The document discusses lymphedema (LF) distribution in India, noting over 7 million morbid cases. It outlines an integrative treatment approach combining ayurveda, biomedicine, yoga, counseling, patient education, and home-based self-care. Specific compression therapies and materials are described, along with challenges in applying compression in resource-poor Indian villages and recommended solutions. Evaluation of various compression techniques and materials used are discussed.

1. Dr. S.R. Narahari, MD, DVD (Modern Medicine)
Director
E-mail: srnarahari@sify.com www.iad.org.in

2. Over 7 million morbid cases LF distribution in India
Courtesy : NVBDCP, New Delhi
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3. Ayurveda Biomedicine
Yoga
Integrative
Treatment Compression
Counseling
Therapy
Patient
Education
Home based and Self-care
Treatment
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4. Cotton and rubber
thread:
-300% extensibility
-100% elastability
Priced at 4.5 per unit
Durability: 2 weeks
30 companies
manufacture but only
one meets quality
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5. We get them when
donated from Europe
Mr. Gerban , Schrale, Physiotherapist
Ms. Malou van Zanten, a skin care therapist
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6. Sandwich mould
Choky bag T mould
CCF mould
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7. MCR
sheet is cut
and made
into
moulds
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8. CCF Mould
Prevents constriction and facilitate free flow of lymph
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9. Cholky bag
Sandwich mould
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10. Step 1: Toe compression
Step 3: Cloth wrapping
Step 2: Placing sponge mould Step 4: Placing CCF sheet
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11. Protuberances
sagging from thigh
region Cotton cloth
wrapping Long stretch
bandaging in figure Bandaging up
of 8 method to thigh
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12. Sagging oedema
below knee region
Prone position with leg Compression of the Foot compression in
bent backward sagging region Supine position
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13. Cotton cloth
wrapping
Toe and foot compression in
sitting position
Compression given with other
limb flexed
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14. Forefoot compression
Double layer compression
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15. Full compression
Half compression
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16. Half- half compression
Mid thigh compression
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21. Work
ambiance
Co-morbities Size and
and shape
complications
No support
cost from family
Challenges of
compression therapy
in resource poor
Indian village
Previously
operated illiteracy
limb
Upper and
lower limb Availability
involvement of product
Bony
deformities of
limb
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22. By using Maximal Bulk of the limb ,one
of the 8 girth measurements, we estimate
the no. of bandages.
The regression model for estimating no.
of compression bandages needed is
E.g.., if maximal bulk is 45 cm, no. of
bandages needed for that patient are 4.
Using Math lab software
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23. • Co-morbidity and complications
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26. • Co-morbidity and complications
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27. • Co-morbidity and complications
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28. Excoriation
Constriction
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30. Friction induced blisters due to MCR mould placed directly
over the skin
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31. Bullous formation due to friction of long stretch
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32. Excoriation caused by sponge moulds used to separate crevasse
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33. Rolling back of long stretch bandages in upper part cause
constriction effect
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34. Slipping of compression bandages in to large crevasses cause constriction
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36. Footwear used pushes the bandages backwards causing constriction

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54. Evaluation
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56. Alleppey
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57. Alleppey
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59. Gulbarga
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60. Gulbarga
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61. IAD
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62. IAD
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65. Occupation Daytime Night
Fisherman Not doing 5 hrs
Coir worker Not doing 6 hrs
Manual laborers Not doing 8 hrs
Driver 10 hrs 6 hrs
Pensioner 8 hrs 1 hr
Unemployed 5 hrs 10 hrs
Govt. employees 8 hrs 8 hrs
Housewife 10 hrs 6 hrs
Farmer/ Coolies in dry 8 hrs 5 hrs
land
Business people 10hrs 10hrs
Barbers 10 hrs 6 hrs
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69. Foot end elevation while
resting at work
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