Post-Polio Syndrome

Question 1

describe PPS

Answer 1

a neurological disease characterized by new and progressive muscle weakness many years following poliovirus infection

Question 2

is PPS contagious

Answer 2

no, only affects polio survivors years after infection

Question 3

what is the etiology of PPS

Answer 3

• idiopathic and unclear cause
• results from graduate deterioration of motor neurons in SC and brainstem that were affected by poliovirus
• polio virus damages specific neurons, surviving nerve cells sprout new terminals that connect with other muscle fibers; following recovery, there is a deterioration of neurons over time leading to muscle weakness; N terminals breakdown

Question 4

S/S of PPS

Answer 4

new, gradual muscle weakness
muscle atrophy
loss of muscle function
fatigue/exhaustion
joint degeneration and worsening pain over time
increase in spinal curvature (scoliosis)
breathing/swallowing issues
sleep related-breathing disorders

Question 5

how many people are affected and when does it normally occur

Answer 5

25-40/100 polio survivors
15-40 years post initial infection

Question 6

how to dx PPS

Answer 6

• no specific test
• physical exam, medical hx review, exclusion of other conditions
• previous polio dx, long interval of recovery after initial polio infection, gradual onset of sx (mm weakness)

Question 7

PPS lab tests to help r/o other conditions

Answer 7

EMG
MRI/CT
muscle biopsy
blood tests - pps will typically have normal lab values

Question 8

how to tx PPS

Answer 8

• no cure
• manage sx
• mutlidisciplinary approach
• pain medications to manage sx
• proper nutrition, regular exercise as appropriate

Question 9

prognosis PPS

Answer 9

• decline in mm function can affect respiratory function and swallowing
• typically normal life expectancies

Question 10

differential dx list PPS

Answer 10

cervical radiculopathy
compression neuropathy
spinal cord lesion
hereditary NM disease
disuse weakness

Question 11

red flags PPS

Answer 11

progressive/worsening mm weakness/pain
breathing/lung issues
sensitivity to cold
abnormal mm fatigability

Question 12

EFNS Diagnostic Criteria for PPS

Answer 12

• confirmed hx of acute paralytic polio with signs of denervation on electromyogram
• partial or complete recovery from initial infection follwed by at least 15 years of stable neurologic function
• gradual or sudden onset of progressive and persistent mm weakness or abnormal mm fatigability
• sx persist for at least 1 year
• exclusion of other neuromuscular, medical or orthopedic conditions

Question 13

PT POC/interventions PPS

Answer 13

gentle stretching, aerobic training, gait training, mm strengthening (as indicated), aquatic therapy

DO NOT push pt to point of fatigue - can further damage motor units