Post Polio Syndrome - Management & Treatment in Primary

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