(LML) Effectiveness of sensory re-education in leprosy

 

Leprosy Mailing List – April 1,  2014 

Ref.:   (LML) Effectiveness of sensory re-education in leprosy

From:  Piet Both, the Netherlands

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Dear Dr Schreuder,

I have read the mails re ‘effectiveness of sensory re-education in leprosy’ with much interest. I suppose that this is about loss of sensation of short duration for which anti-inflammatory treatment can and has been effective, to such an extent that sensation has been restored, but with altered perception.

I am interested in this because it clearly shows that a practitioner like Karthikeyan G. goes beyond restoring sensation. He (or she?) has not stopped after having done ST’s and has not let the patient go home without asking: but what do you feel?

Do I understand this well?

And I am interested because I was recently reminded to how important that loss of sensation must be.

One of our colleagues, while developing a course in leprosy, introduces in the curriculum the idea of losing the pleasure of touch when sensation in hands or feet is lost.

The idea that a parent can not feel the skin of a new-born baby and not experience the pleasure of that touch; to not be able to feel your own skin and play with your fingers and curls (if you have any); to not be able to feel the texture of the different textile at a market and therefore not enjoy the pleasure of choosing what clothe one likes most; not being able to feel the soil and plants you are working with!  And so on. In a chapter of 'Fearfully and Wonderfully made' (by Dr Paul Brand and Philip Yancey) I came across a chapter in which Paul Brand expressed his fear about losing that capacity to enjoy feeling. How he feared never be able to feel the soil, the dew etc. Fortunately for him it was a fear only under a specific circumstance and the joy of feeling came back.

To recover sensation after nerve injury should be of highest importance (early detection of nerve damage and adequate treatment); sincere interest in what one feels after recovery and attempts to sensory re-education seems of equal importance.

I have not heard very much about this sensory re-education, nor did I hear many people explain to me what loss of sensation really means to people, other than about the risks related (burns etc.) and the effect it has on handling tools (and therefore the effect on income), and how it affects activities of daily living (dressing oneself, the buttons and laces, opening a tin or bottle etc.).

Loss of sensation, and possibly also the altered sensation, contributes to the loss of much joy in life.

Any research in an attempt to improve early detection of nerve damage and adequate treatment should be applauded and apparently, if I understand well, it is important to ask the question ‘what do you feel’ after restoring sensation successfully or partially.

But then, who will ask such questions to persons affected, and can someone, who is not an occupational therapist, ‘do’ something in sensory re-education?

 

Yours sincerely,

 

Dr Piet Both

The Leprosy Mission International

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

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

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

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