Post Polio and CRPS Flashcards
What can respiratory muscle weakness result in trouble with
proper breathing, affecting daytime functions and sleep
Weakness in swallowing can result in
aspiration of food and liquids into the lungs and lead to pneumonia
True or False: Post-Polio Syndrome is life threatening
False, symptoms can significantly interfere with a persons independent function
What does the diagnosis of PPS depend on
Clinical Information
Criteria to be diagnosed with PPS
- Evidence of motor neuron loss
- A period of partial or complete functional recovery followed by by an interval (usually 15 years or more) of stable neuromuscular function.
- Slowly progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle and joint pain
- Symptoms that persist for at least a year.
Treatment of PPS focuses on…
- Lifestyle changes
- Healthy diet
- Exercise in moderation
- Positive pressure ventilation
- Treatment for sleep apnea
- Staying warm
- Focus on managing signs & symptoms to Improve QOL
PT goals
- Decrease workload on muscles
- Avoid fatigue
- Ambulate safely
- Achieve an optimal level of functional independence
- Educate patient & family members
What are some general aspects of PPS management?
- Motor
- Postural
- Pain
- Fatigue
- Work Load
- Psychosocial Considerations
Lifestyle modification is VERY difficult for patients with PPS because…
- the pt survived polio
- mobility = freedom
- independence is something they have fought for
- slowing down may be seen as “giving in”
What are PT’s goals for lifestyle modification?
- ↓physical & emotional stress
- joint protection
- modification of home & work environment
- use of mobility aids to ↓fatigue & preserve function
- energy conservation
- decrease weight loss
What is energy conservation?
a means of modifying a person’s lifestyle in order to prevent fatigue
What are some examples of energy conservation techniques?
- ADs, scooter, etc
- one trip vs 2 or 3 using a cart
- sit instead of stand to perform a task
- frequent breaks/naps
- breathing exercises
True or False: When strengthening muscles in post-polio patients you want to induce muscle fatigue.
FALSE. Overdoing a workout can result in the pt needing several days to regain strength.
How is aquatic therapy beneficial in patients with PPS?
improves flexibility, strength, and cardiorespiratory fitness
General guidelines for exercise in pts with PPS
- short intervals with rest in btwn to recover
- submax, short duration every other day (helps ↑ QOL)
Aerobic FITT Principles
3x/wk
60-70% target HR
pre-test, 2 mo, 4 mo
Strength FITT Principles
3-5x/wk 60-80% 1RM 5 sec contract/10 sec rest concentric exercise pre-test, 1 mo, 3 mo, 6 mo, then yearly
True or False: Stretching overworked mm may not be indicated in this population.
TRUE: d/t potential for increasing joint instability
True or False: Any ↑ ROM must be supported by adequate mm strength which may not be possible for this population.
TRUE
True or False: Gentle stretching may be indicated as a strategy to combat pain or cramping from occasional overuse.
TRUE
Pain management for cramping
gentle stretching after application of heat
Pain management for musculoskeletal pain due to overuse
depending on structure involved
- tendon, bursa, fascia, muscle
- meds, modalities, mvmt pattern change
Pain management for biomechanical pain
- Posture education
- Use of an AD
- Orthotics
- Orthoses
Education of family
More exercise is NOT better; less is best!
Polio and Post-Polio Syndrome History
- Polio is a viral infection which attacks the anterior horn cells of the spinal cord
- Polio epidemic in US from 1910-1959
- 20-40% survivors of Polio experience fatigue, new muscle weakness, and loss of functional abilities
- Post-Polio Syndrome was first diagnosed and recorded as a clinical entity in 1972
Global Issue of Polio
- Polio vaccine introduced in 1955
- WHO reports polio cases decreasing 99% from 1988 to 2010
Countries that still have polio endemic as of 2012
- Afghanistan
- Nigeria
- Pakistan
Post-Polio Syndrome Criteria
- History of polio
- Positive neurological exam
- Development of new neurological weakness unexplained by other pathology
- Period of relative stability lasting at least 15 years
Post-Polio Presentation
- Slowly progressing muscle weakness
- Fatigue
- Muscle atrophy
- Pain from joint degeneration
- Skeletal deformities such as scoliosis
Post-Polio Etiology
- PPS is caused by increased metabolic demand made by the body by giant motor units
- Giant motor units were formed during original Polio
PPS Signs and Symptoms
- Fatigue
- New Weakness
- Pain
- Cold Intolerance
- Decreased Function
T or F: Men are affected by CRPS more than woman
False
Risk factors for CRPS
Women>Men Smoking Ages 30-55 (40 is avg. age) Distal Radius Fx (Median nerve damage) 500 mg of Vitamin C daily Hx of Peripheral Nerve Damage Psychological issues/stress and coping problems Inflammatory Disorders