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Phinoj K Abraham
IInd MOTh Student
All India Institute of Physical Medicine & Rehabilitation,
(AIIPM&R) Mumbai


Acute Paralytic Polio
 Stages



Post Polio Syndrome (PPS)









Definition
Epidemiology
Causes
Risk facto...


Virus [ Burnhilde, Lansing & Leon]



Contaminated water / food



Affinity for motor (muscle) nerves



Kills / Inj...


There are four recognized stages:
 Acute Paralysis and/or weakness

 Recovery and Rehabilitation
 Neurological Stabi...


A Neurological condition



New symptoms many years after acute polio typically 30-50 yrs.



New symptoms appear aft...
Confirmed history of polio
Partial or fairly complete neurological and functional
recovery after the acute episode.
 Peri...


The frequency of PPS ranges between 15%-80%,

Natural history data from post-polio clinic in Houston, Texas. A =
birth;...


The pathological changes that cause the
symptoms of PPS are not well understood



There are four different theories o...
Accelerated natural ageing
Falling nerve to muscle motor unit ratio
Inflammation and active immune response
Co-morbidity:
...
10
Halstead, L. S 1988






Higher age at onset of poliomyelitis
The association with other diseases may indicate
that a chronic physical st...
Theories:
Remaining healthy
motor neurons can no
longer maintain new
sprouts
 Decompensation /
chronic denervation
and re...


Motor neuronal loss
due to reactivation of a
persistent latent virus.



Infection of the polio
survivor’s motor
neuro...
Common
 Fatigue
 New Weakness
 Decreased endurance
 Muscle & joint pain
 Loss of function

Less common
 Muscle atrop...


Post Polio Fatigue
 Central (evolved from CNS)
▪ Difficulty regarding cognition, concentration, memory
attention, main...


Extremely prevalent in PPS



Deep aching pain



Myofascial pain syndrome / Fibromyalgia



Small number of patient...


Weakness and Functional Loss.
 focal neurological disease such as a radiculopathy, focal

compressive neuropathy, or s...
Medical management
 Evaluation
 Confirmation of previous Paralytic Polio
 Exclusion of other causes of new symptoms


...


Rehabilitative
 Interdisciplinary team

assessment
▪ Physician, OT, PT,
SLP,P&O, SW, Respiratory
Therapist

 Goal set...




OT interventions are tasks or activities that
promote health and improve occupational
performance .
Role of OT in PP...


Interventions are
 Orthoses for the U/E (e.g. splints )
 Assistive technology

 Modifications at home and work
 Lif...


Energy conservation techniques



Life style changes



Regular rest periods or naps during the day



Pacing (rest ...


Most effective treatments for pain include:
 Heat
 Massage
 Gentle exercise
 Education
 Stretching
 Orthoses and ...




Post-polio syndrome is not life-threatening
unless there is severe pulmonary involvement
or a swallowing disorder.
T...
1.
2.

3.

4.

5.

Halstead LS. 1991. Assessment and differential diagnosis for
post-polio syndrome. Orthopedics. 14(11):1...




Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio
M, Aloisio A, Savettieri G. Prevalence and risk factors...
27
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Occupational Therapy management for Post polio syndrome

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A Brief presentation about Occupational Therapy management for Post polio syndrome (PPS)

Published in: Health & Medicine

Occupational Therapy management for Post polio syndrome

  1. 1. Phinoj K Abraham IInd MOTh Student All India Institute of Physical Medicine & Rehabilitation, (AIIPM&R) Mumbai
  2. 2.  Acute Paralytic Polio  Stages  Post Polio Syndrome (PPS)         Definition Epidemiology Causes Risk factors Path physiology Clinical Features Management Prognosis 2
  3. 3.  Virus [ Burnhilde, Lansing & Leon]  Contaminated water / food  Affinity for motor (muscle) nerves  Kills / Injures motor nerves  Results in weakness / paralysis 3
  4. 4.  There are four recognized stages:  Acute Paralysis and/or weakness  Recovery and Rehabilitation  Neurological Stability  Post Polio Syndrome / Sequelae 4
  5. 5.  A Neurological condition  New symptoms many years after acute polio typically 30-50 yrs.  New symptoms appear after a period of neurological stability  Major sxs- New weakness, loss of function, intense fatigue, pain in muscles / joints 5
  6. 6. Confirmed history of polio Partial or fairly complete neurological and functional recovery after the acute episode.  Period of at least 15 years with neurological and functional stability  Two or more of the following health problems occurring after the stable period:          Extensive fatigue Muscle and or joint pain New weakness in muscles previously affected or unaffected New muscle atrophy Functional loss Cold intolerance No other medical explanation found Halstead LS. 1991 6
  7. 7.  The frequency of PPS ranges between 15%-80%, Natural history data from post-polio clinic in Houston, Texas. A = birth; B = onset of polio; C = maximum recovery; D = onset of new health problems; E = time of evaluation; F = death. (Halstead, L. S. and Rossi, C. D 1987) 7
  8. 8.  The pathological changes that cause the symptoms of PPS are not well understood  There are four different theories on the cause of PPS:  Disintegration of overused motor units  Reactivation of Polio virus  Immune system dysfunction  Neural loss due to ageing 8
  9. 9. Accelerated natural ageing Falling nerve to muscle motor unit ratio Inflammation and active immune response Co-morbidity:  Orthopaedic problems  Radiculopathy and entrapment neuropathy  Respiratory failure  General medical problems  PPS is more likely with  Increasing age;  The more severe the initial weakness was  The more time that elapses after the attack of polio     9
  10. 10. 10 Halstead, L. S 1988
  11. 11.     Higher age at onset of poliomyelitis The association with other diseases may indicate that a chronic physical stress, particularly in already weak motor units, can contribute to the development of signs and symptoms of PPS Poor Socio-economic conditions (Ragonese P et al) Individuals who had polio exhibit "Type A" behavior and experience chronic stress (Richard L. Bruno et al) 11
  12. 12. Theories: Remaining healthy motor neurons can no longer maintain new sprouts  Decompensation / chronic denervation and reinervation process.  Denervation exceeds reinervation  Dalakas, M. C., et al 1985 12
  13. 13.  Motor neuronal loss due to reactivation of a persistent latent virus.  Infection of the polio survivor’s motor neuron by a different enterovirus  Loss of strength associated with aging, in already weakened muscles Dalakas, M. C., et al 1985 13
  14. 14. Common  Fatigue  New Weakness  Decreased endurance  Muscle & joint pain  Loss of function Less common  Muscle atrophy  Respiratory problems  Swallowing problems  Cold intolerance  Sleep apnoea  Gait disturbance  Climbing Stairs  Dressing  (Activities that require repetitive muscular contraction) Julie K Silver, Anne C Gawne 2004 14
  15. 15.  Post Polio Fatigue  Central (evolved from CNS) ▪ Difficulty regarding cognition, concentration, memory attention, maintaining wakefulness (because of the affectation of RAS, Basal Ganglia etc..)  Peripheral (evolving from the peripheral nerves i.e., the motor unit.) ▪ Muscle weakness  According to Schanke and Stanghelle (2001), physical, peripheral fatigue was greater problem for the patients than mental, central Fatigue 15
  16. 16.  Extremely prevalent in PPS  Deep aching pain  Myofascial pain syndrome / Fibromyalgia  Small number of patients have muscle tenderness on palpation Julie K Silver, Anne C Gawne 2004 16
  17. 17.  Weakness and Functional Loss.  focal neurological disease such as a radiculopathy, focal compressive neuropathy, or spinal cord lesion and medical causes of neuropathy such as diabetes, thyroid disease, uremia, alcohol, toxins, and, uncommonly, heredi tary neuromuscular disease.  Fatigue.  anemia, chronic infections, collagen disorders, thyroid disease, diabetes, cancer, depression .  Pain.  osteoarthritis, bursitis, tendinitis, and myofascial pain polymyalgia rheumatica, fibromyalgia, polymyositis, and rheumatoid arthritis 17
  18. 18. Medical management  Evaluation  Confirmation of previous Paralytic Polio  Exclusion of other causes of new symptoms  Medications  No well-proven pharmacologic treatment for this ▪ Pyridostigmine – fatigue (effectiveness ?) ▪ Amantadine (Anti viral agent) effectiveness ? ▪ High dose Prednisone (no significant improvement in M Strength, however a trend to an increse in isometric strength)  Other symptomatic management 18
  19. 19.  Rehabilitative  Interdisciplinary team assessment ▪ Physician, OT, PT, SLP,P&O, SW, Respiratory Therapist  Goal setting  Treat ment Planning & intervention ▪ Management of Weakness ▪ Management of Fatigue ▪ Management of Pain For the assessment of Fatigue 19
  20. 20.   OT interventions are tasks or activities that promote health and improve occupational performance . Role of OT in PPS  Exercise program that involves the U/E  Prevention of overuse injuries  Treatment of any existing arm problems  Education about the principles of energy conservation 20
  21. 21.  Interventions are  Orthoses for the U/E (e.g. splints )  Assistive technology  Modifications at home and work  Lifestyle modification  Exercise program  Discharge and follow-up MOYERS P et al .AJOT 53:251-289,1999 21
  22. 22.  Energy conservation techniques  Life style changes  Regular rest periods or naps during the day  Pacing (rest periods during activity)  Improvement of sleep ( e. g relaxation techniques)  Avoidance of excessive fatigue 22
  23. 23.  Most effective treatments for pain include:  Heat  Massage  Gentle exercise  Education  Stretching  Orthoses and Walking aids  Re-education of Movement 23
  24. 24.   Post-polio syndrome is not life-threatening unless there is severe pulmonary involvement or a swallowing disorder. The symptoms are manageable and with proper measures quality of life can remain good. 24
  25. 25. 1. 2. 3. 4. 5. Halstead LS. 1991. Assessment and differential diagnosis for post-polio syndrome. Orthopedics. 14(11):1209. Halstead, L. S. and Rossi, C. D., Post-polio syndrome: clinical experience with 132 consecutive outpatients, in Research and Clinical Aspects of the Late Effects of Poliomyelitis, Halstead, L. S. and Weichers, D. O., Eds., March of Dimes Birth Defects Foundation, 23(4), White Plains, NY, 1987, 13-26. Halstead, L. S., Late complications of poliomyelitis, in Rehabilitation Medicine, Goodgold, J., Ed., CV. Mosby, Washington, D.C., 1988, 328-340. Dalakas, M. C., Sever, J. L., Fletcher, M., Madden, D. L., Papadopoulos, N., Shekarchi, I., and Albrecht, P., Neuromuscular symptoms in patients with old poliomyelitis: clinical, virological and immunological studies, in Late Effects of Poliomyelitis, Halstead, L. S. and Weichers, D. O., Eds., Symposia Foundation, Miami, FL, 1985, 73-90. Julie K Silver, Anne C Gawne 2004 Post Polio Syndrome p 5 25
  26. 26.   Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio M, Aloisio A, Savettieri G. Prevalence and risk factors of postpolio syndrome in a cohort of polio survivors. J Neurol Sci. 2005 Sep 15;236(1-2):31-5. Stress and "Type A" Behavior as Precipitants of Post-Polio Sequelae: The Felician/Columbia Survey Richard L. Bruno, PhD, and Nancy M. Frick, MDiv, LhD 26
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