Poliomyelitis and post polio syndrome Flashcards
(23 cards)
what is poliomyelitis/polio?
-infectious disease caused by the poliovirus
-primarily affects the CNS causing weakness, paralysis and in severe cases death
-no cure, can get vaccinated
discuss WHO key facts of polio
-affects children <5
-1 in 200 infections lead to irreversible paralysis, 5-10% of these patients die from breathing muscle paralysis
-as long as a single child remains infected, children in all countries are at risk of contracting polio
describe the clinical presentation of polio
-lots are asymptomatic
-fever and gastric symptoms
how does transmission of polio happen?
-faecal-oral route
-eg contaminated food, water etc
-eg if person does not wash hands after using bathroom, they could infect food and drink
what is paralytic poliomyelitis?
-most severe form of polio
-leads to paralysis due to attack of the anterior horn cells of the spinal cord
what are the 2 processes that describe recover from polio?
- rapid recovery- regains function quickly post polio due to cellular healing
- slow recovery - takes longer to recover - axonal sprouting, hypertrophy of remaining motor units
what can be residual problems post polio?
-weakness
-skeletal deformity
-contractures
-growth retardation
-leg length disrepancy
what is post polio syndrome?
the development of new muscle weakness with fatigue, muscle pain, joint pain, decreased functioning that began at least 15 years of stability following acute polio
what are risk factors for PPS?
-more severely affected by acute polio
-greater functional recovery
-longer time since acute polio
-respiratory problems at acute stage
-older age at onset of acute polio
-muscle pain w/ exercise
what are symptoms of PPS?
-fatigue
-weakness
-muscle pain
-gait disturbances
-respiratory problems
-cold intolerance
-swallowing difficulties
-sleep apnoea
why do polio survivors develop new onset neurological weakness years after acute polio infection?
- denervation / rein nervation - ongoing chronic process
- normal aging - sarcopenia and loss of motor neurons and physical inactivity eg decreasing activity secondary to pain
3 reactivation of virus causing progressive motor neuron degeneration
what is the main key feature of PPS?
new muscle weakness
-atrophy
-weakness is evident in gait
what’s the most common symptom of PPS?
is pain common in PPS?
-yes
-muscle pain in 50-91% of patients often LL> spine> UL
-aching, cramping, sharp pain
-activity is primary aggravating factor
what are the possible causes of pain in PPS?
-mechanical joint pain due to MSK deformities from underlying polio
-nerve compression syndromes eg carpal tunnel syndrome
-medical conditions eg spinal stenosis
what would you want to assess in the subjective Ax for these patients?
-Hx of acute polio, age , severity
-course of recovery - surgery or ventilated / iron lung
-use of callipers, aids etc
-other PMHx
-social Hx
-new difficulties / symptoms
-time since onset of new difficulties
-walking distance tolerated now vs 5 years ago
-functional difficulties
what does the objective Ax involve for these patients?
-observation - posture, muscle wasting, deformities
-quantify muscle power - MMT
-ROM and muscle flexibility
-pain - NRS, VAS
-BMI
-cardiorespiratory - 6MWT
-mobility and gait Ax
-functional scale
-fatigue Ax
what does the evidence say about strengthening for PPS?
-non fatiguing strengthening exercises can improve muscle strength and are safe and effective: can prevent further declines of strength
-10-12 week programmes, 3 times per week with rest days
-but very important that the patient learns to manage and monitor weakness and fatigue prior to exercise commencement
what’s important to note regarding contractures in polio patients?
-contractures in polio may be adaptive compensatory strategies for muscle weakness to allow ambulation and mobility
-longstanding contractors may not be changed to stretching and splinting
what is recommended for aerobic exercise for polio patients?
-low intensity aerobic training on treadmill
-decreased fatigue and reduced energy cost of walking
what are some treatment options if a polio patient has difficulties with gait?
-energy conservation techniques
-pacing
-aids and adaptive equipment can decrease fatigue
-orthotics eg AFO, KAFO
what is the function of a knee ankle foot orthotic?
locks the knee in extension
-good for controlling a knee that is prione to buckling in stance phase
