Pocket Book of

Physiotherapy Management
in Poliomyelitis
 Pocket Book of
Physiotherapy Management
in Poliomyelitis

Nidhi Khanna
BPT (Gold Medalist)
Saaii College of Medical Science and Technology
Chaubepur, Kanpur, Uttar Pradesh, India

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Pocket Book of Physiotherapy Management in Poliomyelitis

© 2009, Nidhi Khanna
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or
transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every
effort is made to ensure accuracy of material, but the publisher, printer and author will not be
held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be
settled under Delhi jurisdiction only.

First Edition: 2009

ISBN 978-81-8448-476-2
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset & Packagings Ltd., New Delhi
 To
My beloved husband

Chetan Khanna

and my two
beautiful children

Palak
and

Kashish
 PREFACE

Physiotherapy nowadays has become the integral part

of modern medical sciences. This branch of science has
already been established itself in the other countries of
the world and now becoming popular in India. During
my course, I have undergone many problems related to
studying any topic in detail. Though there were lots of
books on physiotherapy available in the market but for
studying any topic in detail was a great problem,
especially while making the project or while preparing
the speech on a specific topic. This was because I had
to consult many books in order to collect all the
information regarding that topic as there was no such
book available which provided me with full information
on the topic. This inspired me to write this pocketbook
which covers almost all the information regarding the
topic. I think this book will be beneficial for all those
who want to study the topic in detail.
Though I have made every effort to aviod errors,
but in spite of this, error may creep in. If any mistake
or discrepancy noted may be brought into my
knowledge, I shall be grateful for the same.
Wishing you all the best for your bright future and
prosperous life. I also pray for your success in life.
Nidhi Khanna
 ACKNOWLEDGEMENTS

I take this opportunity to present my sincere gratitude

towards all those who have helped me to make all this
happen.
This would not have been possible without the
spontaneous and continuous support of many people.
I am grateful to my parents, Mr Sukhdev Bakshi
and Mrs Mohini Bakshi and my in-laws, Mr Vijay
Khanna and Mrs Chand Khanna for their continuous
support and blessings.
I would like to thank all the professors for their
guidance and encouragement.
With the bottom of my heart I would like to thank
my husband, Mr Chetan Khanna and my kids, Palak
and Kashish who have helped me throughout the
making of this project. Without them it would not have
been possible.
And above all, I am also grateful to Shri Jitendar P
Vij and Mr Tarun Duneja of M/s Jaypee Brothers
Medical Publishers (P) Ltd. for their moral support and
encouragement. It was not possible for me to publish
this book without their support.
Last but not the least, I would like to thank GOD
ALMIGHTY for showering blessings on me.
 CONTENTS

1. Definition ....................................................... 1
2. Epidemiology ................................................. 3
3. Aetiopathology .............................................. 5
a. Causative agent ........................................ 5
b. Age of onset ............................................... 7
c. Sex affected most ...................................... 7
d. Risk factors ............................................... 7
e. Environmental factors ............................. 8
f. Mode of transmission ............................... 8
g. Incubation period ..................................... 8
4. Pathogenesis .................................................. 9
5. Stages of Poliomyelitis ................................. 11
a. Acute Phase .............................................. 11
b. Convalescent or recovery phase ............ 11
c. Chronic or residual phase ...................... 11
6. Clinical Features ......................................... 13
a. Inapparent or subclinical infection ...... 13
b. Minor illness ........................................... 13
c. Non-paralytic polio ................................ 13
d. Paralytic polio ......................................... 15
7. Types of Paralytic Polio .............................. 17
a. Spinal polio ............................................. 17
b. Bulbar polio ............................................ 18
c. Bulbospinal polio .................................... 20
xii Physiotherapy Management in Poliomyelitis
8. Peculiar Features Seen in Polio ................. 21
a. In the early stage .................................... 21
b. In the later stage ..................................... 22
9. Diagnosis ...................................................... 26
a. Viral isolation ......................................... 26
b. Serology ................................................... 26
c. Cerebrospinal fluid (CSF) ..................... 26
10. Prognosis ...................................................... 27
11. Differential Diagnosis ................................. 29
12. Treatment ..................................................... 34
a. Preventive treatment .............................. 34
• Salk vaccine ........................................ 34
• Sabin vaccine ..................................... 35
b. Conservative treatment ......................... 36
c. Surgical treatment .................................. 37
• Tendon transplantation .................... 37
• Release of contracture ....................... 37
• Arthrodesis ......................................... 38
• Resection ............................................ 38
• Tendon lengthening ........................... 38
• Osteotomy .......................................... 39
13. Physiotherapy Treatment ........................... 40
a. Identification data .................................. 40
b. Chief complaint of the patient .............. 41
c. History of the patient ............................. 41
d. On observation ....................................... 42
• Local observation .............................. 42
• General observation .......................... 42
 Contents xiii
e. On examination ...................................... 42
• Local ................................................... 42
• Palpation ............................................ 43
• Motor examination ............................ 43
– MMT .............................................. 43
– Range of motion .......................... 120
– Superficial reflexes ..................... 146
– Deep reflexes ............................... 146
• Sensory examination ....................... 149
• Postural examination ...................... 150
• Gait examination ............................. 154
f. Treatment plan ..................................... 160
• Acute phase ...................................... 160
• Recovery phase ................................ 175
• Chronic or residual phase ............... 193
14. Appliances for Polio Patient ..................... 203
Conclusion .................................................. 209
Some of the Bio-electrical Modalities and
Exercise Gadgets Used in Physiotherapy
Department .................................................. 211

Index ............................................................ 215

 INTRODUCTION

Poliomyelitis, commonly called as polio, is an epidemic

and endemic disease caused by viral infection. It is
transmitted by droplet infection or by oral ingestion. It
usually affects children under the age of five. The
disease can be divided into three phases:
• Acute phase
• Recovery phase
• Residual phase
In the acute phase, the symptoms are general and
the patient recovers soon. This phase lasts for first 3-5
weeks. In the recovery phase some muscles or muscle
group recovers leading to either spontaneous recovery
or varying degree of paralysis depending upon the
damage done by the virus on neurons. This phase lasts
for 4 weeks to 1 year. There is a lower motor neuron
(flaccid) paralysis in the residual phase with sensation
intact. This residual phase starts after 1 year of infection
and last till 18 months.
The muscles affected depend upon the level of
spinal cord affected by the virus. Usually lower limb is
affected more than the upper limb and contractures
occur leading to deformity accordingly.
Physiotherapy plays an important role in the
treatment of polio. Specific exercises and stretching
xvi Physiotherapy Management in Poliomyelitis
programs helps in the recovery of certain paralyzed
patients. But in severe cases surgical procedures are
necessary; here also physiotherapy plays an important
role in preoperative and postoperative condition.
Various forms of orthosis are needed to give support
and stability to the joint.
For complete eradication of disease, prevention of
further cases of polio is essential. In South East Asian
region, India is the only country reporting polio cases.
Government of India had also carried out various
programs like pulse polio immunization to eradicate
this disease. In this program, children under the age of
five are given dose of OPV (Oral Polio Vaccine) free
of cost.
By implementing the appropriate physical therapy
interventions at each stage of the disease we can prevent
the future disabilities and restore maximum functional
activities.