DEEP OSCILLATION® therapy installed in 18 Costa Rican Cancer Rehabilitation Centres for Breast Cancer Related Lymphoedema Treatment
* This article has been translated from a news piece on CCSS by José Mairena Morera. "Oncology rehabilitation at the Costa Rican Social Security Fund (CCSS) is moving to a new level of management with the ability to provide deep oscillation therapy to bring relief to women with Lymphoedema after breast cancer treatment.
This therapeutic modality of German technology is introduced in the rehabilitation of cancer thanks to the investment of 204.5 million colones from the taxes on smoking. The amount includes the equipment and training of fifty therapists.
The beneficiaries are women with breast cancer, as one in four, usually consults for swollen arms (Lymphoedema) as a result of the removal or damage to lymph nodes during mastectomy surgery or radiation therapy.
Women with Lymphoedema report swelling, pain, numbness, and loss of mobility along the arm. This condition affects their ability to lead their daily lives as they did before cancer. There is discomfort with combing or dressing and more complex limitations in arm function that make it difficult to work at home or at work.
"Deep Oscillation" therapy decreases the swelling and mitigates its effects. With the help of high-tech equipment the therapy seems simple. The therapist connects special gloves to the equipment (as above) or uses hand applicators and massages with vibrations that are pleasant for the patient, who holds a titanium contact electrode between his fingers.
According to the instructor Dr. Solangel Hernández, the therapist guides the equipment and not the other way around, so an interesting relationship with the patient is produced and a result with a very high therapeutic value is achieved.
The patient only perceives a gentle vibration and the effect spreads evenly up to eight centimetres deep into the tissues. According to the testimonials collected in the training workshop, the pain relief effect is noticeable and almost immediate.
Rehabilitation as part of comprehensive care
Dr. Hannah Diermissen coordinates the rehabilitation section within the "Project for Strengthening Comprehensive Cancer Care". The introduction of this approach in the approach to cancer represents a triumph for the health system because it closes the cycle of care for the benefit of the patients.
This means that the approach to breast cancer includes actions of prevention, early diagnosis, timely care, rehabilitation or palliative care as the case may be. In all stages there are institutional actions trying to influence in support of the patient either for prevention or for treatment, even from an integral vision.
The introduction of rehabilitation has achieved the awareness of the work team throughout the process: from the doctor who makes the diagnosis to the one who follows up the sequelae, including the one who operates or the one who does the radiotherapy.
At all stages of the disease's evolution, rehabilitation is recognised as a resource to provide quality of life to these patients, Dr. Diermissen points out with satisfaction.
Before, the panorama was different: the ladies arrived at the treating physician with swollen arms and in some cases, it was recommended that they go to the emergency room to have their discomfort treated, since it was not a matter of their field and the Institution lacked the integral approach in the treatment that included rehabilitation.
For Dr. Diermissen, she refers to rehabilitation as a 'promise of improving the quality of life after cancer', since it allows patients to continue living without pain and to do everyday activities without feeling unable to lead a better life.
Training and outreach
The training consisted in knowing the scientific evidence of the use of deep oscillation therapy in different types of conditions that allow offering a new quality of life experience to cancer patients with sequelae such as Lymphoedema.
In addition, the principle of how the equipment works was explained and patients were assisted in order to apply the knowledge acquired in real care scenarios.
The care of the patients implies the programming of the equipment to reach the objective of each particular case, so the therapy is individualised.
The training workshop was given by Dr. Solangel Hernández Tápanes, who has more than 12 years of experience with the use of this therapy. Dr. Hernandez is president of the Latin American Committee for Information Management and Research in Rehabilitation, which belongs to the Latin American Medical Association of Rehabilitation.
The organization brings together 23 Latin American countries in a joint effort to improve the quality of life with rehabilitation medicine. Patients with
restrictions on activities of daily living, family or work improve their condition by not feeling pain and return to their routines without problems.
Once installed in the services, the therapy begins to work after 48 hours of surgery. The number of sessions and the distance between them depends on the evolution of each person.
The specialist in this new therapy is optimistic about the benefits for the population given the level of coordination of the CCSS. "I think Costa Rica is in an advantageous position because it has a very organised network. Now what is missing is to apply the therapies, document them and show the world the things that are done in favour of the women with breast cancer" she added.
Other fields of application
The technique was developed in Germany in 1988 and has since expanded in territories and uses. It has been used in Cuba since 2006 and in Mexico since 2015. Therefore, there is experience and a body of highly developed studies that allow a results-oriented use based on proven medical experience.
Distribution of equipment
The centres where the new therapy will be given are the following:
- Barranca Health Area
- San Rafael Health Area, Puntarenas
- Tilaran Health Area
- National Rehabilitation Center
- National Center for Pain and Palliative Care
- Enrique Baltodano Briceño Hospital
- Hospital of Guápiles
- San Carlos Hospital
- Fernando Escalante Pradilla Hospital
- Hospital La Anexión
- Hospital Maximiliano Terán Valls
- Hospital Mexico
- San Juan de Dios Hospital
- San Rafael Hospital in Alajuela
- San Vicente de Paul Hospital
- Tomás Casas Casajús Hospital
- Tony Facio Hospital in Limón
- Upala Hospital
End of translated article.
Effect of Deep Oscillation on the Lymphatic System:
Oedema and haematomas occur as a result of bleeding as well as destruction or damage of lymphatic capillaries by trauma (mechanical, surgical etc.). In the acute inflammatory phase of wound debridement, there is also increased phagocytosis and a generally higher need for transport of extracellular protein, blood cells and other particles (exudation). This results in an enormous interstitial increase in the lymphatic load. As a result, post-traumatic oedema develops by overloading the lymph transport system (high volume insufficiency) and backing up in the interstitial space, in spite of increase in the lymphatic flow rate.
Increased resorption of subcutaneous oedema by deep oscillation has been shown in several clinical studies. This can be explained by two hypotheses. One would be that mechanical stimulation at the level of the interstitial ground substance produces mixing of materials to be transported with the lymph, enhances its distribution and thus increases the surface area for resorption. Another would be that mechanical impulses generate deforming forces that act on the collagenous fibre structures of the interstitial space, and these apply tensile forces to the endothelial layer of the initial lymphatic vessels (lymph capillaries and pre-collectors) via anchor filaments. In this way they could open junctions in the endothelial layer for inflow of fluid, and assist the interstitial drainage mechanism.
- Post-traumatic oedema formation: Bleeding, increased transport demands, high volume insufficiency, backing-up in interstitial space.
- Deep oscillation assists resorption of oedema: Mixing materials for transport with the lymph, distribution, increasing surface area, tension on endothelial layer of initial lymph vessels (lymphatic capillaries and pre-collectors) via collagenous fibre structures in the interstitial space, opening junctions for fluid inflow, assistance of the interstitial drainage mechanism.
- Transport of lymph together with materials such as various extracellular proteins, blood cells and other particulate material.
- Valves can already be found in the pre-collectors at intervals of 2-3 mm. Transport of lymph is the exclusive function of lymph collectors and the lymph ducts connected with them.
- The lymphatic system contributes to homeostasis by influencing the volume of extracellular fluid, the interstitial protein concentration and the tissue pressure.
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