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32 Cards in this Set
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PPS The name given to the late effects of poliomyelitis. |
Epidemic was from 1910-1959 in The US |
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Polio is a viral infection that attacks the... |
Anterior horns of the SC and results in muscular paralysis |
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Decades after survival 25-40% of pts experience ... |
Fatigue, new mm weakness, loss of functional abilities |
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Criteria for PPS established in 1972 ... |
1. Having had polio based on history 2. A positive neurologic exam or EMG 3. A period of relative stability lasting at least 15 years 4. Development of new neurologic weakness and abnormal fatigue persists for at least a year and is unexplained by any other pathology |
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Records not accurate = number of polio cases only an estimate |
Estimates range from 12-20 million world wide |
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Estimates of 443,000 pts in US may be at risk for PPS |
Severity is related to severity of infection Mild polio=mild PPS |
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Severe polio (use of Iron Lung)= PPS May be just as severe |
PPS shows slow progression over long time period is rarely ode threatening |
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PPS caused by decades of increased metabolic demand made on the body by giant motor units |
These motor units were formed during recovery process from original viral infection |
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After polio virus destroys anterior horn cells, mm fibers innervated by those anterior horn cells are orphaned. |
During recovery, anterior horn cells not destroyed Reinnervate some of these orphaned fibers creating giant motor units |
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This repair process involves branching and cutting back of neural processes |
Repair process continued after the original infection but we time the ability of the body to keep up w changes diminished |
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Stress and overuse of large motor units is hypothesized to lead to distal degeneration of axons |
The body’s original pathology is compounded by age-related changes in NS |
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Because of loss of motor units during normal aging, a person with HO polio may lost some giant motor units |
End result is loss of function in PPS pt |
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Most debilitating problem for PPT pts? |
Fatigue |
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Triad of symptoms |
Fatigue Pain Decline in strength |
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Fatigue characterized as overwhelming tired or exhaustion w only minimal effort Ability to concentrate is affected |
Fatigue may occur at same time as of day and be accompanied by autonomic distress: sweating headaches |
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Defects In neuromuscular transmission caused by degeneration of distal motor unit in PPS May contribute to mm fatigue |
Mm |
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New mm weakness is a hallmark of PPS |
Occurs in mms already involved and in mms that did not clinically show effects of original polio |
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These new mms may have been involved sub clinically based on EMG |
Weakness is ASYMMETRIC, usually PROXIMAL to DISTAL (opposite of ALS) and slowly progressive |
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Mm weakness makes pts susceptible to falls due to impaired balance |
Assist device may be needed |
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Mm and JT pain is common |
Mm pain related to overuse of weak mms- pain and fatigue occur 1-2 days after an activity Lessoned by rest, responds well to pacing activities |
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Mm pain is diffuse, takes long to recover, can lead to atrophy |
Jts May become unstable due to weak mms. Jt and mm pain due to repetitive micro trauma from years of moving misaligned or malaligned jts Jt and mm pain more likely in women w PPS than men |
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COLD INTOLERANCE Due to sympathetic involvement *No cold as modality |
Limbs often cold require extra clothing to minimize heat loss |
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PPT pt w edema |
Can use some cold w extensive pt education. Heat not preferred for edema |
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Pain fatigue weakness = inactivity = cardiopulmonary deconditioning = more fatigue and weakness= loss of function...it’s a a bad cycle |
Original Bulbar involvement can result in affected eating and breathing |
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If polio virus attacked the brain stem, breathing could be compromised w PPS (diaphragm and intercostals) |
SOB often a complaint Disrupted sleep Risks for falls and loss of bone density and injuries |
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Postural abnormalities Forward head Forward leaning trunk Absent lumber curve Uneven pelvic base Scoliosis Greater chance of osteoarthritis |
Symptom management is best |
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PPS pts benefit from physical activity Pts exhibit asymmetrical mm weakness |
Short and submaximal exercise BORG scale rating of 14 = hard Every other day schedule |
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Don’t stretch overworked mms due to potential Jt instability |
Pt may have delicate balance of ligamentouts / muscular tightness substituted for weak or absent musculature |
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Mild shortening of plantarflexors may increase knee stability when quadriceps are weak ::: don’t stretch heel cord! |
Mm stretching must be supported by strength: may not be possible for PPS pt |
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Three types of pain |
Cramping Musculoskeletal Biomechanical Gentle stretching ok after heat application when cramping is present |
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Most frequent type of pain is from biomechanical changes resulting from degenerative Jt diseases, low back pain, nerve compression |
Orthosis May be indicated; most common; Shoe lifts AFOs KAFOs |
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Lifestyle modification is necessary |
Energy conservation: may be the most important aspect of management *** Activity pacing |
