(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 3,  2014 

Ref.: (LML)   WHO disability grading and the term anaesthesia

From:  P. Narasimha Rao, Hyderabad, India

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Dear Pieter,

While interacting with Post graduate students of Dermatology,  there was an interesting discussion on WHO disability grading and its criteria. I would like to bring the same to the attention of our members.

WHO disability grading 1998 (Lepr rev 2003;74:366-73), in part,  states as follows

-       For Hands and feet:

Grade '0' No anaesthesia, no visible deformity or damage.

Grade '1' Anaesthesia present, but no visible deformity or damage.

Grade '2 Visible deformity or damage present.

Based on the above mentioned criteria, the patient need to be tested for  “anaesthesia” as per the definition; (which means complete loss of all sensations). However, it is “hypoaesthesia’   which is often present and not ‘anaesthesia’. And ‘hypoaesthesia’ is sufficient to cause damage/ ulcerations on the affected hands and feet.

Also, in practice while testing for sensations on hands and feet by the help of SW filaments it the ‘sensory impairment’ (hypoaesthesia) which is looked for, not absence sensation.

So, would it not be proper if the term anaesthesia is replaced by ‘hypoaesthesia’ in this grading system?

I invite and seek opinion of fellow LML friends on this.

 

With best regards, 

 

P. Narasimha Rao, MD, D.D, PhD

 

Prof of Dermatology,

Bhaskar Medical college, 

Hyderabad, India

 

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

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

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