Polio, also known as Poliomyelitis is a viral disease that destroys the nerve cells, it is present in the spinal cord, causing muscle weakness or paralysis to some parts of the body. It is a contagious disease caused by a poliovirus - Picornaviridae. Poliovirus can spread from person to person or by food and water containing human faeces. Paralytic syndrome and Post-polio syndrome have a cluster of disabling signs and symptoms like loss of reflexes, loose and floppy limbs, progressive muscle or joint weakness and pain, fatigue, etc. The symptoms of polio are highly variable, ranging from viral problems without paralysis to quadriplegia and even respiratory failure. And thus the treatment intervention varies from patient to patient. These interventions include surgery that can be done to reestablish balance in the muscles around the joints to prevent deformities. Further physiotherapy is also one of the best treatment options available for polio patients. The treatment aims to achieve an acceptable physical status for the patients by designing non-fatiguing exercises which are appropriate to deal with muscle overuse weakness. In this blog, we have discussed physiotherapy management for patients suffering from poliomyelitis.
Physiotherapy Treatment for Poliomyelitis
Exercise programs for polio patients are specifically tailored to the individual's functional status and needs. The exercises should not overly fatigue the patient as these can decrease the patient's functional level. Physiotherapy treatment of post-polio muscular pain can include activity reduction, pacing (rest periods during activity), thermotherapy, cryotherapy, transcutaneous electrical stimulations (TENS) and stretch, use of assistive devices, and lifestyle modifications.
Inspiratory Muscle Training:
Inspiratory muscle training can be performed at home by using a spirometer or simple breathing exercises. The patient performs training for 20 minutes with 1 minute of exercise, 1-minute rest, and repeat 10 times, done every day for a period of 10 14 weeks.
Active and Passive Movements of Joints:
Joint movement exercises are not recommended when the muscles are in spasm or are very tender. Without eliciting pain simple activities are done for hips, ankles and other joints to keep them moving through a full range each day. In case of paralyzed joints, active movements may have to be replaced by doing passive movements.
Posture Splinting and Support:
Correct posture of the patient in bed is maintained to prevent deformities. Detachable supports like above-knee calipers, support knees, and ankles, keep the knee straight and also help to prevent any hip flexion deformities. Spinal supports for the patient with a flail spine helps to support the back.
Mobilization:
Gradually mobilizing the patient i.e progressing from supports in bed, to support in a chair, from sitting to standing and walking. Progressive mobilization of the paralyzed patient out of bed, from a wheelchair used in severely disabled patients to a walking machine, parallel bars, crutches, and calipers are used in less severely disabled patients. Patients with weak quadriceps are capable of walking without calipers by supporting the knee with a hand or by forcing back their knee. This may be done in the patient with strong hip extensors and moderate plantar.
Supervised progressive resistance training regime with voluntary contractions and rest interval is given to allow recovery from fatigue. To safeguard against the possible risk of overuse, the initial training load is minimum and eventually increased gradually.
General warm-up exercises are followed by low-resistance, high-repetition exercises for all major muscle groups, both for upper extremities, lower extremities, and also for the trunk. More emphasis is laid on training the quadriceps muscle.
Cardiovascular Fitness Exercises:
A correct level of exercise must be recommended to gain maximal cardiovascular fitness without worsening levels of chronic fatigue. Excessive cardiovascular exercise has proved to increase levels of chronic fatigue, though some amount of exercise is necessary for improving cardiovascular fitness. Therefore a moderate intensity, short sessions, frequent rests with adequate recovery time between session days is preferred.
Stretching of Muscles and Joints:
Stretching of Muscles and Joints helps in the prevention of contractures. Joints must be stretched in the direction opposite to that of the contracture, should be done once a day at least 3 times. For flexion contracture of the hip, backward pressure should be in the upper third of the thigh, the opposite hip must be fully flexed to eliminate lumbar lordosis, and the leg is brought down in slight adduction to stretch the abductors which are usually tight. The patient is laid on his face in bed, with a pillow under the lower thigh. The hips can also be extended while the patient is in this position. Flexion contracture of the Knee is manipulated by exerting pressure near the joint.
Manipulation of Ankle and Foot Deformities:
The most important deformity to correct is equinus. The ankle is firmly supported as the foot is dorsiflexed, in case of varus of the foot or adduction of the forefoot then it is important to be firm but gentle and avoid too forceful manipulation. Firm pressure for 5 minutes in the opposite direction to the deformity, and is repeated and followed by a surgical correction to prevent a recurrence.
Orthosis:
Children with weak limbs and with the possibility of deformity are encouraged to wear calipers till the growth period is completed. They can walk without support but the caliper must fit properly.
Crutches are required in patients with bilateral calipers or a caliper on one leg with weakness of the opposite leg or spine, also needed in patients with weakness of the hip on the side with severely affected lower leg. Crutches should be correct both in length and in the position of the handgrip. In case of weakness of the trunk or arms, the top of the crutch should be well padded to avoid pressure in the axilla and radial nerve palsy.
Hydrotherapy:
Training sessions can be held in the hydrotherapy pool, designed to train general physical fitness including resistance and endurance activities, balance, stretching, and relaxation. The patient exercises at the intensity level where muscle fatigue is not present during or after the training session.
Aerobic training:
The patient exercises at 70% of maximal heart rate in an aerobic exercise program is found to be beneficial. For example, training on the treadmill 3 times a week for 20 minutes per session in an aerobic exercise program.
The patient should follow these exercises on regular basis or as recommended by the physiotherapist. There is no cure for poliomyelitis, as it has paralyzed thousands of people all over the world. Thus treatment mainly focuses is on increasing comfort, speeding recovery, and preventing complications.