Orthotic Treatment Management of Poliomyelitis

Definition
Acute infection by the polio virus, especially of the motor neurons in the spinal cord and brainstem, leading to muscle weakness, paralysis and sometimes deformity.

Causes
polio virus

Signs & Symptoms
Sub clinical Infection: General discomfort or uneasiness (malaise), Headache, Red throat, Slight fever, Sore throat, Vomiting
No paralytic Poliomyelitis: Back pain or backache, fatigue, Headache, Irritability, Muscle stiffness, Muscle tenderness and spasm in any area of the body, Neck pain and stiffness, etc
Paralytic Poliomyelitis: Irritability or poor temper control, Muscle contractions or muscle spasms in the calf, neck, or back, Muscle pain, Muscle weakness, asymmetrical (only on one side or worse on one side), Location depends on where the spinal cord is affected, Progresses to paralysis, Rapid onset, Sensitivity to touch; mild touch may be painful

Orthotic Treatment
The orthotic goal to halt increasing debility may be to stop the motion at a joint to compensate for failing compensatory motion in order to increase safety and stability, improve walking ability and perceived walking safety with less overall pain.

Objectives of orthotic intervention
1. correcting or accommodating and preventing deformity;
2. supporting the limb for stability;
3. decreasing the stresses placed on the joints;
4. decreasing the energy expenditure that is causing the muscles to become fatigued;
5. To normalize the gait pattern, since normal gait is the most energy-efficient and least stressful way to walk.

The orthotic management of polio patients may consist of the return to functional orthoses, often after many years of nonuse. Designs incorporating increased function and stability with decreased weight are desirable

Management of Ankle Foot Complex

The plantar surface of the foot should be carefully examined for weight bearing, the presence of metatarsalgia or hypercalosity indicate the needs for improvement of weight bearing. If the hip and knee are stable, painless and free from gross deformity, an AFO can be applied. When useful talocrural motion is present, the articulating AFO can be applied.
If there is weakness of pretibial muscles, posterior leaf spring AFO can be used. If the knee is relatively free from transverse plane deformity and recurvatum, but weakness of Calf muscle present, an Anterior Floor Reaction AFO design may suffice.

Management of Knee
Genu recurvatum is common, secondary to weak quadriceps, when there is present of other weakness or deformity at ankle, KAFO with knee Lock often used.

Management of Hip
When the weakness also present on Hip muscle, Ischial Weight Bearing KAFO often used, with Quadrilateral style Brim.

Complications
Contracture, and deformity may develop, such as, cavus, forefoot adductus, halus Valgus, equinus, pes Valgus, pes varus, genu recuravatum, genu valgum, genu varum, Lordosis, scoliosis, etc.

Orthotic Treatment post complication
With the present of contracture and deformity, the orthotic treatment is to reduce / correct the deformity, along with proving stability as well as enhance mobility, so that patient can perform the Activity daily living.

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