Workshop C includes two separate presentations covering two different topics.
MPPA, OTR/L, CLT-LANA
Treating Orthopedic Edema
- Identify the basic anatomy and physiology of the lymphatic and venous system.
- Describe how edema can impede tissue healing and orthopedic outcomes.
- Explain why manual lymph drainage is more effective than retrograde massage.
Casas, L., DePoli, P. Manual Lymphatic Drainage Therapy: An Integral Component of Postoperative Care in Plastic Surgery Patients. Chicago: The First Annual Conference of the American Society of Lymphology, August 21-22, 1999.
Casley-Smith JR, Casley-Smith JR. Modern Treatment of Lymphoedema. Adelaide, Australia: The Lymphedema Association of Australia; 1997.
Choi I, Lee S, and Hong YK. The New Era of the Lymphatic System: No Longer Secondary to the Blood Vascular System. Cold Spring Harb Perspect Med. 2012; 2(4).
Colditz JC. Therapist’s management of the stiff hand. In: Hunter J, Macklin E, Callahan A, eds. Rehabilitation of the Hand: Surgery and Therapy. St. Louis: Mosby; 1995: 1141-1145.
Ebert JR1, Joss B, Jardine B, Wood DJ. Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty. Arch Phys Med Rehabil. 2013 Nov; 94(11): 2103-11. Epub 2013 Jun 26.
Eliska O, Eliskova M. Are peripheral lymphatics damaged by high pressure manual massage? Lymphology. 1995; 28: 21-30.
Foeldi M, Foeldi E, et. al (Eds in Chief). Foeldi’s Textbook of Lymphology for Physicians and Lymphedema Therapists. Urban & Fischer; 2006.
Honigman L, Ofrit B, Yarnitsky D, Sprecher E, Grnaovsky Y. Nonpainful wide-area compression inhibits experimental pain. Pain. 2016 Sep; 157(9): 2000–2011.
Hsu AF, Franceschina D, Haddad S. A novel method of postoperative wound care following total ankle arthroplasty. American Orthopaedic Foot & Ankle Society. 2014; 35(7): 719-724.
Inoue K1, Maruoka H. Effects of simplified lymph drainage on the body: in females with menopausal disorder. J Phys Ther Sci. 2017 Jan;29(1):115-118. doi: 10.1589/jpts.29.115. Epub 2017 Jan 30.
Kloth LC, McCulloch JM. The inflammatory response to wounding. In: McCulloch JM, Kloth LC, Feeder JA, eds. Wound Healing: Alternatives in Management. Philadelphia: FA Davis; 1995: 3-15.
Lee DY, et. al. The comparison of manual lymph drainage and ultrasound therapy on the leg swelling caused by wearing high heels. Technol Health Care. 2014;22(3):309-15. doi: 10.3233/THC-140785.
Lopera C, Worsley PR, Bader DL, Fenlon D. Investigating the Short-Term Effects of Manual Lymphatic Drainage and Compression Garment Therapies on Lymphatic Function Using Near- Infrared Imaging. Lymphat Res Biol. 2017 Jul 27. doi: 10.1089/lrb.2017.0001. [Epub ahead of print]
Majewski-Schrage T1, Snyder K. The effectiveness of manual lymphatic drainage in patients with orthopedic injuries. J Sport Rehabil. 2016 Feb; 25(1): 91-7. doi: 10-1123/jsr.2014-0222. Epub 2015
Miller GE, Seale J. Lymphatic clearance during compressive loading. Lymphology. 1981; 14: 161-166.
Vicki received certification in Lymphedema Management in 2005, and in 2007, she successfully completed certification through the Lymphedema Association of North America (LANA). In 2011, Vicki attended an advanced lymphedema course at the world-renowned Foeldi Clinic in Germany.
Vicki relocated to Denver in 2013 and established an outpatient clinic called Edema Rehab to address lower extremity swelling challenges secondary to oncology, trauma, hereditary, and orthopedic conditions. Previously, she worked at the Adventist Rehabilitation Hospital of Maryland for over 9 years. During that time, she established and built an inpatient and outpatient lymphedema program within two hospital and outpatient clinic locations. That program has grown to employ 8 lymphedema therapists. In April 2016, Vicki joined UCHealth as a senior OT and has a goal to establish the University of Colorado Health System as a Center for Lymphatic Excellence.
Vicki has served as a course instructor for Klose Training and Consulting since 2010. She teaches both the Lymphedema Therapy Certification and Orthopedic Swelling Solutions courses all over the USA. In addition, Vicki has also traveled to Malaysia to teach both basic and advanced lymphedema therapy to health professionals in that country.
Vicki is passionate about sharing her knowledge and experience with patients, family members, and healthcare professionals. Her primary focus is geared toward teaching patients to become independent in managing swelling associated with lymphedema, surgery, trauma, and/or obesity. By decreasing swelling, patients benefit from decreased pain and improved range of motion, ADLs and mobility.
MS, OT, CLT-LANA
The Management of Lymphostatic Fibrosis
- List five types of fibrosis associated with lymphedema.
- Identify at least three methods of upgrading current complete decongestive (CDT) practice to increase effectiveness in treating lymphedema and associated fibrosis.
Agrawal, S (2014) Late effects of cancer treatment in breast cancer survivors. South Asian Journal of Cancer (3)2: 112-115.
Albasini et al (2010) Using Whole Body Vibration in Physical Therapy and Sport: Clinical Practice and Treatment Exercises. Churchill Livingstone.
Aldridge M et al (2017) Effect of pneumatic compression therapy on lymph movement in lymphedema-affected extremities, as assessed by near-infrared fluorescence lymphatic imaging. Journal of Innovative Optical Health Sciences 10(2):1-10.
American Cancer Society (2013) Breast Cancer Facts & Figures 2013-2014. Atlanta: American Cancer Society, Inc.
Anderson, S et al (2008) Randomised, double blinded, placebo controlled, crossover trial determining the effect of treating post-mastectomy lymphoedema with LTU-904H Laser Therapy. Retrieved from http://riancorp.com/media/ClinicalTrialSummary.pdf
Anscher M (2005) The irreversibility of radiation-induced fibrosis: fact or folklore? Journal of Clinical Oncology 23 (34): 8551-8552.
Archambeau JO, Pezner R, Wasserman T (1995) Pathophysiology of irradiation skin and breast. International Journal of Radiation Oncology Biology and Physics 31: 1171–85.
Ashforth K et al (2011) A new treatment for soft tissue fibrosis in the breast. Journal of Lymphoedema 6(2): 42-46.
Avraham T et al (2013) Th2 differentiation is necessary for soft tissue fibrosis and lymphatic dysfunction resulting from lymphedema. The FASEB Journal 27:1114-1126.
Avery K, et al (2000) Treatment of congenital lymphedema with sequential intermittent pneumatic compression therapy. Foot 10(4): 210-5.
Bagheri S, Ohlin K, Olsson G, Brorson H (2005) Tissue tonometry before and after liposuction of arm lymphedema following breast cancer. Lymphatic Research and Biology 3: 66–80.
Bentzen SM, Dische S (2000) Morbidity related to axillary irradiation in the treatment of breast cancer. Acta Oncologia 39: 337–47.
Bock, K (2013) A physical therapy directed approach for axillary web syndrome: a case study Lymphlink 25(2).
Bok, SK et al (2018) Evaluation of stiffness in postmastectomy lymphedema using acoustic radiation force impulse imaging: a prospective randomized controlled study for identifying the optimal pneumatic compression pressure to reduce stiffness. Lymphatic Research and Biology 16(1):36-42.
Braun, M et al (2011) Effectiveness of traditional chinese “Gua Sha” therapy in patients with chronic neck pain: a randomized controlled trial. Pain Medicine 12: 362–369.
Brennan, M (1999) The complexity of pain in post breast cancer lymphedema. Lymphlink 11:1.
Brorson H et al (2006) Quality of life following liposuction and conservative treatment of arm lymphedema. Lymphology 39: 8–25.
Carlson J et al (2009) Otophyma: a case report and review of the literature of lymphedema (elephantiasis) of the ear. American Journal of Dermatopathology 30(1):67-72.
Carati CJ, Anderson SN, Gannon BJ, Piller NB (2003) Treatment of post-mastectomy lymphoedema with low level laser therapy: a double blind, placebo controlled trial. Cancer 98:1114–22.
Chen HC, McC. O’Brien B, Pribaz JJ, Roberts AHN (1988) The use of tonometry in the assessment of upper extremity lymphoedema. British Journal of Plastic Surgery 41: 399– 402.
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Clodius L, Deak L, Piller NB (1976) The use of tissue tonometry as a diagnostic aide in extremity lymphoedema. Lymphology 9: 1–5.
Collins C (2003) Pressure. The interdisciplinary encyclopedia of marine sciences NY:Grolier Vol 3:81.
Coopee, R (2008) Use of “Elastic taping” in the treatment of head and neck lymphedema. Lymphlink 20(4).
Davidson C (1997) Rat tendon morphologic and functional changes resulting from soft tissue mobilization. Medicine and Science in Sports and Exercise 29(3):313-319.
Delanian S, Lefaix JL (2004) The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiation Oncology 73: 119–131.
Desmoulière, et al (2003) Normal and Pathologic Soft Tissue Remodeling: Role of the Myofibroblast, with Special Emphasis on Liver and Kidney Fibrosis. Laboratory Investigation 83(12): 1689-1707.
Facio M eta l (2017) Clinical treatment of penile fibrosis after penoscrotal lymphedema. Urology Case Reports 11:14-16.
Feldman J et al (2012) Intermittent pneumatic compression therapy: a systematic review. Lymphology 45(1):13-25.
Földi M, Földi E (2003) Lymphostatic diseases. In: Foldi M, Foldi E, Kubik S, eds. Textbook of Lymphology for Physicians and Lymphedema Therapists. 1st ed. Urban & Fischer, Munich.
Fowler, S et al (2000) Innovative approach for the treatment of cumulative trauma disorders. Work 15:9-14.
Fu, M, Ridner, S (2011) Inflammation-Infection: A Complication or Trigger of Lymphedema. Lymphlink (23)3: 8,11.
Fu, M et al (2014) Breast Cancer-Related Lymphedema in the Genomic Era. Lymphlink 26(2): 3,4,30.
Gehlsen G et al (1999) Fibroblast responses to variation in soft tissue mobilization pressure. Medicine and Science in Sports and Exercise 31:531-535.
Gergich N, Bell L (2004) Focus on breast and chest wall LE. Lymphlink 16: 22.
Goffman TE, Laronga C, Wilson L, Elkins D (2004) Lymphedema in the arm and breast in irradiated breast cancer patients: risks of an era of dramatically changing breast cancer surgery. Breast Journal 10(5): 405–11.
Hammer, W (2009) The effect of mechanical load on degenerated soft tissue. Journal of Bodywork and Movement Therapies 12: 246–256.
International Lymphoedema Framework (2012) Best practice for the management of lymphoedema. 2nd ed. Compression therapy: a position document on compression bandaging. Accessed from www.lympho.org.
International Lymphoedema Framework (2012) Best practice for the management of lymphoedema. 2nd ed. Surgical intervention: a position document on surgery for lymphoedema. Accessed from www.lympho.org.
Executive Committee of the International Society of Lymphology (2013) The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the international society of lymphology. Lymphology 46(1): 1-11.
Iyer R, Jhingran A (2006) Radiation injury: imaging finding in the chest, abdomen and pelvis after therapeutic radiation. Cancer Imaging 6: S131–S139.
Johansson K, et al (1998) A randomized study comparing manual lymph drainage with sequential pneumatic compression for the treatment of postoperative arm lymphedema. Lymphology 31:56-64.
Johannson S, Svensson H, Denekamp J (2000) Timescale of evolution of late radiation injury after postoperative radiotherapy of breast cancer patients. International Journal of Radiation Oncology Biology and Physics 48: 745–50.
Jothy Basu KS, et al PK (2008) Normal tissue complication probability of fibrosis in radiotherapy of breast cancer: accelerated partial breast irradiation vs conventional external-beam radiotherapy. Journal of Cancer Research and Therapy 4(3): 126–30.
Koehler, L (2006) Axillary web syndrome and lymphedema, a new perspective. Lymphlink 18(3):9-10.
Lawenda BD, Mondry TE, Johnstone PAS (2009) Lymphedema: a primer on the identification and management of a chronic condition in oncologic treatment. Cancer Journal for Clinicians 59: 8–24.
Lawenda BD, Mondrey T (2008) The effects of radiation therapy on the lymphatic system: acute and latent effects. LymphLink 20(3):1-3,30-31.
Leduc O (2009) Axillary web syndrome: nature and localization. Lymphology 42(4):176-181.
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Ridner, S (2013) A pilot randomized trial evaluating low-level laser therapy as an alternative treatment to manual lymphatic drainage for breast cancer-related lymphedema. Oncology Nursing Forum 40(4): 383-393.
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Rockson, S (2013) The lymphatics and the inflammatory response: lessons learned from human lymphedema. Lymphatic Research and Biology. 11(3):117-120.
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Karen’s passions in lymphedema practice are equipment innovation and development, treatment of underlying fibrosis and inflammation, and assessment of complex and difficult cases. She is considered an expert in clinical use of pneumatic compression and has participated in development of numerous devices and appliances. She currently works at St. Joseph’s Medical Center in Stockton, California, providing inpatient and outpatient lymphedema treatment. Karen also has a private consulting practice.
Karen speaks frequently at academic, clinical, and professional settings and performs clinical research that she presents and publishes nationally and internationally. Her presentations have included four International Lymphology Congress meetings: 2017 Spain, 2015 USA, 2011 Sweden, and 2009 Australia, as well as medical conferences in the United States, Canada, and Israel. She is an adjunct faculty member with the University of the Pacific in the Doctoral Physical Therapy Program.
Karen has been published in: Lymphology Journal (USA), AOTA Practice Journal (USA), OTAC Journal (USA), Pathways (Canada) and Journal of Lymphoedema (UK.)