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PHYSIOTHERAPY IN LEPROSY PRESENTED BY DEEPAK DWIVEDI &VYOM GYANPURI

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PHYSIOTHERAPY IN LEPROSY

PRESENTED BYDEEPAK DWIVEDI &VYOM GYANPURI

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LEPROSY

CHRONIC INFECTIOUS DISEASECAUSED BY MYCOBACTERIUM

LEPRAEMAINLY AFFECT THE SKIN,THE

PERIPHERAL NERVES,MUCOSA OF RESPIRATORY TRACT & ALSO THE EYES

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DIAGNOSIS OF LEPROSY

THERE ARE THREE CARDINAL SIGNS:-

HYPOPIGMENTED PATCHES WITH DEFINITE LOSS OF SENSATION

NERVE THICKENING WITH LOSS OF FUNCTION

POSITIVE SKIN SMEARS

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SUGGESTIVE SIGNS

DEFORMITIES OF HAND ,FEET & EYE

MADROSIS

PATCHES

RECURRENT ULCERS

LEONINE FACE

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METHOD OF TRANSMISSION OF LEPROSY

SKIN TO SKIN CONTACT IS UNLIKELY TO BE ROUTE OF SPREAD

EXACT MECHANISM OF TRANSMISSION OF LEPROSY IS NOT KNOWN

MOST WIDELY ACCEPTED ROUTE IS TRANSMISSION BY THE RESPIRATORY ROUTE

ONLY MAN CAN SPREAD

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WHAT ARE REACTIONS ?

SOMETIMES THE BODY DEVELOPS CHANGES IN IMMUNITY STATE.THIS IS CALLED REACTIONS

DURING REACTIONSThe skin can become red & swollenThe nerve can be damaged,this may cause

new weakness or sensory lossNodules may develop in ENL reaction

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WHY IS “REACTION” IS SO SERIOUS ?

During reactions nerves can be damaged,if they are detected & treated early then this can be stopped

Deformities in leprosy develop as a complication of nerve damage

Deformities is the cause of social stigma

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PREVENTION & DISABILITY

PREVENTING A PERSON(SO CALLED NORMAL)FROM ENTERING IN TO MULTILATED STAGE

THROUGH EARLY DETECTION OF LEPROSY ADEQUATE EXPLANATION EARLY DETECTION OF NERVE FUNCTION

LOSS APPROPRIATE TREATMENT SELF CARE TEACHING(EYE, HAND & FEET)

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AFFECTED NERVE AND THEIR DEFORMITY

IN FACE FASCIAL N. - Lagopthalmos TRIGEMINAL N. - Loss of sensation

over cornea

IN HAND ULNAR N. - Ulnar claw

(clawing of 4th & 5th finger) MEDIAN N. - Ape thumb deformity

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ULNAR/MEDIAN N. - Total claw hand

RADIAL N. - Wrist drop

IN FOOT

LAT. POP. N. - Foot drop

POST.TIB. N. - Claw toes

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MANAGEMENT

DEFORMITIES ARE MAINTAINED BY

RECONSTRUCTIVE SURGICAL PROCESS

TYPES OF SURGERY

IN EYE:TMT - Temporalis muscle

transferTARSORRAPHY - Eyelid suturing

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IN HAND

LASSO SURGERY

There are two methods:-

1. DIRECT

2. INDIRECT

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IN FOOT TIBIALIS POSTERIOR TRANSFER + TENDOACHILLES LENGTHENING 1.Circumtibial 2.Interosseous CLAW TOES CORRECTION

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PHYSIOTHERAPY MANAGEMENT

EYE

AIM:- Aim is close the eye, covering the cornea to prevent any secondary deformity

PRE OP.PHYSIOTHERAPY

1. ASSESSMENT OF EYE

2. TEACH ISOLATION EXERCISE

3. TO STRENGTHEN MUSCLES

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POST OP. PHYSIOTHERAPY

Patient must not be allowed to bite or chew until the third week

1st week - liquid diet

2nd week - semi-solid diet

3rd week - normal diet

4th week - strong exercise

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HANDAIM:-1.To prevent contracture 2.To strengthen muscle PRE OP. PHYSIOTHERAPY1.ASSESSMENT OF HAND2.AIM &MEANS OF TREATMENT -To gain patient co-operation -To gain max. passive extension -To gain clean & supple skin

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POST OP. PHYSIOTHERAPY

Hand in POP cast for three weeks

1.AFTER 3 WEEKS -removal of POP & stitches

2.ASSESSMENT OF HAND-on removal of POP

1st WEEK- Isolation exercise

2nd WEEK-Strengthening exercise

3rd WEEK- Mobilisation of joint

4th WEEK- Daily functional activity

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FOOTAIM:-1.To restore normal walking pattern 2.To prevent further deformity PRE OP. PHYSIOTHERAPY1.ASSESSMENT OF FOOT2.AIM & MEANS OF TREATMENT -To improve skin condition -To Strengthen tibialis posterior -To gain max. passive range

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POST OP. PHYSIOTHERAPY Feet in POP cast for five weeks1.AFTER 5 WEEKS- Removal of POP & stitches 2.ASSESSMENT3.AIM & MEANS OF TREATMENT 1st WEEK - Isolation exercise 2nd WEEK-Strengthening exercise 3rd WEEK- Co ordination 4th WEEK- functional position

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