Table 2. Overview of treatment.

Additional explanation for focus areas follow

Focus Area	Treatment	Instructions	Time
Preparation for Treatment	Thermal Modalities ■Hot packs ■Paraffin	Focus thermal treatments on areas with limitations Hot packs (elbows/forearms) Paraffin (hands)	15 minutes
Tissue Mobilization	Physiotouch (also called Lymphatouch)* Apply proximal to distal in areas with pathological skin in sections Use largest head that will achieve good suction	Begin about elbow, move proximally – 4 pulses per head placement/slightly overlap head placements Head size – 60/50/35 mm depending on location Pressure setting- 250 mmHg Vibration- 60 Hz Simple pulse – 2 sec/50% End with hand/digits with same settings as above	10-13 minutes per extremity
Arm Mobility\Range of Motion	Passive Range of Motion Active Range of Motion\Functional Activities	■PROM Hold end position of joint for 3-10 seconds; 3-5 reps (Dependent on skin and joint integrity) see Appendix ■Repeat for each affected joint/digit AROM – 10 reps - see Appendix Functional Activities utilizing available ROM, grip/pinch	10 minutes per extremity 3-5 minutes per extremity (or remaining time in session)
Home Program	■Tailored active and passive ROM based on limitations in upper extremity mobility	*Adaptions may be needed if skin ulcers are present by teaching alternative methods for holding/stretching joints, or if patient experiences lasting increase of musculoskeletal pain by decreasing repetitions.