How to Recognize and Treat Patients With Post-Polio Syndrome…

As the baby boomers get older, the occurrence of post-polio syndrome (PPS) in the clinic is becoming more prevalent.  Approximately half of the 640,000 polio survivors will be afflicted by post-polio symptoms and it takes about 35 years from the acute case to develop PPS.  With our ability to differentially diagnose in a direct access setting, it is vital that we understand how to recognize signs and symptoms of this disorder.

Below are some helpful guidelines in recognizing post-polio syndrome:

•  A confirmed previous case of poliomyelitis;
•  Neurological and functional recovery after the original polio occurrence;
•  A period of appx. 15 years where neurological and functional stability was maintained;
• Complaints of gradual or abrupt onset of muscle weakness, atrophy, and arbitrary weakness;
• Clinical manifestations including fasciculations, cramps, cold intolerance, joint pain, shortness of breath, dysphagia, and changes in vocals;
• No other medical explanation for the patient’s signs/symptoms.

Treatment for PPS focuses on prevention of further deterioration or weakening of muscles.  Below are a few helpful suggestions:

• Endurance programs that consist of moderately high-performance exercises;
• A muscular training program lasting between 6 weeks to 7 months that contains both isokinetic and isometric exercises;
• Avoid overuse by allotting multiple breaks in the program;
• Conduct treatment in a warm environment or in water;
• Utilize proper orthoses or assistive devices as needed;
• Educate on the importance of losing weight if appropriate;
• Early introduction of non-invasive respiratory aids if needed.

Burk J, Agre JC.  Characteristics and management of Postpolio Syndrome.  JAMA.  2000; 284 (4):  412-414.

Farbu E, Gilbus NE, Barnes MP, Borg K, deVisser M, Driessen A, Howard R, Nollet F, Opara J, Stalberg E.  EFNS guideline on diagnosis and management of Post-Polio syndrome.  Report of an EFNS task force.  European Journal of Neurology.  2006; 13:  795-801.

Ernstoff B, Wetterqvist H, Kvist H, Grimby G.  Endurance Training Effect on Individuals With Post poliomyelitis.  Arch Phys Med Rehabil.  1996; 77:  843-848.

Above article was contributed by Kaitlin Witmer, SPT. Kaitlin is a student PT from Slippery Rock University.