Post Polio Syndrome PPS by jennyyingdi


									                   Review 25v3: Post Polio Syndrome (PPS)

Overview: PPS is characterized as a “new slowly progressing muscle weakness
occurring in individuals with a confirmed history of acute poliomyelitis after a prolonged
period of stable functioning.”3 Defining characteristics are abnormal fatigue, asymmetry,
decreased aerobic capacity and muscle weakness.

                                       Post-Polio Syndrome (PPS)
Age               at least 40 yrs. old
Gender            both
Medical           history of acute poliomyelitis as children
Surgical          none specifically
History               But may have:
                             joint replacement (non specific)
                             tendon surgeries
Medications       Antidepressants: Prozac, Elavil

                  Neurotransmitter Inhibitors: serotonin, nor-epinephrine
Pain              Type: Cramping
                         Joint pain – neck, shoulders, back
Sensation         Sensation is not impaired in PPS
                        if it is impaired there is another pathology
Impairments       Decreased strength and endurance
Functional        Decreased endurance for ADLs and work capacity
Disabilities      Might have permanent muscle weakness or paralysis after childhood
                         poliomyelitis which might leave patient with various disabilities
Observations      Pt. might be using orthotics and/or Loftstrand crutches after muscles
                  have been permanently weakened after childhood bout of
Palpation         n/a
AROM              limitation determined by individual’s degree of muscle weakness
                         for that joint
PROM              Should not be affected but:
                        limitation determined by any joint replacement surgeries
                         individual has had
Strength          Asymmetrical weakness
Motor Control,    Muscle atrophy
Tone,             Muscle contractions
Coordination      Muscle paralysis
Special Tests     EMG: looks for new motor unit pathology
                Test to rule out any other suspected psychiatric, neurologic,
                     orthopedic or medical diagnosis.



                Manual muscle testing

Imaging         Chest X-rays if respiratory involvement present
Items from      past history of poliomyelitis
PT diagnosis/   -decreased endurance
Problem list    -decreased strength
                -decreased ROM due to decreased strength
                -gait deviations due to decreased weight
                -decreased ability to climb stairs
                -increased fatigability
                -decreased lung function – only in some cases
                -decreased ability to cough up sputum – only in some cases
                -presence of overuse injuries

PT              Energy conservation techniques
Interventions          - try to get PT scheduled in morning as patient will tire as day
                                 goes on
                       - patient should try and sit as much as possible
                       - plan frequent rest periods throughout day
                       - alternate strenuous tasks with easier ones
                General Body Conditioning
                       - should be non-exhaustive
                       - never exercise to point of fatigue
                       - monitor vital signs before, during, and after activity
                       - aim to improve endurance
                       - aim to improve work capacity
                Equipment Needs
                       - orthosis
                       - crutches
                       - home and/or work modifications
Precautions     do not overwork patient
Prognosis       Progressive disease
                        - periods of up to 10 years have been reported where there is no
                                  decline in function
Red Flags       - problems with sensation
                - diaphragm can become paralyzed with disease progression
Other             - please see Box 38-8 : Special Implications for the P.T. regarding
                  Post-polio syndrome in Pathology: Implications for Therapists p. 1162
                  - please see Box 8-2 for Tips on Energy Conservation in Pathology:
                  Implications for Therapists p. 260

1. Goodman, Fuller, Boissonnault. Pathology: Implications for the Physical Therapist.
       Second Edition. Philadelphia, PA. Saunders, 2003. Pages 1161-1163.

2. Hillegass, Sadowsky. Essentials of Cardiopulmonary Physical Therapy. Second
        Edition. Philadelphia, Pa. Saunders, 2001. Pages 223-224.

3. O’Sullivan, Siegelman. National Physical Therapy Examination Review and Study
       Guide. Evanston, IL. International Educational Resources, 2007. Pages 124-125.

Does PT affect the long term outcome?

        Post polio syndrome is a progressive disease and as such, PT cannot affect the
fact that the person will gradually become weaker and face the loss of endurance. PT can
affect the quality of life of that person for the long term. By instructing the patient in
energy conservation techniques and providing guidelines for general conditioning,
physical therapy can relieve or lessen, to some extent, some of the more common
complaints of patients who are diagnosed with post polio syndrome.

1. 1. Goodman, Fuller, Boissonnault. Pathology: Implications for the Physical Therapist.
        Second Edition. Philadelphia, PA. Saunders, 2003. Pages 1161-1163.

2. McNaughton, H; McPherson, K. Problems Occurring Late After Poliomyelitis: A
        Rehabilitation Approach. Critical Reviews in Physical and Rehabilitation
        Medicine. 2003; 15(3&4): 295-308
 3. At least 3 citations were requested in the assignment

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