Indentation Resistance of Lymphedematous Limbs Accompanying Low - PowerPoint PPT Presentation

Changes in Tissue Water and Indentation Resistance of Lymphedematous Limbs Accompanying Low Level Laser Therapy (LLLT) Harvey N. Mayrovitz, PhD College of Medical Sciences Nova Southeastern University Suzanne Davey, OTR/L, CLT-LANA Healing Hands of Lymphatics Ft. Lauderdale, Florida

Does LLLT acutely affect tissue hardness and/or water content?

Does LLLT acutely affect tissue hardness and/or water content? NLN 2008 – San Diego Ann Attendee Aki Australia ? Finland

Does LLLT acutely affect tissue hardness and/or water content? Patients studied had clinically identified lymphedema and fibrosis (37 Arms 36 Legs) 1 Pre-LLLT Tx 5 min LLLT Post – LLLT Tx 2 M 51.2 ± 1.5 L min D Post – MLD Tx 3

Does LLLT acutely affect tissue hardness and/or water content? Patients studied had clinically identified lymphedema and fibrosis (37 Arms 36 Legs) 1 Pre-LLLT Tx Measurements 5 min • Girth  Tape measure LLLT • Tissue Water  Post – LLLT Tx 2 Tissue Dielectric M Constant (TDC) 51.2 ± 1.5 L • Tissue Indentation min D Resistance  Force Post – MLD Tx 3 for a fixed indentation

Legs: Lymphedema due to Varied Etiologies Males: 18 Females: 18 Control Site Five treatment sites marked with template LLLT Tx 1 min/site

Arms: All Breast Cancer Treatment-Related Lymphedema All Unilateral N=37

Arms: All Breast Cancer Treatment-Related Lymphedema All Unilateral N=37

Girth Measured with fixed tension

Tissue Dielectric Constant (TDC) TDC ~ % H 2 O 100% ≈ 78

Tissue Resistance (Force-Indentation) Force Indentation 2, 3 & 4 mm

LLLT 1 min @ each site

Results Pre-Treatment Comparisons Affected vs. Control Arms  37 Legs  36

Limb Girth 50 Girth Affected Control 40 TH (cm) 30 GIRTH 20 10 P < 0.001 P < 0.001 0 Arms Legs gs Affected > Contralateral

Tissue Water 60 Tissue Dielectric Constant (TDC) Affected Control 50 40 TDC 30 20 10 P < 0.001 P < 0.001 0 Arms Legs gs Affected > Contralateral

Tissue Force 500 Tissue Resistance (Force-Indentation) E (gm @ 4 mm) Affected Control 400 Force Indentation 300 FORCE 200 100 P < 0.001 P < 0.01 0 Arms Legs gs Affected > Contralateral

Results LLLT Treatment Effects Pre - Tx  Post - Tx Pre - Tx  Post - MLD

Tissue Force - Arms 350 Pre-LLLT Tx P<0.001 300 Post-LLLt Tx FORCE (gm ) Post-MLD Tx 250 PRE-TX PST-MLD L L 200 MLD L T P<0.001 150 PST-TX 100 P<0.01 50 P<0.01 P<0.001 P<0.001 0 2 3 4 Indentation Depth (mm)

Tissue Force - Legs 450 P<0.05 Pre-LLLT Tx 400 Post-LLLT Tx FORCE (gm ) 350 Post-MLD Tx PRE-TX 300 P<0.05 PST-MLD L L MLD L 250 T 200 PST-TX P<0.05 150 100 50 P<0.001 P<0.001 P<0.001 0 2 3 4 Indentation Depth (mm)

Tissue Water 50 PRE-TX Pre-LLLT Tx PST-MLD Post-LLLT Tx LLLT MLD Post-MLD Tx 45 P<0.05 NS PST-TX TDC 40 35 P<0.001 P<0.001 30 Arms Legs

Results Active LLLT Treatment Vs. Sham Treatment N= 17 Legs

Active vs. Sham 45 Legs gs N=17 Force @ 4 mm or TDC Pre-LLLT Tx Post-LLLT Tx 40 FORCE TDC (x10 -1 ) 35 30 25 P<0.001 P<0.05 P<0.001 P<0.05 20 Active Sham Active ve Sham

Active vs. Sham 30 Legs gs N=17 Active P<0.001 Sham 25 % Decrease P<0.001 20 15 10 5 Active ve Sham Active ve Sham 0 FORCE TDC

Summary • Rapid acute reduction in local tissue water and hardness with 5 minute treatment • Occurs with active LLLT & with SHAM but greater reductions with ACTIVE • Tissue water & hardness trend back toward pre-tx levels by the end of an MLD session • Specific role & mechanism of low level laser light in observed changes is not yet known