Physiotherapy in Leprosy | A guide to Help People with Injury and Disability
In the past leprosy has been shrouded in mystery and characterized by deformity. While today much more is known about this disease, allowing most of the patients to be treated without much difficulty. Physiotherapy in leprosy has grown out of a need to minimize, prevent, and correct deformities caused by the disease. This blog outlines the role of physiotherapy in the management of leprosy patients with permanent paralysis.
Leprosy Disease
Leprosy disease is a granulomatous disease caused by mycobacterium Leprae, an acid and alcohol fast bacillus. It is one of the most serious, disabling diseases that attack the skin and the nerves. Leprosy also known as Hansens Disease, can cause peripheral neuritis. The disease is spread by droplets from the sneeze of leprosy patients. Though it is not known whether the organism enters by inhalation or through the skin. Some people who have high resistance do not get infected by leprosy disease even though they get in contact with an infectious person. Even the patients who have been taking adequate treatment for 3-6 months are no longer infected if they have been taking adequate treatment for 3-6 months and need to continue drug treatment for a long time.
It is a chronic infection, the disease attacks mainly nerves and skin. It is treated by drugs and can be controlled by taking precautions that can reduce physical damage or disability from occurring. It may also cause great emotional distress to the patient and may seriously affect the social life of the patient.
The mycobacterium Leprae bacteria that causes leprosy multiplies very slowly, thus symptoms usually do not begin at least until 1 year after people have been infected. Usually, symptoms may appear 5 to 7 years after infection. Once symptoms begin, they progress slowly.
The most severe symptoms include a reduced sense of touch and an inability to feel pain and temperature. Patients with peripheral nerve damage may unknowingly burn, cut, or otherwise harm themselves and also cause muscle weakness, resulting in deformities such as fingers may be weakened, causing them to curve inward. Muscles may become too weak and thus make it difficult to flex the foot. Repeated damage may lead to loss of fingers and toes. Other areas of the body like the nose (stuffy nose and nosebleeds), eyes (glaucoma or blindness), kidneys (kidney failure), feet (Sores), and sexual function (impotence and infertility) may also be affected by Leprosy Disease.
Physiotherapy Treatment
The good news is that leprosy is curable. As it is difficult to eradicate leprosy bacteria thus antibiotics must be continued for a long time. Depending on the severity of the infection sometimes the treatment is recommended for lifelong. The major aim of physiotherapy is to prevent or reduce complications, deformities, and disabilities in the body through physiotherapy.
Heat therapy or thermotherapy helps to increase the range of motion by soaking the affected part in warm water and then performing passive movement of the part affected.
Cleaning the skin
Cleaning the skin by soaking the part in soap water, rubbing off thick skin, oiling, self-massage, and protecting the part from infection.
Elevation
Elevation helps to decrease swelling and inflammation, followed by active and passive exercises.
Special Training
Special training can be offered to leprosy patients. For example, they can be taught compensation techniques for using anesthetic hands for example cooking activities, the patient can be taught how to cook while protecting the affected limbs. Special training can also be provided for different groups of patients such as farmers, carpenters, mechanics, tailors, and so on.
Tendon transfer surgery
Motor impairments may result in paralysis and compromise hand functions such as grasp, pinch, and prehension. The lost movements can be restored with tendon transfer surgeries. Due to contractures, absorption of digits, and various other reasons all paralyzed hands may not benefit from tendon transfer procedures. In such circumstances, the use of adaptive devices can facilitate the functional ability of the hand.
Muscle Re-education after tendon transfer
After tendon transfer, the physiotherapist helps to restore new skills in movements provided by tendon transfer. Leprosy may affect an individual's activities of daily living (ADL) as well as work- and leisure-related activities. The goal of the physiotherapist is to enable and enhance performance in ADL and work and leisure-related activities.
Exercises
Muscle weakness of lesser duration can recover with appropriate exercises. For areas that are paralyzed for a longer duration, exercises might only help in maintaining muscle bulk and tone. Exercises prescribed for paralyzed muscles are passive exercises, for weak muscles, active and active assisted exercises are prescribed, and for strong active resisted exercises are recommended.
Strengthening Exercises
Strengthening exercises help to improve strength, especially in tendon transfer.
Assistive technology/devices
Assistive devices like mittens are provided to protect anesthetic hands from heat-related injuries during cooking. Often, the tools used by the patient are padded with soft materials to protect hands from pressure injuries, such as screwdrivers, sickles, spades, and hammers. Padding protects hands from pressure injuries and also enables better grip while using tools. Loss of digits on hands is a common complication in leprosy-affected people with long-term impairments. Due to this their functional abilities to perform their daily activities are compromised. Grip aids are a kind of adaptive device that enhances the ability of the hands to hold objects such as pens, spoons, shaving razors, etc.
Splinting
Splints are supportive devices that are used to immobilize the affected part of the body. Splints are of two types splints and dynamic splints. Static splints immobilize a joint to prevent movement in the area. Dynamic splints allow movements that help in maintaining function while other areas are immobilized.
Offloading measures for Plantar Ulcers
Bohler Iron can be used in the walking cast to transmit weight and pressure to the calf area, preventing weight bearing on the foot, and extending from the neck of the fibula to the tip of the toes. This technique helps ulcers to heal more quickly and is indicated in the presence of a heel ulcer in a foot, whether or not the foot is deformed. A window can be kept in the cast over the ulcer area to enable dressings.
Molded Double Rocker Shoe (MDRS) / Boot
This cast is shaped like a boot and can be used to heal plantar ulcers on the forefoot. An MDRS is not used in the presence of foot drop, stiff claw toes, or heel ulcers. The cast is applied below the malleoli and covers the entire foot, just like a boot.
Preventing Further Deterioration of Impairments
Some of the impairments in leprosy are irreversible because of late diagnosis, and the severity of causative factors leading to late treatment. Such impairments will not be completely reversed. The goal of the physiotherapy team in cases is to prevent any new impairment or the worsening of a primary impairment.
The main aim of the treatment is to increase, maintain, and improve functional skills. Proper treatment results in satisfaction and independence while carrying out routine activities and participating in social activities.
