Know what to look for
Fully qualified: Completed a 135-hour training course, qualifying as a CLT (partial training is common).
LANA certified: Took a written test after meeting training qualifications. The test ensures full CLT training.
Attended a qualified training school:
- NALEA-ACOLS, Norton, Klose, Vodder
- ILWTI (International Lymphedema & Wound Training Institute)
- Other schools, if they offer 135-hour training courses
- Schools come and go: current listings are on the NLN site, which lists only fully qualified schools
Receives post-training & on-the-job learning:
- On going learning (the only training school that required in-person re-certification is Vodder)
- In-clinic supervision
Check the therapist directories
Note that these are primarily US and Canadian resources.
Academy of Lymphatic Studies (ACOLS)
Dr. Vodder School International
Norton School of Lymphatic Therapy
Other notable schools providing the same intensive 135-hour CLT training:
Brennan School of Innovative Lymphatic Studies
Casley Smith International
International Lymphedema & Wound Training Institute (ILWTI)
Pacific Therapy Education, Inc.
Directory of LANA-certified therapists: https://www.clt-lana.org/search/therapists/
National Lymphedema Network therapist directory: http://www.lymphnet.org/find-treatment
Questions to ask about credentials when referred for treatment
The following are recommendations from Judith Nudelman, M.D., and the founders of StepUp-Speakout.org, all of whom have received additional training in lymphedema.
- How many hours of specific lymphedema training have you had, and where did you receive your training?
- Do you take continuing education courses?
- Are you aware of the standards for therapist training established by the Lymphology Association of North America (LANA), and do you meet those standards?
- How much of your practice is devoted to lymphedema?
What to expect in treatment
Background: Lymphedema treatment begins with an evaluation, which should focus not just on limb volume, but should identify functional goals and limitations, and clarify the course of treatment. Ideal treatment is known as complete decongestive therapy, or CDT. The elements of CDT are: diagnosis, manual lymphatic drainage (MLD), multilayered compression bandaging, compression garments, therapeutic exercises, and self-care. Adjuncts to CDT often include use of pneumatic pumps that substitute for MLD, Kinesio tape applied to the skin so it channels lymph to reduce swelling, and aquatic therapy.
Self-care is essential! The therapist must teach and support your ability to
- perform self-MLD
- do appropriate exercises
- monitor your progress
- apply lymphedema bandages
- wear and maintain lymphedema garments, both daytime and nighttime
- scrupulously care for your skin
What to expect at your first visit
- Treatment goals
- Agree upon a plan
The ideal therapist, and barriers to the ideal
The ideal therapist is accessible, experienced, works with appropriate oversight and is well equipped to treat a chronic disease. Unfortunately, there are many barriers to the ideal:
- Shortage of trained therapists
- Reimbursement is poor
- Treatment course may be shortened
- The physical therapy model is not compatible with a chronic disease
- Follow up care may not occur
- Lack of “fitters,” access to garments, coverage for garments
- No team: physician ignorance and lack of “ownership”
- Patients complete treatment and leave without a “tool box,” not prepared for self care.
Set common goals with your therapist
Strive for empowerment: when you learn to control your lymphedema, and you overcome the stigma of the disease.
- Leave with a plan and specific goals for self-management and control.
- Expect to leave with your tool box, and realize that it’s a learning curve for you.
- You may need to review your notes, record your results and questions, and revisit your needs with the therapist.
- Follow up!