poliomyelitis

Definition
Infantile paralysis/ Heine Medin Dse

Greek term:
polios- grey,
myelos marrow (grey matter of spinal cord),
itis inflammation

Cause: poliovirus

Itis the effect of poliolmyelitis virus on the

spinal cord that leads to the classic
manifestation of paralysis
 Poliovirus
Itis a member of the enterovirus
subgroup, family of
Picornaviridae.
Enteroviruses are transient
inhabitants of the
gastrointestinal tract, and are
stabe at acid pH.
The poliovirus is rapidly
inactivated by heat,
 Stereotypes of
poliovirus
Type 1: Brunhilde
- most common cause of paralytic
polio

Type 2 : Lansing

Type 3: Leon
 Means of transmission
Fecal-oral route:

Incubation period: 7-14 days

Thisdisease is spread through contact with

bowel movements of an infected person
or contact with contaminated water

Entryinto mouth Replication in

pharynx
Lymphoids (GIT and lumbar) NS through
VIREMIA
 Types of Polio infections
Subclinical (asymptomatic) approximately
95% of polio cases are sub clinical, and patients
may not experience any symptoms. This form of
polio does not affect the central nervous
system.

Non paralytic this form, which does affect the

CNS produces only mild symptoms and does not
result in paralysis

Paralytic this is the rarest and most serious

form of polio, which produces full or partial
paralysis in the patient. T
 Paralytic polio types:
Spinal polio (79%) most common. It is
characterized by asymmetric paralysis that
most often involves the legs

Bulbar polio (2%) leads to weakness of

muscles innervated by cranial nerves

Bulbospinal polio (19%) a combination

of bulbar and spinal paralysis
 Stages
Acute stage (1-6 weeks)
Fever with peak at 3rd day (7-10 days)
headache, GIT sxs, muscle stiffness and pain
Paralysis evident LE: TA, peroneals,
quads, gluteals
UE: deltoids
Cold intolerance
Cardinal signs: assymmetric muscle
weakness esp LE
Gait pattern: back-knee gait, anterior
trunk lean, foot drop
Convalescent/recovery
stage (6wks 6 months)
Recovery of strength monitored
within 6 weeks
Residual/chronic stage
(>6months)
Weakness, atrophy, limb
shortening, postural and gait
 Diagnosis
Clinically suspected in individuals
with:
acute onset of falccid paralysis
in one or more limbs,
dec or (-) MSR that cannot be
attributed to another apparent
cause,
(-) sensory and cognitive loss
Stool sample or swab of the
Post-polio syndrome
 Definition
Aka: Progressive Post-Polio
Muscular Atrophy (PPPMA)
New, slowly progressive muscle
weakness occuring in individuals with a
confirmed history of acute poliomyelitis
Follows a stable period of functioning
Etiology: unknown
Possible hyperfunctioning of motor
neurons, long term overuse at high
levels resulting in new dennervation
 Diagnosis
Priorhx of polio
A stable period of recovery
A residual deficit of the initial polio
New ms weakness & sometimes ms atrophy
30-40 years after acute onset

Precaution: prevent vigorous PRE in this

stage

Newweakness and atrophy: asymmetrical,

occur in both initially weak and uninvolved
muscle
 Abnormal fatigue: may not be related to
activity levels, doesnt recover easily with
the usual rest periods
Pain: myalgia, cramping pain, joint pain
with repetitive injury, hypersensitivities
Decreased function with reduced endurance
for routine activities
Slow progression, either steady or
stepwise
Environmental cold tolerance
Difficulty in concentration, memory,
attention
 Prevention
JonasSalk & Albert Sabin are
pioneers who discovered vaccine for
polio

Salk (killed) and Sabin (live)

the first polio vaccine was the

inactivated polio vaccine (Salk)
The oral polio vaccine or the
weakened poliovirus (Sabin)
 Vaccine:
IPV (inactive polio virus) is available
alone, or combined with:
DTaP only
DtaP-HepB
DtaP-Hib
Children should receive four doses of the IPV;
one does each at each of the following ages:
2 months (no earlier than 6 weeks)
4 months
6-18 months
4-6 years
 Management
Energy conservation and pacing
Strengthening ex avoid fatigue
Frequency: every other day, RPE less than
very hard (13-15)
Loads: 4-5 sec hold,10 sec rest between
bouts, 5 mins rest between sets; 3 sets of
5-10 reps
E-stim: ms re-education
MPS: heat, ES, trigger point injections,
stretching, biofeedback, ms relaxation
Gait: AD (AFO or KAFO)
 Ambulation: shorter distance, use of
orthosis for protection
Adaptive techniques and equipment for
ADLs
Speech therapy for swallowing
impairments
 Cheating
is a CHOICE, NOT A
MISTAKE -- Anonymous