Test 3: CIDP and Post-Polio Flashcards
things that are different with CIDP compared to AIDP
can have multiple plateaus
can have relapses
complete remission rare
slower progression
need long term meds
less likely to be ventilated
posterior column symptoms
diagnosis of CIDP
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
what characteristics indicate good or poor prognosis
decreased comorbidities, absence of monoclonal protins, elevated CSF proteins = good prognosis
predominant distal weakness = poor
immunotherapy effects
77% ambulate after 6 months; 82% at a year
children respond best
etiology and incidence of CIDP
1-7 cases in 100000
underreported
men more than women
older then 50 = more likely
risk factors for CIDP
no clear risk factors, just possible associations:
- autoimmune
- DM
- HTN
- antecedent infection
main S&S of AIDP
fatigue
pain
impaired physical function
other side effects of CIDP
depression
lower QOL
cognition not affected
medical management of CIDP
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
PT exam components for CIDP
absent DTRs
weak MMT
sensory testing
balance
gait
hx recurrence
depression screen
functional mobility
rule out UMN S&S
screen endurance/fatigue
evaluate pain
PT intervention for CIDP
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
things to keep in mind given CIDP presents similar as MS
monitor fatigue throughout (RPE and HR)
non-pharm management for pain
what is polio
viral infection (enterovirus)
transmission = droplet or contact with fecal matter
types of severity with polio
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
pathophysiology of polio
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
hx of polio
common 1950-70s
initially thought to be static disease but then post polio was discovered
in 50s vaccine was developed; largely eradicated in US
what is post polio syndrome
new mm S&S that occur decades after primary polio infection
avg = 25 years later
incidence/etiology of post polio
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
pathophysiology of post polio
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
S&S of post polio
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
diagnosis of post polio
EMG
mm biopsy; how innervated are mm fibers
rule out other neuro disorder
medical management of post polio
fatigue management with anticholinergics (not largely effective)
non pharm pain management
can do tendon transfer sx for impaired foot posture
PT exam/eval for post polio
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
PT treatment fro post polio
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)
