An amputation is the surgical removal of a limb or part of a limb, such as an arm, leg, foot, hand, toe, or finger. Amputations may be performed due to several reasons, including:

1. Traumatic Injuries: Severe injuries from accidents, such as those involving agricultural implements or machinery, that result in irreparable damage to the limb.

2. Medical Conditions: Advanced infections (e.g., bone infections), dangerous tumors (cancers), severe burns, or diseases like leprosy that render a limb non-functional or life-threatening if not removed.

3. Congenital Absence: In rare cases, children are born without one or more limbs.

4. Vascular Diseases: Conditions like diabetes or peripheral arterial disease that impair blood circulation to the extremities, leading to tissue death and necessitating amputation.

Therapeutic management of an amputee focuses on ensuring optimal recovery, preventing complications, and facilitating the use of prosthetic limbs. Key areas include:

1. Care of the Amputated Limb

The primary goals in caring for the stump (the residual limb) are to maintain a good shape and position for fitting an artificial limb. This involves:

• Avoiding Swelling: Proper bandaging and elevation of the stump can help prevent swelling.

• Maintaining the Full Range of Motion: Regular movement and exercises are crucial to prevent joint stiffness (contractures).

• Maintaining Strength: Strengthening exercises for the remaining muscles help in the effective use of a prosthetic limb.

2. Wrapping the Stump

Proper wrapping of the stump is important to:

• Prevent Swelling: Wrapping helps control edema (swelling) by directing fluid away from the stump.

• Maintain Shape: Properly wrapping the stump helps form a conical shape, which is ideal for fitting a prosthetic limb.

The wrapping technique should ensure that the fluid in the leg is squeezed upwards, preventing it from pooling at the end of the limb.

3. Prevention of Contractures

Contractures occur when muscles or tendons become permanently shortened, leading to joint stiffness. To prevent this:

• Positioning: Encourage positions that keep the joints stretched. Avoid positions that keep the joint bent, as this can lead to contractures.

• Stretching Exercises: Regular stretching exercises for the affected muscles help prevent contractures and maintain flexibility.

• Surgical Intervention: In severe cases, surgery may be required to release contractures.

4. Rehabilitation and Physical Therapy

Physical therapy is essential for:

• Strength Training: Exercises to strengthen the muscles around the stump and other parts of the body.

• Balance and Coordination: Training to improve balance and coordination, which is critical for using a prosthetic limb.

• Mobility Training: Techniques to enhance mobility and independence in daily activities.

5. Psychological Support

Amputation can have significant emotional and psychological impacts. Counseling and support groups can help amputees cope with:

• Body Image Issues: Adjusting to the new body image and overcoming self-consciousness.

• Grief and Loss: Processing feelings of loss and mourning the limb.

• Adjustment: Adapting to lifestyle changes and new ways of performing daily activities.

6. Prosthetic Training

Prosthetic training involves:

• Fitting the Prosthetic Limb: Ensuring the artificial limb fits well and is comfortable.

• Learning to Use the Prosthesis: Training on how to use the prosthetic limb for various activities, including walking, grasping, and other functional tasks.

• Maintenance: Educating the amputee on how to care for and maintain the prosthetic limb.

7. Long-Term Follow-Up

Regular follow-up with healthcare providers is essential to monitor:

• Stump Health: Checking for any issues such as skin breakdown, infection, or changes in shape.

• Prosthetic Fit: Ensuring the prosthetic limb continues to fit well and making adjustments as needed.

• Overall Well-being: Addressing any ongoing physical, emotional, or functional concerns.

By addressing these areas comprehensively, therapeutic management aims to help amputees achieve the best possible outcome and improve their quality of life.

Poliomyelitis, commonly known as polio, is a viral infection that affects the anterior horn cells (AHCs) in the brainstem and spinal cord, leading to temporary or permanent paralysis or weakness of the muscles controlled by those AHCs. The infection is caused by the poliovirus, which spreads primarily through the fecal-oral route in areas with poor sanitation, but it can also spread through respiratory droplets in areas with better hygiene.

It affects the nerves of the spinal cord, located inside the spinal bones (vertebrae) at the back of the body.Since poliomyelitis does not affect the brain, the intellectual ability of children with poliomyelitis remains intact.

Polio is caused by a virus that attacks parts of the spinal cord, damaging the nerve cells responsible for movement. The virus enters the body through the intestinal tract, travels via the bloodstream, and ultimately infects the anterior horn cells (AHCs) in the brainstem and spinal cord. The virus spreads through the stool of an infected child to the mouth of a healthy child, contaminating drinking water or food via flies or dirty hands. In better-sanitation areas, it can spread through coughing and sneezing

Stages of Polio Infection:

1. Pre-paralytic Stage (About 2 days):

   • Symptoms: Fever, nausea, muscle pain, spasms, and fatigue in the vertebral column, limbs, or respiratory muscles.

2. Acute Paralytic Stage (About 2 weeks):

   • Symptoms: Muscle tenderness and complete or partial paralysis. Breathing difficulties if respiratory muscles are involved.

3. Convalescent Stage (Up to 2 years):

   • The infection subsides, and muscle recovery depends on the extent of AHC damage. Muscles supplied by fully recovered AHCs recover fully, while muscles supplied by partially recovered AHCs remain weak, and muscles supplied by dead AHCs remain permanently paralyzed.

4. Residual Stage (After 2 years):

   • The patient relearns to compensate for motor deficits by adapting the actions of paralyzed muscles with the help of weak or unaffected muscles.

Subclinical Polio

• Asymptomatic: 95 to 99 percent of people infected show no symptoms but can still spread the virus.

Non-Paralytic Polio (Abortive Polio)

• Duration: Symptoms last from one to 10 days.

• Flu-like Symptoms:

  • Fever

  • Sore throat

  • Headache

  • Vomiting

  • Fatigue

  • Meningitis

Paralytic Polio

• Incidence: Occurs in about 1 percent of cases.

• Initial Symptoms: Similar to non-paralytic polio.

• Severe Symptoms (after a week):

  • Loss of reflexes

  • Severe spasms and muscle pain

  • Loose and floppy limbs, sometimes on one side of the body

  • Sudden paralysis (temporary or permanent)

  • Deformed limbs, especially hips, ankles, and feet

• Permanent Paralysis: Less than 1 percent of cases result in permanent paralysis.

• Respiratory Muscle Attack: 5–10 percent of paralysis cases may lead to respiratory failure and death.

Post-Polio Syndrome (PPS)

• Occurrence: Can appear 15 to 40 years after initial recovery.

• Common Symptoms:

  • Continuing muscle and joint weakness

  • Increasing muscle pain

  • Fatigue and exhaustion

  • Muscle atrophy (wasting)

  • Difficulty breathing and swallowing

  • Sleep apnea

  • Low tolerance of cold temperatures

  • New weakness in previously unaffected muscles

  • Depression

  • Cognitive issues (trouble with concentration and memory)

Note: If you had polio and experience these symptoms, consult a doctor. PPS affects 25 to 50 percent of polio survivors and is not contagious. Treatment focuses on improving quality of life and managing symptoms.

Poliomyelitis manifests in three main types, each affecting different parts of the nervous system:

1. Encephalitic Type:

   • Involvement: Affects the brain.

   • Symptoms: May include severe headaches, vomiting, neck stiffness, and altered consciousness. This type can lead to encephalitis, an inflammation of the brain.

2. Bulbar Type:

   • Involvement: Affects the brainstem.

   • Symptoms: Can impact functions such as swallowing, breathing, and speaking, as the brainstem controls these vital activities. Bulbar polio can be life-threatening due to respiratory complications.

3. Spinal Type:

   • Involvement: Affects the spinal cord.

   • Symptoms: Leads to asymmetric paralysis, primarily in the legs. This type is the most common and progresses through several stages, potentially causing permanent disability if not managed properly

1. Scoliosis:

   • Description: A lateral curvature of the spine.

   • Impact: Reduces the space in the thoracic cavity, limiting the capacity of the heart and lungs.

2. Hyperextended Knee Joints (Genu Recurvatum):

   • Description: The knee bends backward due to weight bearing on a weak leg.

   • Impact: Causes instability and difficulty in walking.

3. Knee Flexion Contracture:

   • Description: The knee becomes fixed in a bent position if left untreated.

   • Impact: Limits mobility and complicates walking.

4. High Arched Foot (Pes Cavus):

   • Description: The midfoot bones bend downwards, creating a high arch appearance.

   • Impact: Leads to foot instability and difficulty in wearing shoes.

Contractures of Joints:

• Description: Shortening of muscles and tendons that prevents full range of limb movements.

• Impact: Often results from prolonged positioning and disuse of the affected limb, leading to deformities and further complications.

Splint

• Purpose: Keeps body parts in normal positions or symmetrical postures.

• Functions:

  • Facilitates movement.

  • Supports weak muscles.

  • Prevents contractures and deformities.

• Usage: During therapy, after surgery or trauma, and at night to prevent deformities.

Orthosis

• Purpose: Provides support for weak body parts, enabling better functionality.

• Types:

  • AFO (Ankle-Foot Orthosis)

  • HKAFO (Hip-Knee-Ankle-Foot Orthosis)

  • KAFO (Knee-Ankle-Foot Orthosis)

• Usage: Lifelong support for children with permanent muscle weakness due to polio.

Crutches and Walkers

• Purpose: Support during standing and walking.

• Types:

  • Walkers: For children with poor balance and weak muscles.

  • Crutches: For children with stronger muscles. Two types are:

    • Axillary Crutches: Support weight under the armpits.

    • Forearm Crutches: For children with stronger arms and legs.

• Usage: Helps improve balance, confidence, and walking ability.

Wheelchair

• Purpose: Assists children who cannot walk even with assistive devices.

• Usage: For those who tire quickly, need to travel long distances, or require mobility at school or community activities.

Strengthening Exercises

• Purpose: Develops independence by preventing muscle weakness and deformities.

• Guidelines:

  • Keep the child active.

  • Prevent muscle weakness and increase strength.

  • Scale exercises as strength increases (e.g., starting with 5-10 repetitions and progressing to 20-30).

  • Focus on arm strength and balance.

Surgery

• Purpose: To fit better into orthosis, correct or prevent deformities, or improve independence.

• Considerations: Surgery may be necessary when exercises alone are insufficient to prevent deformities or improve function.

The spinal cord is a crucial nerve bundle that extends from the brain and runs down the backbone. It facilitates communication between the brain and the body, controlling:

• Sensation of pain, temperature, and pressure.

• Movement through messages that travel back and forth between the brain and different body parts.

A spinal cord injury (SCI) refers to damage to any part of the spinal cord or nerves at the end of the spinal canal, leading to permanent changes in strength, sensation, and other body functions below the site of the injury.

Spinal cord injuries (SCI) can arise from various causes, which are generally classified into two categories: traumatic and non-traumatic. The severity of an SCI can range from mild to life-threatening, and prompt treatment is crucial to prevent further damage.

Traumatic Spinal Cord Injuries

These occur due to sudden, forceful impacts that damage the spine or sever the spinal cord. Common causes include:

1. Motor Vehicle Accidents

   • Car and motorcycle crashes are the leading cause of SCIs, often resulting from high-impact collisions.

2. Slips and Falls

   • Particularly common among older adults, falls can cause severe spinal injuries.

3. Sports-Related Injuries

   • High-contact sports and recreational activities, such as football, rugby, diving, and skiing, can result in spinal injuries.

4. Medical/Surgical Causes

   • Some spinal injuries occur as complications from surgical procedures or medical conditions.

Non-Traumatic Spinal Cord Injuries

These result from gradual internal damage to the spinal cord region and include:

• Infections Infections like spinal epidural abscesses or viral infections can lead to inflammation and damage to the spinal cord.

• Degeneration of the Spinal Column

  • Age-related wear and tear, such as spinal stenosis or herniated discs, can gradually compress and damage the spinal cord

• Cancer/Tumors

  • Tumors, whether benign or malignant, can grow in or around the spinal cord, leading to compression and injury.

• Inflammation

  • Conditions such as multiple sclerosis or transverse myelitis involve inflammation of the spinal cord, resulting in damage.

• Congenital Medical Issues

  • Birth defects like spina bifida can cause structural abnormalities in the spinal cord.

Spinal cord injuries (SCI) are categorized based on the severity and location of the injury. These factors influence the extent of functional loss and the symptoms experienced by the individual.

Severity-Based Classification

1. Incomplete Spinal Cord Injuries

   • Description: The spinal cord is only partially severed, allowing the person to retain some degree of function. The extent of functional retention depends on the severity and location of the injury.

   • Common Types:

     • Anterior Cord Syndrome: Injury to the front of the spinal cord, affecting motor and sensory pathways. Patients may retain some sensation but struggle with movement.

     • Central Cord Syndrome: Injury to the center of the cord, affecting nerves that carry signals from the brain to the spinal cord. This often results in loss of fine motor skills, arm paralysis, and partial leg impairment. Some patients may also experience loss of bowel or bladder control and sexual function.

     • Brown-Séquard Syndrome: Damage to one side of the spinal cord, causing more pronounced injury on one side of the body. For example, movement may be impossible on the right side but fully retained on the left. The severity varies widely among patients.

2. Complete Spinal Cord Injuries

   • Description: The spinal cord is fully severed, resulting in a total loss of sensory and motor function below the injury site. Despite this, treatment and physical therapy may help regain some function.

   • Symptoms: Complete paralysis and loss of sensation below the injury level.

Location-Based Classification

1. Cervical Spinal Cord Injuries (C1-C8)

   • Injuries to the cervical region, the topmost part of the spinal cord, can result in tetraplegia (quadriplegia), affecting both arms and legs.

   • Symptoms: Loss of function in arms, legs, and torso, potentially affecting breathing and bowel/bladder control.

2. Thoracic Spinal Cord Injuries (T1-T12)

   • Injuries to the thoracic region (middle section of the spinal cord) affect the upper and mid-back, often leading to paraplegia, impacting the legs and lower body.

   • Symptoms: Loss of function in legs, possibly affecting the lower abdominal muscles while typically sparing arm and hand function.

3. Lumbar Spinal Cord Injuries (L1-L5)

   • Injuries to the lumbar region,Lower region where the spinal cord begins to bend, can cause varying degrees of paraplegia.

   • Symptoms: Loss of function in legs and hips, affecting movement and sensation. Bowel and bladder control may also be impaired.

4. Sacral Spinal Cord Injuries (S1-S5)

   • Description: Injuries to the sacral region, the triangle-shaped lower part of the spine(five vertebrae, though there is no actual spinal cord in this section, only nerve roots), can impact the pelvis and lower parts of the body.

   • Symptoms: Loss of function in hips, buttocks, and legs, and potential impact on bowel and bladder function and sexual function.

5. Coccygeal Region Injuries

   • Description: Injuries to the coccyx or tailbone are less common and typically involve damage to the nerve roots rather than the spinal cord itself.

   • Symptoms: Pain and possible loss of function in the pelvic area, generally less severe than higher spinal cord injuries.

Specific Injury Types

1. Tetraplegia (Quadriplegia)

   • Description: Results from cervical spinal cord damage, typically causing paralysis of all four limbs.

   • Symptoms: Loss of movement below the injury site, with potential difficulties in bladder and bowel control, respiration, and other functions.

2. Paraplegia

   • Description: Caused by damage to the thoracic spinal cord, removing sensation and movement from the lower half of the body, including the legs.

   • Symptoms: Loss of function in legs and lower body.

3. Triplegia

   • Description: Results from an incomplete spinal cord injury, causing loss of sensation and movement in one arm and both legs.

   • Symptoms: Partial paralysis, affecting specific limbs based on injury location.

1. Emergency Care:

   • Immediate spine stabilization and oxygenation.

   • Corticosteroids to reduce inflammation.

   • Monitor for complications.

2. Medical Treatment:

   • Surgical intervention for stabilization or decompression.

3. Rehabilitation:

   • Physical and occupational therapy for mobility and independence.

   • Range of motion exercises and chest physiotherapy.

   • Assistive devices like wheelchairs and braces.

4. Medications:

   • Pain management and treatment for complications.

5. Psychological Support:

   • Counseling to address emotional challenges.

6. Long-Term Care:

   • Monitoring and management of complications.

Future Directions:

• Stem Cell Therapy: Promotes motor improvement.

• Vaccination: Stimulates antibodies against growth inhibitors.

• Immunotherapy: Aids recovery through cell transplantation.

• Growth Factors: Facilitate neural regeneration.

• Gene Therapy: Promotes neural tissue regeneration

Spina bifida is a developmental defect occurring during fetal growth, where some of the vertebrae fail to close completely over the spinal cord, resulting in a gap or split in the spine. This condition can lead to the spinal cord being exposed and vulnerable. Sometimes, a sac containing the spinal cord's covering and fluid protrudes from the back, either covered by thin or normal skin. The exact cause is unknown, and the severity varies among cases. In some instances, nerve fibers or parts of the spinal cord may be present in the sac, while in others, the spinal cord may be exposed on the surface. Spina bifida, which means "split spine," affects the central nervous system's development, disrupting the brain's ability to send and receive messages to different parts of the body through the spinal cord. The spinal cord's protection is crucial for overall bodily function, and when the vertebrae fail to close properly during fetal development, it results in this congenital

Spina bifida encompasses three main types, all present at birth:

1. Spina Bifida Cystica: This type features a visible sac or cyst, akin to a large blister on the back, covered by a thin layer of skin. It includes:

   Myelomeningocele: The most severe form, where the cyst contains tissue, cerebrospinal fluid, nerves, and part of the spinal cord. It often leads to paralysis and loss of sensation below the affected region. Bladder and bowel problems are common, as the nerves controlling these functions originate from the bottom of the spinal cord.

   Meningocele: This form involves a sac containing meninges (tissues covering the brain and spinal cord) and cerebrospinal fluid. Although spinal cord development may be affected, the impairment is usually less severe than myelomeningocele.

2. Spina Bifida Occulta: This milder form is common and often goes unnoticed. It involves incomplete joining of the outer part of the vertebrae, without damage to the spinal cord or its covering (meninges).

Other related conditions include:

• Encephalocele: A sac formed when the skull bones fail to develop properly, which may contain cerebrospinal fluid or part of the brain, potentially resulting in brain damage.

• Anencephaly: A condition where the brain is either absent or underdeveloped, leading to stillbirth or death shortly after birth.

• Hydrocephalus: Many babies with myelomeningocele also have hydrocephalus, characterized by an accumulation of cerebrospinal fluid due to an imbalance in its production and drainage.

For newborns with spina bifida, early surgery is vital, often performed within the first forty-eight hours of birth to improve survival rates. Multiple surgeries may be required during childhood to address defects in the hips, feet, and spine.

• Hydrocephalus (large head)

• Paralysis of lower limbs

• Sensory loss in paralyzed limbs

• Deformities in the spine, knees, ankles, and feet

• Urinary and stool incontinence

• Thorough assessment by medical and rehabilitation experts to evaluate physical abilities, mobility, sensory loss, and bowel/bladder control.

• Gentle handling to prevent injury, as sensory loss may hinder the child's ability to sense pain.

• Proper positioning on chairs or wheelchairs to ensure comfort and prevent pressure sores.

PROBLEMS AND MANAGEMENT AT BIRTH AND DURING CHILDHOOD

• Initial examination to assess for other birth defects and determine the type and location of spina bifida.

• Observation of leg movement and sensation, urinary control, and any foot, joint, or spine issues.

• Potential problems in later childhood include urinary infections, spinal curvature, pressure sores, posture issues, foot injuries, contractures, and social isolation.

• Therapeutic management focuses on preventing and correcting contractures, aiding overall development, and preventing pressure sores and injuries through proper positioning, adaptive aids, and regular examination for signs of irritation or sores.

Definition

Muscular dystrophy is a group of genetic disorders characterized by progressive weakening and degeneration of the body's muscles. This condition results from mutations in genes responsible for the structure and function of muscle fibers. As a result, muscle fibres are replaced by fat cells and the muscle gradually waste (strophy). This causes "a progressive" loss of muscle power.

Recognizing Muscular Dystrophy:

1. Primarily affects males (rarely females).

2. Often runs in families, with male relatives showing similar symptoms.

3. Early signs typically appear between ages 3 to 5, including awkward movement, walking on tiptoes, and frequent falls.

4. Muscle weakness starts in lower limbs and gradually spreads to other parts of the body.

5. Most children lose the ability to walk by age 10.

6. Severe curvature of the spine may develop.

7. Weakness may affect the heart and breathing muscles, leading to heart failure or pneumonia by age 20.

Early Signs of Muscular Dystrophy:

• Gower's sign: Difficulty rising from the ground, using hands to climb up thighs due to weak thigh muscles.

Muscular dystrophy is primarily caused by genetic mutations that interfere with the production of proteins needed to maintain healthy muscle tissue. These mutations can affect various genes responsible for muscle structure and function. The specific gene mutations determine the type and severity of muscular dystrophy. In most cases, these mutations are inherited, meaning they are passed down from parents to their children. However, in some cases, the mutations can occur spontaneously without any family history of the condition. Factors such as age, gender, and environmental influences may also play a role in the development and progression of muscular dystrophy, but their exact contribution is still being studied.

Muscular dystrophy encompasses a group of genetic disorders characterized by progressive muscle weakness and degeneration. Some common types include:

1. Duchenne Muscular Dystrophy (DMD): This is the most common and severe form, primarily affecting boys. It typically begins in early childhood, causing progressive muscle weakness and loss of function.

2. Becker Muscular Dystrophy (BMD): Similar to DMD but less severe, with later onset and slower progression. It primarily affects boys but can also occur in girls.

3. Limb-Girdle Muscular Dystrophy (LGMD): This group of disorders affects muscles around the hips and shoulders. It can vary widely in severity and age of onset.

4. Facioscapulohumeral Muscular Dystrophy (FSHD): Characterized by weakness in the muscles of the face, shoulders, and upper arms. Symptoms often appear in the teenage years or early adulthood.

5. Myotonic Dystrophy: This type affects both muscles and other organs, causing muscle stiffness and difficulty relaxing muscles after contraction. It has two subtypes: type 1 (DM1) and type 2 (DM2).

6. Congenital Muscular Dystrophy (CMD): Presents at birth or early infancy with muscle weakness and developmental delays. It encompasses several subtypes with varying symptoms and severity.

Duchenne Muscular Dystrophy (DMD) is a genetic disorder characterized by progressive muscle degeneration and weakness. It primarily affects boys and typically manifests in early childhood, around ages 3 to 5.

1. Muscle Weakness: The condition causes progressive weakness in muscles, starting from the legs and pelvis and eventually affecting the arms, neck, and other areas.

2. Motor Skill Decline: Children with DMD often experience delays in reaching motor milestones such as walking. They may also exhibit a characteristic way of rising from the floor known as the Gower maneuver, where they use their hands to "walk up" their thighs due to weak leg muscles.

3. Waddling Gait: As the disease progresses, individuals may develop a waddling gait due to weakened muscles around the hips and pelvis.

4. Enlarged Calves: One of the distinctive physical signs of DMD is the enlargement of the calf muscles, known as pseudohypertrophy. Despite their size, these muscles are weak and lack functional strength.

5. Respiratory and Cardiac Complications: DMD also affects the respiratory and cardiac muscles, leading to breathing difficulties and heart problems over time.

6. Genetic Cause: Duchenne Muscular Dystrophy is caused by mutations in the DMD gene, which provides instructions for making a protein called dystrophin. Absence or deficiency of dystrophin results in muscle fiber damage and weakness.