Self-drainage lymphatic technique

Evolution of Godoy & Godoy manual lymph drainage. Technique with linear Movements

Manual lymph drainage has become the mainstay in the treatment of lymphedema for decades now. Five evolving variants have been described by Godoy & Godoy over the years: i) manual lymph drainage using rollers; ii) self-applied manual lymph drainage using rollers; iii) manual lymph drainage using the hands (manual lymphatic therapy); iv) mechanical lymphatic therapy using the RAGodoy® device; and v) lymphatic therapy using cervical stimulation in general lymphatic treatment. After breast cancer treatment using adapted technique with intermittent compression therapy. Lymphoscintigraphy, volumetry and bioimpedance were employed to analyze such treatment techniques applied to the upper and lower extremities. These treatment and evaluation topics are described in this brief report.

Adaptations in the treatment of congenital lymphedema centered on the quality of life

Case Description. This report describes the evolution, necessary adaptations, and complications in the treatment of a 9-year-old child with primary congenital lymphedema. Description of Intervention. The clinical treatment of lymphedema was started in the first year of the patient's life and for five years she was only treated using the Godoy & Godoy technique of cervical stimulation. Three years ago the patient was prescribed a compression stocking made from a cotton-polyester fabric (grosgrain) because of a sudden increase in the lymphedema after she started to take growth hormones. Outcome and Conclusion. The combination of cervical stimulation and a compression stocking was effective to keep the child's life relatively normal, performing all day-to-day and recreational activities.

Lymph drainage in pregnant women

Aim. The aim of this study was to evaluate the efficacy of lymph drainage to reduce edema of pregnant women. Method. Pregnant women (30 limbs) from the Obstetrics Outpatient Clinic of the Medical School of Santa Casa in São Paulo in the period December 2009 to May 2010 were enrolled in this quantitative, prospective study. The patients, in the 5th to 8th months of gestation, were submitted to one hour of manual lymph drainage of the legs. The volume of the legs was measured by water displacement volumetry before and after one hour of drainage using the Godoy & Godoy manual lymph drainage technique. The paired t-test was used for statistical analysis with an alpha error of 5% being considered significant. Results. Manual lymph drainage significantly reduced swelling of the legs of pregnant women during the day (P = 0.04). Conclusion. Manual lymph drainage helps to reduce limb size during the day of pregnant women.

Lymphoscintigraphic evaluation of manual lymphatic therapy: the Godoy & Godoy technique

The objective of this study was to evaluate the transport of radiotracers in lymphatic collectors during manual lymphatic therapy. The legs of four male and two female patients with leg lymphedema were assessed using lymphoscintigraphy before, during and after manual lymphatic therapy. The ages of the patients, treated in Hospital de Base in Sao Jose do Rio Preto, ranged from 42 to 64 years with a mean age of 51.2 years. Consecutive patients with grade II leg lymphedema were enrolled in this study. Patients with lymphedema secondary to lymphadenectomy, active infections and weight greater than 130  kg were excluded. Patients were submitted to manual lymphatic therapy, which consists of the collapsing of capillaries using manual compression which is then slid along the skin in a stroking action in the direction of the lymph flow within lymphatic vessels towards the lymph nodes. Two dynamic studies were performed; the first was over 40 minutes (3 images every 10 minutes) which was immediately followed by an entire body scan. A second dynamic evaluation was performed taking images at 10-second intervals over 2 minutes during manual lymphatic therapy. To evaluate the displacement of radiotracers, the path of lymphatic collectors from the knee to a lymph node in the upper thigh was divided into five similarly sized regions of interest. The concentration of radiotracer was quantified in each of the regions of interest. The paired t-test was used for statistical analysis with an alpha error of 5% (p value < 0.05) being considered statistically relevant. The results show statistically significant differences in the number of particles in all the regions of interest comparing before and after treatment (two-tail paired t-test: p value < 0.0001). Manual lymphatic therapy improves the transport of radiotracers in lymphatic collectors.

Evaluation of a new approach to the treatment of lymphedema resulting from breast cancer therapy

PURPOSE

The aim of this study was to evaluate a new form of intensive treatment for arm lymphedema.

METHODS

A prospective study of 66 patients with breast cancer-related lymphedema was performed. The ages of the patients ranged from 35 to 83 years old with a mean of 58.8 years. Diagnosis of lymphedema was made by physical examination and water-displacement volumetry (a difference of ≥ 200 mL between arms). All the patients were submitted to clinical treatment in an outpatient setting which involved a once-weekly session of 3 to 4h of manual and mechanical lymph drainage, myolymphokinetic activities and exercising using facilitating apparatuses and the use of a medical compression sleeve. Monthly volumetry evaluations were routinely performed. The Student t-test was employed for statistical analysis with an alpha level of 5% (p<0.05) being considered significant.

RESULTS

The mean follow-up time between cancer treatment and this study was 12.3 months. A significant reduction in the size of the arms was observed for all patients. The mean difference between the lymphedematous and normal arms of all patients was 553.8 mL at the start of treatment and a mean reduction of 70.1% (388.7 mL) of the edema was achieved (p=0.0001).

CONCLUSION

In our experience, this model of treatment appeared efficacious in decreasing and maintaining the reduction in volume of arm in breast cancer-related lymphedema.

The godoy & godoy cervical stimulation technique in the treatment of primary congenital lymphedema

THE AIM OF THE CURRENT STUDY IS TO REPORT ON THE TREATMENT OF PRIMARY LYMPHEDEMA USING A NEW FORM OF THERAPY: cervical stimulation. In a prospective cohort study, 9 boys and 5 girls with primary congenital lymphedema were evaluated over two years. Age ranged from two months to 8.5 years. After diagnosis, all mothers were trained in the new technique. The Godoy & Godoy cervical stimulation technique consists of between 20 to 30 stimuli per minute using light movements in the cervical region. All the children were submitted to perimetric evaluations of the feet and legs; however, in this study only two points, 3 and 6 cm from the base of the big toe nail, were used. The two-tailed t-test was used for statistical analysis with an alpha error of 5% (P<0.05) considered acceptable. The size of the lymphedematous feet was reduced and even normalized (P<0.0001) for all treated children. Cervical stimulation is a new option in the treatment of primary congenital lymphedema; its association with compression stockings has a synergistic effect in reducing the volume of lymphedema.

Evaluation of lymph drainage using bioelectrical impedance of the body

AIM

The aim of this study was to investigate the effects of manual and mechanical lymph drainage on the bioelectrical composition of body tissues of patients with lymphoedema of the lower limbs.

METHOD

Twenty-one patients with lymphoedema of one leg were evaluated using single frequency bioelectrical impedance with four electrodes (SF-BIA4) immediately before and after a combination of manual and mechanical lymph drainage. Statistical analysis used the two-tailed paired t-test with an alpha error of 5% being considered acceptable.

RESULTS

On comparing the results before and after lymph drainage, statistically significant differences were identified for both lymphoedematous and apparently healthy legs, but there were no significant differences in the alterations caused by the treatment between the healthy and lymphoedematous limbs of the same patient.

CONCLUSION

It was concluded that the association of manual and mechanical lymph drainage both modified the body composition as identified by bioelectrical impedance, and reduced the oedema.

Intensive treatment of leg lymphedema

Background:

Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary.

Aim:

The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema.

Methods:

Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered significant.

Results:

All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13 (56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were recorded for 95.65% of the patients; only 1 patient lost less than 50% (37.9%) of the edema.

Conclusion:

The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

Godoy & Godoy technique in the treatment of lymphedema for under-privileged populations

The aim of this paper is to report new options in the treatment of lymphedema for under-privileged populations. Several articles and books have been published reporting recent advances and contributions. A new technique of manual lymph drainage, mechanisms of compression, development of active and passive exercising apparatuses and the adaptation of myolymphokinetic activities have been developed for the treatment of lymphedema. This novel approach can be adapted for the treatment of lymphedema in mass.