Lower Extremity Lymphedema is a chronic condition of characterized by swelling of body part. It is typically treated with Complex Decongestive Therapy (CDT) to reduce volume. While volume reduction is the primary goal of the treatment, third party payers often require the presence of activity limitations in order to qualify for coverage. The purpose of this dissertation was to identify the types of impairments and functional limitations that occur in this population. A second goal was to determine if volume reduction from CDT is sufficient to resolve the impairments and activity limitations associated with lymphedema, or if traditional physical therapy is necessary to resolve them. In Chapter 2, we performed a study to validate several tools to measure the change in volume that occurred with CDT. Also, a reliability study was performed on the Perometer. The results of this study found that the Perometer had excellent test-retest reliability ( ICC = .99) and that the change measured by the Perometer agreed better with the change measured by the "gold standard" water displacement method, (ICC = .99) than did the change measured by the circumferential tape method (ICC = .92). In Chapter 3, we conducted a cross sectional analysis to determine the baseline impairments and activity limitations associated with lower limb lymphedema. Subjects scored below normal values in all measures of impairments and activity limitations including active range of motion to ankle dorsiflexion and knee flexion, Heel Rise, 30 Second Chair test, Berg Balance Score (BBS), Limits of Stability (LOS), Extended Timed Get Up and Go (ETGUG), Limitation in Mobility Activities Test (LIMAT) and SF-36 Medical Outcomes Study (SF-36). Subjects with severe vs. moderate lymphedema demonstrated scored significantly worse on all tests except ETGUG. Limb Volume was correlated at a fair level with all impairment and activity limitation measures except SF36 which produced a strong correlation. Impairment measures correlated strongly with activity limitations. In Chapter 4, we performed a longitudinal study to address several questions. Were reductions in limb volume related to improvements in impairments and activity limitations? What proportion of subjects completing 2- weeks of CDT continued to have balance impairments or activity limitations severe enough to increase the risk of falling? In subjects at increased risk of falling, does a 4-week standard physical therapy intervention produce improvements in both impairments and the activity limitations? The change in limb volume was significant after the 2 week CDT intervention. However, the loss of volume was not strongly associated with an improvement in impairments or an increase in function over the two week or additional 4 week treatment intervention. Traditional physical therapy intervention produced significant improvements in activity limitations and body function impairments. In Chapter 5, we discussed the clinical and health care policy implications of this research. It was determined that the standard CDT treatment protocol was not sufficient to address impairments and activity limitations other than edema in subjects with lower limb lymphedema. A comprehensive evaluation of these patients requires a traditional physical therapy examination in addition to the volume evaluation to assess the associated impairments and activity limitations. Third party payer coverage guidelines require that the patient be educated to maintain the reduction in limb volume achieved by CDT. This study found a worsening of the edema occurred 4 weeks after termination of the CDT. Policy guidelines were originally developed for individuals with upper extremity lymphedema and may need to be modified for subjects with lower limb edema because of substantial differences in the types of impairments and limitations in mobility and function that occur when the lower limb is involved.

published_or_final_version / abstract / toc / Clinical Psychology / Master / Master of Social Sciences

No description available.

The goal of the present research was to provide a structure for understanding the combinations of client attachment concerns, therapist interventions, and therapist interpersonal qualities that facilitate the development of strong therapeutic relationships by drawing upon the propositions of attachment theory and interpersonal theory. / The first study supported the hypothesis that relationship incidents provide the relational information required for the client to feel secure enough with their therapist to explore in session. Following their third session, thirty volunteer clients seen by therapist trainees nominated an incident they felt was important to the development of their therapeutic relationship. General attachment was associated with the developing relationship with therapist, and this relationship was associated with exploration in-session. As expected, following a relationship building event, the client experienced the therapist as a safe haven from which to explore. The client's ability to attach to the therapist in the relationship building incident was related to avoidant attachment. Client in-session exploration, conceptualized as cognitive openness, was associated with the attachment-related relationship with the therapist, but not general attachment orientation. / Within a framework that explicitly bridges attachment and interpersonal theory; the results of the second study offer differential support for the suggestions of interpersonal theory and attachment theory depending upon the attachment dimension in question. The predictions of interpersonal theory were generally supported in regards to clients with attachment anxiety; in relationship building incidents, therapists allowed themselves to be hooked by client interpersonal schemas however, they also refrained from eliciting emotions with these clients in early sessions. For clients high on avoidance, the results support suggestions from the attachment literature. Therapists met client distancing with proximity---seeking interventions unhooking from client interpersonal expectations; however while doing so, therapists provided the client with a containing framework. Together these studies highlight the importance of client attachment in the development of the therapeutic relationship and extend the findings from attachment research in social psychology to the therapeutic situation. This work adds to the growing literature that supports the clinical utility of Bowlby's attachment framework in assessment and intervention with adults, particularly in regards to the therapeutic relationship.

Thesis (MHSc--Health Science) -- Auckland University of Technology, 2005. / Appendices not included in e-thesis. Also held in print (v, 44 leaves, 30 cm.) in Akoranga Theses Collection. (T 616.8914 MCM)

No description available.

Research on psychotherapy has consistently revealed that a portion of the variance in positive outcomes can be explained by therapist variables. Examination of clients preferences for certain therapist characteristics has led to inconsistent results further complicated by differences in participant characteristics. This study on therapist characteristics examines relationships between student-preferred therapist characteristics and demographic information provided by participants in their survey responses. Therapist characteristics under investigation include counseling style and approach to treatment, level of experience and training, and demographic information. This study also validates an online survey as a quality method of investigating university students preferences for therapist characteristics through the use of a one-parameter Rasch Item Response Theory model of analysis. Results from this study suggest that the Web-based survey employed was a quality method of collecting data on student preferences for therapist characteristics. Results also indicate that student prefer a well educated therapist of advanced training who is a good listener, makes them feel comfortable and is nonjudgmental. Finally, results suggest that student preferences for certain therapist characteristics are influenced by student demographic information and previous counseling experiences.

No description available.

No description available.

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains vi, 149 p. Includes abstract. Includes bibliographical references (p. 117-125).