2. Neuromuscular conditions Poliomyelitis Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon Pediatric Orthopedic Surgeon

3. Poliomyelitis Infectious disease characterized by Asymmetric flaccid motor paralysis

4. Pathology  Entro Virus (Picornavirus)  Polio (3) no cross immunization  Transmitted by oronasal route By water and milk

6. Distribution  Lower limb 92 %  Trunk + LL 4 %  LL + UL 1.33 %  Bilateral UL 0.67 %  Trunk + UL + LL 2 %  Deformities: –Spine (scoliosis, Kyphosis) –Limbs (equinous, pes cavus, flail knee & UL)

7. Causes of deformity in Polio  Unbalanced muscle paralysis: –Unopposed muscle pull from the non-paralyzed muscles  Gravity pull effect  Posture: –e.g. Sitting with knee flexed

8. Deformities  Vary according to degree of muscle imbalance, or if patient was diagnosed early and attempts were made to prevent deformities  Lower limbs are the commonest.  If associated with trunk deformity, they are really disabled

9. Muscle power grading  Grade 0 total paralysis (no contraction palpated)  Grade 1 evidence of slight contractility but no joint movement  Grade 2 complete range of motion with gravity eliminated  Grade 3 complete range of motion against gravity  Grade 4 complete range of motion against some resistance  Grade 5 complete range of motion against maximal resistance

11. Diagnosis  Is not difficult  Asymmetric, flaccid lower motor neuron paralysis  No sensory loss, or loss of proprioception  There is full control of the bladder & bowel  There should be a history of febrile illness

12. Management  Management starts with diagnosis & accurate muscle charting (assessing power & deformities)  Discussion of expectations  Assessment resources  Family support

13. Deformity correction  Mainly lower limb  Aim for walking with or without orthosis by getting straight limb with plantigrade foot  Methods – Reconstructive surgery – Physiotherapy – Orthosis

14. Orthosis

15. Reconstructive surgery  Correction of deformities  Improving the function (transfer of a tendon or muscle, removal of deforming force)  Stabilizing paralyzed joints (arthrodesis)

20. Paralytic scoliosis  Usually long C shaped curve  Trunk collapse occurs when there is weak erector spinae muscles.  Long spine fusion is the treatment  Orthosis might be used to delay fusion till maturity