MS and Polio/Post polio Flashcards
MS
A chronic progressive demyelinating disease of the CNS affecting mostly young adults
Etiology of MS:
unknown, most likely viral, autoimmune (active immune responses detected in CNS)
Variable symptoms:
lesions scattered in time and place; lesions common in pyramidal tract, dorsal columns and periventricular areas of the cerebrum, cerebellum peduncles
Relapsing-Remitting MS (RRMS):
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
Primary Progressive MS (PPMS):
Characterized by disease progression from onset without plateaus or remissions or with occasional plateaus and temporary minor improvements
Secondary Progressive MS (SPMS):
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
Progressive Relapsing MS (PRMS):
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.
Signs and Symptoms:
hypoesthesia, paresthesias pain visual symptoms weakness or paralysis urinary incontinence constipation, diarrhea, incontinence
Modified Fatigue Impact Scale
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
EDSS:
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
EDSS score 1.0-4.5:
refer to patients who are fully ambulatory
EDSS score 5.0-9.5:
defined by the impairment to ambulation and usual equivalents
MRD:
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,
Polio:
viral infection which attacks the anterior horn cells of the SC
Result = Muscular paralysis
What three countries still have polio?
Afghanistan, Nigeria, and Pakistan
Characteristics of polio
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
Presentation of post-polio:
a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus
Most common symptom of post polio:
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
Etiology of PPS:
caused by ↑ metabolic demand made by the body by giant motor units (Jubelt & Agre, 2000; Smith & Kelly, 2001)
What does polio destroy?
the anterior horn cells SO muscle fibers innervated by these anterior horn cells are orphaned
What happens during recovery?
anterior horn cells not destroyed by the virus re-innervate some of the orphaned fibers creating GIANT MOTOR UNITS
Signs and symptoms of PPS:
Fatigue: Beyond typical fatigue new weakness pain cold intolerance decrease function
Criteria for diagnosing PPS:
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
PPS PT goals:
Decrease workload on muscles Avoid fatigue Ambulate safely Achieve an optimal level of functional independence Educate patient & family members
Aerobic frequency for PPS:
3 times a week
Aerobic intensity for PPS:
Target HR low range: 60 -70 %
Aerobic duration for PPS:
15- 30 minutes
Type of aerobic activity for PPS:
Aerobic (walking, swimming, pool walking, stationary biking UBE but select based on strongest mm group)
Strength for PPS:
60-80 % 1RM
Strength frequency for PPS:
3-5 x per week
5 seconds contract time to 10 seconds rest
Strength exercises for PPS:
concentric
