1.9 Osteomyelitis

Osteomyelitis is an inflammation of a bone and its medullary (marrow) cavity. This condition is occa­sionally referred to as myelitis. It is caused by Staphylococcus, Streptococcus, or Pneumococcus organ­isms.

In its early stages osteomyelitis is described as acute. If the infection persists or recurs periodically, it is called chronic. Since chronic osteomyelitis may lin­ger on for years, the physical educator should confer with the physician about the nature of an adapted program.

The bones most often affected are the tibia, femur, and humerus. Pain and tenderness are present, and heat is felt through the overlying skin. Soft tissues feel hard, and neighboring joints may be distended with clear fluid. There are limited effects on range of joint movement. The child may limp because of the acute pain.

Exercise is always contraindicated when infection is active in the body.

Medical Treatment. If medical treatment is delayed, abscesses work out­ward, causing a sinus (hole) in the skin over the af­fected bone from which pus is discharged. This sinus is covered with a dressing that must be changed sev­eral times daily. The medical treatment is rest and intensive antibiotic therapy. Through surgery, the in­fected bone may be scraped to evacuate the pus.

Rehabilitation activity can restore mojor functions so that normal activity can be resumed. However, under certain conditions the child with osteomyelitis can participate in most developmental and recreational activities that allow the affected limb to be mobi­lized.

1.10 Poliomyelitis

There are three prevalent classifications of poliomy­elitis – abortive, nonparalytic, and paralytic.

The symptoms of abortive poliomyelitis are head­ache, fever, and nausea.

Nonparalytic poliomyelitis involves the central nervous system but does not damage the motor cells permanently. In addition to the symptoms of abortive poliomyelitis, the victim might experience general and specific pain and acute contractions of one or more muscle groups located in the upper and lower extremities, neck, and back.

Paralytic poliomyelitis includes three afflictions: spinal poliomyelitis, which involves upper limbs, lower limbs, respiratory muscles, and trunk muscles; bulbar poliomyelitis, which affects the muscles of the respiratory center; and, spinal-bulbar poliomyelitis, which involves a combination of voluntary and invol­untary muscles (the most serious of the three paral­ytic forms).

Medical Treatment. Tendon transplants and arthrodesis are commonly performed during the chronic stage.

Therapeutic Treatment. Exercise programs should focus on motor tasks that develop strength, endurance, flexibility, and coordi­nation.

Orthopedic deformities do not totally restrict move­ment. Children learn quickly to compensate for the inconvenience of an impaired foot or arm. At the el­ementary school level, many children with polio can achieve considerable athletic success. However, as they progress through school life, accumulated de­velopmental lags as a rule influence skill develop­ment enough so that successful participation in com­petitive sports cannot be achieved.