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CLT Recertification Program

This online course series is a complete review of content covered in the full CDT Certification Program offered by the Norton School of Lymphatic Therapy. The program is designed in sections to allow each student to absorb the information at a comfortable pace. If the goal of home study is thorough preparation for the Lymphology Association of North America (LANA®) Examination®†, or to meet the requirements of LANA recertification, this program includes all necessary information.

The CLT Recertification Program covers the following topics:

•  lymphatic anatomy •  the interstitium and connective tissue
•  relevant aspects of the integumentary system •  compression therapy indications/contraindictions
•  physiology of lymphatic fluid formation (Starling's Equilibrium) •  volumetrics, measurements
•  manual lymph drainage principles •  patient education, self-care
•  risk reduction, precautions, lymphedema management •  compression bandaging theory and practical application
•  indications/contraindications •  pneumatic pumps
•  the Law of LaPlace •  compression garments
•  compression classes •  knitting methods and material differences
•  fitting principles, common problems •  exercise principles, methods, effects
•  skin care •  ADLs
•  lymphatic drainage of the head, neck, upper and lower extremities as well as the trunk and genital regions •  quality of life issues, psycho-social impact, compliance, support groups, community resources, palliative care
•  lymph transport, volume, lymphatic loads, mechanical, dynamic, combined insufficiencies, lymph-stasis, protein effects, etiology of edema and its effects •  various associated diagnoses such as lipedema, lipolymphedema, venous edema, chronic venous insufficiency, phlebo-lymphostatic edema, lymphangiosarcoma, myxedema
•  aplasia, hypo/hyperplasia, dysplasia syndromes, Klippel-Trenaunay-Weber Syndrome, Turner syndrome, Noonan's Syndrome, diagnostic tests •  etiology of secondary causes, post-cancer therapy, lymphadenectomy, radiation injury, trauma, filariasis, self-induced (factitious)
•  classification of lymphedema, etiology, primary-congenital, non-congenital, hereditary, secondary causes, ISL classification, staging, severity, congenital and acquired disorders •  patient evaluation, history, diet, infections, complaints, psycho-social impact, physical examination, skin changes, appearance, Stemmer Sign


Lecture Content

Section 1: Anatomy

This section covers the complete structure of the lymphatic system including lymph vessels (capillaries, precollectors, collectors, trunks, and ducts) lymph nodes, the superficial and deep systems, lymph fluid, absorption, transport, volume, immune function, regional node aggregations, territories, watersheds, anastomotic connections, and historical overview of the science of lymphology.

Section 2: Physiology

This section's content includes: diffusion, osmosis, colloid osmotic pressure, ultrafiltration, reabsorption, microcirculation, peripheral resistance, active and passive hyperemia, Starlings Equilibrium, interstitial pressure, colloid osmotic pressure of the interstitium, lymphatic insufficiencies (dynamic, mechanical, combined), lymph load, lymph time volume, transport capacity, high and low protein edema, genesis of lymphedema, venous edema, and phlebo-lymphostatic edema.

Section 3: Manual Lymph Drainage Theory

This section is a study of manual lymph drainage from origin and history to application in treatment of lymphedema. It covers: contraindications, indications, precautions, mechanics of technique, principles of delivery, effects on anatomical and physiological systems, Vodder technique, and strokes (stationary circle, pump, rotary, scoop).

Section 4: Compression Bandage Theory

This section's concepts include: Law of LaPlace, compression gradient, short stretch vs. long stretch bandaging, principles of lymphedema bandaging, contraindications to compression, indications, precaution, effects, mechanical properties, applications to various diagnoses, techniques to generate lymphedema-appropriate bandages, spacing, tension, layering, graduated widths, review of all materials, trade names, and rationale for use.

Section 5: Compression Garments

This section covers medically correct gradient support stockings, sleeves, various configurations, flat knitting, circular knitting, cut and sew machining methods, compression classifications, standard classes for various diagnoses, custom made garments, selection criteria for diagnosis, and tips for developing better outcomes.

Section 6: Diagnosis

This section delivers broad information covering the full scope of lymphedema related topics such as incidence, classification, staging, primary and secondary types, dysplasias of the lymphatic tissue (hypo, hyper, aplasia, Kinmonth syndrome), Milroys and Meiges disease, genetic causes, mechanical insults to the tissues, and differential diagnosis of venous, lymphatic, combined edema, cardiac edema, PTS, CRPS.

Section 7: Therapy

In this section the treatment forms available for lymphedema are discussed including: pneumatic compression pumps, surgical interventions such as liposuction, debulking, skin flaps, transplantation, Complete Decongestive Therapy, history of CDT, two phase therapy, modalities of CDT, expected outcomes, treatment planning, and efficacy of treatment.

Section 8: Complication of CDT

This section discusses typical complicating factors associated with clinical delivery of lymphedema therapy such as scars, hyperkeratosis, papillomatosis, skin folds, lobular outgrowths, elephantiasis, hygiene, cellulitis, contact dermatitis, fungal infections, malignant lymphedema, recurrent cancer phenomena, radiation changes, fibrosis, teleangiectasia, and collateral veins.

Section 9: Applications of CDT

CDT is appropriate for other pathologies. This section's content includes: adaptations for the treatment of chronic venous insufficiency, post-thrombotic syndrome, phlebo-lymphostatic edema, lipedema, lipo-lymphedema, post-traumatic edema, post-surgical edema, compression considerations, manual lymph drainage and garment considerations, compression classes, materials selection, and plan of care including intensive and homecare phases of CDT.

Section 10: Lymphedema Bandaging: Video Practical Instruction

This course provides students with the opportunity to view essential bandaging skills in a comprehensive visual format. The concepts presented include: tensioning, molding, spacing, graduated layering, precision, positioning, and logical progression. This exposure is extremely valuable as much of the skill set developed for lymphedema bandaging is derived from observation, palpation, and kinesthetic awareness. Each compression-bandaging component is approached with a standard layering protocol based upon the performance properties of each material coupled with extensive clinical impression.

Section 11: MLD Strokes & Sequences

This course provides a complete review of the 4 Vodder MLD strokes and their application in various intact and non-intact upper and lower extremity treatment sequences.

Section 12: Compression Garment Measuring

Custom garment measuring and fitting is a skill that rounds out every Certified Lymphedema Therapist's knowledge base. During this video program Steve Norton demonstrates the steps involved in measuring for flat-knit custom gloves, arm sleeves, shoulder caps, knee-high garments, thigh-high garments, pantyhose, and toes caps. Since most techniques and points of measure are universal among all garment manufacturers, this course provides a solid foundation that can be applied to most fitting scenarios.
All courses are written and narrated by Steve Norton and are followed by an exam based on the course's material content.


Reference Articles

The articles selected from the Norton School E-Reference Library function as important contributing references to the field of lymphedema treatment and lymphology and cite an evidence-base that is universally supported as fact. Students should read these articles but will not be tested on their content during the course.


Online Home Study Reference Library Listing

ALFP American Lymphedema Framework Project

  • Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema
  • Exercise in Patients with Lymphedema: A Systematic Review of the Contemporary Literature
  • Palliative Care for Cancer-Related Lymphedema: A Systematic Review
  • Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011
  • The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004–2010
  • Intermittent Pneumatic Compression Therapy 2012

Journal Publications

  • Demystifying Lymphedema: Development of the Lymphedema Putting Evidence Into Practice
  • Early Arm Swelling after Breast Surgery: Changes on Both Sides
  • Efficacy of Manual Lymphatic Drainage in Preventing Secondary Lymphedema After Breast Cancer Surgery
  • Massage and Damage to Lymphatics
  • Minimal Limb Volume Change has a Significant Impact on Breast Cancer Survivors
  • Physical Activity and Lymphedema: Assessing the Safety of Strength Training in Breast Cancer Survivors
  • Post-Breast Cancer Lymphedema: Incidence Increases from 12 to 30 to 60 Months
  • Preoperative Assessment Enables the Early Diagnosis and Successful Treatment of Lymphedema
  • The Diagnosis and Treatment of Peripheral Lymphedema
  • The Risk of Genital Edema after External Pump Compression for Lower Limb Lymphedema

NLN National Lymphedema Network

  • Topic: Air Travel
  • Screening & Measurement for Early Detection of Breast Cancer Related Lymphedema
  • Topic: Exercise
  • Screening & Early Detection of Breast Cancer Related Lymphedema: The Imperative
  • Lymphedema Risk Reduction Practices
  • Training of Lymphedema Therapists
  • The Diagnosis & Treatment of Lymphedema
  • The Diagnosis & Treatment of Lymphedema References

PubMed Publications

  • Psychosocial Impact of Lymphedema: A Systematic Review of Literature 2004 to 2001
  • Post-Breast Cancer Lymphedema: Incidence Increases from 12 to 30 to 60 Months
  • Limitations of Self-Care in Reducing the Risk of Lymphedema: Supportive-Educative Systems
  • Adapting Lymphedema Treatment to the Palliative Setting
  • The Prevalence of Lymphedema Symptoms Among Survivors of Long-term Cancer with or at Risk for Lower Limb Lymphedema
  • Lifestyle Risk Factors Associated with Arm Swelling among Women with Breast Cancer
  • Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women with Early Breast Cancer

For generously granting permission to share its publications in the E-Reference Library, The Norton School of Lymphatic Therapy would like to thank: (1) the American Lymphedema Framework Project; (2) the International Society of Lymphology; (3) the National Lymphedema Network; (4) the International Lymphedema Framework


*CEUs are approved through the Florida Physical Therapy Association (FPTA), the American Occupational Therapy Association (AOTA), and the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). This program has been recognized to provide 32 Contact Hours by the Lymphology Association of North America (LANA®) toward satisfying the requirements for LANA® Recertification.

PLEASE NOTE: The CLT Recertification program is for Certified Lymphedema Therapists only. Registrants will need to complete the CLT Verification form on the next page before proceeding to course registration. Students completing the course will receive a CLT Recertification Certificate of Completion from the Norton School. Registrants must fax us the original Complete Decongestive Therapy Certificate in order to receive the new Recertification Certificate. Original CDT Certificates may be faxed to (866) 681-5349.

†Lymphology Association of North America®, LANA®, and CLT-LANA® are registered trademarks of the Lymphology Association of North America®. The Norton School of Lymphatic Therapy is not associated with the Lymphology Association of North America®. The Lymphology Association of North America® has approved the CLT Recertification course for the purposes of earning credits towards LANA Recertification.
 
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