema independently versus having to rely on daily caregiver assistance.
Clients' effective self-management may contribute to a reduction in secondary complications including the risk of serious infection requiring emergency department visits or hospitalization (Williams, Franks, & Moffatt, 2005). Ko, Lerner, Klose, and Kosimi (1998) found that incidence of infections decreased from 1.10 infections per patient per year to 0.65 infections per patient per year after a course of intensive therapy followed by consistent client self-management. The occupational therapist needs to consider assessing clients' abilities with bathing, skin care, wound care, and appropriately...