Postpolio Syndrome

Question 1

What is it?

Answer 1

• slow progressive muscle weakness occurring in individuals with a confirmed history of acute polio
• follows a stable period (usually 15 years or more) of functioning

Question 2

etiology

Answer 2

• unknown
• possible hyperfuncitoning of motor neurons; long term overuse at high levels resulting in new denervation

Question 3

Signs and symptoms

Answer 3

• gradual onset of new muscle weakness (with or without atrophy)
• pain
• decreased function with reduced endurance
• slow progression (steady or stepwise)
• environmental cold intolerance
• sleep disturbance
• decreased functional mobility, aerobic capacity, labile exercise BPs

Question 4

History

Answer 4

confirm original acute polio illness
- document onset of present symptoms
- presentation
- course
- chronology

Question 5

motor function

Answer 5

• strength
• atrophy
• muscle fatigue
• muscle twitching or cramps
• identify problem musculataure
• identify functional contractions
• look for spotty involvement/asymmetrical paralysis

Question 6

Pain

Answer 6

muscle pain: check tenderness to touch
Skeletal/soft tissue pain: chronic overuse, poor alignment

Question 7

sensory function

Answer 7

any sensory deficit is due to other etiology
- PPS does not affect sensory

Question 8

endurance/activity levels

Answer 8

fatigue is a primary symptom

Question 9

aerobic capacity

Answer 9

recommend discontinuous protocol
- submax exercise test
- use whole body movement to avoid over working involved muscles

Question 10

what is it critical to do?

Answer 10

rule out other neuromuscular health conditions as well as the influence of age related changes

Question 11

what can EMG identity

Answer 11

prior anterior horn cell disease and new motor unit pathology

Question 12

medical management

Answer 12

• antidepressants ( fluoxetine)
• neurotransmitter inhibitors: decreases fatigue and sleep disorders (serotonin; NE)

Question 13

maintain respiratory function

Answer 13

teach breathing exercises, supportive cough maneuvers, postural drainage as indicated

Question 14

energy conservation techniques

Answer 14

• balance activity with frequent rest periods to decrease fatigue, prevent overwork damage in weakened, denervated muscle
• teach relaxation techniques to maximize rest
• avoid unnecessary activities to maximize important work

Question 15

preserve or increase muscle strength - moderate exercise program

Answer 15

modified strengthening and conditioning; use low intensity, discontinuous non fatiguing exercise with increased rest periods

Question 16

preserve or increase muscle strength - moderate resistance training program

Answer 16

recommended for patients with PPS who had near normal muscle strength and no signs of Moto unit remodeling on EMG

Question 17

aerobic conditioning

Answer 17

• moderate to low level training depending upon class of disease, discontinuous protocol
• similar to treating, use whole body movement (upper/lower ergometry) to avoid overworking involved muscles

Question 18

maintain or increase function

Answer 18

• provide recommendations for lifestyle modification
• minimize abnormal postures, gait deviations