POLIOMYELITIS: STUDIES ON DISTRIBUTION OF PARALYSIS AND MANAGEMENT OF DEFORMITIES IN THE LOWER LIMBS OF CHILDREN IBADAN

Abstract

Poliomyelitis or Heinemedin’s disease is one of the commonest crippling diseases amongst children under the age of five years in Nigeria. Though the disease is found in most parts of the world, it is morenoticeable in developing countries. In Nigeria, it is endemic. The disease is infectious and caused by entero-viruses namely Types I, II and III. The polio-virus enters the body through the upper respiratory tract from where it gains access to the anterior horn cells of the spinal cord or the motor nuclei of the brain stem. The virus may damage or destroy the cells thereby causing flaccid paralysis of the muscles supplied by the affected spinal segments. Sensation is not affected. Five hundred and forty-four poliomyelitis children referred from paediatric neurology and surgical outpatient clinics in the University College Hospital, Ibadan were studied between 1978 and 1980. Two thousand, six hundred and eighty-seven muscles of the lower limbswere carefully tested for muscle power and graded in accordance with Medical Research Council of England scale 0 to 5. The grades of muscle power were recorded on a special muscleassessment Chart. Analysis of the results portrayed the likelihood or contractures and deformities in the affected limbs. The magnitude of the deformities were measured with goniometers and recorded in geometrical degrees. ill Studies were carried out of the age, sex distribution, frequency of paralyzed muscles and resultant deformities. The inequality of the length of some limbs were observed as well as the monthly and seasonal occurrence for each year of the study. Five hundred and nine deformities were classified in the hips, knees, ankles and feet of one or both limbs. They were corrected conservatively if mild. In moderately severe contractures with between 25° and 50° of fixed flexion deformity, corrective manipulations, followed by the application of rigid supports were carried out. Severe contractures of more than 50° of fixed flexion deformity were treated surgically by the orthopedic surgeon. The physiotherapist was responsible for physical rehabilitation. The results of this study revealed a predominance of male over female cases with the highest incidence among the ago group 1 - 2 years. Both lower limbs were more incriminated than either the left or the right limb; but the left limb was slightly more affected than the right. Quadriceps muscle (13.2%) was most frequently paralyzed than any other group of muscles. One hundred and fifty-two (29.9%) tendo-Achillis and 50 (29.4%) of tensor fascia lata contractures were responsible for the highest numbers of deformities. Monthly occurrence of the disease was of no significance as we11 as its correlation with rainfall. The use of plaster casts, knee cages, calipers and other rehabilita¬tion aids like the parallel bars, push carts, crutches, sticks and wheel chairs enabled the polio victims to gain confidence in ambulation, as wellas independence in other daily activities. Education of the children in regular schools and prevention of the disease by immunization were always emphasized to the parents.