Post-Polio Syndrome

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  1. Poliomyelitis/Infantile Paralysis
    • means literally an inflammation of the gray matter of the spinal cord
    • destroyed (nerve cells) in anterior horns of spinal cord and brain stem
  2. Polio Recovery:
    • surviving motor neurons in brain stem and spinal cord extend new branches called axonal sprouts to re-innervate muscle fibers that have lost their motor nerve supply
    • muscular function may be partially, or fully regained if this recovery process is extensive enough
    • these new axonal sprouts end up innervating at least several times the number of muscle fibers that an ordinary motor neuron would normally supply
  3. What is post-polio syndrome?
    new muscle weakness and other symptoms including problems swallowing, breathing, and sleeping occurring at least 15 years after the initial acute infection and lasting more than a year
  4. What are the two general presentations of post-polio syndrome?
    • flu-like, generalized exhaustion that may be associated w/ an increased need for rest and difficulty w/ concentration and memory
    • Muscular: a decline in muscle strength upon exertion; described as muscle fatigability or lack of endurance
  5. post-polio syndrome is a diagnosis of:
  6. What causes post polio syndrome?
    • distal degeneration of the overextended motor nueonrs
    • surviving motor units cannot sustain the increased metabolic demand to contract more often to achieve the same force of contraction
    • the new more fragile terminal axonal sprouts degenerate, producing denervation of the muscle fibers
    • neuromuscular junction transmission defects
    • relative weakness may lead to joint and muscle misuse and overuse aggravated by normal aging changes and motor neuron loss
  7. Peripheral disintegration mode of PPS:
    • new axonal sprouts are not indefinitely stable but rather degenerate over time due to an overexertion phenomenon resulting once again in denervation of muscle fibers
    • Here, the muscle fibers from overly extended motor neurons have been denervated and have ceased to contract
  8. Interventions for post-polio:
    • management of weakness in pps
    • strengthening exercise
    • aerobic exercise
    • stretching to decrease/prevent contractures
    • avoidance of specific muscular overuse
    • bracing
    • weight loss
    • assistive devices
    • energy conservation
  9. Intervention for weakness:
    • increased muscle capacity can improve functional capacity
    • no proof that muscle overuse is contraindicated
    • custom exercise programs dependent on the severity of symptoms and the residual strength of individual muscles
    • must carefully determine individual muscle strength as some may already be functioning at max capacity and exercise could be negative
    • establish level of peak performance by patient history and start at 50% and slowly increase performance as tolerated w/ rest as needed
  10. Assistive Devices
    • very helpful for those experiencing muscle weakness and fatigue
    • orthotic devices including braces
    • canes and crutches
    • manual and electric WC
    • motorized scooters
  11. Management of Fatigue:
    • energy conservation w/
    • increasing convenience and accessibility when doing everyday tasks
    • pacing and taking rest breaks during extended activities
    • relaxation techniques
    • assistive devices
    • weight loss
  12. Intervention for Pain:
    • modifications of lifestyle, environment and tasks
    • modalities
    • strengthening exercises
    • assistive devices
    • orthosis
    • non-steroidal anti-inflammatory medications
  13. Psychological implications:
    • difficulty adjusting to the re-emergence of problems associated w/ polio after a lifetime of adjustment
    • may result in depression and need for education, strategies, and support
Card Set
Post-Polio Syndrome
review of post-polio syndrome lecture 4-23
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