Welcome and Features   Installation  Registration and Activation   Operational Procedures   Biophysical Data Recording

Welcome and Features    
Thanks you for using Limb Volumes Professional (LVP) software. We believe that this software will provide you with a useful and easy to use tool
to help you track, document and report limb volume changes in your patients. LVP was "field-tested" by experienced therapists and nurses; it got rave reviews. Also, feedback from referring physicians and other health care providers has indicated that the printed/graphic reports of their patient’s progress have been extremely useful. They have recommended its use as a "gold-standard" for therapy progress documentation. In fact, LVP has essentially achieved this ranking among therapists worldwide. The capabilities of the latest version (LVP6.0) are numerous with some of the  features described described below.

Limb Volumes Professional 6.0 (LVP60) helps you to easily and systematically calculate, track, document and report  your patients' limb volumes and record and track other biophysical measurements made during the course of therapy. For each patient visit that you measure limb size, simply enter the limb measurements and let the software calculate limb volumes and display the needed comparisons graphically to provide an image of how well treatment is progressing. You can name, save, print and recall self-contained patient records as with any Excel file.            
Additional information and images may be seen in the TUTORIAL

Among the new and updated features in 6.0 are the following!
                           
1. Arm and Leg volumes with unilateral or bilateral involvement can be determined with the option to be able to make
     and record girths using any between girth segment lengths. No longer must girth measurements be made using a
     fixed distance between measurement sites. Segment lengths can be uniform or variable depending on your specific
     measurement protocol! In all cases edema volume and percentage edema of affected limbs (unilateral involvement)
     is determined along with a visual representation of the distribution of volume along the limb for each patient visit.
     In addition, a report page that summarizes sequential changes in limb volumes and edema volume over the course
     of all treatment visits is provided for printing and documentation.

2. Based on feedback from users the software now allows the automatic generation of a per visit comment and
    documentation page. With the click of a button the most pertinent quantitave volume and edema data for a
    patient's current visit is summarized and you are provided with the opportunity to comment and document other
    aspects of the visit. This visit-summary page is automatically saved with the patient software. If you are using other
    measures to evaluate your patient's progress such as bioimpedance or tissue dielectric constant then these will
    also be summarized on the visit-summary page and be available for printing and other documentation forms.
                                 
3. Biophysical measurement recording has now been integrated within the software. This feature is important to those
    who use such measurements as a supplement to limb volumes determinations. Most notably these measurements
    include the use of bioimpedance (BIOZ) to estimate whole limb fluid content changes and tissue dielectric constant
    (TDC) to estimate local tissue fluid changes in any body part of interest. Both the TDC and BIOZ methods may be
    used to assess fluid changes as a way to track possible developing lymphedema and also to evaluate changes
   associated with various therapies. LVP60 includes a way to record and track these measured values. If you now use
   or plan to use either or both methods then at each visit you simply enter values for affected and contralateral sides.
   The rest is automatic. Key ratios such as (Affected / Contralateral side) are determined for use to compare to
   literature data and importantly to track patient progress. Seperate summary pages for each biophysical parameter
   are provided that quantitatively and graphically show changes in TDC or BIOZ from visit-to visit. User defined
   thresholds and ratios are used to enhance the tracking utility. Threshold ratios represent the current best thinking
   as to the level indicating the presence of either subclinical or established lymphedema. In the setting of
   frank lymphedema, absolute values and ratios (TDC and BIOZ) may be used as important feedback to patients and
   to therapists as indicators of trends and outcomes of treatment. Numerical threshold ratios based on literature
   and other data are provided for both TDC and BIOZ measurements and can be automatically used as reference for
   tracking comparisons in a graphic mode.

4. Literature and clinical experience has shown that limb edema and lymphedema is often non-uniformaly distributed
    along the limb. Thus to facilitate evaluation, limbs can be divided into proximal and distal parts with each volume
    automatically calculated and reported. The location of the border that separates proximal from distal is completely
    under your control with Its location set by pressing the proximal-distal option tab on any of the visit pages. 
    This feature can be a major advantage in tracking outcomes if the location of the edema or lymphedema is mostly
    in one segment of the limb or if the edema shifts location without an overall edema volume change.
 
5. Except for the utilization of water displacement methods assessment of the contribution of the hand to upper
     extremity volume and the foot to lower extremity volume is frought with errors. However, the software allows
     for the calculation of both hand and foot volume based on a prescribed set of standardized and validated
     measurements derived from the literature. For the HAND volumes two options are provided; one based on
     hand circumference measurements and one based on width-depth measurements. For the FOOT volume a
     calculation method based on a scientifically validated algorithm is used. The inclusion of hand or foot volumes
     is optional and if chosen the values are automatically added to the volumes determined from girth measurements
     of the corresponding limb.        
 
6. Literature indicates that when assessing limb volume changes it is best to measure both the at-risk or affected limb
    AND the contralateral at each visit. This is so since the "control" limb may change in volume and confound the
    determination of edema volume. However, some therapists choose to measure the contralateral limb only at
    the initial visit and use that value going forward. This process does save measurement time. To allow for this
    possibilty an option of the software allows you to automatically apply the first visit contralateral limb girths to all
    subsequent visits. To do simply requires the click of a button.

7. The importance of body mass index (BMI) and body surface area (BSA) as a component of lymphedema progression
     is now recognized. As an aid to the therapist these two quantities are automatically calculated and reported as
     an option included in the software. 

INSTALLATION:
Limb Volumes Professional software licenses are for a single machine or network. It can be installed as trial version anywhere but when you register please be sure that it is installed in the machine/network that you will be finally using. For CD versions, begin installation by putting the CD in the drive and wait for it to auto-run. If it does not auto-run then navigate to the CD and double click on the application setupLVP60CD, setupLVP60DL.exe or setupLVPGK.exe depending on the version. During installation LVP6.0 will be put on to your hard drive for future use. Its install location will be C:\Users\Public\LVP60CD. To run LVP6.0 after installation double click on its icon that is placed on your desktop or navigate to the install location and click on LVP60.xls. Note that LVP6.0 uses macros (small bits of code), to run properly. So, if you are asked, please select OK for macros to be enabled. LVP6.0 runs in conjunction with Excel, so you will need to have Excel on your computer. You will be able to run LVP6.0 after you complete the installation. 

REGISTRATION AND ACTIVATION
This software will run as a trial version for 12 uses. After that, to continue to use Limb Volumes Professional you will need to register to obtain a permament activation code. If you have already purchased a license then you can register directly at the website www.limbvolumes.org. To register you will need to supply the serial number that is listed on the HELLO page of the installed software. You can also get it by clicking on the SERIAL NUMBER tab. When registering you will also be asked for the CD number that is printed on the front of the CD. For downloaded versions for which there is no CD# you can used 999DL as the CD number. If you have not as yet purchased a license then you must do so prior to registering and receiving your permanent activation code. You can start the purchase process by clicking HERE. Once purchased the registration is the same as described above. Please note that no additional CD will be provided since the download version and the trial CDs contain the the full professional version with all features included! However a physical CD can be purchased.

Once you have purchased a license you can register at the web site (www.limbvolumes.org) by providing your serial number, CD number and other required information. Thereafter a permanent life-time activation code will be sent to the email address that you provide. This process is not instantaneous and might take 24 hrs to process so it is a good idea to register before the number of trial version uses expire. The permanent activation code sent to you can be entered at any time using the ACTIVATE tab on the HELLO page or using the ACTIVATE tab on the INFO page. The software must be activated when the number of trial versions are exceeded. When this happens a window on the HELLO page will open for you to enter the activation code. Once activated on your system it is permanent and no further activation should normally be required.

To sum up:
(1) Purchase a license if you like the trial version (12 uses)
(2) Register at the web site (www.limbvolumes.org) with your CD#, serial number and other info
(3) Receive a permanent activation code sent to your email address
(4) Use the code to permanently activate your software

OPERATIONAL PROCEDURES

Operation is generally self-explanatory within the software and is displayed in a standard Excel format. Data may be entered, saved by any file name and printed exactly as you would do in Excel. A tutorial and various instructional references are located on the CD and are also available at http://limbvolumes.org. These should be very helpful.

SAVING AND RECALLING
After entering patient data into LVP50.xls you should save the file using a distinct patient identifier of your choosing – such as Mary Smith or MS123456 etc. This is done using the Save As function in the Excel menu. Do not use the savefunction when working in LVP60.xls as this will write the data you have entered into this master file (LVP60.xls) which you want to keep free of data for ease of subsequent use. However, when recalling a patient’s file, with previously entereddata, this patient file may be re-saved using the standard save function. 

PATIENT INITIAL SETUP
1. If it is the patient's first visit you should enter the new patient information on the PATIENT page
2. Then enter the patient's limb lengths on the START page. This would include the limb length as measured
     from either the wrist or ankle or other custom reference point.
3. The segment length is also chosen on the START page. The segment length is the distance between consecutive
     circumference (girth) measurements with a fixed default value of 4 cm. You can choose any desired segment length.
     You can also opt to have a variable segment length that you specify. To select this option tick the radial button on
     for "variable segment lengths". This will automatically move you to the SEGMENTS page where you can choose
     custom positions to make your girth measurements.
4. Hand Inclusion: If this is an upper limb assessment you have the option to include hand volumes. For this option
     you should select the INCLUDE HAND option on the PATIENT page. You will then have the option to use one of two
     possible methods for hand measurement. Choose either the width-depth or the circumference method.
     For either method you will need to enter a HAND LENGTH as indicated on the START page. The final step is to enter
     the hand measurements on the HANDC page. Once these measurements are entered the hand volume is calculated
     and its value transfered to the main limb volumes page for the current visit. Its value will be automatically added to
     the values determined from the arm girth measurements.
5. Foot Inclusion: If this is a lower limb assessment you have the option to include foot volumes. For this option
     you should select the INCLUDE FOOT option on the PATIENT page. The next step is to enter the foot measurements
     on the FOOTC page. Once these measurements are entered the foot volume is calculated and its value transfered
     to the main limb volumes page for the current visit. Its value will be automatically added to the values determined
     from the leg girth measurements.

SEQUENTIAL OPERATION
Once the intial patient setup is completed the further operation is self-explanatory. The girths are measured and their values are entered into the provided columns on each of the patient's visit. These visits are labeled as v1, v2 v3 and etc. with v1 corresponding to a patients first visit. In addition to the automatic calculation of total limb volume (which at your option could include foot or hand volumes) you have the additional option of automatically getting separately the proximal and distal volumes. This can be a major advantage in tracking outcomes if the location of the edema or lymphedema is mostly in one segment of the limb. If you are also measuring certain biophysical values such as Tissue Dilectric Constant (TDC) or limb bioimpedance (BIOZ) the measured sequential values can recorded and tracked. More details can be found using the tab labeled BIOPHYSICAL MEASUREMENTS.

THE "CONTROL" LIMB USE
Literature indicates that when assessing limb volume changes it is best to measure both the at-risk or affected limb AND the contralateral at each visit. This is so since the "control" limb may change in volume and confound the determination of edema volume. However, some therapists choose to measure the contralateral limb only at the initial visit and use that value going forward. This process does save measurement time. To allow for this possibilty you can automatically apply the first visit (v1) contralateral limb girths to all subsequent visits. To do this you would click on the tab located only on visit 1 labeled "use visit 1 norm values for all visits". When you opt for this you should note that if you had entered any norm values other than for v1 these will be overwritten.

VISIT SUMMARY AND COMMENTS
For each visit you can automatically generate a summary of key measured and calculated values and also add any comments pertaining to that visit. The summary form is saved within the patient file and can be printed using the standard Excel print function. To generate the summary simply click on the COMMENT tab after you have entered the data in that visits data recording sheet. 

PROXIMAL-DISTAL VOLUMES
For evaluation purposes limbs can be segmentized to proximal and distal parts with each volume determined. The location of the border location that separates proximal from distal is completely under your control. Its location is set by pressing the proximal-distal option tab on any of the visit pages.

BIOPHYSICAL DATA RECORDING


TISSUE DIELECTRIC CONSTANT (TDC)
This method has been used to assess local tissue water changes as a way to track possible developing lymphedema and also to evaluate changes associated with various types of therapy and treatment. If you use this method this version of Limb Volumes Professional includes a way to record and track these measured TDC values. To use it you simply enter the measured TDC values on the VISIT page for affected and contralateral sides into the designated cells. Once entered the rest is automatic. A TDC ratio (Affected / Contralateral side) is calculated for that visit and the
TDC values and the ratio is placed in a tracking graphic on the TDC PAGE for comparsion with a THRESHOLD value. The threshold ratio represents the current best thinking as to the ratio, which if exceeded, may suggest the presence of subclinical or initial lymphedema manifestation. In the setting of frank lymphedema that is being treated the TDC values or the TDC ratio may be used as important therapist and patient feedback as to trends and outcomes of treatment. Threshold ratios derived from published research and other data are provided as reference values
for measurements made at different anatomical sites including the forearm, biceps and lateral thorax.

BIOIMPEDANCE (BIOZ)
This method has been used to assess total limb (arm or leg) water and its change by the limb's electrical resistance. The BIOZ principle relies on the fact that the more water that accumulates in a limb the lower will be its measured electrical resistance. This version of Limb Volumes Professional includes a way to record and track these measured BIOZ values. If you are using this method then on each VISIT page you can simply enter the BIOZ values for the affected and contralateral sides into the designated cells. Once entered the rest is automatic. A BIOZ ratio
(Contralateral / Affected side) is calculated for that visit and the BIOZ values and the BIOZ ratio is placed in a tracking graphic on the BIOZ PAGE for possible comparsions with threshold values reported in the literature. In the setting of frank lymphedema that is being treated, BIOZ values or the BIOZ ratio may be used as feedback to therapist and patient as an indicator of trends and outcomes of treatment. In addition to the BIOZ ratio, a parameter known as the L-Dex is calculated. The L-Dex is a lymphedema index calculated from the BIOZ ratio that is used by some workers. An L-Dex numeric value of 10 is taken as the lymphedema threshold.  Threshold BIOZ ratios derived from published research are provided as reference values for measurements made on arms and legs with built in adjustments for handedness in the case of upper extremity measurements.