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Postpolio Syndrome Treatment & Management

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Sep 15, 2015
 

Rehabilitation Program

Physical Therapy

In a pilot study of postpolio syndrome (PPS) patients, a multidisciplinary rehabilitation approach involving tailored physiotherapy exercises has shown to have significant benefit on muscle endurance, exertion, and depression levels for up to 6 months.[27]

The basic management principles for individuals with PPS include energy conservation and pacing one's activities. Although basic, these activity modifications may be difficult for some patients to accept.

Psychological interventions, such as cognitive behavior therapy, may also be initiated to help reduce fatigue.[28, 29] (Although in a multicenter, single-blinded, randomized, controlled study of 68 patients with PPS, Koopman et al reported that neither exercise therapy nor cognitive behavioral therapy were better at reducing severe fatigue than was treatment with usual care.[30] )

Certain psychological issues have been studied in relation to postpolio syndrome. Most studies reveal that depression is not related to postpolio syndrome symptomatology or to the level of residual physical disability. Type A behavior is significantly higher in the polio population than in a control population. Overall, normal psychological and emotional functioning has been found in patients with postpolio syndrome compared with controls.

Reports on exercises are conflicting, but the key factor seems to be exercise intensity. Strengthening exercises should be nonfatiguing. A specific suggestion is to exercise every other day, and the perceived rate of exertion should be less than "very hard." Loads should be held for only 4-5 seconds, and there should be a 10-second rest between bouts and a 5-minute rest between sets. The patient should perform about 3 sets of 5-10 repetitions.[31, 32]

In addition to specifying exercises for those body areas experiencing the deleterious effects of disuse, the exercise prescription also should consider how to protect (1) muscles and joints that are experiencing the adverse effects of overuse and (2) body areas with very significant chronic weakness (generally, areas where the muscles have less than antigravity strength on manual muscle testing).

Results of these exercises vary. Strengthening programs performed as described show a 60% increase on isokinetic strength, improved cardiorespiratory status, no decline in strength in 6-12 months, and 5% increase in isometric strength.

In one randomized controlled study, progressive resistance training program consisted of 3 sets of 8 isometric contractions, 3 times weekly for 12 weeks. Postpolio patients showed a significant improvement in their strength.[33] The training did not adversely affect motor unit survival, and the improvement was largely attributable to an increase in voluntary motor drive.

Electrical stimulation has been used to strengthen weakened muscles or to reeducate muscles weakened through disuse, as well as to decrease pain.

For myofascial pain, consider heat, electrical stimulation, trigger point injections, stretching exercises, biofeedback, muscle relaxation exercises, or static magnetic fields for trigger points.

For gait disturbances, assistive devices can be used, but sometimes patients refuse because of the philosophy of "not giving in." Treatment also can involve limitation of ambulation to shorter distances and the use of orthotics for joint protection.

Exercise therapy and training programs in PPS patients should be carefully customized and planned by physiotherapists to avoid both overuse and disuse, and the level of physical activity should be modified to decrease pain.[34]

Occupational Therapy

Patients with postpolio syndrome usually benefit from different adaptive techniques and equipment to perform any activities of daily living, as well as education and energy conservation techniques.

Speech Therapy

Speech evaluation in persons with postpolio syndrome usually is recommended with any suggestion of swallowing problems. The therapist teaches the patient about different techniques to improve his/her swallowing function.

Next

Consultations

Pulmonologists

When the patient with postpolio syndrome reports respiratory problems, a full pulmonary evaluation may be required. Sometimes, the patient may even need mechanical respiratory support. A sleep evaluation may be necessary for suspected sleep apnea.

Orthopedists

The patient may present with various joint deformities that may require orthoses and sometimes even surgery.

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Contributor Information and Disclosures
Author

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Gerald J Herbison, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University

Disclosure: Nothing to disclose.

Flor M Muñiz, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario

Flor M Muñiz, MD is a member of the following medical societies: American Medical Association, Canadian Association of Physical Medicine and Rehabilitation, and Canadian Medical Association

Disclosure: Nothing to disclose.

References
  1. Halstead LS. Assessment and differential diagnosis for post-polio syndrome. Orthopedics. 1991 Nov. 14(11):1209-17. [Medline].

  2. March of Dimes Birth Defects Foundation. Post-polio syndrome: identifying best practices in diagnosis and care. http://www.marchofdimes.com/mission/polio.aspx. Available at http://www.polioplace.org/sites/default/files/files/MOD-%20Identifying.pdf. Accessed: November 15, 2013.

  3. Gonzalez H, Ottervald J, Nilsson KC, et al. Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation. J Proteomics. 2009 Jan 30. 71(6):670-81. [Medline].

  4. Bouza C, Munoz A, Amate JM. Postpolio syndrome: a challenge to the health-care system. Health Policy. 2005 Jan. 71(1):97-106. [Medline].

  5. Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L. Epidemiology of the post-polio syndrome. Am J Epidemiol. 1992 Oct 1. 136(7):769-86. [Medline].

  6. Quadros AA, Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, et al. Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center. Arq Neuropsiquiatr. 2012 Aug. 70(8):571-3. [Medline].

  7. Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio M, et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors. J Neurol Sci. 2005 Sep 15. 236(1-2):31-5. [Medline].

  8. Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P, et al. Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci. 2012 Dec. 33(6):1271-5. [Medline].

  9. Berlly MH, Strauser WW, Hall KM. Fatigue in postpolio syndrome. Arch Phys Med Rehabil. 1991 Feb. 72(2):115-8. [Medline].

  10. Trojan DA, Arnold DL, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, et al. Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors. PM R. 2009 May. 1(5):442-9. [Medline].

  11. Romigi A, Pierantozzi M, Placidi F, et al. Restless legs syndrome and post polio syndrome: a case-control study. Eur J Neurol. 2015 Mar. 22 (3):472-8. [Medline].

  12. Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve. 2005 Jan. 31(1):6-19. [Medline].

  13. Bickerstaffe A, Beelen A, Nollet F. Change in physical mobility over 10 years in post-polio syndrome. Neuromuscul Disord. 2015 Mar. 25 (3):225-30. [Medline].

  14. Klein MG, Whyte J, Keenan MA, Esquenazi A, Polansky M. Changes in strength over time among polio survivors. Arch Phys Med Rehabil. 2000 Aug. 81(8):1059-64. [Medline].

  15. Stolwijk-Swüste JM, Beelen A, Lankhorst GJ, Nollet F. The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review. Arch Phys Med Rehabil. 2005 Aug. 86(8):1693-701. [Medline].

  16. Fordyce CB, Gagne D, Jalili F, et al. Elevated serum inflammatory markers in post-poliomyelitis syndrome. J Neurol Sci. 2008 Aug 15. 271(1-2):80-6. [Medline].

  17. Stoelb BL, Carter GT, Abresch RT, et al. Pain in persons with postpolio syndrome: frequency, intensity, and impact. Arch Phys Med Rehabil. 2008 Oct. 89(10):1933-40. [Medline].

  18. Werhagen L, Borg K. Impact of pain on quality of life in patients with post-polio syndrome. J Rehabil Med. 2013 Feb. 45(2):161-3. [Medline].

  19. Portnoy S, Schwartz I. Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting. Ann Phys Rehabil Med. 2013 Oct. 56(7-8):527-41. [Medline].

  20. Vreede KS, Henriksson J, Borg K, Henriksson M. Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome. J Rehabil Med. 2013 Sep. 45(9):924-8. [Medline].

  21. Lira CA, Minozzo FC, Sousa BS, et al. Lung function in post-poliomyelitis syndrome: a cross-sectional study. J Bras Pneumol. 2013 Jun-Aug. 39 (4):455-60. [Medline].

  22. Söderholm S, Lehtinen A, Valtonen K, Ylinen A. Dysphagia and dysphonia among persons with post-polio syndrome - a challenge in neurorehabilitation. Acta Neurol Scand. 2010 Nov. 122(5):343-9. [Medline].

  23. Dean AC, Graham BA, Dalakas M, Sato S. Sleep apnea in patients with postpolio syndrome. Ann Neurol. 1998 May. 43(5):661-4. [Medline].

  24. Ring D, Vaccaro AR, Scuderi G, Klein G, Green D, Garfin SR. An association between the flat back and postpolio syndromes: a report of three cases. Arch Phys Med Rehabil. 1997 Mar. 78(3):324-6. [Medline].

  25. Chang KH, Lai CH, Chen SC, Hsiao WT, Liou TH, Lee CM. Body composition assessment in taiwanese individuals with poliomyelitis. Arch Phys Med Rehabil. 2011 Jul. 92(7):1092-7. [Medline].

  26. Correa JC, Rocco CC, de Andrade DV, et al. Electromyographic and neuromuscular analysis in patients with post-polio syndrome. Electromyogr Clin Neurophysiol. 2008 Nov-Dec. 48(8):329-33. [Medline].

  27. Davidson AC, Auyeung V, Luff R, Holland M, Hodgkiss A, Weinman J. Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study. Disabil Rehabil. 2009. 31(4):309-17. [Medline].

  28. Tersteeg IM, Koopman FS, Stolwijk-Swuste JM, Beelen A, Nollet F. A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis. Arch Phys Med Rehabil. 2011 Jun. 92(6):899-904. [Medline].

  29. Atwal A, Giles A, Spiliotopoulou G, Plastow N, Wilson L. Living with polio and postpolio syndrome in the United Kingdom. Scand J Caring Sci. 2013 Jun. 27(2):238-45. [Medline].

  30. Koopman FS, Voorn EL, Beelen A, et al. No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy: Results of an RCT. Neurorehabil Neural Repair. 2015 Aug 7. [Medline].

  31. Skough K, Krossen C, Heiwe S, et al. Effects of resistance training in combination with coenzyme Q10 supplementation in patients with post-polio: a pilot study. J Rehabil Med. 2008 Oct. 40(9):773-5. [Medline].

  32. Skough K, Broman L, Borg K. Test-retest reliability of the 6-min walk test in patients with postpolio syndrome. Int J Rehabil Res. 2013 Jun. 36(2):140-5. [Medline].

  33. Chan KM, Amirjani N, Sumrain M, Clarke A, Strohschein FJ. Randomized controlled trial of strength training in post-polio patients. Muscle Nerve. 2003 Mar. 27(3):332-8. [Medline].

  34. Bertelsen M, Broberg S, Madsen E. Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study. J Rehabil Med. 2009 Jan. 41(1):85-7. [Medline].

  35. Stein DP, Dambrosia JM, Dalakas MC. A double-blind, placebo-controlled trial of amantadine for the treatment of fatigue in patients with the post-polio syndrome. Ann N Y Acad Sci. 1995 May 25. 753:296-302. [Medline].

  36. Dinsmore S, Dambrosia J, Dalakas MC. A double-blind, placebo-controlled trial of high-dose prednisone for the treatment of post-poliomyelitis syndrome. Ann N Y Acad Sci. 1995 May 25. 753:303-13. [Medline].

  37. Vasconcelos OM, Prokhorenko OA, Salajegheh MK, Kelley KF, Livornese K, Olsen CH, et al. Modafinil for treatment of fatigue in post-polio syndrome: a randomized controlled trial. Neurology. 2007 May 15. 68(20):1680-6. [Medline].

  38. Chan KM, Strohschein FJ, Rydz D, Allidina A, Shuaib A, Westbury CF. Randomized controlled trial of modafinil for the treatment of fatigue in postpolio patients. Muscle Nerve. 2006 Jan. 33(1):138-41. [Medline].

  39. Koopman FS, Uegaki K, Gilhus NE, Beelen A, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2011 Feb 16. CD007818. [Medline].

  40. Ostlund G, Broman L, Werhagen L, Borg K. Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders. J Rehabil Med. 2015 Sep 3. 47 (8):727-33. [Medline].

  41. Bertolasi L, Frasson E, Turri M, Gajofatto A, Bordignon M, Zanolin E, et al. A randomized controlled trial of IV immunoglobulin in patients with postpolio syndrome. J Neurol Sci. 2013 Jul 15. 330(1-2):94-9. [Medline].

  42. Trojan DA, Collet JP, Shapiro S, Jubelt B, Miller RG, Agre JC, et al. A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome. Neurology. 1999 Oct 12. 53(6):1225-33. [Medline].

  43. Gonzalez H, Sunnerhagen KS, Sjoberg I, et al. Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol. 2006 Jun. 5(6):493-500. [Medline].

  44. On AY, Oncu J, Uludag B, et al. Effects of lamotrigine on the symptoms and life qualities of patients with post polio syndrome: a randomized, controlled study. NeuroRehabilitation. 2005. 20(4):245-51. [Medline].

  45. Diseases of the motor unit. DeLisa J, Gans B, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998. 1554-6.

 
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