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45 Cards in this Set
- Front
- Back
Overview
CDC, 1952, incidence of Polio peaked in the United States with more than 21,000 paralytic cases Today, very rare in developed countries because of vaccine; good progress being made in developing countries. > 300,000 polio survivors in the US may be at risk of the Post Polio Syndrome, according to the National Institute of Neurological Disorders and Stroke (NINDS) NINDS estimates that the condition affects between 25 percent and 50 percent of these survivors Treatment is aimed at managing the signs and symptoms associated with PPS and increasing quality of life. |
ok
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Polio
Highly contagious virus Caused by small enterovirus entering mouth Acute S & S: Flu-like Attacks the ___ motor neurons of the ____ horns cells |
lower
anterior |
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____ Polio – Clinical picture
Asymptomatic: 90% to 95% Minor illness: 1 to 5 days after exposure: Fever, Malaise, Myalgia, Sore throat, GI upset Major illness: 4 to 10 days: Aseptic meningitis, Fever, Headache, stiff neck, back pain Paralytic disease: 50% of those with major illness After 2 to 5 days of illness Fasciculations: Localized Pain: Intense myalgia, hyperesthesia Weakness Acute dysautonomia Blood pressure instability Cardiac arrhythmia GI: Atony, Constipation Urinary retention Sweating: Increased or Decreased Chronic disease: Permanent Paralysis,Weakness Joint Deformity |
Acute
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Prognosis
30% - recover completely in the first weeks or months 30% mild paralysis . - paralysis. 30% - moderate or severe paralysis. 10% - mortality due to ____ |
respiratory complications or swallowing problems
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post - polio =
deformity focal atrophy (small calf on L, normal on R) when was the vaccine made? |
1954 - note: this is not Creel's trivia test
Salk - 1954 |
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Worldwide Polio Epidemic
1900-1954 12-20 million individuals in world living with polio today |
wow!
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_____:
Signs and symptoms A cluster of disabling signs and symptoms that appear decades — between 10 and 40 years — after the initial illness. Common signs and symptoms include: New muscle weakness in limbs that may have been originally affected or in limbs that didn't seem to have been affected at the time General fatigue and exhaustion with minimal activity Muscle and joint pain Breathing or swallowing problems Sleep-related breathing disorders, such as sleep apnea Decreased tolerance of cold temperatures |
Post Polio Syndrome
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_____:
weakness flaccid no reflexes asymmetrical deformity sensation intact |
original polio sequelae
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_____:
new muscle weakness joint/muscle pain pain decreased endurance fatigue cold intolerance respiratory difficulties |
post-polio syndrome
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Causes
Exact cause unknown. Overuse Hypothesis: A polio infection leaves many motor neurons dead or damaged To compensate, the remaining neurons sprout new fibers that innervate deprived muscle fibers This promotes partial recovery of function but it places added stress on the nerve cell body to nourish the additional fibers Over the years, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers and, eventually, the neuron itself Autoimmune Hypothesis: Another theory is that the initial illness has created an autoimmune reaction, causing the body's immune system to attack normal cells as if they were foreign substances. The amount of evidence surrounding this theory is small compared with the studies supporting the more generally accepted motor neuron degeneration theory. |
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Causes
_____ A polio infection leaves many motor neurons dead or damaged To compensate, the remaining neurons sprout new fibers that innervate deprived muscle fibers This promotes partial recovery of function but it places added stress on the nerve cell body to nourish the additional fibers Over the years, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers and, eventually, the neuron itself |
Overuse Hypothesis:
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Causes
_____: Another theory is that the initial illness has created an autoimmune reaction, causing the body's immune system to attack normal cells as if they were foreign substances. The amount of evidence surrounding this theory is small compared with the studies supporting the more generally accepted motor neuron degeneration theory. |
Autoimmune Hypothesis
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Risk Factors
Severity of initial polio infection. The more severe the initial infection, the more likely the higher the risk of developing PPS Age at onset of initial illness. People who acquired polio as adolescent or adult, rather than as a young child, had an increased risk of developing PPS Recovery. Paradoxically, the greater the recovery after acute polio, the more likely it seems that PPS will develop. Physical activity. Frequent physical activity to ___ or fatigue, may overwork already stressed-out motor neurons and increase the risk of PPS |
the point of exhaustion
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Diagnostic Criteria
Previous diagnosis of polio. Long interval following recovery (10-40 years). Gradual onset. Change in function usually red flag to person with polio. Symptoms last for 1 year. Exclusion of other causes of symptoms: EMG and Nerve conduction velocity tests Imaging (MRI or CT) Decreased or absent tendon reflexes Weakness with no sensory loss Blood analysis Muscle biopsy No other explanation for symptoms |
knowledge!
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Complications
Falls Malnutrition, dehydration, pneumonia. Patients with ___ polio (affects muscles of chewing and swallowing) may have inadequate nutrition and dehydration, as well as aspiration pneumonia Acute respiratory failure. Weakness of the diaphragm and chest muscles may lead to respiratory problems. Obesity, curvature of the spine, anesthesia, prolonged immobility and certain medications (_____) can further decrease breathing ability Osteoporosis. Prolonged immobility and paralysis is often associated with loss of bone density and osteoporosis |
bulbar
benzodiazepines |
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PT Assessment
Daily activities and schedule Fatigue scale Polio Problem List Falls efficacy Pain Musculoskeletal conditions: joint/muscle pain Orthotics - Assistive devices – Wheelchair Posture - Spine Mobility – gait, wheelchair, scooter Functional status – ADLs and IADLs Home environment Possible secondary disease (PD, stroke) |
you can do it!
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Treatment Goals
Promote quality of life through: Management of symptoms Prevention of complications Optimization of functional status |
does the fun ever start?
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Interventions
Energy ___ – most important aspect Fitness program Maintain function without causing further decline – must listen to your patient! Lifestyle and Home modifications Speech therapy. Sleep apnea treatment. Medications? May be used for management of pain and fatigue. Several drugs have been studied as a treatment for PPS fatigue, without clear benefit. Those include: pyridostigmine (Mestinon), amantadine (Symadine, Symmetrel), methylphenidate (Ritalin), bromocriptine (Parlodel) and modafinil (Provigil). |
conservation
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Several drugs have been studied as a treatment for PPS ____, without clear benefit.
Those include: pyridostigmine (Mestinon), amantadine (Symadine, Symmetrel), methylphenidate (Ritalin), bromocriptine (Parlodel) and modafinil (Provigil). |
fatigue
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To exercise, or not?
Symptoms of pain, weakness, and fatigue can result from overuse and misuse of muscles and joints. Symptoms of pain, weakness, and fatigue can result from disuse of muscles and joints. This fact has resulted in debate regarding whether to use exercise as an intervention. |
ok!
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NINDS Recommendations re:
Exercise (2005) “Exercise is ___ and effective when carefully prescribed by experienced health professionals. Exercise should include: The specific muscle groups to be included, The specific muscle groups to be excluded, The type of exercise, together with frequency and duration. |
safe
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NINDS Recommendations re: Exercise (2005):
Precautions: Heavy or intense resistive exercise and weight lifting can be ___ . . . further weaken rather than strengthen. Exercise should be reduced or discontinued if: Additional weakness Excessive fatigue, or Unduly ___ recovery time is noted. |
counterproductive
prolonged |
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Rehabilitation
Energy conservation / time management Exercise (Perceived Exertion) Pool therapy / swimming Orthotics Assistive devices Planning Pain management Falling and plan if one falls Wheelchair or scooter Transfers Bathroom or home environment safety Footwear |
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Prognosis
Evidence suggests that the pathological processes involved are benign. Post-polio syndrome is NOT life-threatening unless there is severe ____ involvement or a ____ disorder. There is on average loss of strength of 1% per year. This represents a rate of natural progression in normal aging. The long-term effects of interventions and treatment are not yet well studied. Presently no intervention has been found to stop the deterioration of surviving neurons. NINDS recommends: Energy Conservation (activity balanced with rest) Proper nutrition and weight control Sufficient sleep and sleep management Avoid unhealthy habits such as smoking Exercise (per guidelines) Proper lifestyle changes Assistive devices, home modifications, etc. |
pulmonary
swallowing |
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Clinical Practice Guidelines
NINDS website – polio information Neurological Rehabilitation, Umphred Clinicaltrials.gov Scientific literature, Trojan et al., 2005 Support groups Websites Paraplegia News |
great resources!
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Poliomyelitis is a ___ disease. There are three types
of poliovirus and many strains of each type. Each with a slightly different capsid protein. The virus enters through the mouth and multiplies in the throat and gastrointestinal tract, then moves into the bloodstream and is carried to the central nervous system where it replicates and destroys the motor neuron cells. Motor neurons control the muscles for swallowing, circulation, respiration, and the trunk, arms, and legs. |
viral
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Human nerve cells have a protruding ___
structure on their surface whose precise function is unknown. When poliovirus encounters the nerve cells, the protruding receptors attach to the virus particle, and infection begins. Once inside the cell, the virus hijacks the cell’s assembly process, and makes thousands of copies of itself in hours. The virus kills the cell and then spreads to infect other cells. |
protein
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Many types of human cells have ___ that
fit the poliovirus; no one knows why the virus favors motor neurons over other cells for replication. • For every 200 or so virus particles that encounter a susceptible cell, only one will successfully enter and replicate. • In tissue culture, poliovirus enters cells and replicates in six to eight hours, yielding 10,000 to 100,000 virus particles per cell. |
receptors
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One way the human immune system protects itself is
by producing antibodies that engage the protein covering of the poliovirus, preventing the virus from interacting with another cell. • There are three types of poliovirus: 1, 2, and 3. ___ is the most virulent and common. Both the ___ vaccines are “trivalent” that is, active against ___ virus types. Type 2 poliovirus has not been detected anywhere in the world since 1999. • A person who gets polio is immune to future infection from the virus type that caused the polio |
Type 1
Salk and Sabin all three |
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Simon Flexner
Isolated the Polio Virus for Lab Study Jonas Salk First to come up with a vaccine for polio Albert B. Sabin Created the first oral polio vaccine |
another creel like question!
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Polio
Consequence range – Barely Noticeable • Some survivors were not even aware – Significant Involvement •Weakness and shortening of one or more arms and legs • Scoliosis • Lasting paralysis • In some cases, respiratory difficulties leading to death |
blah
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Outcomes of poliovirus infection
OutcomeProportion of cases – Asymptomatic 90–95% – Minor illness 4–8% – Non-paralytic aseptic meningitis 1–2% – Paralytic poliomyelitis 0.1–0.5% • Spinal polio 79% of paralytic cases • Bulbospinal polio 19% of paralytic cases • Bulbar polio 2% of paralytic cases |
yo
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A modern negative pressure
ventilator (iron lung) |
hey aqualung
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___ / 32nd President Contracted Polio at age 39
while vacationing in Canada. |
FDR
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• Largely eradicated in the U.S. by ___ .
• Thru vaccination (Salk Injected/Sabin Oral) |
1979
cool kids never have the time |
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Misconception
• “Polio is a thing of the past.” • It has only been recent that Polio is again being discussed in Medical School’s. • Post Polio Syndrome / Sequelae |
sweet
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Post Polio Syndrome / PPS
• Uncommon ___ – Gradual or abrupt onset of neurological weakness with or without extensive fatigue • Increasing Joint and Muscle Pain • New Weakness / Muscle Atrophy • Functional Loss • Cold Intolerance |
Fatigue
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Criteria
• A Confirmed History of Polio • Partial or Fairly Complete Neurological and Functional Recovery After the Acute Episode • Period of at least 15 years with neurological and functional stability • No other ___ |
medical explanation
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Diagnosis By ___
• Don’t assume that because you had Polio as a child that all your current problems and symptoms are PPS |
Exclusion
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Tip 1
• Understanding the Pathophysiology Underlying PPS and How it Affects the Therapy Protocol. |
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___ Protocol
• Encourage The Patient To Be Open and Honest With Their History • Muscle Testing • Functional Assessment |
Rehabilitation
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Tip 2
• Understand the Roles and Limitations of Exercise and ___ |
Stretching
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Tip 3
• Understanding the Need to “Conserve to ____.” |
Preserve
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Tip 4
• ___ with Area and Regional Healthcare Professionals who are Experts with the Complex Issues of PPS |
Network
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Tip 5
• Take an ____ Approach in Addition – Bracing – Fall Prevention – Support Groups |
Educational
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