POST POLIO SYNDROME Flashcards
Acute poliomyelitis:
exposure through ____
polio for 95% people was ____
for less than 5%, invaded CNS with ____, but no paralysis
acute polio:
GI tract (ingested droplets)
most people: cough, fever, aches benign viral illness
<5%, invaded CNS, positive spinal tap, no paralysis (very small amount = paralysis)
for 1-2% of people with acute poliomyelitis,
patients would have variable degree of ____
clinical paralysis
*limbs, trunk, bulbar (CNs), diaphragm, or both
no pattern
has polio been eradicated worldwide?
No
before 12/22/24, last reported case in US 2005, 1998
Nigeria and India are polio free
Afghanistan and Pakistan have wild polio
Why will a patient with polio experience scoliosis, LLD, or contractures?
bones grow quicker than mm, and respond to mm use (Wolf’s law)
weak limb = not grow as long or big
risk for contracture esp during growth spurts
For most people after polio, period of recovery lasts ____ and is affected in severity by ____
weeks to years
varied with severity and age of onset
*complicated by developmental growth, reconstructive Sx
After period of recovery, how long is period of neurological stability after paralytic polio?
15 years +
lasts forever with 50% of those with paralytic polio
For 20-50% of those with paralytic polio, the period of neurological stability ends with _____
post-polio syndrome symptoms
*new onset of weakness
What marks the onset of post-polio syndrome? PPS
30-50 years after polio
*new weakness = hallmark sign
also: cold intolerance, breathing difficulties, swallowing difficulties, excess fatigue, mm atrophy, mm/joint pain, sleep disturbances
what things are needed to diagnose PPS?
- history of polio (spinal tap acutely, giant MUs by EMG if history is vague or no MMT weakness)
- no pattern of weakness
- motor deficits only
- period of neuro recovery, then stability lasting 15 years+
- no other medical reason (Dx of exclusion)
Who is at higher risk for PPS?
- people with more severe permanent impairments
- women
- length of time since acute illness
Is the FIM needed for PPS patients?
No, most are functioning mod or complete independently. use these instead:
*6 minute WT
*Walk-12 (new measure)
*balance measures
Is MMT or HHD a good way to determine strength in PPS?
Not really, unable to detect small declines (24% strength decrease in quads)
also, power production is different than endurance/functional use
3 compensations used in PPS
- weak mm at high capacity
- strong mm substituted with increased energy expenditure
- ligaments used for stability (lock knee, Ys, resulting in hypermobility)
Does a person with PPS with 5/5 MMT have full strength?
NO (40% or higher remaining residual motor cells –> not that much)
If a person w/ PPS has a 4/5 MMT, how many residual motor cells remain?
10-40%
(they can have up to 60% loss of strength before we grade a 4/5!)
what percent of residual motor cells for MMT 3/5 with PPS
8-10%
If you biopsied a pseudohypertrophic mm with a person with PPS, what would you see?
enlarged sarcomeres with fat cells
*big mm does not = strength!
you can see atrophy or pseudohypertrophy
For PPS:
diffuse pain is usually ____
localized pain is usually ____
diffuse: mm (deep achy)
diffuse pain + fasciculations = overuse
need to palpate mm in MMT!
localized: joint/ligaments
Even in people with PPS with no involvement in their UEs, what was weak?
grip strength compared to norms
besides looking at strength, what is also important to assess with PPS?
lung capacity
*impaired vital capacity, sleep anpea, weak diaphragm, accessory mm use
*a rolling walker can help with accessory mm use, similar to putting hands on hips after running to breathe easier
Tor F:
patients with PPS will experience fatigue faster since mm are being used at higher % of mm strength
TRUE
physical strain could be equal to non-PPS, but % of max force used will cause earlier fatigue
What is one symptom common in PPS?
cold intolerance (can increase weakness/cause achy pain)
Can active magnets help decrease mm or arthritic pain?
yes (Gauss level high 300-500 or higher if severe pain)
ambulatory ppl with PPS and weak ____ were 2x likely to have LBP or SI pain
plantar flexors
signs of muscle overuse in PPS
Muscle cramping, at rest or during activity
Muscle twitching (fasciculatons from new denervation)
Progressive weakness
Progressive atrophy
is exercise a good way to reduce weight in people with PPS?
NO
most polio survivors have weakness in big lower limb mm
need light intensity, not loading already overworked mm/joints, and not worsening pain/weakness/fatigue
muscles testing at ___ should not be exercised (gentle stretching, protected during exercise)
3 or below
muscles testing ___ can be exercised cautiously
3+ or 4
muscles testing ___ can be exercised mod-vig, if no signs of overuse present
4+ or 5
What are potentially unsafe exercise programs for PPS?
stationary bike
walk/job programs, ellipticals, stairs
circuit training
free weights
aerobic, kick boxing
Is whole body vibration good for PPS
YES!
groups that started higher intensity protocol first improved in gait speed
no adverse events
improved pain severity and pain interference
