POLIOMYELITIS

(POLIO)
By. Ainun Ma’rufa
  Poliomyelitis is an infectious disease caused by the

poliovirus, for which there is no cure.

 mainly affects children under 5 years of age

INTRODU  attacks the central nervous system through the brain

CTION  It causes temporary or permanent paralysis, leading it to

sometimes being termed infantile paralysis

 up to 70% of infections there are no symptoms at all

 Another fact:
 Poliomyelitis can be spread by food or water that contains

human faeces and in some cases by infected saliva.

 first reported in England, by Michael Underwood, in 1789

 It has been reported of polio as an epidemics from

developed country.

 A vaccine was made available by injection in 1955, while

the trivalent Sabin oral vaccine (OPV) in 1962.

Post Polio Syndrome
A condition that affects polio
survivors years after recovery
from an initial acute attack.
 About PPS
• PPS is a diagnosed neurological condition which will affect up to 40% of people who had
“paralytic” polio.
• The symptoms: new muscle weakness that gradually worsens, decreased muscle endurance
during activities, muscle and joint pain, muscle wasting, muscle spasms/twitching, and
severe fatigue.
• These problems usually come on gradually, but may start suddenly following surgery,
hospitalisation
• The cause is unknown, but it is thought that , the new weakness of post-polio syndrome may
be due to the degeneration of individual nerve terminals in the motor units.
• The poliovirus attacks specific neurons in the brainstem and the anterior horn cells of the
spinal cord. In an effort to compensate for the loss of these neurons, ones that survive create
new nerve terminals to the orphaned muscle fibers. The result is some recovery of movement
and enlarged motor units
 PPS
CRITERIA:
• Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history
of the acute paralytic illness, signs of residual weakness and atrophy of muscles
on neurologic examination, and signs of denervation on electromyography (EMG).
• A period of partial or complete functional recovery after acute paralytic poliomyelitis,
followed by an interval (usually 15 years or more) of stable neurologic function.
• Gradual or sudden onset of progressive and persistent new muscle weakness or
abnormal muscle fatigability (decreased endurance), with or without generalized
fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of
inactivity, or trauma or surgery.) Less commonly, symptoms attributed to PPS include
new problems with breathing or swallowing.
• Symptoms persist for at least a year.
• Exclusion of other neurologic, medical and orthopaedic problems as causes of symptoms
Paralysis and non-paralysis of polio
 SYMPTOM
S:
• Muscle weakness, most commonly in the

legs but can occur in the head, neck and

diaphragm

• Fever

• Fatigue

• Headache

• Vomiting

• Neck Stiffness

• Pain in the arms and legs.

Typical of muscle weakness:
 COMPLICATI
ONS:
• Falls: muscle weakness can lead to balance problems, slipping or getting your toe caught
under a rug or stair step.
• Difficulty swallowing: individuals with PPS that affects oral motor activity such as
chewing and swallowing can lead to nutritional issues and dehydration
• Breathing: issues arise due to weak chest and abdominal muscles.
• Muscle and skeletal structure: changes from strong muscles pulling the body against
weaker muscles can result in structural bone changes leading difficulty in body
positioning, discomfort, pain, contractures, difficulty in hygiene. 
• Neurogenic bowel and bladder: nerve miscommunications change your ability to toilet. 
• Bone mineral density: reductions from skeletal changes or inactivity can create
osteopenia
• Assistive device: issues such as braces and splints may pressure the injury
Two patterns in particular seem to most appropriately apply to the treatment of polio survivors:
1. PATTERN A: Impaired Motor Function and Sensory Integrity Associated with
Congenital or Acquired Disorders of the Central Nervous System in Infancy,
Childhood and Adolescence
2. PATTERN B: Impaired Motor Function and Sensory Integrity Associated with
Acquired Nonprogressive Disorders of the Central Nervous System in Adulthood

Treatment Goals:
• pain reduction
• edema reduction
• improved skin integrity
• improved endurance for activity
• improved ROM
• improved ability to move in bed/transfer
• stabilization of balance/gait
• possible reduction of rate of strength loss and improved
ability to use existing strength; possible small gains in
strength
 PT’s Examination
1. General demographics
2. Complete medical/surgical history
3. Growth and developmental history
4. Social history:
• Past and current work ability
• Social habits, including behavioral health
risks, level of fitness, leisure activities
•  Cultural beliefs/behaviors
•  Family/caregiver resources;
• support systems
•  Social interactions/activities
5. Living environment
7. Health condition:
• General health perception
•  Are there symptomatic areas of pain?
•  Are there body parts at circulatory risk, i.e., is there
cold intolerance, presence of swelling, discoloration of
skin, etc.?
•  Are there any problems with sleeping?
•  Are there any problems with breathing or swallowing?
8. Functional status:
• How is endurance for activities?
• How are survivor’s ability in ambulating?
• Does survivor use special equipment?
• Have those devices changed in recent years?
• Are there any problems using that device?
Clinical Features:
Clinical Features:
Muscle imbalance
Clinical Features: Deformities (1)
Clinical Features: Deformities (2)
Measurement: Deformities (1)
Measurement: Deformities (2)
Measurement:
Deformities (3)
Measurement:
Deformities (4)
Differential Diagnose (Diagnosis Banding)
PT’S
TREATMENT
Positioning
PT’S
TREATMENT
Preventing the deformities
PT’S
TREATMENT
Preventing the deformities
PT’S
TREATMENT
Preventing the deformities
PT’S
TREATM
ENT
 Manipulation
PT’S
TREATM
ENT
 Manipulation
PT’S
TREATM
ENT
 Reducing the deformities
 REFERE
NCES:
https://www.polioplace.org/living-with-polio/reasonable-expectations-physical-therapy
https://www.mossrehab.com/upload/docs/Services/mrri_sos9510.pdf
https://www.physio-pedia.com/Physical_Therapy_Intervention_in_Post_Polio_Syndrome
MANY THANKS!