Leprosy & its pt management

leprosy sign& symptom& classification with pt management

1. LEPROSY BY:- Sweta upadhyay Bpt 4 th year

2. OBJECTIVES Introduction Mode of spread Epidemiology Symptoms Classification Diagnosis Treatment Prosthosis and orthosis used.

3. LEPROSY Leprosy disease is a  chronic granulomatous disease  caused by Mycobacterium leprae , an acid and alcohol fast bacillus. It is one of the most serious, disabling disease which attacks  nerve  and  skin . Leprosy which is also called  Hansen's Disease  is the commonest cause of peripheral neuritis and about 20 million of the population is affected by it.

4. The most important mode of spread of Mycobacterium leprae is by  droplets  from the sneeze of leprosy patients, whose nasal mucosa is heavily infected. It is not certain whether the organism enters by inhalation or through the skin. The bacteria responsible for leprosy multiply very slowly. The disease has an incubation period (the time between infection and the appearance of the first symptoms) of up to five years. Symptoms may not appear for as long as 20 years. MODE OF SPREAD

5. EPIDEMOLOGY AGE:-All age from infancy to very old age. SEX:- BOTH (Male & Female) Males more than females, 2:1 Global prevalence rate is less than one case per 10,000 persons. Elimination achieved in 2000

6. SYMPTOMS(skin) The disease can cause skin symptoms such as : 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.

7. SYMPTOMS(Nerve) 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.

8. Symptoms (mucous membrane) Symptoms caused by the disease in the mucous membranes are: A stuffy nose Nosebleeds Since Hansen’s disease affects the nerves, loss of feeling or sensation can occur. When loss of sensation occurs, injuries such as burns may go unnoticed. Because you may not feel the pain that can warn you of harm to your body, take extra caution to ensure the affected parts of your body are not injured.

9. CLASSIFICATION  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 numbness, 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.

10. Diagnosis Symptoms (such as distinctive rashes that do not disappear, enlarged nerves, loss of the sense of touch, and deformities that result from muscle weakness) provide strong clues to the diagnosis of leprosy. Examination of a sample of infected skin tissue under a microscope (biopsy) confirms the diagnosis. If a laboratory is available, skin smears may be obtained for a more definitive diagnosis

11. Conservative Treatment Multibacillary : The standard combination of drugs is dapsone, rifampin and clofazimine . People take rifampin and clofazimine once a month under a health care practitioner's supervision. They take dapsone plus clofazimine once a day on their own. This regimen is continued for 12 to 24 months, depending on the severity of the disease. Paucibacillary : People take rifampin once a month with supervision and dapsone once a day without supervision for 6 months. People who have only a single affected skin area are given a single dose of rifampin , ofloxacin , and minocycline . Because the bacteria are difficult to eradicate, antibiotics must be continued for a long time. Depending on the severity of the infection and the doctor's judgment, treatment continues from 6 months to many years. Some doctors recommend lifelong treatment with dapsone for people with lepromatous leprosy.

12. Surgical Treatment 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. Example- Transfer of fore-arm muscle to make finger movements. Tendon Lengthening : Lengthening the tendon of a muscle to permit more movement and reduce contracture. Example- Tendo Calcaneus lengthening. 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. Example- Tenodesis of MCP joint to prevent hyperextension.

13. PT. Management AIM:- To increase and regain range of motion. Improve muscle strength particularly 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.

14. Pt. management cont. 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.

15. Clawing of finger Clawing of Fingers. NFI of the ulnar nerve leads to paralysis of the third and fourth lumbricals. All of the interossei muscles are also paralyzed. The paralysis causes the little and ring fingers to claw. Clawing of the medial two fingers is referred to as an “ulnar claw”.

16. APE THUMB Ape thumb deformity. the median nerve leads to thenar muscle paralysis. abduction movement of the thumb are lost, leading to the characteristic ‘ape thumb deformity’ ulnar-median paralysis and is commonly seen in leprosy-affected patients

17. WRIST DROP Wrist drop:- Neuro Fibro matosis of the radial nerve rarely occurs in isolation. the radial nerve is usually damaged along with the median and ulnar nerves, leading to triple nerve paralysis. The clawing of fingers is not significantly visible in a triple nerve paralysis, as the extensors are not capable of hyperextending the MCP joints. The power grip is usually lost in radial nerve palsy. This loss occurs because the flexors of the fingers work in a shortened position and the grasp functions are restricted by the loss of the finger extensors

18. FOOT DROP Foot drop. NFI of the deep branch of the lateral popliteal (common peroneal) nerve leads to paralysis of the tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneusterrus muscles. The peroneus longus and brevis are affected if the superficial branch is affected, leading to the loss of ankle dorsiflexion, foot eversion, and toe extension. An inability to dorsiflex

19. CLAW TOES Claw toes. NFI of the posterior tibial nerve causes the intrinsic muscles of the foot to be para-lyzed . The extensors of the metatarsophalangeal joint pull the joint into extension which, coupled with the flexion of the toes, leads to clawing of the toes

20. Orthosis for little finger

21. Orthotic Management Orthotic management:- Ulnar nerve:- Partial Claw Hand-Knuckle Bender Splints

22. Median Nerve Median Nerve :- Ape Thumb Deformity- Short Openness Splint Immobilization of fingers , provide support and stabilize the wrist in extension

23. Cock up splint Immobilizes, or stabilize the wrist in dorsiflexion with dorsal support.

24. ORTHOTIC MANAGMENT Ankle Foot Orthosis :- For Muscle weakness affecting the ankle and sub talar joints Prevention and correction of deformities of the foot and ankle,

25. KNEE ANKLE FOOT ORTHOSIS IT provides stability to knee, ankle and foot

26. HIP KNEE ANKLE FOOT ORTHOSIS IT provides support and correction to the  hip ,  knee ,  ankle  and  foot . An HKAFO improves body alignment and posture, increases bone and muscle strength, and enhances independence and self-esteem

27. PROSTHESIS (Above Elbow and Below Elbow

28. Prosthesis(Above knee and below knee)