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Physical Therapy in Leprosy

  • Lúcia Helena Soares Camargo Marciano
  • Tatiani Marques
  • Cristina Maria da Paz Quaggio
  • Susilene Maria Tonelli Nardi
Chapter

Abstract

Leprosy is a public health problem worldwide, with Brazil ranking second on the world stage. The introduction of multidrug therapy provided significant changes in the control of the disease, but this treatment does not prevent the occurrence of the physical disabilities caused by the involvement of nerves. The presence of disabilities, including physical disabilities, may lead to a reduction in work potential, restricted social life, and psychological disorders, and are responsible for discrimination against patients. Some factors contribute to the appearance of these problems, such as delayed diagnosis, lack of patient adherence to treatment, and the presence of reactive episodes. Early diagnosis, proper treatment and prevention of disabilities impede the transmission of disease and reduce disabilities including psychosocial impairment. Thus, physical rehabilitation and surgery are important tools to prevent disabilities, to improve functional capacity, aesthetics, and social life, and to alleviate pain.

Keywords

Leprosy Disabled people Rehabilitation Tendon transfer 

Notes

Acknowledgement

The authors wish to thank The Paulista Foundation against Leprosy for the financial support received, and the librarian Alessandra Carriel Vieira for assistance with the references.

Glossary

Bacilloscopy 

A complementary examination in the diagnosis of leprosy. It consists of an analysis by microscopy whereby Mycobacterium leprae are observed directly in smears of lymph and intradermal scrapings.

Corneal opacity 

The cornea has a white appearance throughout.

Disabilities 

Problems in the functions or body structure due to significant impairment or loss.

Ectropion 

A medical condition where the lower eyelid turns outward.

Engrams 

The neurologic organization of preprogrammed patterns of muscle activity. Once formed, the same pattern is produced every time the specific nerves are activated.

Entropion 

Inward folding of the eyelid, whereby in the eyelashes rub against the cornea.

Froment’s sign 

A test used to evaluate paralysis of the ulnar nerve, specifically the action of the adductor muscle of the thumb. The test assesses whether the patient can pinch hold a sheet of paper by thumb adduction. Patients are considered Froment positive when they have sharp flexion of the distal phalanx of the thumb due to instability of the metacarpophalangeal joint.

Graphesthesia 

The individual’s ability with closed eyes to recognize the writing of words or numbers on the skin.

Hypoesthesia 

Decreased sensitivity in a particular region of the body.

Infiltration 

Increased thickness and changed consistency of the skin with less evidence of skin creases. It consists in using an instrument specifically designed to apply one or two tactile stimuli using parallel metal points. The distance between the points varies from 2 to 20 mm.

Lagophthalmos 

Inability to close the eyelids.

Lepromas 

Prominent subcutaneous nodules resulting from an accumulation of Virchow cells.

Leprosy reactions 

Acute and subacute inflammatory episodes that intermittently occur in the chronic course of both paucibacillary and multibacillary disease.

Madarosis of the eyebrows 

Loss of hairs of the eyebrows.

Mycobacterium leprae 

Known as the cause of leprosy, this bacterium has a rod shape. It is alcohol acid-resistant and so staining during biopsy must be carried out using Ziehl–Neelsen stain.

Palpation 

Process of semiologic observation that consists in exploring a particular region of the body with the fingertips and palm.

Paresis 

Dysfunction of movement of one or more limbs.

Paresthesia 

Subjective sensations of the skin that can be described by the individual as cold, hot, tingling, pressure, among others. It may occur due to neural lesions, either by the destruction or by disruption of the nerve endings.

Proprioception 

A sense or perception of the movement of the body, balance etc. provided by the bones, muscles, tendons, and joints.

Skin ulcers (ulceration) 

The generic name given to any superficial lesion in skin tissue. A complication related to neuropathy in leprosy.

Stereognosis 

The ability to recognize objects by touch, shape, and contour.

Tinel’s sign 

A test to check irritation of a nerve. A tingling sensation is felt in the distal end of a limb when an injured nerve is struck.

Trichiasis 

Eyelashes growing toward the eyeball.

Two-point discrimination test 

A functional test that evaluates the ability of the digits to act as a sensory organ. The test determines the minimum distance at which the patient is able to discern that two nearby objects touching the skin are truly two distinct points.

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Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Lúcia Helena Soares Camargo Marciano
    • 1
  • Tatiani Marques
    • 1
  • Cristina Maria da Paz Quaggio
    • 1
  • Susilene Maria Tonelli Nardi
    • 2
  1. 1.Lauro de Souza Lima InstituteBauruBrazil
  2. 2.Adolfo Lutz InstituteSão PauloBrazil

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