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Conference Schedule

Please Note: Program is Subject to Change

Wednesday Sept. 5, 2012 - Pre-Conference Sessions

• [PC1] 10am - 5pm: Introduction to Management of Lymphedema and Related Disorders for Physicians
  Kathleen Francis, MD
  Paula Stewart, MD, CLT-LANA
  Michael Bernas, MS
  Ruth Moseley, MS, PT, CLT-LANA
  Catherine M. Tuppo, PT, MS, CLT-LANA

  View Outline for PC1

  1. Describe the anatomy and physiology of the lymphatic system;
  2. Recognize differential diagnosis and co-morbidities;
  3. Understand pathophysiology of lymphedema;
  4. Be aware of therapeutic and management options for persons with lymphedema;
  5. Explain the process of interpretation of lymphatic imaging;
  6. Understand the need for incorporating a lymphedema program in an existing practice (all disciplines);
  7. Discuss training and certification in the U.S.;
  8. Develop an understanding of the most recent research related to lymphedema assessment and management.
• [PC2] 9am - 5pm: Compression Strategies For The Advanced Therapist: Garment And Bandaging Solutions For Complex Patients
  Steve Norton, CLT-LANA
  Linda Boyle, PT, DPT, OCS, CLT-LANA
  Joy Cohn, PT, CLT-LANA
  Maureen McBeth, PT, CLT-LANA
  Sarah Stolker, PT, CLT-LANA

  View Outline for PC2

  1. Review compression theory and principles of lymphedema bandaging;
  2. Explore therapists rationale for specialized techniques of short-stretch, multi-layered lymphedema bandaging;
  3. Examine standard deviations necessary when working on abnormal contours and enlarged limbs;
  4. Review the appropriate use of various compression padding materials;
  5. Provide compression garment solutions for difficult limbs and areas of involvement;
  6. Discuss the importance of specialized techniques to optimize skin integrity in advanced presentations;
  7. Observe instructors skilled approaches to working with advanced patient presentations.
• [PC3] 1pm - 5pm: Exercise Strategies For Those With Or At Risk Of Lymphedema
  Kathryn H. Schmitz, PhD, MPH, FACSM
  Sandi C. Hayes, PhD

  View Outline for PC3

  1. Have a clear understanding of the importance of exercise following cancer;
  2. Understand barriers faced in being regularly active for those at risk or with lymphedema, and;
  3. Know basic strategies that can be used to assist patients in becoming and staying regularly active.
• [PC4] 9am - 5pm: Skin And Woundmanagement Bootcamp For Patients With Lymphedema
  Caroline Fife, MD, CWS
  Linda Koehler, PT, CLT-LANA
  Adelaide Hebert, MD
  John P. Kennedy, R.Ph., Ph.D.
  David W. Brett, BS, MS

  View Outline for PC4

  At the conclusion of this course participants will be able to:

  1. Identify the skin disorders which most commonly affect lymphedema patients
  2. Describe best practices for skin cleansing lymphedema patients
  3. Make recommendations for skin care and moisturization among lymphedema patients
  4. Understand the basic management of dermatitis and fungal infections in lymphedema patients
  5. Select appropriate dressing options for skin and wound issues in lymphedema patients
  6. Understand the concept of biofilm and how to manage it among lymphedema patients
  7. Identify resources for dressings, skin, and wound care supplies
• [PC5] 8am - 12pm: Congenital Lymphedema & Peripheral Vascular Malformations: Treating The Pediatric Patient And Beyond
  Henna Kalsi, MD
  Jennifer Bradt, PT

  View Outline for PC5

  1. Identify signs and symptoms of congenital vascular disorders in the pediatric population including primary lymphedema, congenital vascular malformations, and Klippel-Trenaunay Syndrome;
  2. Identify various diagnostic testing to evaluate pediatric peripheral vascular disorders, including primary lymphedema;
  3. Comprehend the impact of the developmental process and family involvement upon constructing an edema management/skin care program;
  4. Develop an appropriate and realistic treatment plan for patients with Klippel-Trenaunay Syndrome and primary lymphedema;
  5. Identify possible long term compression options for the care of the pediatric patient.

Advanced Elvarex Workshop hosted by BSN-Jobst
Wednesday, Sept 5, 9am - 5pm
During the NLN Conference
This event is now closed.

Learn how to improve your fitting and measuring skills from leading industry expert, Hans A. von Zimmerman. As Head of Research and Development at Jobst in Germany, Hans will teach you how to troubleshoot the different nuances of garment fitting.

* This event is now closed.

This workshop is independent of NLN conference sessions and it is not eligible for CME credit hours *

Thursday Sept. 6, 2012 - Plenary Sessions

6:30am - 8:00am

• Registration Check-in
• Continental Breakfast

7:00am - 4:00pm

• Exhibits & Posters

8:00am - 8:30am

• Opening Ceremony
  Joseph L. Feldman MD, CLT-LANA
  Saskia R.J. Thiadens, RN
  Keynote Speaker
  Debra Cordner-Carson

8:30am - 10:00am

Topic: Early Identification and Education
Moderator: Nancy A. Hutchison, MD, CLT-LANA

• 8:30 – 8:45
  Sources of Information and Information Needs Among Individuals with Lymphedema
  Sheila H. Ridner, MSHA, MSN, PhD, RN, FAAN
• 8:45 – 9:00
  A Prospective Surveillance Model of Care for Early Detection and Treatment of Breast Cancer Related Lymphedema - The Emerging Standard of Care
  Nicole Stout, MPT, CLT-LANA
  Jill Binkley, PT, MSc, CLT
• 9:00 – 9:15
  Incidence of Breast-Cancer Related Lymphedema - A Systematic Review and Meta-Analysis
  Sandi C. Hayes, PhD
• 9:15 – 9:30
  Lymphedema Should Be Studied in Third World Countries- Clue to Understanding of the Pathomechanism and Progression
  Waldemar L. Olszewski, MD
• 9:30 – 10:00
  Q&A
  

10:00am - 10:30am

• Break, Exhibits, Posters

10:30am - 12:00pm

Topic: Exploring Lymphedema Measurement
Moderator: Paula L. Stewart MD, CLT, LANA

• 10:30 – 10:45
  The Role of Objective and Subjective Measures in Diagnosing Breast Cancer-Related Lymphedema
  Mei R. Fu, PhD, MS, MA, RN, APRN-BC
• 10:45 – 11:00
  Swelling in Head and Neck Cancer Patients as Measured by Three Methods
  Andrew Moore, MD
• 11:00 – 11:15
  Assessment of External Lymphedema in Patients with Head and Neck Cancer: A Comparison of Four Instruments
  Jie Deng, PhD, RN, OCN
  Sheila H. Ridner, MSHA, MSN, PhD, RN, FAAN
• 11:15 – 11:30
  Prospective Assessment of Lymphedema Incidence and Symptoms Using Bioelectrical Impedance Following Lymph Node Surgery in Melanoma Patients
  Kate Cromwell, MS
• 11:30 – 12:00
  Q&A

12:00pm - 1:30pm

• Lunch (on your own), Posters, Exhibits

1:30pm - 3:00pm

Topic: Surgical Treatment of Lymphedema
Moderator: Alex Munnoch, MD, FRCSEd

• 1:30 – 1:45
  Autologous Lymph Node Transfer for Treatment of Chronic Upper Extremity Post-Mastectomy Lymphedema: Preliminary Results
  Constance M. Chen, MD, MPH
• 1:45 – 2:00
  Circumferential Suction-Assisted Lipectomy ( CSAL) in End Stage Primary or Secondary Leg Lymphedema : A Prospective Study in 75 Patients
  Harry GJ. Voesten, MD
• 2:00 – 2:15
  Combined Lymphatic Liposuction and Vascularized Lymph Node Transfer for The Treatment of Long-Term, Non-Pitting Lymphedema
  Jay W. Granzow, MD, MPH, FACS
• 2:15 – 2:30
  Surgical Treatment of Papillomatosis (Elephantiasis Nostras Verrucosa) of the Foot in End-Stage Lymphedema of the Leg
  Harry GJ. Voesten, MD
• 2:30 – 3:00
  Q&A

3:00pm - 3:30pm

• Break, Exhibits, Posters

3:30pm - 5:00pm

Topic: Lymphedema Incidence and Detectio
Moderator: Bonnie B. Lasinski, MA, PT, CI, CLT-LANA

• 3:30 – 3:45
  Lymphoedema Following Gynaecological Cancer: Incidence and Risk Factors
  Sandi C. Hayes, PhD
• 3:45 – 4:00
  Incidence of Lymphedema in Patients Undergoing Axillary Dissection Vs. Sentinel Node Biopsy: Long-Term Results of the ACOSOG Z0011 Multicenter Randomized Trial
  Jamie Wagner, DO
• 4:00 – 4:15
  84-Month Trends and Patterns in Post-Breast Cancer Lymphedema Occurrence
  Jane M. Armer, RN, PhD, FAAN
• 4:15 – 4:30
  Good Shepherd Penn Partners Survey for Edema in the Head and Neck (GPSEHN): Preliminary Development and Validity
  Nathan Bridgeman, PT, CLT
• 4:30 – 5:00
  Q&A

6:00pm - 8:00pm

• Reception hosted by BSN-Jobst and NLN (Exhibit Hall)

Friday Sept. 7, 2012 - Instructional Sessions

7:00am - 8:00am
Registration Check-in
Continental Breakfast
Exhibits & Posters

8:00am – 9:45am

• [H1]Developing A Multidiciplinary Lymphedema Program In The Oncology Setting
  Linda Boyle, PT, DPT, OCS, CLT-LANA
  Nancy Hutchison, MD, CLT-LANA

  View Outline for H1

  Lymphedema intervention is an important service to offer in the cancer rehabilitation setting. According to the CDC in 2011 there are 12 million cancer survivors. In 2006 the Institute of Medicine published From Cancer Patient to Cancer Survivor: Lost in Transition and identified Survivorship as a distinct phase of cancer care. Cancer survivors have specific rehabilitation needs that are not being adequately addressed in many areas due to a lack of systems and providers available. Lymphedema is one of the major conditions that must be a part of a comprehensive cancer rehabilitation program.

  This session will address strategies for developing lymphedema programs within a context of cancer rehabilitation. According to the NCI, the incidence of breast cancer related lymphedema in the United States has been estimated to occur from 8 to 56% in persons 2 years post-operatively. The incidence of cancer-related lower-extremity lymphedema most often occurs with uterine cancer, prostate cancer, lymphoma, or melanoma. The overall incidence of lymphedema for all cancers is estimated to be 15%.

  1. Learn the basis of cancer rehabilitation.
  2. Learn how a lymphedema program should be integrated into total Cancer Rehabilitation.
  3. Learn methods of identifying and building a cancer rehabilitation and lymphedema team.
  4. Learn supporting references to document the evidence basis for developing cancer rehabilitation and lymphedema program.
  5. Learn to utilize published findings in decision making regarding clinical assessment, treatment, and patient self care.
  6. Learn ways to network to build working relationships with key services for these medically complex patients.
  7. Understand the requirement for Cancer Rehabilitation as part of Network Cancer Program accreditation.
• [H2]Developing Research Competence
  Mei Fu, PhD, MS, MA, RN, APRN-BC
  M. Elise Radina, PhD, CFLE

  View Outline for H2

  This session is designed to address the needs of clinicians and others who are interested in conducting research, either independently or collaboratively. With this aim in mind, the session will provide an overview of the basic steps of the research process including the exploration of existing research, developing research questions/hypotheses, choosing research methods, and basic analysis of common research designs (both quantitative and qualitative). This will included hands-on work time where participants will develop researchable hypotheses and/or research questions for possible study. Participants will also receive instruction on the skills necessary for critical evaluation of published research. This will be followed by hands-on work time where participants will work in groups to provide a critical evaluation of a published study. The presenters will discuss issues regarding conducting and supporting research in the context of busy clinical settings. This will be followed by a discussion that will be facilitated by the presenters about how to problem-solve regarding these issues. At the conclusion of the session, participants will be given the opportunity to create peer-supporting teams to sustain ongoing and future research activities.

  1. Express a basic understanding of the steps of the research process.
  2. Develop researchable hypotheses and/or research questions for possible study.
  3. Demonstrate skills necessary for critical evaluation of published research.
  4. Problem-solve regarding conducting and supporting research in the context of busy clinical settings.
  5. Create peer supporting teams to sustain ongoing or future research activities.
• [H3]Telerehabilitation for Self-Management of Lymphedema in Mobility-Impaired Individuals
  Mary Jo Geyer, PT, PhD, CLT-LANA, FCCWS, C.Ped
  Charles Vukotich, BS, Bioengineering
  Susanne Cavanaugh, DPT,CLT-LANA
  Becky Faett, RN, MSN, MBA

  View Outline for H3

  Telerehabilitation (TR) is the delivery of rehabilitation services over telecommunication networks and the internet. Most TR services fall into two categories: clinical assessment (functional abilities in the patient's environment) and clinical therapy. Innovative methods are needed to overcome the current barriers to lymphedema treatment for persons with mobility impairments. Rationale for the use of TR includes: 1) the limited number of qualified lymphedema specialists and their inequitable geographic distribution, 2) the need for extensive travel to obtain specialist care, 3) the difficulty mobility-impaired persons encounter in performing conventional therapy due to the presence of significant functional impairments, 4) the required consideration of the home environment in modifying conventional therapy for this population, and 5) the emerging evidence for the effectiveness of developing necessary self-care skills in a home-based, natural environment. This instructional session will describe an ongoing research study of a novel TR method (real-time videoconferencing for lymphedema self-care) for persons with mobility-impairments. A "live" TR session will be demonstrated with audience participation. Challenging cases will be presented with opportunities for audience participation in problem solving. Finally, a preliminary research report of the effects of the TR method on lymphedema outcomes, quality of life measures, self-efficacy, medical outcomes, and health care utilization will be provided.

  1. Identify the unique factors contributing to the development of persistent edema/lymphedema in persons with limited mobility.
  2. Summarize the scope of the lymphedema problem in the immobile population in terms of both epidemiology and impact on health.
  3. Describe the essential elements of the novel telerehabilitation (TR) method presented and distinguish the similarities/differences from conventional treatment for lymphedema.
  4. Apply the telerehabilitation (TR) method to "live" case scenarios and aid in solving the technical/clinical problems presented.
  5. Justify the use of this novel TR intervention in the immobile population based on reported study outcomes.
  6. Support the use of TR for other populations where lifelong self-management is critical to improved health outcomes.
  7. Estimate the utility of TR in your own practice and know where to get current information and assistance with its application.
• [H4]Delivering Lymphedema Treatment To The Home-Bound Patient
  Michael Alatriste, CLT, LMT

  View Outline for H04

  There are many factors to consider in developing a successful plan of care for the homebound Lymphedema patient. Most homebound patients have a functional disability and limited ADL profile; both of which need to be considered before a successful plan of care can be implemented and/or carried through to completion. Additionally, bariatrics and wound care often present challenges for this patient population and require a coordination of ancillary care. Before initiating treatment, it is important for the therapist to establish an interdisciplinary dialogue with the patient's clinical team to assure that any required ancillary measures are provided and that "beyond-scope-of-practice" challenges or compromises do not occur. Another population of home care patient - the financially capable or entitled - seeks treatment for both discretion and time management purposes. As the relationship between therapist and patient develops within this scenario, it is important that the therapist avoid becoming a "concierge clinician", devoting more time than required to the patient's treatment, as this can result in frustration or resentment towards the patient. Cost is a major factor for homebound care, as a satellite clinic needs to be established in the patient's home, capable of meeting all clinical needs within the scope of our treatment. Therapists and/or lymphedema facilities should provide patients, insurance providers, managed care plans, etc. with a realistic and detailed financial estimate for both Intensive Treatment as well as Self-Care Maintenance.

  1. Establish criteria for homebound treatment based upon ADL and disability profiles
  2. Produce pre-treatment clinical summaries and establish preliminary interdisciplinary communication
  3. Coordinate ancillary care
  4. Establish an offsite satellite clinic in the patient's home
  5. Effectively communicate with Home Health Aides to maximize treatment outcomes
  6. Produce a cost estimate for treatment
  7. Establish a care plan for self-care maintenance
  8. Evaluate patient personality profiles to avoid interpersonal challenges.
  9. Understand the commitment and rigor involved in a complete homebound plan of care
• [H5]Advanced Management: The Complex Patient with Head and Neck Lymphedema
  Brad Smith, CCC-SLP, CLT
  Sheila Ridner, PhD, RN, FAAN
  Jie Deng, RN, PhD, OCN
  
  This session is now closed.

  View Outline for H5

  Description: While current treatment for cancers of the head and neck are typically effective in controlling the disease process, they often result in severe functional deficits and compromised quality of life. Often these patients undergo complex treatments combining surgery, radiation, and chemotherapies, all of which contribute to post-treatment performance deficits. Impairments of swallowing and communication, decreased cervical range of motion, postural changes, and impaired mobility of the upper extremity after cancer treatment are well documented. Patients with head and neck cancer often present with multiple comorbidities and complex symptom burden that create obstacles to provision of traditional lymphedema management services. Head and neck lymphedema is an area of increasing research interest. This session will address lymphedema evaluation and management strategies to address the needs of medically complex patients whose cases require modifications of traditional approaches. Topics will include:

  1. Who is the medically complex patient?
  2. Modifications of evaluation and treatment strategies
  3. Complex compression strategies
  4. Symptom and palliative management
  5. Tricks and tips

  Objectives:

  1. Participants will be able to identify and discuss differences in patient presentation and treatment between patients requiring basic vs more complex treatment methodologies.
  2. Participants will learn about complex facial compression garments, measurements, and how compression pads and garments can be safely and creatively applied for patients with severe head and neck lymphedema.
  3. Participants will be able to describe measurement techniques for internal and external head and neck lymphedema.
  4. Participants will be able to discuss strategies for symptomatic and palliative management of severe head and neck lymphedema.

10:15am – Noon

• [H6]Breast and Upper Trunk Lymphedema
  Leslie Bell, PT, CLT-LANA
  Kristi Johnson, MS, PT, CLT-LANA
  
  This session is now closed.

  View Outline for H6

  Is it ever too early to give our clients the "toolbox" to understand precaution, prevention, and the early management of edemas and scars, so we can reduce their risk of developing breast and truncal lymphedema? Breast and truncal edemas are often overlooked until the symptoms affect activities of daily living and are then finally recognized as lymphedema. In the early stages of cancer care and treatment, gross tissue changes can occur, stressing delicate lymphatics. The longer inflammation, pain and swelling persist and/or worsen, the more difficult resolution of symptoms and treatment may become. Some signs, symptoms, and subjective findings seem clear and straightforward, but others are more obscure, and we need to know what we are looking for. The focus of this session will encompass evaluation and management of breast and truncal edemas, including lymphedema. Topics will include: early warning signs, differential diagnosis of edemas, comprehensive evaluation (including assessments of the edema, shoulder, ribcage, and breath control), common lymphedema complications (cording, scarring), compression options (kinesiotaping, chip pads, quilted padding, bra options) and successful documentation.

  Lab: We will demonstrate evidence based techniques and provide clinical pearls of wisdom. Participants will have the opportunity to practice various assessment and interventional techniques.

  1. Develop a "tool box" for the clinician, and for the patient to promote independent management and care
  2. Understand the pathophysiology of edema and lymphedema and its role in fibrosis, scar tissue, and pain
  3. Recognize the early warning signs of breast/trunk edema and lymphedema
  4. Recognize characteristics of different edemas through the continuum of care, including lymphedema
  5. Develop a comprehensive evaluation of the breast and trunk
  6. Develop a comprehensive plan of care including the use of compression for the breast and trunk
  7. Understand the components of successful, defensive documentation of the evaluation and management of breast and truncal edema
• [H7]Advanced Treatment Techniques and Medical Considerations in Lymphedema
  Kathleen Francis, MD
  DeCourcy Squire, PT, CLT-LANA, CI-CS

  View Outline for H7

  Clinicians are being presented with more and more complex lymphedema patients whose co-morbidities make traditional treatment challenging or even contraindicated. This workshop will cover the medical considerations and clinical implications of these problems and look at ways they can be addressed. Among the topics we will discuss will be differential diagnosis, modifications of treatment, the use of different treatment modalities, and the pros and cons of some of the surgical interventions.

  The clinician will be able to:

  1. Recognize some of the red flags for treatment
  2. Discuss the implications of various co-morbidities and how lymphedema treatment can be adapted
  3. Understand some of the pros and cons of different surgical interventions
• [H8]Unraveling the Mysteries of Insurance
  Robert Weiss, MS
  Nicole Stout, MPT, CLT-LANA

  View Outline for H8

  Lymphedema is primarily managed in medical domains but is recognized to be a substantial public health problem. The disease has a relatively under-recognized profile due to deficits in provider, payer and public awareness. Inadequacies exist regarding evidence-based interventions, models of care for early identification and prevention, access to appropriate care providers, and coverage and payment for care. These are potentially remedied through policy initiatives.

  An expanding body of literature supports the clinical efficacy as well as cost efficacy of lymphedema management. These efforts, while laudable, have not yet been extrapolated to inform policy issues that are often the most significant barriers to patients receiving care. The health care environment has changed substantially since the passage of the Accountable Care Act. New regulations at the provider and payer levels have impacted the medical management of patients with lymphedema, and it is anticipated that there will be continued evolution of care delivery. Additionally, legislative efforts have been undertaken to remedy the under-served needs of patients with lymphedema.

  This session will discuss ongoing policy initiatives that have both direct and indirect impact on the management of lymphedema including; updates on coding and coverage advancements, legislation impacting lymphedema management, regulatory impact of the Accountable Care Act, and the ongoing projects of various lymphedema treatment advocacy organizations. In addition, recommendations for future initiatives will be discussed including; development of evidence, development of clinical practice guidelines and awareness programs targeting payers and the public.

• [H9]Kinesiotaping for Lymphedema and Scar Management
  Ruth Copee, OTR, CHS, CLT

  View Outline for H9

  Kinesiotape has become a widely used modality with various indications such as analgesia, decreased edema, neuromuscular re-education, and scar mobilization. This instructional session is intended for therapists who are new to kinesiotaping. The first half of the session will elaborate on how to properly apply kinesiotape and include a short lab for hands-on practice. The second half will focus on the pathophysiology of scar tissue resulting from surgery and radiation fibrosis. Various therapeutic interventions that include kinesiotape, compression strategies, and manual therapy will be presented and demonstrated. A second lab will allow attendees to practice the manual techniques used to minimize scar tissue with the goal of re-establishing drainage pathways.

  1. Know the indications for kinesiotaping.
  2. Acquire the skill of basic kinesiotaping.
  3. Understand the pathophysiology of scar tissue and radiation fibrosis.
  4. Learn how to effectively address scar tissue and radiation fibrosis with kinesiotape, compression therapy, and manual techniques.
• [H10]Managing the Patient with Morbid Obesity and Lymphedema
  Paula J. Stewart, MD, CLT-LANA
  Caroline Fife, MD, CWS
  Denise Baylor, LMT, CLT-LANA
  Billi Gordon, PhD

1:30pm – 3:15pm

• [H11]Responding to Nonadherence: Psychological Techniques for Increasing Adherence with Self-Care Recommendations
  Elizabeth McMahon, PhD

  View Outline for H11

  Nonadherence is one of the most common and frustrating problems encountered in treating lymphedema. Insights from psychological research can help you understand and respond to nonadherence. Behavior change, like implementing and maintaining recommended self-care, is a five-stage process. Learn to increase patient adherence--and decrease personal frustration and helplessness--by identifying the patient's current stage of change and providing stage-appropriate suggestions. This session also presents ways to strengthen the patient-clinician relationship and enhance effective communication.

  1. Understand the process of change and how it affects adherence
  2. Learn the five stages in the process of change
  3. Be able to identify where a patient is in the process of change
  4. Understand how to respond based on the patient's current stage of change and help the patient move forward
  5. Know techniques that enhance communication, strengthen the patient-clinician relationship, and help reduce clinician feelings of frustration, helplessness, or being overwhelmed
• [H12]Differentiating Edemas
  Andrea Cheville, MD, MSCE
• [H13]Management of Genital and Lower Trunk Lymphedema
  Nancy Hutchison, MD, CLT-LANA
  Monica Heinen, PT, CLT
  Christie Crep, PT, CLT
  
  This session is now closed.

  View Outline for H13

  Genital and lower trunk lymphedema can be primary or secondary. Secondary causes include chronic infection, trauma, surgery, radiation, cancer. There are significant psychosocial and sexual consequences associated with this difficult condition that providers need to address in treating these patients. Participants will learn differential diagnosis, diagnostic testing, medical and therapy management strategies.

  1. Participants will learn the etiologies of genital and lower trunk lymphedema
  2. Participants will learn appropriate medical diagnostic work up
  3. Participants will learn which medical specialists and medical therapies may need to be involved in the care of the genital lymphedema patient
  4. Participants will learn practical therapy and garment techniques for lymphedema management
  5. Participants will learn importance of addressing musculoskeletal and soft tissue restrictions in patients with genital and lower trunk lymphedema.
  6. Specific cases will be discussed as examples.
• [H14]Living with Lymphedema: Impact on Self-Care and Treatment Outcomes
  Jeanette Cosentino, OTR/L, PAM, CLT-LANA
  Sheila H. Ridner, PhD, RN, FAAN

  View Outline for H14

  1. Participants verbalize an understanding of the role lymphedema therapist play in facilitating self-care
  2. Participants verbalize an understanding of the importance of assessing ability to perform activities of daily living as treatment outcomes
  3. Participants understand the need to account for patient's ability to perform activities of daily living into their self-care plan of treatment
  4. Participants can state 3 barriers to completing self-care
  5. Participants can list 3 symptoms other than swelling that should be addressed when planning lymphedema self-care
  6. Participants can state two ways to support self-care adherence

  Outline:

  1. Role of Lymphedema Therapist in facilitation of self care
  2. Importance of assessing ability to perform activities of daily living as treatment outcomes
  3. Report on study evaluating affect of swelling on performance of activities of daily living, at assessment and post op lymphedema service intervention, using a clinician designed measurement tool
  4. Importance of incorporating ability to perform activities of daily living when discharging patient's from treatment
  5. Adherence to self-care activities
  6. Patient's perspective of Barriers, Burdens, and Benefits of self-care
  7. Lymphedema related symptoms that impact self-care
  8. Levels of evidence supporting self-care
  9. Tips for improving self-care
• [H15]Introduction to Head and Neck Lymphedema Intervention
  Brad Smith CCC-SLP, CLT
  Leila Little MS, CLT, CCC-SLP

  View Outline for H15

  Patients diagnosed with cancer of the head and neck often undergo complex treatments combining surgery, radiation, and chemotherapies, all of which can contribute to post-treatment performance deficits and compromised quality of life. Head and neck lymphedema occurs in approximately half the patients who undergo treatment for head and neck cancer, yet is much less common than lymphedema in the extremities. As a result, many therapists rarely encounter patients with edema of the head and neck and feel ill-equipped to provide treatment. This session will address the following:

  1. Basics of head and neck cancer and its treatment
  2. General anatomy and physiology of the head and neck with regard to communication and swallowing
  3. Lymphatics of the head and neck
  4. Differences between lymphedema of the head and neck and the extremities
  5. Evaluation strategies and treatment techniques for head and neck lymphedema.

  Outline:

  1. Participants will be able to identify and discuss relevant anatomy and physiology of the head and neck and their relationship to head and neck lymphedema.
  2. Participants will be able to describe differences between standard CDT and modified approaches for patients with head and neck lymphedema.
  3. Participants will learn how compression pads and garments can be safely and creatively applied for patients with head and neck lymphedema.
  4. Participants will be able to discuss how Kinesiotape may be applied for patients with head and neck lymphedema.
  5. Participants will gain a better understanding of a practical, effective approach to managing patients with head and neck lymphedema.

3:45pm – 5:30pm

• [H16]Axillary Web Syndrome
  Jodi Winicour, PT, CLT- LANA
  Linda Koehler, PT, CLT-LANA
  This session is now closed.

  View Outline for H16

  Axillary Web Syndrome continues to be an understudied condition that many therapists who treat patients recovering from breast cancer surgeries will encounter. Unfortunately, most lymphedema certification programs do not have the time to adequately address AWS during their curriculum and so many lymphedema therapists will encounter AWS but not have the knowledge or skills to safely address it. This lecture will improve your awareness of the identification, etiology and treatment of AWS so that you may safely begin to treat this very common syndrome and improve the speed of your patients' recovery.

  1. Attendees will become aware of recent research and the proposed biophysiologic causes of AWS since 2010.
  2. Attendees will become aware of recent trends in the treatment of AWS.
  3. Attendees will increase their ability to safely assess and treat clients with AWS.
• [H17]Documentation For Lymphedema Therapy: Minimizing Insurance Denials
  Jeannette Zucker, DPT, CLT-LANA, CSCS
  Robert Weiss, MS

  View Outline for H17

  The American healthcare system is comprised of multiple governing laws, statutes, and policies administered by numerous entities. However, the Centers for Medicare and Medicaid Services (CMS) establish policies that are widely followed or paralleled by other insurers. The guidelines for compliance with billing and documentation can be complicated and the nuances of how they should be applied to the clinical setting often require clarification. The focus of this instructional session will be a comprehensive discussion on proper billing and documentation specifically for lymphedema therapy. Yet even with proactive billing and documentation claims may still be denied. It is therefore also instructive to gain a thorough understanding of CMS procedural guidelines for appeals.

  1. Participants will become familiar with the CMS guidelines for proper billing and documentation in order to minimize denial rates for reimbursement.
  2. Participants will know the most common reasons for CMS denial of claims.
  3. Participants will gain the ability to demonstrate strong documentation that clearly demonstrates medical necessity and skilled therapy.
  4. Participants will leave with a thorough understanding of the CMS appeals system.
• [H18]Management Of The Patient With Lymphedema In The Palliative Care Setting
  Anna Towers, MD

  View Outline for H18

  This interactive workshop is based on the position document on palliative care published by the International LymphoedemaFramework (www.lympho.org). Treating patients with malignant lymphedema and those who are in the terminal phases of their illness can pose many challenges. This session will review the characteristic features of malignant lymphedema and of chronic edema in advanced disease, including comorbidities. We will look at the assessment of patients who have lymphedema and who are in palliative care, how to reorient the aims of care, and how to work in close collaboration with palliative care teams. We will discuss how to adapt the various conventional elements of decongestive therapy, and how to use bandaging and other aids, to serve these patients. We will learn about management of lymphorrhea and therapy in the presence of malignant wounds. We will discuss how to monitor the effect of therapy in these patients, and how to communicate when difficult situations arise. We will look at research on the needs of patients and families in palliative care, as well as the literature on dignity and communication. We will learn abouthow to deal with our own emotional responses, how to obtain staff support and how to care for ourselves and so that we are better able to help palliative patients to the end of their lives.

• [H19]Integrative Approaches To Lymphedema Management
  Janet McFarland, BSC, PT
  Linda Ann Kahn, CLT

  View Outline for H19

  In this informative and inspiring workshop we will explore various tools that can be effectively used to improve the effects of CDT. As lymphedema is an ongoing condition, solutions often involve more than purely physical strategies and management techniques. The client's emotions, intellect and spiritual aspects play very important roles in creating solutions that lead to the best outcomes for therapists and the clients. In addition skills such as aromatherapy, meditation, guided imagery, natural remedies...can be supportive additions for the LE client and improve their overall management plan for living successfully with lymphedema. These strategies will be explored in lecture, case studies and practical sessions within the workshop.

  The solution-focused approach to treatment is an application from the new field of Positive Psychology that utilizes the strengths and expertise of both the therapist and the client. In this session, current research in neuroanatomy, psychology, psycho-neuro-immunology, and sociology will be presented as an evidence base for new models and strategies. New models of the therapist/client relationship will be presented that allow for the most efficient, empowering and effective use of the resources and skills of both parties.

  This instructional session will include an experiential component in which participants can explore and practice various methods of finding solutions in a problem saturated field. Participants will have skills and models that they can apply immediately in their clinical settings. This session is for the therapist who wishes to broaden their skills in working with the whole person for the best outcomes.

  1. Explore various models and aspects of working as a whole person with the whole person, in lecture, art and discussion format.
  2. Explore various tools such as aromatherapy, solution focused approach, stress management, meditation, guided imagery... that can be used as adjunctive therapies to enhance the effects of CDT.
  3. Gain an understanding of how an integrative approach will help clients and therapists improve the quality of their lives, promoting balance.
  4. Identify new scientific discoveries and theories in the fields of neuro-anatomy, psychology and sociology which enhance the therapists understanding and choices in working with the lymphedema client.
  5. Enrich their current skill base in both listening and interviewing the client, towards co-creating treatment strategies that fulfill both the therapist and client goals.
  6. Identify and work with at least 3 practical strategies, from a Solution Focused approach, to co-create solutions in a lymphedema management plan.
  7. Problem solving sample case studies, in small groups, using the approaches and strategies presented in the workshop.
• [H20]Strategies For Addressing Lymph-Venous Dysfunction
  Erin Swift, NP, CLT
  Ruth Moseley, MS, PT, CLT-LANA

  View Outline for H20

  Lymph-venous dysfunction is becoming more widely recognized in the lymphedema world, as vascular specialists turn to lymphedema therapists to aide in the control of chronic swelling post DVT, and wound care physicians turn to lymphedema therapists to aid in the healing of chronic open wounds associated with venous stasis disease. Lymphedema is much more than a post cancer diagnosis and/or a congenital dysfunction. This presentation will prepare the lymphedema therapist to recognize lymphedema secondary to venous dysfunction and provide him/her with an understanding of how to treat it when referrals come their way.

  1. Understand the pathophysiology of Venous Dysfunction and how it affects lymphatic function
  2. Obtain an understanding of how Chronic Venous Insufficiency (CVI) can, and often will, progress to secondary lymphedema
  3. Understand the complications associated with lymphedema secondary to CVI
  4. Obtain useful/practical information on the treatment of venous stasis ulcers in the presence of secondary lymphedema

Saturday, September 8, 2012 - Plenary Sessions

7:30am - 8:30am
Roundtable Sessions I
Continental Breakfast

8:30am - 9:15am

• The Generation and Regulation of Lymph Flow
  Keynote Speaker: David C. Zawieja, Ph.D.

9:30am - 10:15am

• Point/Counter Point
  Topic: Surveillance and Early Detection for Breast Cancer Related Lymphedema (BCRL)
  Andrea Cheville, MD, MSCE
  Nicole Stout, MPT, CLT-LANA
  
  Moderator: Sheila H. Ridner, MSHA, MSN, PhD, RN, FAAN

10:45am – 11:30am

• Point/Counter Point
  Topic: Surgical Intervention
  Jay W. Granzow, MD
  Sarah McLaughlin, MD
  
  Moderator: Kathleen Francis, MD

11:30am – 12:00pm

Topic: Imaging of Lymphatic Dysfunction
Moderator: Joseph L. Feldman MD, CLT-LANA

• 11:30 – 11:45
  Near-Infrared Fluorescence Imaging of Lymphatics in Metastatic Melanoma and Post-Surgical Recovery
  John C. Rasmussen, PhD
• 11:45 – 12:00pm
  Lymphatic Abnormalities in the Normal Contralateral Arms of Subjects with Breast Cancer-Related Lymphedema as Assessed by Near-Infrared Fluorescent Imaging
  Melissa Aldrich, PhD

12:00pm - 2:00pm
Keynote Luncheon: Development of a Lymphedema Program at William Beaumont Hospital

Keynote Speaker: Frank A. Vicini, MD

Award Ceremony
Exhibitors Round Up

2:00pm – 3:00pm

Topic: Complicated Issues in Lymphedema Management
Moderator: Jennifer Bradt, PT, CLT-LANA

• 2:00 – 2:15
  Cording Following Treatment for Breast Cancer: Associated Risk Factors and Impact on Function
  Jean O'Toole, PT, MPH, CLT-LANA
• 2:15 – 2:30
  Strategies for Inpatient Management of the Medically Complex Lymphedema Patient
  Karin Botti, COTA/L, CLT-LANA
  This session has been cancelled.
• 2:30 – 2:45
  Surgery of Male Genital Lymphedema
  Waldemar L. Olszewski, MD
• 2:45 – 3:00
  Bioelectrical Impedance Self-Measurement Protocol Development and Comparison of Daily Variation Between Healthy Normal Controls and Breast Cancer Survivors with Lymphedema
  Sheila H. Ridner, MSHA, MSN, PhD, RN, FAAN
• 3:00 – 3:15
  Q&A

3:45pm – 5:00pm

Topic: Psychosocial Issues and Quality of Life
Moderator: Linda Boyle, PT, DPT, OCS, CLT-LANA

• 3:45 – 4:00
  Comparison of Pre-treatment and Post-treatment Body Image Related Quality of Life in Patients with Head and Neck Cancer
  Bethany Andrews, RN, MSN
• 4:00 – 4:15
  A Qualitative Comparison of the Impact of Lymphedema on Sexual Experience among Breast Cancer Survivors
  M. Elise Radina, PhD
• 4:15 – 4:30
  Yoga for Breast Cancer Related Lymphoedma, Benefits Beyond Objective Measures
  Jan Douglass, HSC
• 4:30 – 4:45
  Fear of Lymphedema After Treatment for Breast Cancer
  Lauren Jammallo, BS
• 4:45 – 5:00
  Q&A

Sunday, September 9, 2012 - Plenary Sessions & Conference Wrap-up

7:30am - 8:30am
Roundtable Sessions II
Continental Breakfast

8:30am - 9:30am

• The Wittlingers and the Legacy of Emil Vodder
  Keynote Speaker: Professor Hildegard Wittlinger

9:30 – 10:15am

Topic: Lymphatic Imaging in Clinical Disorders
Moderator: Michael Bernas MS

• 9:30 – 9:45
  Early Experience of MR Lymphangiogram in Patients with Primary & Secondary Lymphoedema of the Lower Limb
  Alex Munnoch, MD, FRCSEd
• 9:45 – 10:00
  Revealing Lymphatic Disorders Phenotypes Associated with Cardiovascular Malformations Using NFR Imaging
  I-Chih Tan, PhD
• 10:00 – 10:15
  Q&A

10:45am – 11:45pm

Topic: Lymphedema Treatment and Mechanism (Physiology)
Moderator: Andrew Moore, MD

• 10:45 – 11:00
  Visualization of Lymphatic Dysfunction Among Patients with Stasis Ulcers and the Effect of Pneumatic Compression; Results of A Pilot Study
  Caroline E. Fife, MD, CWS
• 11:00 – 11:15
  Where Does Tissue Fluid/Lymph Accumulate During Manual and Pneumatic Massage and Elastic Garment Compression in Lymphedematous Lower Limb
  Waldemar L. Olszewski, MD
• 11:15 – 11:30
  A Randomized Controlled Trial Comparing Two Types of Pneumatic Compression Devices for Breast Cancer Related Lymphedema Treatment in the Home
  Erik A. Maus, MD
• 11:30 – 11:45
  Q&A

11:45am - 12:00pm
Conference Wrap-Up

Please Note: Program is Subject to Change

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