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Neurophysiotherapy > poliomyelitis > Flashcards

poliomyelitis Flashcards

1
Q

what is poliomyelitis?

A

viral infection of nerve cells in the anterior gray matter (anterior horn cell of the spinal cord) or cranial nerve nuclei in the brain stem which is leading in many cases to temporary or permanent paralysis of the muscle

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2
Q

causes

A

viral infection

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3
Q

type

A

type 1 - brunhilde
type 2- lanchi
type 3- leon

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4
Q

mode of transmission

A

mainly by fecal contamination (orofecal) route in countries where hygiene is poor

by droplets infection where the sanitation is good

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5
Q

where the viral infection colonized

A

GIT

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6
Q

incubation periods of virus

A

3 to 30 days

while 7 to 14 days is the most common interval between infection and clinical illness .

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7
Q

who decrease the incubation period?

A

injection
massage
physical activities
minor operation

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8
Q

pathology stages

A

Alimentary stages
viremic stages
neural stages

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9
Q

what happen in alimentary stages?

A

After gaining access— to the body—through nasopharynx—or the git—virus multiple in the epithelial cells of the intestinal mucosa

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10
Q

what happen in viremic stages?

A

virus —spread —via the blood stream—after a sort of conflict between the virus and the antibodies—in case the virus turn victorious —then it lead to third stage

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11
Q

what happen in neural stage?

A

virus—anterior horn cell of the spinal cord (& sometimes to nerve cell in the brain stem—& damage or kill the cell—if the cell will damage—recovery is possible—but if the cell are killed—the paralysis will be permanent

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12
Q

what is first stage?

A

alimentary stage

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13
Q

what is second stage?

A

viremic stage

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14
Q

what is third stage?

A

neural stage

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15
Q

write the stage of clinical features in poliomyelitis?

A 
prodromal stage or pre paralytic stage
acute stage
convalescent stage
stage of recovery 
chronic or residual phase
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16
Q

clinical features in predormal stage

A 
headache
sore throat 
malaise
slight cough
diarrhea or constipation 
backache
joint pain
pyrexia of variable duration  & severity
mild neck stiffness 
irritability
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17
Q

duration stage in prodromal stage or pre paralytic stage

A

1 to 3 days

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18
Q

Pt mgt in predormal stage

A

rest if possible

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19
Q

Acute stage

(early stage of paralysis) c/f

A
  • most of the sign the symptoms remain smilier to predormal stage but are more pronounced especially the following
  • fever
  • diarrhea
  • nausea
  • vomiting
  • irritability
  • limb & joint pains
  • muscle tenderness (most important sign)
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20
Q

what is the most important sign in acute stage?

A

muscle tenderness

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21
Q

duration in acute stage?

A

3 to 6 weeks

22
Q

pt mgt in acute stage?

A

rest- physical activity should be discouraged at this stage
isolation-prevented from mingling with other children
•booster dose - dose of vaccination
•nutrition- rich in protein
•correct handling technique-
the child should be held in front & preferably with the hip in extension without any abduction
•splintage & correct positioning
•sister knny’s bath
•MMT
•Gentel passive movement

23
Q

convalescent stage (true or actual paralysis)types

A

spinal type
bulbar type
spinobulbar
postencephalitic

24
Q

who is most common in convalescent stage?

A

Spinal

25
Q

Spinal

A

lower motor neuron type

lower limb muscle are more involved than upper limb

26
Q

bulbur

A

inability to swallow due to pharayngeal paralysis
cannot cough properly due to paralysis of larynx
difficulty in speaking due to paralysis of the palate

27
Q

spinobulbar

A

spinal + bulbur

28
Q

post encephalitic

A

associate with bulbar paralysis

mental disturbance & even coma may occur

29
Q

stage of recovery

A

also called late convalescent

30
Q

duration in convalescent stage

A

3 months

31
Q

duration in stage of recovery

A

2 years

32
Q

chronic or residual phase duration

A

12-18 months

33
Q

chronic or residual phase c/f

A

paralysis or weakness after 2 years

•permanent

34
Q

mgt in convalescent stage

A

•continues splintage:
above knee splint or even L splint maybe given to prevent knee flexion & equines deformity
below knee splint may be sufficient if the pt. has a tendency to develop equines deformity.
•abdominal corset-weakness of the abdominal muscle especially patch type may cause protrusion of the organ from the weak spot due to lack of proper abdominal support.
_towel can also be wrapped tight around the abdomen in the absence of abdomen corset
•chest pt- can be give as good abdominal pressure
•muscle charting
•mmt should be done every week or alternate
week
•positioning
child should be kept in prone position to aboid flexion contracture
•changing the position (every 2 to 4 hours a day)
•stretching of contracture
•Stimulation & facilition technique

35
Q

stage of recovery

late convalescent

A
  • sensory integration
  • resisted exercises with the help of springs & pulley
  • hydrotherapy
  • suspension therapy
  • pnt technique
  • mat exercise
36
Q

stage of residual paralysis mgt

A

stretching
strengthening
calliperization

37
Q

Goals

A
  • prevent contracture
  • strengthening of muscle
  • increase flexibility of muscle
  • improve balance
  • recovery of paralysed muscle
  • prevent deformities
  • reduce pain & weakness of muscle
  • decreased fatigue
  • improve swallowing fuction
  • improve walking
38
Q

contracture in lower limb

A

hip - flexion abduction
knee flexion
ankle &foot plantar flexion (equinus) varus or valgus

39
Q

in upper limb

A

should- abduction

elbow-flexion

40
Q

what are the differential diagnosis?

A 
pyogenic meningitis 
Guillain barre syndrome 
acute osteomyelitis 
peripheral nerve injury 
spina bifia
cerebral palsy
erb palsy
muscular dystrophy 
myopathies
41
Q

pyogenic meningitis

A

muscular spasticity instead of flaccidity

42
Q

Guilliain barre syndrome

A

bilaterally symmetrical involvement

43
Q

acute osteomyelitis

A

sign of localized acute inflammation (warmth ,redness,at the body ends with painful limitations of joints movement)

44
Q

peripheral nerve injury

A

definite history of injury, paralysis involves muscle group innervated by the injured peripheral nerve

45
Q

spina bifida

A

congenital,bilaterally symmetrical paralysis of muscle

46
Q

cp

A

spastic paralysis with exaggerated reflex,typical arm posture of adduction & internal rotation

47
Q

erb palsy

A

history of birth trauma , involves only one upper extremity

48
Q

muscular dystrophy

myopathies

A

bilaterally symmetrical with characteristics

49
Q

age

A

younger than 12 months

but may occur up to 5 year of age

50
Q

involvement of muscle in upper

A

deltoid

51
Q

involvement of muscle in lower extremity

A

quadriceps

tibialis anterior

52
Q

c/f

A

age -children (younger than 12 months but may occur up to 5 years of age)

sex- no differentiation

involvement:
lower extremities are involved but may affect other part of body include bulbur paralysis
localized pain
tenderness
awkward limb positioning due to acute muscle spasm
delete in upper extremity
quadriceps & tibialis anterior in the lower extremities are most common
restlessness may be associated with fever
usually, a history of inadequate or no vaccination against all the three types of poliovirus is reported
•early detection
-tenderness over the affected muscle group
-cold limbs due to impaired circulation are observed
-gross weakness of the limb is reported
-intercostal & diaphragmatic weakness will indicated by insufficiency of inspiration
-weakness of abdominal will produce deficient abdominal
-deviation of the umbilicals upward,downward or to one side indicates segmental weakness of the abdominals
-reflex are reduced/lost
-flaccid paralysis
-asymmetrical in nature
-degree of paralysis can be done by mmt

Neurophysiotherapy (10 decks)

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