Lenfödemde Fizyoterapi ve Rehabiltasyon
Özet
Lenfödem, lenfatik sistemin patolojik bir durumu olup, proteinden zengin sıvının interstisyel aralığa birikimesi sonucu inflamasyon, adipoz artışı ve fibrozis ile karakterize bir ödem şeklidir. Etkilenen bölgede şişliğe ve hatta eklem hareket açıklığında kayıplara neden olabilmektedir. Lenfödem nedensellik bakımından primer ve sekonder olarak incelenirken, ödemin şiddeti ve ekstremitenin tutulumu açısından 4 evrede sınıflandırılabilir. Evre 4 semptomlar ve hasta yakınmaları açısından en şiddetli evredir. Lenfödem tanılandırılması belli ölçümler ve tetkikler gerektirirken hastanın kapsamlı bir fizik muayenesi de gereklidir. Gode oluşumu, cilt-cilt altı yapışıklıkları değerlendirilmesi gereken başlıca fiziksel semptomlardır. Lenfödemin konservatif tedavisinde altın standart Kompleks Boşaltıcı Fizyoterapidir (KBF). Bu yöntem manuel lenf drenajı, kompresyon bandajı, cilt bakımı ve egzersizleri içeren çok bileşenli bir yaklaşımdır. Tedavi iki fazdan oluşur: Faz I yoğun tedavi, Faz II idame tedavisidir. KBF’nin etkinliği hem üst hem de alt ekstremite lenfödeminde randomize kontrollü çalışmalarla kanıtlanmıştır. KBF’nin bileşenlerinden biri olan egzersizler, konservatif tedavi yaklaşımlarının temelini oluşturmaktadır. Boşaltıcı egzersizler lenf sıvısının mobilizasyonunu sağlarken, eklem hareket açıklığı egzersizleri fonksiyonelliği korumakta, dirençli egzersizler kas kuvvetini ve pompa etkinliğini artırmakta, diyafragmatik solunum egzersizleri ise lenf sıvısının geri dönüşünü kolaylaştırmaktadır. Lenfödemin fizyoterapi ve rehabilitasyonunda birincil yaklaşım KBF olmakla birlikte son yıllarda tamamlayıcı ve alternatif yöntemlerin de tedaviye destek sağladığına dair kanıtlar giderek artmaktadır.
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