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. [38]
A retrospective study by Curtis et al of 214 patients with clinically confirmed PPS found improvement in multiple characteristics, but not in quality of life, after completion of a residential self-management program. Following the program, which was headed by a multi-disciplinary clinical team, the investigators determined that symptoms, knowledge concerning PPS, and walking speed had improved among the patients. However, no significant changes were seen in anxiety and depression scores, which remained low, or in self-reported quality of life. Although this was a group-based program, it also featured individually tailored support with regard to physical exercise and fatigue management. [39]
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. [7, 8] (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. [40] )
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. [41] 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. [42, 43]
A study by Voorn et al indicated that individuals suffering from severe PPS-associated fatigue tend to lack the ability to follow a high-intensity aerobic exercise program using a cycle ergometer, thus making it difficult for them to improve their lower extremity muscle function and cardiorespiratory fitness. Participants in the study were able most of the time to maintain exercise intensities at about the anaerobic threshold, but over more than 75% of the time, they did not exercise intensely enough to stay within their target heart range. The investigators stated that a more individualized approach to exercise in PPS, with patients using large muscle groups other than those of the lower extremities, may prove beneficial. [44]
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. [45] 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 them because of the philosophy of "not giving in." [9] Treatment also can involve limitation of ambulation to shorter distances and the use of orthotics for joint protection.
A study by Da Silva et al of 15 polio survivors with/without postpolio syndrome indicated that whole-body vibration can safely be administered to these patients and, if first delivered at higher intensity, can improve walking speed. [46]
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. [47]
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.
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.
