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Definition
- New, slowly progressive muscle weakness
- Occurs in individuals with confirmed hx of acute poliomyelitis
- Follows stable period of functioning
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Etiology
- Unknown
- Possible hyperfunctioning of motor neurons
- Long-term overuse at high levels resulting in new denervation
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Characteristics
- New weakness and atrophy, asymmetrical distribution
- Occurs in both initially weak and uninvolved muscles
- Abnormal fatigue: may not be related to activity levels, doesn't recover easily with usual rest periods
- Pain: myalgia, cramping, joint pain with repetitive injury, hypersensitivities
- Decreased function with reduced endurance for routine activities
- Slow progression
- Environmental cold intolerance
- Difficulty in concentration, memory, attention (damage to reticular formation, hypothalamus, dopaminergic neurons (brain fatigue generator model))
- Sleep disturbances
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Examine
- History
- Motor function
- ROM/deformity
- Pain
- Sensory function
- Respiratory function
- Functional status
- Endurance
- Aerobic capacity
- EMG
- Depression/anxiety
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Respiratory Function
- Dyspnea
- Difficulty speaking
- Weak cough
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Examine Endurance
Fatigue is a primary symptom
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Examine Aerobic Capacity
- Use ergometer that involves both UE and LE
- Examples = Schwinn Air-Dyne, discontinuous protocol, submaximal test (ACSM recommendation)
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Examine EMG
- Identify prior anterior horn cell disease and new motor unit pathology
- Denervation changes
- Fasciculations
- Fibrillations
- Increased motor unit amplitude and duration
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Medical Management
- Antidepressants
- Neurotransmitter inhibitors = decreases fatigue and sleep disorders
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PT Goals, Outcomes, and Interventions
- Maintain respiratory function
- Teach energy conservation/relaxation techniques
- Preserve/increase muscle strength (caution against widespread use of strength training - consider pool program)
- Aerobic conditioning (in severe atrophic polio = exercise is contraindicated)
- Maintain/increase function
- Eliminate/control pain
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