Post-polio Residual Paralysis Research Articles

Clinical Utility of Electronic Balance Board and Treadmill Training in Pott’s Paraparesis: A Case Study

Abstract Background: Pott’s Paraparesis is one of the serious manifestations of Tuberculosis of Spine. The presence of Post Polio Residual Paralysis (PPRP) in one of the lower extremity adds to the seriousness of the sufferer. There is hardly any study about the electronic balance board and treadmill training in patients with Pott’s Paraparesis as well as PPRP. Therefore, the objective of this study was to find out the clinical utility of electronic balance board and treadmill training. Methods: A 33 years old male patient with a diagnosis of early onset grade 2 Pott’s Paraparesis for eight months along with right lower limb PPRP since childhood participated in this study. He was trained with Electronic Balance Board training for 15 minutes, Treadmill Training for 20 minutes and conventional physiotherapy for 45 minutes of 36 sessions over the period of six weeks and the outcome was assessed with Berg Balance Scale (BBS), Electronic Balance Board Score (EBBS), Spinal Cord Independence Measure (SCIM), Walking Index for Spinal Cord Injury (WISCI) and Computer Dyno Graphy (CDG)® system. Results: The results of this study showed 41.07% improvement in BBS, 50% in EBBS, 13% in SCIM, 30% in WISCI and in gait parameters such as Left/Right symmetry by 3.38%, single support time (left by 4.57%, right by 13.93%), double support time (left by 62.92%, right by 56.03%), single swing (left by 13.93%, right by 15.23%), distance (left by 49.16%, right by 47.64%) and step time (left by 45.14%, right by 43.20%). Conclusion: Electronic Balance Board and Treadmill Training may be used as an adjunct to Conventional Physiotherapeutic Rehabilitation of Pott’s Paraparesis along with PPRP patient.

Estimation of accuracy of patient-specific musculoskeletal modelling: case study on a post polio residual paralysis subject

For patients with patterns ranging out of anthropometric standard values, patient-specific musculoskeletal modelling becomes crucial for clinical diagnosis and follow-up. However, patient-specific modelling using imaging techniques and motion capture systems is mainly subject to experimental errors. The aim of this study was to quantify these experimental errors when performing a patient-specific musculoskeletal model. CT scan data were used to personalise the geometrical model and its inertial properties for a post polio residual paralysis subject. After having performed a gait-based experimental protocol, kinematics data were measured using a VICON motion capture system with six infrared cameras. The musculoskeletal model was computed using a direct/inverse algorithm (LifeMod software). A first source of errors was identified in the segmentation procedure in relation to the calculation of personalised inertial parameters. The second source of errors was subject related, as it depended on the reproducibility of performing the same type of gait. The impact of kinematics, kinetics and muscle forces resulting from the musculoskeletal modelling was quantified using relative errors and the absolute root mean square error. Concerning the segmentation procedure, we found that the kinematics results were not sensitive to the errors (relative error < 1%). However, a strong influence was noted on the kinetics results (deviation up to 71%). Furthermore, the reproducibility error showed a significant influence (relative mean error varying from 5 to 30%). The present paper demonstrates that in patient-specific musculoskeletal modelling variations due to experimental errors derived from imaging techniques and motion capture need to be both identified and quantified. Therefore, the paper can be used as a guideline.

Provocative poliomyelitis causing postpolio residual paralysis among select communities of two remote villages of North Karnataka in India: A community survey

Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India), where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41) subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably) muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.

Congenital dislocation of patella with ipsilateral hip flexion-abduction deformity: a case report

Iliotibial band tightness and its abnormal insertion on patella is one of the contributing factors in congenital dislocation of patella. Although hip flexion-abduction deformity is caused by a tight iliotibial band, as frequently seen in postpolio residual paralysis, an association of hip flexion-abduction deformity with congenital dislocation of patella has never been reported previously. Such a case was presented to us, and surgical repositioning of the patella was carried out by means of release of the tight iliotibial band from the patella besides other tight lateral structures along with medial augmentation and distal realignment of the quadriceps mechanism. The hip deformity was corrected spontaneously after release of the tight iliotibial band from the knee without need for additional surgery at the hip.

Paraplegia of late onset in adolescents with healed childhood caries of dorsal spine: A cause of pressure on the cord and treatment

Background:Paraplegia of late onset in adolescents with caries of dorsal spine is considered to be due to the reactivation of infection. Internal salient at the level of acute kyphotic deformity of the dorsal spine is formed by posterior cartilaginous remains of grossly destroyed vertebral bodies. The author presents a study of eight adolescent patients with paraplegia of late onset associated with severe kyphotic deformity of dorsal spine with observations on the cause of paraplegia, the final neurological outcome following anterior decompression and its prevention.Materials and Methods:Eight adolescent patients mean age 14.4 yrs 6 males and 2 females with healed childhood caries of dorsal spine, having a mean kyphotic angle of 80° (range 60°–140°) presented with paraplegia of late onset. Of these patients, two had medical research council grade 0 muscle power; four had grade 2 muscle power, and two others had grade 3 muscle power in the lower limbs and were unable to walk unaided. One patient with 140° kyphoscoliotic deformity with grade 3 muscle power had post-polio residual paralysis (PPRP) in addition. All patients were subjected to thorough anterior spinal decompression through transthoracic, transpleural thoracotomy from the left side.Results:In six of the eight patients, the spine at the site of deformity being very rigid, the deformity could not be corrected and the intervertebral gap was bridged with appropriate autogenous tricortical cortico cancelluous bone graft. In one patient (case 4), the kyphotic deformity could be corrected by 50%. In one patient with 140° kyphosis and PPRP, the gap after the decompression of cord, could not be bridged with bone graft and was given a custom made, well molded plastic black shell to wear while walking and, in particular, while traveling in a vehicle. In all seven patients, bone grafts took six months for bridging the intervertebral gaps. All patients recovered to grade 4 muscle power 6–12 months after surgery.Conclusion:In adolescents with healed caries of dorsal spine with acute kyphosis and paraplegia, the treatment of choice is anterior surgical decompression of the cord and bridging the gap thus created with bone graft.

In vivo 31P MRS study of skeletal muscle metabolism in patients with postpolio residual paralysis

The muscle metabolism of at-rest patients with varying degrees of postpolio residual paralysis (PPRP) was studied and compared with that of controls using in vivo phosphorus magnetic resonance spectroscopy. The phosphocreatine (PCr)/inorganic phosphate (Pi) and PCr/adenosine triphosphate ratios were lower in patients than in controls. Reduction in PCr/Pi suggests abnormalities in oxidative phosphorylation. A significant increase was observed in the phosphomonoester/PCr ratio in patients, indicating the accumulation of intermediary compounds of the glycolytic pathway. Furthermore, the phosphodiester/PCr ratio was also significantly increased in patients. In general, the observed changes in metabolite ratios were found to be related to the degree of residual paralysis, suggesting that metabolic changes are secondary to chronic neurogenic processes. These metabolic alterations appear to be the possible cause of energy deficit and underlying muscle fatigue in PPRP patients. The present results provide an insight into the metabolic impairment and degree of muscle damage in patients with PPRP.

In vivo proton magnetic resonance spectroscopy (MRS) study of post polio residual paralysis (PPRP) patients

In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indicate that the presence or absence of intra-myocellular lipids (IMCL) is related to the severity of the paralysis. It is observed that mildly paralyzed patients are comparable ( p > 0.05) with the control subjects in relation to the presence of IMCL, while moderate and severely paralysed patients are comparable ( p > 0.05) in relation to the absence of IMCL. In addition, there is reduction or complete absence of creatine, carnitine and choline metabolites in severely paralyzed patients. The ability to detect noninvasively the subtle differences in in vivo, the lipid compartments of muscle may prove to be a valuable tool in understanding the pathogenesis of muscle diseases. This could open up the possibilities in designing effective rehabilitative exercise programs or development of new drug therapies.

Massive prepatellar bursitis in post-polio residual paralysis: A case report.

We report a case of post-polio residual paralysis, an eighteen-year old girl who was ambulatory on all four limbs and presented to us with a massive pre-patellar bursitis on her left knee.

Circumferential Periosteal Sleeve Resection: Results in Limb-Length Discrepancy Secondary to Poliomyelitis

We report the results of circumferential periosteal sleeve resection of lower-limb bones for mild degrees of limb-length discrepancy (mean, 3.5 cm) secondary to postpolio residual paralysis in 23 patients. Results were expressed by calculating percentage of length discrepancy of the operated-on limb with respect to the normal limb and gain in length in centimeters of the operated-on limb over the normal limb. All patients had a uniform trend of gain in length with response in the femur lasting for approximately 1 year, whereas that in the tibia persisted >2 years. Circumferential periosteal sleeve resection is a safe and reliable method of longitudinal bone-growth stimulation, providing consistent results, especially for mild to moderate discrepancies.

Fibular shortening in poliomyelitis.

This study arose from observation that in children will leg shortening from paralysis, the relationship between the tibia and fibula is disturbed. This article analyses 76 patients of post polio residual paralysis involving only one lower limb. Sixteen patients had fibular shortening. Several factors that interfere with fibular growth, i.e. anatomical continuity, soleus strength, abnormal forces at distal fibular physis, result in fibular shortening. Early the age at onset of paralysis, more is the fibular shortening which is associated with lateral wedging of distal tibial epiphysis, valgus at ankle, external torsion of tibia and genu valgus.

Limited fusion for the flail valgus foot in poliomyelitis

11 cases of post-polio residual paralysis with flail feet and ankles tending to valgus deformity on weight bearing, were stabilised by arthrodesis of the ankle and subtalar joints through the posterior approach. Functional results were excellent and, compared with pantalar arthrodesis the operating time was much less and soft tissue complications minimal.

Recovery in lower limb muscles in poliomyelitis of 6 months' duration.

362 muscles in different grades of post-polio residual paralysis of 6 months' duration were studied for a period of three months. There was a good potential for recovery. The extent of recovery depended on the extent of damage and the duration of the disease. The pattern of involvement and recovery had been almost similar in the present and the previous study. The prognosis of completely paralysed muscles is very poor (almost nil) after six months of the onset of paralysis.