INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA
JOHOR BAHRU
DIPLOMA IN PHYSIOTHERAPY
REFLECTIVE PRACTICE
RECORD
TITLE:
MANUAL LHYMPATIC DRAINAGE ( MLD )
NAME : NUR FARHANAH BINTI ARIFFIN
MATRIX NUMBER : BJPA2019-0016
YEAR / SEMESTER : YEAR 3 SEMESTER II
DISCIPLINE : WOMEN’S HEALTH
1
DIPLOMA IN PHYSIOTHERAPY
INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA JOHOR BAHRU
REFLECTIVE PRACTICE RECORD
NAME: NUR FARHANAH BINTI ARIFFIN DATE OF LEARNING EVENT: 27 FEB 2022
Experience
1. What was your experience 2. What was your reaction/
during clinical placement? response during this
experience?
On 27 Feb 2022 was my 8th week of When I was ask to apply MLD, I was
posting in the Hospital Sultanah Nora nervous because this was my first time
Ismail Physiotherapy department. On this applying to patient even though I already
rotation I was assigned at the learn during my theory and practical
Electrotherapy which clinical placement session. Actually . I was scare that Miss
for women’s health. Before I posting there, Christ might scold me because I did not
Miss Zaleha has given an introduction to know to apply this technique properly.
me that in this Electrotherapy they will Miss Christ demonstrate to apply gentle
handle a case for musculoskeletal and pressure to patient. After that, I was asked
women’s health. Miss Zaleha also told me to apply too and i was clumsy as my hand
that women’s health case are very rare. If position was wrong and the pressure was
they come, that case will handle by Miss too strong. However, Miss Christ calm me
2
Christina Devi as specialist for this case. and told me to perform it relax. She also
Therefore, at the night before my posting told that this case need to handle by
at Electrotherapy, I had done my revision someone that already have certification in
about the assessment and treatment for lymphedema course. Miss Christ was
women’s health condition .I had read happy and excited to teach me how to
through my notes thoroughly that my apply this technique, he also said that if I
lecturer had given me. I was nervous for did not take this opportunity to practice this
this area because my last clinical posting, time, then when will I can learn this
I did not more exposed for women’s health knowledge. I was motivated by this
case due to pendemic. At that time, there therapist encouragement and she ask me
was a Malay woman which diagnosed as to more learn about it. After he had taught
lymphoedema secondary to right me. I was curious about this technique and
mastectomy came to physiotherapy want to know more about how to apply this
department as outpatient. The patient has technique correctly. I had done my
moderate body size. Patient come to readings and searching an article about
department with slouched posture, walk MLD when I go back to home.
independently with normal gait and obey
MLD is a light, skin-stretching massage
command. After I had done my subjective
that helps promote the movement of
and objective assessment, my patient had
lymphatic fluid out of the swollen limb. It
done mastectomy on Mei 2021, now she
should not be confused with a traditional
having limited ROM on right shoulder
massage. MLD is specifically focused on
movement and swelling on right arm. I was
the lymph vessels to help the flow of
discuss with Miss Christina to do active
lymphatic fluid. Therapy is applied to
free exercise to improve shoulder range
your unaffected areas first, making it
of motion and do compression bandaging
possible for the fluid to move out of the
for the swelling, unfortunately Miss
affected area, or “decongest” the region.
Christina suggested me that for this
MLD helps open the remaining
patient I can apply Manual Lymph
functioning lymph collectors and move
Drainage ( MLD ). As this is the first time I
protein and fluid into them, as well as to
had use this technique, Miss Christ has
explained and the purpose of this
3
technique given. After that, Miss Christ help speed up lymph fluid flow through
explain all the characteristics of this the lymphatics. ( Physioedia )
technique and some indication and
contraindications.
Learning analysis
3. What have you learnt from this experience?
From this experience, this patient was with lymphoedema secondart to right
mastectomy condition, which the patient was presented with bigger size on her right
hand compare to her left hand. She had complaint that she was unable to wear her
previous clothes and she was forced to buy a larger size clothes to let her hand fit
through. From the subjective assessment, I had known that she had done total
mastectomy on her right breast with axillary clearance on Mei 2021. One of the
complication that related to this surgery was lymphoedema. Lymphoedema is the
accumulation of protein-rich fluid in tissues. The impaired function of lymph vessels
interrupts the drainage of lymphatic system that is a part of the circulatory system.
Lymph vessels remove excess fluid from tissues and transport it back to the circulation.
Lymph capillaries are located in the dermis, woven like a cobweb, then drain to
lymphatic vessels in the subcutaneous plane and ultimately to the deeper system and
the thoracic duct. For this condition, I had measure limb girth of each finger and every
4 cm from wrist joint above for patient right hand and also left hand for comparison.
The conservative management for lymphoedema condition is a combination of
regular skin care, manual lymphatic drainage (MLD), Simple lymphatic drainage
(SLD), Sequential intermittent pneumatic compression, exercises and
compression bandaging to reduce the swelling. While for the operative management
which is the laser treatment, liposuction, Lymphatic reconstruction (anastomosis),
tissue transfer. Compression therapy is not suitable for all people with lymphoedema.
4
It can be dangerous for people with uncontrolled congestive heart failure or
uncontrolled high blood pressure. These conditions need to be stabilised before
starting compression therapy. (Cancer Council Australia, 2017)
MLD is intended to stimulate lymph nodes and increase rhythmic contractions
of the lymphatics to enhance their activity so that stagnant lymphatic fluid can be
rerouted. MLD is composed of four main strokes: stationary circles, scoop
technique, pump technique, and rotary technique. Is effective both as a
preventative treatment and as a postoperative rehabilitation treatment, and has
optimal results when it is combined with the other elements of CDT (Complete
Decongestive Therapy). It also increases blood flow in deep and superficial veins.
Other than lymphedema, MLD may be useful in conditions such as post-traumatic
and post-surgical edema, and palliative.
This technique usually performed with the patient in the lying position. Starts
and ends with deep diaphragmatic breathing. The unaffected lymph nodes and
region of the body are treated first. Moves proximal to distal to drain the affected
areas and must do in slow and rhythmical movements. Lastly, uses gentle pressure.
Principles of MLD
The skin is stretched in specific directions using hand movements to
promote variations in interstitial pressure without the use of oils.
Slow repetitive movements are used which incorporate a resting phase
allowing skin to return to its normal position.
The pressure is varied according to the underlying tissue with the aim to
promote lymphatic drainage.
Areas of fibrosis are treated using deeper and firmer movements in
combination with Compression therapy.
The lymphatic drainage starts centrally and proximally with treatments
usually starting around the neck.
5
Functional and healthy lymph nodes are treated first, followed by proximal
and contralateral areas and then ipsilateral and lymphoedematus areas.
There is emphasis on treatment of anterior and posterior trunk in the early
phases before the swollen limb is treated.
Breathing techniques used are combined with pressure by the therapist's
hands which promotes drainage of deep abdominal lymph nodes.
Limb mobilization and relaxation techniques are often combined with
lymphatic drainage
6
Conclusion
4. What you do if this situation happens again?
If the same situation happens again, I will feel more confident to apply the
manual lymphatic drainage technique. I will first explained clearly about the purpose of
this technique to the patient. I will not repeating the same mistake that I had done to
the first patient which I will make sure the adequate pressure apply to the patient and
make sure that my hand was in correct placement. In the mean time, I will practice my
soft skills with my classmate.
Furthermore, by having knowledge of this treatment, it will be able to save time for the
patient. It also benefits people around me such as physiotherapist, patient and friend,
when I also can share information or knowledge about it. With proper understanding
and continuous practice mistakes will eventually being avoided
Conclusion
5. How would you practice your learning experience in another
circumctance?
With all the knowledge and condition that I had known which can apply on the
patient. I will assess the patient condition and analyse the problem of patient. I will find
the opportunity to apply this technique to other patient which I can practice my soft skill
on the real condition. Confident level will increase gradually while I have the soft skill
during practice with classmate or apply on patient. Furthermore, the patient will be more
confident with me that I can explained the function, effect of the technique. While I will
also share my knowledge among my friends which that they can also provide an
efficient treatment for the patient.
( 1940 words)
7
6. REFERENCE
Cancer Council Australia. (2017). Understanding Lymphoedema.
About manual lymphatic drainage (specialised massage) for lymphoedema.
(2017).
[Link]/about-cancer/coping/physically/lymphoedema-and-
cancer/treating/massage-manual-lymphatic-drainage/about
Manual Lymphatic Drainage. (2022, March 24). Physiopedia, . Retrieved
16:43, March 30, 2022 from [Link]
[Link]/[Link]?title=Manual_Lymphatic_Drainage&oldid=298702.
Mayo Clinic Staff. (2017). Lymphedema. [Link]/diseases-
conditions/lymphedema/symptoms-causes/syc-20374682
Carey, E. (2019, February 27). How to perform lymphatic drainage massage.
Healthline. Retrieved March 31, 2022, from
[Link]
massage
8
DIPLOMA IN PHYSIOTHERAPY
INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA JOHOR BAHRU
REFLECTIVE PRACTICE RECORD MARKING SCHEME
Name : ____________________ Matrix No. :____________________
Hospital : ____________________ Date of placement : ___________________
Discipline : ____________________ Tutor : ___________________
MARKS MARKING CRITERIA
Experience-
1. What was your experience during clinical placement?
Did not explain their experience in the specific discipline or explains on
0.0
irrelevant experience during their clinical placement.
0.5 Explain incomplete experiences from the criteria given.
1.0 Explains experiences completely according to the criteria given.
Experience-
2. What was your reaction/response during this experience?
Did not explain their reaction or response to their experiences or explains
0.0
on irrelevant reaction or response during their clinical placement.
1.0 Explain incomplete reaction or response from the criteria given.
Explains their reaction or response completely according to the criteria
2.0
given.
Learning/analysis-
3. What have you learnt from this experience?
Did not explain the learning experiences accurately and requirements
0.0 (diagram, table, procedures, graph references and/or etc.)
Explain the learning experiences partly and do not have aspect (diagram,
1.0
table, procedures, graph references and/or etc.)
Explain the learning experiences accurately and include the
2.0 requirements (diagram, table, procedures, graph references and/or etc.)
Conclusion-
4) What you do if this situation happens again?
9
Not specify the planning/action taken or plan/action set not directly
0.0
related to what they have learned.
State planning / action taken with less complete or less related to
1.0
what they have learned.
State planning / action taken with complete and relevant to what they
2.0
have learned.
Conclusion-
5) How you put your learning into practice in another situation?
Not explain the application of learning or learning application described
0.0
is not appropriate to events / situations
Describes the application of learning inappropriate or less effective to
0.5
the events / situations.
Describes the application of learning appropriate and effective to the
1.0
events / situations
6) References
0.0 No references provided
1.0 Untrusted evidence with poor format of referencing
2.0 Trusted evidence with correct format of referencing
Total Marks: /10
Comment: _________________________________________________________
_________________________________________________________
_________________________________________________________
10