Chapter 2: Postpolio Syndrome

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  1. Definition

    • New, slowly progressive muscle weakness
    • Occurs in individuals with confirmed hx of acute poliomyelitis
    • Follows stable period of functioning 

  2. Etiology

    • Unknown
    • Possible hyperfunctioning of motor neurons
    • Long-term overuse at high levels resulting in new denervation

  3. 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

  4. Examine

    • History
    • Motor function
    • ROM/deformity
    • Pain
    • Sensory function
    • Respiratory function
    • Functional status
    • Endurance
    • Aerobic capacity
    • EMG
    • Depression/anxiety

  5. Respiratory Function

    • Dyspnea
    • Difficulty speaking
    • Weak cough

  6. Examine Endurance

    Fatigue is a primary symptom

  7. Examine Aerobic Capacity

    • Use ergometer that involves both UE and LE
    • Examples = Schwinn Air-Dyne, discontinuous protocol, submaximal test (ACSM recommendation)

  8. Examine EMG

    • Identify prior anterior horn cell disease and new motor unit pathology
    • Denervation changes
    • Fasciculations
    • Fibrillations 
    • Increased motor unit amplitude and duration

  9. Medical Management

    • Antidepressants
    • Neurotransmitter inhibitors = decreases fatigue and sleep disorders 

  10. 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

Card Set:
Chapter 2: Postpolio Syndrome
2015-03-13 18:55:39
Postpolio Syndrome
NPTE: Chapter 2
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