Post Polio Syndrome - Management & Treatment in Primary

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The Post Polio Syndrome 5 this theory it is assumed that many motor neurons were destroyed by the original infection, leaving small numbers of overworked neurons to innervate many (orphaned) muscle fibres. With time and overuse, these few working neurons simply wear out leaving muscles denervated. 7 Proposed aetiologies include: ● Motor unit dysfunction-degenerative change within motor units. ● Muscle overuse. ● Muscle underused. ● Loss of motor units due to age. ● Growth hormone or other hormonal effects. ● The combined effects of disuse, overuse, pain, weight gain or other illness. Management of Post Polio Syndrome There is no medical or pharmacological treatment of choice for PPS but there are many ways of managing polio-related difficulties, which should be symptom specific and involve a multidisciplinary team. 8 A well informed general practitioner may be at the hub of this team which may include the following disciplines: ● Neurology. ● Physiotherapy. ● Occupational Therapy. ● Speech and Language Therapy. ● Respiratory medicine. ● Chiropody/Podiatry. ● Counsellors/psychologists. ● Dietetics. ● Pain specialists. ● Social workers. ● Nurse specialists. ● Orthotists. The three main symptoms which need evaluation, treatment and PPS Mngt and Treat.indb 5 02/07/2007 16:07:49
6 Post Polio Syndrome monitoring are muscle weakness, fatigue and pain. 9 Other problems which require specific care and management are dysphagia and speech problems, which must be referred to a speech and language therapist. Sleep disturbance is very common and sleep apnoea is more common in polio survivors than in the general population, even in those who did not have bulbar polio. This may be evaluated by a respiratory physician in a sleep laboratory. Continuous positive airway pressure (CPAP) using nasal or oral, or intermittent positive airway pressure (IPAP) at night may be used to improve oxygen levels and reduce symptoms of fatigue. This may be the case for a small number of people who did not require assisted ventilation during their acute attack of polio but who may have scoliosis or COPD or some other biomechanical problem affecting respiration. Joint and limb deformities may require evaluation and sometimes treatment by an orthopaedic surgeon; collaboration between a physiotherapist and an orthotist may improve gait, control flexible conditions and rigid deformities with suitable orthotics. The role of the occupational therapist (OT) is vital in assessing a patient’s ability to perform activities of daily living and move about their home or work place. The OT will evaluate activities which cause pain and fatigue and will suggest the need for special equipment or adaptions to the environment. OTs will advise ways to avoid fatigue of muscles in line with the overuse theory. Pharmacology The physician should be aware that some drugs may aggravate the symptoms of PPS. Benzodiazepines and beta-blockers are contraindicated; certain antiepileptic drugs such as phenytoin are also to be avoided. 10 With regard to pain relief, caution must be observed when prescribing opiates which may precipitate respiratory depression. Anaesthetists should be made aware of the special needs of people who are polio survivors: Smaller doses of anaesthetic agents may be required than in the general population and the same is true for the doses of muscle relaxants used in general surgery. PPS Mngt and Treat.indb 6 02/07/2007 16:07:49
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Post Polio Syndrome - Management & Treatment in Primary

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