treatment
Last reviewed 01/2018
The treatment of poliomyelitis depends on the disease phase:
- acute stage:
- no specific treatment is available, patients should be managed supportively and symptomatically.
- bed rest to prevent extension of the paralysis
- when paralysis occurs, supportive treatment becomes important,
- pain relief
- regular passive movements to avoid contractures and joint ankylosis
- intubation and intermittent positive pressure ventilation for acute respiratory failure
- recovery period:
- physiotherapy - aimed at retraining affected muscles to avoid wear and tear.
- between periods of exercise, splintage may be necessary in order to prevent fixed deformities (1).
If there is residual paralysis, then there are four types of problem that may be addressed:
- isolated muscle weakness without deformity: tendon transfer may be used, for example, in paralysis of thumb opposition. Paralysis of the quadriceps muscle is managed with the use of a caliper that straightens the knee.
- deformity: tendon transfer may be appropriate.
- flail joint: permanent splintage or arthrodesis.
- limb shortening: if a leg length inequality is not more than 3cm then it may be compensated by building up the shoe. A greater disparity may be corrected by operative shortening, or lengthening, of the limb.
Transmission risk in endemic countries can be reduced with the use of clean water and improved hygienic practices and sanitation (2).
Immunisation is the cornerstone of polio eradication.
- two types of vaccines are available:
- an inactivated poliovirus vaccine (IPV)
- a live attenuated OPV
- European countries have gradually shifted from OPV to IPV over the last decades and today all EU Member States use IPV in their childhood immunisation programmes.
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