HISTORY AND THEORY OF APPLICATION
The use of compression of vasculature for therapeutic purposes has been around since the 1800s, when physicians experimented with the application of external compression to improve circulation. A paper published in 1917 in the Journal of the American Medical Association described the use of compression for thromboangiitis obliterans.1 Today, compression devices use a mechanical pump and a sleeve to deliver intermittent pneumatic compression (IPC), also known as vasopneumatic compression. Rehabilitation practitioners use IPC devices as an intervention for patients with circulatory conditions and with a variety of outcome measures (Box 8-1) (Figs. 8-1 and 8-2).
Box 8-1 Outcome Measures of Intermittent Pneumatic Compression
Deep vein thrombosis (DVT) prevention Edema reduction
Improved sensory function after CVA
Faster venous stasis wound healing
Increased blood flow in peripheral artery disease (PAD)
Reduction in limb volume in lymphedema
(A) Single and (B and C) multichamber sleeves for application of IPC.
(A) Single and (B) multichamber IPC mechanical pumps.
IPC is often used for edema control. Compression of tissue can elevate the pressure of fluid in interstitial spaces higher than that of blood and lymph vessels. The change in pressure gradient may facilitate the flow of fluid out of the interstitial space back into the venous and lymphatic vessels for drainage. IPC has also been used for a variety of clinical conditions, including improving venous circulation to prevent blood clots, healing stasis ulcers, and reducing lymphedema.2,3 Recent research has focused on the treatment of arterial insufficiency with IPC4 and for treatment of sensory impairment after a cerebrovascular accident (CVA).5
Although the exact mechanism of how IPC affects venous blood flow remains elusive, a proposed theory is that, when compression is applied, compression results in forward propulsion of blood flow. This accelerated blood flow helps prevent venous stasis and can cause distention of the lumen, increasing the peak flow velocity by as much as 200%,6,7 which may aid in the clearance of the valve sinuses.
INDICATIONS FOR INTERMITTENT PNEUMATIC COMPRESSION
Edema in a limb or joint can delay patient healing and interfere with rehabilitation. This condition occurs when an abnormal amount of fluid collects in the interstitial space. Edema can be localized due to increased vascular permeability, a lymphatic blockage, or venous obstruction.
Edema is also associated with the acute phase of inflammation, reduction of plasma proteins, and electrolyte or fluid imbalances and when limbs are in the dependent position. Systemic edema can occur due to pathology of the cardiac, pulmonary, or renal systems.
Edema can slow down the rehabilitation process in many patient populations. ...