11/22/2010

1

PHYSICAL THERAPY

CARDIAC REHAB

&

LYMPHEDEMA

What is Cardiac Rehab?

• Cardiac rehabilitation (cardiac rehab) is a

professionally supervised program to help

people recover from heart attacks, heart

surgery and percutaneous coronary

intervention (PCI) procedures such as

stenting and angioplasty. Cardiac rehab

programs usually provide education and

counseling services to help heart patients

increase physical fitness, reduce cardiac

symptoms, improve health and reduce the

risk of future heart problems, including

heart attack.

Type of Services

• There are 3 stages to cardiac Rehab

• Inpatient rehab in a hospital setting

• Supervised programs with PT and

cardiologists – monitoring via ECG’s,

BP, Heart rate

• Maintenance phase in general

outpatient rehab setting. Monitored by

BP and heart rate.

Which of your patients

need Cardiac Rehab?

• Those who have

been stinted to

help improve

healing for

wounds or

upcoming

surgeries.

How Long is Rehab

• Your rehabilitation plan is

designed to meet your needs.

You may need six weeks, six

months or longer to learn how

to manage your condition and

develop healthier habits. Many

programs last only three

months, but some continue for

years.

Benefits of Rehab

• Decreased

occurrence of

clogged arteries

• Improved wound

healing

• Improved blood

flow

• Improvement of

other Co-

morbidities

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2

Have You Seen These

Legs? Venous Ulcer

LYMPHEDEMA

• Lymphedema is a HIGH protein

edema!

• “Lymphedema is a

chronic and incurable

condition which

requires ongoing

maintenance, care,

and periodic expert

supervision.”

Pathophysiology

• Active Hyperemia

• Vasodilation via the arterial limb

• Causes:

• Trauma

• Infection

• Inflammation

• Heat

• Passive Hyperemia

• Vasodilation via the venous limb

• DVT

• CHF

• CVI

• Malignancy

Pathopysiology

• Lymphatic Sufficiency

• LL<TC; Healthy lymphatic system

• Dynamic Insufficiency

• LL>TC in a Healthy lymphatic

• Mechanical Insufficiency

• LL>TC, Diseased lymphatic system

• Combined Insufficiency

• LL>TC, Former healthy system that

becomes Diseased.

Types of Lymphedema

• Primary

• Lymphatic dysplasia

• Secondary

• Damage to lymphatic system

• Combined

• Normal lymphatics that become

damaged secondary to other

medical conditions.

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Stemmer’s Sign

• This is a pinching of the second

toe in an attempt to lift the skin,

it is positive if you can only

grasp the skin and not lift it

away from the toe.

Staging

• Latency Stage 0

• No visible swelling, patient notes a feeling

of heaviness

• Stage 1

• Pitting edema, will decrease with elevation

• Stage 2

• Decreased Pitting edema and hardening of

the underlying tissues

• Stage 3

• Large volume extremities and noticeable

skin changes

Proper Treatment

• Complete Decongestive Therapy

• Manual Lymph Drainage

• Compression Bandaging

• Therapeutic Exercise

• Skin Care

• Patient Education

Manual Lymph Drainage

• Effectively increases interstitial

fluid uptake into the lymph

capillary network.

• The stretch stimulus raises

intravascular pressure and

peristalsis of the lymph collectors,

trunks and ducts.

• Creates a siphon effect to promote

healthy fluid hydraulics.

Compression bandaging

• Causes a reduction in the return of

lymph to the involved area

• A reduction in the production of

new lymph

• Increases reabsorption by

increasing tissue pressure

• Improves the efficiency of the

muscle pump

• Mechanical manipulation &

improvement in lymphostatic

fibrosis with movement

Compression Bandaging

• Working Pressure vs. Resting

Pressure

• Working Pressure – resistance

generated by a bandage or garment

when the limb is at work.

• Resting Pressure –

recoil/constriction force generated

by an elastic bandage or garment

when the limb is at rest.

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Therapeutic Exercise

• With the application

of the bandaging

materials, the leg is

in a soft cast that

will not give to the

fluid with exercise.

• For the treatment of

lymphedema the

best form of

exercise is non-

resistive active

motion exercises of

the involved

extremity.

Therapeutic Exercise

• Stretching/flexib

ility exercises

are beneficial as

well to help

minimize

tightness which

can block lymph

flow.

Pumps

• Pumps –

• At one time the

standard of care for

lymphedema

treatment and now

they are used as a

means to get rid of

compression

bandaging.

• Do not assist in

opening up the

lymphatics

• Do not help remove

proteins

Skin Care

• Proper skin

lubrication with a

low pH lotion

• Prevents

breakdown of the

skin and over

drying due to the

increase and

decrease of fluid

in the extremity.

• Prevents

infection.

Patient Education

• MOST IMPORTANT!

• Educate your patients on what to

expect

• Tell them everything they need to do

to help the process so they can

choose if they want to go through with

the treatment.

• They need to be taught how to

bandage their own extremity and how

to perform some light manual lymph

drainage.

• Local Support groups.

Questions???