Effect of a physical therapy program analyzing the neurological state, pain and activity limitation in leprosy neural injury: a clinical trial
DOI:
https://doi.org/10.1590/Keywords:
Leprosy, Neuropathy, Physical therapy, Pain, DisabilityAbstract
Leprosy affects peripheral nerves and leads
to neural damage, physical disabilities, and functional
impairments. Physical therapy has emerged as a crucial
component in managing patients living with leprosy, offering
various treatment modalities, including neural mobilization,
stretching, and joint mobilizations. This study aimed to evaluate
the effects of physical therapy on the neural status, pain, and
functionality of patients with neural damage due to leprosy.
This clinical trial selected 40 patients living with leprosy with
neural damage. Simplified neurological examinations (SNE)
were performed to assess neural palpation, muscle strength,
and sensitivity. Pain intensity was measured using the visual analog scale (VAS) and functionality was evaluated using the
screening of activity limitation and safety awareness (SALSA) scale.
Participants underwent a three-week physical therapy intervention.
Techniques such as stretching, Cyriax transverse massage, pumping,
joint mobilizations, myofascial release, and neural mobilization
were employed to improve pain, joint mobility, and neural impulse
conduction. The data showed improved palpation, muscle strength,
and sensitivity, particularly in the posterior tibial nerve. Pain intensity
decreased after the intervention (6.4±2.5 before and 5.3±2.9 after
physical therapy treatment, p<0.004). The SALSA scale showed
a reduction in functional limitations, from 25% to 17.5% in severe
limitations. However, the disability score failed to significantly change
(1.2±0.08 before and 1.2±0.09 after, p<0.999). Physical therapy
effectively enhanced neural status, reduced pain, and improved
functionality in patients living with leprosy and neuritis. This study
also shows the importance of the VAS, SALSA, and SNE scales in
evaluating patient improvement.
Downloads
References
Eichelmann K, González González SE, Salas-Alanis JC, Ocampo-
Candiani J. Leprosy. An update: definition, pathogenesis,
classification, diagnosis, and treatment. Actas Dermosifiliogr.
;104(7):554-63. doi: 10.1016/j.adengl.2012.03.028
Kubota RMM, Brancini VCL, Gouveia AS, Nardi SMT, Paschoal
VDA, et al. Adverse effects of multidrug therapy for leprosy:
use of alternative doses and post discharge evaluation. Hansen
Int. 2014;39:8-21. doi: 10.47878/hi.2014.v39.35024
Queiroz TA, Carvalho FPB, Simpson CA, Fernandes ACL,
Figueirêdo DLA, et al. Perfil clínico e epidemiológico de
pacientes em reação hansênica. Rev Gaúcha Enf. 2015;36:185-
doi: 10.1590/1983-1447.2015.esp.57405
Ministério da Saúde (Brasil). Orientações para uso
corticoesteroides em Hanseníase. Normas e Manuais Técnicos
[Internet]. Brasília: Ministério da Saúde; 2010 [citado 12 Ago 2021].
Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/
orientacoes_para_corticosteroides_hanseniase.pdf
Pimentel MIF, Nery JAC, Borges E, Rolo R, Sarno FN. Neurite
silenciosa na hanseníase multibacilar avaliada através
da evolução das incapacidades antes, durante e após a
poliquimioterapia. An Bras Dermatol. 2004;79(2):169-79.
doi: 10.1590/S0365-05962004000200005
Pereira Junior NS, Almeida RM. Manual de recursos terapêuticos
manuais. João Pessoa: UFPB; 2016.
Reis BM, Fernandes LFRM. Association between the Rosén
and Lundborg Score and the Screening Activity Limitation and
Safety Awareness scale in hand functional evaluation of patients
with leprosy diagnosis. Disabil Rehabil. 2019;41(13):1578-83.
doi: 10.1080/09638288.2018.1432708
Martins RL, Albuquerque APF, Holanda AL, Pacas ASS, Galdino
DMC, et al. Intervenção fisioterapêutica nos comprometimentos
da hanseníase. Br J Health Rev. 2021;4(1):983-90.
doi: 10.34119/bjhrv4n1-086
Diaz AF, Moro FL, Binotto JM, Fréz AR. Estudo comparativo
preliminar entre os alongamentos proprioceptivo e estático
passivo em pacientes com sequelas de hanseníase. Fisioter Pesqui.
;15(4):339-44. doi: 10.1590/S1809-29502008000400004
Véras LS, Vale RG, Mello DB, Castro JA, Lima V, et al.
Electromyography function, disability degree, and pain in
patients living with leprosy undergoing neural mobilization
treatment. Rev Soc Bras Med Trop. 2012;45(1):83-8.
doi: 10.1590/s0037-86822012000100016
Tiago LMP, Barbosa MFF, Santos DFD, Faria AD, Gonçalves
MA, et al. Late follow-up of peripheral neural decompression in
leprosy: functional and clinical outcomes. Arq Neuropsiquiatr.
;79(8):716-23. doi: 10.1590/0004-282X-ANP-2020-0032
Seijas G. Anatomia e alongamentos essenciais. São Paulo:
Ed. Manole; 2015.
Kysner C, Colby LA. Exercícios terapêuticos – fundamentos e
técnicas. 6a ed. São Paulo: Manole; 2015.
Lederman E. Fundamentos da terapia manual – fisiologia,
neurologia e psicologia. São Paulo: Manole; 2001.
Maitland GD. Treatment of the glenohumeral joint by passive
movement. Physical therapy. 1971;57(6):261-7.
Ministério da Saúde (Brasil). Manual de prevenção de
incapacidades [Internet]. Brasília: Ministério da Saúde; 2008
[citado 12 Ago. 2021]. Disponível em: https://bvsms.saude.gov.
br/bvs/publicacoes/manual_prevencao_incapacidades.pdf
Butler D. Mobilização do sistema nervoso. São Paulo:
Manole; 2003.
Pereira Júnior AA, Schons DG. Os efeitos da mobilização
neural em pacientes com lombalgia. Fisioter Saude Func.
;4(2):14-20.
Galvão O, Silva MG. Validade e fidedignidade preliminares
da EVA modificada para a população idosa. EssFisi Online.
;1(4):22-30.
Sousa JB, Carqueja CL, Baptista AF. Physical rehabilitation
to treat neuropathic pain. Rev Dor. 2016;17(Suppl 1):S85-90.
doi: 10.5935/1806-0013.20160056
Santos VS, Santana JC, Castro FD, Oliveira LS, Santana JC,
et al. Pain and quality of life in patients living with leprosy in
an endemic area of Northeast Brazil: a cross-sectional study.
Infect Dis Poverty. 2016;5:18. doi: 10.1186/s40249-016-0113-1
Scollard DM, Truman RW, Ebenezer GJ. Mechanisms of
nerve injury in leprosy. Clin Dermatol. 2015;33(1):46-54.
doi: 10.1016/j.clindermatol.2014.07.008
Manivannan G, Das P, Karthikeyan G, John AS. Reconstructive
surgery in children to correct ulnar claw hand deformity due
to leprosy. Lepr Rev. 2014;85(2):74-80. doi: 10.47276/lr.85.2.74
Souza MV, Silva MO. Laserterapia em afecções locomotoras: revisão
sistemática de estudos experimentais. Rev Bras Med Esporte.
;22(1):76-82. doi: 10.1590/1517-869220162201144326
Stasinopoulos S, Johnson MI. Cyriax physical therapy for tennis
elobow/lateral epicondylitis. Br J Sports Med. 2004;38(6):675-7.
doi: 10.1136/bjsm.2004.013573
Rath S, Schreuders TA, Stam HJ, Hovius SE, Selles RW. Early
active motion versus immobilization after tendon transfer for
foot drop deformity: a randomized clinical trial. Clin Orthop
Relat Res. 2010;468(9):2477-84. doi: 10.1007/s11999-010-1342-4
Nascimento DDS, Ramos Junior AN, Araújo OD, Macêdo SF, Silva
GVD, et al. Activity limitation and social participation restriction
of people with leprosy: a cross-sectional analysis of magnitude
and associated factors in a hyperendemic municipality in
the state of Piauí, Brazil, 2001-2014. Epidemiol Serv Saude.
;29(3):e2019543. doi: 10.5123/s1679-49742020000300012
Barbosa JC, Ramos Jr AN, Alencar MJF, Castro CGJ. Pós-alta
em hanseníase no Ceará: limitação da atividade funcional,
consciência de risco e participação social. Rev Bras Enf.
;61:727-33. doi: 10.1590/S0034-71672008000700012
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Vanessa Matias Souza Duarte, Dinorá Simone Santi Bonazza, Cor Jesus Fernandes Fontes, Amílcar Sabino Damazo
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
