(LML) WHO disability grading and the term anaesthesia

Leprosy Mailing List – August 15,  2014 

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

From:  Linda Lehman, Belo Horizonte, Brazil

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Dear Pieter,

 

I have enjoyed the discussions.  We have come a long way in better clarifying and defining the WHO grading criteria which will hopefully produce better consistent data allowing comparisons within countries and between countries.  I agree with Wim Brandsma that the consensus on Grade 1 needed further discussion and attention.  

 

I have three observations:

 

Grade 1 - Risk of injury (protective sensory loss)

1.  Personally knowing and speaking with Dr. Paul Brand about their original work with the Disability Grading taught me that their original criteria for Grade 1 was to identify feet and hands with a "protective sensory loss" which would put them at Risk for injury.  At that time it was touching the foot or hand with a ball point pen.  

• Today this is known to be a loss of feeling 10g on the foot as Brandsma points out but is not for the hand (Bell-Krotoski).  
• Care is needed to clearly understand that feeling the touch of a ball point pen does not mean the sensation is normal, it may not be.  However, we do know the person is at lower risk for injury.  
• Early identification of a nerve problem (before it is at a level of protective loss) is ideal, so interventions can be started earlier and return the nerve to normal or near normal function in which protective sensation is preserved. This is obtained by carefully evaluating and monitoring routinely nerve function (sensory & motor)

Training & Supervision

2.  Brasil defined the WHO grades more clearly, including defining what would be Grade 1 in 1997. Extensive work was done for about 5-7 yrs to try and help people learn the criteria and use it consistently.  Extensive practical training and supervision helped to increase the percent of new cases with Disability Grading evaluated at diagnosis and now at the end of MDT.  Also the quality improved.  However one thing observed is if there is not repeated training which includes practice with patients, good supervision checking on the Grading, the quality can deteriorate and inconsistencies begin again.

 

Hopefully each country will carefully give attention to the Disability Grading in their training and supervision activities so that the quality improves and is sustained.

 

3.  Further work is needed to help people understand and know how to use the results of the Disability Grading at the national program level down to the local patient care level.  Perhaps further discussion can be continued on this point.

 

Best regards.

Linda

 

 

 

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

Senior Advisor for Morbidity Management & Disability Prevention

 

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

USA:  +1 505 504 8749

 

llehman@leprosy.org | www.leprosy.org

 

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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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