Slide 110 — Poliovirus – non-enveloped single-stranded RNA virus, a picornavirus and enterovirus

Clean FRCS notes with inline figures

•Poliovirus – non-enveloped single-stranded RNA virus, a picornavirus and enterovirus

•Disease caused by poliovirus infection → destruction of ant horn cell in spinal cord and brain stem motor nuclei

•faecal-oral route, major [meningitis, encephalitis] and minor [flu like] type

•Poliomyelitis: Non progressive asymmetrical motor paralysis with sensory sparing

4 Phases:

•Acute – prodromal flu like, muscle painful, joints flexed

•Paralysis – after 2-3 days; limbs weak, swallowing/breathing affected; end 7-10 days

•Recovery – within 6 months

•Residual – residual paralysis (LMN, flaccid) with intact sensation → (with time) → deformity and growth disturbance

•Vaccination: 1958: First general use of Sabin (live attenuated vaccine) by mouth (OPV), Salk = inactivated polio vaccine (IPV)

•Post polio syndrome

•Aging phenomenon where the remaining neurons degenerate after working extra hard to compensate for the damaged neurons

•NOT reactivation

•Up to 50%

•Exercise at sub exhaustion levels to tone affected muscle groups + period of rest + light weighted caliper

•(PACING, maintain but not overuse)

Usually 2 scenarios:

•New sx after a period of convalescence i.e. post polio syndrome

Chronic problem of:

•Weakness/ Flail joint

•Deformity (due to posture, muscle imbalance, gravity)

•OA

•LLD

•Vascular dysfunction

•Assessment for 1. = rule out post polio syndrome, rule out other causes (medical, ortho, neuro)

Assessment for 2.

•Look at the following and treat accordingly

•Hip

•FABER contracture (Ober procedure, Campbell procedure)

•Trendelenberg gait (EO transfer, iliopsoas to GT)

•Dislocation

•Glut max weakness (glut max lurching gait)

•Knee

•Quads weakness (hand knee gait) (KAFO)

•FFC (serial casting, soft tissue release, extension osteotomy)

•Recurvatum (triple tenodesis)

•Flail knee (Fusion, KAFO)

•F&A

•Foot drop gait + circumduction gait

•Cavovarus, equinovarus

•LLD (short limb gait)

•Spine + pelvis – determine if pelvic obliquity is infra, supra or combined causes

IT band is the culprit for lots of presentations:

•Increased lumbar lordosis

•Pelvic obliquity

•FABER hip

•Knee FFC + valgus

•LLD

•Tibial ER

•Secondary F&A problems

•Most common weakness is at the quads

•2 adaptive mechanisms to bring the CG in front of the knee for passive standing/ stance phase

•Weak quads → knee flexion → CG behind knee causing flexion moment at knee

•To compensate, hip flexion to bring CG forward, ankle plantar flexion (ankle plantarflexion knee extension couple)

•Weak quads → knee recurvatum so ITB acts as extensor, CG now in front of knee. Counterbalanced by glut max and ankle dorsiflexor

•Weakness (from most common to least)

•LL: TibAnt, quads, glut max, gastroc

•UL: Deltoid, biceps, opponens

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	Poliovirus – non-enveloped single-stranded RNA virus, a picornavirus and enterovirus
2	0	None	None	0	Disease caused by poliovirus infection → destruction of ant horn cell in spinal cord and brain stem motor nuclei
3	0	None	None	0	faecal-oral route, major [meningitis, encephalitis] and minor [flu like] type
4	0	None	None	0	Poliomyelitis: Non progressive asymmetrical motor paralysis with sensory sparing
5	0	None	None	0	4 Phases:
6	0	171450	-171450	1	Acute – prodromal flu like, muscle painful, joints flexed
7	0	171450	-171450	1	Paralysis – after 2-3 days; limbs weak, swallowing/breathing affected; end 7-10 days
8	0	171450	-171450	1	Recovery – within 6 months
9	0	171450	-171450	1	Residual – residual paralysis (LMN, flaccid) with intact sensation → (with time) → deformity and growth disturbance
10	0	None	None	0	Vaccination: 1958: First general use of Sabin (live attenuated vaccine) by mouth (OPV), Salk = inactivated polio vaccine (IPV)
11	0	None	None	0	Post polio syndrome
12	0	171450	-171450	1	Aging phenomenon where the remaining neurons degenerate after working extra hard to compensate for the damaged neurons
13	0	171450	-171450	1	NOT reactivation
14	0	171450	-171450	1	Up to 50%
15	0	171450	-171450	1	Exercise at sub exhaustion levels to tone affected muscle groups + period of rest + light weighted caliper
16	0	0	0	0	(PACING, maintain but not overuse)
17	0	0	0	0	=========================================
18	0	0	0	0	Usually 2 scenarios:
19	0	228600	-228600	1	New sx after a period of convalescence i.e. post polio syndrome
20	0	228600	-228600	1	Chronic problem of:
21	0	228600	-228600	1	Weakness/ Flail joint
22	0	228600	-228600	1	Deformity (due to posture, muscle imbalance, gravity)
23	0	228600	-228600	1	OA
24	0	228600	-228600	1	LLD
25	0	228600	-228600	1	Vascular dysfunction
26	0	0	0	0	Assessment for 1. = rule out post polio syndrome, rule out other causes (medical, ortho, neuro)
27	0	0	0	0	Assessment for 2.
28	0	0	0	0	Look at the following and treat accordingly
29	0	228600	-228600	1	Hip
30	1	685800	-228600	2	FABER contracture (Ober procedure, Campbell procedure)
31	1	685800	-228600	2	Trendelenberg gait (EO transfer, iliopsoas to GT)
32	1	685800	-228600	2	Dislocation
33	1	685800	-228600	2	Glut max weakness (glut max lurching gait)
34	0	228600	-228600	1	Knee
35	1	685800	-228600	2	Quads weakness (hand knee gait) (KAFO)
36	1	685800	-228600	2	FFC (serial casting, soft tissue release, extension osteotomy)
37	1	685800	-228600	2	Recurvatum (triple tenodesis)
38	1	685800	-228600	2	Flail knee (Fusion, KAFO)
39	0	228600	-228600	1	F&A
40	1	685800	-228600	2	Foot drop gait + circumduction gait
41	1	685800	-228600	2	Cavovarus, equinovarus
42	0	228600	-228600	1	LLD (short limb gait)
43	0	228600	-228600	1	Spine + pelvis – determine if pelvic obliquity is infra, supra or combined causes
44	0	0	0	0	IT band is the culprit for lots of presentations:
45	0	228600	-228600	1	Increased lumbar lordosis
46	0	228600	-228600	1	Pelvic obliquity
47	0	228600	-228600	1	FABER hip
48	0	228600	-228600	1	Knee FFC + valgus
49	0	228600	-228600	1	LLD
50	0	228600	-228600	1	Tibial ER
51	0	228600	-228600	1	Secondary F&A problems
52	0	0	0	0	Most common weakness is at the quads
53	0	0	0	0	2 adaptive mechanisms to bring the CG in front of the knee for passive standing/ stance phase
54	0	171450	-171450	1	Weak quads → knee flexion → CG behind knee causing flexion moment at knee
55	0	171450	-171450	1	To compensate, hip flexion to bring CG forward, ankle plantar flexion (ankle plantarflexion knee extension couple)
56	0	171450	-171450	1	Weak quads -> knee recurvatum so ITB acts as extensor, CG now in front of knee. Counterbalanced by glut max and ankle dorsiflexor
57	0	0	0	0	Weakness (from most common to least)
58	0	0	0	0	LL: TibAnt, quads, glut max, gastroc
59	0	0	0	0	UL: Deltoid, biceps, opponens

110. Poliovirus – non-enveloped single-stranded RNA virus, a picornavirus and enterovirus

Clean FRCS notes with inline figures

4 Phases:

Usually 2 scenarios:

Chronic problem of:

Assessment for 2.

IT band is the culprit for lots of presentations:

Direct Q&A

4 Phases:

Look at the following and treat accordingly

Usually 2 scenarios:

Chronic problem of:

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes