Polio

Question 1

Pathogenesis

Answer 1

highly contagious virus
oral route of transmission (oral-fecal)
replicates in lymphatic tissue of GI tract
spreads throughout body
asymptomatic primary transient viremia (minor)

Question 2

3 patterns

Answer 2

asymptomatic- majority
non-paralytic infection- develop flu-like symptoms, small fraction develop CNS symptoms; stiff neck, fever, N&V, 4-8%
paralytic infection- .1% infected ppl

Question 3

Spread of polio

Answer 3

possibly by crossing blood/brain barrier
possibly axonal transport from ms to SC to brain
leads to destruction of anterior horn cells and neurons in thalamus, brainstem, motor cortex

Question 4

Clinical presentation

Answer 4

motor neurons in SC affected
LMN in presentation
1-many muscles, tetraplegia, resp failure
proximal>distal more affected
LE>UE
asymmetrical
reflexes absent or decreased
sensory normal

Question 5

PT management

Answer 5

acute stage- ROM, positioning, pain relief; ms pain, cramps
rehab stage- strengthening what ms left, orthotics, functional mobility training (poor MMT but have adapted), decrease consequences

Question 6

Prognosis

Answer 6

<10% die with modern tx
no way to predict recovery potential
regain strength in partially denervated ms up to year later

Question 7

Vaccines

Answer 7

Salk vaccine- 2 IM injections of inactive virus at 1 month, booster at 6 mo, Now called IPV
Sabine vaccine- live virus given orally at 2,4, and 18 months, booster at 4-6 yo; now called OPV; cheaper
IPV preferred d/t slight rik of getting polio from live vaccine

Question 8

1-2 does of booster if:

Answer 8

planning of traveling to foreign country with high polio
lab worker handles polio
health are worker who tx pts who have polio
if survive initial attack of polio should still be immunized

Question 9

Post-polio syndrome Prevalence

Answer 9

300,000 polio survivors in US with paralytic form; of those, 1/4 to 1/2 have new health problems

Question 10

S/S of PPS

Answer 10

fatigue and decreased endurance
weakness in ms both affected from original polio and new
ms and jt pain
breathing difficulties
intolerance to cold
fasiculations
symptoms appear to progress slowly

Question 11

risk factors for PPS

Answer 11

age of original polio dx (older more likely)

extent of initial recovery (better recovery more likely)

Question 12

Dx of PPS

Answer 12

prior episode of Polio
hx of >15 yrs stable neuro function
gradual onset of symptoms
exclusion of other conditions causing similar symptoms

Question 13

Etiology of PPS

Answer 13

compensatory mechanism (motor unit enlargement) is overwhelmed; working motor neurons innervate ms fibers of wiped out ant horn cells and get overwhelmed
greater metabolic demand leads to failure of neurons transmission
effects of aging (loss of motor units)

Question 14

Primary Functional Limitations PPS

Answer 14

inability to: climb stairs, perform WC transfers, dress I, walk

Question 15

Energy conservation

Answer 15

prioritize activities of day so can do what you need to first

Question 16

Exercise Guidelines

Answer 16

Normal MMT: no restrictions
4/5 to 5/5: increase STR to promote fitness, prevent overuse, 60-80% max HR, 15-30 min
3/5-4/5: some atrophy, 60% max HR if 4/5, exercise from norm use of limbs sufficient, avoid fatigue if 3/5
2/5-4/5: atrophy present, prevent further weakness, energy conservation, exercise contraindicated, non-fatiguing exercise if STR increases with rest, carefully
0/5-2/5: energy conservation and jt protection, WC or scooter use, exercise contraindicated