Post Polio Syndrome - Management & Treatment in Primary

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The Post Polio Syndrome 3 restore function and prevent wear and tear. Most survivors with bulbar polio were weaned off negative/positive pressure respiration though some continued to use this intermittently. Some still use intermittent positive pressure ventilation. Stable Disability Polio was described as a chronic, yet stable, disease with a period of stable disability following rehabilitation in the recovery phase. The severity of disability varies greatly from almost imperceptible muscle weakness to significant weakness leading to reduced mobility and from no bulbar problems to intermittent dependence on assisted respiration. Summary of Classic Phases in Polio ● Acute illness. ● Period of recovery. ● Stable disability. Post Polio Syndrome Polio was considered to be a chronic but stable disease once the acute phase was over and rehabilitation had restored a lesser or greater degree of function. However, it is now known that some survivors of polio develop new symptoms after many decades of stable functioning. The first descriptions of new muscle weakness in polio survivors, developing years after the initial illness, were published by the great French neurologist Charcot in 1875. 3 It was not until the 1980s that the post polio syndrome was widely acknowledged; the term post polio syndrome (PPS) was first used at the first International Post-Polio Conference at Warm Springs Georgia in 1984. 4 Diagnosing Post Polio Syndrome PPS is a condition resulting in new symptoms in people who had polio years earlier but who have had functional and neurological stability for at PPS Mngt and Treat.indb 3 02/07/2007 16:07:49
4 Post Polio Syndrome least 15 years. The symptoms may include the following: ● New muscle weakness. ● Fatigue. ● Muscle and joint pain. ● Atrophy of muscle. ● New difficulties in activities of daily living, particularly mobility related activities. ● Cold intolerance. ● Sleep impairment. ● Speech difficulties. ● Dysphagia. ● Respiratory dysfunction. The cardinal symptom is new weakness. 5 There is no laboratory test for PPS and in making a diagnosis all other causes of these symptoms must be excluded. Therefore careful clinical evaluation using history, observation and examination are the diagnostic tools required to eliminate other disease entities. These causes include: ● Natural effects of age. ● Bone or joint problems due to deformity or “wear and tear”. ● Other neurological disease. ● Medical disease such as hypothyroidism. ● Depression. Since this is a diagnosis of exclusion, laboratory tests such as FBC and TFTs will be important. Diagnostic imaging such as joint X Rays or MRI scans of spinal cord may be useful in ruling out other causes. 6 Referral to a consultant neurologist is usually essential for EMG, confirmation of the diagnosis and exclusion of other neurological and muscle disorders. Causes of Post Polio Syndrome There is no definite explanation for the new symptoms associated with PPS but the most widely accepted theory is that of neuron fatigue. In PPS Mngt and Treat.indb 4 02/07/2007 16:07:49
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Post Polio Syndrome - Management & Treatment in Primary

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