Poliomyelitis
Dr Maryam Safdar; PT
The University of Faisalabad
Poliomyelitis:
Infectious disease characterized by
Asymmetric flaccid motor paralysis
Paralysis (muscle weakness)- like bad cold with fever and
sometimes diarrhea.
Paralysis of any muscle- mostly legs(floppy type)
Affected limb not able to straighten, due to shortening or
contracture.
Affected Limb thinner, grows slowly and shorter.
Unaffected limb-extra strong
Intelligence and mind normal.
Feeling is not affected.
Cont…
Cause: viral infection- attacks spinal cord, damages nerves
that control movement.
Contagious: No, not after 2 weeks from when a child get
sicks with polio
Spread: through coughing, sneezing and stool in poor
sanitation areas.
Age: babies 8-24 months old but occasionally children up
to age 4-5 years.
How does paralysis begins: Begins after signs of cold and
fever, sometimes diarrhea/vomiting.
Any paralysis left after 7 months is usually permanent
Does not gets worsen with time-secondary complications.
Polio is not inherited, does not affect ability to have
children
Distribution
Lower limb 92 %
Trunk + LL 4%
LL + UL 1.33 %
Bilateral UL 0.67 %
Trunk + UL + LL 2%
Deformities:
Spine (scoliosis, Kyphosis)
Limbs (equinous, pes cavus, flail knee & UL)
Causes of Deformity in Polio
Unbalanced muscle paralysis:
Unopposed muscle pull from the non-paralyzed muscles
Gravity pull effect
Posture:
e.g. Sitting with knee flexed
Possible Causes of Late
Complications of Polio
Deformities
Vary according to degree
of muscle imbalance, or
if patient was diagnosed
early and attempts were
made to prevent
deformities
Lower limbs are the
commonest.
If associated with trunk
deformity, they are
really disabled
Paralytic Scoliosis
Usually long C
shaped curve
Trunk collapse
occurs when there
is weak erector
spinae muscles.
Orthosis might be
used to delay
Paralytic Scoliosis
Main Clinical Features of PPS
Fatigue (Commonest)
Weakness
Muscle pain
Gait disturbance
Respiratory problems
Swallowing problems
Cold intolerance(metabolism)
Sleep apnoea
Fatigue
Prominent in the early hours of the
afternoon
Decreases with rest
Pathogenesis:Chronic pain / Muscle pain
Sleep disorders/ respiratory dysfunction
Difficulty in remembering/ concentrating
Decreased muscular endurance /
Increased muscular fatigability
“Polio wall”
Generalized or muscular
Weakness
Disuse
Overuse
Inappropriate use
Chronic weakness
Weight gain
Joint problems
Muscle Pain
Extremely prevalent in PPS
Deep aching pain
Myofascial pain syndrome / Fibromyalgia
Small number of patients have muscle
tenderness on palpation
Swallowing Problems
Can occur in bulbar and non bulbar polio
Subclinical asymmetrical weakness in the
pharyngeal constrictor muscles : almost
always present in PPMA (Post polio
muscular atrophy)
Not all are symptomatic
Cold Intolerance
Autonomic nervous system dysfunction?
May relate to sympathetic intermediolateral
column damage during acute poliomyelitis
Peripheral component may include
muscular atrophy leading to reduced heat
production
Sleep Apnoea
Combination of the following:
Central: residual dysfunction of
surviving bulbar reticular neurons
Obstructive: pharyngeal weakness and
increased musculoskeletal deformities
from scoliosis or emphysema
PPMA, diminished muscle strength of
respiratory,intercostal & abdominal
muscle groups
Is it PPS? – Other things to think of
Other rheumatological disorders:
rheumatoid arthritis, lupus, Sjorgren’s
syndrome or just osteoarthritis
Endocrine disorders: hypothyroidism,
adrenal failure, rarely pituitary failure
Orthopaedic problems: shoulder rotator
cuff tears and impingement syndrome,
spondylosis, bursitis, metatarsalgia.
Breathing disorders: restrictive problems
with scoliosis, obstructive sleep apnoea
General medical problems: heart failure,
diabetes
How is it Investigated?
MRI scans
Blood tests
EMG and nerve conduction studies
X-rays
Overnight oximetry
Sleep studies
Pulmonary function tests
What can be Done for PPS?
Treat Co-Morbidities
If you rely on your shoulders,
protect them and seek early advice for shoulder
symptoms. e.g.. “Save Our Shoulders”
Insist on proper evaluation of the shoulder e.g.
USS or MRI
Ensure the surgeon has experience of PPS.
Treat general medical and endocrine
problems.
Treat carpal tunnel syndrome
Look at posture to prevent progressive
deformities e.g.. Profiling bed, trunk support
when sitting.
Make every effort to treat and avoid rising
BMI: diet, Orlistat, Sibutramine.
Treat
Co-morbidities
Get orthoses to
off load and
support joints that
are failing
Use lightweight
modern materials
for orthoses e.g.
carbon fibre,
titanium
Treat
Co-Morbidities
Use strategies
to avoid over
stressing
systems that
are already
challenged e.g.
powered wheel
chair, PAPAW.
Treat
Co-Morbidities
Night time
hypoventilation
can be easily
treated with
NIPPV
Active Management of PPS
Start an exercise program:
Aerobic, i.e.. Within the limits of the muscles’
glucose and oxygen supplies. In practice this
means 2-3 minutes exercise, 1-3 minutes
rest.
Within your limit (Avoid “boom and bust”).
Do not exercise until it hurts the muscles. If
your muscles ache and are stiff the next day
you over did it.
Use pacing and graded exercise goals: small
increments in your limit are achievable e.g..
5-10% every 1-2 weeks.
Exercise for
PPS
Where possible try
and use water
based activities:
you are 30% lighter
in the water and
will off load joints
that might be
struggling with
gravity based
exercises.
Be consistent.
Exercise reverses
DECONDITIONING
Active Management of PPS
Get good pain control: non-steroidal anti-
inflammatory drugs, medium grade opiates
e.g.. codeine, but use non-pharmacological
means e.g.. Counter stimulation TENS,
rubifacients
Keep warm, where possible, spend time in
a warm climate (Nordby 2007)
Keep respiratory difficulties under review
and take advice about the need for night
time ventilation support, stop smoking, and
ask for advice about respiratory muscle
training
Active Management
of PPS
Make
environmental
adaptations and use
assistive
technology: e.g..
Door entry systems,
remote switches,
environmental
control systems,
level access
bathroom facilities
Join a group or
start one.
Deformity Correction
Aim for walking with or without orthosis by
getting straight limb with plantigrade foot
Methods
Reconstructive surgery
Physiotherapy
Orthosis
Assessment
Pain. Gait.
Posture. Body Mechanics &
Anthropometric Ergonomics.
characteristics. Assistive Device need.
ROM/ Muscle Length. Aerobic capacity and
Muscle Performance. Endurance.
Joint Integrity. Community and Work
Motor Function. Integration.
Balance.
Physical Therapy Goals
Pain reduction
Edema reduction
Improve skin integrity
Improve endurance
Improve ROM
Improve ability to move/ transfer
Possible gains in strength
Improve posture
Improve balance
Quality gait cycle
Management of post-polio syndrome
Many patients require revision of orthotic
devices such as braces, canes, and
crutches or may use new, lighter orthotic
devices to treat new symptoms. Common
issues include genu recurvatum, knee pain,
back pain, degenerative arthritis, or
arthralgia. Surgery for scoliosis or fractures
may also be necessary to treat new
conditions.
