Old Poliomyelitis

Physical Examination

Inspection:

• Muscle wasting in lower limbs, particularly in affected muscles.

• Deformities like foot drop, scoliosis, or limb length discrepancy.

Motor - Tone:

• Hypotonia or flaccidity in affected muscles.

• Spasticity in some muscles due to compensatory mechanisms.

Motor - Power:

• Muscle weakness in specific muscle groups, especially those affected by polio.

• Power may vary from mild to severe weakness.

Reflexes:

• Hyporeflexia or absent reflexes in areas with significant muscle atrophy.

Cerebellar:

• Normal

Sensory

• Normal

Additional Examination if Required:

• Muscle strength grading using the Medical Research Council (MRC) scale.

• Assessing the range of motion in affected joints.

• Evaluating gait and functional mobility.

• Assessing any orthopaedic complications that may have developed due to muscle imbalances.

Investigations

Laboratory Investigations:

• Creatine Kinase (CK) levels - Elevated CK levels indicate muscle damage and can help confirm the presence of muscle weakness and atrophy due to polio.

Imaging Studies:

• X-ray of the affected limbs and spine - to assess for bone deformities, scoliosis, or limb length discrepancies that may have developed as a result of muscle imbalances caused by polio.

Other Tests:

• Electromyography (EMG) and Nerve Conduction Studies (NCS) - to assess nerve and muscle function, identify denervation patterns, and distinguish between different types of neuromuscular disorders, including polio.

Management

General Management:

• Provide supportive care and assistive devices for mobility.

• Educate the patient on self-management strategies.

Medical Management:

• Symptomatic treatment for pain and discomfort.

• Physical therapy to maintain muscle strength and prevent contractures.

• Orthotics or braces to support weak limbs and correct deformities.

• Management of associated complications, such as respiratory issues or scoliosis.

Surgical Management:

• Orthopedic surgery for severe deformities or limb length discrepancies.

• Tendon lengthening or transfer procedures to improve muscle balance.

• Corrective surgery for scoliosis, if required.

Other Interventions:

• Assistive devices (e.g., crutches, canes, wheelchairs) to improve mobility.

• Occupational therapy to enhance functional independence.

• Psychological support and counselling for coping with long-term effects.