poliomyelitis Flashcards
what is poliomyelitis?
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
causes
viral infection
type
type 1 - brunhilde
type 2- lanchi
type 3- leon
mode of transmission
mainly by fecal contamination (orofecal) route in countries where hygiene is poor
by droplets infection where the sanitation is good
where the viral infection colonized
GIT
incubation periods of virus
3 to 30 days
while 7 to 14 days is the most common interval between infection and clinical illness .
who decrease the incubation period?
injection
massage
physical activities
minor operation
pathology stages
Alimentary stages
viremic stages
neural stages
what happen in alimentary stages?
After gaining access— to the body—through nasopharynx—or the git—virus multiple in the epithelial cells of the intestinal mucosa
what happen in viremic stages?
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
what happen in neural stage?
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
what is first stage?
alimentary stage
what is second stage?
viremic stage
what is third stage?
neural stage
write the stage of clinical features in poliomyelitis?
prodromal stage or pre paralytic stage acute stage convalescent stage stage of recovery chronic or residual phase
clinical features in predormal stage
headache sore throat malaise slight cough diarrhea or constipation backache joint pain pyrexia of variable duration & severity mild neck stiffness irritability
duration stage in prodromal stage or pre paralytic stage
1 to 3 days
Pt mgt in predormal stage
rest if possible
Acute stage
(early stage of paralysis) c/f
- 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)
what is the most important sign in acute stage?
muscle tenderness
duration in acute stage?
3 to 6 weeks
pt mgt in acute stage?
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
convalescent stage (true or actual paralysis)types
spinal type
bulbar type
spinobulbar
postencephalitic
who is most common in convalescent stage?
Spinal
Spinal
lower motor neuron type
lower limb muscle are more involved than upper limb
bulbur
inability to swallow due to pharayngeal paralysis
cannot cough properly due to paralysis of larynx
difficulty in speaking due to paralysis of the palate
spinobulbar
spinal + bulbur
post encephalitic
associate with bulbar paralysis
mental disturbance & even coma may occur
stage of recovery
also called late convalescent
duration in convalescent stage
3 months
duration in stage of recovery
2 years
chronic or residual phase duration
12-18 months
chronic or residual phase c/f
paralysis or weakness after 2 years
•permanent
mgt in convalescent stage
•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
stage of recovery
late convalescent
- sensory integration
- resisted exercises with the help of springs & pulley
- hydrotherapy
- suspension therapy
- pnt technique
- mat exercise
stage of residual paralysis mgt
stretching
strengthening
calliperization
Goals
- 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
contracture in lower limb
hip - flexion abduction
knee flexion
ankle &foot plantar flexion (equinus) varus or valgus
in upper limb
should- abduction
elbow-flexion
what are the differential diagnosis?
pyogenic meningitis Guillain barre syndrome acute osteomyelitis peripheral nerve injury spina bifia cerebral palsy erb palsy muscular dystrophy myopathies
pyogenic meningitis
muscular spasticity instead of flaccidity
Guilliain barre syndrome
bilaterally symmetrical involvement
acute osteomyelitis
sign of localized acute inflammation (warmth ,redness,at the body ends with painful limitations of joints movement)
peripheral nerve injury
definite history of injury, paralysis involves muscle group innervated by the injured peripheral nerve
spina bifida
congenital,bilaterally symmetrical paralysis of muscle
cp
spastic paralysis with exaggerated reflex,typical arm posture of adduction & internal rotation
erb palsy
history of birth trauma , involves only one upper extremity
muscular dystrophy
myopathies
bilaterally symmetrical with characteristics
age
younger than 12 months
but may occur up to 5 year of age
involvement of muscle in upper
deltoid
involvement of muscle in lower extremity
quadriceps
tibialis anterior
c/f
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
