martes, 24 de octubre de 2023

ADDRESSING DISABILITY AND FUNCTIONAL LIMITATIONS IN LYMPHEDEMA - CAN A PERSON WORK WITH LYMPHEDEMA? - Organic Lymphatic Vascular Disease - Symptoms, Complications and Functional Problems of Lymphoedema - Primary and Paediatric Lymphoedema - Secondary Lymphoedema - Lymphatic Filariasis/Podoconiosis - The International Classification of Functioning, Disability, and Health (ICF)


To properly understand and assess how lymphedema affects people’s overall health, impairments, and Quality of Life (QoL), the following questions should be considered: What is it like to live day by day with lymphedema? How does lymphatic dysfunction limit an individual? What is the principal cause of disease progression? What complications and degrees of disability can lymphedema cause? And what levels of anguish and suffering can be experienced by those affected? 



Lymphedema is a progressive disfiguring and disabling disease of the skin, classified as a functional, immune, and lymphatic circulatory system disorder (Organic Lymphatic Vascular Disease). The lymphatics are an active and integrated component of the immune response, and in lymphedema, there is always an increased susceptibility due to the compromised immune system. Read more about what is an Organic Impairment HERE


Lymphedema arises when there is a disruption of lymphatic flow (Organic Impairment), leading to the buildup of lymphatic fluid. 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 ICF (International Classification of Functioning, Disability, and Health), is the international standard to describe and measure health and disability. The ICF includes physical alterations such as disfigurement; sensory impairments; nail malformations; skin swelling and infections; pain; immunity response; functions of the lymphatic vessels and nodes; and general mobility and functional impairments, which have the potential to interfere with personal and social levels. 


Lymphedema is a disease that may affect arms, legs, fingers, toes, head, neck, abdomen (belly), genitalia, internal organs, or the whole body, which causes chronic inflammation and swelling in the affected area.



The functional limitations of people with lymphatic dysfunction (i.e. The Heath Condition), and the recognition of disability, in the case of lymphedema there may be a dual impairment. On the one hand, there is a PERMANENT ORGANIC DISABILITY (i.e. The Body Function), due to failure in the lymphatic system, and on the other hand, there can also be a PERMANENT PHYSICAL DISABILITY (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 disability and lymphedema HERE.


Signs and symptoms resulting from lymphatic dysfunction (Organic Lymphatic Vascular Disease) of the upper and lower limbs may include edema (lymphatic stasis), progressive swelling, visible disfigurement, fullness sensation, heaviness, weakness, fatigue, burning sensation, pins and needles, tightness or stiffness sensation, tenderness and soreness to the touch, numbness, discomfort, pain, structural change of the skin, abnormal wound healing, nail structure disorders, etc. Read more information about the signs, symptoms, and complications derived from lymphatic dysfunction (lymphedema) HERE.



Functional impairments resulting from lymphatic dysfunction (Organic Impairment) of the upper and lower limbs may include experiencing difficulties with restricted limb mobility, limb rotation, bending or getting up, standing or sitting for long periods, walking long distances, performing basic daily household activities, self-care, sexual performance (Genital lymphedema), engaging in some sports or leisure activities, poor quality of sleep, difficulty with physically-demanding jobs that may limit work performance or exacerbate lymphedema, etc. 


Regarding disability and Quality of Life (QoL) in disorders of the lymphatic venous circulation, the physical impairments and consequences (the symptom and function domains), are the most important factors and what most conditions individuals, and which consequently may also trigger the psychological and emotional outcome on their personal and social functioning. Read more about what is the psychological and quality of life impact of nontreatment or undertreatment in lymphedema HERE.



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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