final exam CIDP & Post-Polio Flashcards
work up of CIDP is often looking for:
infectious markers, HIV, hepatitis, lyme’s disease profiles
similar to AIDP, you can do a ______ to check CSF
Different from AIDP, you can do ______ to look for nerve root inflammation
- lumbar puncture
- lumbar MRI
a good prognosis of CIDP includes:
Worse prognosis?
decreased comorbidities, absence on monoclonal proteins, elevated CSF proteins
worse:
predominantly distal weakness
after immunotherapy, is ambulation prognosis good or bad for those with CIDP?
good
77% ambulate after 6 months
82% ambulate after 1 year
are there risk factors associated with CIDP?
what are some potential associations?
no
autoimmune disease
diabetes
HTN
antecedent infection
what are the main symptoms of CIDP?
fatigue
pain
impaired physical functioning
what are other effects seen in those with CIDP?
depression –> screen for this!
lower QOL scores
cognition is NOT affected
is long term medication therapy needed for CIDP?
if so, what?
yes
oral prednisone (significant side effects)
IVIG (can damage venous access points over time)
subcutaneous IG (if IV is not feasible)
plasmapheresis (if not responding to IVIG or corticosteroids)
immunosuppressants sometimes coupled with IVIG as treatment
CIDP:
- DTRS?
- MMT?
- Sensory?
- 0 (LMN)
- weak
- diminished
aerobic exercise for CIDP:
- how many times a week for how many weeks?
- increases?
- target HR?
- 3x/week for 12 weeks
- VO2Max
- 70% of max
resistance training for CIDP:
- how many times a week for how many weeks?
- increases?
- strengthened which muscle groups?
- sets & reps?
- 3x/week for 12 weeks
- isokinetic muscle strength
- knee flexors/extensors and elbow flexors/extensors
- 3 sets of 12 reps of 12 rep max weight
since CIDP presents similar to MS, what do you want to focus your interventions on?
monitor fatigue (RPE scales, HR)
functional task training
gait
balance
what settings can you see CIDP in?
acute care
acute rehab - less likely due to fatigue
SNF
home health
LTACH - less likely than AIDP
OP PT
Peds
Poliomyelitis is a ______ infection transmitted through ______
viral ; droplet or contact with fecal matter
what are the 3 different severity types for poliomyelitis?
- virtually asymptomatic
- GI, flu-like symptoms and muscular pain
- flu-like symptoms that progress to paralysis
what cells in the spinal cord are targeted? this results in what?
anterior horn cells ; wallerian degeneration process
result in muscle atrophy, LMN symptoms, and asymmetric
what is post polio syndrome?
new muscular symptoms that occur decades after primary polio infection (avg. 25 years later)
patients who have post-polio are likely in their ____ because of when the vaccine came out
70s or older
after the initial polio infection, axons go through a process of _____ to _____
collateral sprouting
regain functional ability
explain collateral sprouting
instead of innervating 3000 muscle fibers now one axon innervates 5000 muscle fibers –> overworked with the same demand
eventually the axon cannot take this increased stress and new denervation occurs
common symptoms of post-polio syndrome
muscle weakness
muscle atrophy
fatigue
muscular or joint pain
weakness can also affect axial muscles and impair breathing
weakness worse with cold and increased physical activity
weakness progresses slowly overtime
what would occur for diagnosis of post-polio?
EMG
muscle biopsy
rule out other neurologic disorders
medical management for post-polio
fatigue management with anticholinergics
non-pharmacologic pain management
can do tendon transfer surgeries for impaired foot posture
what would you do during your exam/eval of post-polio?
LMN signs
strength
functional ability
rule out UMN signs
fatigue/endurance levels
pain scales
gait
balance
is there the ability to overwork post-polio patients? if yes, can it cause detrimental effects?
yes, yes
these muscles and nerves have exhausted all collateral sprouting ability, if you tax them too much there may be irreparable damage
how can we as PTs treat post-polio?
teach lifestyle modification
compensation
energy conservation
never exercise to fatigue
only do non-exhaustive exercise and track vitals and RPE throughout
may have joint deformities from uneven strain of musculature on joint –> may need orthoses or surgery
