Updated: 10/27/2019

Poliomyelitis

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Questions
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Introduction
  • A disease caused by viral destruction of the anterior horn cells in the spinal cord and brain stem motor nuclei
    • hallmark is motor weakness with normal sensation
  • Epidemiology
    • has been eradicated in the United States with the use of a vaccine
  • Associated conditions
    • Postpolio syndrome
      • an aging phenomenon where more nerve cells become inactive with time
        • it does not represent reactivation of the virus
        • occurs after middle age
        • occurs in up to 50% of polio cases
      • leads to increasing difficulty performing activities of daily living
      • patients should exercise at sub-exhaustion levels to tone affected muscle groups without causing muscle breakdown 
Presentation
  • Physical Exam
    • hallmark is muscle weakness with normal sensation
Treatment
  • Postpolio Syndrome
    • nonoperative
      • limited exercise with periods of rest, +/- lightweight orthosis 
        • indications
          • first line of treatment
        • technique
          • goal is to maintain but not overuse muscles 
    • operative
      • tendon transfers, contracture releases, and arthrodesis
        •  indications
          • used to optimize functional capacity
  • Polio foot deformities
    • nonoperative
      • lightweight orthoses 
        • indications
          • first line of treatment
          • help patient remain functionally independent
    • operative
      • contracture release, tendon transfer, and arthrodesis  
        • indication
          • if orthoses do not achieve satisfactory standard of living
 

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Questions (1)

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(OBQ07.221) A newly adopted 7-year-old girl from Liberia has a history of poliomyelitis 2 years ago. She had flaccid paralysis of her legs that made her bedridden for 6 months. She has recovered all strength and has no complaints at this time. The parents would like to know if they should be concerned about any residual effects of the infection. How should they be counseled? Review Topic

QID: 882
1

The child has no risk of further paralysis or weakness from polio

7%

(257/3779)

2

The child may experience muscle weakness and fatigue as an adult

86%

(3237/3779)

3

If the child has no recurrent episodes of paralysis by the time she reaches skeletal maturity, then she will never have further weakness

4%

(148/3779)

4

The child will certainly have weakness and possibly paralysis as an adult, and therefore she should abstain from sports to prevent further muscle injury

3%

(97/3779)

5

The child will most likely be wheelchair bound by the age of 25 years.

1%

(23/3779)

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