The Role of Physiotherapy in the Treatment of Poliomyelitis

PHYSIOTHERAPY plays a large part in the treatment of poliomyelitis and it is expedient to review the subject after the epidemic of 1947. There are few disorders more distressing than the severe manifestations of this disease with its predilection for the younger members of the community and the extreme helplessness it may leave in its wake. As yet there is no specific prophylactic or cure for the disease. It is not surprising therefore that promising new methods of treatment are tried sometimes with the haste which leads to exaggerated claims. We have so much to do with these patients during the stage of potential recovery that it is our special duty to maintain a critical judgment. We must sustain the confidence of patients and relatives throughout a long period of potential improvement and at the same time avoid raising false hope. I support Seddon's view that it cannot be too strongly emphasized that no one has ever cured a case of poliomyelitis. All that we can do is to help or hinder a process of recovery that is quite outside our control (Seddon, 1947). Seddon is referring to the treatment of the disease after the virus has invaded the central nervous system. This does not preclude the possibility that future means will be found to induce immunity or arrest the activity of the virus before irreparable damage has been done. Nevertheless it is highly probable that such an advance, when it comes, will be in the laboratory. New forms of physiotherapy must be presumed to be potential weapons to assist recovery and not the means to prevent or cure the disease. At the same time we must remember that we can help Nature to localize and destroy the virus by such means as rest and heat, which is every bit as important as preventing deformity and assisting recovery of function. We are prone to accept the diagnosis of poliomyelitis too easily. McAlpine and his colleagues investigated 104 cases admitted between August and October last year to a unit for the early treatment of poliomyelitis at the Middlesex Hospital. They arrived at the following classification: (1) Non-paralytic poliomyelitis 24 cases; (2) paralytic poliomyelitis 26; (3) polioencephalitis 4; (4) abortive poliomyelitis 6; (5) incorrect diagnosis 44 cases. Thus of 104 cases admitted with a tentative diagnosis of poliomyelitis only 26 proved to have the paralytic form of the disease, although other cases showed transient paresis which cleared up spontaneously in a short time (McAlpine, Kramer, Buxton and Cowan, 1947). It is obvious that if these cases had come under the care of less critical clinicians quite erroneous conclusions might have been drawn as to the value of any particular therapeutic agent. These figures conform to the general experience that significant paralysis occurs in less than a third of all cases. In the early stages the chances of a diagnostic error are at least as great as the risk of serious paralysis supervening. The assessment of any therapeutic method depends first on an accurate diagnosis and secondly on the trial of a single agent in a sufficient number of cases and controls to give statistically valid results. It is difficult to carry out a scientific investigation when severe paralysis may ensue if the method on trial proves unsuccessful. In the absence of conclusive proof that a particular agent reduces the risk or severity of paralysis or deformity it is essential to rationalize treatment in accordance with fundamental principles and to avoid