Post Polio Syndrome - Management & Treatment in Primary

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