Post-Polio

Question 1

what is poliomyelitis

Answer 1

viral infxn which attack anterior horn cells of brainstem and SC which leads to muscular paralysis

Question 2

polio SxS seen

Answer 2

flu-like symptoms
meningitis / encephalitis
paralysis / weakness in arms, legs or both ASYMMETRICAL
LMN SxS
bulbar and respiratory involvement

Question 3

are polio SxS common?

Answer 3

no, majority of pt’s will not have visible symptoms

Question 4

what is spared with a polio dx

Answer 4

sensory system
bowel/bladder
sexual dysfxn

Question 5

post polio syndrome

Answer 5

condition that affects survivors of polio years after recovery from an initial acute attack of the poliomyelitis virus

Question 6

what is post polio syndrome characterized by

Answer 6

acute onset of weakness, atrophy and a myriad of other SxS

Question 7

how is post polio sydrome caused

Answer 7

giant motor units were formed after initial polio onset and now have a high demand of work - added stress

Question 8

risk factors for PPS

Answer 8

+ paralytic poliomyelitis
older age at onset
degree of initial recovery
greater physical activity in intervening years

Question 9

PPS dx

Answer 9

dx of exclusion

Question 10

PPS diagnositc criteria

Answer 10

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

Question 11

PPS characteristics

Answer 11

experience gradual new weakening in muscles that were previously affected by polio

Question 12

progression of PPS?

Answer 12

slow, either steady or stepwise

Question 13

what is stepwise progression

Answer 13

marked by periods of relative stability, interspersed with periods of decline

Question 14

PPS SxS

Answer 14

progressive weakness - atrophy**
fatigue
pain - myalgia, cramping, jt pain, etc.
cold intolerance (bulbar)
sleep disorders
dysphonia, dysphagia
respiratory deficiency

Question 15

secondary complications of PPS

Answer 15

falls
malnutrition & dehydration
pneumonia
chronic respiratory failure
osteoporosis

Question 16

medical management for PPS

Answer 16

not effective: steroids, IVIG
treatment focuses on: lifestyle changes, healthy diet, exercise in moderation, positive pressure vent, sleep apnea, staying warm, improve QOL

Question 17

prognosis for PPS

Answer 17

rarely life threatening but can interfere with independent function

mainly respiratory dysfxn increases morbidity

Question 18

PT management and goals

Answer 18

strength and endurance training
fatigue, pain managment
AD recs
achieve optimal level of fxn
pt & family ed

Question 19

what does strengthening look like for post-polio pt’s

Answer 19

avoid fatigue
sub max intensity with short duration exercise every other day
short intervals, increased rest time

Question 20

for pts with clinical stable PPS with muscles at least 4/5 what should you do

Answer 20

60-70% HRmax, 3 days/wk, 20-30min with pacing and avoiding fatigue

Question 21

what type of aerobic activity if muscles are 4/5

Answer 21

swim, bike, walk, seated UE aerobics

Question 22

for pts with clinical stable PPS with muscles at least 3/5 what should you do

Answer 22

exercise from normal use of limbs
pace and avoid fatigue

Question 23

for clinically unstable PPS (acute PPS - recent onset of weakness)

Answer 23

energy conservation
typically contraindicated until pt rests & see stabilization & improvement – then can do non-fatiguing exercise program

Question 24

stretching considerations for PPS

Answer 24

be cautious due to jt instability

any increase ROM must be supported by muscle strength

Question 25

gentle stretching may help with what

Answer 25

pain or cramping

Question 26

3 major causes of pain in PPS

Answer 26

cramping
MSK related
biomechanical