polio 61
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.
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
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.
hip
ankle
wrist
fingers
foot knee
elbow
thumb
TYPICAL DEFORMITIES
OF ANKLE AND FOOT
bending
down at
ankle (tiptoe
contracture)
bending
down at
mid-foot
bending
out at
ankle
bending
in at
ankle
Weight bearing (supporting the body’s weight) on weak joints can cause deformities,
including:
OVER-STRETCHED JOINTS
bending
out at
knee
swayback
foot out of
line with
back-knee
knee (when
knee points
forward,
foot points
to the side)
DISLOCATIONS
partly or
completely
dislocated joints
(especially
knee, foot, hip,
shoulder, elbow,
thumb)
partly
dislocated
knee
partly
dislocated foot
WARNING:
Dislocations
like these are
sometimes
caused by
stretching
contractures
incorrectly.
(See p. 28.)
SPINAL
CURVE
Minor
curve of
spine can
be caused
by tilted
hips, as a
result of a
short leg.
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 paralyzed child
dislocated
shoulder
elbow
contracture
dislocated
hip
elbow bent
backward
apparent
hunchback
from bulge
of ribs
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.
disabled village children