Management of :

1. Poliomyelitis
2. Motor Neuron Disease
3. Multiple Sclerosis
4. Guillain-Barre Syndrome

Prof. Shamay Ng
(11-15 March 2025)
 Preparation
Poliomyelitis
https://www.who.int/health-topics/poliomyelitis#tab=tab_1

Motor Neuron Disease

https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/motor-
neurone-disease-mnd/

Multiple Sclerosis
https://www.who.int/news-room/fact-sheets/detail/multiple-sclerosis

Guillain Barre Syndrome

https://www.who.int/news-room/fact-sheets/detail/guillain-barr%C3%A9-syndrome
 Objectives
• Understand the pathophysiology
• Understand the prognosis
• Implement physiotherapy management

For patients suffering from:

1. poliomyelitis,
2. motor neuron disease,
3. multiple sclerosis and
4. Gulliain-Barre syndrome
 Upper & Lower Motor Neuron Lesions (UMNL & LMNL)

• Upper and lower motor neurons control the

voluntary movements.

• Upper motor neurons are located mainly in

the primary motor and premotor areas of
cerebrum

• Lower motor neurons are located in the motor

nuclei of the cranial nerves in the
brainstem and anterior horn of spinal cord

https://anatomyqa.com/uuper-lower-motor-neurons-lesions/
 Upper & Lower Motor Neuron Lesions (UMNL & LMNL)
UMNL and UMNL affect different parts of the motor pathway and result in distinct clinical signs and symptoms

Feature UMNL LMNL

PNS: Anterior horn cells, cranial nerve

Location CNS: Brain and spinal cord
nuclei, peripheral nerves
Poliomyelitis, GBS, peripheral nerve
Causes Stroke, MS, brain/spinal cord injury
injury
Weakness General Localized
Muscle Tone Spasticity Hypotonia
Reflexes Hyperreflexia Hyporeflexia
Other Signs Clonus, Babinski sign Atrophy, fasciculations
 Class Activities
• Divide yourselves into 4 sub-groups.

• Present 5-6 slides for each disease on the following topics:

 Pathology – site of lesion (include drawings of the brain, spinal cord,
motor neurons, and muscle supply)
 Pathophysiology
 Signs and symptoms
 Prognosis
 Physiotherapy management
Diagram Showing the Site of Lesions of :
1) poliomyelitis,
2) motor neuron disease,
3) multiple sclerosis and
4) Gulliain-Barre syndrome
 Poliomyelitis Motor Neuron Disease Multiple Sclerosis Guillain-Barré
(POLIO) (MND) (MS) Syndrome (GBS)

Lesion Site

Pathophysiology

Clinical Picture
 POLIO MND MS GBS

Immune
System
Involvement

Progressive
Nature
 POLIO MND MS GBS

Disease
Profile

Rate of
Recovery

Potential
for
Recovery
 POLIO MND MS GBS

Clinical
Picture

Treatment
Goals

PT
Treatment
Different Types of Motor Neuron Disease (MND):
Motor neuron diseases (MNDs) are progressive neurological disorders affecting motor neurons, which control
voluntary muscle activity. Common types include:

Type of MND Affected Neurons Key Characteristics

Amyotrophic Lateral Sclerosis

(ALS)

Primary Lateral Sclerosis

(PLS)

Progressive Muscular Atrophy

(PMA)

Spinal Muscular Atrophy

(SMA)

Bulbar Onset ALS

Kennedy's Disease
Results of Discussion
 Poliomyelitis Motor Neuron Disease Multiple Sclerosis Guillain-Barré
(POLIO) (MND) (MS) Syndrome (GBS)

Demyelination in the
Anterior horn cells of Upper and lower motor Primarily affects the
CNS, including brain,
the spinal cord in the neurons in the CNS and PNS; secondary CNS
Lesion Site CNS. spinal cord.
spinal cord, and optic
effects possible.
nerves.
(LMNL) (UMNL+LMNL) (LMNL)
(UMNL +/-LMNL)

-Autoimmune
-Caused by poliovirus; -Progressive disorders -Autoimmune attack
demyelination in the
-Affects anterior horn affecting motor neurons; on peripheral nerves,
Pathophysiology cells, leading to motor -Leads to muscle weakness
CNS,
leading to
-Disrupting nerve
neuron destruction. and atrophy. demyelination.
signal transmission.

-Rapid onset of
muscle weakness,
-Muscle weakness and -Progressive muscle -Relapsing-remitting
Clinical Picture paralysis. weakness and atrophy. or progressive course.
starting in legs;
possible respiratory
involvement.
 POLIO MND MS GBS

-Not primarily
-Viral infection; autoimmune, but
-not primarily immune mechanisms
Immune
autoimmune, but may contribute to -Autoimmune -Autoimmune
System
immune mechanisms pathology. disorder. disorder.
Involvement may contribute to -Aetiology: unknown
pathology. - ? Genetics

-Variable -Rapid onset;

-Rapid onset; progression; -Increasing paralysis;
-Typically progressive; -
Progressive -Potential for -relapsing- -recovery phase
ALS progresses rapidly.
Nature permanent paralysis. remitting or follows, often full
.
progressive. recovery.
 POLIO MND MS GBS

-Acute autoimmune; often

-Includes ALS; affects
-Caused by poliovirus; -Autoimmune; follows infection;
Disease -Primarily affects children;
adults 40-70;
-More common in women; -Acute and diffuse post-
Profile -Progressive motor neuron
-Fecal-oral transmission. -Diagnosed 20-40. infective disorder of PNS
degeneration.
-Affects all ages.

-Recovery varies, generally good

-Live with certain degree of -Typically progressive
disability with no recovery -Characterized by relapses and
Rate of -30% recover fully Often progresses rapidly but
-PMA: survive beyond 5 remissions;
-30% mild paralysis recovery can begin within
Recovery -30% have moderate or severe years -Recovery from relapses
weeks to months.
paralysis -ALS: survive around 3 varies.
-10% have severe respiratory years
involvement

-No cure; -If death is prevented,

Potential -Depends on severity and nerve -Gradual decline in motor -Some recover well from prognosis is good; -~80% of
damage; -rehabilitation can function; relapses, others accumulate patients have complete
for help, but some effects may be -Treatment focuses on disability recovery;
Recovery lifelong. symptom management and -5-10% of patients cover
quality of life. with disability
 POLIO MND MS GBS

-Rapid onset of muscle

-Relapsing-remitting
Clinical Muscle weakness and Progressive muscle
-relapsing/progressive
weakness, starting in legs;
Picture paralysis. weakness and atrophy. -possible respiratory
-progressive
involvement.

-Maintain mobility &

functional independence -Manage symptoms, -Support recovery,
-Postural correction -Prevent secondary disuse and -Prevent complications.
Improve strength,
Goals maintain range of motion.
-Respiratory care adaptation -Prevent secondary disuse and
-Pain relief -Improve functional mobility & adaptation
-wheelchair prescription independence
-comfort

Acute:
-Prevent deformity -Mobilising & strengthening
-Stabilise unstable joints -Comfort exercises
-Respiratory care in acute
Chronic: -Maintenance -Maximize the functional
exacerbation
PT -Maximize functional -Prevent secondary disuse capacity
-Gradual strengthening,
Treatment capacity and adaptation -Fatigue management
-ADL training,
-Active mobilizing and -Stretching, strengthening, -Psychological support
-Psychological support
strengthening exercise respiratory exercises. -Healthy life-style
-Use of orthosis &
assistive devices
 Pathology – site
of lesion

poliomyelitis
Supplementary Information
Different Types of Motor Neuron Disease (MND):
Motor neuron diseases (MNDs) are progressive neurological disorders affecting motor neurons, which control
voluntary muscle activity. Common types include:
:
Type of MND Affected Neurons Key Characteristics

Amyotrophic Lateral Sclerosis Upper and lower motor

Muscle weakness, atrophy, eventual paralysis.
(ALS) neurons

Primary Lateral Sclerosis

Upper motor neurons Muscle stiffness and weakness; slower progression than ALS.
(PLS)

Progressive Muscular Atrophy Muscle wasting and weakness; generally slower progression
Lower motor neurons
(PMA) than ALS.

Spinal Muscular Atrophy Genetic disorder; muscle weakness and atrophy; varies in
Lower motor neurons
(SMA) severity and age of onset.

Upper and lower motor Initially affects speaking, swallowing, and breathing muscles;
Bulbar Onset ALS
neurons progresses to others.

Genetic disorder; muscle weakness and atrophy, especially in

Kennedy's Disease Lower motor neurons
face and throat.
The Ice Bucket Challenge, sometimes called
the ALS Ice Bucket Challenge, was an activity
involving the pouring of a bucket of ice water over
a person's head, either by another person or self-
administered, to promote awareness of the
disease amyotrophic lateral sclerosis (ALS, also
known as motor neuron disease or Lou Gehrig's
disease) and encourage donations to research.
 Multiple Sclerosis

https://en.wikipedia.org/wiki/Multiple_sclerosis#/media/File:Ms_progression_types.svg
 Matching Activity
• For the following, match all CNS dysfunction(s) observed with each of the 4
diseases/syndromes.
Note: There may be more than one answer.
A. Spasticity
B. Demyelination
C. Upper motoneuron dysfunction
D. Lower motoneuron dysfunction

_________Multiple sclerosis
_________Poliomyelitis
_________Guillain-Barre syndrome
_________Amyotrophic lateral sclerosis
Prof. Stephen Hawking

- Stephen Hawking May

Have Been the Longest-
Living ALS Survivor

- Died at age of 76
 Matching Activity
• For the following, match all CNS dysfunction(s) observed with each of the 4
diseases/syndromes.
Note: There may be more than one answer.
A. Spasticity
B. Demyelination
C. Upper motoneuron dysfunction
D. Lower motoneuron dysfunction

___ABC___ Multiple sclerosis

_____D____Poliomyelitis
____BD___ Guillain-Barre syndrome
____ACD__ Amyotrophic lateral sclerosis
If the patient survives the initial (acute) phase, which of
these diseases/syndromes has a better prognosis?

Guillain-barre syndrome
Poliomyelitis
Which conditions may involve the respiratory system?

MND, GB syndrome
Draw a line indicating the rate of recovery or decline for
each condition

Functional

Death
Draw a line indicating the rate of recovery/decline
in each condition
 References
• Dal Bello-Haas V, Brown C. Motor neuron disease. In Lennon S, Ramdharry G & Verheyden G. (2018)
Physical Management in Neurological Rehabilitation. 4th Ed., Elsevier. Chapter 13, pp. 285-307.

• Freeman JA, Gunn H. Multiple Sclerosis. In Lennon S, Ramdharry G & Verheyden G. (2018) Physical
Management in Neurological Rehabilitation. 4th Ed., Elsevier. Chapter 10, pp. 205-226.

• Ramdharry G, Carr A, Laurá M. Polyneuropathies. In Lennon S, Ramdharry G & Verheyden G. (2018)

Physical Management in Neurological Rehabilitation. 4th Ed., Elsevier. Chapter 14, pp. 309-313, 318-
323.
 Useful Information
• http://en.wikipedia.org/wiki/Guillain_Barre_Syndrome

• http://en.wikipedia.org/wiki/Poliomyelitis

• http://en.wikipedia.org/wiki/Multiple_sclerosis

• http://en.wikipedia.org/wiki/Motor_Neurone_Disease
End