5 Ways to Incorporate Edema Management Into Your OT Practice
As an occupational therapy practitioner, you likely encounter swelling and edema with many of your patients. Swelling and chronic edema is an issue that can occur post-trauma, surgery, with chronic conditions such as diabetes and vascular insufficiency – and many more.
Edema can have a profound effect on occupational performance. Often felt as heaviness, achiness, and pain in the limbs, it can reduce transfers and mobility; independence with basic and instrumental ADLs; and even community reintegration.
Yet, in our typical occupational therapy plan of care, we do not always think to set an edema management goal! When we are collaborating with our patients, setting goals, and establishing a plan of care, swelling may not come up – either on the part of the patient or clinician.
So, why is this area of practice so underserved, misunderstood, and overlooked by typically shrewd (yes, I’ll say it! 💁♀️) and holistic OT practitioners?
Edema management in OT is often overlooked as it is felt to be a ‘specialty’ area of practice. And, while it is true to say that treating edema in a complex and thorough capacity will require ongoing training, edema management is still an area that any OT practitioner can have an impact on!
Let’s take a look at 5 ways that you can incorporate edema management into your daily OT practice.
1. Check for swelling and its telltale signs as part of your evaluation
The first thing you can do as a well-rounded OT practitioner is to be aware of chronic swelling in the first place! We are often doing ADLs, using our skilled observation to monitor for impairments and occupational performance issues – so beginning to look for the telltale signs of swelling and edema as a part of our ongoing assessment is just a natural next step!
What kinds of signs/symptoms could you be on the alert for?
Well, the subjective symptoms of swelling – such as tired and aching limbs, difficulty lifting heavy legs (during bed transfers is a great example), and self-reported swelling in their limbs. Objectively, you can of course be on the lookout for increased girth, puffiness, pitting, and shoes/socks not fitting. Chronic edema will also lead to a progressive change in skin condition – the content of the fluid creating changes at the molecular level and manifesting in some characteristic skin conditions.
If you notice any of these signs, or your patient brings them to you, it can trigger you to both begin to observe and monitor these issues, and begin a conversation with your patient as to how this could lead to further complications if left untreated.
2. Stimulate the lymphatic system with manual edema mobilization
If edema is an issue for your patients, it can be quite straightforward to stimulate and harness the movement of the lymphatic system to help with circulation. One easy-to-include exercise is: diaphragmatic breathing!
Why is something as ubiquitous as diaphragmatic breathing helpful in the treatment of chronic swelling? Well, understanding the mechanics of the lymphatic system helps to clarify: lymphatics are influenced by hydraulics (read: pressure changes!). By changing the pressure and creating a vacuum effect within the abdomen, where a large lymphatic vessels reside, you can influence the flow in peripheries.
There are multiple reasons to teach your patient diaphragmatic breathing, of which improving circulation may be just one!
For more info on how to teach you patient, check out YouTube for tutorials for “Teaching Your Patient Diaphragmatic Breathing.”
3. Focus on skin assessment and proper care
Skin care is a classic case of an overlooked but vital aspect of care. If your patients’ skin has broken down, or they have developed infections, non-healing wounds and/or ulcers, it will screech your patient’s rehab to a halt! It is also one of the most common reasons that your person may not be able to discharge home, need continued rehab, or even be re-admitted to the hospital.
Make sure you are aware of appropriate treatment for various skin conditions, and educate your patient about hygiene, skin care and protection, and avoiding potential triggers! Setting a skin care goal is a great way to help manage edema in your patient’s treatment plan.
4. Use regular exercises in savvy ways
Using exercise to stimulate the lymphatic system is crucial – and many of the exercises that are recommended may be ones that your patient is already doing! Walking, joint mobilization exercises, repetitive and non-resistive movements (like the recumbent bike, for example) are all excellent exercises to use to stimulate circulation and lymphatic drainage.
NOTE: we can make these exercises work far better if we educate and encourage our patients to wear their compression garments to maximize the circulation during these movements.
Need more exercise ideas? Check out our article, 6 Totally Free Home Exercise Programs To Use With Your Patients.
5. Include education and resources as a part of your treatments
At the end of the day, even if you do not feel that treating your patients’ edema is going to be a part of your plan of care – you can always identify the swelling and educate your patient as to resources and follow up that they should consider.
Going to an outpatient clinic to get treatment and home management for ongoing swelling can truly boost your patients’ quality of life and prevent further edema and complications setting in. Many clients do not know that outpatient lymphedema clinics exist until they are referred to one!
Additionally, you can connect your patient to online resources such as support groups, local advocacy chapters and home therapists. Reading blogs by people who are going through the same issues, what helped them and the supports that worked for them may be life-changing for a patient who had no previous knowledge of the condition.
So, as you can see – incorporating edema management techniques is not as daunting as it may appear at first blush! As mentioned, it is worth seeking out more training and CEUs if you want to become even more effective in folding these treatments – but always remember, you don’t have to be certified to start educating, assessing, supporting, and advocating for swelling and edema treatment with your patients.
Once you know that this is an issue for your patient – you may the only one who brings it up, sets a goal, and lets your patient know that they have options around intervention.
Don’t underestimate the effect that we can have when treating holistically!
Emily Cahalan, OTR/L, CLT, CBIS writes on all things swelling, rehab, and OT at ARCSeminars.net. Check out her writing, get some free edema management resources, and learn more at ARC Seminars!