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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
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
____ 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
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
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
Worldwide Polio Epidemic
1900-1954
 12-20 million individuals in world living
with polio today
wow!
_____:

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
_____:

weakness
flaccid
no reflexes
asymmetrical
deformity
sensation intact
original polio sequelae
_____:

new muscle weakness
joint/muscle pain
pain
decreased endurance
fatigue
cold intolerance
respiratory difficulties
post-polio syndrome
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.
ok
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:
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
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
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!
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
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!
Treatment Goals
Promote quality of life through:
 Management of symptoms
 Prevention of complications
 Optimization of functional status
does the fun ever start?
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
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
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!
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
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
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
ok
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
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!
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
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
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
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
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!
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
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
A modern negative pressure
ventilator (iron lung)
hey aqualung
___ / 32nd President Contracted Polio at age 39
while vacationing in Canada.
FDR
• Largely eradicated in the U.S. by ___ .
• Thru vaccination (Salk Injected/Sabin
Oral)
1979

cool kids never have the time
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
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
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
Diagnosis By ___
• Don’t assume that because you had Polio
as a child that all your current problems
and symptoms are PPS
Exclusion
Tip 1
• Understanding the Pathophysiology
Underlying PPS and How it Affects the
Therapy Protocol.
ok
___ Protocol
• Encourage The Patient To Be Open and
Honest With Their History
• Muscle Testing
• Functional Assessment
Rehabilitation
Tip 2
• Understand the Roles and Limitations of
Exercise and ___
Stretching
Tip 3
• Understanding the Need to “Conserve to
____.”
Preserve
Tip 4
• ___ with Area and Regional
Healthcare Professionals who are Experts
with the Complex Issues of PPS
Network
Tip 5
• Take an ____ Approach in Addition
– Bracing
– Fall Prevention
– Support Groups
Educational