All WALES LYMPHOEDEMA GUIDANCE:

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Moris Hubbard
5 years ago
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1 All WALES LYMPHOEDEMA GUIDANCE: Measuring Limb Volumes to Determine Lymphoedema Outcome April 2013 Created by the All Wales Lymphoedema Service Leads

2 Aim To standardise the procedure for taking limb circumferential measurements to determine limb volumes as well as excess volumes. Background As of 2011 Wales has dedicated services within all Health Boards to assess and manage people who have lymphoedema / chronic oedema. All clinics utilise circumferential measurements and input these into a Lymcalc programme to determine limb and excess volumes. It has been recognised that standardisation of how measurements are taken is needed so that all therapists and assistant staff will follow the same procedure for consistency, reproducibility and comparability. This standard will also give service users uniformity should they transfer to a neighbouring Health Board, and it will enable research to take place across Wales. This guidance follows on from the work done by the Australian Lymphoedema Association s (ALA) Measuring Standards Protocol March and is supported by recent research executed by Brorson and Höijer 2 (2012). Tools Required: The following tools are recommended for the taking and recording of circumferential measurements: Tape measure Ruler Marking pen or pencil Measuring chart for recording measurements Skin wipes Type of tape measure: the tape must be of plastic/nylon material with an accuracy of 1 millimetre. The choice of hand held or spring-tensioned is dependent on staff training and personal choice. Cleaning equipment: Ensure the tape and ruler are cleaned and dried between patient use in accordance with manufacturer s guidance and local Health Board Health & Safety and Infection Control policies. 2

Measuring: Positioning: hand held tape measure: lay the tape measure to overlap with the mark* in the middle

photos below) Tension: hand held tape measure: place the tape measure snugly around the limb without tightening the tape

position the tape at the required mark, hook the plastic end in the hole of the unit, and push the button so as to take

3 Measuring: Positioning: hand held tape measure: lay the tape measure to overlap with the mark* in the middle spring-tensioned tape: lay the tape above the mark* * the mark is the point on the limb that has been drawn (see in photos below) Tension: hand held tape measure: place the tape measure snugly around the limb without tightening the tape (secure tape to prevent it slipping/falling down) Correct laying of tape Too much tension spring-tensioned tape: position the tape at the required mark, hook the plastic end in the hole of the unit, and push the button so as to take up the slack of the tape Inter-reliability: where possible, the same therapist should do measurements during a course of intensive treatment. 3

Measuring the Upper Limb: Position of the patient: The plinth should be raised to obtain 90 shoulder elevation (or as near as) Sitting with arms extended to the

Ensure elbows are as straight as possible and palms down Avoid forearm resting on the plinth Marking: Use ruler to mark the arm First mark: from the nail bed of

aspect of the arm) Use the ruler to mark every 4cm along the lateral edge of the arm up to the axilla; if a ruler unavailable, use the tape measure tensioned

4 Measuring the Upper Limb: Position of the patient: The plinth should be raised to obtain 90 shoulder elevation (or as near as) Sitting with arms extended to the front and hands resting on the plinth or back of a chair. Ensure elbows are as straight as possible and palms down Avoid forearm resting on the plinth Marking: Use ruler to mark the arm First mark: from the nail bed of the little finger to above (proximal) the ulnar process; alternatively measure 2cm from the wrist crease The mark is made on the lateral border of the arm (outer aspect of the arm) Use the ruler to mark every 4cm along the lateral edge of the arm up to the axilla; if a ruler unavailable, use the tape measure tensioned straight (i.e. not following curvature of arm) End point is 2cm below the axilla For Lymcalc documentation: o Distal = from wrist to elbow crease o Proximal = from elbow crease to axilla o If unsure about elbow crease, flex elbow to determine if mark is above or below the elbow 4

Measuring the Lower Limb: Position of the patient: Sitting on plinth with legs in an elevated position;

feet flat on floor or on the foot plate if in wheel chair; document patient position in notes Marking: Use

of leg) The mark is made on the lateral border of the leg (outer aspect of the leg) Use the ruler to mark

tape measure tensioned straight (i.e. not following curvature of leg) End point is 2cm below the groin If

measurements For Lymcalc documentation: o Distal = from ankle to crease of knee o Proximal = from crease

5 Measuring the Lower Limb: Position of the patient: Sitting on plinth with legs in an elevated position; knees as straight as possible If the patient is unable to get on plinth or straighten their legs; sit with feet flat on floor or on the foot plate if in wheel chair; document patient position in notes Marking: Use ruler to mark the leg First mark: from the base of the heel to above the lateral malleolus (lateral border of leg) The mark is made on the lateral border of the leg (outer aspect of the leg) Use the ruler to mark every 4cm along the lateral border of the leg up to 2cm below the groin; if a ruler unavailable, use the tape measure tensioned straight (i.e. not following curvature of leg) End point is 2cm below the groin If measuring in the chair: measure lower leg to the knee; then straighten the leg to obtain some knee/thigh measurements For Lymcalc documentation: o Distal = from ankle to crease of knee o Proximal = from crease of knee to groin o If unsure about crease of knee, flex knee to determine if mark is above or below the knee 5

6 The Palliative Patient For the patient who is in the terminal phase of their illness the therapist can choose to do measurements as for made-to-measure garments or ready-to-wear garments. Document in the patient notes the method of measurement used for repeatability. References: 1. Setting a National Standard for Measurement of Lymphoedematous Limbs; Prepared for ALA Conference, Brisbane 2004 by ALA Standards Committee: Louise Koelmeyer, Kerryn Shanley, Hildegard Reul-Hirche, Neil B Piller 2. Brorson H, Hoijer P (2012) Standardised measurements used to order compression garments can be used to calculate arm volumes to evaluate lymphoedema treatment; J Plast Surg Hand Surg (2012) 46: Review Date: April

Resistance Training Package

Resistance Training Package GENERAL INSTRUCTIONS: Always complete a warm up and a cool down before and after resistance training. Select a weight (dumbbell or band) that you are able to complete 8 to 10 repetitions of the exercise