Finally activated the Vascular Rehabilitation Service at the San Giuseppe Hospital in Marino. The 4 dedicated physiotherapists (Romaldini Fabio, Cocozza Giulia, Caramadre Anita and Vaglio Daniela), with the coordination of diagnostic and vascular rehabilitation activities by dr. Sandro Michelini and Polyclinic Head nurse Padroni Maria Vittoria and, with the support of the company managers Molinari Maria Rita, Sandroni Cinzia, D’Antonio Stefania and Lolli Nadia, began to provide their qualified work in favor of the many patients suffering from primary Lymphedema (pathology recognized since 2017 as ‘rare’), from secondary Lymphedema (unfortunately in constant growth especially in oncological patients in whom complementary surgical and chemo and radiotherapy treatments induce the permanent clinical picture), from post-flebotomy syndromes of the limbs, from peripheral arteriopathies and from thoracic Egress syndromes.
The service is active from Monday to Saturday and is provided both in the morning and in the afternoon. The protocols followed in physical treatments follow the guidelines of the most important scientific societies accredited in the field, in the light of Evidence-Based Medicine and in full compliance with the limits imposed by the Essential Levels of Care.
Among the most commonly used rehabilitation techniques assume important importance manual lymphatic drainage (in the two methods of Leduc and Vodder), inelastic multilayer bandaging (which, as explicitly specified in Annex 4 of the DPCM of 2017, is also included in the LEAs for the branch 56 of physical rehabilitation, with particular reference to Lymphedema), Segmental motor rehabilitation in the treated limbs, joint mobilizations (frequent is the impairment of shoulder function in the large arm post-mastectomy, up to frank sub-luxation), proprioceptive postural exercises (proprioception is in some cases strongly altered by suprafascial edema) and occupational therapy (especially in secondary forms of edema it is proven that gradually the patient unconsciously omits to activate specific muscle masses resulting in a reduction of certain movements that occupational therapy is responsible for restoring).
Each patient is subjected at the beginning and at the end of the treatment cycle to a global and segmental functional assessment (with definition of joint Range Of Motion, including the movements of elevation, extra-rotation, hyperabduction and active plantar/palmar and dorsal flexion) and centimeter measurements of the limbs at various agreed levels. Pre- and post-treatment differences are the subject of in-depth study, both in terms of numerical data and the values of some of the qualifiers of the domains of the ICF (evaluation method suggested by the O.M.S.) that are established at the time of taking charge and at the time of discharge.
At the end of the treatment all patients with chronic edema are prescribed the definitive elastic garment (compared in the ‘Consensus Document’ of important international scientific societies to the antihypertensive drug for the hypertensive or the antidiabetic for the diabetic patient). The garments are provided (as per the new LEAs, fully implemented in this sense by the Lazio Region with a special circular of 2018) by the Regional Health System. Once the elastic garments have been tested, the patient is discharged and invited to comply with periodic clinical ‘Follow ups’. The operators are also involved in the ‘training’ of the ‘Care-Giver’ of the patients (with particular regard to the age of development and senility) to whom are illustrated the main therapeutic techniques useful for the containment of chronic diseases in question.
Patients coming from the various Roman AA.SS.LL., from the province, from other regional provinces and also from extra-regional realities are afferent to the Service.