Post Polio Syndrome - Management & Treatment in Primary

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Physiotherapy and Post Polio Syndrome 27 Aerobic exercise Prior polio individuals have been shown to require greater energy 9, 10 expenditure in everyday activities such as walking and cycling. Cardiorespiratory de-conditioning of prior polio subjects has been reported especially in those who are non-ambulatory. 42 Dean and Ross18 reported an improvement in energy cost and movement economy following modified low intensity (55-70% of age predicted maximum heart rates) aerobic training on a treadmill 30-40 minutes, 3 times a week for 6 weeks. Management of pain Management of pain is dependent on the aetiology and aggravating factors present with each individual. It is important to identify the type of pain presenting as described and tailor treatment appropriately. Physiotherapeutic management of pain should be cognisant of any pharmaceutical management of pain, e.g. injection or analgesia. Interventions that may alleviate pain are summarised in Box 7. box 7: PhysiotheraPy interventions For Pain management Identification of the cause of pain Modification of activity levels Weight reduction Use of aids and appliances to relieve or support weak muscles and joints Electrophysical agents Stretching exercises / Strengthening exercises Postural re-education Correction of gait problems Hydrotherapy Modification of lifestyle and activity levels Muscular aching and cramping are thought to be as a result of muscle overuse and should be avoided. 16 Reduction in activity levels, regular rest periods (pacing), weight reduction and use of assistive devices can help. 43 PPS Mngt and Treat.indb 27 02/07/2007 16:07:51
28 Post Polio Syndrome Activity levels have been shown to correlate highly with pain therefore a reduction may be of benefit. Maintaining a healthy weight is advisable as one study demonstrated that a higher BMI was associated with a higher risk of joint pain. 15 Education about posture and back care may help to minimize aggravating factors. Appropriate use of aids and appliances Aids and appliances should be provided with the aim of improving abnormal body mechanics, and correcting and minimising postural and gait deviations mechanically. An appropriate orthosis has been shown to significantly reduce overall pain levels. 29 A “comfy” grip crutch may improve the wrist and hand position. Use of electro-physical agents Heat has been shown to help to relieve pain. 14 Stretching can be helpful but should be used carefully as particular patients may benefit from shorter muscle length and associated reduced range of movement that improve stability. TENS is also recommended. Hydrotherapy Exercise in water is recommended for management of pain in prior polio individuals. 16 Water provides a resistance but minimises stress on muscles and joints. The properties of water allow assisted, resisted or supported exercise, often enabling those limited by weakness on land to exercise with minimal assistance. The heat in hydrotherapy pool may also be beneficial. Prior polio patients who exercised in water for up to 8 months demonstrated a positive functional impact, a subjective positive experience, less pain, and a lower heart rate at a submaximal work level in a controlled trial, lending evidence to this form of treatment. 44 Hydrotherapy may also result in increased strength without exacerbating fatigue or pain. 46 It is essential that the individual’s overall physical condition is assessed prior to commencing a hydrotherapy programme. 45 PPS Mngt and Treat.indb 28 02/07/2007 16:07:51
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