Hesperian Health Guides

Secondary Problems to Look for with Polio

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HealthWiki > Disabled Village Children > Chapter 7: Polio: Infantile Paralysis > Secondary Problems to Look for with Polio


By secondary problems, we mean further disabilities or complications that can appear after, and because of, the original disability.

TYPICAL CONTRACTURES IN POLIO


A child with paralysis who crawls around like this and never straightens her legs will gradually develop contractures so that her hips, knees, and ankles can no longer be straightened.

list of typical contractures
hip
ankle
foot
knee
elbow
thumb
fingers
wrist



TYPICAL DEFORMITIES
OF ANKLE AND FOOT


DVC Ch7 Page 61-2.png
DVC Ch7 Page 61-3.png DVC Ch7 Page 61-4.png DVC Ch7 Page 61-5.png
bending down at ankle (tiptoe) contracture) bending down at mid-foot bending out at ankle bending in at ankle

CONTRACTURES OF JOINTS

A contracture is a shortening of muscles and tendons (cords) so that the full range of limb movement is prevented.

Unless preventive steps are taken, joint contractures will form in many paralyzed children. Once formed, often they must be corrected before braces can be fitted and walking is possible. correction of advanced contractures, whether through exercises, casts, or surgery (or a combination), is costly, takes time and causes discomfort. Therefore early prevention of contractures is very important.

A full discussion of contractures, their causes, prevention, and treatment is in the next chapter (Chapter 8). Methods and aids for correcting contractures are described in Chapter 59.

OTHER COMMON DEFORMITIES

Weight bearing (supporting the body’s weight) on weak joints can cause deformities, including:

OVER-STRETCHED JOINTS

arrows pointing to an overstretched knee
bending
out at
knee
foot out of line with knee(when knee points forward, foot points to the side)
arrows pointing to an overstretched knee and hip
swayback
back-knee



DISLOCATIONS

partly or completely dislocated joints (especially knee, foot, hip, shoulder, elbow, thumb)
DVC Ch7 Page 61-8.png
partly dislocated knee
DVC Ch7 Page 61-9.png
partly dislocated foot


WARNING! Dislocations like these are sometimes caused by stretching contractures incorrectly.


SPINAL CURVE
Minor curve of spine can be caused by tilted hips,as a result of a short leg.
DVC Ch7 Page 61-10.png
More serious curve of the spine is caused by muscle weakness of the back or body muscles. The curve can become so severe that it endangers life by leaving too little room for the lungs and heart.
a severely paralysed child
arrows pointing at a paralyzed child
dislocated shoulder
elbow bent backward
apparent hunchback from bulge of ribs
elbow contracture
dislocated hip
At first, the spinal curve straightens when the child is positioned better. But in time the curve becomes more fixed (will not straighten any more). For information on spinal curves, see Chapter 20.



This page was updated:19 Jan 2018