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Acute Poliomyelitis Treatment & Management

  • Author: Christine L Munson, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Feb 11, 2016
 

Rehabilitation Program

Physical Therapy

Physical therapy plays an important role in rehabilitation for patients with poliomyelitis. Patients with muscle paralysis benefit from frequent passive range of motion (PROM) and splinting of joints to prevent contracture and joint ankylosis. Chest physical therapy (CPT) helps patients with bulbar involvement prevent any pulmonary complications, such as atelectasis. Frequent repositioning of paralyzed patients helps to prevent bedsores (see image below).

Orthotic treatment for deformities around the knee Orthotic treatment for deformities around the knee in poliomyelitis.

Occupational Therapy

Patients with paralysis of the extremities may benefit from hand or arm splints, knee or trochanter rolls, a footboard, or Multi-Podus boots to prevent foot drop, ulcers, and other deformities. Hot packs also are helpful to relieve the muscle pain.

Speech Therapy

Patients with cranial nerve involvement may develop swallowing dysfunction. To protect the airway and prevent aspiration pneumonia, a speech therapist needs to be involved early to perform an evaluation of the safety of swallowing. Decisions on the appropriate consistency of oral foods and use of various strategies/techniques greatly reduce the risk of aspiration. Periodic follow up of patient status can be performed with serial video swallow testing.

Recreational Therapy

Patients may attend leisure activities to reduce stress and learn how to get involved in group activities.

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Medical Issues/Complications

All patients should be placed on bedrest in an isolation unit. Monitor patients' vital signs carefully; focus especially on the swallowing function, vital capacity, pulse, and blood pressure, in anticipation of respiratory or circulatory complications. Patients who develop respiratory failure because of depression of the brainstem respiratory center, in addition to paralysis of the intercostal and diaphragmatic muscles, may require immediate positive pressure ventilation and/or tracheotomy in the respiratory intensive care unit.

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Surgical Intervention

In severe cases of contracture from limb immobilization, the patient may benefit from orthopedic surgery to release the contracture and restore limb function (see image below).

Surgical correction of a fixed flexion deformity o Surgical correction of a fixed flexion deformity of the knee and hip due to iliotibial band contracture, by Souttar and Yount's release.
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Other Treatment

No specific treatment exists for acute poliomyelitis except supportive care, which may help to ensure survival, modify the disability, and improve the outcome.

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Contributor Information and Disclosures
Author

Christine L Munson, MD Franklin Medical Offices, Kaiser Permanente

Christine L Munson, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, Association of Academic Physiatrists, Colorado Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Selina Yingqi Xing, MD, MS Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University

Selina Yingqi Xing, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Harry Schwartz, MD Director of Medical Rehabilitation Program & Spinal Cord Injury Program, Moss Rehabilitation Hospital; Clinical Assistant Professor, Department of Physical Medicine and Rehabilitation, Temple University School of Medicine

Harry Schwartz, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Medical Association, Academy of Spinal Cord Injury Professionals, American Spinal Injury Association, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Milton J Klein, DO, MBA Consulting Physiatrist, Heritage Valley Health System-Sewickley Hospital and Ohio Valley General Hospital

Milton J Klein, DO, MBA is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Medical Acupuncture, American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, American Pain Society, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

References
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The typical contractures of postpolio residual paralysis.
Orthotic treatment for deformities around the knee in poliomyelitis.
Surgical correction of a fixed flexion deformity of the knee and hip due to iliotibial band contracture, by Souttar and Yount's release.
 
 
 
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