• Based at the Cork Clinic, Western Road, Cork
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Level 3 – Course content

Lymphoedema and chronic oedema course (73 hours or 90 UIs). Theoretical instruction: 16 hours or 24 UIs

Taught by a physician/lymphologist with special lymphology training.

LYMPHOOEDEMA:

Diagnostics of lymphooedema, lymphoscintigraphy, indirect and direct lymphograpy, patent blue test, Stemmer’s sign, primary lymphoedema and its pathophysiology, secondary lymphoedema and its pathophysiology, malignant lymphoedema, MLD and metastatization;

Risks and prevention of oedema, oedema fact sheets;

Compression therapy of lymphoedema using
bandaging, stockings and compression devices;

Surgical interventions in lymphoedema;

Complications in lymphoedema such as erysipelas, lymph vesicles, lymphatic fistulas, lymphocele, lymphogenic ulcers, protein fibroses, interdigital mycoses, papillomatosis cutis lymphostatica, Stewart- Treves syndrome = angiosarcoma;

Lymphoedema and pregnancy;

Radiation injury in combination with lymphoedema;

Radiation dermatitis, radiation fibrosis, radiofibrotic plexus injury, radiation injury of other organs;

Outpatient and inpatient lymphology treatment and results in lymphoedema

Face lymphoedema after neck dissection.

ARTIFICIAL LYMPHOOEDEMA (SELF-INDUCED OEDEMA):

  • Assessment and measurement of lymphoedema.

VENOUS OEDEMA:

  • Anatomy of veins and pathophysiology of the venous system
  • Thromboses, thrombophlebitis, varicose veins, ulcus cruris venosum
  • Compression therapy in phleboedema, phleboedema/ulcus cruris/phlebolymphoedema as indications for MLD.

POST-TRAUMATIC OEDEMA / POST-OPERATIVEOEDEMA/ PERI-OPERATIVE OEDEMA:

  • In fractures, contusions, distortions, sprains, dislocations, pain, postoperative oedema and hematoma as well as oedema in burns.
  • Pathophysiology and role of MLD and other accompanying therapies.

REFLEX SYMPATHETIC DYSTROPHY = SUDECK’S DISEASE (COMPLEX REGIONAL PAIN SYNDROME)

  • Pathophysiology, manifestations, medical therapy andMLD as supplementary treatment.

OEDEMA CAUSED BY PHYSICAL INACTIVITY:

  • Pathophysiology, role of MLD.

OEDEMA IN ARTERIAL CIRCULATORY PROBLEMS:

  • Pathophysiology, gangrene, indication for and limits of MLD and compression therapy

LIPOEDEMA

Distinction between adiposity, lipohypertrophy, lipoedema and lipolymphoedema.

Pathophysiology, diagnosis and therapy.

IDIOPATHIC OEDEMA:

Pathophysiology, clinical picture and therapy, role of MLD and compression.

CHRONIC INFLAMMATORY OEDEMA:

Rheumatic oedema, pathophysiology, MLD as additional therapy.

CONTRAINDICATIONS FOR MLD, IN PARTICULAR:

• Acute infections
• Cardiac decompensation
• Acute phlebothrombosis
• Local recurrence of tumor, local metastasizing
• Acute eczema in oedema region

OEDEMA THAT ONLY RESPOND TO MEDICATION AND DIETARY THERAPY:

Pathophysiology, role of MLD.

PRESCRIPTION OF MLD

Prescription of compression bandaging and stockings: Indications for bandaging;

Different types of compression stockings, compression devices and prostheses;

Psychological problems in patients with oedema in post-cancer treatment.

PATIENT DEMONSTRATIONS:

Eight or more patients suffering from oedematous disorders need to be presented, among them at least one case of primary oedema, one case of secondary lymphoedema of the arm, one case of secondary lymphoedema of the leg, one phleboedema and one lipoedema. As a matter of principle, these patients must be introduced. Deviations are admissible in countries other than Germany/Austria.

MINIMUM CONTENTS OF MEDICAL / THEORETICAL INSTRUCTION:

Anatomical and physiological basics of the circulatory system (arterial, venous, lymphatic); etiology and pathogenesis of oedema, especially in malignant diseases; complications in lymphoedema; organ damage and oedema following radiation therapy; indications and contraindications for MLD. Other medical and non-medical treatment options in lymphoedema in addition to MLD.

MINIMUM CONTENTS OF PRACTICAL INSTRUCTION
(57 hours, 66 UI)

Repetition of practical instruction from Elementary (Level I) Courses. Oedema strokes and special strokes. Lymphatic drainage and compression therapy of primary lymphoedema of the leg, secondary lymphoedema of arm and leg, lipoedema and venous oedema. Lymphatic drainage and remedial exercises as well as decongestive respiratory therapy. Treatment of ulcerations, protein fibroses and radiation-induced fibroses.

Participants will practice on each other. Treatment will be demonstrated in two or more oedema patients (at least one secondary oedema of the arm and one secondary oedema of the leg, when available) by the practical instructor or the treating therapist including complete bandaging of the oedematous extremity.

FINAL EXAMINATION:

This test includes a written, a practical and a medical/oral examination of all training contents. Students will pass the examination if they score “sufficient” in all portions of the examination. Each failed portion of the examination may be repeated no more than two times.