Leprosy and disability

This paper "will seek to open and begin to address the following questions: Is self-care a valid option?; Why don’t people adhere to self-care advice?; What can be learned from people who do adhere to self-care practices?; How can lessons be applied to affect better results in future?"
Leprosy Review, Vol 78, Issue 1

This paper provides an update on community based rehabilitation for leprosy practitioners
Leprosy Review, Vol 79, Issue 1

The booklet is intended for persons affected by leprosy, their close family members and friends who can help them practice self-care at home
SEA/GLP/2007.2

"This guide is intended for all health workers who may have to manage the complications of leprosy. It contains practical advice on how to recognise leprosy reactions and give the correct treatment. Also included is advice on referral of reactions and specialist treatment"

"Manual muscle strength testing has an important function in the management of leprosy patients. Its importance was first recognized in the 1960s, especially when following patients who were started on steroid treatment to monitor the nerve function and the effect of treatment. In those days, and still in many centres today, many or all muscles were tested that are innervated by the nerves that can be at risk in leprosy. The author argues that not all muscles innervated by the nerves at risk need to be tested and also that many muscles cannot be tested in isolation. A muscle charting form is presented which is suitable for screening purposes, and that also allows for more detail when motor function is impaired"
Leprosy Review, Vol 71, Issue 3

This paper explores risk factors for participation restrictions experienced by people affected by leprosy. The objective was to develop a screening tool to identify individuals at risk. An initial round of qualitative fieldwork in eight centres in Nepal, India and Brazil identified 35 potential risk factors for participation restriction. This was further assessed through quantitative fieldwork in six centres in India and Brazil. In all, 264 individuals receiving leprosy treatment or rehabilitation services made a retrospective assessment of their status at time of diagnosis. Their level of participation restriction was assessed using the Participation Scale, and regression analysis identified risk factors for participation restriction. Four consolidated items were identified as the basis for a simple screening tool to identify individuals at risk: physical impact of leprosy, an emotional response to the diagnosis, female gender and having little or no education. Such a tool may form the basis for a screening and referral procedure to identify newly diagnosed individuals at risk of participation restrictions and the need of actions that may prevent such restrictions
Leprosy Review, Vol 76, Issue 4

"This paper reflects on the current emphases in the domain of prevention of disability (POD). A review of literature is presented and issues relating to the challenges that affect POD, in the changing scenario of services for leprosy-affected people are considered"
Leprosy Review, Vol 78, Issue 4

"The paper discusses the WHO grading in the light of its dual use: as an indicator for early case detection and as an indicator for change in impairments. The paper presents operational definitions for the grading options"
Leprosy Review, Vol 74, Issue 4

"Leprosy-related disability is a challenge to public health, and social and rehabilitation services in endemic countries. Disability is more than a mere physical dysfunction, and includes activity limitations, stigma, discrimination, and social participation restrictions." This paper assesses the extent of disability and its determinants among persons with leprosy-related disabilities after release from multi drug treatment
Global Health Action, Vol 5

"This guide is part of a series of four Guides to reduce stigma. The guides are for all managers, health and social workers and service staff who have to deal with stigma in leprosy and other health conditions. These Guides provide evidence-based and best-practice information from different disciplines, and recommendations for field workers on how to reduce stigma against and among affected persons and in the community...The second Guide describes when and how to assess stigma using qualitative and quantitative methods and instruments. It also explains how to use the instruments"

"This guide is part of a series of four Guides to reduce stigma. The guides are for all managers, health and social workers and service staff who have to deal with stigma in leprosy and other health conditions. These Guides provide evidence-based and best-practice information from different disciplines, and recommendations for field workers on how to reduce stigma against and among affected persons and in the community...The fourth guide explains the use of counselling at a basic level in dealing with stigma. It provides an explanation on different techniques and approaches for counselling persons affected by stigma"

This study explored the perceptions of people affected by leprosy regarding impact of socio-economic rehabilitation (SER) on stigma-reduction. The study combined a quantitative questionnaire (the P-scale) with semi-structured interviews of 20 individual SER participants, five focus group discussions and 10 key informant interviews. The P-scale results showed four men suffered significant participation restrictions (scores of >12 points) in finding work and in social integration. The narratives of SER participants, focus groups and key informants showed that SER improved self-esteem, financial independence, acquisition of new skills, and access to public institutions. The authors speculate that through the pathway of improvements in economic and living conditions, SER is beginning to influence the process of social interaction, resulting in positive attitudinal change towards SER participants. The subjective opinions of interviewees suggest that improved self-esteem, positive family and community support for SER participants and increasing participation in community activities are indications of stigma-reduction.

Asia Pacific Disability Rehabilitation Journal, Vol 18, No 2

This resource provides a manual and related scale to measure (social) participation for use in rehabilitation, stigma reduction and social integration programmes
Note: Contact the author or ILEP for further information

"These community-based rehabilitation (CBR) guidelines are applicable to all disability groups. However, the need was identified for a supplementary booklet to highlight a number of issues which CBR programmes have historically overlooked, i.e. mental health problems, HIV/AIDS, leprosy and humanitarian crises...CBR is a strategy for community-based inclusive development which takes into account the principles of the Convention on the Rights of Persons with Disabilities, e.g. non-discrimination and the need to include all people with disabilities in development initiatives. Therefore, it is important that CBR programmes take steps to address issues which they have traditionally excluded, such as mental health problems, HIV/AIDS, leprosy and humanitarian crises. While these four issues have been chosen for inclusion in this booklet, CBR programmes are encouraged to think broadly about other issues (e.g. CBR and children, CBR and ageing) that are particularly relevant in their communities and which may be included in future editions of the guidelines"

"The present literature review identified 29 reports from 22 countries in Asia, Africa and Central America reporting on the outcomes of rehabilitation-in-the-community programmes in low and middle income countries published between 1987 and 2007. Interventions included home visits by trained community workers who taught disabled persons skills to carry out activities of daily living, encouraged disabled children to go to school, helped find employment or an income generating activity, often involving vocational training and/or micro-credit. Many programmes had a component of influencing community attitudes towards disabled persons. The information collected shows that such programmes were effective in that they increased independence, mobility and communication skills of disabled persons, helped parents of disabled children to cope better and increased the number of disabled children attending schools. Economic interventions effectively increased the income of disabled persons although they rarely made them financially independent. CBR activities result in social processes that change the way community members view persons with disabilities, increase their level of acceptance and social inclusion and mobilise resources to meet their needs"
Leprosy Review, Vol 79, Issue 1

This article explores the global trends in disability rehabilitation and the implications for leprosy programmes. It provides a brief summary the Biwako Millennium Framework of the Asia and Pacific decade to gain a better understanding of current issues and the implications for leprosy rehabilitation programmes
Leprosy Review, Vol 79, Issue 1

"In this paper, the common surgical procedures (of neuropathic conditions of the hand) are discussed. The procedures for uncomplicated neurologically impaired hand with paralysis of ulnar, median or radial nerve paralysis will be discussed first, followed by surgical interventions for the impairments that may have developed secondary to the paralysis or the surgery. Recommendations for best practice and further research will be given"
Leprosy Review, Vol 77, Issue 4