PHYSICAL THERAPY MANAGEMENT OF A PATIENT WITH PRIMARY LYMPHEDEMA: A CLINICAL CASE REPORT. Samantha L. Marocco*1; Debra A. Ryan2 1. Center for Health Sciences, Clarkson University, Potsdam, NY; 2. Physical Therapy, Adirondack Medical Center, Saranac Lake, NY PURPOSE: This case report was completed in order to study the effects of physical therapy intervention for a patient with a diagnosis of primary lymphedema who was undergoing an outpatient lymphedema rehabilitation program. Current research has shown the clinical benefits of lymphedema rehabilitation. This report examined the benefits of lymphedema rehabilitation for a patient with long-standing and previously untreated primary lymphedema. BACKGROUNDS/SIGNIFICANCE: Rehabilitation for patients with lymphedema is a fairly new concept in the United States. Treatment has existed in Europe for at least 15 years with excellent outcomes. This service is now being offered more consistently in the US by certified lymphedema therapists who have undergone many hours of training in various methods. Physical therapy can improve the impairments and functional limitations that individuals with lymphedema experience. Further clinical research documenting the outcomes of lymphedema rehabilitation is needed. SUBJECTS: The patient described in this case report is a 67-year-old female who was diagnosed with primary lymphedema of the left lower extremity at the age of 18. She had never undergone lymphedema rehabilitation previously. Her work history includes being a retired office worker and the mother of six children. She is married and lives with a supportive husband in a two-story house. This patient's past medical history includes medically controlled hypertension and mild osteoarthritis of her left knee. The patient began physical therapy treatment after suffering from an infection of the left lower extremity and reading about lymphedema rehabilitation in a local paper. Her impairments and functional limitations included decreased activity tolerance, left lower extremity edema, left knee pain, and impaired skin integrity. The patient reported that she was independent with all activities of daily living and instrumental activities of daily living, but that she self limited her activity level and her ambulation distance, and that she did not participate in daily exercise. METHODS AND MATERIALS: The patient's intervention program consisted of patient education, manual lymphatic drainage to the left lower extremity for 45-60 minutes, followed by multilayer bandaging to the limb. The patient was also fitted with a custom compression garment and instructed in a home exercise program including functional activities such as climbing stairs and brisk walking throughout the day. These interventions were performed four times a week for six visits and then three times a week for six visits. Circumferential measurements were taken of the extremity upon initial evaluation, daily during the intervention, and upon discharge from services. Measurements were taken again at six months post treatment, one year post treatment, and two years after treatment. Circumferential measurements were taken starting at the first web space of the great toe and every ten centimeters up the entire foot and leg due to changes in landmarks that can occur with lymphedema reduction. Circumferential measurements were also taken at the malleoli. ANALYSES: Percent change in edema volume was calculated after the first six visits and after twelve visits. As this is a case report, no statistical analyses were completed. RESULTS: After six visits, the percent change in volume was -27%. At the completion of treatment (12 visits) the percent change in volume was -50%. Upon completion of the intervention, the patient was independent with self-massage and proper skin care. She was also independent with the precautions associated with lymphedema, her custom compression garment wearing schedule, and she was independent with her home exercise program. This patient also reported decreased left knee pain and increased physical activity tolerance. Considering the limited number of treatments this patient received, the percent of edema reduction was significant. This patient has also maintained her edema reduction as noted during her six-month re-examinations. This patient had endured her lymphedema for decades without knowledge of a possible treatment. Despite long standing lymphedema, this patient had positive outcomes and reported an improved quality of life following completion of a comprehensive lymphedema rehabilitation program. CONCLUSIONS: The results of this case report suggest that lymphedema rehabilitation can result in measurable change in the volume of a limb and can improve function for the individual with primary lymphedema. Further research is needed regarding clinical outcomes for patients undergoing a comprehensive lymphedema rehabilitation program. FUNDING SOURCE: Funding support to establish a comprehensive lymphedema rehabilitation program at Adirondack Medical Center was provided by the Jacob and Valeria Langeloth Foundation, 521 Fifth Avenue, Suite 1612, New York, New York 10175-1699. None of the authors have any potential for material gain as a result of this study. KEYWORDS: Primary Lymphedema, manual lymphatic drainage, case report Copyright 2009 by the American Physical Therapy Association. Requests for reprints should be directed to the corresponding author of the article. 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