This therapy is used primarily in the treatment of lymphedema and
venous insufficiency edema and it has been shown to relieve the edema,
fibrosis and the accompanying pain and discomfort of these conditions:
Combined Decongestive Therapy (CDT) is a combination of the Dr.
Vodder method of Manual Lymph Drainage, remedial exercise therapy,
compression bandaging (or compression garments in the maintenance
phase) and therapeutic skin care.
According to the International Society of Lymphology, this is the
treatment of choice for lymphedema. Results of scientific research have
been documented and published in many peer-reviewed journals.
Initial Phase:
Patients undergo a medical assessment by a physician and are
referred to a certified therapist. After a thorough evaluation to
determine the best treatment plan, patients are advised of the
treatment choices, which are customized to the individual needs.
During this Initial Phase, CDT is usually required 5 – 6 times per
week and treatment may last anywhere from 2 – 4 weeks.
Depending on the condition, each session typically lasts one hour
and involves daily assessment of the patient’s condition. Skin and
wound care may be undertaken.
This is followed by a Manual Lymph Drainage massage treatment
which usually lasts about 45 minutes and is followed by compression bandaging.
The bandages are applied exactly to conform to the patient’s tissues
and are reapplied on a daily basis. They are short-stretch bandages
that resist muscle contraction and are applied with comfortable padding
underneath.
The bandages help to maintain the reductions achieved with
MLD and may even cause further reduction.
After bandaging, therapeutic exercises may be demonstrated that the
patient can easily perform. These also help in further reducing the
limb.
Reduction in limb volumes vary, dependent on many factors such as
age, weight, extent of the edema, skin condition and co-morbidities.
Typically patients might expect a 40 – 50% reduction in limb volume
although it may be more or less than this. Sometimes improvement in
other measurable factors such as tissue hardness, pain and mobility may
be more significant to patient than volume reduction.
Maintenance Phase:
Towards the end of the initial phase, volume reduction starts to
stabilize and the therapist will usually recommend that the patient is
fitted for a compression garment. For lymphedematous limbs, the optimal
material to use for these garments is a flat knit, low-stretch material
that is similar to the short-stretch bandages.
A
treatment plan is devised for the maintenance phase and this may
require weekly, monthly or six-monthly visits to the therapist.
Patients continue to wear their compression garments, continue to do
exercise and home care as well as monitor their condition carefully.
MLD may also be used during these visits.
Successful maintenance of the reduced limb is essential to prevent
further problems developing. With correct therapeutic intervention
using CDT, patients can successfully manage their lymphedema.
