July, 1948 P H Y S I O T H E R A P Y Page Seven

The Physiotherapist and the Treatment of Anterior Poliomyelitis
B y  S Y L V I A  S O U T H E R N , M .C .S .P ., D .P .T .

|N SPITE OF THE ADVANCES in Medicine 
I in recent years, the prevention and cure 
of A nterior Poliom yelitis still puzles the most 
brilliant brains in Medical Research.

In South Africa, where we have just 
experienced one of our worst epidemics, the 
call for a fund to finance an extensive 
exploration into the (1 ) cause, (2 ) channels 
by which infection is carried, and (3 ) pre­
vention of Poliom yelitis will surely meet with 
a hearty response from  all sections of the 
community. Although only a few hundreds 
of the population have been smitten with the 
disease, while thousands have been affected 
in England, Am erica and Australia in recent 
epidemics, we must remember that the 
population is smaller, and therefore the 
damage in com parison is as great.

The need for specialised treatment is 
apparent from  the outset. Nowhere is the 
necessity m ore marked than in Poliomyelitis, 
for the damage caused mentally and physically 
to the patient is for a long period, which may 
extend from  three weeks to tw o years, and 
very often for the whole life of an individual. 
Although much can be achieved by Doctors 
and Nurses, the residual symptoms can only 
be healed by the mental and bodily activities 
of the patient in close co-operation with the 
Physiotherapist. Long periods o f rest are 
necessary, and it is during this time that the 
services of a well qualified Physiotherapist 
are essential.

The human body was not built to remain 
at rest indefinitely. A ctivity is essential for 
the recovery of health, and early movement 
will repair wasted tissue. The skin loses its 
function when im m obilized —  it becomes 
scaly, rough and unhealthy. Impaired circula­
tion affects the organs of digestion and 
elimination. Nutrition and metabolism are 
upset, and one of the main roads to re­
establish health is blocked.

The mental effect of treatment is now well 
realised, and every hospital where Anterior 
Poliomyelitis is treated has its staff of Physio­
therapists and Occupational or Diversional 
Therapists, for the danger of the stagnant 
body is fully reognised by many members of 
the Medical Profession.

If rest is an important factor in the healing 
° f Poliomyelitis, the Public Health authorities

must avail themselves o f a suitable hospital 
where everything is available for the com fort 
of the patient and for the treatment o f the 
disease. An early decision must be made as 
to whether hospitalisation is imperative.

There may be hesitation over this, because 
of the lack of knowledge as to how  the disease 
is contracted. If hospitalisation is required, it 
is advisable that continuity o f treatment 
should be carried out in the one Institution 
for the first six to twelve months, as it is 
usual for all stages o f paralysis to have m ani­
fested themselves during that time.

All wards, bath rooms, treatment rooms 
and workshops should be on the ground floor. 
Every requirement for the immediate com fort 
of the patient should be eas:ly obtainable, 
whatever it may be, from  an Iron Lung to a 
M onkey Chain or Fracture Board or Sand­
bag. The wards should be spacious and airy, 
with well regulated heat if necessary. They 
should be painted in soothing colours, as the 
prevailing atmosphere required is one of 
calm, hope and freedom.

Nurses and Physiotherapists should be 
chosen for their mental affect on the patients. 
Let them wear coloured overalls— white so 
often strikes holy terror in a nervous child. 
They must be sympathetic and exude 
optimism. A  refreshing personality gives the 
patient a feeling of com fort which results in 
confidence, thereby inducing relaxation. 
There is a general feeling that “ all is w ell.” 
It is also very desirable that Nurses and 
Physiotherapists have a thorough knowledge 
of Orthopaedic Nursing.

One Nurse to every four patients is ideal, 
and one Nursing Sister and one Physio­
therapist should be in charge of every ward. 
Co-operation between Doctors, Physiothera­
pists, Sisters and Nurses is the order of the 
day.

W e now consider the bed on which the 
sick patient must be rested. It should be flat 
and firm,, with a mattress made in sections 
to ensure clean and easy nursing. W hen no 
com plications are likely to occur the patient 
is placed flat on the bed with the body in 
strict alignment. The legs and arms must be 
arranged in a com fortable, relaxed position; 
and an adaptable footboard placed at the

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Page Eight P H Y S I O T H E R A P Y July, 1948

foot of the bed to give the patient a firm 
support to push himself on, and to keep the 
feet dorsi flexed. This board will also prevent 
pressure of the bed clothes. The patient must 
not be constricted in any way. By constant 
supervision limbs can be kept in a good 
natural position by means of sandbags and 
small pillows.

The types of P olio are various, but nearly 
all sufferers are affected mentally in some 
way or another. This calls for a good per­
sonality in those who have anything to do 
for these cases. Each case requires individual 
treatment. The types are differentiated by the 
region of the involvm ent o f the spinal cord 
and brain. Thus we have the Bulbar P olio­
myelitis, the Encephalitic Poliom yelitis, the 
Paralytic Poliom yelitis and the Abortive. 
Fortunately the A bortive type is the most 
usual. The patient is ill for a short duration, 
and symptoms m ay last for a few hours or 
a few days. V om iting and headache are the 
chief characteristics o f this type. There may 
be some spasm, usually in the lumbar region, 
sometimes in the arms and legs. Daily 
vigilance on the part o f the Physiotherapist 
is required for the early detection o f weak­
ness in muscles, groups of muscles and limbs, 
but on no account should the patient be 
w orried or wearied. This type, when willing 
and eager to recover, responds quickly to 
muscle re-education, and the recovery is so 
rapid as to be miraculous. A t a first treat­
ment the patient appears unable to move the 
whole of one limb, but when fear is overcom e 
and movement is evident the apparent loss 
of function is quickly restored. It is under­
stood that the patient is resting in bed and 
that no weight bearing exercises are allowed 
until the patient is sufficiently recovered and 
is able to perform  a complete series of m ove­
ments ivolving all joints while in the re­
cumbent position. The next progression is to 
sit and then stand. This type is usually fit 
to return home after the three weeks allowed 
for the infectious period.

W hen there is spasm, this can remain for 
some time, and in some cases for as long as 
six weeks or tw o months. It can be relieved 
in a great measure by hot packs, hot cradles, 
hot saline baths and sometimes by very gentle, 
soothing stroking of the spine, back 
muscles and gluteii muscles. The back stroking 
has a very good psychological effect on the 
patient, who is very often irritable and 
despondent.

The Bulbar type of Poliom yelitis is the 
most serious, as it affects the nose, throat

and respiratory muscles. The patient is often 
unable to swallow, and breathing is enfeebled. 
These children are very ill, and few recover, 
but the Iron Lung treatment combined with 
various medical treatments and super human 
nursing has brought these sufferers from  the 
jaws o f death —  sometimes, alas, with 
paralysis o f large groups of muscles o f arms, 
legs and back. As soon as these patients are 
sufficiently well to remain for a short period 
out o f the Iron Lung, it is amazing to see 
what results can be obtained by the Physio­
therapist. She is asked to give a few breath­
ing exercises daily, for a few minutes at the 
commencement, and gradually progresses to 
gentle massage to all limbs, and gentle m ove­
ments o f all joints within the inner range of 
movement. Great care is exercised not to 
exhaust the patient. The treatment and pro­
gression must of necessity be very slow and 
it is only when they have recovered sufficiently 
to be able to leave the Lung for all time that 
treatment can be progressed to hydrotherapy, 
electrotherapy and the like. T oo often recovery 
of muscles is retarded or even frustrated by 
too much enthusiasm on the part o f the 
Physiotherapist to bring about a miraculous 
and spectacular result. One or tw o gentle 
faradic stimulii are beneficial to a muscle 
recovering from paralysis, but overw ork will 
kill it. The psychological effect is good.

The Encephalitic type of Poliom yelitis will 
make a total recovery after being very 
seriously ill.

The Paralytic type often has a group of 
muscles or one particular muscle paralysed. 
The most com m on groups are the muscles 
of the shoulder girdle. The Quadriceps 
Extensors, the Anterior Tibial group, the 
Gluteii and Hamstrings. There are cases 
where one muscle only is paralysed, such as 
the Tibialis Anticus, which is the m ost usual 
one to be picked out. Sometimes it may be 
the Peroneus Longus.

The aims of the Physiotherapist are there­
fore to relieve spasm, induce relaxation, 
prevent deform ity and restore function.

The w ork of the Physiotherapist can 
usually commence on the tenth or fourteenth 
day, according to the condition of the patient 
— both children and adults. The treatment 
must be o f a high order, for any tendency 
to roughness or undue pressure on tender 
and painful tissues may result in total 
paralysis, where recovery may otherwise have 
been obtained. The moral value of early 
treatment cannot be over emphasised.

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