Download presentation
Presentation is loading. Please wait.
1
Exercise in Post-Polio Syndrome A New Classification
Anne C. Gawne, MD Director Post-polio Program Roosevelt Warm Springs Institute for Rehabilitation
2
Benefits of Exercise Increase strength Increase Cardiovascular Fitness
Decrease Weight and Cholesterol Improve sense of Well being
3
Rationale/Problems in PPS
Exercise may be harmful Not all limbs are affected equally Current protocols don’t quantify involvement Need to enhance communication between doctor and therapists
4
How to use Classification
Determine Classification for each limb Prescribe individualized limb-specific exercise program, using the least affected limbs Follow-up periodically to assess strength and function, modifying exercise program as needed
5
Classification Elements
Remote history- Extent of original polio Recent History- New neurological Symptoms Physical Exam- Musculoskeletal,Neurological EMG/NCS- Standard Protocol Exercise- Limb Specific Recommendations Note-Classification refers to limbs not to person
6
NRH Limb Classification For Exercise
1 No Polio 2 Subclinical Polio 3 Clinically Stable Polio 4 Clinically Unstable Polio 5 Atrophic Polio
7
Class 1 - No Polio Remote history No weakness
Recent history No new weakness Physical Exam Good to Normal strength normal sensation and reflexes EMG/NCS Normal
8
Class 2- Subclinical Polio
Remote history No weakness or if weak, full recovery Recent history No new weakness Physical Exam Good to normal strength, sensation and reflexes EMG/NCS Evidence of old Polio
9
Class 3 -Clinically Stable Polio
Remote history Weakness with variable recovery Recent history No new weakness Physical Exam Poor to good strength, normal sensation normal to decreased reflexes EMG/NCS Evidence of old polio
10
Class 4- Clinically Unstable Polio
Remote history Weakness with variable recovery Recent history New weakness Physical Exam Poor to good strength, normal sensation and normal to decreased reflexes EMG/NCS Evidence of old polio
11
Class 5- Atrophic Polio Remote history Weakness with little recovery
Recent history May have new weakness Physical Exam Trace to poor strength, atrophy normal sensation and decreased reflexes EMG/NCS Evidence of old polio decreased insertional activity, few motor units
12
Summary Class of Polio Remote History Recent History
Physical Examination Neurological Examination I No clinical No weakness No new weakness Good-to-normal strength, normal sensation and reflexes, no atrophy. Normal using standard screening examination. II Sub-clinical No weakness or, if affected, full clinical recovery. Chronic denervation consistent with anterior horn cell disease, no evidence of acute denervation III Clinically stable Weakness with variable recovery. Poor-to-good strength, normal sensation, normal-to-decreased reflexes, may have atrophy. Chronic denervation consistent with anterior horn cell disease, may have evidence of acute denervation. IV Clinically unstable New weakness V Severely Atrophic Weakness with little recovery. May have new weakness Trace-to-poor strength, normal sensation, areflexic, severe atrophy. Decreased insertional activity, few to no motor unit action potentials, may have acute denervation.
13
General Exercise Recommendations
Stretching-Active Range of Motion(AROM) or Passive Range of Motion (PROM) Warm up Strengthening Exercises Aerobic Exercises Cool Down
14
ACSM Exercise Recommendations
Frequency X /Week Duration Minutes Intensity % Of Maximum Heart Rate ( 220-age)
15
Class 1 Exercises Active ROM/Passive ROM Warm Up
Strengthening Exercises- 3 sets of 10 at 10reps max Aerobic exercises 3-5 days/week 15-30 min at % of maximum HR Cool down
16
Class 1 Sample Exercises
Swimming yards/minute Walking 5-6 MPH Bicycle Riding MPH
17
Class 2 Exercises Warm Up
Strengthening Exercises- Use modified Class 1 program Active ROM/Passive ROM Aerobic exercises 3 days/week min at 80 % of maximum HR Pacing- Perform 4-5 minutes, rest 1 minute Cool down Modify if new weakness fatigue or pain
18
Class 2 Sample Exercises
Swimming 25 yards/Min Walking 4-5 MPH Bicycle riding MPH
19
Class 3 Exercises Warm Up Active ROM/Passive ROM
Strengthening Exercises-Non fatigueing/paced Aerobic exercises 3 days/week(alternate) 15 min at 60 % of maximum HR Pacing- Perform2-3 minutes rest 1 minute Cool down Modify if new weakness fatigue or pain
20
Class 3 Sample Exercises
Swimming 20 Yds/min Walking 4MPH Bicycle Riding 10MPH
21
Class 4 Exercises Passive ROM
Trial of rest to exclude overuse weakness Aerobic exercises only in Activities of Daily Living (ADLS) If overuse is excluded, trial of nonfatiguing, paced exercise ( like class 3)
22
Class 4 Sample Exercises
No cardiopulmonary aerobic exercise Use of brace, Wheel chair, Scooter If overuse weakness excluded trial of nonfatigueing exercise
23
Class 5 Exercises PROM Usually Bracing, Wheelchair is needed
24
Results of NRH classification of 100 consecutive patients
25
NRH Classification of 100 Patients
Similar presentations
