Post-Polio Syndrome

Polio Mother of the Year, 1957

If you work with older adults, you have a good possibility of encountering a patient with post-polio syndrome, or PPS (estimated to affect 22-68% of survivors, with a prevalence of 1.6 million).

PPS appears in survivors of polio approximately 30 years after the initial diagnosis of polio. It is described as a recent weakening of muscles, both those initially affected by polio as well as those that were not. Symptoms include progressive weakness, atrophy, and fatigue. It can also affect respiratory and swallowing muscles. Additionally, an increase in inflammatory cells has been found on approximately half of PPS biopsies.

The cause of PPS is not known. There are two major theories: the neurons affected by polio continue to sprout new axons but is eventually unable to maintain them, or the polio virus is reactivated. Other theories include a different enterovirus affects the motor neurons, or PPS is just normal weakness that occurs with aging that is more noticeable than the general population.

Symptoms: fatigue especially in the early afternoon, decreasing after a brief rest; somnolence, difficulty with concentration or memory, decreased endurance, increased muscle fatigability, muscle weakness, muscle pain (very common), gait disturbance (due to weakness, pain, OA, joint instability), respiratory problems for those who initially experienced respiratory muscle weakness (but can also be due to new weakness, scoliosis, poor posture or reduced cardiovascular sufficiency), swallowing problems, autonomic dysfunction, sleep apnea, and flat-back syndrome. Additionally, fasciculations may sometimes be observed in atrophied muscles.

There is limited research on a rehabilitation program for patients with PPS. However in general, strengthening exercises should not be done to fatigue or be heavy/ intense. Consider water exercise, group training, patient education, and fitting and training for assistive devices as necessary. Cardiopulmonary endurance training is also recommended. A great resource is the EFNS guideline on diagnosis and management of post-polio syndrome – Report of an EFNS task force which is from the National Guideline Clearinghouse.  Additionally, here are some abstracts of studies or reviews I hope to get access to which I found in a Pubmed search:

References:
1. NINDS – http://www.ninds.nih.gov/disorders/post_polio/detail_post_polio.htm
2. eMedicine – http://emedicine.medscape.com/article/306920-overview
3. EFNS guideline – http://www.guideline.gov/content.aspx?id=10465

Photo credit: Polio Mother of the Year, 1957, originally uploaded by nicco.

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