Role of physiotherapy in polio

Polio treatment

The disease might be staged as:-

Stage 1: Acute stage of paralysis: : it starts with fever and headache, then neck stiffness and meningitis. Muscles are painful and tender. Paralysis soon follows and reaches its maximum in 2-3 days. Limbs are weak there may be difficulty with breathing and swallowing. When the patient does not succumb to respiratory failure, pain and pyrexia subsides after 7-10 days and also the patient enters the convalescent stage.

Stage 2: Recovery/convalescent stage: : This stage is prolonged. The return of muscle power is most noticeable throughout the first 6 months, but there might be continuing improvement for as much as 2 years. 

Stage 3: Residual paralysis: : Some cases don't progress beyond the initial phase of meningeal irritation. In other people, however recovery is incomplete and also the patient is left with a few degree of asymmetric flaccid paralysis or muscle weakness.

Polio treatment within the acute stage of muscle paralysis: It calls for meticulous attention to intensive care throughout the acute paralytic phase.

• Feeding by nasogastric tube in individuals with bulbar dysfunction.

• Endotracheal intubation and ventilation ought to be instituted in case of respiratory muscle failure or bulbar and laryngeal muscle paralysis.

• Pulmonary atelactasis and infection are given antibiotics and regular physiotherapy intervention.

• Rest on the firm mattress with back supported on the lumbar board. Avoid forceful exercise because this may increase paralysis. Avoid massage.

• Moist hot packs towards the affected muscles produce considerable respite from the pain. Analgesics may also be used to relief pain.

• Feet to become supported by rigid boards at 90° angle. Early spinal bracing for the rear if it is weak.

• Hip and knees ought to be positioned as straight as you possibly can and arms in abduction with mild support.

• Passive flexibility for the joints to prevent contracture formation.

• Positon the patient with face-down and hip extended every 2 hourly to avoid pressure sores and deformities.

Polio treatment within the recovery or convalescent stage:

• Sitting up could be encouraged if the paralysis isn't severe.

• As soon because the fever drops, exercises ought to be started to prevent contractures and return strength.

• Passive, active assisted to active resisted/ strengthening exercises, sitting balance training, standing balance learning parallel bars, gait training ought to be started.

• Crutches, leg braces(calipers) along with other aids may help the child to maneuver better and may prevent contractures or deformities.

• Whenever possible make exercises fun. Active games, swimming along with other activities to keep limb moving around they can are important through the child’s rehabilitation.

Rehabilitation (stage 3) in poliomyelitis once all of the recovery has taken place. Goals of polio treatment within the stage of residual paralysis:

• Strengthening of all of the innervated muscles.

• Preventing contractures and deformities.

• Making the individual as independent as you possibly can.

• Emotional and psychological support.

• Examination from the patient

the stage of residual paralysis following problems may need polio treatment.

• Isolated muscle weakness without deformity: Quadriceps paralysis could make walking impossible, it's best managed with a splint which supports the knee straight. Elsewhere, isolated weakness might be treated by tendon transfer.

• Deformity: Unbalanced paralysis can lead to deformity. At first it's passively correctable and can be counteracted with a splint. Fixed deformity require tendon transfer and joint stabilization, if required by arthrodesis.

• Flail joint: When the joint is unstable or flail it should be stabilized either by permanent splintage or by arthrodesis.

• Shortening: Insufficient muscle activity undermines normal bone growth. Leg length inequality of upto 3 cm could be compensated for by shoe modification. Something more may require operative lengthening from the limb.

Common biomechanical deficits in post polio

• Genu Recurvatum

• Knee flexion contracture

• Inadequate dorsiflexion in swing

• Dorsiflexion collapse in stance

• Genu valgum

• Mediolateral ankle instability

Orthotic prescription

Before prescribing orthosis it's important to assess:-

• Strength of hip abductors and hip extensors

• Knee extensor

• Hip, knee and ankle stability

• Strength of upper limb

• Limb length measurement and gait pattern

• Contractures and derformities

A child with foot drop could be given an ankle foot orthosis of plastic or metal.

A child with weak knee may require a long-leg brace of plastic or metal.

It might be with or without a knee joint that locks straight for walking and bends for sitting.

Child with weak trunk may need long leg braces mounted on a body brace or body jacket.

ADL’s training and occupational therapy role in polio treatment

• Washing and toilet: supporting rails, bath or shower seats and alterations in the height of washing bowl, basin or bath might be provided

• Dressing: clothes with zip fasteners and Velcro might be provided

• Housing, domestic aids and furnitures might be modified for the severely disabled

• Transport: wheelchairs should be strong enough for rough roads and become patient propelled whenever you can. Motorized wheelchairs and cars with special control can also be found.