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Q: Why do some therapists measure my limb in different ways? Some use tape measures and some use other methods. Which is correct?
A: Different techniques for measurement have been found to be reliable and valid in assessing limb changes over time. The technique that your therapist chooses should be the same each time that the measures are taken. This will ensure that the measurement is correct to accurately assess the changes taking place in the limb. Techniques include: circumferential limb measurement, water displacement and optoelectronic devices. Circumferential measures are typically done with a tape measure at specific intervals up the limb. Water displacement involves submerging the limb into a vessel full of water and measuring the amount of water that the limb displaces. These two methods are the most common techniques used in clinics to measure limb volume. Both techniques are accurate ways for therapists to measure a limb. Regardless of the technique that your therapist chooses, the most important aspect that contributes to accurate assessment of the limb is that the technique be repeated in the same way each time the measurements are taken.
When your therapist measures your limb for the first time, he/she should note the technique used so that it can be repeated for subsequent measurements. Before beginning treatment, it is important for measurements to be taken on both extremities. This enables a more accurate assessment of the change in your limb volume over time. Measurement of your limb should be ongoing at regular intervals during your therapy. Regular measurement objectively helps to ensure that your limb is responding to the treatment. The same measurement technique and limb position should be used with each follow-up measurement session. Altering the position from sitting to standing or lying down can change the distribution of the tissue and alter the measurements. If your therapist uses circumferential measurements, he/she should make sure that the interval is standardized for each session. They may take measures every 4 centimeters along the limb or at another predetermined interval. It is important to assure that this interval for measurement is repeated at each follow up session to assure that the limb change is being accurately assessed.
Q: Is it important to have regular follow up with my therapist for measurements even though I am finished with treatment?
A: Yes! It is absolutely important that you maintain a regular follow-up schedule with your therapist. This followup will enable you and your therapist to determine if your condition is being maintained adequately and will assist in assuring that you are receiving the most appropriate treatment.
After you have finished therapy sessions and are working independently to manage your lymphedema, it is important to have a way to gauge whether or not the treatment and compression garments that you are using are effective. Your therapist likely taught you how to self-bandage and how to wear your compression garment correctly. Additionally, you may be incorporating other self-care techniques to manage your limb. Following up with your therapist at regular intervals will assure that techniques you are using are adequately maintaining the limb.
A compression garment will only effect and maintain lymphedema in a limb for approximately six to nine months. After this time, natural wear and stretch to the garment will decrease the strength of the material making it somewhat less effective at maintaining the limb's volume. It is important to see your therapist for follow up measurements on your limb so you can order the garment in the correct size. Additionally, measurements at this time will help you and your therapist to determine if the compression of the garment is adequately maintaining your limb. If regular compression garment wear is proving to be ineffective in managing your condition, follow-up measurements may demonstrate an increase in your limb volume and will help to guide you and your therapist in determining a better approach to care.
If you are experiencing a new medical diagnosis or medical condition, checking in with your therapist for re-measurement is important to determine if the condition has adversely affected your lymphedema.
Q: Can I take my own measurements?
A: There are some ways in which you can incorporate self-measurement into your own regimen of care. One simple way is to find a spot on your limb that you can easily locate and that does not move or change over time. An example may be a boney landmark such as the wrist bone or a long-standing skin mole or birthmark. With a tape measure, use the landmark to take a simple measure around your limb from time to time. It is an excellent way to determine if you are adequately maintaining your limb volume. If you notice an increase in the volume of your limb that does not resolve with your self-care regimen, schedule a follow-up visit with your therapist so that he/she can take further measurements to determine the appropriate course of care.
Nicole L. Gergich MPT, CLT-LANA, is the lead physical therapist in the Breast Care Center at the National Naval Medical Center in Bethesda, MD. Current president of the Oncology Section of the American Physical Therapy Association; Member of the NLN Medical Advisory Committee; Secretary of the LANA Board.
Please address questions to: Editor c/o NLN, 116 New Montgomery Street, Suite 235, San Francisco, CA 94105 or e-mail: nln@lymphnet.org. Deadlines for submissions (for the following issue) are: Feb 15, May 15, Aug 15, Nov 15.
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