Post Polio and CRPS Flashcards
1
Q
What can respiratory muscle weakness result in trouble with
A
proper breathing, affecting daytime functions and sleep
2
Q
Weakness in swallowing can result in
A
aspiration of food and liquids into the lungs and lead to pneumonia
3
Q
True or False: Post-Polio Syndrome is life threatening
A
False, symptoms can significantly interfere with a persons independent function
4
Q
What does the diagnosis of PPS depend on
A
Clinical Information
5
Q
Criteria to be diagnosed with PPS
A
- Evidence of motor neuron loss
- A period of partial or complete functional recovery followed by by an interval (usually 15 years or more) of stable neuromuscular function.
- Slowly progressive and persistent new muscle weakness or decreased endurance, with or without generalized fatigue, muscle atrophy, or muscle and joint pain
- Symptoms that persist for at least a year.
6
Q
Treatment of PPS focuses on…
A
- Lifestyle changes
- Healthy diet
- Exercise in moderation
- Positive pressure ventilation
- Treatment for sleep apnea
- Staying warm
- Focus on managing signs & symptoms to Improve QOL
7
Q
PT goals
A
- Decrease workload on muscles
- Avoid fatigue
- Ambulate safely
- Achieve an optimal level of functional independence
- Educate patient & family members
8
Q
What are some general aspects of PPS management?
A
- Motor
- Postural
- Pain
- Fatigue
- Work Load
- Psychosocial Considerations
9
Q
Lifestyle modification is VERY difficult for patients with PPS because…
A
- the pt survived polio
- mobility = freedom
- independence is something they have fought for
- slowing down may be seen as “giving in”
10
Q
What are PT’s goals for lifestyle modification?
A
- ↓physical & emotional stress
- joint protection
- modification of home & work environment
- use of mobility aids to ↓fatigue & preserve function
- energy conservation
- decrease weight loss
11
Q
What is energy conservation?
A
a means of modifying a person’s lifestyle in order to prevent fatigue
12
Q
What are some examples of energy conservation techniques?
A
- ADs, scooter, etc
- one trip vs 2 or 3 using a cart
- sit instead of stand to perform a task
- frequent breaks/naps
- breathing exercises
13
Q
True or False: When strengthening muscles in post-polio patients you want to induce muscle fatigue.
A
FALSE. Overdoing a workout can result in the pt needing several days to regain strength.
14
Q
How is aquatic therapy beneficial in patients with PPS?
A
improves flexibility, strength, and cardiorespiratory fitness
15
Q
General guidelines for exercise in pts with PPS
A
- short intervals with rest in btwn to recover
- submax, short duration every other day (helps ↑ QOL)
16
Q
Aerobic FITT Principles
A
3x/wk
60-70% target HR
pre-test, 2 mo, 4 mo
17
Q
Strength FITT Principles
A
3-5x/wk 60-80% 1RM 5 sec contract/10 sec rest concentric exercise pre-test, 1 mo, 3 mo, 6 mo, then yearly
18
Q
True or False: Stretching overworked mm may not be indicated in this population.
A
TRUE: d/t potential for increasing joint instability
19
Q
True or False: Any ↑ ROM must be supported by adequate mm strength which may not be possible for this population.
A
TRUE
20
Q
True or False: Gentle stretching may be indicated as a strategy to combat pain or cramping from occasional overuse.
A
TRUE
21
Q
Pain management for cramping
A
gentle stretching after application of heat
22
Q
Pain management for musculoskeletal pain due to overuse
A
depending on structure involved
- tendon, bursa, fascia, muscle
- meds, modalities, mvmt pattern change
23
Q
Pain management for biomechanical pain
A
- Posture education
- Use of an AD
- Orthotics
- Orthoses
24
Q
Education of family
A
More exercise is NOT better; less is best!
25
Polio and Post-Polio Syndrome History
- Polio is a viral infection which attacks the anterior horn cells of the spinal cord
- Polio epidemic in US from 1910-1959
- 20-40% survivors of Polio experience fatigue, new muscle weakness, and loss of functional abilities
- Post-Polio Syndrome was first diagnosed and recorded as a clinical entity in 1972
26
Global Issue of Polio
- Polio vaccine introduced in 1955
| - WHO reports polio cases decreasing 99% from 1988 to 2010
27
Countries that still have polio endemic as of 2012
- Afghanistan
- Nigeria
- Pakistan
28
Post-Polio Syndrome Criteria
- History of polio
- Positive neurological exam
- Development of new neurological weakness unexplained by other pathology
- Period of relative stability lasting at least 15 years
29
Post-Polio Presentation
- Slowly progressing muscle weakness
- Fatigue
- Muscle atrophy
- Pain from joint degeneration
- Skeletal deformities such as scoliosis
30
Post-Polio Etiology
- PPS is caused by increased metabolic demand made by the body by giant motor units
- Giant motor units were formed during original Polio
31
PPS Signs and Symptoms
- Fatigue
- New Weakness
- Pain
- Cold Intolerance
- Decreased Function
32
T or F: Men are affected by CRPS more than woman
False
33
Risk factors for CRPS
```
Women>Men
Smoking
Ages 30-55 (40 is avg. age)
Distal Radius Fx (Median nerve damage)
500 mg of Vitamin C daily
Hx of Peripheral Nerve Damage
Psychological issues/stress and coping problems
Inflammatory Disorders
```
34
The 3 Grades of CRPS
Grade 1: Algodystrophy (disruption of bone growth combine with sympathetic symptoms)
Grade 2: Sympathetic dystrophy without pain
Grade 3: Sympathetic maintained pain
35
Which of the 3 Grades of CRPS is least severe? (according to the presenter)
Grade 3
36
T or F: You have to have pain in order to have CRPS
False, pain is not necessary
37
Hyperalgesia Definition
An increased sensitivity to pain, may be caused by damage to nocioceptors or peripheral nerves. More extreme than allodynia
38
Hyperesthesia Definition
A condition that involves an abnormal increase in sensitive stimuli of the senses (hear,touch,taste etc). Increased touch sensitivity is known as 'tactile hyperesthesia' and increased sound sensitivity is known as 'auditory hyperesthesia'.
39
Allodynia Definition
Pain in specific dermatome distribution that is a result of a stimulus that is not normally painful
40
Hyperpathia Definition
Abnormal painful reactions to a stimulus. The above terms fall under this category
41
Vasomotor Definition
Dilation and constriction of blood vessels
42
Sudomotor Definition
Autonomic function associated with the sweat glands
43
Trophic Definition
Changes in tissues, due to loss/reduction of nerve and/or blood supply (muscle atrophy, increased nail growth, changes in nails, increased hair growth)
44
Patient's with CRPS are often labeled as being a _____, ______, or ___________
Malingerer, magnifier, or having psychological issues
45
MOI
Usually follows some type of trauma such as fracture, sharp force injury, surgery, infections, heart problems and cumulative trauma disorders. Insult may be quite mild in nature.
46
Common Symptoms
- Inflammation
- Pain out of proportion to injury (not in all cases)
- Skin color changes
- Shiny appearance to skin
- Stiffness
- Abnormal hair growth
- Spasms in blood vessels and muscles of the extremities.
- Temperature variance: Extremities may be either hot or cold and there is often a difference between involved and uninvolved extremities.
- Osteopenia
- Insomnia/ Emotional Disturbances
- Dystonia/motor planning difficulty
47
IASP Diagnostic Criteria
- Presence of an inciting noxious event or prolonged immobilization.
- Continuing pain, allodynia, or hyperglesia which is disproportionate to any inciting event.
- Edema, changes in the skin, blood flow or abnormal sudomotor activity in the region of pain.
- The diagnosis is excluded by the existence of a condition that would otherwise account for the degree of pain and dysfunction.
48
What is Complex Regional Pain Syndrome (CRPS)
- Autonomic Nervous System is not under voluntary control
- Not all individuals with CRPS have sympathetic symptoms.
- Involves several physiological and psychological systems.
- Process is progressive without intervention.
49
What is the Sympathetic System responsible for?
Fight or flight. Increase in blood flow, heightened sensitivity, dilation of pupils, sweat. We are preparing to engage in a fight or run away.
50
What is the Parasympathetic System responsible for?
Rest and digest, very calming
51
True or False
| Injury can result in sympathetic overflow
True
52
True or False
| The Sympathetic Chain both monitors efferent and afferent messages
True
53
What is the history of CRPS?
First Documented in 1864 by Weir Mitchell as a common nerve injury associated with gun shot wounds effecting Civil War Soldiers . He called it Causalgia (burning pain)
54
How many types of CRPS are there?
two
55
What are the types of CRPS?
Type I: Occurs after an illness or injury that did not directly damage the peripheral nerves of the affected limb.Something totally unrelated.
Type II: There is an identifiable peripheral nerve injury.
Known injury to area
56
What causes CRPS?
Doctors aren’t sure what causes CRPS. In some cases the sympathetic nervous system plays an important role in sustaining the pain. The most recent theories suggest that pain receptors in the affected part of the body become responsive to a family of nervous system messengers known as catecholamines.
57
What are the pathophysiologic mechanism that may contribute to CRPS?
Altered cutaneous innervation, central sensitization, peripheral sensitization, altered SNS function, circulating catecholamines,inflammatory factors, brain plasticity, genetic factors, and psychological factors
58
Sensory Factor Symptoms and Signs
Symptoms
- Hyperesthesia/Allodynia
Signs
- Hyperalgesia, Allodynia, Light Touch, Movement, Deep Pressure
59
Vasomotor Factor Symptoms and Signs
Symptoms
- Temperature changes and color asymmetry
Signs
- Temperature colder or hotter than involved side
- Color of extremity is different (red, blue, gray)
60
Sudomotor/Edema Symptoms and Signs
Symptoms
- Edema, Hyperhydrosis (excessive sweating) asymmetry
Signs
- Swelling, Sweating
61
Motor/Trophic Symptoms and Signs
Symptoms
- Decreased ROM, Atrophy, Motor Dysfunction
Signs
- Trophic Changes, Stiffness, Hair Growth, Nail Growth
62
Diagnostic Testing
- Three phase bone scan
- Monitoring digital pulp temperature
- X-Rays: Used to evaluate regional osteopenia
63
Therapy Identification of CRPS
- Thorough history of health
- Pain threshold evaluation
- Clinical Observation
- Movement, Skin color, Nails, Atrophy
- Semmes Weinstein Monofilament testing
- Pain with 2.83 monofilament is abnormal
- Neuromusculoskeletal Evaluation
64
Pain scale used for CRPS
McGill Pain Questionnaire
65
Acute Phase Time Frame
1-3 Months
66
Acute Phase
- Burning, Edema, Hyperesthesia, Warm Skin, Allodynia, Change in Skin Color, Abnormal Hair Growth
67
True or False
| Treatment in Acute Phase has been proven to be very effective?
TRUE
68
CRPS Progression Phase Time Frame
3-6 Months
69
Progression Phase
- Sympathetic nerve activity heightened, Burning pain, Cool and gray skin, Reduced hair and nail growth, Pain spread into entire extremity, Muscle wasting and joint stiffness, Osteopenia
70
CRPS Late Phase
- Skin and muscle atrophy, significant loss of motion in joints, loss of hair and nail growth, cold limb, severe osteopenia
71
___% of patients with CRPS who receive treatment within the first year will have significant improvement.
80%
72
___% of patients with CRPS will improve if treatment is started within the second year.
50%
73
Treatment options for CRPS
- PT and/or OT
- Intense patient education once diagnosis confirmed.
- Stellate ganglion blocks
- Hyperbaric chamber
- Pharmacologic interventions
- Baclofen or Botox
- Surgical Intervention
74
T/F: Pharmacologic interventions are used in isolation in treating CRPS.
FALSE. Multiple pharmacologic interventions have been used in treating CRPS and are usually combined with therapy and adaptive modalities.
75
T/F: Pain medications are NOT affective in alleviating neurogenic pain.
TRUE. Pain medications, although often prescribed, are not affective in alleviating neurogenic pain.
76
What are some examples of therapy interventions to manage pain in CRPS?
- Modalities
- TENS
- Graded Motor Imagery
77
What are some examples of therapy interventions to manage hypersensitivity in CRPS?
- desensitization with various textures
- fluidotherapy
- sensory boxes
78
What are some examples of therapy interventions to address vasomotor issues in CRPS?
- massage
- modalities
* *caution with extremes in temperature
79
What are some examples of therapy interventions to address edema in CRPS?
- elevation
- exercise
- massage
80
What are some examples of therapy interventions to address motor trophic changes in CRPS?
- active PAIN FREE ROM
- orthotics
- CPM
81
What are some examples of therapy interventions to address movement disorders (dystonia and neglect) in CRPS?
- PNF
- stationary bike
- functional tasks
- yoga
- tai chi
- dance
- Chinese meridian balls
82
What are some examples of therapy interventions to promote relaxation in CRPS?
- diaphragmatic breathing
- biofeedback
- meditation (shut down fight or flight)
83
What does the Watson and Carlson stress loading intervention for CRPS include?
Scrub and carry.
- scrub 3x/day for 10 mins
- carry around a 1-5 lb wt
84
T/F: Neural Mobilization Techniques, promotion of aerobic exercise, and participation in normal life activities are therapy interventions for CRPS.
TRUE
