final exam CIDP & Post-Polio

Question 1

work up of CIDP is often looking for:

Answer 1

infectious markers, HIV, hepatitis, lyme’s disease profiles

Question 2

similar to AIDP, you can do a ______ to check CSF
Different from AIDP, you can do ______ to look for nerve root inflammation

Answer 2

• lumbar puncture
• lumbar MRI

Question 3

a good prognosis of CIDP includes:
Worse prognosis?

Answer 3

decreased comorbidities, absence on monoclonal proteins, elevated CSF proteins

worse:
predominantly distal weakness

Question 4

after immunotherapy, is ambulation prognosis good or bad for those with CIDP?

Answer 4

good
77% ambulate after 6 months
82% ambulate after 1 year

Question 5

are there risk factors associated with CIDP?
what are some potential associations?

Answer 5

no
autoimmune disease
diabetes
HTN
antecedent infection

Question 6

what are the main symptoms of CIDP?

Answer 6

fatigue
pain
impaired physical functioning

Question 7

what are other effects seen in those with CIDP?

Answer 7

depression –> screen for this!
lower QOL scores
cognition is NOT affected

Question 8

is long term medication therapy needed for CIDP?
if so, what?

Answer 8

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

Question 9

CIDP:
- DTRS?
- MMT?
- Sensory?

Answer 9

• 0 (LMN)
• weak
• diminished

Question 10

aerobic exercise for CIDP:
- how many times a week for how many weeks?
- increases?
- target HR?

Answer 10

• 3x/week for 12 weeks
• VO2Max
• 70% of max

Question 11

resistance training for CIDP:
- how many times a week for how many weeks?
- increases?
- strengthened which muscle groups?
- sets & reps?

Answer 11

• 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

Question 12

since CIDP presents similar to MS, what do you want to focus your interventions on?

Answer 12

monitor fatigue (RPE scales, HR)
functional task training
gait
balance

Question 13

what settings can you see CIDP in?

Answer 13

acute care
acute rehab - less likely due to fatigue
SNF
home health
LTACH - less likely than AIDP
OP PT
Peds

Question 14

Poliomyelitis is a ______ infection transmitted through ______

Answer 14

viral ; droplet or contact with fecal matter

Question 15

what are the 3 different severity types for poliomyelitis?

Answer 15

1. virtually asymptomatic
2. GI, flu-like symptoms and muscular pain
3. flu-like symptoms that progress to paralysis

Question 16

what cells in the spinal cord are targeted? this results in what?

Answer 16

anterior horn cells ; wallerian degeneration process
result in muscle atrophy, LMN symptoms, and asymmetric

Question 17

what is post polio syndrome?

Answer 17

new muscular symptoms that occur decades after primary polio infection (avg. 25 years later)

Question 18

patients who have post-polio are likely in their ____ because of when the vaccine came out

Answer 18

70s or older

Question 19

after the initial polio infection, axons go through a process of _____ to _____

Answer 19

collateral sprouting
regain functional ability

Question 20

explain collateral sprouting

Answer 20

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

Question 21

common symptoms of post-polio syndrome

Answer 21

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

Question 22

what would occur for diagnosis of post-polio?

Answer 22

EMG
muscle biopsy
rule out other neurologic disorders

Question 23

medical management for post-polio

Answer 23

fatigue management with anticholinergics
non-pharmacologic pain management
can do tendon transfer surgeries for impaired foot posture

Question 24

what would you do during your exam/eval of post-polio?

Answer 24

LMN signs
strength
functional ability
rule out UMN signs
fatigue/endurance levels
pain scales
gait
balance

Question 25

is there the ability to overwork post-polio patients? if yes, can it cause detrimental effects?

Answer 25

yes, yes
these muscles and nerves have exhausted all collateral sprouting ability, if you tax them too much there may be irreparable damage

Question 26

how can we as PTs treat post-polio?

Answer 26

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