Assistive technologies for improving the oral hygiene of leprosy patients residing in a former leprosy colony in Betim, Minas Gerais, Brazil.

BACKGROUND: This study deals with management of a group of elderly patients with a history of leprosy and hand deformities by a multidisciplinary team of dentists and occupational therapists. Assistive technology devices have been developed to allow such patients to obtain independence in oral self-care and can be a cost-effective approach to improving oral care in this population. The objective of this study was to describe the development of assistive devices to facilitate daily oral hygiene in older people with enduring leprosy-related impairments. METHODOLOGY: Case study realized among elders with a history of leprosy residents in a former isolation colony in Betim, Minas Gerais, Brazil. The elders were evaluated for dependence on others for denture hygiene and mouthwash using the Daily Oral Hygiene Activity Index (ADOH). Those deemed partially or completely dependent on others were eligible for an intervention based on assistive technology. We adopted a personalized approach to each case, taking into account medical history, physical impairment and living environment. Six months after the intervention, the participants were assessed again using the ADOH and an unstructured interview about use of the devices. PRINCIPAL FINDINGS: Assistive devices for denture hygiene and mouthwash were developed for 16 elders. These devices facilitated oral hygiene in most patients and there was no worsening in any of the cases. Patients' report suggested they were satisfied with the devices provided. CONCLUSIONS: This study demonstrated that assistive devices can facilitate oral hygiene activities in leprosy patients. It also reinforces the importance of using a multidisciplinary team for the rehabilitation of these patients.

Desempenho funcional de pacientes com deformidades visíveis na hanseníase / Functional performance of patients with visible deformities in leprosy

Esse estudo tem por objetivo avaliar a capacidade funcional da mão das pessoas atingidas pela hanseníase na realização das atividades básicas e instrumentais da vida diária. A amostra foi constituída por 50 pacientes, maiores de 18 anos, que estavam sendo acompanhados no ambulatório do Instituto Lauro de Souza Lima. Para avaliação das características sociodemográficas e clínicas foi elaborado um questionário próprio. As dificuldades manuais para realizar atividades nas áreas de vestuário, alimentação, higiene pessoal, cuidados com a casa, escrita e outros foram avaliados por meio da Avaliação Funcional das Mãos em Hanseníase. Os resultados demonstram que em todas as atividades houve algum grau de dificuldade, porém, a maioria dos pacientes as realiza com independência. As atividades consideradas mais difíceis de serem executadas pelos pacientes com garra ulnar foram: pegar objetos pequenos em superfície plana, abrir/fechar fecho de corrente e cortar unhas. Na população de pacientes com garra ulnar/mediano foram: pegar objetos pequenos em superfície plana, abotoar/desabotoar, dar laço/ amarrar cadarço e abrir/fechar fecho de corrente. As atividades são realizadas com algum grau de dificuldade, porém, com independência pela maioria dos indivíduos que tem ou tiveram hanseníase e apresentam deformidades visíveis. Muitas dessas dificuldades podem ser minimizadas por meio de transferências tendinosas ou pela indicação, confecção e uso de tecnologia assistiva(AU).

This study aims to assess the functional capacity of the hand of people affected by leprosy in carrying out basic and instrumental activities of daily living. The sample consisted of 50 patients, aged over 18, who were being followed up at the outpatient clinic of the Instituto Lauro de Souza Lima. A questionnaire was developed to assess sociodemographic and clinical characteristics. Manual difficulties in carrying out activities in the areas of clothing, food, personal hygiene, home care, writing and others were assessed through the Functional Hand Assessment in Leprosy. The results show that in all activities there was some degree of difficulty, however, most patients perform them independently. The activities considered most difficult to be performed by patients with an ulnar claw were: picking up small objects on a flat surface, opening / closing the chain clasp and cutting nails. In the population of patients with an ulnar / median claw were: picking up small objects on a flat surface, buttoning / unbuttoning, looping / tying shoelaces and opening / closing chain fastening. The activities are performed with some degree of difficulty, however, independently by the majority of individuals who have or have had leprosy and have visible deformities. Many of these difficulties can be minimized by means of tendon transfers or by the indication, preparation and use of assistive technology(AU).

The influence of assistive technology on occupational performance and satisfaction of leprosy patients with grade 2 disabilities.

INTRODUCTION:: We aimed to investigate the feasibility of assistive technology (AT) devices to improve leprosy patients' occupational performances and satisfaction. METHODS:: This is a pretest-posttest design study. The Canadian Occupational Performance Measure was used to assess the occupational performance and satisfaction of five leprosy participants with grade 2 disabilities before and after ten 45-minute interventions using assistive technology devices. RESULTS:: The data showed a statistically significant 7-point average improvement (p<0.05) in participants' post-intervention performance and satisfaction scores. CONCLUSIONS:: Assistive technology devices may be useful therapeutic tools to enhance autonomy/independence and satisfaction of leprosy patients with grade 2 disabilities.

The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy.

BACKGROUND: This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. METHODS: A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. FINDINGS: Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. CONCLUSIONS: Assistive technology empowers the subject to perform care of the self and promotes social inclusion.

O uso da tecnologia assistiva no resgate da autonomia de pacientes com sequelas da Hanseníase / The use of assistive technology in the rescue of the autonomy of patients with sequelae of leprosy

Trata-se de um estudo sobre a abordagem da terapia ocupacional em nível de reabilitação em saúde, cujo foco é a autonomia de pacientes com sequelas da hanseníase. Constituem temas desta pesquisa: a adoção da tecnologia assistiva no processo de cuidado, a subjetividade, a autonomia do cliente. Os objetivos: descrever a repercussão da tecnologia assistiva na autonomia do sujeito; analisar a relação entre sujeito e tecnologias no processo de cuidado. Quanto ao método, o estudo qualitativo, cujas técnicas foram entrevista semiestruturada e observação participante. O cenário do estudo foi o Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. A pesquisa foi realizada no período de novembro/2014 a fevereiro/2015. Foram entrevistados oito clientes que se tratam no serviço de Terapia Ocupacional. O tipo de análise escolhido foi hermenêutica do sujeito. Quanto aos resultados, três categorias foram descritas e discutidas sendo elas: a contribuição dos dispositivos nas suas rotinas e no cuidado de si; os sentimentos e sensações gerados pelo uso dos instrumentos adaptados e por fim, a percepção do cuidado recebido pelos profissionais de saúde. Conclui-se que tecnologia assistiva representa uma ferramenta com potencial transformador no resgate de possibilidades, através desta, é possível instrumentalizar o sujeito para o exercício do cuidado de si e promover inclusão social. Constatamos ainda, que os participantes deste estudo, percebem o cuidado recebido em nosso serviço como acolhedor, sensível e competente

This is a study on the approach of occupational therapy at the level of health rehabilitation, which focuses on the autonomy of patients with leprosy sequelae. Are themes of this research: the adoption of assistive technology in the care process, subjectivity, customer autonomy. The goals: to describe the impact of assistive technology in the autonomy of the subject; analyze the relationship between subject and technologies in the care process. A far as a qualitative study was preferred, the techniques used were semi-structured interview and participative observation. Having been made in the University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, the research was performed between November/2014 and February/2015. Eight patients under treatment in the Occupational Therapy Service were interviewed. The kind of analysis chosen was the hermeneutics of the subject. As for the results, three categories were described and discussed. They are: the contribution of the devices in the patients´ routine and in self-care; the feelings and sensations arosen by the use of adapted instruments; and, finally, the patient's perception about the health professional's care. It is concluded that assistive technology is a potential tool with transformer in the rescue possibilities, through this; you can equip subject to the exercise of self-care and promote social inclusion. We note also that the study participants perceive the care received in our service as warm, sensitive and competent

A utilização da tecnologia assistiva para alimentação na melhora do desempenho ocupacional de hansenianos com mão em garra / Feeding using assitive technology in the improvement of occupational performance of leprosy patients with claw hand

A hanseníase é uma doença infecciosa crônica, granulomatosa, de curso lento, causada pelo Mycobacterium Leprae. A doença causa lesões na face, mãos e pés, que podem gerar incapacidades físicas severas que contribuem para a instalação de padrões deformantes e incapacitantes. A lesão do tipo mão em garra é uma sequela que pode ser observada em pacientes com lesões ao nível dos membros superiores sendo muito incapacitante, dificultando a realização das Atividades de Vida Diária destes indivíduos e consequentemente prejudicando sua qualidade de vida e satisfação pessoal. A intervenção terapêutica ocupacional utilizando a tecnologia assistiva de baixo custo para auxílio nas atividades de vida diária de pacientes com mão em garra objetiva a minimização dos déficits motores e de destreza manual. Desse modo, este estudo objetiva demonstrar a autopercepção dos pacientes acerca da melhora do seu desempenho na atividade de alimentação após uso da adaptação funcional. Efetuou-se aplicação do protocolo da Medida Canadense de Desempenho Ocupacional antes e após 10 intervenções de treino com adaptação para atividade de alimentação para avaliar a autopercepção de 20 pacientes sobre o desempenho e satisfação com a realização da Atividade de Vida Diária, observou-se que os quesitos apresentaram índices de melhora com aumento dos graus de independência, o material proposto e utilizado no estudo mostrou-se adequado para a confecção das adaptações desenvolvidas, proporcionando redução de custos, conforto e higienização. As adaptações desenvolvidas no presente estudo demonstraram resultados favoráveis, obtidos através da análise dos dados finais que apontaram significância estatística.

Leprosy is a slow course, chronic, granulomatous infectious disease caused by Mycobacterium leprae. Leprosy is a slow course, chronic, granulomatous infectious disease caused by Mycobacterium leprae. Leprosy is a slow course, chronic, granulomatous infectious disease caused by Mycobacterium leprae. The disease causes lesions on face, hands and feet,which can generate severe physical disabilities that contribute to the installation of deformities and disabling patterns. The claw hand type lesion is a sequel observed in patients with upper limbs lesions. It can be very disabling, making it difficult to the individuals to carry out their Daily Living Activities which impairs their quality of life and personal satisfaction. The occupational therapy intervention using low cost assistive technology to aid in daily living activities of patients with claw hand aims at minimizing motor and manual dexterity deficits. Thus, this study aims to demonstrate the self perception of patients about improving their feeding performance activity after use of functional adaptation. We conducted the Canadian Model of Occupational Performance protocol before and after 10 training interventions with adaptation to feeding activity to evaluate the perception of 20 patients on the Performance and Satisfaction with the performance of Daily Living Activities. It was observed that the variables showed improved indices with increase in the independence levels. The material proposed and used in this study showed to be adequate to the confection of the adaptations that were developed, which promoted reduction of costs. The adaptations developed in this study showed favorable results with statistical significance, obtained through analysis of the final data.

Assistive devices for people affected by leprosy: underutilised facilitators of functioning?

OBJECTIVES: People affected by leprosy and their families face social and economic problems. The focus of interventions is often on prevention of disabilities and socioeconomic rehabilitation. The objective of this study was to explore to what extent the potential of assistive devices to facilitate activities and participation of people affected by leprosy has been utilised. DESIGN: Published literature was reviewed and the findings analysed. RESULTS: Considerable attention has been given to the protecting role of assistive devices. The focus of assistive devices facilitating functioning has been on mobility aspects of self-care and domestic life. CONCLUSIONS: The findings indicate that the potential of assistive devices to facilitate activities and participation in life areas such as work and employment is still waiting to be utilised on a broad scale.

[Training of the rehabilitation staffs through taking measures against leprosy in Union of Myanmar].

I participated in "Leprosy Control and Basic Health Service Project in Myanmar" by JICA from 2002 to 2004. I went to Myanmar three times as a short-term expert of physiotherapy. I carried out evaluation training for physio staffs in national Yenanthar leprosy hospital. They learned how to evaluate activity of daily living. And they were able to make modified spoons and the canes. Later, they looked for the contents to evaluate by themselves. And they evaluated and decided by themselves what they should do. They felt the necessity for toilet chairs, modified beds and etc. They formed the plan and manufactured them. They were able to perform by themselves. It is thought that evaluation was fixed to staffs. This knowledge will surely be helpful to patients. I expect that this knowledge will be put to evaluations and exercises of many diseases. The physio staffs of this hospital will surely perform. Cooperation of the shoemaker and nursing staffs is very secure. I hope that it may become the model of saying [working in cooperation with other occupational descriptions] from now on.

Modulan grip-aids for leprosy patients.

Made-to-measure Modulan grip-aids were fitted to 755 articles for 155 patients with hand deformities due to leprosy. The acceptance of the grip-aids was, in general, good. No instance of contact dermatitis or skin irritation was reported. These grip-aids facilitated a normal grip with crippled hands, and thus considerably improved the quality of the patient's personal and working life. They increased the patient's self-esteem and self-confidence because he/she could handle everyday objects or tools without the help of others and could do his/her job--an important step toward social and economic rehabilitation.