PNS - Poliomyelitis Flashcards
Polio attacks what cells and this leads to
Attacks anterior horn cells - a lot of muscle weakness
Have large motor units (one nerve takes over the job that other neurons used to do)- lack of functional neurons
If you are treating someone with post polio you would you compensate or accommodation
Both
People with polio usually have difficulty with what type of motion
They usually have difficulty with find specific motion, they do not have much segmental control due to the lack of functional neurons
S/S of polio
Early S/S:
High fever, HA, stiff neck & back, asymmetrical weakness, sensitivity to touch, paresthesias, difficulty swallowing, irritability, constipation, or difficulty urinating
Paralysis develops 1-10 days post early sx begin, then progresses for 2-3 days, and is usually complete by the time pt is afebrile
Types of Polio (3)
3 Different Types:
- 90% no symptoms
- 9% non-paralytic
- 1% paralytic (Spinal, Bulbar, or Bulbospinal Paralytic Polio)
Paralytic Spinal Polio attacks, progression and symptoms
Virus attacks the anterior horn cells of the SC
Extent of involvement depends on the region affected – cervical, thoracic, lumbar
Rapid progression (2-4 days) of asymmetrical weakness & atrophy, proximal > distal, LE>UE
Flaccid paralysis & hyporeflexia
Sensation is preserved
Paralytic Bulbar Polio involves
Typical CN involvement:
- Glossopharyngeal n. -> dysarthria, dysphagia
- Vagus n. ->parasympathetic system
- Accessory n. -> upper neck movement
- Trigeminal & Facial n. -> facial weakness, difficulty w/ mastication
- Extraocular muscles typically spared
Paralytic Bulbospinal Polio involves
Both spinal & bulbar symptoms:
- Upper C/S involvement (C3-5 diaphragm)
- Weakness/paralysis of muscles of extremities
Diagnosis of Polio
Presenting signs & symptoms
Lab tests for the presence of poliovirus from stool sample or a swab of the pharynx
Antibodies are found in the blood during the early phase of infection
CSF with elevated WBC (primarily lymphocytes) and a mildly elevated protein level
Recovery and polio
Restoration of neurons that were not irreversibly damaged – w/in 4-6 wks
Collateral sprouting from neighboring, surviving axons
- Compensation via hypertrophy of intact motor units
- “Giant Motor Units”
50% w/ spinal polio recover fully, 25% w/ mild disability, 25% w/ severe disability
Post-Polio Syndrome is due to
Long term stress to system that has been compromised overtime
Post-Polio Syndrome is
New, gradual onset of progressive pain, weakness, & fatigue:
-Caused by long term overstress of the musculoskeletal system due to compensation
- Overwork of giant motor units that were formed via collateral sprouting
- Not an infectious process, PPS pts do not shed the poliovirus
Rehab and Post-Polio Syndrome
Strengthen within their range, do not want to stress a symptoms that is already stressed
Energy conservation & pacing
Strengthening of muscle groups not affected or least affected by polio
Aerobic & endurance training more beneficial than strength training:
- Avoid heavy or intense resistive exercises to prevent overwork of already weakened muscles
- Recommendation for adaptive equipment, assistive devices, and bracing for support
Diabetic Neuropathy is
Common complication of DM
Is a metabolic abnormality of the nerve resulting in nerve fiber loss and atrophy
Progressive deterioration of motor & sensory fn
Distal, symmetrical loss of sensation & proprioception/vibration
“Stocking Glove” Distribution
Diabetic Neuropathy risk factors
Poor glycemic control Hyperlipidemia HTN Obesity Age (> 40) Cigarette smoking
Diabetic Neuropathy most common findings
Distal paraesthesia & dysesthesia
Loss of vibration sense
Diminished DTRs
Why should people with diabetic neuropathy do daily skin checks
At high risk for ulcers and injuries
Neuropathy is implicated to cause 50-75% of DM amputations
Do people with diabetic neuropathy have the same symptoms
Anyone of the peripheral nerves can be affected so everyone can experience slightly different symptoms
Diabetic Neuropathy affects
All peripheral nerves: pain fibers, motor neurons, autonomic nerves
What is Autonomic Neuropathy:
Changes in digestion, B/B function, sexual response, respiration, cardiac function
-Orthostatic hypotension is most common
What is Focal Neuropathy and which on is most common:
CN III neuropathy most common
Periorbital pain, diplopia, loss of all eye muscles function except lateral rectus & superior obliques, loss of ability to open eyelid & constrict the pupil
CN IV & VI involvement is unusual
