PHYSIOTHERAPY IN

LEPROSY

PRESENTED BY
DEEPAK DWIVEDI &VYOM GYANPURI
 LEPROSY

 CHRONIC INFECTIOUS DISEASE

 CAUSED BY MYCOBACTERIUM
LEPRAE
 MAINLY AFFECT THE SKIN,THE
PERIPHERAL NERVES,MUCOSA OF
RESPIRATORY TRACT & ALSO THE
EYES
 DIAGNOSIS OF LEPROSY

THERE ARE THREE CARDINAL SIGNS:-

 HYPOPIGMENTED PATCHES WITH

DEFINITE LOSS OF SENSATION

 NERVE THICKENING WITH LOSS OF

FUNCTION

 POSITIVE SKIN SMEARS

 SUGGESTIVE SIGNS

 DEFORMITIES OF HAND ,FEET & EYE

 MADROSIS

 PATCHES

 RECURRENT ULCERS

 LEONINE FACE
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
 WHAT ARE REACTIONS ?

SOMETIMES THE BODY DEVELOPS

CHANGES IN IMMUNITY STATE.THIS
IS CALLED REACTIONS
DURING REACTIONS
 The skin can become red & swollen
 The nerve can be damaged,this may cause
new weakness or sensory loss
 Nodules may develop in ENL reaction
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

 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)
 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
 ULNAR/MEDIAN N. - Total claw hand

 RADIAL N. - Wrist drop

IN FOOT

 LAT. POP. N. - Foot drop

 POST.TIB. N. - Claw toes

 MANAGEMENT

DEFORMITIES ARE MAINTAINED BY

RECONSTRUCTIVE SURGICAL PROCESS
TYPES OF SURGERY
IN EYE:
 TMT - Temporalis muscle
transfer
 TARSORRAPHY - Eyelid suturing
 IN HAND

LASSO SURGERY
There are two methods:-
1. DIRECT
2. INDIRECT
 IN FOOT
 TIBIALIS POSTERIOR TRANSFER
+
TENDOACHILLES LENGTHENING
1.Circumtibial
2.Interosseous
 CLAW TOES CORRECTION
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
 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
 HAND
AIM:-1.To prevent contracture
2.To strengthen muscle
PRE OP. PHYSIOTHERAPY
1.ASSESSMENT OF HAND
2.AIM &MEANS OF TREATMENT
-To gain patient co-operation
-To gain max. passive extension
-To gain clean & supple skin
 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
 FOOT
AIM:-1.To restore normal walking pattern
2.To prevent further deformity
PRE OP. PHYSIOTHERAPY
1.ASSESSMENT OF FOOT
2.AIM & MEANS OF TREATMENT
-To improve skin condition
-To Strengthen tibialis posterior
-To gain max. passive range
 POST OP. PHYSIOTHERAPY
Feet in POP cast for five weeks
1.AFTER 5 WEEKS- Removal of POP &
stitches
2.ASSESSMENT
3.AIM & MEANS OF TREATMENT
1st WEEK - Isolation exercise
2nd WEEK-Strengthening exercise
3rd WEEK- Co ordination
4th WEEK- functional position