Post-Polio Syndrome

Question 1

what is polio?

Answer 1

a viral infection which attacks the anterior horn cells of the brainstem and SC → muscular paralysis

• recovery ranged from quick return to baseline, temporary or permanent paralysis, or even death

Question 2

Polio S/S

Answer 2

1. most ppl who get infected with poliovirus will not have visible symptoms
2. about 1 out of 4 will have flu-like symptoms
   
   • sore throat
   • fever
   • tiredness
   • nausea
   • HA
   • stomach pain
   • **these symptoms usually last 2-5 days then go away on their own

Question 3

describe more serious symptoms of Polio

Answer 3

1. meningitis and encephalitis
2. paralysis or weakness in the arms, legs, or both (asymmetrical)
   
   • fasciculations
   • atrophy
   • decreased DTRs
3. bulbar and respiratory involvement
4. sensory system spared

Question 4

what is post-polio syndrome?

Answer 4

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

• characterized by acute onset of weakness, atrophy, and a myriad of other S/S

Question 5

Post-Polio Syndrome Etiology

Answer 5

1. PPS is though to be caused by increased metabolic demand made by the body by giant motor units
   
   • giant motor units were formed during the original virus infection (axonal sprouting)
2. Years of high use of these recovered but overly extended motor units add stress to the motor neurons
   
   • over time lose the ability to maintain the increased work demands

Question 6

risk factors for post-polio syndrome

Answer 6

1. (+) paralytic poliomyelitis
2. older age at onset (initial illness)
3. degree of initial recovery
4. greater physical activity in intervening years

Question 7

Post-Polio Syndrome Diagnosis

Answer 7

1. no definitive diagnostic test - diagnosis of exclusion
   
   • based primarily on symptoms (systemic, neurologic, MSK) and exclusion of any other neuromuscular diagnosis

Question 8

Diagnostic criteria for Post-Polio Syndrome

Answer 8

1. Prior paralytic poliomyelitis with evidence of motor neuron loss
2. A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neuromuscular function
3. Slowly progressive and persistent new muscle weakness or decreased endurance, with or w/o generalized fatigue, muscle atrophy, or muscle and joint pain
4. Symptoms that persist for at least a year

Question 9

Post-Polio Syndrome Characteristics

Answer 9

1. Most often, polio survivors start to experience gradual new weakening in muscles that were previously affected by the polio infection
   
   • slow progression, either steady or stepwise
     
     • stepwise: marked by periods of relative stability, interspersed with periods of decline

Question 10

Post-Polio Syndrome S/S

Answer 10

1. Progressive weakness, atrophy (Hallmark of PPS)
2. Fatigue
3. Pain
4. Cold Intolerance
5. Sleep disturbances, dysphonia or dysphagia, respiratory deficiency

Question 11

Common secondary complications of PPS S/S

Answer 11

1. Falls
2. Malnutrition, dehydration, and pneumonia
3. Chronic respiratory failure
4. Osteoporosis

Question 12

Post-Polio Syndrome Medical Management

Answer 12

1. Meds have not been found to be effective in pts with PPS
   
   • steroids, IVIg
2. Treatment focuses on:
   
   • lifestyle changes
   • healthy diet
   • exercise in moderation
   • positive pressure ventilation
   • treatment for sleep apnea
   • staying warm
   • focus on managing S/S to improve QOL

Question 13

Post-Polio Syndrome Prognosis

Answer 13

1. post-polio syndrome is rarely life-threatening, but the symptoms can significantly interfere with an individual’s ability to function independently
2. respiratory muscle weakness, for instance, can result in trouble with proper breathing, affecting daytime functions and sleep
3. weakness in swallowing muscles can result in aspiration of food and liquids into the lungs and lead to pneumonia

Question 14

PT management and goals for Post-Polio Syndrome

Answer 14

1. Strength and endurance training
2. Fatigue management
3. Pain management
4. Adaptive equipment recommendations (DME, AD, orthotics)
5. Achieve optimal level of functional independence
6. patient and family edu

Question 15

Post-polio syndrome and strengthening

Answer 15

1. Have to be careful - very easy to fatigue
   
   • individuals who undertake strengthening exercise should do so under carefully prescribed conditions to avoid overworking or fatiguing muscle groups and localized motor units
2. sub-maximal intensity with short duration exercise every other day helpful to increase QOL
3. short intervals of exercise with rest in between recover

Question 16

Exercise guidelines for Clinical stable PPS

Answer 16

1. Clinically stable PPS (subacute PPS - hx of prior decrease in strength with subsequent improvement)
   
   • with muscles at least 4/5 strength
     
     • 60-70% HRmax, 3 days/week 20-30 min - with pacing and while avoid fatigue
     • recommend swim, bikem walk, seated UE aerobics
     • aquatic therapy an excellent adjunct for this pt population
   • with muscles in 3/5 range, exercise from normal use of limbs may be sufficient
     
     • implement pacing and avoid fatigue

Question 17

Exercise guidelines for Clinically unstable PPS

Answer 17

1. acute PPS - recent onset of weakness)
   
   • goal shifts to instead preventing further weakness or improve status of limb function by energy conservation strategies
   • exercise generally contraindicated until pt takes time to rest and begin to see stabilization or improvement. At which point, non-fatiguing exercise program may be careful performed

Question 18

Energy conservation techniques PPS

Answer 18

1. a large focus of PPS rehab
2. consider how to modify a person’s lifestyle in order to prevent fatigue
3. pacing techniques
4. lifestyle modifications

Question 19

stretching considerations for PPS

Answer 19

1. stretching overworked muscles may not be indicated due to potential for increasing joint instability
2. any increase ROM must be supported by adequate muscle strength which may or may not be possible for this population
3. gentle stretching may be indicated as strategyto combat pain or cramping from occasional overuse

Question 20

Pain management PPS

Answer 20

• 3 major cause of pain in PPS
  
  1. Cramping (18% of pts)
     
     • gentle stretching after application of heat
  2. MSK (47% of pts)
     
     • due to overuse
     • tendinitis, bursitis, muscle strains, myofascial pain
     • meds → anti-inflammatory
  3. Biomechanical (77% of pts)
     
     • degenerative joint pain, LBP, nerve compression
     • posture edu
     • use and proper fitting of an AD
     • Orthotics