Post-Polio Syndrome: Pathophysiology and Clinical Management

Abstract

Post-polio syndrome (PPS) is a progressive neuromuscular syndrome characterized by symptoms of weakness, fatigue, pain in muscles and joints, and breathing and swallowing difficulties. Survivors of poliomyelitis experience it many years after their initial infection. Although the etiology for these symptoms is unclear, it may be due to motor unit dysfunction manifested by deterioration of the peripheral axons and neuromuscular junction, probably as result of overwork. An estimated 60% of the over 640,000 paralytic polio survivors in the U.S. may suffer from the late effects of polio. Their physical and functional rehabilitation care presents a challenge for practitioners in all disciplines. To evaluate these symptoms, a comprehensive assessment must be done, as frequently PPS is a diagnosis of exclusion. Care of the patient with PPS is best carried out by an interdisciplinary team of rehabilitation specialists. This article reviews the epidemiology, pathophysiology, characteristics, assessment, and rehabilitation care of the patient with PPS.

Fatigue in polio survivors

“…Accepted criteria to identify the post polio syndrome include a prior history of paralytic poliomyelitis; a period of neurologic recovery followed by an extended interval of neurological and functional stability preceeding the onset of new problems; a gradual or abrupt onset of new symptoms in previously a ected and/or una ected muscles, which may or may not be accompanied by other health problems such as excessive fatigue, muscle pain, joint pain, decreased endurance, decreased function, and arthropathy; and exclusion of medical, orthopedic, and neurologic conditions that might cause the health problems listed above. 4 The de®nition of PPS acknowledges that fatigue and muscle pain are present in the syndrome, but that these features do not need to be present to meet the criteria for the syndrome. 5 On average, the PPS appears 30 ± 40 years after the acute onset.…”

“…4 Among polio survivors, fatigue is described as an increasing loss of strength during exercise, such as overwhelming exhaustion, or¯u-like aching accompanied by a marked change in the level of energy, endurance and sometimes mental alertness. 4 It is possible that the post polio individual, in responding to questions about fatigue, interprets fatigue to mean one or a combination of the following: emotional fatigue, central nervous system fatigue,`general fatigue', and/or peripheral neuromuscular fatigue. 6 Post polio fatigue can be both transitory and persistent, as lifestyle changes, resting periods and assistive devices may reduce fatigue.…”

“…Fatigue lasting all day is atypical for the PPS and warrants further medical examination. 4 Further, fatigue is often mixed with new weaknesses and vice versa [op.cit].…”

Retrospective study on the behavior of muscular strength of Post-Poliomyelitis Syndrome patients

“…Os dados coletados da avaliação fisioterapêutica foram dados pessoais, dados sobre a história e recuperação da pólio aguda, novos sintomas, doenças associadas, exame físico e teste de FM manual classificados pela Medical Research Council MRC 9 [10][11][12] .…”

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“…In children, non-paralytic meningitis is the most likely consequence of CNS involvement, and paralysis occurs in only one in 1000 cases. In adults, paralysis occurs in one in 75 cases 9 . In children under five years of age, paralysis of one leg is most common; in adults, extensive paralysis of the chest and abdomen also affecting all four limbs-quadriplegia-is more likely.…”