Post Polio Syndrome - Management & Treatment in Primary

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Physiotherapy and Post Polio Syndrome 23 discomfort due to cold intolerance. The patient will complain that their limbs are cold, and cold exposure produces weakness. Cardiorespiratory Reduced pulmonary function results from the virus affecting the medullary respiratory centres, the muscles of respiration and the cranial nerves. 18 It may be compounded by thoracic cage deformity, e.g. kyphoscoliosis, and obesity. As many as 42% of patients with prior polio may complain of new breathing problems. 19 Patients who required ventilatory support at polio onset and those with polio onset after 10 years of age are at higher risk of developing new breathing problems, 18, 19 and also complain of more fatigue. However, patients who did not require ventilation at polio outset may also develop new breathing problems. One report found that 33% of ambulatory prior polio patients who were free from cardiorespiratory disease and did not have any significant chest wall involvement at the outset of polio complained of shortness of breath, and that those with shortness of breath had a significantly lower percent predicted FEV1 and FVC. 18 A patient’s cardiorespiratory status may appear normal at rest, but impairment cannot be ruled out unless formal exercise testing has been carried out. The cardiorespiratory assessment should include a careful history, measurement of peak flow, oxygen saturation, and interpretation of the results of pulmonary function tests. In patients complaining of fatigue, morning headache, sleep disturbance, difficult arousal, daytime somnolence, impaired concentration, memory and irritability, chronic alveolar hypoventilation and sleep apnoea should be suspected and patients referred to respiratory specialists. 21 Forced expiratory techniques such as coughing and huffing to assess a patient’s ability to expectorate secretions effectively should be assessed. In patients who are using ventilatory support, physiotherapists may be involved in assessing the patient’s and/or carer’s ability to apply and manage equipment. Ventilatory support may be in the form of oxygen therapy, non-invasive positive pressure ventilation (oral, nasal or combined), or in extremely rare cases, negative pressure body ventilation (the iron lung). PPS Mngt and Treat.indb 23 02/07/2007 16:07:50 18, 20
24 Post Polio Syndrome Cardiorespiratory endurance can be assessed subjectively by asking the patient how far they can walk without getting breathless or with the Physiological Cost Index. 22 Formal exercise testing can be performed where specialised equipment is available. 9 The American College of Sports Medicine’s 23 recommendations for exercise testing of patients with prior polio and post polio syndrome are shown in Box 4. box 4: the ameriCan College oF sPorts mediCine’s reCommendations For the exerCise testing oF Patients with Prior Polio and Post Polio syndrome. Mobility Optimally utilise available muscle mass. Avoid use of a painful and/or recently weakened limb during an exercise test. Use equipment that does not require complex motor co-ordination. Use submaximal exercise tests (elicit at least a “somewhat hard” rating of perceived exertion and terminate testing when the “hard” rating of perceived exertion is reported (24,25). A detailed assessment of transfers and mobility including gait analysis should be carried out as the majority of post polio patients complain of difficulty mobilising and going up stairs. Walking speed will probably be significantly slower. Spontaneously chosen walking speed is much closer to maximal walking speeds in prior polio subjects compared with healthy controls, indicating that prior polio subjects may perform daily activities at close to maximal capacity. 14 Some of the more common biomechanical abnormalities in post polio are detailed in Box 5. box 5: Common biomeChaniCal deFiCits in Post Polio (27,7) Genu Recurvatum. Knee flexion contracture. Inadequate dorsiflexion in swing. Dorsiflexion collapse in stance. Genu valgum. Mediolateral ankle instability. PPS Mngt and Treat.indb 24 02/07/2007 16:07:50
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