While leprosy is completely curable today, many individuals continue to live with long term consequences. Ahead of World Leprosy Day (January 30), a look at how Occupational Therapy plays a central role in helping patients with rehabilitation and reintegration
- VAILANKI NAZIRA RAPOSO
Leprosy commonly affects peripheral nerves, leading to loss of sensation, muscle weakness, and deformities of the hands and feet. These impairments can make everyday activities such as cooking, dressing, writing, walking, or working unsafe and difficult. Occupational Therapy focuses on enabling individuals to perform these essential activities safely and independently, using a holistic, person-centred approach.
Preventive approach
In this approach, occupational therapists focus on preventing secondary disabilities that arise due to loss of sensation, muscle imbalance, and repeated unnoticed injuries.
Splinting: The occupational therapist provides protective and corrective splints to prevent deformities such as claw hand, foot drop, or joint contractures, and to maintain proper joint alignment.
Joint protection, skin care and sensory education: Individuals are taught on how to avoid deforming postures, excessive pressure, and unsafe handling of objects. Emphasis is placed on regular skin inspection, pressure relief, and protection of insensate areas to prevent wounds and ulcers.
Ergonomic and environmental advice: Advice is provided on modifications of home, work, and community environments to reduce the risk of injury, burns, and repeated trauma—especially during activities involving tools, heat, or prolonged weight-bearing.
Remedial approach
The remedial approach focuses on restoring function and maintaining mobility in affected limbs following nerve involvement.
Strengthening activities: These are guided activities to improve muscle strength in partially innervated muscles, helping to maintain joint stability and functional use of hands and feet.
Range of Motion (ROM) activities: Active and passive movements are used to maintain joint flexibility, prevent stiffness, and reduce the risk of contractures in hands, feet, and other affected joints.
Coordination and balance training: These involve activities to improve motor control, balance, and gait, particularly in individuals with sensory loss in the feet, reducing the risk of falls and injuries.
Adaptive approach
When permanent nerve damage or deformity is present, occupational therapy focuses on enabling independence in daily living through adaptation.
Energy conservation techniques: Individuals are taught how to pace activities, prioritise tasks, take regular rest breaks, and respect fatigue levels to manage reduced endurance and prevent overuse injuries.
Work simplification and task modification: This includes adapting methods of performing daily and vocational tasks to minimise strain, avoid excessive gripping, pressure, or repetitive movements, and promote safe productivity.
Environmental modification: The physical environment is modified to improve safety and accessibility. This involves altering kitchen layouts, seating, footwear adaptations, and use of assistive devices.
Hand rehabilitation
Hand involvement significantly impacts independence and self-identity. Nerve damage may result in weakness, stiffness, clawing of fingers, or loss of fine motor control, and could even lead to amputations of fingers. Occupational therapy interventions focus on restoring functional hand use to meaningful task-oriented activities like— eating, grooming, writing, cooking, and work-related activities — ensuring that rehabilitation is practical and relevant. Where necessary, adaptive techniques and assistive devices like build up handle spoons, brushes, combs, scrubs, universal cuffs, splinting like anti claw splints knuckle bender, static progressive splints for corrections in contracture and deformity are introduced to enhance function while preserving dignity
and self-reliance.
Foot care, mobility, and safety
Foot deformities and sensory loss can lead to ulcers, instability, and difficulty in walking. Occupational therapists guide individuals in pressure distribution techniques, footwear modification, and safe mobility strategies to reduce such complications.
Psychosocial rehabilitation and social inclusion
The impact of leprosy extends beyond physical disability. Social stigma, fear, and discrimination often result in isolation, loss of self-esteem, and emotional distress due to disfigurement. Occupational Therapy addresses these challenges by restoring structure, routine, and purpose to daily life.
Through support groups and self-help skills given by the occupational therapist, individuals are supported in reclaiming their roles within family and society.
Vocational rehabilitation
For many individuals affected by leprosy, loss of livelihood threatens independence and identity. Occupational therapists assess skills, recommend task modifications, explore alternative occupations, and support vocational retraining. Community-based rehabilitation and home visits ensure that therapy remains accessible, practical, and sustainable.
A collaborative approach
Effective leprosy rehabilitation depends on an interdisciplinary approach, where occupational therapists work alongside doctors, nurses, physiotherapists, social workers, and community teams. This collaboration ensures comprehensive care — addressing physical recovery, emotional well-being, functional independence, and social reintegration together. World Leprosy Day calls for compassion, awareness, and action. Leprosy should never define a person’s worth or limit their future. With timely treatment, rehabilitation, and community support, individuals affected by leprosy can lead independent, meaningful lives.
(The writer is an occupational therapist at Occupational Therapy OPD 17 Department of Orthopaedic Surgery, Goa Medical College & Hospital Bambolim)
