Test 3: CIDP and Post-Polio

Question 1

things that are different with CIDP compared to AIDP

Answer 1

can have multiple plateaus
can have relapses
complete remission rare
slower progression
need long term meds
less likely to be ventilated
posterior column symptoms

Question 2

diagnosis of CIDP

Answer 2

look for infection markers, HIV, hepatitis, lyme’s disease

serum IgG, IgM, IgA

LP to check CSF

nn conduction tests

1/3 have been incorrectly diagnosed

Question 3

what characteristics indicate good or poor prognosis

Answer 3

decreased comorbidities, absence of monoclonal protins, elevated CSF proteins = good prognosis

predominant distal weakness = poor

Question 4

immunotherapy effects

Answer 4

77% ambulate after 6 months; 82% at a year

children respond best

Question 5

etiology and incidence of CIDP

Answer 5

1-7 cases in 100000

underreported

men more than women

older then 50 = more likely

Question 6

risk factors for CIDP

Answer 6

no clear risk factors, just possible associations:
- autoimmune
- DM
- HTN
- antecedent infection

Question 7

main S&S of AIDP

Answer 7

fatigue
pain
impaired physical function

Question 8

other side effects of CIDP

Answer 8

depression
lower QOL
cognition not affected

Question 9

medical management of CIDP

Answer 9

long term meds common

oral prednisone; pts responds well but significant side effects

IVIG = helpful but can damage vein access overtime

subcutaneous IG = alternative if IV admin not feasible

plasmapheresis = for those who don’t respond to IVIG or corticosteroids

immunosuppressants coupled with IVIG

Question 10

PT exam components for CIDP

Answer 10

absent DTRs
weak MMT
sensory testing
balance
gait
hx recurrence
depression screen
functional mobility
rule out UMN S&S
screen endurance/fatigue
evaluate pain

Question 11

PT intervention for CIDP

Answer 11

aerobic (3x/wk for 12 wks) = increase VO2Max; 70% max was target HR

resistance (3x/wk for 112 wks) = increase in isokinetic mm strength in pts; 3 sets 12 reps of 12 rep max weight

functional task training

gait

balance

etc

Question 12

things to keep in mind given CIDP presents similar as MS

Answer 12

monitor fatigue throughout (RPE and HR)

non-pharm management for pain

Question 13

what is polio

Answer 13

viral infection (enterovirus)

transmission = droplet or contact with fecal matter

Question 14

types of severity with polio

Answer 14

1 = virtually asymptomatic
2 = GI, flu like, mm pain
3 = flu like that progresses to paralysis
- 10% of those paralyzed died
- some require mechanical vent

Question 15

pathophysiology of polio

Answer 15

anterior horn cells in SC are targeted

these can die and lead to damage of axons interacting with the anterior horn cells (called Wallerian degeneration process)

mm atrophy is result

LMN S&S

usually asymmetric

Question 16

hx of polio

Answer 16

common 1950-70s

initially thought to be static disease but then post polio was discovered

in 50s vaccine was developed; largely eradicated in US

Question 17

what is post polio syndrome

Answer 17

new mm S&S that occur decades after primary polio infection

avg = 25 years later

Question 18

incidence/etiology of post polio

Answer 18

1.6 million polio survivors in US at risk of developing; about 25-50% will develop

women more likely

more serious polio case = more likely to develop

pts who have post polio are likely 70+ bc of when the vaccine came out

Question 19

pathophysiology of post polio

Answer 19

after initial infection axons go through process of collateral sprouting to regain functional ability

surviving axons increase innervation ratio (i.e. instead of innervating 3000 mm fibers, now one axon innervates 5000)

eventually axon cannot take this increased stress and new denervation occurs

Question 20

S&S of post polio

Answer 20

mm weakness
atrophy
fatigue
mm/jt pain

weakness can also affect axial mm and impair breathing

weakness is worse with cold and increased PA

weakness slowly progresses over time

Question 21

diagnosis of post polio

Answer 21

EMG

mm biopsy; how innervated are mm fibers

rule out other neuro disorder

Question 22

medical management of post polio

Answer 22

fatigue management with anticholinergics (not largely effective)

non pharm pain management

can do tendon transfer sx for impaired foot posture

Question 23

PT exam/eval for post polio

Answer 23

LMN signs
strength
functional ability
rule out UMN signs

fatigue/endurance (do not push past fatigue lvl)

pain scales
gait
balance

** similar training to ALS; do not want to over fatigue

Question 24

PT treatment fro post polio

Answer 24

be careful with exercise and conventional strengthening
- mm and nerves have exhausted all collateral sprouting ability; of you tax too much there may be irreparable damage

lifestyle modification

compensation (lightweight bracing as needed)

energy conservation

never exercise to fatigue

only do non-exhaustive exercise and track vitals and RPE

may have jt deformities from uneven strain of mm on joint; consider this when picking intervention (may need orthoses or sx)