MECHANICAL LYMPHATIC THERAPY
VOLUMETRIC ALTERATIONS UTILIZING THE RAGODOY® DEVICE TO TREAT LYMPHEDEMA OF THE LOWER EXTREMITIES
Lymphedema is a specific type of edema due to failure of the lymphatic system associated with deficiency of proteolysis in the cell interstice resulting in an abnormal accumulation of proteins and macromolecules including hyaluronic acid. The aim of the current study was to evaluate the efficacy of a one‐hour session using the RAGodoy® electromechanical device to reduce the volume of lymphedematous lower extremities.This study involved 10 case reports of female patients with ages ranging from 20 to 60 years old and with clinical diagnosis of lymphedema of lower limbs. The participants were submitted to a one‐hour session of mechanical lymph drainage using the RAGodoy® device in order to evaluate the volumetric improvement of the limbs. There was a statistically significant volumetric reduction (p‐value < 0.0002) comparing the size of the extremities before and after treatment. Mechanical lymphatic drainage using the RAGodoy® apparatus is efficacious in reducing the size of lymphedematous limbs.
THE EFFECT OF MECHANICAL LYMPH DRAINAGE ACCOMPANIED WITH HEAT ON LYMPHEDEMA
BACKGROUND: Thermotherapy has been indicated by some researchers as a treatment for lymphedema. A study comparing temperatures demonstrated that a temperature of 40ºC significantly increased the transportation of lymph compared to other temperatures assessed. The aim of this study was to evaluate the possible benefits of mechanical
lymph drainage accompanied with heat in the treatment of lymphedema of the lower limbs. METHODS: In a cross-over randomized study, the effect of heat on lymph drainage was evaluated in the treatment of leg lymphedema. The study, performed in the Godoy Clinic in São Jose do Rio Preto, Brazil, involved seven patients (two
males and five females) with leg lymphedema. The patients\\\' ages ranged from 18 to 79 years old with a mean of 48.5 years. The subjects underwent a total of 38 assessments including 19 evaluations of mechanical lymph drainage alone and 19 combined with thermotherapy. Heat was applied using an electric blanket which was wrapped around the legs of the patients. The volume of legs was evaluated by water plethysmography before and after treatment sessions. The paired t-test was used for statistical analysis with an alpha error of p = 0.05 being considered as acceptable. RESULTS: No statistically significant differences were evidenced between mechanical lymph drainage alone and lymph
drainage combined with thermotherapy. CONCLUSIONS: There was no obvious synergic effect in the immediate post-treatment period when heat was combined with mechanical lymph drainage in the treatment of lymphedema.
SYNERGISTIC EFFECT OF ELASTIC STOCKINGS TO MAINTAIN VOLUME LOSSES AFTER MECHANICAL LYMPHATIC THERAPY
Lymphedema is an accumulation of water, salts, electrolytes, high molecular weight proteins, and other elements in the interstitial space resulting from dynamic or mechanical
changes of the lymphatic system which lead to a progressive increase in size of an extremity or body region with decreased functional and immune capacity and morphological changes. Clinical staging takes into account the manifestation of the edema and the deformities observed. In grade I lymphedema, the swelling appears during the day and in grade
II, the patient awakens with edema in the morning which normally worsens during the day. Grade III lymphedema is similar to grade II but more advanced and with worse
deformities . Severitymay be mild with a volume increase of up to 20% (compared to the normal contralateral leg), medium with increases of between 20% and 40%, or severe
with increases of more than 40%
SYNERGISTIC EFFECT OF ADJUSTMENTS OF ELASTIC STOCKINGS TO MAINTAIN REDUCTION IN LEG VOLUME AFTER MECHANICAL LYMPH...
Use of elastic stockings is one of themain clinical approaches to the treatment of venous edema and lymphedema. The pressures introduced by compression hosiery, muscle
activity, the environmental temperature, and the integrity of joint mobility are factors that can interfere in reductions in edema and in maintaining the size of limbs
PILOT STUDY TO EVALUATE NA APPARATUS FOR MECHANICAL LYMPH DRAINAGE
Introduction. An association of therapies is recommended in the treatment of lymphedema with lymph drainage constituting one of the most important. Material and methods. The aim of this study was to evaluate a 3-hour session of a new mechanical lymph drainage method utilizing the RAGodoy® apparatus. Volumetry was used to assess passive exercising in 13 patients suffering from arm lymphedema after breast cancer treatment. The participants’ age varied between 42 and 78 years old. Patients were submitted to mechanical lymph drainage using a passive, electromechanical apparatus for the upper limbs denominated RAGodoy®. This apparatus performs bending and stretching exercises of the elbow. Measurements by water displacement volumetry were taken at the start and at hourly intervals during the 3-hour session. The paired t-test was used for statistical analysis, with an alpha error of 5% being considered acceptable. Results. The greatest reduction was observed in the first hour (p-value = 0.0001) with increases in volume
being seen after the second and third hour compared to the end of the first hour (p-value = 0.001). Conclusion. Mechanical lymph drainage utilizing the RAGodoy® apparatus is efficient to reduce the volume of lymphedematous arms, however its use is not recommended for more than one hour.
DYNAMIC EVALUATION OF THE VENOUS PRESSURE DURING PASSIVE PLANTAR FLEXION AND DORSIFLEXION EXERCISES WITH THE RAGODOY® APPARATUS
Objective: The objective of this case report was to dynamically evaluate pressure changes during passive exercises using a device that performs plantar flexion and dorsiflexion.
Design and setting: The medial vein of the left hallux was punctured using a 0.9 mm x 25 mm angiocat catheter and this was connected to a DTX Plus TM sensor. With this portable apparatus, pressure variations are measured at half-second intervals and the data stored in a numerical form. The RAGodoy® apparatus was used to perform passive exercises that stretched and bent the ankle joint. Six evaluations were made and the minimum and maximum pressures during each session were assessed. Main outcome measures and results: In all the sessions, variations in the pressures were obtained with a minimum pressure of 8 mmHg and a maximum of 77 mmHg. Conclusion: The device, named the RAGodoy®, creates pressure variations in the venous system, which assist blood flow in the lower limbs and thus it can be used to avoid venous stasis.
DEVELOPMENT AND EVALUATION OF NEW APPARATUS FOR LYMPH DRAINAGE PRELIMINARY RESULTS
Due to the lack of a specific treatment apparatus that enhances lymph flow, we developed a simple, easy-to-use, portable device for patients presenting with lower extremity lymphedema. The aims of the present study were to demonstrate the design and operation of the equipment and to test its efficacy. The new apparatus encourages articulation of the ankle and contraction of the muscles of the calves and feet. Eight patients with clinically diagnosed primary or secondary lymphedema were imaged by lymphscintigraphy before and after one week of using the apparatus. The images were evaluated by two experienced nuclear medicine physicians blinded to the other\\\'s results. An improvement in the lymphscintigram images was seen in all patients evaluated. This preliminary study suggests that the new apparatus was easily tolerated, enhanced lymph flow as assessed by lymphscintigraphy, and may have benefits as an adjunctive treatment. Further clinical studies are necessary to fully evaluate its use.
BIOIMPEDANCE ASSESSMENT OF EDEMA IN PATIENTS WITH MASTECTOMY-RELATED LYMPHEDEMA TREATED BY MECHANICAL LYMPH DRAINAGE USING THE RAGODOY® DEVICE
Few apparatuses have been developed for the treatment of arm lymphedema. The objective of this study was to use bioimpedance to evaluate the efficiency of the RAGodoy® mechanical drainage device in reducing swelling in the treatment of mastectomy-related arm lymphedema. Twenty-one patients with arm lymphedema after mastectomy were enrolled in a prospective study (clinical trial) to quantitatively evaluate reductions in limb size using a passive electromechanical device to perform mechanical lymph drainage. The study was conducted in the Vascular Laser Center in Sao Jose do Rio Preto. The InBody S10® body composition analyzer was used to evaluate edema. The paired t-test was used for statistical analysis with significance being set for an alpha error = 5% (p-value < 0.05). The results showed that a significant reduction in edema was observed after mechanical lymph drainage using the RAGodoy® device (p-value < 0.012). In conclusion, lymph drainage performed with the electromechanical RAGodoy® device is effective in reducing volume of arm lymphedema as assessed by bioimpedance.