EXAM ( HEAD INJURY)

TOTAL: 20 MARKS
TIME: 10 MIN
 2 Marks
2

1. Battle’s sign
2. Diffuse axonal injury
3. Secondary impairment after brain injury
4. Locked in syndrome
5. Coma stimulation technique (any 4)
6. Mention stages of RLA scale. Mention
characteristic of RLA Scale 2.

POLIOMYELITIS 2/13/2020
 MCQ
3

1. If the lesion is located in the brainstem

between vestibular nucleus and superior
collicules so its called
a. Decorticate rigidity
b. Decerebrate rigidity
c. Hypertonisity
d. None of the above

POLIOMYELITIS 2/13/2020
 CONT....
4

2. When pt is an unresponsive state from which

the patient can be aroused only vigorous
stimuli it is called
a. Coma
b. Stupor
c. Obtunded
d. State of unconsiousness

POLIOMYELITIS 2/13/2020
 CONT...
5

3. Among them which is not included in

behaviour impairment
a. Irritability
b. Egocentricity
c. Lack of concern
d. Impaired pragmatics

POLIOMYELITIS 2/13/2020
 CONT....
6

4. Which cranial nerve mostly affected in head

injury patients
a. 2nd, 6th, and 7th
b. 2nd, 6th, 7th and 8th
c. 2nd, 6th, 4th and 10th
d. 2nd, 9th, 3th and 8th

POLIOMYELITIS 2/13/2020
 CONT....
7

5. Rehabilitation technique for memory deficits

POLIOMYELITIS 2/13/2020
 CONT....
8

6. Among one technique use for developmental

sequence by inhabitation abnormal movement
pattern by facilitating normal movement
pattern.
a. Neuromuscular training
b. Neuropsychiatric training
c. Neurodevelopment training
d. None of the above

POLIOMYELITIS 2/13/2020
 CONT....
9

7. For modified ashworth scale grade 2 indicate

a. No increase in muscle tone.
b. Affected part is rigid in flexion and extension.
c. Slight increase in muscle tone, manifested by
catch and release , minimal resistance at the
end of ROM, when affected part is moved.
d. Increased resistance present throughout the
range during passive movement but part can
be easily moved.
POLIOMYELITIS 2/13/2020
 CONT....
10

8. . If galveston orientation and amnesia test

score less than 76 its called
a. Communication problem
b. PTA
c. Behaviour problem
d. Normal

POLIOMYELITIS 2/13/2020
POLIOMYELITI
S

DR. BHAKTI DESAI

 INTRODUCTION
12

Poliomyelitis is an infectious disease, epidemic

and endemic in nature through out the world.
It is basically virus infection of nerve cell in the
anterior gray matter or cranial nerve nuclei in
the brainstem leading in many cases to
temporary or permanent paralysis of muscle
that they activated
More common Asian and African population

POLIOMYELITIS 2/13/2020
 CAUSES
13

Caused by infection with a virus of which at

least three types identified as:
Type I : Brunhilde
Type II : Lanchi
Type III : Leon

POLIOMYELITIS 2/13/2020
 Mode of transmission of the
14
virus
Mainly spread by fecal contamination route in
where hygiene is poor and by droplet infection
where sanitation is good.

POLIOMYELITIS 2/13/2020
 Incubation period
15

It varies from 3 to 30 days while 7 to 14 days is

the most common interval between infection
and clinical illness.
The incubation period decrease on
provocation like injection pricks, stenosis,
physical activities, massage or minor
operation.
In infants below six month the involvement
may be transplacentally transmitted if the
maternal immunity is very low.
POLIOMYELITIS 2/13/2020
 PATHOLOGY
16

The disease occur in 3 stage:

1. Alimentary stage
2. Viremic stage
3. Neural stage

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
17

It divided into 4 different stages:

1. Prodromal or Pre- Paralytic stage:
It is a nonspecific and mimics any viral infection.
This illness is usually vague and variable
duration.
It may last for few hours to few days and 1 to 3
days is usual duration.
It may be sever or mild as to pass unnoticed. It
is usually but not always followed by
asymptomatic stage before the onset of
POLIOMYELITIS 2/13/2020
paralysis.
 CLINICAL FEATURES
18
(CONT..)
Many patients never progressed beyond this
stage and are only diagnosed by the
laboratory finding of the polio virus in throat
and stool.
The importance of this stage is that exercise,
injection or operation may precipitate sever
paralysis in the limbs exercised or
traumatized.
C/F : Headache, sore throat, malaise, slight
cough, diarrhea or constipation, back pain,
joint pain, pyrexia of variable duration and
severity, mild neck stiffness and2/13/2020
POLIOMYELITIS irritability.
19

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
20
(CONT..)
Rx :
Proper rest and care.
Major surgery should be avoided in this
duration.
The nasopharyngeal secretion and feces are
highly infected so person should be isolated in
this stage.
Additional booster dose may be given to the
affected and unaffected children which will
also act as added protection.
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
21
(CONT..)
2. Acute Stage:
If the infection dose not resolve in the prodromal stage
it enters the acute stage which is the early stage of
paralysis.
Here most of the signs and symptoms remains similar
to the prodromal stage but are more pronounced
specially the following:
Fever
Diarrhea, nausea, vomiting
Irritability
Limb and joint pains
Muscle tenderness
Duration : 3 to 6 weeks from the onset of poliomyelitis.
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
22
(CONT..)
Rx :
Rest
The child should not be over handled. Over handling of
the children during this stage will definitely aggravate
the condition and may increase the muscle damage.
All the physical activity should be discourage in this
stage of inflammation.
Minimum handling of child will prevent movement to the
lumbar spine and there by help in decreasing in
chances of aggravation of symptoms.
The PT should not call patient on daily basics of OPD.
Isolation of child is necessary.

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
23
(CONT..)
Booster dose
Nutrition : Diet rich in protein
Correct handling technique
The parents of child taught correct handling technique
that will prevent further damage to neural structure.
Child should not be lifted by one hand while caring the
child in front.
Splintage and correct position
Lower limb can be immobilized to prevent further
damage. Prevent the muscle from contracture.
Sister Kenny's bath
MMT
Gentle passive movement
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
24
(CONT..)
3. Convalescent Stage:
This is the stage where there is true or actual
paralysis.
The duration of this stage is 3 months.
Effect of paralysis may be one of these form:
Spinal, Bulbar, Spinobulbar, Postencephalitis.

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
25
(CONT..)
Spinal type:
AHC are affected with resulting paralysis of a lower
motor neuron type with asymmetrical flaccid paralysis
and normal sensation.
The muscle affected depends on which AHC of SC is
involved but paralysis tends to affects certain muscle
more commonly than other muscles.
LL are more involved as compared to UL.
Involvement of muscle are very asymmetrical.
Contracture
Its leads to deformity. Where flexion of the hip, knee and
ankle are often less paralyzed than extensor. So, flexion
contracture of the hip, knee and equines deformity of the
ankle.
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
26
(CONT..)
Bulbar type:
Inability to swallow due to pharyngeal paralysis.
The patient chock on both solid and liquid food and
cannot swallow his/her own saliva.
Pt can not cough properly due to paralysis of larynx.
Difficulty in speaking due to paralysis of the palate.
The respiratory muscles or swallowing muscles or
both are affected.
Early sign of respiratory involvement include
breathlessness, a feeling of suffocation, slight
cyanosis and use of SCM, alae nasae as well as other
accessory muscles of respiration.

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
27
(CONT..)
Spinobulbar:
Combination of spinal and bulbar type of polio.
Some patients may present with predominant
spinal presentation and less bulbar in which
case its called spinobulbar.
Some patients may present with predominant
bulbar presentation and less spinal in which
case its called bulbospinal.

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
28
(CONT..)
Postencephalitic
Rare usually associated with bulbar palsy.
Mental disturbance and coma can occur.
Facial muscles also involved.

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
29
(CONT..)
Rx :
Continuous splintage
Knee splint or L- splint may be given to prevent
knee flexion and equines deformity.
Weakness of abdominal muscle specially leads to
protrusion of organ from weaker spot due to lack
of abdominal support so patient may be given
abdominal corset.
In absence of it towel can be wrapped tightly around
it.
Muscle charting
Regular checking of muscle power.
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
30
(CONT..)
Positioning
Prone position should advice to avoid hip flexion
contracture. Paralyzed arm best supported on
pillow with slight abduction.
Shoulder rolls can be placed under axilla helps
to prevent shoulder subluxation.
Changing the position
Stretching of contracture
Stimulation and facilitation technique

POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
31
(CONT..)
Stage of recovery:
It also called late convalescent stage, it also
extended up to almost 2 years.
Muscles of polio patient can be strengthened to
their maximum capacity upto 2 years after this it
won’t be possible to activate any paralyzed
muscle.
Even active muscle may show some improvement
after 2 years due to change in muscle structure.
Initially gentally and later on vigorous.
Techniques: ???
POLIOMYELITIS 2/13/2020
 CLINICAL FEATURES
32
(CONT..)
Stage of residual paralysis:
Paralysis or weakness persistent after 2 years
is permanent.
Whatever improvement may be seen could be
attribute to the increase in the size of available
muscle fibres or muscle.
Gross muscular imbalance coupled with limb
length discrepancy causes deformity of the
trunk and the limbs.
Treatment : ??
POLIOMYELITIS 2/13/2020
 COMMON PROBLEMS
ENCOUNTERED BY POLIO
33
PATIENTS
Muscle weakness
Bony changes
Deformities

POLIOMYELITIS 2/13/2020
34

POLIOMYELITIS 2/13/2020
35

POLIOMYELITIS 2/13/2020
36

POLIOMYELITIS 2/13/2020