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Application Development forLymphedema care :
More active, Self-directed Care Eun Joo Yang, MD., PhD.
Department of Rehabilitation MedicineSeoul National University Bundang
Hospital
Introduction• Lymphedema Care Continuum• Empowerment, more active, self-directed• Technique? Vs Care?• Disease issue• Technique issue• UX issue• Future step!
Cancer Care Continuum
Survivorship Care Continuum
Diagnosis Acute Cancer Treatment
Prehabilitation
Rehabilitation
No impairments
Impairments
General Exercise/Wellness
Lymphedema Care Continuum
Survivorship Care Continuum
Diagnosis Acute Cancer Treatment
No impairments
Impairments
Risk factor Natural course
Survivorship Care Continuum
Diagnosis Acute Cancer Treatment
F/40 Breast ca, Rt UOQ (IDCa), cT3N2M0
2013.12-2014.4AC #3 D #4
2014.5.13Rt MRM
2014.11 (5month after surgery)3-4 일전부터 우측 상지가 부어요Volume difference (ml) 156.89
2014.6-7PMRT to Rt C/W& SCL2014.5 zoladex+tamodifen
2014.6POD 10 days
Lifestyle..High-risk
Acute lymphedema
Active, empoweredLifestyle
Chroniclymphedema
Education -Prevention -Early detection
TreatmentEvidence-based approach
Coach Empowerment
Health-related empowerment
• Empowerment refers to an individual’s feelings of being able to manage the challenges of the cancer experience.
• Empowering an individual who had cancer during different phases of trajectory is often an objective that informs the provision of support services.
Health-Related Empowerment in Cancer
Cancer. 2014 Oct 15;120(20):3228-36.
Health-directed activity (HDA)
Positive and active engagement in life (PAE)
Emotional distress (ED)
Self-monitoring and insight (SMI)
Constructive attitudes and approaches (CAA)
Skill and technique acquisition (STA)
Social integration and support (SIS)
Health service navigation (HSN)
ActiveLifestyl
eDisease issue Lymphedema
Risk stratificationNatural course
Technical issue
IoT/ wearable device
UX issueDoctor-Patient
Time course of Lymphedema
• Acute lymphedema : 60%• Chronic and/or progressive lymphedema : 30-40%• Fluctuating lymphedema : 15-22%
Norman et al.,J Clin Oncol 2009;27:390-397
Exercise and management of lymphedema
• Randomized controlled trials have challenged this belief and found no association between upper body exercise and the onset or worsening of breast cancer-related lymphedema.
Schmitz KH, et al Med Sci Sports Exerc. 2010;42(7):1409–1426.
Progressive, resistive exercise
• Some forms of exercise, mainly progressive RE, is associated with less exacerbation of lymphedema-related symptoms in BCS.
Sander AP et al. Phys Ther. 2012;92(4):525–536. Schmitz KH, et al. N Engl J Med. 2009;361(7):664–673.
Weight Lifting for Women at Risk for Breast Cancer–Related Lymphedema
Kathryn H. SchmitzN et al., Engl J Med 2009;361:664-73.
10 회 10 회 10 회 팔 증상의 변화 없는 경우 ?가장 최소량의 무게 증가 ?
2 session 연속 빠지는 경우무게 감소
10 회 10 회 10 회
ActiveLifestyl
eDisease issue Lymphedema
Technical issue
IoT/ wearable device
UX issueDoctor-Patient
Set up : Screening tool
Survivorship Care Continuum
Diagnosis Acute Cancer Treatment
무엇으로 screening ?림프부종의 조기 발견할 수 있는 도구 ?
Stage 0 or 1 ?
림프부종이 진행되는 증상 ? 징후 ? 검사 ?
• The latent stage– Before overt swelling
• Lymphedema-related symptom– Heaviness, tightness, firmness, pain,
numbness, impaired mobility
• Armer, Radina, Porock, & Culbertson, 2003; International Society of Lymphology [ISL], 2003
0 Stage
Symptom report in detecting breast cancer-related lymphedema
Breast Cancer (Dove Med Press). 2015; 7: 345–352.
Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인
운동강좌 리스트
암재활 신체활동 모니터 App UI 디자인 _ 운동강좌 페이지
운동강좌 상세페이지 탄력밴드 근력운동기록 페이지
Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인
메인 화면
암재활 신체활동 모니터 App UI 디자인 _ 메인페이지
운동전 상태체크하기 운동후 상태체크하기
Design서울대학교 병원의 메인칼라를 활용하여 아이덴티티를 강화하였습니다 . Key Concept - Refined | Design Direction- Identity 강화 | GUI Style – 플랫디자인
림프부종 관리 체크 _ 아니오 했을경우
림프부종 관리 체크 _ 예 했을경우림프부종 상태체크
암재활 신체활동 모니터 App UI 디자인 _ 설문페이지
ActiveLifestyl
eDisease issue Lymphedema
Technical issue
IoT/ wearable device
UX issueDoctor-Patient
의사 : 환자가 운동을 제대로 하고 있는지 ?:“ 운동을 제대로 하고 있는지 알 수 없어요 .”
환자 : 의지와는 달리 운동의 정확도 확인 어려움 : “ 운동하다가 통증이 오는데 이 정도는 괜찮은 건가요 ?”