Degree of disability, pain levels, muscle strength, and electromyographic function in patients with Hansen's disease with common peroneal nerve damage

Abstract

Introduction: This study evaluated the degree of disability, pain levels, muscle strength, and electromyographic function (RMS) in individuals with leprosy. Methods: We assessed 29 individuals with leprosy showing common peroneal nerve damage and grade 1 or 2 disability who were referred for physiotherapeutic treatment, as well as a control group of 19 healthy participants without leprosy. All subjects underwent analyses of degree of disability, electromyographic tests, voluntary muscle force, and the Visual Analog Pain Scale. Results: McNemar's test found higher levels of grade 2 of disability (∆ = 75.9%; p = 0.0001) among individuals with leprosy. The Mann-Whitney test showed greater pain levels (∆ = 5.0; p = 0.0001) in patients with leprosy who had less extension strength in the right and left extensor hallucis longus muscles (∆ = 1.28, p = 0.0001; ∆ = 1.55, p = 0.0001, respectively) and dorsiflexion of the right and left feet (∆ = 1.24, p = 0.0001; ∆ = 1.45, p = 0.0001, respectively) than control subjects. The Kruskal-Wallis test showed that the RMS score for dorsiflexion of the right (∆ = 181.66 m·s -2 , p = 0.001) and left (∆ = 102.57m·s -2 , p = 0.002) feet was lower in patients with leprosy than in control subjects, but intragroup comparisons showed no difference. Conclusions: Leprosy had a negative influence on all of the study variables, indicating the need for immediate physiotherapeutic intervention in individuals with leprosy. This investigation opens perspectives for future studies that analyze leprosy treatment with physical therapeutic intervention.

Avaliação Eletromiográfica Em Pacientes Portadores De Hanseníase Com Quadro De Neuropatia Periférica

“…Esses dados vão de encontro a um estudo recente de Veras [9], que encontrou níveis diminuídos de sinais eletromiográficos no músculo tibial anterior quando comparando portadores de hanseníase e indivíduos saudáveis. Outros estudos eletromiográficos prévios que avaliaram músculos do membro inferior em pacientes com hanseníase também verificaram redução de atividade muscular na maioria dos casos, nos quais 77,5% apresentavam algum sinal de denervação [14][15][16][17][18].…”

“…Por isso, um exame adequado da função neuromuscular é necessário para a melhor indicação de tratamento [9]. A eletromiografia de superfície, que é um instrumento de avaliação clínica e cinesiológica da função muscular, tem mostrado ser uma nova e avançada tecnologia para quantificar a atividade de trabalho muscular [10].…”

Interpretation of Nerve Conduction Study in Polyneuropathy With Multibacillary Leprosy Type 2 Reaction

“…3 Terminologi reaksi digunakan untuk menggambarkan keadaan mengenai berbagai gejala dan tanda radang akut lesi pasien kusta. 1,6 Berbagai faktor yang dianggap sering mendahului timbulnya reaksi kusta antara lain: setelah pengobatan antikusta yang intensif, infeksi rekuren, pembedahan, stres fisik, imunisasi, kehamilan, dan saat-saat setelah melahirkan. 1 Ada dua tipe reaksi menurut hipersensitivitas yang menyebabkannya, yaitu reaksi lepra tipe 1 disebabkan oleh hipersensitivitas selular dan reaksi lepra tipe 2 disebabkan oleh hipersensitivitas humoral.…”

“…6 Kerusakan saraf dianggap masih reversibel apabila terjadi kurang dari 6 bulan. 3 Oleh karena itu, dibutuhkan evaluasi rutin fungsi saraf selama pengobatan reaksi untuk mendeteksi hilangnya fungsi saraf akibat reaksi.…”

“…Penggunaan steroid ditujukan memperbaiki kerusakan saraf, sekaligus memperbesar kebutuhan akan evaluasi fungsi neural secara periodik, sehingga dapat meningkatkan prognosis dan kualitas kehidupan pasien lepra. 6 Pada prinsipnya penanganan reaksi kusta terutama ditujukan untuk mengatasi neuritis untuk mencegah agar tidak berkelanjutan menjadi paralisis atau kontraktur, secepatnya dilakukan tindakan agar tidak terjadi kebutaan bila mengenai mata, membunuh kuman penyebab agar penyakitnya tidak meluas, dan mengatasi rasa nyeri. Prinsip pengobatan meliputi pemberian obat antireaksi, istirahat atau imobilisasi, analgetik dan sedatif untuk mengatasi rasa nyeri, serta obat antikusta diteruskan.…”