Crawling patterns in neglected poliomyelitis in the Solomon Islands

The 1945 St Helena Poliomyelitis Epidemic after 40 Years

Twenty-six of the 28 patients known to have been paralysed by poliomyelitis on St Helena over 40 years ago were traced. All had led fulfilled lives. Nine had since died but no deaths were attributable to the disease. The satisfactory outcome of these people's lives was due to a combination of factors. Initially early diagnosis and immediate appropriate treatment minimized contracture formation. Early intensive rehabilitation and return of the patient in an upright and ambulant position to a caring community established the pattern of their future lives. The later lack of surveillance resulted in six of the patients reverting to crawling and only two still using their calipers. In remote and poor areas appliances where possible should be made and maintained locally.

[Walking in children after poliomyelitis]

Between 1983 and 1990 the authors examined 630 children who had suffered from poliomyelitis, mostly between the age of one and three, at an average age of 9 years 3 months. Half were unable to walk because of residual paralysis. Operation was carried out on 252 children. Most underwent soft tissue release at the hips, knees or tendo Achilles. Triple arthrodesis was carried out on 24. Calipers, produced locally, were used, and trunk bracing was not employed. The average duration of treatment was 3 months, with gradual achievement of correction. Vascular complications occurred in one leg, there were 5 paralyses of the sciatic nerve and 4 fractures of the upper tibia. One hundred children who were not able to walk before operation were reviewed. Sixty five were walking and able to go to school. The best results were achieved before the age of 12.

[Flexion of the knee in poliomyelitis. Results and indications for femoral and tibial osteotomies]

Of 62 patients with a fixed flexion deformity of the knee due to poliomyelitis, 36 were treated by femoral osteotomy and 26 by tibial osteotomy. Their ages ranged between 10 and 30 years, with an average of 16. In 37 of the patients other procedures were also performed. The aim of operation was to enable walking in 6 patients, to allow walking without, or with smaller, calipers in 21, and to allow walking without additional help in 35. These objectives were usually achieved; failure was due to technical error or to lack of appreciation of residual muscle power. The operation is indicated for flexion deformities of less than 30 degrees, and as an adjunct to other procedures. The level of osteotomy is decided from lateral radiographs taken before operation.

A clinical study of post polio infantile paralysis

This study reports on 3,000 cases of poliomyelitis seen at the Rehabilitation and Artificial Limb Centre at Lucknow between January 1976 and December 1980. Factors such as age and sex incidence, extremity involvement, incidence of deformities at hip, knee and ankle, lower limb discrepancy, treatment and orthoses prescribed are discussed.

The team fights the scourge of poliomyelitis

Poliomyelitis is still a medical problem in Nigeria, the aftermath of which leaves patients with muscular paralysis, contractures and abnormalities which require elaborate treatment. One thousand one hundred and twenty patients affected with poliomyelitis and treated at the polio-clinic of Physiotherapy Department of the University College Hospital, Ibadan were studied. The multi-disciplinary approach of a professional health team was used to integrate the polio victims back into the community so that they do not constitute an economic liability. A case of a poliomyelitis victim who resorted to crawling is illustrated, effective treatment being given by the team approach resulting in his ability to maintain himself in the community. The importance of prophylactic immunization to prevent the wide spread of the disease in the community is also stressed.