How to Disease Young Polio Victims Patients?
Polio Victims Patients
1- The child is rested in bed with a firm mattress. The back is supported at the lumbar region by a board and so are the paralyzed limbs.
2- Feet are supported by rigid boards in padded KAFO with 90 degree FDS. Early spinal bracing is indicated if the back is weak.
3- Knee and hips are mildly flexed and arms are positioned in abduction with mild support.
4- The therapist puts joints through a full range of motion once a days.
Deformity Patients and Traetment
Deformities in Polio Patients
The causative organism of poliomyelitis is an enterovirus, which is specific in its action, and primarily attacks and destroys the anterior horn cells. The predominant age group affected is children between the age of 1-4 year, but theoretically no age is immune by ‘carriers’ as well as by those who are in the incubation period or early stage of the disease, by droplet infection or more commonly feco-oral route (the gastrointestinal tract); the incubation period is 4-14 days.
Muscle spasm is followed by interstitial fibrosis and collagen deposits. Contractures set in even within a month, and spasms are thought to be due to in coordination and involuntary contraction of the weak muscle, and to avoid to in coordination and involuntary contraction of the weak muscle, and to avoid pain. The growth of the limb is almost always retarded. All residual deformities are measured by a goniometer. Contractures will usually occur if there is imbalance of opposing groups of muscles which are not held in check, gravity, flexed joint in bed, or results of bearing weight on a weak leg. Long-standing contractures, especially of a major joint may be corrected by major operations. Operative correction is required if knee and ankle contractures prevent the fitting of orthoses.
Knee: Flexion deformity measured with the hip extended as much as possible to avoid error due to tight hamstrings. External rotation of the tibia is measured with knee extended. The common deformities at the knee include subluxation, genu recuruatum, and rotation of the tibia. The lower end of the femur may be more globular than normal and the posterior articular surface of the femoral condyles may be flattened on long standing. The patella is often much smaller than normal, and the tibial plateau may be deformed and sloped either backwards or forwards.
Scoliosis of the spine in polio is usually due to an imbalanceof the lateral flexors of the trunk. There are usually compensatory curves above and below the main curve in the opposite direction except when the spin is completely flail. Deformities may also be due to a much lesser extent to tilt of the pelvis or to abduction contracture. Lordosis is usually an attempt by the patient to balance a weak spine on a weak pelvis.
Supporting corset made out of polyethylene or polypropylene only give partial support and hardly prevent a worsening of the deformity. Milwaukee brace, In which distracting pressure is exerted between the skull and chin above requires accurate adjustment and regular supervision Equinus, varus, valgus, cavus, pes planus.
The elbow may be out of shape with dislocation of the head of the radius. Rotation of the forearm may be present, with deformities of the wrist metacarpals and phalanges. X-rays show narrow shafts and globular heads in relation to the shaft. Common upper limb deformities are:
1- Addiction and subluxation of shoulder.
2- Flex-or deformity of elbow.
Isolated knee contractures of less than 30 degree: In a child these are best treated by fortnightly manipulations under anesthesia. An HKAFO is then fitted. A supracondylar osteotomy or hamstring release may be done if the foot is stable, and if the limb cannot be fitted at all with the calliper.
If the child with deformity has a reasonable chance of being able to walk even with callipers on both legs, then the deformity should be corrected.
Contraindications to operation in children: When both legs are severely involved, or flail with one or both arms, weak particularly at the triceps, which is needed to bear weight on the axillary crutches, then surgery is avoided. The motivation of the child and relatives towards post operative care and physiotherapy also is important before taking the decision to operate. Surgery to release the soft tissues without caring to take a proper muscle power to release the soft tissues without caring to take a proper muscle power assessment or communication to the patient about the outcome of the operation is of no use and in fact detrimental because the patient does not cooperate with any rehabilitation initiatives after that.
Indications for Surgery
Hip and Knee contractures of over 30 degree: In a young child with fairly recent contractures the commonest cause for the deformity is a tight tensor fascia lata and ilio-tibial band.
Ankle and foot deformities: A tight tendo-Achilles is the major cause for an equines deformity of the foot when there is no associated varus and this is corrected by subcutaneous elongation of the tendon.
The treatment of paralytic poliomyelitis involves:
1- The use of all measures to save the life of the patient.
2- Maintenance of weak muscles in as good a condition as possible.
3- Immediate recognition and treatment of medical complications.
4- Prophylaxis and therapy of emotional disorders.
5- Surgical treatment of correctable defects.
6- Social, economic occupational and physical rehabilitation.
7- Physiotherapy and occupational therapy.
In the early stages of spinal paralytic poliomyelitis there is severe cramping pain in the muscles with hyperaesthesia of the overlying skin. In patients between 5 and 15 year old age weakness of one arm or both lower extremities is more frequent. Paralysis of the muscles of respiration is often present in those over 16 year of age getting infected. There is inflammation of motor neurons within the brain stem, motor cortex and the spinal cord, and presents as stiffness of the back and neck, muscle cramps, dysphagia, loss of reflexes, headache and paraesthesias. Paralysis occurs within ten days after symptoms develop, progresses in two or three days, and is complete by the time the fever subsides.
Proportion of cases
— Spinal polio
80% of paralytic cases
— Bulbospinal polio
21% of paralytic cases
— Bulbar polio
5% of paralytic cases