PPS Flashcards by Jenn Cantilli

what age is polio most common in and why?

children <5yo
- immune systems not as well developed

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what is a common polio presentation in children <5yo

more likely to develop msk effects -> “infantile paralysis”

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what is the etiology of polio

single strange RNA enterovirus
-entero = intestines, mucosa -> found in oral secretions and fecal matter -> effects GI tract

highly contagious

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what is the sx of polio in 90% of people

asymptomatic or have mild flu-like sx

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what is the pathogenesis of polio

spread via airborne droplets and contract w fecal matter of a carrier
- food or water supply
- poor hygiene/sanitary/wash
- close quarters
- transmission via flies/insects

virus replicates in lymphoid tissue of throat and intestines of infect person
- enters thru oral mucosa and travel thru digestive tract

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what are 3 risk factors for polio

pregnancy
immuno-compromised
- (HIV, stress, meds, comorbidities)
h/o tonsillectomy (less of barrier)

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what is the dissemination pathway once infected w polio

oral ingestion
alimentary tract
blood stream
BBB
CNS

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what is the pathophys of polio once it has entered the CNS

selective attack on anterior horn cells in SC and/or brainstem nuclei
- LMN condition
- random, asymmetric, spotty
- LEs often more affected than UEs

results in death of spinal and/or bulbar (peripheral) motor neurons
-> denervated ms become weak and exhibit flaccid paralysis

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what are clinical s/sx of spinal poliomyelitis (8)

flu-like illness
fever
fatigue
nausea/diarrhea
HA
stiffness of neck/back
pain in limbs
flaccid paralysis (LMNL w ms fasciculations, atrophy, weakness)

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what are clinical s/sx of bulbar polio

weakness of ms in thorax/abs
- weakness of respiratory ms
affects ability to breathe as well as speech and swallowing functions

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what is a concern of polio in areas of less resources and poorer access to care

have to compensate using UE
- extra strain on UE joints
- postural alignment impacted
- higher risk for secondary complications

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what was the iron lung

tank respirator, airtight box that had an engine to push and pull air out of box changing the pressure within it and aiding inspiration/expiration
- precursor to mechanical vent

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how is polio dx

clinical s/sx
presence of virus in culture
- throat culture
- stool sample
- CSF sampling via lumbar puncture

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what is the best management for polio

prevention

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what is the medical management for polio

no cure exists
sx management

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what are examples of sx management in polio

pain - analgesics
vent - respiratory support
- protect airway
antibiotics
- secondary & nosocomial infections
parenteral nutrition & hydration
orthopedic surgery:
- joint deformity
- tendon transfer
- joint replacement

what is axon sprouting

nearby intact motor neurons “adopt” orphaned units thru connecting to endplate and taking over the function
- preservation of function and prevention of frank weakness and joint deformities

when does recovery from polio start and what does it look like

begins in wks and reaches plateau in 6-8mo
- will establish new functional baseline

axon sprouting and formation of significantly enlarged motor units called “super units” or “giant units”

what is a super unit and what is a concern with them

single motor neuron that innervated 100 ms fibers adn may end up innervating 2000 fibers as part of axon sprouting

can result in really high metabolic demands that can lead to degen in those compensatory neurons

what are late effects of polio and why

compensation and substitution for weak ms over long period of time may lead to secondary joint and/or ligament trauma
- DJD
- CTS
- repetitive strain/stress syndromes
- tendinitis
- bursitis

what is post-polio syndrome and how widespread is it

distinct dx from acute polio
seen 15-40yrs later

40-60% develop PPS after initial infection

what are s/sx of PPS (5)

NEW ONSET OF ATROPHY AND WEAKNESS in ms affected by initial dz AND seemingly unaffected ms

intense fatigue/cramping
- deep searing pain in ms/jts
dec endurance/function
cold intolerance
breathing/swallowing issues
- if bulbar involvement

why is cold intolerance a s/sx of PPS

sympathetic nerve involvement and dec vasoconstriction w heat loss

what is the pathophys of PPS

likely d/t premature aging secondary inc metabolic demands of enlarged “super” motor units

no evidence of reactivation of virus or latent autoimmune response

what is the step-wise decline seen in PPS

new sprouting occurs followed by degen - can have process occurring for many years before evidence of it -> as degen of super units, can have nearby axons sprout and take over, then they degen and so on

when does PPS commonly develop

after surgery, trauma, periods of inactivity & can appear to be sudden

what consists of PPS dx inclusion criteria (based on March of Dimes criteria)

1. hx of acute poliomyelitis 2. 15yrs of neuro & functional stability 3. onset of 2+ of following: fatigue, ms and/or joint pain, new weakness, atrophy, decline in ADL function 4. sx persist for at least 1yr

what is an important part of PPS dx since no dx test or biomarkers are available

acute medical issues must be r/o - ie neuro, ortho, psych

what type of dx is a PPS dx

clinical dx

what are social considerations for PPS to consider

fear of polio and dz stigma past polio treatments likely won't want to talk Type A new social isolation d/t fatigue

what is the key question to ask in the subjective interview and what should be avoided

are there activities that you are unable to do now that you could do a few years ago? avoid asking many questions ab their hx w polio to avoid triggering PTSD? - doesn't matter how managed in past, won't impact treatment now

why is participation level a helpful part of the exam

may be able to offer them suggestions to alternative ways to do things

what are appropriate measures to get an idea of participation level in PPS

fatigue severity scale sickness impact profile (SIP) SF-36

what are the 3 goals of PT interventions in PPS

improve function and quality of life reduce task demands safe exercise - energy conservation

what is an important balance to have when exercising in PPS

balance b/w overwork damage and disuse atrophy - can get weak ms if resistive exercise or overwork them - can exacerbate weakness and neg impact life

what is the most important exercise recommendation

exercise should be pain free - if painful then stop

what are exercise recommendations for PPS

exercise shouldn't inc fatigue 3/5 exercises for ms that have full ROM - last rep should be as good as first - only as many pain free reps exercise shouldn't inhibit ability to perform every day activities or cause need for extended rest

what are PT interventions for PPS

encourage regular use of an activity/sx log or journal - pacing principles, energy conservation and work simplification joint protection and body mechanics focus on strengthening uninvolved ms groups CV endurance training balance interventions and ed on falls preventions adaptive ed

what education should you give to pt when focus on strengthening uninvolved ms groups

min to no gains expected in affected ms teach avoidance of over work damage avoid resisted therex in affected ms and low number of reps (less than 10)