Voluntary Muscle Testing in Leprosy | No stigma | Full Knowledge 2021

In my previous article, I have told full information about the history of Leprosy disease, the origin of Leprosy disease, About stigma in Leprosy, full details about medicines used in the treatment of Leprosy, the Role of rifampicin in Leprosy, about all NLEP programs which are conducted in Leprosy, Sign, and Symptoms of Leprosy, full form of PEP, FLC, etc, and milestones of Leprosy.

In this article, I will tell you about voluntary muscle testing in Leprosy. I will tell you how to test all common nerves which may be involved in Leprosy patients. It is very important to test the nerves very carefully to find that whether it is involved or not. If there is any sign indicating the nerve involvement ( like-if patient feels pain when we touch the nerve, it indicates that the nerve is tender and it confirms the involvement of the nerve.).

In this condition immediately start the treatment of the patient otherwise patient may become disabled.

Note: Leprosy is not a contagious disease it is completely curable with MDT (Multidrug therapy).

You may also read:

• History of Leprosy(hansens disease)

• Stigma in Leprosy

• Role of refempicin in Leprosy

• NLEP programms

• Milestones in Leprosy

Assesment of Leprosy patients Physical Examination of Leprosy:

Assessment of Nerve Functions:

Voluntary Muscle Testing (VMT):

• The first step in a voluntary muscle test is to assess the movement to see if it is normal, decreased, or absent due to paralysis.

• Ask the patient to move; if he does, the affected area is not paralysed.

• We must now determine whether that section is strong or weak.

• Give resistance and gently press in the opposite direction while asking  the patient to hold posture, resisting pressure as vigorously as possible, and judge whether resistance is normal or lowered to determine which area is strong or weak.

The grading of the result can be done as follows:

1. Strong(S): If the patient can perform movement against resistance then the part is strong.
2. weak(W): If the patient can perform movement but when resistance is applied to the part then the patient can’t maintain the position against resistance, then the part is weak.
3. paralyzed (P): If the patient is not able to perform the movement at all, then that part is paralyzed.

Picture of Peripheral Nerve Involvement in Leprosy Patient :

VMT For Facial Nerve | Voluntary Muscle Testing in Leprosy :

• Tell the patient  to close his eyes slowly and lightly as though he is sleeping.

• The muscle is paralysed (P) if the patient cannot close his eyes and there is a space between the upper and lower eyelids .

• If the patient can close her eyes and if there is no gap between the upper eyelid and lower eyelid, ask him to close his eye tightly and try to pull the lower eyelid down as shown in the figure and monitor whether the patient can keep his eyes closed against resistance.

• If the patient can keep his eyes closed against resistance then it is strong(S).

• If the patient is not able to keep his eyes closed against resistance then it is weak(W).

VMT For Ulnar Nerve | Voluntary Muscle Testing in Leprosy :

• Tell the patient to bring out his little finger in the same plane of the palm.

• The muscle is paralysed (P) If the patient is unable to bring out his little finger.

• If the patient can bring out his little finger give resistance at the base of the little finger from outside and push it towards the hand as shown in the figure while asking the patient to try to hold it in the test position.

• If the patient can hold a little finger against resistance in the test position then it is strong(S).

• If the patient is not able to hold a little finger against resistance in the test position then it is weak(W).

VMT For Median Nerve | Voluntary Muscle Testing in Leprosy:

• Tell the patient to hold his thumb verticaly at the right angle to the palm.

• The muscle is paralysed (P) If the patient is unable to move his thumb.

• If the patient is able to hold his thumb verticaly at the right angle to the palm give resistance at the base of the thumb and push the thumb towards the index finger as shown in the figure while the patient is asked to hold the thumb in the test position.

• If the patient holds the thumb in the test position against resistance it is strong(S).

• If the patient can not  able hold the thumb in the test position against resistance it is weak(W).

VMT For Radial Nerve Voluntary Muscle Testing in Leprosy:

• Tell the patient to clench his  fist of affected hand and dorsiflex the wrist.

• The muscle is paralysed (P) If the patient is unable to dorsiflex the wrist.

• If the patient can do this then give resistance to the dorsum aspect of the hand and push the hand downwards as shown in the figure and ask the patient to hold the wrist in the test position.

• If the patient holds the wrist in a test position against resistance then it is strong(S).

• If the patient can not hold the wrist in test position against resistance then it is weak (W).

VMT For Lateral Popliteal Nerve | Voluntary muscle testing in leprosy :

• his foot fully( Ask the patient to move his feet upward ).

• The muscle is paralysed (P) If the patient is not able to perform this movement.

• If the patient can perform this movement then give resistance from the dorsum aspect of the foot and push the foot downwards as shown in the figure while the patient is asked to hold the foot in the test position.

• If the Patient can hold the foot in a test position against resistance then it is strong(S).

• If the patient can not hold the foot in test position against resistance then it is weak(W).

VMT For Posterior Tibial Nerve | Voluntary muscle testing in Leprosy:

• Tell the patient to fann (spread the toes) their toes.

• The muscle is paralysed (P) If the patient is not able to perform this movement.

• If the patient can perform the movement then give resistance at the base of the great toe and little toe from outside and push them inwards as shown in the figure while asking the patient to hold the toes in the test position.

• If the patient can hold the toes in a test position against resistance then it is strong (S).

• If the patient can not hold the toes in test position against resistance then it is weak(W).

For more details, you can read this PDF about voluntary muscle testing

Disability Grading:

Hand and feet:

• Grade 0: No anaesthesia in palm and sole, no obvious deformity or harm to the palm or sole.
• Grade 1: There is anaesthesia over the palm/sole, but no visible deformity.
• Grade 2: There is a visible deformity or damage.

Eyes :

• Grade 0: no leprosy-related  problems in vision, no signs of vision loss.
• Grade 2: Severe  impairment in vision ( like-patient is unable to count fingers at a distance of six metres), lagophthalmos, corneal ulcer, and iridocyclitis (inflammation of iris and ciliary body)

EHF SCORE:

It is some of the individual disability guides for each eye, hand, and foot.EHF score can range from 0 to12.

The maximum EHF score is 12. ( 6 on each side of the body )

Calculation of EHF Score :

One side of eye—0/2 ( 0 means no impairment in the eye if any impairment then it is 2 )

One side of the hand—1/2 ( 1 means anesthesia in the palm, if there is any disability like-clawing of finger or ulcer in the palm it is 2 )

One side of feet—1/2 ( 1 means anesthesia insole if there is any disability like- claw toes or ulcer insole it is 2 )

So in this manner, the maximum EHF score is 6+6=12 ( 6 on each side )

Important key points:

1. To prevent disability early detection and early treatment are very important.
2. If the Patient is early diagnosed and treated then he will be saved from being disabled.
3. If he is early diagnosed and started treatment then he will not spread the disease to others
4. Monitoring of the patient who is taking medicine is very important that he should not break the medicine in the middle, because due to this patient may be disabled.

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FAQs for Voluntary Muscle Testing in Leprosy :

Summary :

How do you like this article? give your valuable comments in the comment box. Your comments are valuable to me. In this article, I tried to tell you how to test the muscles involved in Leprosy. Give your suggestion also that what you want to read about Leprosy. In my next article, I will cover the topic of Disability Prevention and Management in leprosy.