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Is Polio an UMN issue or LMN issue?
LMN disorder
- Muscle atrophy
- Generalized and muscular fatigue
- Muscular weakness
- Pain from joint degeneration
- Skeletal deformity
- LMN s/s
Presentation of PPS
- Fatigue
- Assess bilaterally even if the initial disease was unilateral
PT examination for PPS
What is the cause of PPS?
Unknown -- related to severity of initial illness, related to burden over time on surviving anterior horn cells
New neuro symptoms affecting polio survivors 15-30 years after initial infection
Post-polio syndrome
- Avoid overworking weakened areas
- Recommendation: mild to moderate activities with low reps and sets
- Exercises for flexibility and endurance
- Assistive device training
- Use of orthotics
- Lifestyle modification
- Energy conservation techniques
PT interventions for PPS
What are the (3) criteria for diagnosis of PPS?
1. History of polio
2. Initial strength improvement after paralysis
3. At least 15 years of stability
- No specific test
- Can be difficult to diagnosis due to vague and non-specific subjective symptoms
- Criteria: history of polio, initial strength improvement after paralysis, at least 15 years (typically 25-35) of stability
Diagnosis of PPS
- Carefully monitor symptoms and functional decline in this population
- Patients own behavior is an emerging factor in symptom severity
- Special attention should be given to a patients perceived need of assistive technology because age, family factors and need for assistive technology are the 3 most important factors affecting happiness for patients with PPS
POC - Considerations for PPS
- 25-60% of polio survivors eventually develop PPS
- Affected by weight gain, muscle overuse, age, and medical comorbidities
- Unaffected by gender, time since polio, symptom status, and residual weakness
- Fatigue is severe and persistent - affects patients physically and psychologically
Prognosis of PPS
- No medications reverse the physiological changes
- Meds can address fatigue, depression and pain
- IVIg may improve QOL, functional outcomes and pain
Medical treatment for PPS
What are the (3) most important factors affecting happiness in PPS?
1. Age
2. Family factors
3. Need for assistive technology
Post polio QOL scale
Disease specific outcome measures
- Overuse weakness does not occur in muscles with an MMT grade of 3 or greater out of 5
- WAIT UNTIL MUSCLE HAS ANTIGRAVITY STRENGTH BEFORE STRESSING
- Moderate resistance exercises can increase strength in muscles with an MMT grade 3 or higher out of 5
- Strength gains are proportional to initial muscle strength
- Heavy eccentric exercise should be avoided
- Avoid neuromuscular electrical stimulation
- Monitor fatigue !! DO NOT OVERWORK !!
Exercise and PPS