polio Flashcards
what is poiio
Polio is a viral infection which attacks the anterior horn cells of the brainstem and SC muscular paralysis
Recovery ranged from quick return to baseline, temporary or permanent paralysis, or even death
most ppl infected with polio will
not have any visible s/s
polio s/s
A smaller proportion of peoplewith poliovirus infectionwill develop other, more serious symptomsthat affect the brain and spinal cord:
Meningitisand encephalitis
Paralysis or weakness in the arms, legs, or both (ASYMMETRICAL)
Fasciculations, atrophy, decreased DTRs
Bulbar and respiratory involvement
SENSORY SPARED
polio vax developed
1955
PPS is a condition that
affects survivors of polio years after recovery from an initial acute attack of the poliomyelitis virus.
Characterized by acute onset of weakness, atrophy, and a myriad of other signs & symptoms
PPS etiology
PPS is thought to be caused by ↑ metabolic demand made by the body by giant motor units
Giant motor units were formed during the original viral infection (axonal sprouting)
yrs of high use -> motr units lose ability to meet work demands
risk factors for PPS
+ paralytic poliomyelitis
Older age at onset (initial illness)
Degree of initial recovery
Greater physical activity in intervening years
PPS dx
No definitive diagnostic test = DIAGNOSIS OF EXCLUSION
PPS dx criteria
prior paralytic poliomyelitis w/ motor neuron loss
A period of partial or complete functional recovery
Slowly progressive and persistent new muscle weakness or decreased endurance
s/s persist for at least a yr
PPS characteristics
Most often, polio survivors start to experience gradual new weakening in muscles that were previously affected by the polio infection
Slow progression, either steady or stepwise
Stepwise: marked by periods of relative stability, interspersed with periods of decline.
hallmark sign of PPS
weakness atrophy of mm previously affected
yrs of inc metabolic efford = break down in giant motor cells
PPS s/s
weakness atrophy
Fatigue
Beyond typical fatigue, and typically occurs at same time each day
Can be accompanied by signs of autonomic distress: sweating or headaches
Described as “Hitting the polio wall”
pain
Cold intolerance
Result of sympathetic nervous system involvement (bulbar)
Sleep disorders; dysphonia or dysphagia; respiratory deficiency
PPS common secondary complications
falls
malnutrition
pneumonia
chronic respiratory failure
OA
meds found to be effective in PPS pt
steriods and IVIG
PPS prognosis
Post-polio syndrome is rarely life-threatening, but the symptoms can significantly interfere with an individual’s ability to function independently.
PPS symptoms can secondarily affect what
Respiratory muscle weakness, can result in trouble with proper breathing, affecting daytime functions and sleep.
Weakness in swallowing muscles can result in aspiration of food and liquids into the lungs and lead to pneumonia.
PPS and strengthening
Have to be careful – VERY easy to fatigue
avoid overworking or fatiguing muscle groups and localized motor units
Patients must be WELL EDUCATED in not overdoing workouts & to avoid pain and fatigue
If it takes several days to regain strength – they have overdone it!
PPS and stengthening intensity
Sub-maximal intensity with short-duration exercise every other day helpful to ↑ QOL
Short intervals of exercise with rest in between to recover
more exercise not better
less is best
energy conservation techniques PPS
A large focus of PPS rehabilitation
Consider how to modifying a person’s lifestyle in order to prevent fatigue
Pacing techniques
Lifestyle modifications
stretching considerations
Stretching overworked muscles may not be indicated due to potential for increasing joint instability
Any inc ROM must be supported by adequate muscle strength which may not be possible for this population
Gentle stretching may be indicated as a strategy to combat pain or cramping from occasional overuse
3 maj causes of pain in pps
Cramping (18% of patients):
- Gentle stretching after application of heat
Musculoskeletal (47% of patients):
- over use
- itis
- meds
biomechanical
- degen
- posture
