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DISABILITY IN LEPROSY PREVENTION & REHABILITATION

DR. PL . VIJAYA KUMAR MS ORTHO PROF. DR. PRABHAKARAN MS ORTHO

13.09.2006

INTRODUCTION

IF LEPROSY DID NOT CAUSE DEFORMITIES & DISABILITIES IT WOULD NOT BE A DREADED DISEASE, CONSIDERED AS JUST ANOTHER SKIN DISEASE TO, THE LAY MAN, PATIENTS AND EVEN FOR MANY MEDICAL MEN LEPROSY MEANS DEFORMITY, BUT ONLY 20 25 % SUFFER FROM DISABILITIES

THEREFORE, EVERY PERSON DEALING WITH LEPROSY PT HAS A CLEAR UNDERSTANDING OF THE DEFORMITIES, HOW THERY ARE CAUSED 13.09.2006 HOW FAR THEY MAY BE PREVENTED 2 AND

5 TIER CONSEQUENCES OF LEPROSY


IMPAIRMENT DISABILITY HANDICAP DEHABILITATION DESTITUTION


3

13.09.2006

IMPAIRMENT

PRIMARY
INVOLVEMENT OF FACIAL OCULAR PERIPHERAL NERVE ACUTE DEPRESSION

SECONDARY
ANESTHETIC DEFORMITY NEGLECTED DEFORMITY
SPECIFIC PARALYTIC
4

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DISABILITY

DETERIORATION IN ONES ABILITY FELT ONLY BY THE PATIENT DIFFICULTY IN


DAILY LIVING ACTIVITY AT WORK LOCOMOTION COMMUNICATION & PERSONAL CARE BEHAVIORAL DISABILITY

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DISABILITY PHYSICAL, PSYCHOLOGICAL & SOCIAL


5

FACTORS INFLUENCING THE DEFORMITY


DURATION - LONG ACTIVE DISEASE TYPES IN LL, BORDERLINE INVOLVEMENT OF NERVE TRUNK

AGE & SEX


INTELLIGENCE OF THE Pt OPPURTUNITIES FOR Rx & ADVICE
6

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DEFORMITY CLASSIFICATION

ACCORIDNG TO CAUSE
FACE +++ HAND ++ FEET + IMPAIRMENT PRIMARY PRIMARY SECONDARY
7

TYPE SPECIFIC PARALYTIC ANESTHETIC


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+ +

+++ +

++ +++

NERVE INVOLVEMENT & DAMAGE


5

STAGES
TISSUE RESPONSE PARASITIZATION CLINICAL INVOLVEMENT NERVE DAMAGE NERVE DESTRUCTION

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TYPE OF NERVE AFFECTION


CUTANEOUS CRANIAL PERIPHERAL AUTONOMIC

DEFORMITY DUE TO PERIPHERAL NERVE INVOLVEMENT 13.09.2006 9

NERVE DAMAGE
RELATIVE FREQUENCY BODY PART NERVE

INVOLVEMENT

DAMAGE

FREQUENCY OF RECOVERY

ULNAR UPPER LIMB MEDIAN RADIAL COMMON PERONEAL POSTERIOR TIBIAL

+++ ++ + +++ +++

+++ ++ + + +++

+ ++ +++ ++ +10

LOWER LIMB
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SITES OF PRESENTATION OF NERVE INVOLVEMENT

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EVALUATION OF NERVE DAMAGE

TIME FREQUENCY ONE DAY BEFORE Sx 2 WEEKS POST OP FOUR WEEKS 2 MONTHS 3 MONTHS AFTER 6 MONTHS 6 MONTHLY THEREAFTER

RECORD SENSORY, MOTOR, PAIN & TENDERNESS SCORING SYSTEM IS SUGGESTED 12 13.09.2006 NERVE CONDUCTION STUDY & EMG

SENSORY TESTING
METHODS

1. TOUCH THRESHOLD USING MONOFILAMENT NYLON THREAD


2. PIN PRICK TEST
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MOTOR TESTING
VOLUNTARY MUSCLE TEST
ULNAR ULNAR

( SUPERFICIAL BRANCH ) ( DEEP BRANCH )

ABDUCTOR

DIGITI

MINIMI
1ST

DORSAL INTEROSSEOUS
ABDUCTOR

MEDIAN

POLLICIS
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BREVIS
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HAND PROBLEMS IN LEPROSY


IMPAIRMENT SOMATIC SENSORY FIBRES MOTOR FIBRES DIRECT CONSEQUENCES SENSIBILITY LOSS LATE CONSEQUENCES ANESTHETIC DEFORMITY CONTRACTURE & INFECTIONS DEEP CRACKS HAND INFECTIONS & SPECIFIC 15 DEFORMITY

MUSCLE PARALYSIS

SUDOMOTOR AUTONOMIC FIBRES


ACUTE 13.09.2006 INFLAMMATION

DRY SKIN

REACTION HAND

SPECIFIC DEFORMITIES IN HAND


1. 2.

BANANA FINGERS MILD SHORTENING OF FINGERS


DONOT INTERFERE WITH FUNCTION CANNOT BE CORRECTED BUT CAN BE PREVENTED BY EARLY DIAGNOSIS & Rx

3.

REACTION [FROZEN ] HAND


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REACTION HAND

FOCI OF ACUTE INFLAMMATION & RESOLVE WITH DENSE FIBROSIS DEFORMITIES


NON PARALYTIC CLAWING STIFF & STRAIGHT FINGERS SWAN NECK DEFORMITY REVERSE OF CLAW BOUTONNIERE DEFORMITY GUTTERING DEFORMITY TWISTED FINGER DUE TO MALUNITED 13.09.2006 OSTEOPOROTIC FRACTURE OF PHALANX 17

REACTION HAND

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ANKYLOSIS OF ELBOW

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REACTION HAND cont


TREATMENT

AIMS

RESOLVE EDEMA & INFLAMMATION


PROTECT THE HAND AVOID PATHOLOGICAL FRACTURE PREVENT STIFFNESS & DEFORMITY

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REACTION HAND cont


TREATMENT MODALITIES
1. ANTILEPROSY Rx ALONG WITH
2. STEROIDS 3. HAND SPLINTING IN FUNCTIONAL POSITION

4. ELEVATION OF HAND
5. APPLICATION OF HEAT WAX BATH 6. CPM AFTER INFLAMMATION SUBSIDES

7. ACTIVE MOVEMENTS
8. RADIOGRAPHY BONE STATUS ASSESSMENT
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ASSESSMENT OF HAND

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ANESTHETIC DEFORMITIES

SCAR CONTRACTURE STIFFNESS & SHORTENING OF FINGERS MUTILATION OF FINGERS OM OF PHALANX # OF CARPAL & METACARPAL NEUROPATHIC DISORGANISATION OF WRIST JOINT

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INJURIES IN AN ANESTHETIC HAND

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MUTILATED FINGER IN GLOVE & STOCKING ANESTHESIA

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HAND CARE MEASURES

SKIN CARE PROCEDURES


AIM TO KEEP SKIN SOFT & SUPPLE
1. DAILY HAND SOAKING IN WATER 15 MINUTES
2. RUB PALM TO REMOVE SUPERFICIAL KERATIN 3. LIQUID PARAFFIN SMEARING

INJURY CARE PROCEDURES


25

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INJURY CARE PROCEDURES


ANTICIPATE, AVOID & ATTEND INJURY INJURY CONSCIOUSNESS TO REALISE THE SERIOUSNESS OF INJURY PREVENTIVE PRECAUTIONS
FOR DAILY ACTIVITIES COOKING, EATING, HANDLING KNIVES, WORK TOOLS, etc

PROTECTIVE AIDS - THICK TOWEL, GLOVE, UTENSILS WITH INSULATED HANDLE


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INJURY CARE MEASURES FOR INSENSITIVE HAND

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INJURY CARE PROCEDURES


DETECT & ATTEND INJURIES
1. HAND INSPECTION DAILY, AFTER EVERY WORK
2. WOUND DRESSING 3. IN CLOSED INJURIES 72 hrs REST; SLING
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PARALYTIC DEFORMITY OF HAND

ULNAR CLAW HAND - MC

TOTAL CLAW HAND


TRIPLE NERVE PARALYSIS - rare

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ULNAR CLAW HAND

HIGH PALSY > LOW PARALYSIS DEFORMITY & DISABILITY REMAINS SAME IN BOTH MUSCLES PARALYSED ARE
ALL INTEROSSEI LUMBRICALS III & IV HYPOTHENAR MUSCLES ADDUCTOR POLLICIS FLEXOR POLLICIS BREVIS ( 30 % Pts)
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ULNAR CLAW HAND

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ULNAR CLAW HAND contd

DEFORMITY

CLAWING OF LITTLE & RING FINGER (+/- INDEX & MIDDLE) Z DEFORMITY OF THUMB (HYPER EXT OF MCP JOINT, FLEXION OF IP JOINT)
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ULNAR CLAW HAND contd

DISABILITY
INABILITY TO HOLD OBJECT, INABILITY TO SPREAD THE FINGERS & BRING THEM TOGETHER FINGER SPAN REDUCED ACTIVITY LIKE TYPING NOT POSSIBLE SMALL OBJECTS (eg; COINS, EATING RICE) FALL OUT GRIP POWER BECOMES WEAK
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ULNAR CLAW HAND contd


CLINICAL EXAMINATION
WASTING - HYPOTHENAR, THUMB WEB SPACE FAILURE OF ABDUCTION OF FINGERS

FAILURE OF ADDUCTION OF FINGERS CARD TEST


LUMBRICAL TEST

FROMENT SIGN ( BOOK TEST )


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SENSATION - MEDIAL 1 FINGERS

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TOTAL CLAW HAND

DUE TO COMBINED PARALYSIS OF HIGH ULNAR & LOW MEDIAN Nr PARALYSIS OF ALL SMALL MUSCLES OF HAND (INTRINSIC ZERO HAND)

DEFORMITY
CLAWING OF ALL 5 DIGITS DEROTATION OF THUMB

WASTING OF THENAR, HYPO THENAR WASTING & WEB SPACE


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HAND INSENSITIVE

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TOTAL CLAW HAND

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TOTAL CLAW HAND contd


DISABILITY
SEVERELY DISABLED HAND BOTH HOLDING & POWER GRIP IS IMPOSSIBLE - ONLY HOOK GRIP RETAINED IN HIGH MEDIAN Nr. PALSY ALL POWER OF FLEXION LOST, NO GRIP POSSIBLE LUCKILY IT IS VERY VERY RARE
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TRIPLE NERVE PARALYSIS

ULNAR + MEDIAN + LOW RADIAL


WRIST DROP FINGER DROP

THUMB DROP

DEFORMITY NIL ; CLAWING IS ABOLISHED DISABILITY TOTAL DISABILITY; HAND IS USELESS


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EVALUATION OF PARALYTIC CLAW FINGERS


DEGREE OF DEFORMITY DEGREE OF INTRINSIC MINUS DISABILITY

INTEGRITY OF EXTENSOR APPARATUS


PRESENCE OF FLEXION CONTRACTURE POSTURAL CAPABILITIES OF ARTICULAR SYSTEM OF FINGERS
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PARALYTIC DEFORMITIES OF HAND - Rx

EARLY STAGE
1. ANTILEPROSY DRUGS 2. STEROIDS

3. SPLINT PREVENTS STRETCHING OF PARALYSED MUSCLE


4. SURGICAL DECOMPRESSION
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PARALYTIC DEFORMITIES OF HAND - Rx

LATE STAGE AIM : TO RESTORE BALANCE OF FORCE OF MOVEMENT ACTING ON THE FINGER JOINT SYSTEM
SPLINT TEMPORARY
Sx - PREFERRED

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PARALYTIC DEFORMITIES OF HAND - Rx

PRE OPERATIVE PHYSIOTHERAPY


TO KEEP SKIN OF THE HAND SOFT & SUPPLE
TO AVOID DEVELOPMENT OF CONTRACTURE MODALITIES
1. OIL MASSAGE

2. EXERCISE
3. WAX BATH
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4. SPLINT

42

PARALYTIC DEFORMITIES OF HAND - Rx

TIME OF SURGERY
1. AFTER ATLEAST 6 MONTHS OF ANTILEPROSY Rx WITH GOOD CLINICAL RESPONSE 2. SHOULD NOT HAVE ANY REACTION / ACUTE EXACERBATION 3. MUSCLE PARALYSIS > 1 YR DURATION (STABLE / IRREVERSIBLE)

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PROCEDURES FOR RESTORATION OF FINGER FUNCTION - GRASP

RESTRICT MCP JOINT HYPEREXTENSION (PASSIVE PROCEDURES)


1. VOLAR CAPSULOPLASTY & FLEXOR PULLEY ADVANCEMENT

2. DERMADESIS & FLEXOR PULLEY ADVANCEMENT


3. EXTENSOR DIVERSION GRAFT 4. POSTERIOR BONE BLOK
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PROCEDURES FOR RESTORATION OF FINGER FUNCTION - GRASP

FOR INTRINSIC SUBSTITUTION


INTRINSIC REACTIVATION VOLAR ROUTE DORSAL ROUTE
1. BRANDS EF4T TRANSFER
2. BUNNELS OPERATION 3. FOWLER RIORDANS TRANSFER

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4. EXTENSOR INDICISION

45

PROCEDURES FOR RESTORATION OF FINGER FUNCTION - GRASP

BRANDS EF4T TRANSFER


MOTOR TENDON - ECRL FREE TENDON GRAFT PL, FASCIA LATA - SPLIT INTO
4 PARTS ATTACHED TO EXTENSOR EXPANSION

ANTIA PROCEDURE
PL MOTOR TENDON

BUNNELS OPERATION
FDS TO RING FINGER DEINSERTED- SPLIT INTO 2 STRIPS & INSERTED INTO EXTENSOR EXPANSION OF RING & LITTLE FINGER

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PROCEDURES FOR RESTORATION OF FINGER FUNCTION - GRASP

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PRE OP

POST OP

47

PROCEDURES FOR RESTORATION OF FINGER FUNCTION - GRASP

TO PROVIDE PROPER FLEXION OF PPX


BONE INSERTION PROCEDURE PULLEY INSERTION PROCEDURE 1. BROOKS 2. ZANCOLLIS LASSO

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ZANCOLLIS LASSO PULLEY INSERTION PROCEDURE


MODIFICATION USING SINGLE FDS SLIP- POPULAR

SAFELY USED FOR CORRECTION OF ASIANS


(THIN LONG FINGRS WITH HYPERMOBILE PIP JT.)

ADVANTAGES
GRIP, PINCH STRENGTH 90 % SUCCESS RATE LUMBRICAL POSITION POSSIBLE RESTORATION OF MAXIMUM WORK

DISADVANTAGES
INDIVIDUAL FINGER CONTROL NOT POSSIBLE
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SRINIVASAN PROCEDURE (EXTENSOR DIVERSION)


AIM TO STABILISE THE MCP JT. BY DIVERTING PART OF THE EXTENSOR FORCE TOWARDS THE FLEXOR ASPECT FREE TENDON GRAFT( PALMARIS, FL ) IS ATTACHED TO THE EXTENSOR TENDON OF DIGIT PROXIMALLY & LATERAL BAND OF THE SAME FINGER DISTALLY RELATIVELY EASY TECHNIQUE SUCCESS RATE 75 %

GRIP & PINCH STRENGTH NOT AFFECTED LUMBRICAL POSITION NOT POSSIBLE INDIVIDUAL FINGER CONTROL POSSIBLE NOT USEFUL IN HYPERMOBILE FINGERS
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SRINIVASAN PROCEDURE (EXTENSOR DIVERSION)

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POST OPERATIVE CARE


POP IN FUNCTIONAL POSITION IP JT. ARE LEFT FREE POP IN FUNCTIONAL POSITION FOR 3 WEEKS INTERMITTENT MCP JT. FLEXION & EXTENSION EXERCISES GREATLY IMPROVE MOTOR FN BUT NOT SENSIBILITY SO INJURIES COMMON
52

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RESTORATION OF THUMB FUNCTION ( PINCH, GRASP )


AIM RESTORATION OF ABDUCTION IN APPOSITION BRANDS OPERATION
FDS-IV TO ABDUCTOR POLLICIS BREVIS / EPL

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53

Rx FOR TIP FLEXION DEFORMITY OF THUMB

ARTHRODESIS OF MCP JT. JT. INSTABILITY + ARTHRODESIS OF IP JT. FLEXOR ADDUCTOR REPLACEMENT FPL TENODESIS
54

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SURGERY FOR TRIPLE NERVE PARALYSIS


COMBINATION

OF TRANSPLANT

RESTORATION OF WRIST EXTENSION BY TRANSFORMING PT TO ECRB FOR FINGER EXTENSOR FCR ARE USED REPLACEMENT OF INTRINSICS BY THE FDS OPPONENS REPLACEMENT BY THE RING FDS ARTHRODESIS OF WRIST
IF AS WITH HIGH MEDIAN NR. PALSY WRIST INSTABILITY, SUBLUXATION, NEUROPATHIC DISORGANISATION OR PAIN

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FOOT PROBLEMS IN LEPROSY

SPECIFIC DEFORMITIES
REACTION FOOT & TWISTED TOES

PARALYTIC DEFORMITIES
CLAW TOES & FOOT DROP

ANESTHETIC DEFORMITIES

NEUROPATHIC PLANTAR ULCER & DISORGANISATION OF FOOT, SHORTENING OF TOES 13.09.2006

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TWISTED TOES

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DISABILITY

DUE TO PLANTAR ULCERATION


MOBILITY AFFECTED

DUE TO FOOT DROP


RUNNING & WALKING DIFFICULTY

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NEUROPATHIC PLANTAR ULCERATION


MC FOOT PROBLEM

SITES

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PLANTAR ULCER ETIOLOGY

INSENSITIVE SOLE INJURY INFECTION OF FISSURES, CRACKS PARALYSIS OF INTRINSIC MUSCLES MC


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NEUROPATHIC PLANTAR ULCER

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PLANTAR ULCER
STAGES

COMPLICATIONS

THREATENED

CONCEALED
OPEN

CAULIFLOWER GROWTH SQ. CA GAS GANGRENE


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SEPTICEMIA
TETANUS OM
62

PLANTAR ULCER TYPES & Rx


TYPES ACUTE ULCER CHRONIC SIMPLE & COMPLICATED RECURRENT
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Rx REST, ELEVATION & WOUND CARE WOUND CARE & POP CAST, PROTECTIVE FOOT WEAR SCAR REVISION, FOOT WEAR MODIFICATION, CORRECTIVE Sx, INFECTION 63 ERADICATION

POP CAST FOR TREATING PLANTAR ULCERS

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RECURRENT PLANTAR ULCERATION


CAUSES

POOR QUALITY OF SCAR EXCESSIVE LOADING OF SCAR FLARE UP OF LATENT INFECTION


PREVENTION
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OF RECURRENCE
65

FOOT WEAR & CARE

FOOT WEAR

SENSORY LOSS WITHOUT INTRINSIC MUSCLE PARALYSIS - TOUGH OUTER SOLE SENSORY LOSS WITH INTRINSIC MUSCLE PARALYSIS
MCR 10 15 DEG SHORE FOR SOLE RESILIENT, NON COLLAPSING, SHOCK ABSORBING INSOLE

WITH DENSE SCAR


METATARSAL BAR ADDITION MEDIAL ARCH SUPPORT

PRESSURE IS STILL HIGH


MOULDED INSOLE CORRECTIVE Sx 13.09.2006 LAST SORT FIXED ANGLE ORTHOSIS
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Sx FOR RECURRENT PLANTAR ULCER


REDUCING SCAR LOADING IN FORE FOOT
PLANTAR CONDYLECTOMY SRINIVASAN METATARSAL SLING METATARSAL OSTEOTOMY RESECTION OF METATARSAL HEAD SESAMOIDECTOMY
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NEUROPATHIC DISORGANISATION OF FOOT

FORE FOOT ( MC )METATARSO PHALANGEAL REGION HIND & MID FOOT CAUSE SERIOUS DISABILITY TYPES SEPTIC - MC ACUTE OM & ARTHRITIS OF INTER TARSAL & ANKLE JT. DESTRUCTION OF TALUS & CUBOID GOOD PROGNOSIS TRAUMATIC OSTEOPOROSIS:TALUS, NAVICULAR DESTRUCTION Rx IMMOBILISATION POP STABILISING Sx 13.09.2006 68 ORTHOSIS WT. RELIEVING

NEUROPATHIC DISORGANISATION OF FOOT

NEUROPATHIC DISORGANISATION OF FOOT

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FOOT DROP

LOSS OF FOOT DORSIFLEXION 7& EVERSION + DROOPING OF TOES DAMAGE - COMMON PERONEAL IN POPLITEAL REGION MUSCLES PARALYSED TA, EHL, EDL, PERONEUS LONGUS & BREVIS
70

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CONSEQUENCES OF FOOT DROP


MUSCLES PARALYSED
ANTERIOR GROUP OF MUSCLES

CONSEQUENCES
FOOT, TOES DROP HIGH STEPPING GAIT

LATERAL GROUP OF MUSCLES

EVERSION FAILURE OVERLOADING OF OUTER PART OF FOOT ULCER ON FIFTH METATARSAL BASE & HEAD DESTRUCTION OF OUTER PART OF THE FOOT
72

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Rx OF FOOT DROP
EARLY CASES (INCOMPLETE PARALYSIS) RECOVERY CHANCES 1 YR Rx
ANTILEPROSY STEROIDS FOOT DROP SLING / STRAPPING WITH FOOT WEAR DAILY ELECTRICAL STIMULATION Sx DECOMPRESSION OF THE NERVE (IF SYMPTOMS PERSIST)
13.09.2006

LATE CASES FOOT DROP APPLIANCES TEMPORARY Sx


TENDON TRANSFER POSTERIOR BONE BLOCK ANTERIOR TENOLYSIS TRIPLE ARTHRODESIS (FOR FIXED EQUINOVARUS DEFORMITY)
73

TENDON TRANSFER FOR FOOT DROP


ANTERIOR TRANSPOSITION OF TIBIALIS POSTERIOR TENDON SRINIVASAN PROCEDURE


TWO TAILED TRANSFER OF TP TO EHL & EDL IN THE DORSUM OF FOOT

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CLAW TOES
DEGREE I

DAMAGE POSTERIOR TIBIAL, MEDIAL & LATERAL PLANTAR NR.


COMPLICATION Rx
DORSAL

DEFORMITY

MOBILE JT FLEXION CONTRACTION OF PIP JT

TRANSPOSITION OF FLEXOR DIGITORUM LONGUS


PIP

II

ULCER IN THE TIP

JT ARTHRODESIS

SOFT MTP

III

JT STIFF PROXIMAL PHALANX DISLOCATED

PLANTAR ULCERATION

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TISSUE RELEASE MTP CAPSULOPLASTY RESECTION OF METATARSAL HEAD INTERPHALANGEAL ARTHRODESIS CONDYLECTOMY OF 75 METATARSAL HEAD

COMBINED FOOT DROP & CLAW TOE DEFORMITY


CLAWING

OF TOE IS OBVIOUS (HOOK LIKE APPERANCE) NO HYPER EXTENSION OF THE MTP JT Rx - ARTHRODESIS OF IP JT.

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FOOT WEAR FOR LEPROSY PATIENTS


NORMAL FEET STANDARD FOOT WEAR

EARLY ULCER
MODERATELY SCARRED FOOT MARKED SCARRING FOOT DROP TARSAL DISORGANISATION SHORT FOOT SYMES AMPUTATION BK AMPUTATION SHORT BK AMPUTATION AK AMPUTATION
13.09.2006

MCR CHAPPALS
ARCH SUPPORT + METATARSAL PAD MCR

MOULDED IN SOLE RIGID ROCKER SHOE


SHORT LEG BRACE + 90 DEG BACK STOP FIXED ANKLE BRACE PTB BOOT SYMES PROSTHESIS PTB PROSTHESIS BK PROSTHESIS + THIGH CORSET AK PROSTHESIS
77

FOOT WEAR
LOW MOULDED SHOE

MCR HIGH MOULDED PLASTAZOTE SHOE

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FIXED ANKLE BRACE WALKER

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FOOT DROP APPLIANCES


SPRING STRAP
BK BRACE WITH 90 deg BACK STOP

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PHYSIOTHERAPY

WAX THERAPY STIFF, REACTION HAND,


PRE/POST OP PERIOD, ACUTE NEURITIS ( CI BLISTERS, OPEN SORE )

OIL MASSAGE PREVENTS CONTRACTURE


ONSET; GIVEN BEFORE WAX Rx / EXERCISES EXERCISES SPLINTING

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PHYSIOTHERAPY

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EXERCISES

ACTIVE

ACTIVE ASSISTED PASSIVE

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EXERCISES

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SPLINTING

USES
1. 2. 3. 4. 5. 6. REST IMMOBILISE SPECIFIC MOVEMENT RESTRICTION CONTINUOUS TRACTION STABILISE JT RELEASE OF CONTRACTURE SERIAL SPLINTING
85

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SPLINTING

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SPLINTING

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OCCUPATIONAL Rx IN LEPROSY

AIM : TO TREAT THE PATIENT WITH SOME


DISABILITY TO PERFORM THEIR ACTIVITIES IN A WAY TO PREVENT FURTHER DAMAGE TO THE AFFECTED PARTS

METHODS
AIDS TO ACTIVITIES OF DAILY LIVING & AGRICULTURE

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OCCUPATIONAL Rx FOR DAILY ACTIVITIES


FOR INSENSITIVE HAND

FOR CLAW HAND

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OCCUPATIONAL Rx FOR MUTILATED HAND

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OCCUPATIONAL Rx FOR AGRICULTURAL JOBS

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FUNCTIONS OF AN OCCUPATIONAL THERAPIST


FUNCTIONAL ASSESMENT PSYCHOLOGICAL ASSESMENT TEACHING PT TO CARRY OUT THEIR WORK SAFELY

SUPERVISION
OCCUPATIONAL THERAPY IS A TEAM WORK
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METHODS OF OCCUPATIONAL Rx FOR AGRICULTURAL WORK


PROTECTIVE MEASURES GLOVE MICROCELLULAR COVERING FOR TOOL HANDLES FOOT WEAR WET FARMING

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PROGNOSIS

FACTORS

TYPE OF DISEASE AVAIALBILITY OF ADEQUATE Rx, BOTH MEDICAL & SURGICAL EXTENT OF CARE OF THE AFFECTED PART
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REHABILITATION
PERIOD
EARLY

REHABILITATION
FAMILY COUNSELLING OCCUPTION CERTIFICATION PHYSIOTHERAPY CORRECTION RECONSTRUCTIVE Sx OF DEFORMITY OCCUPATIONAL Rx REEMPLOYMENT SHELTERED INDUSTRY DOMICIALLARY REHABILITATION

MIDDLE

LATE
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PENSION RESIDUAL INSTITUTIONAL CARE

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PSYCHOLOGICAL REHABILITATION

THE WORST OF ALL DISEASE IS NOT TB / LEPROSY, IT IS THE FEELING OF UNWANTEDNESS

NOT FOR ONE BUT FOR EVERYONE


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PREVENTION - 6 LEVEL INTERVENTION


LEVELS CONSEQUENCE PREVENTION
PRIMARY IMPAIRMENT

MEASURES
EARLY RECOGNITION & Rx TRAINING THE AFFECTED , FAMILY & SOCIETY HAND & FOOT CARE MEASURES EARLY Rx OF ULCER RECONSTRUCTIVE Sx PSYCHOLOGICAL OCCUPATIONAL RESTORATION OF HUMAN 97 DIGNITY TO DESTITUTE

I II

SECONDARY IMPAIRMENT

III IV V
13.09.2006 VI

DISABILITY PREVENTION

HANDICAP PREVENTION

REHABILITATION

PREVENTION IS ALWAYS BETTER THAN CURE


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