RESULTS OF MODERN METHODS OF TREATMENT OF POLIOMYELITIS

¹ BALTIMORE, MARYLAND

1. All muscles, even in a widespread, complete paralysis of entire extremities, should have three months of careful and painstaking protection and treatment comparable to that given in peripheral-nerve lesions.

2. At the end of such a three months' regimen, a very accurate prognosis of recovery can be arrived at, for the muscles can then be differentiated into three categories:

a. Those which have not recovered to a point of 30 per cent. of power in three months. No return of useful power is to be expected; and these make up the group of the permanently paralyzed extremities.

b. Those which by this time have 80 per cent. or more power, and can be counted on to function satisfactorily without any further treatment except general supervision.

c. The group which has demonstrated some return of power and has a threemonth level of 30 to 75 per cent. These have potentiality for further recovery to a point where useful function can be restored. These cases are the crucially important ones as far as further active treatment is concerned, and every effort should continue to be expended on this group to build up power and develop hypertrophy of the active muscle tissue persisting, and to protect these patients against overfatigue and postural strain during at least the next year.

3. No appreciable recovery continues beyond eighteen months, even under ideal conditions, but untreated or inadequately treated cases have been salvaged by this regimen as late as six to ten years after the acute attack, indicating a previous nerve recovery which had been masked or nullified by the overstretching or overfatigue of the muscle or by opposing contracture.

4. On occasions we have observed loss of power in muscles of our own cases from overfatigue and too early removal of support, with permanent damage in some few instances, again demonstrating the need for careful supervision during recovery.

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