Awareness of Poliomyelitis

AWARENESS OF
POLIOMYELITIS
POLIOMYELITIS
■ This is a viral infection of the anterior horn cell of the spinal cord or
nerve cells of brainstem resulting in temporary or permanent
paralysis.
■ Common in children less than 5 years, often attacks young adults.
VIRUSES
■ Picorna group of viruses is known to cause poliomyelitis:
■ Brunhilde (type I)
■ Leon (type II)
■ Lansing (type II)
PATHOGENESIS
■ The virus is transmitted by droplet infection & through the faeco-oral

route & enters the nevous tissue and destroys the nerve cells,
anterior horn cells of the spinal cord and brainstem as a result of
which the peripheral nerve degenerates resulting in muscle & tendon
atrophy due to flaccid paralysis.
■ The bones become small, the joint capsules and ligaments become
lax as there is no protection by the healthy muscles.
■ All results in development of various deformities.
CLINICAL FEATURES
■ PREPARLYTIC:
MINOR-> 2 weeks (INCUBATION)
ILLNESS-> 2 Days (Onset) –Headache –Fever –Malaise –Neck Stiffness present
■ PARALYTIC
MINOR -> 2 months (Greatest paralysis)
 SPINAL (75%)-> Involves neck, trunk and extremities –Lower limbs affected twice
 BULBAR (25%)-> Cranial nuclei affected –Nasal intonation –Difficulty in
swallowing
2 months (Recovery) Complete or none
ILLNESS-> 2 years ( Residual) –Permanent –Mild to Severe paralysis of trunk and all
the 4 limbs
HOW DOES RECOVERY IN
POLIOMYELITIS TAKE PLACE?
■ 3rd-5th week maximum recovery.
■ 6 month considerable recovery.
■ By 12 month 95% recovery.
■ After 16 months, remote.
PRECAUTIONS TO BE TAKEN DURING
THE EARLY STAGES OF POLIO
■ Avoid unnecessary activities.
■ Avoid injections, surgical operations, etc.
■ Avoid unnecessary transfers etc.
■ Avoid improper positions.
COMMON ORTHOPEDIC DERFORMATIES
ENCOUNTERED IN POSITIONS
FOOT
■ Claw toes
■ Claw foot
■ Talipes Equinus
■ Talipes Equinovalgus
■ Flail foot
■ Pes Cavus
■ Dorsal Bunion
■ Talipes Equinovarus
■ Talipes Calcaneovalgus
■ KNEE
Flexion Contracture of the knee
Quadriceps paralysis
Genu recurvatum
Flail Knee
■ HIP
Flexion abduction contracture of the hip
Paralysis of Gluteus medius, maximus
■ ILLIOTIBIAL BAND CONTRACTURES
Hip flexed and abducted
External Rotation of femur
Flexion and valgus of knee
Posterior and Lateral Subluxation of tibia
Foot in equinus
Shortening
■ SPINE
Kyphosis
Scoliosis
Kyphoscoliosis
■ UPPER LIMBS
Paralysis of shoulder, elbow, forearm and hand muscles.
CAUSES OF THE DEFORMITY
DURING THE ACUTE PHASE

■ Muscle Spasm
■ Faculty limb positioning
■ Habitual postures
DURING THE SUB ACUTE PHASE
■ Muscular imbalance (due to asymmetric paralysis)
■ Extensor
DURING THE CHRONIC PHASE
■ Muscle and soft tissue contractures
DIFFERENTIAL DIAGNOSIS
ACUTE STAGES
■ Pyogenic meningitis
■ Guilian Barre Syndrome
■ Postdipthertic Paralysis
■ Acute Osteomyelitis
■ Scurvy, etc
LATE STAGES
■ Cerebral Palsy
■ Spina bifida
■ Myopathies
■ Muscular Dystrophies, etc
TREATMENT
■ To prevent deformities from developing.

■ To assist returning of muscle power by graduated exercises.
■ To reduce disability by appropriate appliance or by operations on
joints and muscle.
CONSERVATIVE TREATMENT
■ STAGE OF ONSET: Bed Rest

■ STAGE OF GREATEST PARALYSIS: Splints
■ STAGE OF RECOVERY: Physiotherapy, Walking aid Crutches etc.
■ STAGE OF RESIDUAL PARALYSIS: Can be corrected by provision of
suitable Orthotic appliances or by operation.
TREATMENT METHODS
EARLY STAGE(<3 WEEKS):

■ During the stage of onset, maximum paralysis and the stages of recovery the
following treatment is recommended, the child is admitted into hospital, and
supportive treatment is given.
■ The child is put on a ventilator support if there is respiratory paralysis due to
bulbar polio.
■ Warm and moist packs are give to the joints and all intramuscular injections are
avoided during the phase.
■ The affected joints are immobilized by plaster splints in functional positions to
prevent contracture.
■ Supportive measure are given for relief of muscle pain and spasm.
RECOVERY STAGE (4WEEKS TO 18 MONTHS):
■ In this stage the joints are properly splinted through various appliances to prevent or
correct the deformities.
OTHER MEASURES DURING THE RECOVERY STAGE:
■ Exercises to increase the muscle mass of the intact muscle fibers.
■ Tricycle exercises are ideal.
■ HYDROTHERAPY WARM water pool therapy is found to be very effective during this phase.
■ PNF Techniques.
■ Unnecessary immobilization by splinting should be avoided
■ Orthotic support should be provided to children who attempt to walk and bear weight
■ One of two exercises for important muscles should be taught to the parents and the child
for carrying it out at home.
■ Prematue weight bearing at this stage of the disease should be discouraged
■ The importance of regular check up & treatment by PT should be hight-lighted.
■ After 6 months to 1 year graded resistive exercises, preferably during the activities of daily
living greatly improves the resistance and strength of the exciting muscles.
■ Swimming, Jogging, Walking and other aerobic exercises should be greatly encouraged.
EXTERNAL APPLIANCE
■ SPINE BRACE: to support weak spine.

■ ABDOMINAL SUPPORT: To check abdominal protrusion when abdominal
muscles are weak.
■ HIP, KNEE,ANKLE, FOOT ORTHOSIS with or without PELVIC SUPPORT
(HKAFO): For deformities of the hip, knee and ankle.
■ KNEE CALIPER (KAFO): To hold knee extended in quadriceps palsy.
■ BELOW KNEE BRACE: To stabilize a flail ankle or foot.
■ SINGLE BELOW KNEE( LATERAL OR MEDIAL): To Control varus or valgus.
■ DROP FOOT APPLIANCE: For mobile equinus deformity
HOME TRETMENT REGIMEN
DURING EARLY RECOVERY STAGE
■ Simple exercises for important muscle groups in the beginning
■ Emphasizing prevention of early weight bearing to prevent
deformities
■ Methods to prevent contractures should be taught to the mother and
the child.
■ The value of regular physiotherapy follow-up should be explained to
the parents
■ Only one or two exercises are taught in one session
TREATMENT DURING POSTPOLIO
PARALYSIS
■ After 2 years, the chances of neurological are remote.

■ Functional recovery with appropriate guidance, training, supports,
aids, etc are encouraged in this phase rather than individual muscle
exercises.
■ Compressive and stretching forces on the affected joints should be
avoided.
■ Care should be taken to avoid compensatory muscle movements
(trick movements) to take the place of functional activity during the
phase of recovery.
■ After the phase of recovery is over, compensatory movement in place
of functional activities is encouraged and developed by strenghtening
exercises.
■ Fatigue to the muscles should be avoided by proper orthotic supports.
GOALS OF SURGERY
■ To obtain muscle balance.

■ To prevent or correct soft tissue contractures.
■ To prevent or correct bony deformities.
■ To improve functioning tendon transfers.
■ To improve limb length discrepancy.
POSTSURGICAL PHYSIOTHERAPY IN POLIOMYELITIS
■ AFTER RELEASE OF SOFT TISSUE CONTRACTURES:
MEASURES TO PREVENT RECURRENCE:
After the release of contracture, recurrence have to be prevented by
appropriate joint positioning.
■ MEASURES TO MOBILIZE THE JOINTS
Active and Passive ROM exercises are advised to mobilize the joints.
■ MEASURE TO STRENGTHEN THE MUSCLES
To prevent recurrence, the antagonistic muscles should be exercised to
strengthen them and increase their endurance.
■ MEASURES OF HOME TREATMENT PROGRAMME
The patient should be taught proper positioning exercises, weight bearing
etc to be followed at home for better recovery.
■ RETRAINING MEASURES
After the surgery, patient should be retained in gait, weight bearing joint
movements etc.
■ AFTER TENDON TRANSFERS HERE
Re education of the transferred tendon for its newly acquired role is very
vital.
Gentle passive stretching exercises
Gradual active and active assisted movements
The process of electrical stimulation greatly helps.
Dynamic orthotics may help in some cases
■ AFTER ARTHRODESIS
Strengthening exercise to the adjacent joints are given.
Patient is trained in non-weight bearing crutch, walking.
Mobilization regime after arthrodesis is planned.
Single leg balance, walking aids, weight transfers etc are some of the
recommended measures.
■ AFTER LIMB LENGHTHENING PROCEDURES
Active ROM exercises to unaffected joints
Isometric exercises to quadriceps and glutei after removal of the fixator
Training in gait, balance, weight bearing and weight transfers are given.

Awareness of Poliomyelitis

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Awareness of Poliomyelitis

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AWARENESS OF

■ The virus is transmitted by droplet infection & through the faeco-oral

DURING THE ACUTE PHASE

■ To prevent deformities from developing.

■ STAGE OF ONSET: Bed Rest

EARLY STAGE(<3 WEEKS):

■ SPINE BRACE: to support weak spine.

■ After 2 years, the chances of neurological are remote.

■ To obtain muscle balance.

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