PPS Flashcards
what age is polio most common in and why?
children <5yo
- immune systems not as well developed
what is a common polio presentation in children <5yo
more likely to develop msk effects -> “infantile paralysis”
what is the etiology of polio
single strange RNA enterovirus
-entero = intestines, mucosa -> found in oral secretions and fecal matter -> effects GI tract
highly contagious
what is the sx of polio in 90% of people
asymptomatic or have mild flu-like sx
what is the pathogenesis of polio
spread via airborne droplets and contract w fecal matter of a carrier
- food or water supply
- poor hygiene/sanitary/wash
- close quarters
- transmission via flies/insects
virus replicates in lymphoid tissue of throat and intestines of infect person
- enters thru oral mucosa and travel thru digestive tract
what are 3 risk factors for polio
pregnancy
immuno-compromised
- (HIV, stress, meds, comorbidities)
h/o tonsillectomy (less of barrier)
what is the dissemination pathway once infected w polio
oral ingestion
alimentary tract
blood stream
BBB
CNS
what is the pathophys of polio once it has entered the CNS
selective attack on anterior horn cells in SC and/or brainstem nuclei
- LMN condition
- random, asymmetric, spotty
- LEs often more affected than UEs
results in death of spinal and/or bulbar (peripheral) motor neurons
-> denervated ms become weak and exhibit flaccid paralysis
what are clinical s/sx of spinal poliomyelitis (8)
flu-like illness
fever
fatigue
nausea/diarrhea
HA
stiffness of neck/back
pain in limbs
flaccid paralysis (LMNL w ms fasciculations, atrophy, weakness)
what are clinical s/sx of bulbar polio
weakness of ms in thorax/abs
- weakness of respiratory ms
affects ability to breathe as well as speech and swallowing functions
what is a concern of polio in areas of less resources and poorer access to care
have to compensate using UE
- extra strain on UE joints
- postural alignment impacted
- higher risk for secondary complications
what was the iron lung
tank respirator, airtight box that had an engine to push and pull air out of box changing the pressure within it and aiding inspiration/expiration
- precursor to mechanical vent
how is polio dx
clinical s/sx
presence of virus in culture
- throat culture
- stool sample
- CSF sampling via lumbar puncture
what is the best management for polio
prevention
what is the medical management for polio
no cure exists
sx management
what are examples of sx management in polio
pain - analgesics
vent - respiratory support
- protect airway
antibiotics
- secondary & nosocomial infections
parenteral nutrition & hydration
orthopedic surgery:
- joint deformity
- tendon transfer
- joint replacement
what is axon sprouting
nearby intact motor neurons “adopt” orphaned units thru connecting to endplate and taking over the function
- preservation of function and prevention of frank weakness and joint deformities
when does recovery from polio start and what does it look like
begins in wks and reaches plateau in 6-8mo
- will establish new functional baseline
axon sprouting and formation of significantly enlarged motor units called “super units” or “giant units”
what is a super unit and what is a concern with them
single motor neuron that innervated 100 ms fibers adn may end up innervating 2000 fibers as part of axon sprouting
can result in really high metabolic demands that can lead to degen in those compensatory neurons
what are late effects of polio and why
compensation and substitution for weak ms over long period of time may lead to secondary joint and/or ligament trauma
- DJD
- CTS
- repetitive strain/stress syndromes
- tendinitis
- bursitis
what is post-polio syndrome and how widespread is it
distinct dx from acute polio
seen 15-40yrs later
40-60% develop PPS after initial infection
what are s/sx of PPS (5)
NEW ONSET OF ATROPHY AND WEAKNESS in ms affected by initial dz AND seemingly unaffected ms
intense fatigue/cramping
- deep searing pain in ms/jts
dec endurance/function
cold intolerance
breathing/swallowing issues
- if bulbar involvement
why is cold intolerance a s/sx of PPS
sympathetic nerve involvement and dec vasoconstriction w heat loss
what is the pathophys of PPS
likely d/t premature aging secondary inc metabolic demands of enlarged “super” motor units
no evidence of reactivation of virus or latent autoimmune response
what is the step-wise decline seen in PPS
new sprouting occurs followed by degen
- can have process occurring for many years before evidence of it -> as degen of super units, can have nearby axons sprout and take over, then they degen and so on
when does PPS commonly develop
after surgery, trauma, periods of inactivity & can appear to be sudden
what consists of PPS dx inclusion criteria (based on March of Dimes criteria)
- hx of acute poliomyelitis
- 15yrs of neuro & functional stability
- onset of 2+ of following: fatigue, ms and/or joint pain, new weakness, atrophy, decline in ADL function
- sx persist for at least 1yr
what is an important part of PPS dx since no dx test or biomarkers are available
acute medical issues must be r/o
- ie neuro, ortho, psych
what type of dx is a PPS dx
clinical dx
what are social considerations for PPS to consider
fear of polio and dz stigma
past polio treatments
likely won’t want to talk
Type A
new social isolation d/t fatigue
what is the key question to ask in the subjective interview and what should be avoided
are there activities that you are unable to do now that you could do a few years ago?
avoid asking many questions ab their hx w polio to avoid triggering PTSD?
- doesn’t matter how managed in past, won’t impact treatment now
why is participation level a helpful part of the exam
may be able to offer them suggestions to alternative ways to do things
what are appropriate measures to get an idea of participation level in PPS
fatigue severity scale
sickness impact profile (SIP)
SF-36
what are the 3 goals of PT interventions in PPS
improve function and quality of life
reduce task demands
safe exercise
- energy conservation
what is an important balance to have when exercising in PPS
balance b/w overwork damage and disuse atrophy
- can get weak ms if resistive exercise or overwork them
- can exacerbate weakness and neg impact life
what is the most important exercise recommendation
exercise should be pain free
- if painful then stop
what are exercise recommendations for PPS
exercise shouldn’t inc fatigue
3/5 exercises for ms that have full ROM
- last rep should be as good as first
- only as many pain free reps
exercise shouldn’t inhibit ability to perform every day activities or cause need for extended rest
what are PT interventions for PPS
encourage regular use of an activity/sx log or journal
- pacing principles, energy conservation and work simplification
joint protection and body mechanics
focus on strengthening uninvolved ms groups
CV endurance training
balance interventions and ed on falls preventions
adaptive ed
what education should you give to pt when focus on strengthening uninvolved ms groups
min to no gains expected in affected ms
teach avoidance of over work damage
avoid resisted therex in affected ms and low number of reps (less than 10)
