SOME ORTHOPEDIC ASPECTS OF SOCIAL RECOVERY IN LEPROSY

Abstract

In recent years, a substantial number of leprosy patients have been rehabilitated to Society from the hospital, due to the fact that it is now possible to arrest the disease, and then, to give orthopedic treatment for disturbance of function and malformation of extremities. However, social rehabilitation involves many difficulties peculiar to this ldisease.
Let me report on our research of rehabilitation of patients in the National Leprosarium Kikuchi Keifu-en. First, in regard to the number of patients studied, 168 patients were rehabilitated to society from the Leprosarium between the years 1956 and 1961, especially after 1959.
The disfunction and malformation of the extremities begins with paralysis and follows the pathological changes of leprosy.
We must start physical therapy as soon as possible, as the prevention and treatment of this condition. But, if we do not get satisfactory results from this therapy, we must use surgical procedures, for example, tendon-transfer, hinter arthrolysis and so on.
Not only to know the condition of muscles, bones and joints, but also to understand the daily living requirements of the individual person is a very important surgical consideration. If we do not investigate these conditions, we can not achieve satisfactory function for daily life.
The improvement of function of the hand is the most important in making daily life easier.
The findings of rentgengram of amputated leg are very important for the application of prothesis, because of rescorption, atrophy and addition of bone.
The fixed drop lip due to the paralysis of the facial nerve may be treated by surgery, for example, rhytidectomy, Z-plastic, transplantation of fascia and transfer of muscle. Especially, the transfer of m. masseter or m. temporalis is useful for improvement of function of the lip, since there are no pathological changes in electromyogram of these muscles.
The problem of personality in leprosy is very important for social recovery, the same as in the case of crippledness. The observation of personality tells us that the patients are very different compared with healthy persons in regard to somatic inferiority complex.
1) They have somatic inferiority complex even without the malformation or disfunction of extremities. 2) They have deep inferiority complex with cosmetic difficulties in the face. 3)Child patients have no somatic inferiority complex, in spite of severe disfunction of extremities.Conclusions
I) The morbid condition of the patient, which impedes social recovery, must be treated not only somatically, but psychologically.
a) Comprehensive staff and equipment for rehabilitation must be secured.
b) The patient's motivation to fight against the disease must be improved.
c) Disorder of extremities in childhood should be treated as soon as possible.
II) Society must be orientated to accept patients so that their social recovery is possible.
a) Correct understanding of the disease.
b) Improvement of equipment for daily life.