Post Polio Syndrome - Management & Treatment in Primary

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the Post Polio syndrome Acute Poliomyelitis Dr John Latham Before discussing the Post Polio Syndrome it is worth reminding ourselves of the original disease poliomyelitis and its effects on the young patients who developed it. Polio is mainly a disease of children and young adults caused by polio enterovirus type 1, 2 or 3. This much feared illness occurred in epidemics, usually in summertime in Europe and America. The last great polio epidemic was in the mid 1950s in Ireland (e.g. Cork 1956) as well as the rest of Europe and America. 1 The inactivated polio vaccine developed by Jonas Salk was available in 1955, and the oral polio (attenuated live) was available in 1962 developed by Albert Sabin. Following the widespread use of these vaccines, acute polio in the developed world has become a rarity. It is estimated that there are approximately 7,500 survivors of polio living in the Republic of Ireland at present. Most of these people are middle aged and becoming elderly. Each general practitioner with a personal list of 2,000 may have 2 or 3 survivors of polio in his/her practice. Infection Polio is caused by an enterovirus of high infectivity whose main route of infection is via the human gastrointestinal tract. Infection is oral and the virus multiplies in the gut for one to three weeks when it is either contained by an immune response or a viraemic phase occurs. The virus is excreted in the faeces for a number of weeks and in saliva for some days. Infection rates are very high but it is likely that 95% of all infections are asymptomatic or cause a flu-like illness. PPS Mngt and Treat.indb 1 02/07/2007 16:07:48
2 Post Polio Syndrome Acute Paralytic Polio It is not known why some patients developed spinal polio while others suffered a flu-like illness with no neurological sequelae. 2 Acute spinal polio is characterised by asymmetric paralysis of muscles served by motor units originating in spinal cord anterior horn cells which have been damaged or killed by the polio virus. This paralysis is often very sudden and sometimes very severe, usually involving the lower limbs and is often maximal after 48 hours. There is also a bulbar form of acute polio which causes paralysis of respiratory muscles and those of deglutition; this had a particularly high mortality and frequently required ventilation (tracheostomy and positive pressure ventilation or negative pressure ventilation, e.g. the body encasing “iron lung”). During the acute phase of polio, strict bed rest was sometimes used to prevent further spread of paralysis. Summary of neurological effects of acute polio: ● Spinal polio due to damaged or killed anterior horn cells, ● Acute paralysis of groups of muscles in limbs, or ● Respiratory muscles in acute bulbar polio leading to: – Respiratory failure. – Dysphagia. – Speech difficulties. Recovery Phase The recovery phase of polio requires that “orphaned” muscle fibres become re-innervated by axon sprouts and large numbers of hypertrophied muscle fibres may be innervated by small numbers of overworked surviving neurons. Some muscle fibres and groups of muscles may never be re-innervated and the remaining muscle groups will compensate by hypertrophying and working very much harder. Patients underwent physiotherapy and mobilisation with stretching and sometimes splinting of affected limbs. This was to retrain affected muscles and help regain function. Orthoses were sometimes used to help PPS Mngt and Treat.indb 2 02/07/2007 16:07:48
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Post Polio Syndrome - Management & Treatment in Primary

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