3Poliomyelitis polio= gray matter Myelitis= inflammation of the spinal cord
4Poliomyelitis First described by Michael Underwood in 1789 First outbreak described in U.S. in 184321,000 paralytic cases reported in the U. S. in 1952Global eradication in near future4
5PoliomyelitisPoliomyelitis, literally meaning “gray spinal cord inflammationIt is a viral infectionThere are three types of poliovirus and many strains of each typeIt is contagious: usually spread from person to person.Only harmful to humans
6The PoliovirusVirus localized in the anterior horn cells of the spinal cord and certain brain steam motor nuclei.
10Poliomyelitis Pathogenesis Entry into mouthReplication in pharynx, GI tract, local lymphaticsHematologic spread to lymphatics and central nervous systemViral spread along nerve fibersDestruction of motor neurons
11Poliomyelitis Pathogenesis The ant. Horn motor cells may be damaged by viral multiplication or toxic byproducts of the virus or indirectly by ischemia, edema, and hemorrhage in the glial tissues.Destruction of the spinal cord occurs focally and within 3 days wallerian degeneration is evident.
12poliomyelitisMost affects children under the age of 5 years in developing tropical countries.Incubation period ranges from 6 to 20 days
13What are the symptoms? Acute stage: generally lasts 7 to 10 days. Many include fever, pharyngitis, headache, anorexia, nausea, and vomiting. Illness may progress to aseptic meningitis and menigoencephalitis in 1% to 4% of patients. These patients develop a higher fever & sever headache with stiffness of the neck and back.
14What are the symptoms?Paralytic disease occurs 0.1% to 1% of those who become infected with the polio virus.Paralysis of the respiratory muscles or from cardiac arrest if the neurons in the medulla oblongata are destroyed.
15Clinical courseSymptoms range :from mild malaise to generalized encephalomyelitis with widespread paralysis.Hyperesthesia or paresthesia in the extremities and muscular pain is common.Muscles are tender even to gentle palpation.
16PoliomyelitisAccording to Sharrard, weakness is clinically detectable only when more than 60% of the nerve cells supplying the muscle have been destroyed.Paralysis occurs twice as often in the lower extremity as in upper extremity.
17Poliomyelitis The most commonly affected muscles are the Quadriceps, glutei, tibialis anterior, medial hamstrings, and hip flexors.Deltoid, triceps, and pectoralis major.
19PoliomyelitisPatients have some or full recovery from paralysis, most clinical recovery occurs during the 1 month and almost complete within 6 months.Limited recovery may occur for about 2 years.
20PoliomyelitisIn cases with paralysis superficial reflexes usually are absent first, and deep tendon reflexes disappear when the muscle group is paralyzed.DDX.: Guillain-Barre syndrome, and other forms of encephalomyelitis
22Treatment in the acute stage Bed rest, analgesics, hot packs, and anatomical positioning of the limbsgentle passive ROM exercises of all joints
23Treatment in the acute stage close monitoring of respiratory and cardiovascular functioning is essential during the acute stage of poliomyelitis along with fever control and pain relievers for muscle spasms.Mechanical ventilation, respiratory therapy may be needed depending of the severity of patients.
24Convalescent stageFrom 2 days after the temperature return to normal and continues for 2 yearsMuscle power improvesPhysical therapy is recommended for full recovery.Passive stretching exercises and wedging casts can be used for mild to moderate contractures.
25Convalescent stageSurgical release of tight fascia and muscle aponeuroses and lengthening of tendons may be necessary for contractures persisting longer than 6 months.Orthoses should be used until no further recovery is anticipated.
26Chronic stage 24 months after the active illness: The goals of treatment include correcting any significant muscle imbalance and preventing or correcting soft tissue or bony deformities.
28Chronic stage Static joint instability can be controlled by Orthoses. Dynamic joint instability result in a fixed deformity that cannot be controlled by Orthoses.
29Chronic stageSoft tissue surgery, such as tendon transfers, should be done in young children before the development of any fixed bony changes.Bony procedures for correcting a deformity can be delayed until skeletal growth is near completion.
30Global eradication in near future PreventionImmunization of the young continues
34Wild Poliovirus 1988 National Immunization Program Centers for Disease Control and Prevention
35Wild Poliovirus 2004 Centers for Disease Control and Prevention National Immunization ProgramNational Immunization ProgramCenters for Disease Control and PreventionNational Immunization ProgramCenters for Disease Control and Prevention
36Study We study 246 patient with polio in Sari Male:156 cases (63/4%) female: 90 cases (36/6%)age :22 to 63 years old main age 46/3One lower limb: 164 cases (66/6%)Both lower limb: 62 cases (25/2 %)Both lower limb together with upper limb 10 cases (4/1% )
37Result: From 246 patients ;108 used brace 56 patients needs brace but not used187 operation has down for these patients97 patients more than one operation has down82 patients have mild symptoms and don’t needTo any operation or brace.
38Result: From 187 operation : 53 cases; ankle triple arthrodesis 81 cases; tendon transfer EHL to dorsum foot10 cases; other kind of tendon transfers11 cases; ATL8 cases; lower limb lengthening
39Result: 2 cases; Ephypisodesis 1 case; ankle fusion 23 cases; toe deformity correction53 cases; soft tissue release for knee and hip flexion contracture37 cases; osteotomy around knee
40Result: Very important point No any new case in last 10 years reported.