Leprosy Mailing List – December 2, 2021
Ref.: (LML) Detection of nerve damage in leprosy and timely treatment
From: Wim Theuvenet, Apeldoorn, the Netherlands
Dear Pieter,
Thank dr. Naafs so much for his valuable comments (LML, November 29, 2021) and perhaps of these his most important recommendations:
"Record everything carefully. You can use a ready-made form or mention the deviations in your notes. All this can be done in 5-10 minutes. When he/she comes in, talk to the patient after you have prepared by reviewing your notes about the patient. Talk not only about the disease but about his or her family, work and problems too. Take personal notes (these are private between you and the patient). In this way, an increase in nerve damage can be detected early and the action is timely. The patient can get better instead of worse under your care, what happens too often nowadays" .
Also because of these holistic observations he is one of the most appreciated leprologists within our global horizon!!
On a more technical level;
- For the Neurosensory Testing with the Semmes Weinstein Monofilaments:
In my personal practise I daily use the Semmes Weinstein Monofilants as supplied by North Coast Medical (https://www.ncmedical.com/live_search.php?q=semmes)
When using these please take into consideration that temperature and humidity can strongly influence the bending force of each filament, this far more than the age of the set.
- For the Neurosensory Testing in an even more advanced way (research setting) with the PSSD as developed by Prof. Lee Dellon: (https://tucsonfoot.com/wp-content/uploads/2019/02/neuro_testing.pdf)
- For the Intrinsic Muscle Strength Assessment dr. Ton Schreuders has developed an impressive apparatus called the RIHM (https://pubmed.ncbi.nlm.nih.gov/15043908/)
- Extrinsic Muscle Strength Testing should fall within the routine skills of every Physiotherapist, Occupational therapist and anyone who deals with peripheral neuropathies.
Peripheral Muscle Nerve Testing is an important part of "The Surgical and Physiotherapy Training Courses" in leprosy that dr. Ton Schreuders, dr. Indra Napit and myself regularly conduct abroad, but which are also routinely given in e.g., many TLM Centres in India, Nepal etc.
In these courses we always start with a section on the early detection, prevention and treatment of nerve function loss.
In the field leprosy budgets are limited, one will have to deal with limited resources, but with proper training it indeed should be possible to improve on the prevention of nerve damage in leprosy!
And indeed, we advocate as recommend that one starts with:
"Talk not only about the disease but about his or her family, work and problems too! "
With Best regards, and please stay healthy,
"Worried too!"
Wim Theuvenet
Willem J.Theuvenet, M.D., Ph.D
Plastic, Reconstructive and European Certified Hand Surgeon
Consultant for TLMI and the NLR
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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