Poliomyelitis: Difference between revisions

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'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}      
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}      
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== Introduction ==
Poliomyelitis is a virus infection of nerve cells in the anterior gray matter or cranial nerve nuclei in the brain stem leading in many cases to temporary or permanent paralysis of muscles that they activate.


== Cause ==
== Polio? ==
It is caused by infection with virus of three types have been identified as;
Poliomyelitis or Polio is a virus infection of  cranial nerve nuclei in the brain stem leading  to temporary or permanent paralysis of muscles that they activate.The virus affects children under 5 years of age.


Type-1-Brunhilde,
== '''Mode of transmission:''' ==
The spread is mainly by fecal contamination route and by droplet infection.Poliovirus is an Enterovirus that colonises the GIT.Due to vaccination,the prevalence is so low.33 cases were identified in [[Https:www.ncbi.nlm.nih.gov/pmc/articles/PMC421216/|2018]]<ref>https:/ /www.ncbi.nlm.nih.gov/pmc/articles/PMC4212416</ref><ref>https/ /www.who.int/news-room/factsheets/detail/poliomyelitis</ref>


Type-2-Lanchi,
=== '''Pathology''' ===
1.'''Alimentary Stage''':After gaining access to the body through the nasopharynx on the GIT,the virus muliplies in the epithelial cells of the intestinal mucosa.


Type-3-Leon.
'''2.Viremic Stage''':The virus spreads through the blood stream and after a sort of conflict between the virus and the antibodies,in case the virus turns victorious then it leads to the third stage.


'''Mode of transmission:'''
'''3.Neural Stage''':The virus finds its way to the anterior horn cells of the spinal cord and nerve cells in the brain stem..


The spread is mainly by fecal contamination route and by droplet infection.
==== '''Clinical features:''' ====
 
Poliovirus is an Enterovirus that colonises the GIT.
 
== Pathology ==
The disease occurs in three stages:
 
1.'''Alimentary Stage''':
 
After gaining access to the body through the nasopharynx on the GIT,the virus muliplies in the epithelial cells of the intestinal mucosa.
 
'''2.Viremic Stage''':
 
The virus spreads through the blood stream and after a sort of conflict between the virus and the antibodies,in case the virus turns victorious then it leads to the third stage.
 
'''3.Neural Stage''':
 
The virus finds its way to the anterior horn cells of the spinal cord and nerve cells in the brain stem.
 
According to the virulence of the infection the cells  may be damaged or killed.If cells are killed then the paralysis is permanent.
 
===== '''Clinical features:''' =====
Th course of the disease is divided into four stages;
Th course of the disease is divided into four stages;


'''1.Prodromal Stage or Pre-Paralytic Stage''':
'''1.Prodromal Stage or Pre-Paralytic Stage''': '''few hours to a few days and 1 to 3 days''' is the usual duration.
 
It is nonspecific.
 
It may last from a '''few hours to a few days and 1 to 3 days''' is the usual duration.
 
Many patients  are only diagnised with laboratory findings of the polio virus in the throats or the stools.
 
The importance of his stage is that" exercise,injections or operations may precipitate severe paralysis in the limbs exercise or traumatized".


''Signs and Symptoms:''
''Signs and Symptoms:''
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'''''Treatment:'''''
'''''Treatment:'''''


The only practical measures which can be taken: is to stop the playing of games and other such manual work if possible.
The only practical measures which can be taken: is to stop the playing of games and other such manual work if possible.The nasopharyngeal secretions and feces or highly effective at this stage of illness.An additional booster dose may be given.


Performance of tosillectomies and other non-emergency surgery should be discouraged.
'''2.Acute Stage:'''3 to 6 weeks'''  from the onset of Poliomyelitis.'''
 
The nasopharyngeal secretions and feces or highly effective at this stage of illness and children  should be isolated particularly from other children and babies.An additional booster dose may be given to both affected and unaffected children for added protection.
 
'''2.Acute Stage:'''
 
This is the early stage of paralysis.


''Signs and Symptoms''
''Signs and Symptoms''
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to '''test''' this press the calf muscles when child is quiet.If he cries,he has tenderness.
to '''test''' this press the calf muscles when child is quiet.If he cries,he has tenderness.
''Duration:''
'''3 to 6 weeks'''  from the onset of Poliomyelitis.


''Treatment:''
''Treatment:''
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''1.Rest:''The child should not be over handled.
''1.Rest:''The child should not be over handled.


''2.Isolation'':This is necessary to protect the other children from contacting the infection because  stools,urine and droplets are highly contaminated and contagious.
''2.Isolation''


''3.Booster dose''
''3.Booster dose''


''4.Nutrition'':Diet rich in Protein.
''4.Nutrition'':Diet rich in" Protein".
 
''5.Correct handling technique'':
 
Parents should be taught correct handling technique to prevent further damage other neural structures.
 
1.The child should not be lifted by one hand. 


2.While carrying the child,they should be held in front and preferably with the Hip in extension without any abduction.
''5.Correct handling technique:''The child should not be lifted by one hand.While carrying the child,they should be held in front and preferably with the Hip in extension without any abduction.


''6.Splinting and correct positioning:'' Splinting-Lower limb to be immobilized to prevent further damage to the muscles.
''6.Splinting and correct positioning:'' Splinting-Lower limb to be immobilized to prevent further damage to the muscles.
 
[[File:HSC-973.39.1.jpg|thumb|Sister Kenny's Bath]]
''7.Sister Kenny's Bath'':This is a form of moist heat.The towel is dipped in hot water and wringed.Then it is placed on the limbs and lumbar spine of the patient.This helps to resolve inflammation to some extent.
''7.Sister Kenny's Bath'':This is a form of moist heat.This helps to resolve inflammation to some extent.


'''Massage is contraindicated''' as it may cause more damage.
'''Massage is contraindicated''' as it may cause more damage.


''8.MMT'':To know the extent of weakness or paralysis.
''8.MMT.''
 
''9.Gentle passive movement'':Given '''2 to 3 times a day''' to keep the muscle and joint flexible and to improve circulation to the limbs.
 
'''3.Convalescent Stage:''' This is a stage of true or actual paralysis.
 
''Duration'' :'''3 months'''.
 
Signs and Symptoms: Vary in both duration and severity.The effects may lead to paralysis which may take any of the following forms:
 
1.Spinal.
 
2.Bulbar.
 
3.Spinobulbar/Bulbospinal.
 
4.Postencephalitic type of paralysis.
 
''1.Spinal Type:''
 
Here the anterior horn cells are affected with resulting paralysis of lower moor neuron type with assymetrical flaccid paralysis and normal sensation.
 
The" lower limb muscles are more often involved".
 
Due to gross motor imbalance , contractures are liable to occur. Contractures evevntually lead to deformity in lower limbs where flexors of Hip,knee and ankle are often paralyzed than the extensors.
 
'''''Flexion contractures of hip,knee and equinus deformity of the ankle are common'''''.


''2.Bulbar Type'':
''9.Gentle passive movement'':


The most ''important sign'' of Bulbar paralysis is- the <nowiki>''</nowiki> inability to swallow" due o pharyngeal paralysis.
'''3.Convalescent Stage:''' ''Duration'' :'''3 months'''.


-The patient chokes on both solid and liquid food,
Signs and Symptoms:


-Cannot swallow on his own.
''1.Spinal Type:''The" lower limb muscles are more often involved".'''''Flexion contractures of hip,knee and equinus deformity of the ankle are common'''''.


-Cannot cough properly- due to paralysis of larynx,
''2.Bulbar Type'':The most ''important sign'' of Bulbar paralysis is- the <nowiki>''</nowiki> inability to swallow" due o pharyngeal paralysis.The patient requires urgent ''ventilatory support'' for respiration and ''Ryle's tube'' for feeding to save his life as both respiratory and swallowing muscles are affected.The "early signs" of respiratory involvement includes ''breathing,feeling of suffocation,slight cyanosis,use of sternomastoids,alae nasae and other accessory muscles of respiration.''


-Has difficulty in speaking- due to paralysis of palate.
''3.Spinobulbar:''This type has a combination of both spinal and bulbar type.


-The patient requires urgent ''ventilatory support'' for respiration and ''Ryle's tube'' for feeding to save his life as both respiratory and swallowing muscles are affected.
''4.Postencephalic:Mental disturbance,coma,paralysis of facial muscles,symptoms similar to meningitis like headache,vomiting,neck stiffness'' may occur
 
-The "early signs" of respiratory involvement includes ''breathing,feeling of suffocation,slight cyanosis,use of sternomastoids,alae nasae and other accessory muscles of respiration.''
 
''3.Spinobulbar:''
 
This type has a combination of both spinal and bulbar type.
 
Patients with predominant spinal and less bulbar presentation-Spinobulbar type.
 
Patients with more bulbar signs and less spinal signs-Bulbospinal type.
 
''4.Postencephalic'':
 
This is rare.
 
''Mental disturbance,coma,paralysis of facial muscles,symptoms similar to meningitis like headache,vomiting,neck stiffness'' may occur


''Treatment:''
''Treatment:''


1.Continuous Splintage;'''Above knee splint or L splint'''-to prevent knee flexion,
1.Continuous Splintage;'''Above knee splint or L splint,Below knee splin'''t,'''Abdominal Corset'''


'''Below knee splin'''t-Equinus deformity.
2.Muscle Charting.


'''Abdominal Corset'''-weakness of abdominal muscles.
3.Positioning.
 
2.Muscle Charting: It is important to assess all the muscle groups as soon as the tenderness in the muscles will allow(3 to 4 weeks after the onset of paralysis)
 
3.Positioning:-''Patients relatives  should not carry the child in indian position as it increases IT band contractures.''
 
''-Allow child to sleep in prone to avoid flexion conractures.''
 
''-Paralyzed arms are best supported on pillows with slight abduction.''
 
''-Child should not be pulled up holding his hands as it may lead to shoulder subluxation.''
 
''-Shoulder rolls in the form of towel rolled and kept under axilla helps to prevent shoulder subluxation.''


4.Changing the position:Turning the patient '''every 2 to 4 hours and night prevents''' bed sores and keeps the skin dry.
4.Changing the position:Turning the patient '''every 2 to 4 hours and night prevents''' bed sores and keeps the skin dry.


5.Stretching of contractures:Stretching should be gentle and consistent.Principal contractures are IT band and ankle equines.
5.Stretching of contractures:Principal contractures are IT band and ankle equines.
 
-For tendo Achilles,if the muscle is weak with grade 0 or 1,excessive stretching should be avoided,as there is more anterior gliding of tibia which could lead to              calcaneal deformity.
 
-In gluteus medius weakness,full stretching of IT band should be avoided as it will further weaken the muscle and will lead to exaggerated Trendelenburg lurch.


6.Stimulation and facilitation technique:IG stimulation can be given if patient can tolerate to maintain muscle property.
6.Stimulation and facilitation technique:


'''4.Stage of Recovery'''
'''4.Stage of Recovery'''


This stage extends for almost 2 years.Thus muscle in the polio patient can be strengthened to their maximum capacity upto 2 years after this it won't be possible to activate any paralyzed muscle.Before 2years time if any muscle is seen regaining the power,it must be exercised quite skillfully to achieve maximum rehabilitation output.
This stage extends for almost 2 years.Thus muscle in the polio patient can be strengthened to their maximum capacity upto 2 years.
 
Various strengthening techniques include:
 
1.Sensory integraion.


2.Resisted exercises with springs and pulleys.
Various strengthening techniques include:Sensory integraion,Resisted exercises with springs and pulleys,Hydrotherapy and suspension therapy,Play therapy,Mat Exercises.
 
3.Hydrotherapy and suspension therapy.
 
4.Play therapy.
 
5.Mat Exercises.


'''Stage of Residual Paralysis'''
'''Stage of Residual Paralysis'''


Paralysis or weakness after 2 years is permanent.The extent of residual paralysis ranges between mild significant local weakness to gross paralysis of trunk and limb musculature leading to severe disability and functional dependency.
Post polio [https://physiopedia.com/Post-Polio_Syndrome#share syndrome]


''Treatment:''
''Treatment:''


Patient may be given combination of stretching,strengthening and calliprization.
Patient is given combination of stretching,strengthening and calliperization.


Tailor-made [https://5.imimg.com/data5/WW/WE/MY-19411349/polio-brace-500x500.jpg calipers] can prevent the deformity from aggravating.
Tailor-made [https://5.imimg.com/data5/WW/WE/MY-19411349/polio-brace-500x500.jpg calipers] can prevent the deformity from aggravating.


Tendon transfers may be done in case there is availability of good donor muscle without compromising balance on that side.
Tendon transfers may be done for compromising balance on that side.
 
[[File:Triple-Arthrodesis-500x420.jpg|thumb|Arthrodesis]]
Arthrodesis [https://footeducation.com/wp-content/uploads/2019/03/Triple-Arthrodesis.jpg] is preferred especially around the ankle in case of severe instability making weight bearing difficult.
Arthrodesis 


'''Common Problmes Encountered by Polio Patients'''
'''Common Problmes Encountered by Polio Patients'''
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== References<ref>Physiotherapy in neuro-conditions-Glady Samuel Raj</ref>  ==
== References<ref>Physiotherapy in neuro-conditions-Glady Samuel Raj</ref>  ==
Physiotherapy in Neuro-conditions,Glady Samuel Raj
Physiotherapy in Neuro-conditions,Glady Samuel Raj
<references />

Revision as of 18:55, 1 March 2020

Original Editor -Chrysolite Jyothi Kommu

Top Contributors - Chrysolite Jyothi Kommu, Nikhil Benhur Abburi, Momina Khalid and Simisola Ajeyalemi  

Polio?[edit | edit source]

Poliomyelitis or Polio is a virus infection of cranial nerve nuclei in the brain stem leading to temporary or permanent paralysis of muscles that they activate.The virus affects children under 5 years of age.

Mode of transmission:[edit | edit source]

The spread is mainly by fecal contamination route and by droplet infection.Poliovirus is an Enterovirus that colonises the GIT.Due to vaccination,the prevalence is so low.33 cases were identified in 2018[1][2]

Pathology[edit | edit source]

1.Alimentary Stage:After gaining access to the body through the nasopharynx on the GIT,the virus muliplies in the epithelial cells of the intestinal mucosa.

2.Viremic Stage:The virus spreads through the blood stream and after a sort of conflict between the virus and the antibodies,in case the virus turns victorious then it leads to the third stage.

3.Neural Stage:The virus finds its way to the anterior horn cells of the spinal cord and nerve cells in the brain stem..

Clinical features:[edit | edit source]

Th course of the disease is divided into four stages;

1.Prodromal Stage or Pre-Paralytic Stage: few hours to a few days and 1 to 3 days is the usual duration.

Signs and Symptoms:

-Headache.

-Sore throat.

-Malaise.

-Slight Cough.

-Diarrhea or constipation.

-Backache.

-Joint pains.

-Pyrexia of variable duration and severity.

-Mild neck stiffness.

-Irritability.

Treatment:

The only practical measures which can be taken: is to stop the playing of games and other such manual work if possible.The nasopharyngeal secretions and feces or highly effective at this stage of illness.An additional booster dose may be given.

2.Acute Stage:3 to 6 weeks from the onset of Poliomyelitis.

Signs and Symptoms

-Fever

-Diarrhea,nausea,vomiting.

-Irritability.

-Limb and joint pains-Due to painful surrounding muscles.

-Muscle tenderness is the most important sign seen in this stage.

to test this press the calf muscles when child is quiet.If he cries,he has tenderness.

Treatment:

1.Rest:The child should not be over handled.

2.Isolation

3.Booster dose

4.Nutrition:Diet rich in" Protein".

5.Correct handling technique:The child should not be lifted by one hand.While carrying the child,they should be held in front and preferably with the Hip in extension without any abduction.

6.Splinting and correct positioning: Splinting-Lower limb to be immobilized to prevent further damage to the muscles.

Sister Kenny's Bath

7.Sister Kenny's Bath:This is a form of moist heat.This helps to resolve inflammation to some extent.

Massage is contraindicated as it may cause more damage.

8.MMT.

9.Gentle passive movement:

3.Convalescent Stage: Duration :3 months.

Signs and Symptoms:

1.Spinal Type:The" lower limb muscles are more often involved".Flexion contractures of hip,knee and equinus deformity of the ankle are common.

2.Bulbar Type:The most important sign of Bulbar paralysis is- the '' inability to swallow" due o pharyngeal paralysis.The patient requires urgent ventilatory support for respiration and Ryle's tube for feeding to save his life as both respiratory and swallowing muscles are affected.The "early signs" of respiratory involvement includes breathing,feeling of suffocation,slight cyanosis,use of sternomastoids,alae nasae and other accessory muscles of respiration.

3.Spinobulbar:This type has a combination of both spinal and bulbar type.

4.Postencephalic:Mental disturbance,coma,paralysis of facial muscles,symptoms similar to meningitis like headache,vomiting,neck stiffness may occur

Treatment:

1.Continuous Splintage;Above knee splint or L splint,Below knee splint,Abdominal Corset

2.Muscle Charting.

3.Positioning.

4.Changing the position:Turning the patient every 2 to 4 hours and night prevents bed sores and keeps the skin dry.

5.Stretching of contractures:Principal contractures are IT band and ankle equines.

6.Stimulation and facilitation technique:

4.Stage of Recovery

This stage extends for almost 2 years.Thus muscle in the polio patient can be strengthened to their maximum capacity upto 2 years.

Various strengthening techniques include:Sensory integraion,Resisted exercises with springs and pulleys,Hydrotherapy and suspension therapy,Play therapy,Mat Exercises.

Stage of Residual Paralysis

Post polio syndrome

Treatment:

Patient is given combination of stretching,strengthening and calliperization.

Tailor-made calipers can prevent the deformity from aggravating.

Tendon transfers may be done for compromising balance on that side.

Arthrodesis

Arthrodesis

Common Problmes Encountered by Polio Patients

Muscle weakness

Bony Changes:Most common changes are-Shortening,Ostoporesis,Deformities.

References[3][edit | edit source]

Physiotherapy in Neuro-conditions,Glady Samuel Raj

  1. ↑ https:/ /www.ncbi.nlm.nih.gov/pmc/articles/PMC4212416
  2. ↑ https/ /www.who.int/news-room/factsheets/detail/poliomyelitis
  3. ↑ Physiotherapy in neuro-conditions-Glady Samuel Raj
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