Disabilities in leprosy: an open, retrospective analyses of institutional records

Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.

Dynamic procedures for claw-finger correction--dilemma of balancing tension in transferred tendon slips.

The critical step in dynamic claw-finger correction procedures is adjustment of tension on the tendon slips which are being sutured at the new insertion sites to correct finger-clawing. Several methods to balance and adjust the tension have been described ever since these procedures have been in use. Ultimately it is the experience of the operating surgeon that helps to decide as to the tension that is to be kept on each slip so that maximum deformity correction is obtained without compromising the functional capabilities of the hand. An attempt has been made to describe this "experience" in words so that the surgeons who perform these corrective surgical procedures for the first time have some criteria to guide them.

A new approach in muscle training to rehabilitate the hand in leprosy.

Rehabilitation of the hand in Leprosy with its deformities and anaesthesia no doubt poses a formidable challenge as far as rehabilitation is concerned. Here we have applied a combination of latest concepts in sports physiology and the exercise followed by the students of ancient Indian martial art known as Krishni Vidya. This exercise consists of crumpling a newspaper sheet with a single hand without any external support. We are unable to explain the type of exercise done by the people before existence of newspaper. They might be using naturally occurring materials for the same like woodbark. With this exercise we have been able to improve the function of the hand remarkably well and the rehabilitation time following surgery is drastically reduced, with function returning close to normalcy. The full function is achieved within four weeks from the date of removal of plaster as compared to eight to ten weeks or more with conventional physical therapy. This full function is not only in mobility but also in co-ordination, static and dynamic strength, speed of movement and flexibility required of a normal hand. 16 patients operated for lumbrical replacement (using sublimis as a motor from the long finger) at the Dr. Bandorawalla Leprosy Hospital were put under the paper crumpling exercise. It was observed that the average time for the achievement of fully close fist was two weeks. (All of them had thumb function intact, i.e. either normal or operated-out of sixteen, four patients were operated for opponens prior to lumbrical replacement).