Norton School of Lymphatic Therapy
The Comprehensive Recertification Program is designed for completion in two independent parts, which can be satisfied at the pace and in the preferred order of each participant. Total continuing education, 48 hours. Participants of both elements will earn a current CLT Recertification Certificate of Completion from the Norton School. Completion of both portions is elective and each can be applied independently towards LANA recertification individually.
This 32-hour online course series is a complete theoretical review of content covered in the CDT Certification Program offered by the Norton School of Lymphatic Therapy. The program is organized in sections to allow each student to absorb the information at a comfortable pace. If the goal of home study is thorough preparation for the Lymphology Association of North America (LANA®) Examination®†, or to meet the requirements of LANA® recertification, this program includes all necessary information. Completion of this online portion awards students a Theoretical Recertification Certificate of Completion.
A complete description of the 16-hour Technique Review for CLTs course can be found here. Completion of this live instructional program awards students a Practical Recertification Certificate of Completion.
Tuition for the CLT Recertification Program is $495.
The Online CLT Recertification Program covers the following topics:
  • lymphatic anatomy
  • relevant aspects of the integumentary system
  • physiology of lymphatic fluid formation (Starling's Equilibrium)
  • manual lymph drainage principles
  • risk reduction, precautions, lymphedema management
  • indications/contraindications
  • the Law of LaPlace
  • compression classes
  • fitting principles, common problems
  • skin care
  • lymphatic drainage of the head, neck, upper and lower extremities as well as the trunk and genital regions
  • lymph transport, volume, lymphatic loads, mechanical, dynamic, combined insufficiencies, lymph-stasis, protein effects, etiology of edema and its effects
  • aplasia, hypo/hyperplasia, dysplasia syndromes, Klippel-Trenaunay-Weber Syndrome, Turner syndrome, Noonan's Syndrome, diagnostic tests
  • classification of lymphedema, etiology, primary-congenital, non-congenital, hereditary, secondary causes, ISL classification, staging, severity, congenital and acquired disorders
  • the interstitium and connective tissue
  • compression therapy indications/contraindictions
  • volumetrics, measurements
  • patient education, self-care
  • compression bandaging theory and practical application
  • pneumatic pumps
  • compression garments
  • knitting methods and material differences
  • exercise principles, methods, effects
  • ADLs
  • quality of life issues, psycho-social impact, compliance, support groups, community resources, palliative care
  • various associated diagnoses such as lipedema, lipolymphedema, venous edema, chronic venous insufficiency, phlebo-lymphostatic edema, lymphangiosarcoma, myxedema
  • etiology of secondary causes, post-cancer therapy, lymphadenectomy, radiation injury, trauma, filariasis, self-induced (factitious)
  • patient evaluation, history, diet, infections, complaints, psycho-social impact, physical examination, skin changes, appearance, Stemmer Sign
This section covers the complete structure of the lymphatic system including lymph vessels (capillaries, precollectors, collectors, trunks, and ducts) lymph nodes, the superficial and deep systems, lymph fluid, absorption, transport, volume, immune function, regional node aggregations, territories, watersheds, anastomotic connections, and historical overview of the science of lymphology.
This section's content includes: diffusion, osmosis, colloid osmotic pressure, ultrafiltration, reabsorption, microcirculation, peripheral resistance, active and passive hyperemia, Starlings Equilibrium, interstitial pressure, colloid osmotic pressure of the interstitium, lymphatic insufficiencies (dynamic, mechanical, combined), lymph load, lymph time volume, transport capacity, high and low protein edema, genesis of lymphedema, venous edema, and phlebo-lymphostatic edema.
This section is a study of manual lymph drainage from origin and history to application in treatment of lymphedema. It covers: contraindications, indications, precautions, mechanics of technique, principles of delivery, effects on anatomical and physiological systems, Vodder technique, and strokes (stationary circle, pump, rotary, scoop).
This section's concepts include: Law of LaPlace, compression gradient, short stretch vs. long stretch bandaging, principles of lymphedema bandaging, contraindications to compression, indications, precaution, effects, mechanical properties, applications to various diagnoses, techniques to generate lymphedema-appropriate bandages, spacing, tension, layering, graduated widths, review of all materials, trade names, and rationale for use.
This section covers medically correct gradient support stockings, sleeves, various configurations, flat knitting, circular knitting, cut and sew machining methods, compression classifications, standard classes for various diagnoses, custom made garments, selection criteria for diagnosis, and tips for developing better outcomes.
This section delivers broad information covering the full scope of lymphedema related topics such as incidence, classification, staging, primary and secondary types, dysplasias of the lymphatic tissue (hypo, hyper, aplasia, Kinmonth syndrome), Milroys and Meiges disease, genetic causes, mechanical insults to the tissues, and differential diagnosis of venous, lymphatic, combined edema, cardiac edema, PTS, CRPS.
In this section the treatment forms available for lymphedema are discussed including: pneumatic compression pumps, surgical interventions such as liposuction, debulking, skin flaps, transplantation, Complete Decongestive Therapy, history of CDT, two phase therapy, modalities of CDT, expected outcomes, treatment planning, and efficacy of treatment.
This section discusses typical complicating factors associated with clinical delivery of lymphedema therapy such as scars, hyperkeratosis, papillomatosis, skin folds, lobular outgrowths, elephantiasis, hygiene, cellulitis, contact dermatitis, fungal infections, malignant lymphedema, recurrent cancer phenomena, radiation changes, fibrosis, teleangiectasia, and collateral veins.
CDT is appropriate for other pathologies. This section's content includes: adaptations for the treatment of chronic venous insufficiency, post-thrombotic syndrome, phlebo-lymphostatic edema, lipedema, lipo-lymphedema, post-traumatic edema, post-surgical edema, compression considerations, manual lymph drainage and garment considerations, compression classes, materials selection, and plan of care including intensive and homecare phases of CDT.
This course provides students with the opportunity to view essential bandaging skills in a comprehensive visual format. The concepts presented include: tensioning, molding, spacing, graduated layering, precision, positioning, and logical progression. This exposure is extremely valuable as much of the skill set developed for lymphedema bandaging is derived from observation, palpation, and kinesthetic awareness. Each compression-bandaging component is approached with a standard layering protocol based upon the performance properties of each material coupled with extensive clinical impression.
This course provides a complete review of the 4 Vodder MLD strokes and their application in various intact and non-intact upper and lower extremity treatment sequences.
Custom garment measuring and fitting is a skill that rounds out every Certified Lymphedema Therapist's knowledge base. During this video program Steve Norton demonstrates the steps involved in measuring for flat-knit custom gloves, arm sleeves, shoulder caps, knee-high garments, thigh-high garments, pantyhose, and toes caps. Since most techniques and points of measure are universal among all garment manufacturers, this course provides a solid foundation that can be applied to most fitting scenarios.
Reference Articles
The articles selected from the Norton School E-Reference Library function as important contributing references to the field of lymphedema treatment and lymphology and cite an evidence-base that is universally supported as fact. Students should read these articles but will not be tested on their content during the course.
  • Systematic Review of the Evidence for Complete Decongestive Therapy in the Treatment of Lymphedema
  • Exercise in Patients with Lymphedema: A Systematic Review of the Contemporary Literature
  • Palliative Care for Cancer-Related Lymphedema: A Systematic Review
  • Self-Management of Lymphedema: A Systematic Review of the Literature From 2004 to 2011
  • The Surgical Treatment of Lymphedema: A Systematic Review of the Contemporary Literature (2004–2010)
  • Intermittent Pneumatic Compression Therapy 2012
  • Demystifying Lymphedema: Development of the Lymphedema Putting Evidence Into Practice
  • Early Arm Swelling after Breast Surgery: Changes on Both Sides
  • Efficacy of Manual Lymphatic Drainage in Preventing Secondary Lymphedema After Breast Cancer Surgery
  • Massage and Damage to Lymphatics
  • Minimal Limb Volume Change has a Significant Impact on Breast Cancer Survivors
  • Physical Activity and Lymphedema: Assessing the Safety of Strength Training in Breast Cancer Survivors
  • Post-Breast Cancer Lymphedema: Incidence Increases from 12 to 30 to 60 Months
  • Preoperative Assessment Enables the Early Diagnosis and Successful Treatment of Lymphedema
  • The Diagnosis and Treatment of Peripheral Lymphedema
  • The Risk of Genital Edema after External Pump Compression for Lower Limb Lymphedema
  • Air Travel
  • Screening & Measurement for Early Detection of Breast Cancer Related Lymphedema
  • Exercise
  • Screening & Early Detection of Breast Cancer Related Lymphedema: The Imperative
  • Lymphedema Risk Reduction Practices
  • Training of Lymphedema Therapists
  • The Diagnosis & Treatment of Lymphedema
  • The Diagnosis & Treatment of Lymphedema References
  • Psychosocial Impact of Lymphedema: A Systematic Review of Literature 2004 to 2001
  • Post-Breast Cancer Lymphedema: Incidence Increases from 12 to 30 to 60 Months
  • Limitations of Self-Care in Reducing the Risk of Lymphedema: Supportive-Educative Systems
  • Adapting Lymphedema Treatment to the Palliative Setting
  • The Prevalence of Lymphedema Symptoms Among Survivors of Long-term Cancer with or at Risk for Lower Limb Lymphedema
  • Lifestyle Risk Factors Associated with Arm Swelling among Women with Breast Cancer
  • Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women with Early Breast Cancer
CEUs are available for Physical Therapists through the Florida Physical Therapy Association (FPTA), for Occupational Therapists through the American Occupational Therapy Association (AOTA) (AOTA Classification Codes: Category 2, Domain of OT), and for Massage Therapists through the NCBTMB.
This program has been recognized by the Lymphology Association of North America (LANA®)to provide 32 Contact Hours toward satisfying the requirements for LANA® Recertification.
†Lymphology Association of North America®, LANA®, and CLT-LANA® are registered trademarks of the Lymphology Association of North America®. The Norton School of Lymphatic Therapy is not associated with the Lymphology Association of North America®. The Lymphology Association of North America® has approved the CLT Recertification course for the purposes of earning credits toward LANA® Recertification.