Orthotic Treatment For PoliomyelitisOrthotic Treatment For Poliomyelitis

Prepared By:Amina Jamil Bsc (hons) Orthotics And Prosthetics 2nd year K.E.M.U

Prepared By:Amina Jamil Bsc (hons) Orthotics And Prosthetics 2nd year K.E.M.U

ContentsContents

Poliomyelitis Orthotic treatment of poliomyelitis Objectives of orthotic intervention Management of ankle foot complex Management of knee Management of hip Complications Orthotic treatment post complications

Poliomyelitis

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.

Orthotic Treatment Of Poliomyelitis

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

Correcting or accommodating and preventing deformity

Supporting the limb for stability Decreasing the stresses placed on the joints Decreasing the energy expenditure that is

causing the muscles to become fatigued To normalize the gait pattern, since normal

gait is the most energy-efficient and least stressful way to walk.

Objectives Of Orthotic Intervention

The orthotic management of polio patients may consist of return to functional orthoses, often after many years of non use.

Design incorporated 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 in pre tibial muscles, posterior leaf spring AFO can be used.

If the knee is relatively free from transverse plane deformity and recurvatum. But weakness of CALF muscles present.an Anterior Floor Reaction AFO may suffice.

Management Of Knee

Polio survivors are aging and facing multiple pathologies. With age, walking becomes more difficult, partly due to locomotor deficits but also as a result of weight gain, osteoarticular degeneration, pain, cardiorespiratory problems or even post polio syndrome (PPS).

These additional complications increase the risk of falls in this population where the risk of fractures is already quite high. The key joint is the knee.

The muscles stabilizing this joint are often weak and patients develop compensatory gait strategies, which could be harmful to the locomotor system at medium or long term.

Management Of Knee

Classically, knee recurvatum is used to lock the knee during weight bearing; however, if it exceeds 10 degrees , the knee becomes unstable and walking is unsafe.

Thus, regular medical monitoring is necessary. Orthoses play an important role in the therapeutic care of polio survivors.

The aim is usually to secure the knee, preventing excessive recurvatum while respecting the patient's own gait.

Orthoses must be light and pressure-free if they are to be tolerated and therefore effective.

Other joints present fewer problems and orthoses are rarely indicated just for them.

Management Of Knee

The main issue lies in the prior evaluation of treatments' impact. Some deformities may be helpful for the patients' gait .

Therefore corrections may worsen their gait, especially if a realignment of segments is attempted.

It is therefore essential to carefully pre-assess any change brought to the orthoses as well as proper indications for corrective surgery. In addition, it is essential for the patient to be monitored by a specialized team.

Management Of Hip

When the weakness also present on hip muscle, ischial weight bearing KAFO often used with Quardilateral style Brim.

Complications

Contracture or deformity, may develop, such as:

Cavus Forefoot aducts Halus valgus Equinus Pes valgus Genu recurvatum Genu valgum Genu varum Lordosis Scoliosis

Orthotic Treatment Post Complication

With the presence of contracture and deformity, the orthotic treatment is to reduce / correct the deformity , along with providing stability as well as enhance mobility. So that patient can perform the activity daily living.

The use of carbon fibre material in the orthotic treatment of polio patients seems to be supported by the positive results.