Post-Polio Flashcards
what is poliomyelitis
viral infxn which attack anterior horn cells of brainstem and SC which leads to muscular paralysis
polio SxS seen
flu-like symptoms
meningitis / encephalitis
paralysis / weakness in arms, legs or both ASYMMETRICAL
LMN SxS
bulbar and respiratory involvement
are polio SxS common?
no, majority of pt’s will not have visible symptoms
what is spared with a polio dx
sensory system
bowel/bladder
sexual dysfxn
post polio syndrome
condition that affects survivors of polio years after recovery from an initial acute attack of the poliomyelitis virus
what is post polio syndrome characterized by
acute onset of weakness, atrophy and a myriad of other SxS
how is post polio sydrome caused
giant motor units were formed after initial polio onset and now have a high demand of work - added stress
risk factors for PPS
+ paralytic poliomyelitis
older age at onset
degree of initial recovery
greater physical activity in intervening years
PPS dx
dx of exclusion
PPS diagnositc criteria
prior paralytic poliomyelitis
period of partial or complete functional recovery
slowly progressive and persistent new muscle weakness or decreased endurance
symptoms persist for at least a year
PPS characteristics
experience gradual new weakening in muscles that were previously affected by polio
progression of PPS?
slow, either steady or stepwise
what is stepwise progression
marked by periods of relative stability, interspersed with periods of decline
PPS SxS
progressive weakness - atrophy**
fatigue
pain - myalgia, cramping, jt pain, etc.
cold intolerance (bulbar)
sleep disorders
dysphonia, dysphagia
respiratory deficiency
secondary complications of PPS
falls
malnutrition & dehydration
pneumonia
chronic respiratory failure
osteoporosis
medical management for PPS
not effective: steroids, IVIG
treatment focuses on: lifestyle changes, healthy diet, exercise in moderation, positive pressure vent, sleep apnea, staying warm, improve QOL
prognosis for PPS
rarely life threatening but can interfere with independent function
mainly respiratory dysfxn increases morbidity
PT management and goals
strength and endurance training
fatigue, pain managment
AD recs
achieve optimal level of fxn
pt & family ed
what does strengthening look like for post-polio pt’s
avoid fatigue
sub max intensity with short duration exercise every other day
short intervals, increased rest time
for pts with clinical stable PPS with muscles at least 4/5 what should you do
60-70% HRmax, 3 days/wk, 20-30min with pacing and avoiding fatigue
what type of aerobic activity if muscles are 4/5
swim, bike, walk, seated UE aerobics
for pts with clinical stable PPS with muscles at least 3/5 what should you do
exercise from normal use of limbs
pace and avoid fatigue
for clinically unstable PPS (acute PPS - recent onset of weakness)
energy conservation
typically contraindicated until pt rests & see stabilization & improvement – then can do non-fatiguing exercise program
stretching considerations for PPS
be cautious due to jt instability
any increase ROM must be supported by muscle strength
gentle stretching may help with what
pain or cramping
3 major causes of pain in PPS
cramping
MSK related
biomechanical
