In my previous articles I have told about the History of Leprosy, most important information about from where Leprosy originated, all information about medicines which are used in the treatment of Leprosy, What changes occurs in the treatment of leprosy from starting to present time, About stigma in Leprosy, about definition and types of Leprosy, How to examine the Leprosy Patient and so many other information. If you want to know deeply about that you must read my previous articles. Links are given below.
In this article, I will tell you about Disability Prevention and management in leprosy. Disability occurs due to nerve damage in Leprosy. You can not imagine if a person who has a disability due to Leprosy how he survives. His life becomes full of challenges at every moment of life. His family members become started to hate them and throughout them from home. And that patient is forced to live in an asylum even though he has his own house. and this is just only due to stigma.
My whole motive to write this series of Leprosy is so that the people of all over the world know about Leprosy and pass this information to others which helps to remove Stigma in Leprosy.
Note: Leprosy is not a contagious disease it is completely curable with MDT (Multidrug therapy).
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Disability Prevention and Management:
Disabilities in LEPROSY are mainly due to damage of peripheral nerves. Nerve damage can occur as a part of reaction cases in leprosy (will be described in next articles)with signs of acute inflammation.
In simple language, disability means that a person is unable to do their daily living activity with that affected part.
Reason for disability in Leprosy:
It is the habit of a leprosy patient that if an anesthetic patch is formed on his body, which is the first symptom of leprosy. He hides it because he doesnt have any problem with that patch and he doesnt have any pain in that place because that place is anesthetic. This is the reason that the patient neglect it and his disease progresses and in the end, he becomes disabled. So early detection and treatment of leprosy would prevent the occurrence of disability.
In case of a reaction in leprosy, even if the nerve is involved, disability can occur. In this situation, early detection and treatment of nerve dysfunction would prevent the occurrence of disability.
Damage to nerves results in impairment of sensory, motor, and automatic functions in the body, leading to anesthesia, paralysis, of muscles in eyes and extremities, loss of sweating, and fissures/cracks/ulcers over extremities. These disabilities can increase because of neglect by the patient.
Disabilities in Leprosy:
Disabilities concerning peripheral nerves that are damaged:
1.Disability in hands:
- Clawing of the 4th and 5th fingers, as well as loss of sensation and perspiration over the little finger and the inside half of the ring finger, may occur as a result of Ulnar nerve injury.
- The inability to move the thumb away (unable to do abduction) and touch the tips of other fingers(opposition) is caused by injury to the Median Nerve.
- Sensory loss over the thumb, index finger, middle, and half of the ring finger.
- When there is damage of Ulnar and median Nerve both then there is clawing of all five fingers.
- Sensory loss and loss of sweating over the whole palm.
- Due to damage of radial nerve, there is wrist drop(inability to extend the wrist joint)
2.Disability in feet:
- Due to damage of lateral Popliteal Nerve, there is foot drop(inability to do foot up).
- Loss of sensation and sweat over the lower leg and dorsum of the foot.
- Due to damage of posterior tibial nerve, there are claw toes(inability of fanning of toes)
- Loss of sensation and sweat over the sole of feet.
3.Disability in the face:
Name of deformity: lagophthalmos
- Inability to close the eye.
- Due to damage of trigeminal nerve in face cause loss of sensation over the cornea in the eye.
Reason: Due to damage of facial nerve
Management of disability:
Management of disability is done in the following ways:
A.Thoroughly Examine the Patient :
For the Management of Disability First, check the range of motion of the disabled part. If the disabled part is mobile (for example claw hand)then provide a splint to the patient and demonstrate the process of use of a splint to prevent F.F.D (fixed flexion deformity).
BY THE USE OF SIMPLE SPLINTS WE CAN CORRECT DISABILITIES OF HAND :
Use of MCR: By the use of MCR(Microcellular rubber), we can prevent the soles from injury and reduce the pressure on wounds
Use of Spring shoes or sandals: By the use of Spring shoes or sandals a Leprosy patient who has foot drop can walk easily. In simple language, he can take steps normally.
B-Counseling of the patient:
- It is very important to counsel the patient properly because due to deformity Patient is so much depressed.
- So via counseling, we try to stop the further progress of Disability of the patient.
- The patient is told that the part which involves will not be sweating so it will remain dry forever.
- So daily soak that part in normal water for 20 minutes. (One thing that should be kept in mind is that the water should not be hot.)
- After soaking in water, take that part out, but do not dry it with a cloth.
- Oil massage has to be done on the wet part only. (demonstrate the proper way of how to do oil massage).
- If the patients hand is anesthetic then tell him not to touch the hot thing. Due to anesthesia, you will not feel and your hand will burn and become ulcerated.
- Same here if the patient has a sole anesthetic then the patient is told not to walk without a slipper because your soles are anesthetic. and you will not feel anything that may cause an ulcer in your soles.
- The patient of Lagophthalmos is told to cover his eye with a cotton cloth or wear a sunglass so that the soil particles do not enter the eye so that the ulcer does not form.
C-Physiotherapy management in deformity:
Limb deformities can be prevented with simple physiotherapy:
wax therapy improves blood circulation which prepares the deformed hand for exercise.
Use muscle stimulation in Partial muscle weakness or paralysis. It makes a muscle stronger.
Check the deform part whether it is fixed or not, If it is mobile then teach the patient different exercises to maintain the mobility of the part and prevention of muscle wasting.
Some exercises to prevent disabilities:
1.For claw hand:
Put the claw fingers of the affected hand close to the fingers of a normal hand like hello, and spread and contract the fingers. Put the claw hand on a plain surface and With the help of another hand, straighten the bent fingers of the affected hand.
2.For wrist drop:
In case of a wrist drop, try to press it downwards by pulling the wrist upwards with the other hand.
3.For foot drop:
Ask the patient to sit on the chair and by trapping a long cloth in his disabled leg, ask the patient to pull the cloth up and then slowly lower the cloth with the foot.
Ask the patient to stand in front of the mirror and do this:
1. Gently close your eyes without squeezing them.
2. Count to two while closing your eyes in this position.
3. Instruct the patient to close their eyes and slowly squeeze their eyelids together.
4. Gently open and relax the eyes.
5. Slowly close that eye with the other hands finger.
6. Carry on with the technique a total of five times.
D. RCS (Reconstructive surgery):
- If disability can be correct then via RCS we correct the disability of the patient.
- First, check the mobility of the disabled part.
- If the disabled part of a Leprosy Patient is mobile, then it can be corrected by surgery and this surgery is done free of cost by the Indian government.
Ulcer in leprosy:
- Damage to the sensory nerve results in impairment of sensory functions.
- Due to loss of sensation Patient is unable to feel pain and due to repetitive injury or pressure to the anesthetic part can cause an ulcer, which may lead to Disability.
- Due to damage of autonomic nerve which supplies to sweat gland causes loss of sweat(sweat provide lubrication to the skin) to the anesthetic part, which may result to the cracking of the skin which may lead to ulcer.
- Due to lagophthalmos patient is unable to close to eyelids and due to this When dust particles enter the eye and cause repetitive injury to the cornea that cause corneal ulcer.
- The patient doesnt feel pain because damage to the trigeminal nerve causes corneal anesthesia.
- A corneal ulcer can completely blind the patient.
- Ask the patient to rest the ulcerated part by which the ulcer can heal easily.
- Teach the patient proper dressing of ulcer.
- If the ulcer is deep then get admitted to the patient in hospital and their patient gets treated properly and his ulcer heals.
For more detail about ulcer management
Disability can be prevented by:
- Early detect the patient and treat the patient and prevent Disability.
- Adequate counseling at the start and during the treatment covering the following point for high-risk Patients.
- Detecting loss of nerve function early. (early diagnosis of lepra reaction/neuritis)
- From time to time check muscle strength and sensation.
- Managing early loss of nerve function appropriately.
- If the Patient has recent nerve function loss, immediately he should be given a course of steroids to prevent Disability.
So friends how you like this article give your valuable comments and suggestion also. which help me to improve my skills.Although I have tried my level best to give you more information about leprosy. In my next article, I will cover the treatment part of Leprosy. so keep reading my articles and dont forget to give your comment and suggestion. Your comments are valuable to me.
FAQs for Disability Prevention and Management :
What is lagophthalmos?
The patient is unable to close his eyelids.
Why develops ulcer in Leprosy patients?
Damage to Sensory nerves causes anesthesia which may lead to ulcers.
What is a claw hand?
Fingers of the hand become flexed.
What are claw toes?
The patient is unable to fane his toes.
What is the Full form of RCS?
The full form of RCS is reconstructive surgery.