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PHYSIOTHERAPY IN LEPROSY
PRESENTED BYDEEPAK DWIVEDI &VYOM GYANPURI
LEPROSY
CHRONIC INFECTIOUS DISEASECAUSED BY MYCOBACTERIUM
LEPRAEMAINLY 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 REACTIONSThe skin can become red & swollenThe nerve can be damaged,this may cause
new weakness or sensory lossNodules 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
transferTARSORRAPHY - 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
HANDAIM:-1.To prevent contracture 2.To strengthen muscle PRE OP. PHYSIOTHERAPY1.ASSESSMENT OF HAND2.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
FOOTAIM:-1.To restore normal walking pattern 2.To prevent further deformity PRE OP. PHYSIOTHERAPY1.ASSESSMENT OF FOOT2.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 weeks1.AFTER 5 WEEKS- Removal of POP & stitches 2.ASSESSMENT3.AIM & MEANS OF TREATMENT 1st WEEK - Isolation exercise 2nd WEEK-Strengthening exercise 3rd WEEK- Co ordination 4th WEEK- functional position