Scoliosis Resulting From Neuromuscular Disease

The lessons learned from treating patients with polio were easily understood because of the obvious effects of the disease on the functions of muscles. People who treated these patients appreciated that deformities could develop where muscle imbalance existed. They saw the devastating effects of muscle weakness and the subsequent tightness or contracture in opposing muscles, not the least of which were the effects on the spine. Some potentially severe problems were helped by appropriate intervention.

The accompanying photographs show the marked weakness of the right abdominal musculature and the associated lateral curve. This patient had polio at the age of 1 year and 4 months but was not admitted to a hospital for treatment until the age of 8 years and 8 months. She was placed on a flexed frame to relax the abdomi nal muscles with a pullover strap pulling in the direction of the right external oblique. Specific exercises were given to the weak muscles of the trunk in addition to the support from the pullover strap. Seven months after treatment was started, the strength of the abdominal muscles had improved, with the right external oblique showing an increase from a poor minus to a good grade.

In treating patients with polio, it became obvious in many instances that weakness caused by stretching had been superimposed on the initial weakness caused by the disease. As in the case illustrated here, the muscles were not reinnervated by relieving stretch and strain on them, innervation existed as a latent factor. The stretched muscles were incapable of response until the stretch and strain were relieved by adequate support, and until the weak muscles were stimulated by proper exercises.

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