Polio and Post-Polio

Question 1

discuss poliomyelitis

Answer 1

poliovirus affects the ant horn and brainstem via oral-fecal route

infantile paralysis - rare but permanent

flaccid assym weakness and atrophy of proximal LE

6 mo - 3 yo
MALES
contaminated food, water

Question 2

pathophysio of polio

Answer 2

incubation: 5-35 days

replicates at GI or nasopharynx

resistant to cold
inactivated by: heat, chlorine, UV and formaldehyde

Question 3

phases of polio in pathophysiology

Answer 3

alimentary: enters oral or nasal

lymphatic: GI tract then lymph ndoes

viremic: goes to blood

neural/neurologic: fever then paralysis

Question 4

forms of polio

Answer 4

inapparent: 90-95%
- usual fever or no sx

apparent: 5-10%
- abortive
- non-paralytic
- paralytic
- immunocompromised

Question 5

discuss abortive polio

Answer 5

5% of patients

usually just flu like sx and no neurologic signs

complete recovery

BUT has POTENTIAL to be paralytic

Question 6

discuss non-paralytic polio

Answer 6

1% of patients

more intense abortive polio

nuchal and spinal rigidity

Question 7

discuss paralytic polio

Answer 7

0.1% of patients

spinal: MC

bulbar: brainstem

polioencephalitis: brain

Question 8

discuss spinal paralytic polio

Answer 8

ant horn cell

assym flaccid paralysis of 1 leg then 1 UE; proximal to distal

muscle pain

intact sensation

Question 9

discuss bulbar polio

Answer 9

respiratory difficulty, EOMs, facial and masticatory affected

nasal twang
diff swallow, coughing
accumulation of secretions
deviation of palate, uvula and tongue
cardiorespi probs
vocal cord paralysis
rope sign

Question 10

discuss polio encephalitis

Answer 10

becomes CNS lesion

seizures, coma, spastic paralysis

cognitive problem, tremors

Question 11

prodromal stage of polio

Answer 11

typical flu like sx

Question 12

acute stage of polio

Answer 12

3-6 wks from onset

muscle tenderness - press calf; seen in abortive/paralytic

sister kenny bath

NO MASSAGE

Question 13

covalescent stage of polio

Answer 13

3 mo.

spinal: hip and knee flexion contracture and equinus deformity

bulbar: tube feeding, vent

spinobulbar: both

post encephalitic: mental disturbance, coma, meningitis, facial paralysis

Question 14

recovery stage of polio

Answer 14

up to 2 yrs: can strengthen pa

p 2 yrs: maintain

Question 15

discuss post-polio syndrome

Answer 15

confirmed prior paralytic polio then stable for 20 yrs or more

Question 16

ssx of post-polio syndrome

Answer 16

fatigue

weakness and atrophy in previously affected

weight gait

gait prob

diff in breathing

cold sensitivity

swallowing prob

Question 17

dx of polio

Answer 17

CSF, stool, throat

inc yung mga IG

Question 18

common muscles affected in polio

Answer 18

shoulder

elbow ext

back

thumb

hip muscles

knee ext

ankle DF

Question 19

common contractures in polio

Answer 19

hip flexion-abd contracture

knee flexion contracture c callus and valgus

ankle varus and valgus or equinus

Question 20

optimum limb pos in polio

Answer 20

slight hip flexion

knee 5° flexion

foot neutral

Question 21

discuss inc of strength in polio

Answer 21

2-10 mins 3x a day

1 mo: 2 grades
6 mo: 1 grade
p 2 yrs: maintain

Question 22

polio vaccine is given when

Answer 22

2 mo
4 mo
6-18 mo

4-6 yo: booster

Question 23

prognosis of polio

Answer 23

bulbar poorest then spinal

inapparent or abortive - goods sila