Please enable JavaScript.
Coggle requires JavaScript to display documents.
Post-Polio Syndrome (PT Intervention (exercises done at minimum to…
Post-Polio Syndrome
PT Intervention
(exercises done at minimum to moderate intensity- exercises should
not
cause fatigue, muscle soreness or pain)
Shoe lift measurement and placement
Cardiovascular endurance/aerobic training:
treadmill, cycling, walking, stair climbing, aquatic exercise
Aerobic activity 3-4 times per week building up to a total
of 30 minutes each session.
Pt education on energy conservation techniques
Pt education on device usage (leg brace and cane)
Stretching
To improve flexibility, decrease pain, reduce risk of falls
DBEs
Diaphragmatic breathing, summed breathing
Strengthening
Spine/core strengthening
Help address scoliosis impairments
Resistance training LE/UE: STS, bridging, modified lunges, Seated: rows, bicep curls, triceps
Strengthen muscles that can move through full range of motion
ICF
Body Function/Structure
Generalized paralysis
Ventilatory compromise
Moderately severe scoliosis
Possibly caused from 3 cm LLD or skeletal deformities from PPS
Increased fatigue, pain and muscle weakness in both legs and right arm
Activities
Difficulty with stair climbing, ADLs, difficulty getting up in the morning, extremely tired by mid-afternoon, SOB after intense exercises, Can only walk one block
Environment
Lives with wife and 2 children in a small town
Participation
Watching polo and Law & Order, difficulty going to work, fancy dinners and vacations,
Personal Factors
55 y.o Male, Lawyer, 22 lbs overweight
PMH: Poliomyelitis 48 years ago, (-) smoking hx
Uses long leg brace on left leg and cane
Pathophysiology
Symptoms:
Progressive muscle and joint weakness
Pain
Fatigue and exhaustion with minimal activity
Muscle atrophy
Breathing or swallowing problems
Sleep-related breathing disorders ex. sleep apnea
Decreased tolerance to cold temperatures
Specific cause = unknown
Pt had a history of paralytic poliomyelitis with evidence of motor neuron loss and an interval of stable neuromuscular function
Theory
= post initial infection -->lasting degeneration of nerve terminals within motor units remains --> Motor units become enlarged due to compensation from lost/degerated neurons (sprouting) --> use of these enlarged fibers causes an increased stress to neuron after years of use --> units are unable to maintain metabolic demand of the new sprouts --> slow degeneration of motor units
Restoration of nerve function may occur in some fibers a second time but eventually nerve terminals malfunction and lasting weakness occurs
Risk Factors: Severity of initial infection, Pt's with mild symptoms experienced a greater recovery, Age of onset- younger the age of the child when infected, higher the chance of developing, Excessive physical activity post-recovery and presently
Medical Management
Diagnostic Testing
Important Criteria
: previous diagnosis of polio, long interval after recovery and the gradual onset of weakness, symptoms that persist for at least a year
Diagnosis of Exclusion:
Muscle Biopsy, MRI, neuroimaging, spinal fluid analysis can all be useful in helping establish the diagnosis of Post-polio syndrome, but none are definitive diagnostic tests.
Treatment
Medications
Paracetamol (analgesiac), Ibuprofen, Lamotrigine (anti-convulsant), intravenous immunoglobulin, Pyridostigmine (Anticholinesterase)
PT Evaluation
Hx, Auscultation, Pain Scale, RPE, Gross MMT, Gross Movement Assessment (transfers, bed mobility, ambulation) 2MWT, walk and talk test, Breathing Assessment (MARM + 4-Question Breathing Outcome Measure), stress index questionnaire
