Rehabilitation of Leprosy

Cice Tresnasari
Physical Medicine and Rehabilitation
Bandung Islamic University
May 28
, 2018
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Physical Medicine and Rehabilitation

Focuses on the restoration of function and the

reintegration of the patient into the community

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 The goal of PMR

The patient attaining:

the fullest physical, psychological, social,
vocational, avocational, and educational
potential consistent with physiologic or
anatomic impairment and environmental
limitation

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 WHO : ICIDH  ICF

International Classification of Functioning,

Disability and Health

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 The Components of ICF

1. Body function
2. Body structure
3. Impairment
4. Activity
5. Participation
6. Activity limitation
7. Participation restriction
8. Environmental factor
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Interaction between the
components of ICF

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• Body functions
the physiological functions of body systems
(including psychological functions)

• Body structures
anatomical parts of the body such as organs,
limbs and their components

ICF
• Impairments
problems in body function or structure such as a
significant deviation or loss

• Activity
the execution of a task or action by an individual

• Participation
involvement in a life situation 8
• Activity limitations
difficulties an individual may have in executing
activities

• Participation restrictions
problems an individual may experience in
involvement in life situations

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 Body Function

1. Mental functions
2. Sensory functions and pain
3. Voice and speech functions
4. Functions of the cardiovascular, haematological,
5. immunological and respiratory systems
6. Functions of the digestive, metabolic and endocrine
systems
7. Genitourinary and reproductive functions
8. Neuromusculoskeletal and movement-related functions
9. Functions of the skin and related structures
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 Body structure

1. Structures of the nervous system

2. The eye, ear and related structures
3. Structures involved in voice and speech
4. Structures of the cardiovascular, immunological and
respiratory systems
5. Structures related to the digestive, metabolic and
endocrine systems

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 Body structure

6. Structures related to the genitourinary and

reproductive systems
7. Structures related to movement
8. Skin and related structures

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 Activities and participation

1. Learning and applying knowledge

2. General tasks and demands
3. Communication
4. Mobility
5. Self-care
6. Domestic life
7. Interpersonal interactions and relationships
8. Major life areas
9. Community, social and civic life
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 Environmental factors

1. Products and technology

2. Natural environment and human-made changes to
environment
3. Support and relationships
4. Attitudes
5. Services, systems and policies

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• Environmental factors
make up the physical, social and attitudinal
environment in which people live and conduct
their lives

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 LEPROSY

Gerhard Henrik Armauer Hansen

1873

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 Leprosy / Morbus Hansen / Lepra
/ Kusta

• Leprosy
a chronic infection caused by Mycobacterium
leprae

• Affect superficial tissues (primary)

especially the skin and peripheral nerves

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 Leprosy / Morbus Hansen / Lepra
/ Kusta

• M. Leprae infection causes a wide array of

cellular immune responses

• The second part of the disease

a peripheral neuropathy with potentially long-
term consequences

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The disease :
• Infectious
• Basically is a peripheral nerve
• Very disabling

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Two kinds of impairments
• Primary
• Secondary

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Primary impairments
NERVE DAMAGE

AUTONOMIC SYSTEM SENSORY SYSTEM MOTOR SYSTEM

Dryness Anaesthesia / Insensitive Muscle weakness

Skin cracks Injuries Joint contracture

(Burns, Blisters, Wounds)

INFECTION
Secondary impairments

Absorbtion / Mutilation 21
Peripheral neuropathy, ulcer

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Ocular lesion

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Mutilation, claw hand

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Psychological

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Functional problem
 Functional problem

Level Functional problem

Disease Leprosy

Impairment Upper limb muscle weakness,

contracture
Activity limitation Couldn’t grasping ADL
Participation restriction Couldn’t cooking
Environment factor Crowded
Personal factor Poor nutrition, immunity
 Body function in LEPROSY

• Mental function
• Sensory functions and pain
• Neuromusculoskeletal and movement-
related functions
• Functions of skin and related structures

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 Body structure in Leprosy

• Structures of nervous system

• The eye, ear and related structures
• Structures related to movement
• Skin and related structure

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 Impairment in Leprosy

• Impairment  body function and structure

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 Activities in Leprosy

1. Learning and applying knowledge

2. General tasks and demands
3. Communication
4. Mobility
5. Self-care
6. Domestic life
7. Interpersonal interactions and relationships
8. Major life areas
9. Community, social and civic life
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 Participation in Leprosy

1. Learning and applying knowledge

2. General tasks and demands
3. Communication
4. Mobility
5. Self-care
6. Domestic life
7. Interpersonal interactions and relationships
8. Major life areas
9. Community, social and civic life
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 Environmental factors

1. Products and technology

(Products and technology for personal use in daily living, for
personal indoor and outdoor mobility and transportation, for
communication, education, employment, culture, recreation, sport,
practice religion and spirituality, building and technology for public
use, for private use)

2. Natural environment and human-made changes to

environment
(geography, population, flora fauna, climate, natural and human
cause event, light, sound, air quality, )

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 Environmental factors

3. Support and relationships

(family, friend, neighbor, colleague, community
members)

4. Attitudes
(attitude of family, friend, etc)

5. Services, systems and policies

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 PMR Management

Insensitive hand
• education (improve safety)
• protective gloves, check temperature of
water
• hands are soaked and oiled
• flexor surface of finger cracks splint it
straight
• range of movement exercise
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Plantar ulceration
• Covering any skin break to prevent
secondary infection
• Dead tissue or callus removed by
debridement
• Limb immobilize (plantar cast, crutches, or
bed rest)
• Complete healing  protective footwear
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Ocular problem
• Training patients :
 to compensate through their remaining
senses (such as hearing, smell, proprioception, and
tactile sensation in the lips and hand)
 using any remaining light perception to teach
sense of direction

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Psychological rehabilitation
• Include in preventive rehabilitation
• Minimize development of psychiatric
problem
• Casing of recovery from problems
• Restoration of confidence and ability to
cope
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 Socioeconomic rehabilitation

• Prevent the social displacement

• Counselling, domiciliary rehabilitation, retraining,
resettlement, care of residual disabilities etc
• to promote acceptance of leprosy programs
• to dispel public prejudice and social stigma
• to seek participation of community care of leprosy patient
• to facilitate self-reporting of patient’s problem
• to promote patient self-care and compliance to treatment

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 THE REHABILITATION
MEDICINE PROGRAMS

1. For the insensitive hand

2. For the mobile claw hand
3. For the stiff claw hand

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 THE INSENSITIVE HAND :

S.O.S. ( Save Our Skin )

HEALTH EDUCATION

1. S oaking

2. O iling

3. S crapping 41
THE MOBILE CLAW HAND :

Exercise all the fingers and thumb to maintain

their ROMs

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Knuckle bender splint / Lumbrical bar
• Claw hand (MCP extension, PIP flexion)
• by holding the metacarpals in a slightly flexed
position, the central slip can actively extend the
PIP joint
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ADL Exercises
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 PRE-OPERATIVE PROGRAM FOR
TENDON TRANSFER :
1. Maintain the ROM of all joints
2. Strengthen the extrinsic muscles to be
transferred

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 POST-OPERATIVE PROGRAM
FOLLOWING TENDON TRANSFER

1. POP immobilization  early

2. ROM exercise should be continued gently
3. Re-educate the transferred muscle with the
original function
4. Re-educate the transferred muscle to the
new function
Strengthening and ADL exercises

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Thank
you

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Thank you

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Presentation Title
Subheading goes here