Week 6- Post-Polio Syndrome Flashcards
PART 1: INTRODUCTION, POLIOMYELITIS
PART 1: INTRODUCTION, POLIOMYELITIS
Polio is a viral infection which attacks the anterior horn cells of the ________ and ______ → muscular paralysis.
-brainstem and SC
Recovery from polio ranged from quick return to baseline to temporary or permanent ________, even death.
-paralysis
Poliomyelitis generally affected ______, and was primarily occurring during the _______.
- children (could affect adults as well)
- summer
About __/___ polio patents will not have any visible symptoms.
- What are the S/Sx of polio?
- How long do symptoms usually last?
- 3/4
- Flu-like symptoms including sore throat, fever, tiredness, nausea, HA, stomach pain.
- 2-5 days
A smaller proportion of people with poliovirus infection will develop other more serious symptoms that affect the brain and SC. What are these S/Sx?
- Meningitis and encephalitis
- Paralysis or weakness in arms, legs, or both (fasciculations, atrophy, decreased DTRs
- bulbar and respiratory involvement
- Was paralysis/weakness of the arms and legs symmetrical or asymmetrical?
- What system was spared?
- ASYMMETRICAL
- sensory system spared
What S/Sx typically were the cause of death with polio?
-bulbar and respiratory involvement
Post-Polio Syndrome (PPS):
- What is Post-Polio Syndrome?
- What characterizes it?
- PPS is a condition that affects survivors of polio years after recovery from an initial acute attack of the poliomyelitis virus.
- Characterized by acute onset of weakness, atrophy, myriad of other S/Sx.
- PPS is thought to be caused by ↑ ________ demand made by the body by giant motor units that were formed during the original viral infection.
- Years of high use of these recovered but overly extended motor units adds stress to the motor neurons and over time we lose the ability to maintain increased work demands.
- ↑ metabolic demands
Post-Polio Risk Factors:
- ________ poliomyelitis
- ______ age of onset
- degree of initial ________
- Greater physical activity in intervening years
- paralytic poliomyelitis
- older age of onset
- degree of initial recovery (greater recovery = more likely PPS)
What does diagnosis of PPS include?
-diagnosis of exclusion (based primarily on symptoms and exclusion of other neurological diagnosis)
What are the (4) diagnostic criteria for PPS?
- ) Prior paralytic poliomyelitis with evidence of motor neuron loss.
- ) Period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval of stable neuromuscular function.
- ) Slowly progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue/atrophy/muscle and joint pain.
- ) Symptoms that persist for at least a year.
PART 2: PPS CLINICAL PRESENTATION, MANAGEMENT, PROGNOSIS
PART 2: PPS CLINICAL PRESENTATION, MANAGEMENT, PROGNOSIS
When patients who have a Hx of polio start to demonstrate new onset of weakness, the weakness we see __________ slowly.
-progresses
What is the hallmark sign of PPS?
Progressive weakness, atrophy
What muscles are primarily affected with PPS?
-Muscles previously affected by poliomyelitis.
- What is a second big sign of PPS that typically occurs at the same time each day and is described as “Hitting the polio wall”?
- These patients also complain of _______ ______.
- Fatigue
- Cognitive fatigue
What are some other S/Sx of PPS?
- Pain (myalgia, cramping, joint pain with repetitive injury, hypersensitivities, joint deformities)
- Cold intolerance (results of SNS involvement)
- Sleep disorders; dysphonia or dysphagia; respiratory deficiency
What are some common secondary complications of PPS S/Sx? (4)
- Falls
- Malnutrition, dehydration, and pneumonia
- Chronic respiratory failure
- Osteoporosis
Are medications effective in patients with PPS?
No
PPS Medical Management:
- ________/_____ changes
- Exercise in moderation
- ____
- Treatment for sleep apnea
- Staying _____
- Focus on managing signs & symptoms to improve QOL
- Lifestyle/Diet changes
- PPV (Positive Pressure Ventilation)
- Staying warm
PPS Prognosis:
- Is PPS life-threatening?
- What are some examples of this?
- Rarely life-threatening, but symptoms can significantly interfere with an individual’s ability to function independently.
- Respiratory muscle weakness result in trouble with proper breathing as well as weakness affecting swallowing muscles.
PART 3: PT MANAGEMENT
PART 3: PT MANAGEMENT
PT Management and Goals:
- ________/________ training
- _______/______ management
- Adaptive equipment recommendations
- Achieve optimal level of functional independence
- Patient and family education
- Strength/Endurance training
- Fatigue/Pain management
Why do we have to be careful with strength training with PPS?
VERY EASY TO FATIGUE
-Patient must be well educated in not overdoing workout.
- Sub-maximal intensity with short duration exercise ________ day helpful to increase QOL.
- Short intervals of exercise with rest in between to recover.
-every other day
How are people with PPS categorized?
- Clinically stable PPS
- Clinically unstable PPS
Clinically Stable PPS (subacute) Exercise Guidelines:
- With muscles at least 4/5 strength
- __-__% HRmax,__days/week, __-__ minutes
- Recommend swim, bike, walk, seated UE aerobic
- Aquatic therapy excellent adjunct
- With muscle in 3/5 range
- Exercise from normal use of limbs sufficient
- Implement pacing and avoid fatigue
-60-70% HRmax, 3 days/week, 20-30 minutes
Clinically Unstable PPS (acute) Exercise Guidelines:
- Goals shift to what?
- Exercise generally ___________ until patient takes time to rest and begins to see stabilization or improvement. At which point, non-fatiguing exercise program may be carefully performed.
- Goals shift to preventing further weakness or improve status of limb function by energy conservation techniques.
- generally contraindicated
What is a large focus of PPS rehabilitation instead of strengthening?
-Energy Conservation Techniques
What is the most difficult part for PPS patients to buy into?
Lifestyle modifications
Stretching Considerations:
- Stretching overworked muscles may not be indicated due to potential for increasing joint _________.
- Any ↑ ROM must be supported by adequate muscle _______ which may not be possible for this population.
- Gentle stretching may be indicated as a strategy to combat pain or cramping from occasional overuse.
- instability
- strength
What are the 3 major causes of pain in PPS?
- Cramping (18%)
- Musculoskeletal (47%)
- Biomechanics (77%)
