What is LEPROSY ?... CLASSIFICATION OF LEPROSY ... SYMPTOM... PHYSIOTHERAPY IN LEPROSY... PHYSIOTHERAPY GOALS... PHYSIOTHERAPY TECHNIQUES ...
LEPROSY

LEPROSY

| LEPROSY
What is LEPROSY ?

A chronic infectious disease caused by a mycobacterium (Mycobacterium leprae) affecting especially the skin and peripheral nerves and characterized by the formation of nodules or macules that enlarge and spread accompanied by loss of sensation with eventual paralysis, wasting of muscle, and production of deformities  called also Hansen’s disease

CLASSIFICATION OF LEPROSY
Clinical studies use the Ridley-jopling  system. It has six classifications based on severity of symptoms. They are:
1. Intermediate leprosy: a few flat lesions that sometimes heal by themselves and can progress to a more severe type
2. Tuberculoid leprosy: a few flat lesions, some large and numb; some nerve involvement; can heal on its own, persist, or may progress to a more severe form.
3. Borderline tuberculoid leprosy: lesions similar to tuberculoid but smaller and more numerous; less nerve enlargement; may persist, revert to tuberculoid, or advance to another form.
4. Mid-borderline leprosy: reddish plaques, moderate , swollen lymph glands; may regress, persist, or progress to other forms.
5. Borderline lepromatous leprosy: many lesions including flat lesions, raised bumps, plaques, and nodules, sometimes numb; may persist, regress, or progress.
6. Lepromatous leprosy: many lesions with bacteria; hair loss; nerve involvement; limb weakness; disfigurement; doesn’t regress
SYMPTOM
Symptoms mainly affect the skin, nerves, and mucous membranes (the soft, moist areas just inside the body’s openings).
The disease can cause skin symptoms such as:
 • A , discolored lesion on the chest of a person with Hansen’s disease.
 • A large, discolored lesion on the chest of a person with Hansen’s disease.
 • Discolored patches of skin, usually flat, that may be numb and look faded (lighter than the skin around)
 • Growths (nodules) on the skin
 • Thick, stiff or dry skin
 • Painless ulcers on the soles of feet
 • Painless swelling or lumps on the face or earlobes
 • Loss of eyebrows or eyelashes
 ✓Symptoms caused by damage to the nerves are:
 • Numbness of affected areas of the skin
 • Muscle weakness or paralysis (especially in the hands and feet)
 • Enlarged nerves (especially those around the elbow and knee and in the sides of the neck)
 • Eye problems that may lead to blindness (when facial nerves are affected)
 • Enlarged nerves below the skin and dark reddish skin patch overlying the nerves affected by the bacteria on the chest of a patient with Hansen’s disease. This skin patch was numb when touched.
 • Enlarged nerves below the skin and dark reddish skin patch overlying the nerves affected by the bacteria on the chest of a patient with Hansen’s disease. This skin patch was numb when touched.
✓If left untreated, the signs of advanced leprosy can include:
 • Paralysis and crippling of hands and feet
 • Shortening of toes and fingers due to reabsorption
 • Chronic non-healing ulcers on the bottoms of the feet
 • Blindness
 • Loss of eyebrows
 • Nose disfigurement
Other complications that may sometimes occur are:
 • Painful or tender nerves
 • Redness and pain around the affected area
 • Burning sensation in the skin
PHYSIOTHERAPY IN LEPROSY
Physiotherapy in leprosy has grown out of a need to prevent, minimise and correct deformities caused by the disease. 
The major aim is to prevent or reduce complication, deformity and disability in body .
The ways of reaching these Goals are-
 
 • By teaching the patient.
 • By treating and helping the patient.
 
Teachings
 • What the disease of leprosy is?
 • The possible complications and deformities resulting from leprosy.
 • Prevention of complication, deformities and disabilities.
 
Treating and Helping
 • To respect themselves enough to take medication regularly and to take care of complications.
 • To protect their own anaesthetic hands, feets and eyes.
 • To keep their skin soft and supple.
 • To keep their joint flexible.
 • To preserve all posible movements of hands and feet.
 • To keep their muscles strong.
 • To use their hands, feet and eyes safely, in daily work.
 
Goals of Physical Therapy for surgical treatment
 
 • To protect and prevent further damage and deformity.
 • To improve and restore function.
 • To improve appearance of hands, feet, face and eyes.
 • Surgical Techniques used in Leprosy Disease
 
∆Tendon Transfer: Moving the distal end of the tendon to a new place so that contraction of muscle belly will produce a needed movements used to replace paralysed muscles. 
 
∆Tendon Lengthening: Lengthening the tendon of a muscle to permit more movement and reduce contracture. 
 
∆Capsulotomy: To loosen tight joint capsule often done with tendon lengthening and tendon transfer to improve range of motions. Tighten the loose joint capsule using suture.
 °Arthrodesis: Elimination of unstable and deformed joints.
°Tenodesis: Attach a piece of tendon across the joint to reduce the movement. The tendon then act as ligament.
PHYSIOTHERAPY GOALS
• To increase and regain range of motion.
 • Improve muscle strength perticularly in muscles to be transferred.
 • Clean supple skin in areas of surgery.
 • Teach home self care.
 • Protect tissue during wearing.
 • Prevent/reduce swelling.
 • Muscle re-education after tendon transfer.
 • Safe use of any new restored skill in work
PHYSIOTHERAPY TECHNIQUES
 • For increasing/regaining ROM:
 ROM can be increased by soaking the skin or part in warm water and then performing passive movement to the part affected.
 • To improve strength specially in tendon transfer:
 Active exercise in all part in which surgery is performed.
 • Clean supple skin: 
It is provided by soaking the part in soap water, rubbing off thick skin, oiling, self massage and protecting the part from infection.
 • Home care:
 •  teaching skin, hand, foot and eye care to groups and individuals and teaching the patients actual home care.
 • Protect tissue during healing: 
Rest, body position and POP cast.
 • Prevent/Reduce swelling: 
Elevation, active and passive exercise.
 • Muscle Re-education after tendon transfer:
 Teaching new restored skills in movements provided by tendon transfer.
 • Self restored skills in daily work:
Teaching patient ot use any new skill safely in specific task. Providing hand, eye and foot protection.
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