Post Polio Syndrome

Question 1

Poliomyelitis

Answer 1

-enterovirus (no in US except for vaccination)
-mostly asymptomatic limited to gut

Minor diesease
-flu like

Major disease
-CNS invasion (anterior horn)
-<1% paralysis and <5% invaded CNS w/ no paralysis

S/s: muscle atrophy and weakness via anterior horn

Question 2

Post-Polio Syndrome Diagnostic Criteria

Answer 2

1. Hx Paralytic poliomyelitis (no pattern)
2. Partial or complete recovery for 15 yrs
3. Onset of persistent muscle weakness
   -motor deficits only
   -giant motor units
   -spinal tap acutely
4. Symptoms for >1yr
5. Exclude other cases

Question 3

Post-Polio Syndrome Pathophysiology

Answer 3

-Onset 30-50 years after
-Lower motor neuron syndrome (anterior horn cells) that degenerates terminal axonal sprout
-inability to maintain inc metabolic demand
-May have a new neurologic problem unrelated polio (new weakness hallmark)

Question 4

Post-Polio Syndrome S/s

Answer 4

-Joint pain w/ cold intolerance
-fatigue
-Muscle atrophy
-Breathing issues (iron lung)
-acute pain
-chronic pain
-require energy conservation
-impact developmental growth

Question 5

Natural History of Polio

Answer 5

-exposure through GI tract
-virtually eradicated by vaccines
-recent resurgence
-lasted weeks to years
->15 years
~50% will have post polio sequelae
~ Have pos polio syndrome

Question 6

Compensatory Mechnanisms

Answer 6

-use of weak muscles at high levels
-substitution of strong muscles
-use of ligamens for stability causing hypermobility
-large motor units

Question 7

Muscle Power vs. % Residual Motor Cells

Answer 7

5 or >40%
4 or 10-40%
3 or 8-10%
2 or 3-5%
1 or 2-3%

Question 8

Polio Treatment Goals

Answer 8

-Self management
-MSK goals (pain, workload, posture/gait, function)

Question 9

Polio Treatments

Answer 9

-Patient Education
-Pain reduction (Cold/heat, Magnet therapy, TENS, dec spasms, edema, mobilize joints)
-Energy conservation
-Exercise considerations

Question 10

Magnet Therapy

Answer 10

-pain management (trigger points) for PPS
-most effective when taped on skin

Considerations:
-allergies
-magnets must be strong enough
-education essential

Question 11

Participation Limitation

Answer 11

-working
-fulfill personal
-hobbies

Question 12

Functional Limitations

Answer 12

-functional loss
-falling
-mechanism of falls
-recent functional loss
-gait analysis
-ADLs

Question 13

Impairments

Answer 13

-strength (atrophy or pseudohypertrophy)
-power vs. endurance
-ROM
-respiratory
-fatigue

Question 14

Energy Conservation

Answer 14

-pacing of activities with rest
-weight control or reduction
-orthoses
-AD

Question 15

Exercises

Answer 15

-Start at ~50%
-Aquatic therapy
-Beware of muscle overuse signs
-can worsen s/s
-not for weight reduction
-look for ways to unweight
-target specific muscles
-muscles >3 should not be exercises

Question 16

Signs of Muscle Overuse

Answer 16

-cramping, twiching, progressive weakness and atrophy