Polio

Question 1

Polio is a viral infection that attacks what? What does this lead to?

Answer 1

anterior horn cells of the brainstem and spinal cord that leads to muscular paralysis

Question 2

25% of people with polio will have _____________ symptoms. How long do these symptoms last?

Answer 2

flu-like symptoms
- sore throat
- fever
- tiredness
- nausea
- headache
- stomach pain

Symptoms usually last 2-5 days then go away on their own

Question 3

Hallmark symptoms of polio

Answer 3

LMN symptoms
- muscle spasms persisted days to weeks that limits ROM due to pain and contributes to mobility issues
- imbalance issues
- contractures

Question 4

S&S of polio

Answer 4

• meningitis and encephalitis
• ASYMMETRICAL paralysis/weakness in extremities (fasciculations, atrophy, decreased, DTRs)
• bulbar and respiratory involvement
• sensory system spared

Question 5

What is spared with Polio? What does this allow to happen?

Answer 5

• sensory system spared
• allows for functional control of bowel/bladder and sexual function

Question 6

characteristics of post-polio syndrome

Answer 6

acute onset of weakness, atrophy, and other signs and symptoms

Question 7

etiology of post-polio syndrome

Answer 7

• PPS causes giant motor neurons to form (axonal sprouting) to compensate for lost neurons
• there is an increased metabolic demand on these giant motor neurons
• then over time these motor neurons are overworked and lose their ability

Question 8

risk factors for post-polio syndrome

Answer 8

• • paralytic poliomyelitis
• older age of onset
• degree of initial recovery (the greater the recovery the more likely to develop PPS)
• greater physical activity in intervening years

Question 9

How is post-polio syndrome diagnosed?

Answer 9

diagnosis of exclusion
- based primarily on symptoms and exclusion of any other neuromuscular diagnosis

Question 10

diagnostic criteria for post-polio syndrome?

Answer 10

1) prior paralytic poliomyelitis w/ motor neuron loss
2) period of partial or complete functional recovery after acute polio
3) slowly progressive and persistent new muscle or decreased endurance
4) symptoms that persist for at least a year

Question 11

What is a stepwise progression?

Answer 11

periods of relative stability with interspersed periods of decline

Question 12

characteristics of post-polio syndrome

Answer 12

• gradual new weakening in muscles that were previously affected by the polio infection
• slow progression, either steady or stepwise

Question 13

S&S of post-polio symptoms

Answer 13

• progressive weakness, atrophy
• fatigue
• pain
• cold intolerance
• sleep disorders
• dysphonia or dysphagia
• respiratory deficiency

Question 14

characteristics of fatigue with post-polio

Answer 14

• typically occurs at same time each day
• can be accompanied by signs of autonomic distress (sweating or headaches)

Question 15

characteristics of pain with post-polio

Answer 15

• myalgia
• cramping
• joint pain with repetitive injury
• hypersensitivities
• joint deformities (scoliosis)

Question 16

What causes cold intolerance with post-polio syndrome?

Answer 16

result of sympathetic nervous system involvement (bulbar)

Question 17

common secondary complications of post-polio

Answer 17

• falls
• malnutrition and dehydration
• pneumonia
• chronic respiratory failure
• osteoporosis

Question 18

What medications are effective for post-polio?

Answer 18

No medications shown to treat symptoms

Question 19

prognosis of post-polio

Answer 19

• rare life-threatening but symptoms can significantly interfere with independent function
• weakness can affect swallowing and respiratory which can lead to aspiration/pneumonia and sleep/breathing dysfunction

Question 20

strengthening considerations with post-polio

Answer 20

• carefully prescribed conditions to avoid overworking or fatiguing muscles
• patients must be WELL-EDUCATED to avoid pain and fatigue

Question 21

How to tell if a patient has overdone it with strengthening?

Answer 21

if it takes several days to regain strength

Question 22

What intensity should be done with post-polio strengthening?

Answer 22

sub-max intensity w/ short duration exercise every other day is helpful to increase QoL

Question 23

exercise guidelines for clinically stable post-polio

Answer 23

With muscles at least 4/5 strength
- 60-70% HRmax
- 3 days/week
- 20-30 min - with pacing and while avoiding fatigue

With muscles 3/5, exercise from normal use of limbs may be sufficient
- implement pacing and avoid fatigue

Question 24

What type of exercises are good for clinically stable post-polio?

Answer 24

• aquatic therapy
• bike
• walking
• seated UE aerobics

Question 25

exercise guidelines for clinically unstable post-polio

Answer 25

- prevent further weakness or improve the status of limb function by energy conservation strategies - exercises generally contraindicated until rest and see stabilization or improvement - non-fatiguing exercise program may be carefully performed

Question 26

stretching considerations for post-polio

Answer 26

- stretching overworked muscles not indicated as it may increase joint instability - any increase ROM must be supported by adequate muscle strength (may not be possible with this population) - gently stretching to combat pain or screaming from occasional overuse

Question 27

How to address cramping pain?

Answer 27

gentle stretching after application of heat

Question 28

How to address MSK pain?

Answer 28

- due to overuse - tendonitis, bursitis, muscle strains, myofascial pain - anti-inflammatory medications

Question 29

How to address biomechanical pain?

Answer 29

- degenerative joint pain, low back pain, nerve compression - posture education - AD and orthotics