domingo, 20 de mayo de 2018

IS LYMPHEDEMA DISABLING - IS LYMPHEDEMA A DISABILITY - INCAPACITY FOR WORK AND DISABILITY RECOGNITION DUE TO LYMPHEDEMA - AWARENESS CAMPAIGN - JOBS THAT CAN AGGRAVATE LYMPHEDEMA - ORGANIC LYMPHATIC VESSEL DISEASE



To understand the underlying causes and implications of lymphatic dysfunction (Lymphedema) it is necessary to first clear concepts on what is an Organic Impairment, an Organic Disease, and a Physical Impairment.



An Organic Impairment refers to the loss of functionality of a body system, including internal organs or physiological processes, whether congenital or acquired. An Organic Disease refers to any disorder that is caused by a known physical dysfunction of an organic structure. Read more about what is an Organic Impairment HERE.



Physical Impairment refers to any physiological disorder or anatomical loss affecting one or more body systems that substantially limits a person's physical functioning, that may result from medically diagnosed injuries, illnesses, or congenital conditions, which interferes and has a substantial long-term negative effect on an individuals ability to perform normal Activities of Daily Living (ADLs).



Lymphedema is an inflammation of limbs or parts of the body caused by dysfunction of the Lymphatic Circulatory System (Organic Lymphatic Vascular Disease). It is usually due to consequences such as surgery on lymph nodes, cancer, radiation treatment, repeated infections, genetic and birth-related edema, chronic venous insufficiency, traumas, etc.



It is clear that no patient or their lymphedema is the same and neither is its progress. Some patients with limb lymphedema can easily do different degrees of physical activity, while others feel the strain and experience increased swelling with minimum effort.








The International Classification of Functioning, Disability, and Health (ICF) supplies a common language and allows a description of human functioning and disability, using a universal view of disability. If we approach lymphatic venous insufficiency from the ICF point of view, the functional limitations of people with lymphatic dysfunction (i.e. the Health Condition), and the recognition of disability, in the case of chronic lymphedema there may be a dual impairment. On the one hand, there is a PERMANENT ORGANIC IMPAIRMENT (i.e. the Body Function), due to failure in the lymphatic system, and on the other hand, a PHYSICAL DISABILITY may develop (i.e. the Body Structure), due to the functional deficit produced by the consequent inflammation and progressive chronic edema. Depending on the disease location and severity, patients may experience difficulties in executing activities (i.e. the Activity Limitation), or problems related to involvement in life situations (i.e. the Participation Restriction), making up the physical, social, and attitudinal circumstantial considerations (i.e. the Personal and Environmental Contextual Factors). Read more about what are the signs, symptoms, and complications of lymphedema HERE.



As for the edema, it can be very mild and hardly noticeable, or prominent with difficulty in using the swollen limb. National assessment teams evaluate people's physical impairments to assess degrees of disability and incapacity for work.



Even after volume reduction treatment and the use of compression garments, the underlying organic lymphatic impairment still persists, and over-stressing tasks may contribute to worsening the condition. Lymphatic dysfunction is a chronic disease, and people suffering from lymphedema may be eligible for disability and incapacity for work recognition when the condition affects their personal, family, social, or work level.



Lymphedema as well as Chronic Venous Insufficiency (CVI), have some symptoms that are clinically equal in severity. Venous and lymphatic insufficiency occurs when veins and capillaries are blocked or damaged, and lymph in the case of lymphedema builds up and pools in the limbs. The resulting chronic and progressive edema can make walking or movements of arms, difficult to undertake in some jobs and everyday tasks.



Lymphedema may also cause joint dysfunction, pain, and disfigurement to limbs, and depending on the body parts affected makes it difficult to move, walk, or inability to use hands effectively. The medical recommendations for lymphoedema and chronic venous insufficiency (CVI) are essential, for they are thus to prevent the progression of the disease and can represent in themselves causes and factors of disability recognition.






At the working level, lymphedema can restrict carrying out some activities of daily living (ADL) and jobs such as: lifting weights, over-stressing jobs, doing tasks that require keeping elbows or knees bent, prolonged sitting or standing, etc. Regarding work inability, there are cases where lymphedema can condition and may not permit an active working life, in the same circumstances as healthy people or without a disability. Read more about addressing disability and functional limitations in Lymphedema HERE.



Regarding the RFC (Residual Functional Capacity), if lymphedema affects the legs, the assessment may restrict the kinds of work that involve lifting weights, standing or sitting for long periods, walking, kneeling, or remaining in one position for certain periods of time. If lymphedema affects arms, the RFC assessment may limit the kinds of work that involve lifting weights, writing or typing, pushing, grasping, or anything else that requires fine movements of arms or hands. Extreme temperatures should be avoided for all lymphedema.








Concerning Orthotic Devices and disability, it is necessary to bear in mind that there are people who depend on Assistive Devices to enable them to participate actively and productively in the community. An Assistive Device is a technology that is adapted and specially designed to support, maintain, or replace a part of the body or deficient body function. Body function impairments like Organic Lymphatic Vascular Disease (Lymphedema) can require the permanent use of Orthotic Devices to function (ambulate or undertake different tasks), and this should be taken into consideration in the medical examination used for the Social Security disability or incapacity to work application and recognition. Likewise, when the person´s impairment progresses and aggravates without the Orthotic Device, this should also be part of the report.



Orthopedic Compression Garments for lymphatic dysfunction in upper and lower limbs are a medical necessity. It is crucial to take into consideration the significant role that Orthotic Devices play in managing and preventing complications associated with lymphatic impairment. Their function is to help support and control the severity of stasis overload, dermal complications, limb contour deformity (disfigurement), pain, decreased peripheral sensation, swelling comorbidity, and thus a means necessary to help carry out Activities of Daily Living (ADLs).



When lymphedema is present in the extremities of the limbs (hands, fingers, feet, toes), a glove and toe caps are added to the compression garments. Without a glove, the hand and fingers can swell causing reduced independence or loss of dexterity. Likewise, if toe caps are not applied, the toes can become more swollen and skin breakdown can occur, and there can be further loss of toe and foot movement. In some cases, there may also be a need for Orthopedic Shoes.



There are persons who, even though they need the permanent use of Orthotic Devices, have difficulty with the device in place or cannot use it, the medical professional should document the medical reasons for it. Issues regarding limitations when using assistive devices including heat, sweating, discomfort when sitting, kneeling, or resulting from the permanent all-day use, should be taken into consideration at disability or incapacity for work recognition level.



There can be restrictions in specific occupations due to wearing compression garments, and people can be worse off in terms of work performance and career. Orthotic Devices can cause difficulties with jobs involved in precision work with the hands and fingers of the affected limb, and likewise certain restrictions regarding lower limbs. There can also be disadvantages or discrimination to accessing some jobs due to the visible assistive device. The permanent use of Compression Devices can negatively condition and not allow an active working life in the same conditions as healthy people or without a disability. Read more about Orthotic Devices in the framework of disability and incapacity HERE.







If a country's social security system does not list lymphatic system impairments, a person filing for disability or incapacity for work on the basis of lymphedema may have to rely on their symptoms being medically equivalent or similar to other impairment listings such as chronic venous insufficiency, ioint dysfunction, musculoskeletal system impairment, etc).



At the working level, patients must prove that they can no longer work at a level that Social Security considers to be substantial gainful income, and this can be accomplished by providing their medical records and vocational work history. If the information shows they are no longer able to do any of their past jobs or any other kind of work due to the effects of their lymphedema, they may be approved for disability.



Medical records must be specific enough to indicate why the physician considers that the patient is disabled and unable to work. It should indicate the claimant's diagnosed condition or conditions, the prognosis, the physical functional shortcomings they may have like range of motion, postural limitations, ambulatory limitations (walking, bending, or standing/sitting for long periods), and if there is a need for the permanent use of compression orthoses. In many disability claims, it may also include the results of a report issued by a physician who examines the claimant at the request of the Social Security Administration.



Sometimes, for the process of recognition of disability and incapacity for work recognition, it is necessary to call in a specialized lawyer with experience in dealing with disability and incapacity to advise on or handle the procedure, and who knows how to approach the symptoms and impairments due to lymphedema. At times, the process for recognition of incapacity for work or disability is long and tedious and may be denied or not recognized the first time. Patients should insist on a fair and equitable recognition of their possible personal, social, and occupational limitations.






IMPORTANT NOTICE 

Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. 


To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 


Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 


Patients should also take special care when choosing a Multidisciplinary Center of Reference for Lymphedema, as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides Complete Decongestive Therapy (CDT), which is recognized as the Gold Standard treatment for lymphedema.

  • Read more about what is the best treatment option for Lymphedema HERE.
  • Read about what are the principal functions of Manual Lymphatic Drainage HERE.
  • Read about what are the main differences between the two principal lymphedema treatment protocols HERE. 
  • Read about what are the strategies for the implementation of low-cost treatment options for Lymphedema HERE.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS




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CLICK ON THE TEXTS 
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AND PREVALENCE





































POSTER IN DIFFERENT LANGUAGES


SPANISH: Trabajos que pueden agravar linfedema / Reconocimiento discapacidad.




GERMANArbeiten, die ein Lymphödem verschlimmern können / Anerkennung von Behinderungen


FRENCHTravail qui peut aggraver le lymphoedème / Reconnaissance du handicap



ITALIANLavoro che può aggravare il linfedema / Riconoscimento della disabilità
 

PORTUGUESETrabalho que pode agravar o linfedema / Reconhecimento da deficiência


RUSSIANРабота, которая может усугубить лимфедему / Признание инвалидности


CHINESE可能加重淋巴水肿的工作/残疾的确认


JAPANESEリンパ浮腫を悪化させるような仕事/障害者認定


KOREAN림프 부종을 악화시킬 수있는 일 장애 인식


ARABالأعمال التي يمكن أن تؤدي إلى تفاقم وذمة لمفية التعرف على الإعاقة


SWEDISH: Arbete som kan förvärra lymfödem / Erkännande av funktionshinder


DUTCH: Werk dat lymfoedeem kan verergeren / Invaliditeitserkenning



FINNISH: Työ, joka voi pahentaa Lymfedeema / työkyvyttömyyden tunnustaminen


GREEK: Εργασία που μπορεί να επιδεινώσει το λεμφοίδημα / Αναγνώριση αναπηρίας




























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