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7.Leproy

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  • 1. R. SNEKAVALLI ROLL NO - 73 DISABILITY AND ITS MANAGEMENT
  • 2. INTRODUCTION
    • LEPROSY - FOREMOST CAUSE OF DEFORMITY & CRIPPLING
    • 25% OF PATIENT - NOT TREATED AT AN EARLY STAGE DEVELOP ANAESTHESIA & DEFORMITIES OF HAND & FEET
  • 3. THREE TIER CONSEQUENCES OF LEPROSY IMPAIRMENT DISABILITY HANDICAP
  • 4.
    • IMPAIRMENT –
    • ANATOMIC, PHYSIOLOGIC, PSYCHOLOGIC ABNORMALITIES OR LOSES RESULTING FROM DISEASE OR DISORDER
    • DISABILITY –
    • IMPAIRMENTS – PROBLEMS – AFFECTED INDIVIDUALS – CERTAIN TASKS & ACTIVITIES – NORMAL FOR PERSONS AGE, SEX, TRAINING – BECOME DIFFICULT OR IMPOSSIBLE
    • THIS DIFFICULTY – INABILITY – CARRY OUT TASK - DISABILITY
  • 5.
    • HANDICAP –
    • DISADVANTAGES WHICH MAKE DISABLED INDIVIDUALS UNABLE TO DISCHARGE THEIR SOCIAL OBLIGATIONS
  • 6. DEFORMITY & DISABILITY IN LEPROSY
    • RISK FACTORS
    • TYPE OF LEPROSY
    • DURATION OF ACTIVE DISEASE
    • NUMBER OF NERVE TRUNKS INVOLVED
  • 7. THREE KINDS OF DEFORMITIES LOCAL LEPROSY RELATED PATHOLOGY COMMON IN FACE DAMAGE TO MOTOR NERVES COMMON IN HAND DAMAGE TO SENSORY NERVES AND LOSS OF SENSIBILITY COMMON IN FEET DEFORMITY SPECIFIC PARALYTIC ANAESTHETIC
  • 8.
    • DEFORMITY MAY BE DUE TO
    • DISEASE PROCESS eg. LOSS OF EYEBROWS
    • PERIPHERAL NERVE DAMAGE - PARALYSIS OF MUSCLES eg. CLAW HAND
    • RESULTING FROM INJURIES TO HAND AND FEET eg. MUTILATION OF HAND & FEET
  • 9. DEFORMITIES OCCURING IN LEPROSY
    • NERVE
    • STAGES OF NERVE INVOLVEMENT
    • STAGE OF PARASITIZATION
    • STAGE OF HOST RESPONSE
    • STAGE OF CLINICAL INVOLVEMENT
    • STAGE OF NERVE DAMAGE
    • STAGE OF NERVE DESTRUCTION
  • 10. PERIPHERAL NERVES AFFECTED
    • SUPERFICIALLY LOCATED DERMAL NERVE TWIGS
    • CUTANEOUS NERVES
    • NERVE TRUNKS LOCATED DEEP TO THE DEEP FASCIA
    • UPPER LIMB – ULNAR NERVE THICKENING
    • LOWER LIMB – COMMON PERONEAL NERVE
  • 11. MODES OF ONSET AND PROGRESS
    • QUIET NERVE PARALYSIS
    • EPISODIC ONSET & SALTATORY PROGRESS
    • CATASTROPHIC MODE OF ONSET
    • NERVE DAMAGE OF LATE ONSET
  • 12.
    • ACUTE NEURITIS – SEVERE PAIN & TENDERNESS
    • ENL NEURITIS
    • NERVE ABSCESS
    COLD ABSCESS HOT ABSCESS CASEOUS NECROSIS OF NERVE FASCICLES BT,TT ENL RELATED NEURITIS
  • 13. FACE
    • MASK FACE
    • FACIES LEONINA
  • 14.
    • SAGGING FACE
    • LOSS OF EYEBROWS (SUPERCILIARY MADAROSIS)
    • LOSS OF EYELASHES (CILIARY MADAROSIS)
  • 15. EYE
    • CORNEAL ULCERS
    • ACUTE IRITIS
    • CORNEAL OPACITY
  • 16.
    • LAGOPTHALMOS
    • BLINDNESS
  • 17. EAR
    • NODULES ON THE EAR
    • ELONGATED LOBULES
    • EAR DEFORMITIES
  • 18. NOSE
    • PERFORATED NOSE
    • DEPRESSED NOSE
    • SUNKEN NOSE DEFROMITY
  • 19. HAND
    • ULNAR CLAW HAND –
    • ULNAR NERVE INVOLVEMENT
  • 20.
    • HYPEREXTENSION - METACARPO - PHALANGEAL JOINT & FLEXION -PROXIMAL & THE DISTAL INTER-PHALANGEAL JOINTS
    • DUE TO PARALYSIS OF LUMBRICALS – SUPPLY BY ULNAR NERVE
  • 21.
    • WRIST DROP –
    • RADIAL NERVE PALSY
    • WRIST - PALMAR FLEXION - WEAKNESS OF DORSIFLEXORS
    • EXTENSOR MUSCLES OF THE FOREARM AND THE HAND
  • 22.
    • APE THUMB DEFORMITY -
    • MEDIAN NERVE
    • PARALYSIS OF OPPONENS POLLISIS MUSCLE
  • 23.
    • TOTAL CLAW HAND –
    • ULNAR & MEDIAN NERVE INVOLVEMENT
    • HOLLOWING OF INTROSSEOUS SPACES & SWOLLEN HAND
  • 24. FEET
    • FOOT DROP –
    • COMMON PERONEAL NERVE INVOLVEMENT
    • PLANTAR FLEXION DUE TO WEAKNESS OF THE DORSIFLEXORS
  • 25. FOOT DROP
  • 26.
    • PLANTAR ULCER -
    • DUE TO NERVE INVOLVEMENT - ANAESTHESIA
  • 27.
    • CLAWING OF TOES
    • ABSORPTION OF TOES
    • COLLAPSED FOOT
    • SWOLLEN FOOT AND CALLOSITIES
  • 28. ABSORPTION OF TOES
  • 29. OTHER DEFORMITIES
    • GYNAECOMASTIA
    • PERFORATION OF PALATE
    • ACUTE EPIDIDYMO ORCHITIS
  • 30. GRADING
    • HANDS & FEET -
    • GRADE 0 - NO ANAESTHESIA & NO VISIBLE DEFORMITY
    • GRADE 1 – ANAESTHESIA BUT NO VISIBLE DEFORMITY
    • GRADE 2 – VISIBLE DEFORMITY DAMAGE PRESENT
  • 31. GRADING
    • EYE -
    • GRADE 0 – NO EYE PROBLEM, NO EVIDENCE OF LOSS OF VISION
    • GRADE 1 – EYE PROBLEM DUE TO LEPROSY PRESENT BUT VISION NOT AFFECTED
    • GRADE 2 – SEVERE VISUAL IMPAIRMENT, LAGOPTHALMOS, IRITIS, CORNEAL OPACITY
  • 32. INTERVENTIONS FIRST LEVEL - Primary, secondary & psychological impairment Anti-leprosy treatment, health education, supportive social action SECOND LEVEL – Reversible disability preventive measures Early recognition and treatment THIRD LEVEL – Permanent irreversible disabilities Physiotherapy, corrective measures, provision of appliances FOURTH LEVEL – Disability & handicap Rehabilitation measures
  • 33.
    • FIFTH LEVEL –
    • FOR THE DESTITUTES
    • RESCUE, RESTORE & REHABILITATE
  • 34. MANAGEMENT
    • NERVE DAMAGE CAUSES 3 LEVELS OF PROBLEMS – ONE LEADING TO THE NEXT
  • 35. LEVEL 1 LEVEL 3 LEVEL 2
  • 36. LEVEL 1 LEVEL 2 LEVEL 3 OFTEN PREVENTABLE WITH MEDICAL TREATMENT OF LEPROSY BEFORE THERE IS NERVE DAMAGE OFTEN PREVENTABLE WITH PROTECTIVE EYE AND SKIN CARE AND EXERCISE TO KEEP FULL MOVEMENT OF JOINTS OFTEN PREVENTABLE WITH CAREFUL EARLY TREATMENT OF SORES, BURNS AND INFECTIONS
  • 37. A Person with leprosy gets a blister It does not hurt. So keeps walking until blister bursts - infected Still without pain - infection gets deeper and attacks the bone Bone is destroyed - foot becomes more and more deformed.
  • 38. PREVENTION OF INJURY FOR PERSONS WITH LOSS OF FEELING& STRENGTH
    • EYE –
    • EYE DAMAGE – COMES FROM NOT BLINKING ENOUGH, BECAUSE OF WEAKNESS OR LOSS OF FEELING
    • BLINKING - EYES WET AND CLEAN. PERSON DOES NOT BLINK WELL, OR HIS EYES ARE RED, THEN ADVICE -
  • 39.
    • TO WEAR SUNGLASSES WITH SIDE SHADES, AND MAY BE SUN HAT
  • 40.
    • CLOSE EYES TIGHTLY – DAY- ESPECIALLY WHEN DUST BLOWS
    • ROLL THE EYEBALLS UP AS YOU TRY TO CLOSE EYES TIGHT
  • 41.
    • KEEP EYES CLEAN.
    • WASH WELL AROUND EYES, KEEP FLIES AND DIRTY HANDS AWAY
  • 42. NERVE
    • ACUTE NEURITIS – ANTI-REACTION THERAPY – STEROIDS & ANALGESICS, SEDATIVES
    • ENL NEURITIS – THALIDOMIDE
    • LOCAL MEASURES – SPLINTING OF THE PART
    • PHYSICAL THERAPY – WAX BATH, SHORTWAVE OR MICROWAVE DIATHERMY
  • 43. SURGICAL DECOMPRESSION OF NERVE TRUNKS
    • INDICATION -
    • MEDICAL & AUXILLARY TREATMENT FAILED
    • PROCEDURE -
    • RELEASE EXTERNAL COMPRESSING FACTOR
    • DIVIDE EPINEURIUM
    • RELIEVE THE FASCICLES FROM BEING STRANGULATED BY THE SCLEROSED EPINEURIUM
  • 44.
    • NERVE ABSCESS
    • COLD ABSCESS – SURGICAL INTERVENTION – DRAINING THE ABSCESS – MOPPING – NECROTIC CONTENT – REMOVING ADHERENT SLOUGH – EXCISING THE ABSCESS
    • HOT ABSCESS – SURGERY RARE
  • 45. HANDS
    • SPECIAL CARE WHEN WORKING WITH HANDS OR COOKING MEALS
    • NEVER PICK UP A PAN OR OTHER OBJECT THAT MIGHT BE HOT, WITHOUT FIRST PROTECTING HAND WITH A THICK GLOVE OR FOLDED CLOTH
  • 46.
    • AVOID WORK THAT INVOLVES HANDLING SHARP OR HOT OBJECTS.
    • DO NOT SMOKE
  • 47.
    • USE TOOLS WITH SMOOTH, WIDE HANDLES, OR WRAP CLOTH AROUND HANDLES
    • FOR A PERSON WITH WEAK OR DEFORMED FINGERS - HOLD A TOOL OR UTENSIL - YOU CAN MOLD HANDLE TO THE SHAPE OF THE PERSON’S CLOSED HAND.
  • 48. FEET
    • AVOID GOING BAREFOOT. USE SHOES OR SANDALS
  • 49.
    • LEARN TO TAKE SHORT STEPS
  • 50. INJURY CARE
    • EYES –
    • CLOSE EYES OFTEN. IF NECESSARY USE A SIMPLE EYE PATCH
    • IF EYE GETS INFECTED - ANTIBIOTIC EYE OINTMENT- LOWER LID WITHOUT TOUCHING THE EYE
  • 51. HANDS AND FEET
    • IF YOU HAVE A CUT OR SORE, KEEP THE INJURED PART VERY CLEAN AND AT REST UNTIL IT HAS HEALED COMPLETELY
    • TAKE CARE NOT TO INJURE THE AREA AGAIN
  • 52. THINGS TO DO EVERY DAY
    • EXAMINE HANDS AND FEET CAREFULLY OR SOMEONE ELSE EXAMINE THEM.
    • LOOK FOR CUTS, BRUISES THORNS, SPOTS OR AREAS ON THE HANDS AND FEET THAT ARE RED, HOT, SWOLLEN OR SHOW THE START OF BLISTERS
  • 53.
    • IF YOU FIND ANY OF THESE – REST THE HANDS OR FEET - SKIN IS COMPLETELY NORMAL AGAIN
    • IF THE SKIN GETS DRY AND CRACKS - SOAK FEET DAILY - WATER - 20 MIN
  • 54.
    • THEN RUB COOKING OIL, VASELINE, OR LANOLIN HAND CREAM INTO THEM
    • DO STRETCHING EXERCISES - KEEP COMPLETE RANGE OF MOTION IN THE JOINTS
  • 55.
    • CONTINUED DAILY CARE, MOST DEFORMITIES OF LEPROSY CAN BE PREVENTED
  • 56. PREVENTION OF CONTRACTURES AND DEFORMITIES
  • 57. EYE
  • 58. HAND
    • LOSS OF FEELING MAKES PREVENTION MORE DIFFICULT
    • EXERCISES TO PREVENT FIXED CLAWING OF THE HANDS CAN BE DONE BY GENTLY STRAIGHTENING THE FINGERS
  • 59. SPLINTAGE FOOT DROP SPLINT COMMON PERONEAL NERVE INVOLVEMENT KNUCKLE BENDER SPLINT ULNAR NERVE PALSY COCK-UP SPLINT RADIAL NERVE PALSY SPLINT USED NERVE INJURED
  • 60. COCK - UP SPLINT
  • 61. KNUCKLE BENDER SPLINT
  • 62. FOOT DROP SPLINT
  • 63.
    • GOOD EXERCISE TO PREVENT ‘TIPTOE’ CONTRACTURES WITH ‘FOOT DROP’ IS TO STRETCH THE HEEL CORDS BY LEANING FORWARD AGAINST A WALL OR BY SQUATTING WITH HEELS ON THE GROUND
  • 64. FOOT WEAR USED IN LEPROSY
    • WELL – FITTED UPPER PART THAT DOES NOT RUB AND HAS PLENTY OF TOE ROOM
    • A SOFT INNERSOLE ABOUT 1 CM THICK
  • 65.
    • A TOUGH UNDER-SOLE, SO THORNS, NAILS AND SHARP ROCKS DONOT INJURE FOOT
    • FOOTWEAR SHOULD BE ACCEPTABLE AND NOT LOOK STRANGE SO THAT THE PERSON WILL USE IT
  • 66. THINGS TO BE AVOIDED
    • PLASTIC SHOES OR SANDALS
    • SOFT-SOLED SANDALS OR THONGS THAT THORNS CAN PASS THROUGH
    • USING NAILS TO FASTEN HEELS AND SOLES
  • 67. POSSIBLE WAYS TO GET FOOTWEAR
    • CONTACT A LEPROSY HOSPITAL WITH A FOOTWEAR WORKSHOP. THEY CAN MAKE SANDALS IF YOU SEND A TRACING OF THE FOOT
  • 68.
    • CHECK THE MARKET. YOU MAY FIND A CANVAS SHOE OR TENNIS SHOE THAT ALREADY HAS A GOOD INSOLE
    • OR THEY CAN PUT SOFT INSOLES INTO THE SHOES
  • 69.
    • MAKE SPECIAL FOOTWEAR. FOR THE INNER SOLE, YOU CAN USE A SOFT SPONGE SANDAL OR THONG OR BUY MICROCELL RUBBER WHICH IS SOFT BUT FIRM.
    • FOR THE UNDER SOLE YOU CAN USE A PIECE OF OLD CAR TIRE.
  • 70.
    • FOR PERSONS WHO HAVE DEVELOPED SORE ON THEIR FOOT - FOOT SUPPORT HERE MAY HELP TAKE PRESSURE OFF THE BALL OF THE FOOT AND PREVENT NEW SORES.
  • 71.
    • TO PREVENT SORES – A SOFT, HEAT-MOLDABLE FOAM PLASTIC CALLED ‘PLASTAZOTE’.
    • LACES SHOULD BE AVOIDED. IN THAT CASE VELCRO IS AN IDEAL ALTERNATIVE
  • 72.
    • FOR PERSONS WITH A ‘DROP FOOT’, A BRACE OR LIFT CAN HELP PREVENT SORES AND INJURIES
  • 73.
    • GET A BRACE OR SUPPORT AT A REHABILITATION WORKSHOP OR MAKE A SPECIALLY-FITTED, WELL-PADDED PLASTIC BRACE
    • MAKE A SIMPLE DEIVICE TO HOLD THE FOOT UP
  • 74. ORTHOPAEDIC SURGERY AND PLASTIC SURGERY
    • PARALYSED FINGERS – STRAIGHTENED BY TAILED GRAFT OF BRAND - PLANTARIS TENDON
    • DROPPED FOOT – TRANSVERSE TIBIALIS POSTERIOR MUSCLE
    • CLAWED HAND AND TOES – TRIPLE ARTHRODESIS
  • 75.
    • CHRONIC PLANTAR ULCERATION – REMOVAL OF DAMAGED META-TARSAL WITH EXCISION OF THE ULCER
    • GROSS DEFORMITY OR BONE DESTRUCTION – BELOW KNEE AMPUTATION
  • 76. WHEN TREATMENT IS COMPLETED
    • CONGRATULATE THE PATIENT
    • THANK FAMILY / FRIENDS FOR THEIR SUPPORT
    • REASSURE THAT MDT COMPLETELY CURES LEPROSY
    • ANY RESIDUAL LESIONS WILL FADE AWAY SLOWLY
    • SHOW THEM HOW TO PROTECT ANAESTHETIC AREAS / DISABILITIES
    • ENCOURAGE TO COME BACK IN CASE OF ANY PROBLEM
    • TELL THAT THEY ARE WELCOME TO BRING OTHER MEMBERS OF FAMILY OR FRIENDS FOR CONSULTATION
    • REMOVE THE PATIENT’S NAME FROM THE TREATMENT REGISTER
  • 77. BIBLIOGRAPHY
    • JOPLING
    • HASTINGS
    • PARK
    • MAHESHWARI
    • SNELL’S CLINICAL ANATOMY
    • INTERNET
  • 78.