PPS

Question 1

what age is polio most common in and why?

Answer 1

children <5yo
- immune systems not as well developed

Question 2

what is a common polio presentation in children <5yo

Answer 2

more likely to develop msk effects -> “infantile paralysis”

Question 3

what is the etiology of polio

Answer 3

single strange RNA enterovirus
-entero = intestines, mucosa -> found in oral secretions and fecal matter -> effects GI tract

highly contagious

Question 4

what is the sx of polio in 90% of people

Answer 4

asymptomatic or have mild flu-like sx

Question 5

what is the pathogenesis of polio

Answer 5

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

Question 6

what are 3 risk factors for polio

Answer 6

pregnancy
immuno-compromised
- (HIV, stress, meds, comorbidities)
h/o tonsillectomy (less of barrier)

Question 7

what is the dissemination pathway once infected w polio

Answer 7

oral ingestion
alimentary tract
blood stream
BBB
CNS

Question 8

what is the pathophys of polio once it has entered the CNS

Answer 8

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

Question 9

what are clinical s/sx of spinal poliomyelitis (8)

Answer 9

flu-like illness
fever
fatigue
nausea/diarrhea
HA
stiffness of neck/back
pain in limbs
flaccid paralysis (LMNL w ms fasciculations, atrophy, weakness)

Question 10

what are clinical s/sx of bulbar polio

Answer 10

weakness of ms in thorax/abs
- weakness of respiratory ms
affects ability to breathe as well as speech and swallowing functions

Question 11

what is a concern of polio in areas of less resources and poorer access to care

Answer 11

have to compensate using UE
- extra strain on UE joints
- postural alignment impacted
- higher risk for secondary complications

Question 12

what was the iron lung

Answer 12

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

Question 13

how is polio dx

Answer 13

clinical s/sx
presence of virus in culture
- throat culture
- stool sample
- CSF sampling via lumbar puncture

Question 14

what is the best management for polio

Answer 14

prevention

Question 15

what is the medical management for polio

Answer 15

no cure exists
sx management

Question 16

what are examples of sx management in polio

Answer 16

pain - analgesics
vent - respiratory support
- protect airway
antibiotics
- secondary & nosocomial infections
parenteral nutrition & hydration
orthopedic surgery:
- joint deformity
- tendon transfer
- joint replacement

Question 17

what is axon sprouting

Answer 17

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

Question 18

when does recovery from polio start and what does it look like

Answer 18

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”

Question 19

what is a super unit and what is a concern with them

Answer 19

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

Question 20

what are late effects of polio and why

Answer 20

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

Question 21

what is post-polio syndrome and how widespread is it

Answer 21

distinct dx from acute polio
seen 15-40yrs later

40-60% develop PPS after initial infection

Question 22

what are s/sx of PPS (5)

Answer 22

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

Question 23

why is cold intolerance a s/sx of PPS

Answer 23

sympathetic nerve involvement and dec vasoconstriction w heat loss

Question 24

what is the pathophys of PPS

Answer 24

likely d/t premature aging secondary inc metabolic demands of enlarged “super” motor units

no evidence of reactivation of virus or latent autoimmune response

Question 25

what is the step-wise decline seen in PPS

Answer 25

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

Question 26

when does PPS commonly develop

Answer 26

after surgery, trauma, periods of inactivity & can appear to be sudden

Question 27

what consists of PPS dx inclusion criteria (based on March of Dimes criteria)

Answer 27

1. hx of acute poliomyelitis
2. 15yrs of neuro & functional stability
3. onset of 2+ of following: fatigue, ms and/or joint pain, new weakness, atrophy, decline in ADL function
4. sx persist for at least 1yr

Question 28

what is an important part of PPS dx since no dx test or biomarkers are available

Answer 28

acute medical issues must be r/o
- ie neuro, ortho, psych

Question 29

what type of dx is a PPS dx

Answer 29

clinical dx

Question 30

what are social considerations for PPS to consider

Answer 30

fear of polio and dz stigma
past polio treatments
likely won’t want to talk
Type A
new social isolation d/t fatigue

Question 31

what is the key question to ask in the subjective interview and what should be avoided

Answer 31

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

Question 32

why is participation level a helpful part of the exam

Answer 32

may be able to offer them suggestions to alternative ways to do things

Question 33

what are appropriate measures to get an idea of participation level in PPS

Answer 33

fatigue severity scale
sickness impact profile (SIP)
SF-36

Question 34

what are the 3 goals of PT interventions in PPS

Answer 34

improve function and quality of life
reduce task demands
safe exercise
- energy conservation

Question 35

what is an important balance to have when exercising in PPS

Answer 35

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

Question 36

what is the most important exercise recommendation

Answer 36

exercise should be pain free
- if painful then stop

Question 37

what are exercise recommendations for PPS

Answer 37

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

Question 38

what are PT interventions for PPS

Answer 38

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

Question 39

what education should you give to pt when focus on strengthening uninvolved ms groups

Answer 39

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)