All patients were encouraged to elevate their legs whenever possible. If patients had a degree of mobility they were taught simple exercises to encourage the pumping action of the calf muscle - for example, ankle rotation, wriggling of toes and extension and flexion of the foot. It was made clear that it would be the patient's decision to proceed with ISCT and that treatment could be declined at any point. A full explanation of ISCT was provided and questions were encouraged. They were given information on dependent oedema and advised that it was not likely to improve without intervention. Six patients with uncomplicated dependency oedema were approved for ISCT during the evaluation period. Medical assessment and approval for ISCT based on the clinical findings was sought before the start of treatment in all cases. The patients' limbs were examined for the degree and severity of swelling, skin condition and colour. Contraindications to this therapy include deep vein thrombosis in the previous six weeks, congestive cardiac failure, acute pulmonary oedema and acute infection. Patients were assessed by a nurse for the use of ISCT on admission to the unit. The peristaltic cycle moves from the distal to the proximal end of the limb and ensures the proximal flow of fluid by always having the fully pressurised chamber behind the inflating chamber. This is placed over the affected limb and the chambers inflate and deflate according to a predetermined pattern. ISCT involves the use of a garment made up of a number of chambers that fill with air in sequence. ISCT aims to gently massage this excess fluid from the interstitial spaces back into the venous and lymphatic vessels. If an individual has restricted movement in the lower limbs and blood is not being propelled effectively through the veins fluid can escape into the interstitial spaces, resulting in oedema. Repeated contraction and relaxation of the calf muscle which takes place during exercise is important to maintain satisfactory blood flow in the deep veins of the lower leg (Hoffman, 1995). As a number of patients had expressed an interest in buying an ISCT system, staff at the unit decided to evaluate the impact of a model which would be appropriate for use at home. Patients are usually admitted to the unit for two weeks to improve and maintain functional ability and independence, and ISCT often forms part of the treatment. Poorly managed dependent oedema can also result in skin and tissue changes, ranging from dry flaky skin in uncomplicated oedema to hyperkeratosis in cases of chronic swelling (Veitch, 1993). However, it is important that it should be treated, as swollen limbs may result in heaviness, discomfort, further reduction in mobility and impaired function (Mortimer, 1995). Dependent oedema of the lower limbs is a symptom of reduced mobility which is often overlooked in patients with these conditions. The community rehabilitation unit at St Mary's Hospital in Leeds caters for patients with a variety of neurological conditions - for example, multiple sclerosis, cerebral palsy and cerebral vascular accident, all of which can result in reduced levels of mobility. Intermittent sequential compression therapy (ISCT) is effective in reducing oedema of the lower limbs (Vowden, 2001) and can improve circulation of blood in the affected areas (Sayegh, 1987). Monica Carcary, RGN, is a primary nurse, Community Rehabilitation Unit, St Mary's Hospital, Leeds
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