(LML) Sensory testing

Leprosy Mailing List – August 17,  2013 

Ref.:    (LML)  Sensory testing

From:  Linda F. Lehman, Belo Horizonte, Brazil

---

 

Dear Pieter,

 

It has really been nice to hear from so many people about sensory testing.  

 

As I listen it seems that people need to be clear what they are wanting to accomplish with the testing and what is the objective of the testing:

-        1.   Diagnose Hansen's disease/leprosy(skin lesions);

-        2. Determine Protective sensory Loss in eyes/hands/feet which put them at Risk of injury if self-care and protection/footwear is not used;

-        3.  Early nerve function loss/change that when detected early and treated with Corticosteroids can get better and if not improving may need to be referred for surgery to decompress the nerve.  

 

One of the things I observe frequently in my supervision visits is that reactions and nerve function change is not being identified and/or treated adequately or treated so late the nerve function does not return.  It is recognized only after there are big changes and an ulcer.  I have seen several cases within the last 6 months that were diagnosed and with nerve function impairments but the worker only gave  MDT treatment thinking that this would be sufficient.  In busy clinics, often patient education and daily self-care practices are not adequately taught.  Self-care groups and empowering patients/families to recognize problems and take action are very important.

 

IN SUMMARY:

1.    We test cutaneous skin lesions to determine if it is leprosy or not.  Dr. Manuel Villarroel (neurologist) from Brasil did very interesting work on early sensory loss in single skin lesions.  Difficulty identifying small changes in temperature were first.  I am attaching an article that was published that readers may find interesting.  

2.    We monitor/test peripheral nerve function(eyes, hands & feet) in leprosy for three purposes:

·         TO IDENTIFY EARLY NERVE FUNCTION CHANGE or LOSS so other treatments can be started to preserve nerve function

·         TO MONITOR RESPONSES TO INTERVENTIONS (better, worse, unchanged) AND MAKE CHANGES IN TREATMENT IF NEEDED (ADL's -activities of daily living, Drug, Surgery, etc)

·         TO DETERMINE PERSONS AT RISK OF INJURY OR ULCER ("protective sensory loss determined by the ball point pen, clip, 10g filament)  This is NOT early nerve function loss but it tells us which persons are at RISK and are in need of good daily self-care practices, protective footwear, etc.   This is the WHO Grade 1, those at RISK for injury/ulcer.  The Diabetic foot program emphasis today is only to identify feet at risk of injury not early nerve function loss.  Limbs at Risk need protection and good self-care practices.

The challenge is preserving nerve function so that the eyes, hands or feet are not "at risk" of further damage and complications.  For those who have "Protective Loss", the challenge is preventing further damage.

 

 

Linda

Linda F. Lehman, OTR/L MPH C.Ped

Technical Director, Programs

American Leprosy Missions

One ALM Way, Greenville, South Carolina 29601 USA

R. Castelo de Alenquer 390 Apt 302  Belo Horizonte, MG 31330-050 BRASIL

BRASIL Direct:  +55 31.3476.6842  +55 31.9637.5576

 

llehman@leprosy.org | www.leprosy.org

 

---

LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com