Brandsma and Van Brakel proposed operational criteria for impairment in leprosy to improve application of the WHO grades. The authors are from the Green Pastures Hospital and Rehabilitation Centre in Nepal and the KIT Leprosy Unit in Amsterdam.
WHO impairments in leprosy:
(1) for hands and feet
(2) for eyes
Parameters for hands and feet:
(1) sensory impairment
(2) visible impairment
(3) skin ulcers
(4) muscle weakness
(5) skin cracks
(6) muscle atrophy
(7) reconstructive surgery
Parameter
Grade 0
Grade 1
Grade 2
sensory impair
absent
present
present
visible impairment
absent
absent
present
skin ulcers
healed scars with intact sensation
healed scars without intact sensation
present
muscle weakness
none
without clawing
with clawing
skin cracks
none or minor
moderate
severe
muscle atrophy
none
mild
moderate to severe
reconstructive surgery
NA
successful
unsuccessful
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