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The effects of pregnancy on the body can be both physical and physiological.

When it comes to exercise in pregnancy, each woman is an individual, its not necessarily the exercises but how they do it.

Antenatal education is a huge role when it comes to Labour prep, perineal trauma, optimal positioning for delivery

complications of pregnancy to be aware of include: Pelvic Girdle, low back, coccyx, Hip Thoracic Pain, carpel tunnel syndrome, sciatica, prolapse, rectus diastasis, Urinary incontienence

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EACH WOMAN IS AN INDIVIDUAL - MODIFY - choose an exercise you enjoy :)
It's not necessarily the exercise but how they do it.

General advice:

Ensure adequate energy intake and hydration

Avoid exercise in hot environment or when pyrexic

Wear supportive runners and a comfortable supportive bra

Always start with a gentle warm up and finish with a cool down

•Intensity: ‘Talk Test’ or Borg Rate of Perceived Exertion Scale (12-14 ‘somewhat hard’ on the 6-20 scale)

If you have no medical or pregnancy complications, you should exercise for 30 minutes most days of the week (150 minutes)

Avoid: ballistic stretching•standing motionless for long periods of time•supine lying after first trimester

When to terminate exercise:

Excessive SOB or fatigue

Dizziness or headache

Abdominal pain

Reduced foetal movement

Dyspnoea or muscle weakness

PV bleeding

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Improved mood

Decreased levels of antenatal/postnatal depression

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Positive effects on BP

Reduces risk of pre-eclampsia

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Benefits of Exercise- Hormonal and metabolic

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Benefits of Exercise- Hormonal and metabolic

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Better glucose screen results reducing risk of gestational diabetes. Boosts endorphins

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Prenatal fitness programmes improve ventilation, peak oxygen pulse values and workload capacity

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Urinary Incontinence is a symptom NOT a diagnosis. It is estimated to affect about 50% of adult women and 3% to 11% in adult men, however, only 25% to 61% of those women seek care.
There are 3 types:
Stress Urinary Incontinence(50%):

The symptom of involuntary leakage on effort of exertion or sneezing/coughing

Urgency Urinary Incontinence(11%)

Overactive bladder

The symptom of Involuntary loss of urine with urgency.

Mixed Urinary Incontinence(36%)

The symptom of loss of urine with urgency and effort of exertion.

- Minassian VA 2012 et al.

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Constipation

chronic cough

heavy lifting

obesity

pregnancy

vaginal delivery

UTI

Pathology in bladder

Perineo-Detrusor Inhibitory Reflex

-Hannestad YS 2002 et al.

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STRESS URINARY INCONTINENCE

first line treatment: Pelvic physiotherapy

second line treatment: Medication (Duloxetine)

third line treatment: Surgery (Tension free vaginal tape procedure)

URGENCY URINARY INCONTIENCE

first line treatment: Pelvic Physiotherapy (Bladder Retraining)

second line treatment: Medication (Antimuscarinics)

third line treatment: Botox

fourth line treatment: Neuromodulation

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•Advice and Education

•Health Promotion

•Exercise Therapy – tailored to individual needs considering strength, endurance, repetitions

•Bladder Retraining

•Electrotherapy

•Biofeedback

•Myomed

•Drugs

•Vaginal Cones

•Real time Ultra Sound

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Practice 3 x a day:begin supine or seated

10 long holds x 10 seconds

10 short holds

Tips for women:

From back passage to vagina

'Doing up a zip"

'Bath full of eels'

Tips for Men:

Drawing their testicles up

Walking into a cold shower

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Physical Therapist Pelvic Floor Exercises for Beginners

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Pelvic organ prolapse(POP) is the herniation of the pelvic organs through the perineum due to weakened pelvic floor muscles and supporting structures, it can be catergorized into 1.Anterior 2. Middle Compartment or 3. Posterior compartment.

A departure from normal sensation, structure or function, experienced by the women in reference to the position of pelvic organ.

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About 50% of women having a regular gynecological exam are affected by pelvic organ prolapse. it is a prevalent condition in parous women and has a severe impact on overall quality of life, particularly on sexual function and self confidence. Future POP levels are likely to rise. According to estimates, the proportion of American women who have POP will rise by 46% by 2050.
- Adi Y. Weintraub 2020

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Imagine a boat tied to a dock. Pelvic Organs are the Boat. Water is Pelvic Floor muscles. Ligaments are supporting the organs from above.

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If water level drops (pelvic floor weakness), the boat (organs) hangs on the ligaments (rope). Eventually the rope will break resulting in the boat dropping (prolapse)

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Even if ropes are replaced (ligament surgery), the boat will continue to hang until ropes collapse again. this means that raising the water levels ( strengthening pelvic floor) is vitally important.

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First line treatment: Pelvic Physio

Second line treatment: Pessary and Oestrogen Cream

Third line treatment: Surgery

Pessaries Core Strength

Lifestyle Re-Education

Femeeze: to splint the rectum

Bristol Stool Chart 3-4

Voiding Positions

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Pelvic Floor muscles Training
In a study by Panman et al in 2016, examining the two-year effects of pelvic floor muscle retraining, it was demonstrated that in women aged 55 and greater with symptomatic mild pelvic organ prolapse, pelvic floor muscle retraining results in a significant decrease in pelvic floor symptoms when compared to watchful waiting (note: statistically significant but below the minimal clinically important difference.

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Stools and positioning

Not restricting water

Caffeine: Decaf on ward?

BMI: weight loss management groups

Leg bags:Falls risk

Pubic hair: Catheters

See Incontinence: THINK IAD (Incontinence Associated Dermatitis.

Discharge planning think worst case scenario: Commodes, Bottles, She-wees, Pads

Reduced mobility: THINK toileting.

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•Enables parents to develop a confident and relaxed approach to pregnancy and childbirth - normalise the process

Collaboration between MDT

Increase awareness amongst women of their own bodies, feelings and needs during and after pregnancy

Promotion of physical activity & guidelines

Functional Strengthening - Pelvic floor exercises/ Abdominal exercises

Coping strategies for minor discomfort – CTS, swelling, heartburn, constipation, leg cramps

Labour education & prep – coping, optimal positioning

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Autism is a complex neurological and developmental disability that appears within early developmental stages of life. Autism affects the normal functioning of the brain, communication development as well as social skills of the child.

Autism

75-80% have IQ < 70.

Others have normal, or superior intelligence.

Prevalence of 20-30 per 10,000.

20% risk of having a second child with autism.

wide agreement re hereditable genetic differences and/or mutations

Male : female = 4-8 : 1

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The World Health Organization (WHO) estimates the international prevalence of ASD at 0.76%; however, this only accounts for approximately 16% of the global child population with an increase over the past two decades.

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With varying levels of intellectual ability, children and young people with ADS will require varying levels of support to function. They could have a severe intellectual deficiency, little or no verbal communication, and very limited behavioural adaptions.

Attention deficit in nearly 75% of patients

Anxiety, irritability

Bipolar disorder

Depression

Tourette Syndrome

Insomnia

Eating and digestive difficulties

Decreased intellectual ability

Deficiency in social communication

- Sharma SR et al; 2018.

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1. Abnormal social development
2. Communications deficits.
3. Restrictive and repetitive interests and behaviour

- Durand VM 2015 et al.

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Because the entity is usually identified in childhood, a variety of pediatric psychological therapies have been recommended, including behavioural, play, and occupational therapy alongside physical and speech therapy.
- Alpert JS 2021

Education: Children and young adults with ASDs have both gifts/talents and disabilities and need to be put in mainstream schools where they can discover their abilities. Additionally, there is a need to create and assess academic opportunities, assets, and motivation that can direct both talent development and special education goals, particularly for young adults planning to enroll in selective universities.

Medication can be prescribed by a child psychiatrist.

Play and behavioral therapy are used in pediatric psychology and social treatment to assist children become more adept at nagivagting social situations. Numerous psychosocial treatments, including Applied bahviour analysis (ABA) and pivotal response Treatment (PRT), have ben created to address both the core and associated symptoms of ASD

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Educate parents and people how to notice intellectual disability and Autism. the sooner they can diagnosed the better we can help them with life.

In most cases, the evaluations and treatments can happen in different places. Physiotherapists are also involved in the rehabilitation process after accidents, such as when a child sustains a fractured limb and needs rehabilitation services. however, while planning therapy sessions, physiotherapists must take the autism diagnosis into account. This is as a result of the highly planned character of many physiotherapy sessions. A crucial component of the treatment is education them on hoe to feel confident and competent in their bodies

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Physiotherapists had stated that teaching techniques for swimming to children with ASD can enhance the learning of theses skills in connection to motor skill development. According to some study, hydrotherapy can be an effective type of exercise for kids with autism. In addition, children with autism may benefit greatly from physiotherapy that is exercise- based.

Autism sufferers have frequently received hydrotherapy treatments. This typically occurs in a swimming pool. An autistic youngster can feel calmed by the pressure and temperature of the water pressing against the body. While the child performs exercise meant to increase range of motion and overall mobility, water as a physical form can offer a claiming sensory input. Warm water is the best medium for body rehabilitation since it may reduce body weight by 90\5, lessens impact force on the body, relaxes muscles, and reduces stiffness.

- Jebakumar AZ

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It has been proposed that children with neuropsychiatric disorders require more specifically designed physical education that fosters the growth of motor skills, a sense of self-efficacy, and physical fitness.
- Lang R 2010 et al.

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Overweight and Obesity are defined as "abnormal or excessive fat accumulation that may impair health"
- World Health Organisation WHO

OVERWEIGHT= BMI > 95th percentile

OBESE= BMI ≥ 98th percentile

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Socio-economic status is a large factor influencing obesity. In a study conducted in 2009, of 12,000 children and teenagers aged between 2 – 19 years, levels of high obesity were around 1.7 times greater in those from a deprived area, than those in a non-deprived area.

- Skleton JA 2009 et al.

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Provision of personalised lifestyle advice, taking into account individual attitudes, beliefs, circumstances, cultural and social preferences, and the patient's readiness to change;

Prescription, supervision, and progression of appropriate physical activity to increase muscle strength, flexibility, and endurance; to sustain energy output as well as enhancing and maintaining weight loss under safe and controlled conditions;

Management of conditions associated with overweight or obesitya eg arthritis, back pain, and other musculoskeletal and chronic conditions (such as heart disease).

Co-ordination of comprehensive and sustainable programmes of management in collaboration with service users, community service and other health and social care professionals

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Physiotherapy communication approaches in management of obesity and overweight

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Physiotherapy communication approaches in management of obesity and overweight

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Specialist knowledge and skills that physiotherapists can apply to this issue include:

Anatomical, physiological, and psychosocial mechanisms of health and disease

Assessment and diagnosis

Behaviour change

Biomechanics

Exercise prescription and therapeutic exercise

Management of long-term conditions.

There are four processes in Motivational Interviewing

1. Engaging

2. Focusing

3. Evoking

4. Planning

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CHI Temple Street’s Weight Management clinic called  W82go – health professionals area http://w82go.ie/for-health-professionals/

Links – The 5 As of Obesity Management (5 min video), A Word about BMI (4:43 min video)

Assessment section, and also follow links to 2013 growth charts

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Lymphedema is a swelling in the tissue spaces that develops due to an interruption in the lymphatic system

Main Cause: Cancer

Adopting a holistic approach to patient care as used in the palliative setting ensures a patient centred plan of care is developed

The  World  Health  Organization  (2004)  defines palliative  care  as  an  approach  that  improves  the quality  of  life  of  those  patients  who  face  life-threatening  illness,  and  their  families,  through prevention and relief of suffering using early identification, assessment and treatment of pain and other problems.

An increase of 1cm at any data point compared with other arm warrants a FU physio visit in 1 month, patient calls in see them before 1 month

An increase of 2cm warrants immediate referral to Certified Lymphedema Therapist MD, Nurse, OT or Physio
- National Lymphedema Advisory Committee

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Understand the patient’s main concerns, goals and priorities

Help the clinician understand the main cause of and the mechanisms behind the swelling

Understand the underlying condition and how quickly it is progressing

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Traditionally lymphedema is managed with CDT (Complete Decongestive Therapy ) and is based on four pillars of care: 1.compression 2.massage 3.skin care and 4.exercise

Standard CDT

Goals to reduce swelling, transition to garments, life-long maintenance, self-care

Four elements of CDT

Two distinct phases of treatment

Definitive contraindications to treatment

Palliative CDT

Goals to provide comfort, support, relief of symptoms, maintain function, include caregivers in care

CDT elements may be modified or omitted

Less distinction between phases of treatment

Contraindications now relative

- Best Practice for the management of lymphoedema 2016

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Losing functional ability, losing independence can impact pyschological well-being - Physio important role to maintain independence- short term goals.

in a palliative setting goal setting must be sensible and specific to the patient's individual needs.

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1.  Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. International urogynecology journal. 2012 Aug 1;23(8):1087-93.

2.  Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Scandinavian journal of primary health care. 2002 Jan 1;20(2):102-7

3.  Jebakumar AZ. PHYSIOTHERAPY CURES AUTISM: A REVIEW.

4.  Lang R, Koegel LK, Ashbaugh K, Regester A, Ence W, Smith W. Physical exercise and individuals with autism spectrum disorders: A systematic review. Research in autism spectrum disorders. 2010 Oct 1;4(4):565-76.

5.  Durand VM, Barlow DH. Essentials of abnormal psychology. Cengage Learning; 2015.

6.  Skleton JA, Cook SR, Auinger P, Klein JD, Barlow SE. Prevalence and Trends of Severe Obesity Among US Children and Adolescents. Academic Paediatrics 2009; 9 (5): 322- 329. http://www.sciencedirect.com/science/article/pii/S1876285909001090 (accessed 26 Jan 2016).

7.  Lymphoedema Framework. Best Practice for the Management of Lymphoedema. International consensus. http://www.woundsinternational.com/media/issues/210/files/content_175.pdf(accessed 15 January 2016).

8.  Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 2014 Apr 1;4(2):105-45.

9. Padayachee C, Coombes JS. Exercise guidelines for gestational diabetes mellitus. World journal of diabetes. 2015 Jul 25;6(8):1033.

10.  Burgio KL. Current perspectives on management of urgency using bladder and behavioral training. J Am Academy Nurse Pract 2004;16:4-7.

11. Romeikienė KE, Bartkevičienė D. Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods. Medicina (Kaunas). 2021 Apr 16;57(4):387. doi: 10.3390/medicina57040387. PMID: 33923810; PMCID: PMC8073097.

12. Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020 Jan-Feb;46(1):5-14. doi: 10.1590/S1677-5538.IBJU.2018.0581. PMID: 31851453; PMCID: PMC6968909.

13. Sharma SR, Gonda X, Tarazi FI. Autism spectrum disorder: classification, diagnosis, and therapy. Pharmacology & therapeutics. 2018 Oct 1;190:91-104

14.  Alpert JS. Autism: A Spectrum Disorder. The American Journal of Medicine. 2021 Jun 1;134(6):701-2

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Usually occurs during the second half of pregnancy or immediately after the delivery.
Pre-eclampsia is defined by gestational hypertension (hypertension that develops for the first time at ⩾ 20 weeks of gestation)and one or more of the following:

New proteinuria(of greater than or equal to 0.3 g in a 24-h urine specimen), or

One/more adverse conditions, or

One/more severe complication(s) such as Kidney failure, liver damage, pulmonary oedema, Cerebral haemorrhage, Eclampsia.

RISK FACTORS:
•Obesity

•Family history

•Multiple births

•First pregnancy

•Previous pre-eclampsia

-Magee LA 2014 et al;

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Pregnancy Complications - Gestational Diabetes

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Pregnancy Complications - Gestational Diabetes

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Gestational diabetes (GM) is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes. Gestational diabetes occurs during pregnancy.

CONSEQUENCES FOR
BABY:

Fetal hyperglycemia and hyperinsulinemia

Preterm delivery

Intensive neonatal care

High neonatal body fat percentage

Clinical neonatal hypoglycemia

MOTHER:

Cesarean section

Gestational diabetes mellitus in subsequent pregnancies

Physiotherapy Management and treatment
Exercise - Exercise guidelines for gestational diabetes mellitus. World journal of diabetes. 2015

May need to be adjusted if on insulin

May need to check blood glucose levels prior to exercising

Gradual introduction of exercise if previously very low activity levels.

Exercise can positively effect blood glucose levels on testing

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Everything the physio can do and provide and advice and education on:
1. Massage: •Demonstrates caring and non-verbal support & communication

•Sensory input from massage activates ‘gate-         closing’ mechanism at spinal levels

•Deep sacral kneading may stimulate release of endogenous opiates.
2. Relaxation: •Role of oxytocin vs. adrenaline

•Distraction is key

•Music, TV, candles

•Encourage “verbal analgesia” and positive affirmations throughout labour
3.Pain Relief:•Epidural Anaesthesia

•Entonox “gas and air”

•Pethidine Injection

•TENS
4. Movement
5. Ice/Heat
6. Breathing (see next box)

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•Breathe awareness

•Emphasise exhalation

•Alterations in breathing pattern in response to pain & anxiety (hyperventilation/ holding breath)

•Sighing out at the end of each contraction. Focusing on the entire breath out to ‘let go’ of the tension in your body

Aim to avoid breath holding and ‘purple pushing’

•Infant heart rate slows and can lead to hypoxia

•Non reassuring foetal heart rate patterns with delayed recovery

•Reduces mother’s blood pressure so reduces placental blood flow

•Mother becomes exhausted, stressed and build up lactic acid

•Increased risk of DVT

•Flexed position of lumbar spine curves birth canal and closes pelvic floor, encourages separation of rectus abdominus

•Increased risk of forceps/vacuum

•Pelvic floor nerve and muscle damage

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Physiotherapy plays an important Role during pregnancy, regarding education on safe and healthy exercise, advice on labour positioning, breathing and other coping mechanisms. However we also can help with management and preventions of complications when it comes before during and after pregnancy.

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•Don’t go to the toilet “just in case”

•If you go to the toilet more often than every 2 hours, train your bladder to wait just a few minutes each time

•Getting a healthy bladder – what you eat and drink can affect your bladder

•Drink at least 2 litres of fluid a day

•Reduce your caffeine intake by cutting down on coffee, tea, fizzy drinks, alcohol and chocolate

•Also citrus fruits, tomatoes, orange juice, spicy food can irritate the bladder
- Burgio KL 2004

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Behavioural Therapy and Health Peromotion

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Behavioural Therapy and Health Peromotion

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Weight Control

Providing patient education and understanding the role  of the bladder and the pelvic floor muscles. - Payne CK 2000

Discussing bowel habits/constipation - no straining, toilet position, perineal support

Avoid strenuous exercises

Avoid smoking

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Urinary Incontinence affects more than 200 million people worldwide  with only 1 in 5 women seeking help for urinary incontinence after waiting an average of 6.5 years before doing so. Physiotherapy has been proven to be clinically effective. Training and strengthening the pelvic floor muscles (the muscles that support the bladder and urethra) is recommended as first-line management for women with stress, urge or a mixture of stress and urge urinary incontinence. We also can help with education and health promotion, along with treatments such as bladder training.

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pelvic floor prolapse (POP) is only one problem form pelvic floor dysfunction. According to Adi Y. Weintraub et al; (2020) From the perspective of public health, POP places a significant financial burden on health systems. Increased life expectancy and efforts to improve quality of life are factors in both the rise in POP prevalence and the Prevalence of women seeking therapy and relief from their symptoms. Physiotherapy again plays in huge role in the treatment and management of this from education to pelvic floor muscle training.  According to a review by Karolina Eva Romeikienė and Daiva Bartkevičienė on Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Period Most of the studies agree with the use of PFMT in PFD prevention in prepartum and postpartum periods, although more high-quality studies are needed.

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Whether adult patients with the autism spectrum can lead relatively normal lives depends on the severity of the expression of the disease and whether as children or adults they have responded to some or all of the therapies mentioned above. There is no cure for autism, but the spectrum is not lethal. However, many patients are unable to function normally in society. The role of  the physiotherapist is to take care of autistic children with motor impairments in the body (for instance; issues with respiratory control and coordination level, improvement in posture, and addressing misalignment in the musculoskeletal system including chest wall deformities as well as foot and ankle misalignment issues.

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Training for caregivers of children with developmental delays and disabilities

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39 million children under the age of 5 were overweight or obese in 2020. Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016. Obesity is preventable
- WHO

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I really enjoyed this assignment as it wasn’t like every other assignment where something was thrown on a board and I had to learn it, I was in control of my own learning, it made me want to dive deeper and deeper into certain areas and find out things that I hope will in future help me to be a better physio. On completing this assignment, I honestly was shocked on all the specialties in Physiotherapy, and I feel that no matter what condition, disease, problem there is a place for physiotherapy to help and on the medical team. I found that on my previous placements I had only come across lymphoedema and obesity after in neurology and musculoskeletal, I found I didn’t address lymphoedema the way I should, I never questioned is there anything I could do help or advice I could give I was always looking ag the bigger disease, I’m grateful now that I know exactly what the disease is and how as a physiotherapist I can treat it but it has also made me release that just because I’m asked to treat or manage something else that should be all I look at in their management I need to take a look back and look at everything that I can contribute my skills to. Another topic i picked to discuss was childhood obesity, the reason for this was because I myself felt my communication skills for this specific topic was something I fell down on in the past and i struggled with in my treatment and management. I now feel more confident to apply my new knowledge to these situations. Throughout this module though there was one particular area that stood out to me in particular and to my surprise that was pelvic health as when I first found out about this module I was most curious about Pediatrics as this is a field I hope to go into someday. Definitely one of the reasons for my massive interest in pelvic health is probably because at the moment as my sister is currently expecting her first. Besides it’s the first time I’ve really came across a time where I could use my knowledge and profession for myself, I’ve never broken or bone or even sprained an ankle before, so I never ever attended physio myself. I noticed myself with never ending questions. After talking around I found fellow student did placement with a pelvic health physio and she sent me on her notes from placement and exercise and now each Sunday me and my sister do our pelvic floor exercises together. When reflecting on this project I found most rewarding of this assignment is that I was able to relate my career with my This assignment has definitely opened my eyes to a whole new light and world of physiotherapy and I thoroughly enjoyed the learning of the diverse specialties that physiotherapy has to offer.

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HSE Childhood Obesity Surveillance Initiative

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HSE Childhood Obesity Surveillance Initiative

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Ireland was one of the 13 nations that joined the European childhood Obesity Surveillance Initiative( COSI), which was launched in 2007 as a follow-up to this suggestion by the Nutrition and Food security Programme of WHO/Europe.

The Continual, Systematic process of gathering, analyzing, interpreting, and disseminating descriptive data for tracking excess body weight is known as COSI/WHO Europe. The approach seeks to evaluate trends in overweight and obesity in children aged 6 to 10 every three years, allowing for inter-country comparisons within the WHO European Region while also providing an accurate knowledge of the progression of the epidemic.

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HSE Webinar - Launch of  (COSI) - Dr. Lachlan Mitchell & Professor Cecily Kelleher

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Compression garments help to stop lymphoedema getting worse. They can reduce mild swelling. Your specialist will usually recommend multi-layered bandaging first if you have severe lymphoedema. The garments vary in how much pressure they put on the tissues

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In palliative patients, the skin can become very fragile and the aim is to prevent any damage

Care should be taken to wash and dry thoroughly, especially between the digits and any skin folds. Apply an unscented moisturiser to prevent drying of the skin. If compression hosiery is being applied care should be taken to prevent damage during application

Any breaks in the skin can result in lymphorrhoea – lymph fluid leaking onto the surface of the skin. The extent of the lymphorrhoea will depend on the size of the tear in the skin and whether the limb is dependent or not. The fluid causes maceration of the skin, soaking of clothing, footwear and bedding and can be very cold and distressing for the patient

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Physical activity and Breathing exercises 

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Physical activity and Breathing exercises 

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Belly Breathing
• Hands on the belly
• Breath in through the nose
• Exhale with a “whooshing sound”
• Incorporate belly breathing into
the post op exercises
Walking
• Goal : 150 mins brisk walking a
week
• Start with short walks
• Progress over 12 weeks until able
to walk 30 mins briskly
BMI
• BMI (Gold standard Dexascan)
• Medically recommended < 25
• Work with registered dietician

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Lymph is colourless and vessels are hard to see and it
wasn’t until lymphography in early 20th century that
interest in the lymphatic system function grew. The Main Role of physiotherapists is to set treatment goals that allow a patient to maintain or improve function s and delay disease progression for as long as possible.