Indications for and limitations of treatment of poliomyelitis

Abstract

Summary Poliomyelitis is self-limited and if deformities are prevented the end result is determined largely by the damage done to the motor cells during the acute febrile stage. Many patients recover completely without treatment and others remain extensively paralyzed in spite of the best treatment. No known treatment affects the degree or extent of the initial paralysis, but we are able to ameliorate the effects of the disease. In the acute febrile stage the treatment is general medical care plus protection of the patient from irritation. If the respiratory function is affected, efforts must be made to save the patient's life. In the subacute stage rest and immobilization dominate the treatment. We relieve the patient's pain, protect paralyzed muscles from stretching, prevent early deformities due to the contracture of painful muscles, and give the injured nerve cells the best possible chance to recover. In the convalescent stage we protect and restore the maximum of power to the weakened muscles, stretch the contracted muscles and restore normal movement to the parts, and train the patient to use his weak extremities. In the chronic stage we prevent or minimize late deformities and increase function by braces and surgery.