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PHYSIOTHERAPY IN LEPROSY ( H.D.)
PHYSIOTHERAPY IN LEPROSY TREATMENT (The Hand)
OUR MAIN WEBSITE WITH LINKS TO LEPROSY
Physiotherapy and Reconstructive Surgery are two aspects of leprosy treatment for which there should be no need. If the disease is diagnosed in the very early stages and Multi Drug Therapy (MDT) started immediately, serious nerve damage and resultant deformities and disabilities can be totally prevented. Unfortunately, physiotherapy is too often not started until many months or even years after the first disabling symptoms are noticed. Sadly, in many cases, physiotherapy is not even considered until reconstructive surgery is thought to be necessary.
It is true to say that Hansen’s Disease (leprosy) and its treatment, more than any other health problem, brings all three specialists - Para-Medical Workers (PMW’s) / Nurses, Surgical staff and Physiotherapists - together in a very close cooperative, working relationship.
Because the PMW is generally the first to make contact with the leprosy patient, he/she is often the most logical one to initiate physiotherapy, perhaps in the field at a Control clinic.
These few pages are designed to whet the appetite of physical therapists who are encouraged to access the Home Page of ILEP (International Federation of Anti-Leprosy Associations) at :-
http://www.oneworld.org/ilep
for a more detailed study of this subject. In the bibliography, at end of these notes, I have listed some helpful books and literature which make a more in-depth study of this subject.
One basic fact to remember is that a insensitive or anaesthetic limb (finger, hand, foot etc.) which has been traumatised by any form of injury, must have REST if it is to heal. Often the sufferer is thought to have a incurable disease because, inspite of liberal applications of antibiotic ointments and the taking of so many pills, the ulcers etc. do not heal. All that may be necessary is REST. In this regard, pain is a blessing in disguise. Pain is the medium used by the body to inform the brain to give the affected member rest, but if the patient cannot feel and his/her damaged sensory nerves fail to transmit the message to the brain, the injured limb etc. continues to be further traumatised until often amputation is necessary. To provide rest, it may be necessary to use a splint, a Plaster of Paris (POP) Shoe , with “rocker”, to immobilize the foot, or a sling if the arm is involved. Where nerves are tender and inflamed, soft cotton-wool padding may be necessary to prevent any further damage. Sometimes, when the nerve is seriously swollen, the surgeon needs to incise the nerve sheath to prevent further damage to the nerve.
Before a leprosy patient is referred to a physiotherapist, in a well organised Leprosy Control Programme, generally it is the PMW who carries out simple assessments. If the disease is diagnosed in the early stages, a well trained PMW, in consultation with the physiotherapist, is able to provide all the treatment necessary to prevent disability and deformity.
SIMPLE PHYSIO ASSESSMENTS
1. Detection of Sensory Deficit:-
The most common way of identifying those areas where there is loss of feeling is to cover the patient’s eyes and ask him/her to point to that part of the skin which is touched with a wisp of cotton wool or a feather etc.. Patients may have areas of skin which manifest different forms of insensitive to either / or touch, pressure, heat / cold, pin prick etc.. The patient, with eyes covered, should be asked to point to those areas where the therapist touches. In this way, it is possible to “map” or “chart” a leprosy patient’s body indicating areas involved.
2. Detection of Muscle Weakness:-
A) Hands:- Where the motor nerves ( ulnar, median and radial) have been affected, a simple assessment can be made by asking the patient to extend all fingers. If the index and long fingers can be straightened but not the ring and little finger, this is an indication that the ULNAR nerve is involved. This is the most common deformity in neglected Hansen’s Disease.
If the patient can extend the ring and little fingers but not the index and long which remain bent, this indicates MEDIAN Nerve involvement. However, the therapist also needs to be aware of the possibility of Carpal Tunnel Syndrome.
If the patient is unable to straighten any of the four fingers which remain “clawed”, this indicates both ULNAR and MEDIAN nerve involvement and this also is a common deformity.
Weakness of the INTRINSIC MUSCLES of the hand, due to Ulnar nerve involvement, is indicated when the patient is unable to spread the fingers apart and hold them in that position against resistance.
MEDIAN Nerve involvement is indicated when the patient is unable to oppose and rotate the thumb away for the palm of the hand. Complications of this form of Median nerve involvement can often lead to THUMB WEB CONTRACTURE.
RADIAL Nerve involvement is indicated when the patient is unable to extend the wrist against resistance, resulting in the deformity of “Wrist Drop” .
MEDIAN Nerve involvement is indicated when there is Atrophy of the THENAR MUSCLES of the palm of the hand and base of the thumb.
ULNAR Nerve involvement is indicated when the HYPOTHENA MUSCLES on the Ulnar aspect of the hand and the DORSAL MUSCLE between the index finger and thumb (first dorsal interosseus) manifest atrophy.
Please email me if you are interested in Simple Assessments of the Foot and Eye.
Suggested Reading material :-
“Physical Therapy in Leprosy” by Ellen Davis Kelly Ph.D. - available from AMERICAN LEPROSY MISSIONS 1 ALM Way, Greenville, SC, 29601, 1-800-543-3131 -
AMERICAN LEPROSY MISSIONS Email:- amlep@leprosy.org
“Physiotherapy in Leprosy” by S.L.Kolumban, Chief of Physiotherapy, Schieffelin Leprosy Research
Centre, Karigiri, India.
“Handbook of Leprosy” by E.H. Jopling
“Leprosy” by Anthony Bryceson and Roy E. Pfaltzgraff
“A Manual of Leprosy” by R.H. Thangaraj
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