19.5.3  Disability

Disability in leprosy is an inability to perform some or all of the tasks of daily life. The disabilities associated with leprosy are mainly due to nerve damage. As you learned in Study Session 18, some nerves are responsible for the movement of the hands or feet or closure of the eyelids; others signal the sensation of pain, hotness or coldness, or trigger sweating in the skin. When leprosy reactions go untreated for a few months, they may result in damage of nerves which control the functions of the hands, feet or eyes; you saw some examples of these in Figure 18.1 in the previous study session. Primary nerve damage can lead to complications, which in turn affects other nerves (so-called secondary nerve damage); for example:

• Dryness of skin, leading to cracked skin, which may become infected.
• Loss of sensation, which may lead to ulcers (areas of damaged infected tissue that won’t heal, usually on the legs).
• Weakness or paralysis, which may lead to ‘claw’ fingers or toes.

You should watch out for reduced skin sensation, impaired nerve function such as weakness in the hands or feet and/or eye closure, which you can detect using simple observation and history-taking; you learnt about voluntary muscle tests (VMTs) and sensation tests (STs) in Study Session 18. Where you see such indications of damage, refer the patients to the clinician for advice on how to manage them. You can prevent primary nerve damage by early diagnosis, prompt and adequate treatment and by regular VMTs and STs. Secondary complications can be prevented by teaching patients how to carry out self-care, which we will discuss in more detail shortly.