Complete decongestive therapy (CDT) is a noninvasive treatment for lymphedema. The therapy includes a variety of techniques, including manual lymphatic drainage, compression, exercise and skin care.
It is the best global treatment of lymphedema, also known as the gold standard treatment, according to the international guidelines of the International Society of Lymphology.
CDT originated in Europe and Australia but is now becoming more prevalent in the United States.
Complete decongestive therapy has two distinct phases:
1.) Intensive therapy or intensive phase, also called active therapy,
It takes place in a medical setting with a specially trained therapist.
consists of the mobilisation of fluid and the initiation of a decrease in the proliferated connective tissue.
To achieve maximum effectiveness or significant results, it is highly recommended for patients to be treated at least 5 times per week, 1 session per day for several weeks
Bandages with foam are worn about 23 hours per day and often only removed to bathe.
2.) Maintenance therapy or maintenance phase
It begins in the medical setting and then continues at home where patients and families use the techniques they learned in therapy.
This phase maintains the swelling reduction and aims for optimization of connective tissue reduction
It should last for months or for years
Elastic compression garments that fit like a second skin are worn during the day.
Often bandages with foam are worn at night to decrease daily daytime swelling.
Exercises are done while wearing compression.
Self manual lymphatic drainage is done for 20 minutes per day
The goal of complete decongestive therapy is to:
Reduce the swelling from lymphedema
Keep future swelling to a minimum and
Allow your child to live as active and healthy a life as possible.
Components of CDT
Complete decongestive therapy (CDT) consists of the following components:
Manual Lymphatic Drainage (MLD): A light skin stretching technique that stimulates the lymphatic system.
Compression Therapy: Layered bandaging with foam or specially fitted garments that support the area to control swelling.
Exercises: With compression, special exercises will help to pump lymph out of the swollen area.
Skin and Nail Care: Keeping the skin and nail clean will help prevent infections that often can happen with lymphedema particularly in those with lymph node dissection or removal, causing lower immune defence system, therefore more prone to acquiring infections. It is important to keep skin moisturised to protect the integumentary system and prevent the risk of developing infections such as cellulitis or fungal infections.
Self-Care Management and Training: Learning how to manage lymphedema at home including self bandaging or self MLD (as needed), thorough review of infection control practices, skin and nail care protocols, donning and doffing of compression garments, exercises, importance of follow-up/review visits[3].
Other support services: counselling, nutritional advice
Manual Lymphatic Drainage
MLD is a light, skin-stretching massage that helps promote the movement of lymphatic fluid out of the swollen limb.
It is worth noting that this is not the traditional massage.
It focuses on the lymph vessels to help the flow of lymphatic fluid.
It starts with the unaffected areas first, making it possible for the fluid to move out of the affected area, or “decongest” the region.
It helps to speed up lymph fluid flow through the lymphatics.
Diaphragmatic breathing is incorporated here to help increase movement of fluid toward the heart.
There are various techniques used in MLD. Watch out for this space for more information on these techniques.
Compression Therapy
Even when MLD is performed correctly, swelling does not decrease without compression (in most cases).
Compression bandages should remain on the extremities until the next session of MLD.
Products used for compression therapy are low-stretch bandages and elastic garments (elastic stockings/sleeve/gloves)
Bandaging is the main component of the complete decongestive therapy.
Bandaging is a mainstay of treatment for stage 2 and stage 3 lymphedema (moderate to severe lymphedema). Bandaging involves creating a soft cast on the arm or upper body by wrapping with multiple layers.
There are compression garments that are designed to keep a continuous pressure on the swollen/affected area to assist the drainage of fluid and minimize swelling. They are:
-Sleeve worn on the arm
-Fingerless glove or a gauntlet (which does not have individual finger openings), often worn with a sleeve
-Support bra for the chest area or a vest for the entire trunk area
Bandaging or sleeve, which is better?
A compression sleeve may be enough for mild lymphedema, however more advanced cases require bandaging before a compression sleeve can be used.
Bandaging works by reducing limb volume. Whereas, sleeves apply what’s known as resting pressure, meaning that the pressure is higher when the arm is at rest. When you move your arm, the elastic fabric moves right along with it, which actually reduces the amount of pressure.
Exercise
Initial phase
Gentle stretches and Range of Motion exercises to improve lymphatic flow
Latter phase
Aerobic exercises to improve physical fitness and reduce body weight
Generally, a combination of stretching, monitored strengthening exercises, and aerobic activities are recommended, but the plan has to be individualized. If client has more ambitious fitness goals work towards this gradually.
Skin Care
The skin of patients with lymphedema is usually very sensitive, dry, and itchy due to disturbances of skin metabolism
Due to the impaired healing process, skin injury can lead to severe inflammation, infection (eg cellulitis) or even ulcers, worsening the condition, thus therapeutic and protective measures are essential components of skin care.
Compression therapy may lead to a dry, broken, and sensitive skin which is prone to injuries.
The aim is to keep the skin in a normal and healthy state, or to heal it as well as possible.
Patients skin must be completely dry after a bath
Soft pharmaceuticals must be used for hydrating ski
Compression garments should not be applied if the products have not been fully absorbed.
All skin infections should be treated and cleaned by a doctor.
During treatment, special attention should be paid to the care of any secondary skin lesions resulting from radiation.
Infections and Ulcers must be treated and managed.
Your therapist will guide you and instruct you about all the needful including self care to be taken by you.
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