post polio syndrome: examination , evaluation and interventions

Question 1

how was acute poliomyelitis exposed

Answer 1

thru the GI tract (coughing , breathing it in)

Question 2

what kind of virus was polio

Answer 2

benign viral illness

Question 3

for <5% it invaded the ___ with a ___ spinal tap bu no clinical ___

Answer 3

CNS
+
paralysis

Question 4

what cells and neurons does acute polio affect

Answer 4

anterior horn cell
lower motor neuron cells (final pathway to mm)

Question 5

for 1-2% of people with polio it causes a variable degress of what ?

Answer 5

paralysis to the limbs/trunk , swollowing /breathing or both

Question 6

when were vaccine made that virtually eradicated polio

Answer 6

late 1950

Question 7

when did india and nigeria deem polio free

Answer 7

2013
2019

deemed polio free mean no new cases of polio for 3 whole years

Question 8

who will continue to have wild polio

Answer 8

afghanistan and pakistan

Question 9

what kind of countries are at high risk of resurgence

Answer 9

under developed

Question 10

how long is the period of recovery for polio patients

Answer 10

weeks to years depending on how severe the polio is

Question 11

how long is the period of neurological stability for polio

Answer 11

greater then 15 years
being with plateau of maximum neurologic and functional recovery

Question 12

the period of neurological stability lasts indefinitely in _ of those with paralytic polio

Answer 12

50%

Question 13

what is post polio sequelae

Answer 13

when someone with polio develops a functional limitions and then adapts to that over the years

Question 14

for 20-50% of people with polio the period of neurological stability ends with the onset of new ___ and other post polio ___ symptoms

Answer 14

weakness
syndrome

Question 15

what does someone HAVE to HAVE with the onset of post polio syndrome

Answer 15

new weakness

Question 16

when is post polio syndrome typically start

Answer 16

30-50 years after polio and has to have new weakness

Question 17

for the diagnosis of post polio syndrome there must be what 3 things

Answer 17

a history of polio
a period of neurological recovery followed by period of stability lasting at least 15 years
no other medical problems that can cause similar issues

Question 18

how do u determine if someone has a history of polio

Answer 18

spinal tap acutely and there will be polio in CSF
GIANT motor units by EMG (this is where u will see the reinnervation)
no pattern in weakness
motor deficits ONLYYYYY

Question 19

what is the hallmark of polio related weakness

Answer 19

that there is NOOOO patten

Question 20

who is the risk higher for in PPS

Answer 20

• people with more severe permanent impairments
• women
• length of time since acute illness

Question 21

what is the PPS pathophysiologu

Answer 21

degenerating terminal axonal sprouts and an inability to maintain the increased metabolic demand from the giant motor unit

Question 22

what is persistent poliovirus

Answer 22

people who has polio with PPS

Question 23

how will people with polio compensate to increase their function

Answer 23

• use their weak mm at high level of capacity
• substitution of strong mm with increased energy expenditure
• use of ligaments for stability with resulting in hypermobility

Question 24

in the clinic we will see pilio survivors with/without PPS who have

___ pain complained that need intervention
have ___ pain complaints
require re education for functional activities
require ___ conservation education
desire exercise programs in or out of water
require follow up after bracing

Answer 24

acute
chronic
energy

Question 25

what is the **hand held dynamometry** limited to

Answer 25

200N low reproducibility over time unable to detect small declines in strength

Question 26

**pertaining to the mm power and residual motor cells** what is the % of residual motor cells with a **mm power of 5**

Answer 26

> 40% so 60% loss of motor cells

Question 27

pertaining to the mm power and residual motor cells what is the % of residual motor cells with a **mm power of 4**

Answer 27

10-40 so at lest 60% loss of motor cells

Question 28

pertaining to the mm power and residual motor cells what is the % of residual motor cells with a **mm power of 3**

Answer 28

8-10% so at least 90% loss of motor cells

Question 29

pertaining to the mm power and residual motor cells what is the % of residual motor cells with a **mm power of 2**

Answer 29

3-5% so at lest 95% of motor cells lost

Question 30

pertaining to the mm power and residual motor cells what is the % of residual motor cells with a **mm power of 1**

Answer 30

2-3% so at least 97% of motor cells lost

Question 31

who is % of residual motor cells done on

Answer 31

polio survivors that died with something else

Question 32

what is the difference between **Atrophy** and **Pseudohypertrophy**

Answer 32

atrophy is weakness Pseudohypertrophy is a huge mm

Question 33

pertaining to the results and summary of **netherlands study** the subject with PPS needed __ time and reported ___ exertion than those in non PPS group .. there was **no difference in actual effort**

Answer 33

more greater

Question 34

what is the **golden rule** for **polio patients**

Answer 34

if anything causes **fatigue**, **weakness** or **pain** dont do it !!! MMFFFF bittttcchhhh

Question 35

what are **goals** for patients with **PPS**

Answer 35

self management of body and symptoms

Question 36

what are the specific **MSK goals** for polio patients

Answer 36

decrease and prevent causes of pain decrease abnormally high work load of mm correct and minimize postural and gait deviations maintain and increase function , safety anf quality of life

Question 37

what are the **main treatment** for polio patients

Answer 37

patient education pain reduction energy conservation exercise considerations

Question 38

what is the **patient education** that needs to be given during treatment for polio

Answer 38

no “cure” but successful self management can decrease or alleviate symptoms

Question 39

t/f: the study with the double cline mage net study showed that **active magnet** reported decreased pain in post polio patients

Answer 39

true there was a decrease pain ## Footnote so active magment decreased pain with post polio pateints

Question 40

when is the **magnets** most effective for pateints post polio

Answer 40

when patient has specific triggger points and it is taped directly to skin

Question 41

what is essential when using magnets

Answer 41

patient education

Question 42

what is the treatment for **pain reduction** in pateints post polio

Answer 42

cold vs heat magnet therapy , TENS inhibit mm spasm , myofascial release , mm re ed decreased edema mobilize or stabilize joints avoid painful end ranges be careful w mm stretching

Question 43

**weak PF** are **significantly** related to what kind of **pain**

Answer 43

low back and SI pain

Question 44

if these patients have **increasing pain** or **numbness** at night what may it indicate

Answer 44

mattress is to firm

Question 45

what **extremity** does **polio** affect the **most**

Answer 45

legs

Question 46

“The extreme exercises and therapies that helped polio survivors to appear ‘normal’ set the stage for PPS and are the ___ of what [they] need to do today to manage PPS.

Answer 46

opposite

Question 47

what are **signs** of **mm overuse** in polio patients

Answer 47

* mm cramps at rest or during activity * mm twitching * progressive weakness * progessive atrophy

Question 48

Patients with PPS will experience ___ symptoms when exercising in addition to regular daily acitvities

Answer 48

worsen

Question 49

T/F: PPS patient should use exercise for weight reduction

Answer 49

F.. exercise should not be used for weight reduction

Question 50

patient with PPS , if symptoms have resolved or significantly diminished , exercise may be resumed as long as what 2 things

Answer 50

pain , weakness, and fatigue do not worsen it is light intensity with frequent rests

Question 51

t/f: when prescribing exercises for PPS u sho pull have them do a bunch of different exercises that are repetitive ex: warm up on bike

Answer 51

false

Question 52

when working with patients with PPS how should u make each exercise

Answer 52

very specific towards treatment goals using only the targets mms

Question 53

the big thing when exercising patients with PPS is to make sure u know when their mm are ____

Answer 53

deconditioned

Question 54

in patients with PPS , mm that show signs of overuse can be exercises only to help train what

Answer 54

improved/painless posture and promote relaxation

Question 55

what is the general rule for pateints with PPS if their mm test at a 3 or below

Answer 55

u should not exercise that mm other then gentle stretching and should be protected during exercise

Question 56

what is the general rule for pateints with PPS if their mm test at a **3+ to 4**

Answer 56

the mm can be exercised cautiously ## Footnote but remermber if it is a 3/5 then u can not workout just stertch mm

Question 57

what is the general rule for pateints with PPS if their mm test at a **4+ to 5**

Answer 57

can be exercised moderately to vigorously , provided no sings of overuse present can use the borg RPE

Question 58

Varied **water exercise** program to include aqua jogging, standing and walking, limb exercise,lap swimming with flippers, kick board and/or snorkel * “Sit and be fit” type program * UE ergometer * Isolated muscle exercises without weights * Self stretching * Modified programs like yoga, tae chi these are all examples of what

Answer 58

safe exercises for patient with PPS

Question 59

what are 5 examples of potentially unsafe exercises for patient with PPS

Answer 59

riding a bike walking or jogging programs circuit training programs free weights aerobics or kick boxing

Question 60

how should u start with the intensity for a patient with PPS

Answer 60

50% of nonpolio survivor and make sure they have twice as much rest do only the essential exercises

Question 61

how was the study of the whole body vibration

Answer 61

both groups showed improved pain group that started with higher intensity protocol first showed improved in gait speed

Question 62

Patients who partially comply or do not comply will likely ___

Answer 62

worsen

Question 63

a individual with post polio has decreased:

Answer 63

function safety QOL