MS and Polio/Post polio

Question 1

MS

Answer 1

A chronic progressive demyelinating disease of the CNS affecting mostly young adults

Question 2

Etiology of MS:

Answer 2

unknown, most likely viral, autoimmune (active immune responses detected in CNS)

Question 3

Variable symptoms:

Answer 3

lesions scattered in time and place; lesions common in pyramidal tract, dorsal columns and periventricular areas of the cerebrum, cerebellum peduncles

Question 4

Relapsing-Remitting MS (RRMS):

Answer 4

Relapses with either full recovery or some remaining neurological signs/symptoms and residual deficit on recovery
Periods between relapses characterized by lack of disease progression

Question 5

Primary Progressive MS (PPMS):

Answer 5

Characterized by disease progression from onset without plateaus or remissions or with occasional plateaus and temporary minor improvements

Question 6

Secondary Progressive MS (SPMS):

Answer 6

Characterized by initial relapsing-remitting course, followed by initial relapsing-remitting course, followed by progression at a variable rate that may also include occasional relapses and minor remissions

Question 7

Progressive Relapsing MS (PRMS):

Answer 7

Characterized by progressive disease from onset but without clear, acute relapses that may or may not have some recovery or remission, commonly seen in individuals who develop the disease after 40 years of age.

Question 8

Signs and Symptoms:

Answer 8

hypoesthesia, paresthesias
pain
visual symptoms
weakness or paralysis 
urinary incontinence 
constipation, diarrhea, incontinence

Question 9

Modified Fatigue Impact Scale

Answer 9

interviews with MS patients concerning how fatigue impacts their lives. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial function

Question 10

EDSS:

Answer 10

Based on a standard neurological examination, the 7 functional systems (plus “other”) are rated. These ratings are then used in conjunction with observations and information concerning gait and use of assistive devices to rate the EDSS

Question 11

EDSS score 1.0-4.5:

Answer 11

refer to patients who are fully ambulatory

Question 12

EDSS score 5.0-9.5:

Answer 12

defined by the impairment to ambulation and usual equivalents

Question 13

MRD:

Answer 13

record of disability (MRD) has two main functions. It is used to help plan and coordinate care for the individual with MS, and to provide a standardized means of recording repeated clinical evaluations for research purposes. The MRD consists of five parts: demographic information, the Environmental Status Scale, the Disability Status Scale,

Question 14

Polio:

Answer 14

viral infection which attacks the anterior horn cells of the SC
Result = Muscular paralysis

Question 15

What three countries still have polio?

Answer 15

Afghanistan, Nigeria, and Pakistan

Question 16

Characteristics of polio

Answer 16

History of having polio
Positive neurological exam or EMG
Period of relative stability lasting at least 15 years
Development of new neurological weakness unexplained by other pathology

Question 17

Presentation of post-polio:

Answer 17

a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus

Question 18

Most common symptom of post polio:

Answer 18

The most common symptoms include slowly progressive muscle weakness, fatigue (both generalized and muscular), and a gradual decrease in the size of muscles (muscle atrophy).
Pain from joint degeneration and increasing skeletal deformities such as scoliosis (curvature of the spine) is common and may precede the weakness and muscle atrophy

Question 19

Etiology of PPS:

Answer 19

caused by ↑ metabolic demand made by the body by giant motor units (Jubelt & Agre, 2000; Smith & Kelly, 2001)

Question 20

What does polio destroy?

Answer 20

the anterior horn cells SO muscle fibers innervated by these anterior horn cells are orphaned

Question 21

What happens during recovery?

Answer 21

anterior horn cells not destroyed by the virus re-innervate some of the orphaned fibers creating GIANT MOTOR UNITS

Question 22

Signs and symptoms of PPS:

Answer 22

Fatigue: Beyond typical fatigue 
new weakness
pain
cold intolerance
decrease function

Question 23

Criteria for diagnosing PPS:

Answer 23

Prior paralytic poliomyelitis with evidence of motor neuron loss
A period of partial or complete functional recovery after acute paralytic poliomyelitis,
Slowly progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle and joint pain
Symptoms that persist for at least a year

Question 24

PPS PT goals:

Answer 24

Decrease workload on muscles
Avoid fatigue
Ambulate safely
Achieve an optimal level of functional independence
Educate patient & family members

Question 25

Aerobic frequency for PPS:

Answer 25

3 times a week

Question 26

Aerobic intensity for PPS:

Answer 26

Target HR low range: 60 -70 %

Question 27

Aerobic duration for PPS:

Answer 27

15- 30 minutes

Question 28

Type of aerobic activity for PPS:

Answer 28

Aerobic (walking, swimming, pool walking, stationary biking UBE but select based on strongest mm group)

Question 29

Strength for PPS:

Answer 29

60-80 % 1RM

Question 30

Strength frequency for PPS:

Answer 30

3-5 x per week

5 seconds contract time to 10 seconds rest

Question 31

Strength exercises for PPS:

Answer 31

concentric