Post Polio Syndrome - Management & Treatment in Primary

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Physiotherapy and Post Polio Syndrome 25 Gait analysis should include an evaluation of any orthoses or callipers to ensure correct fit, state of repair and suitability. Orthoses that were prescribed years ago may no longer be suitable for the patient and new orthoses have the potential to improve gait, decrease the energy cost of walking, 28 and subjectively improve the ability to walk. 29 It is imperative that the physiotherapist liaise with the orthotist or prosthesist in this instance. Gait aids should be frequently assessed for wear and tear and metal fatigue and replaced where necessary. The physiotherapist may need to liaise with the Occupational therapist with regard to the need for provision of a wheelchair. Carers A meeting with carers is recommended to assess carer need and perhaps provide additional information pertinent to the patient. Of particular importance is the assessment of carer manual handling skills where there is a higher level of patient dependence. Outcome measures The following outcome measures have been used in research involving post polio patients and may be of use in assessment. • The Rivermead Mobility Index. 30 • Dynamometry, Maximum voluntary isometric contraction (MVIC) or isokinetic dynamometery. 31 • Timed walk. 26 • Physiological Cost Index. 22, 32 • Nottingham Health Profile. 3 • Visual analogue scales for pain and fatigue. 17 • Fatigue severity scale. 33 15, 34 • Short-Form Health Survey (SF-36). • The Piper fatigue Scale. 35 PPS Mngt and Treat.indb 25 02/07/2007 16:07:51
26 Post Polio Syndrome Physiotherapy Management Management of New Weakness The management of the new weakness in the post polio population with exercise has been controversial. Some early case reports (1915- 1957) suggested that exercise resulted in further damage to already vulnerable motor units and resulted in increasing weakness. Other early studies (1948-1966) found, however, that progressive resistive exercises produced improvements in muscle strength. 36 Recent studies have found that appropriate, carefully monitored, exercise programmes can be of benefit to prior polio patients. 16, 37-41 One randomised controlled trial found an improvement in voluntary strength of the thumb muscles after 12 weeks of moderate intensity training 3 times per week. Moreover, it was found that training did not impact on the viability of the motor neurons of the trained muscles. 38 A study investigating a higher intensity programme, using maximal isokinetic and isometric exercise on a Cybex resulted in an increase in Quadriceps muscle strength and some changes in fibre size. 40 Two other studies have examined the effect of moderate intensity exercise, 39, 41 and found overall increases in muscle strength but each of the studies described some individuals who showed a decrease in strength and/or increased pain. It is recommended that individuals should learn to monitor and manage weakness and fatigue before commencing an exercise programme and that ‘additional exercise should be completely avoided in patients who are too weak and fatigued and are already spending most of their energy simply performing activities of daily living’. 16 Furthermore, muscle overuse, manifested as an aching on exertion should be avoided and regarded as a warning sign. Recommendations for muscle strengthening are summarised below in Box 6. box 6: guidelines on the use oF strengthening exerCises Prior Polio subjects can increase muscle strength with appropriate individualised exercise programmes An individual prescribed an exercise programme should be monitored for deterioration in muscle strength, increased pain or increased fatigue Individuals should learn to monitor and manage weakness and fatigue prior to commencing an exercise programme Muscle overuse, manifested as an aching on exertion should be avoided PPS Mngt and Treat.indb 26 02/07/2007 16:07:51
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Post Polio Syndrome - Management & Treatment in Primary

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