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Post-polio syndrome

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Post-polio syndrome (PPS) is the term used for the new late manifestations that occur in patients 30 to 40 years after the occurrence of acute poliomyelitis. PPS has been recognized for over 100 years, but is more common at the present time because of the large epidemics of poliomyelitis in the 1940s and 1950s. PPS is manifested by neurologic, musculoskeletal, and general manifestations. Neurologic manifestations include new weakness, muscle atrophy, dysphagia, dysphonia, and respiratory failure. Musculoskeletal manifestations include muscle pain, joint pain, spinal spondylosis and scoliosis, and secondary root and peripheral nerve compression. General manifestations include generalized fatigue and cold intolerance. New muscle weakness of a mild-to-moderate degree responds well to a nonfatiguing exercise program and pacing of activity with rest periods to avoid muscle overuse. Generalized fatigue may be treated with energy conservation and weight loss programs and lower extremity orthoses. Pharmacologic agents also may be helpful, but have not been beneficial in controlled trials. Bulbar muscle weakness includes dysphagia, dysphonia, sleep disorders, and chronic respiratory failure. Dysphagia may be improved with instruction on compensatory swallowing techniques. Dysphonia is treated with voice exercise therapy and voice amplification devices. Sleep disorders are treated similarly to sleep disorders in non-PPS patients. Respiratory failure may be treated with continuous positive airway pressure, bilevel positive airway pressure, and nasal ventilation, or tracheotomy and permanent ventilation if necessary. Musculoskeletal (muscle and joint) pain is treated with weight loss, pacing of activities, use of assistive devices, and prescribing anti-inflammatory medications and physical therapy techniques. Cardiopulmonary conditioning can be improved without muscle overuse with cycle or arm ergometer exercise or dynamic aquatic exercise.

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References and Recommended Reading

  1. Jubelt B, Cashman NR: Neurological manifestations of the post-polio syndrome. Crit Rev Neurobiol 1987, 3:199–220.

    PubMed  CAS  Google Scholar 

  2. Jubelt B, Drucker J: Poliomyelitis and the post-polio syndrome. In Motor Disorders. Edited by Younger DS. Philadelphia: Lippincott Williams & Wilkins; 1999:381–395.

    Google Scholar 

  3. Halstead LS, Rossi D: Post-polio syndrome. Birth Defects 1987, 23:13–26.

    PubMed  CAS  Google Scholar 

  4. Agre JC, Rodriquez AA, Sperling KB: Symptoms and clinical impressions of patients seen in a post-polio clinic. Arch Phys Med Rehabil 1989, 70:367–370.

    PubMed  CAS  Google Scholar 

  5. Sonies BC, Dalakas MC: Progression of oral-motor and swallowing symptoms in the post-polio syndrome. Ann NY Acad Sci 1995, 753:87–95.

    Article  PubMed  CAS  Google Scholar 

  6. Abaza MM, Sataloff RT, Hawkshaw MJ, et al.: Laryngeal manifestations of postpoliomyelitis syndrome. J Voice 2001, 14:291–294. In two case reports, PPS patients had improved dysphonia with treatment.

    Article  Google Scholar 

  7. Dean E, Ross J, Read JD, et al.: Pulmonary function in individuals with a history of poliomyelitis. Chest 1991, 100:118–123.

    PubMed  CAS  Google Scholar 

  8. Steljes DG, Kryger MH, Kirk BW, et al.: Sleep in postpolio syndrome. Chest 1990, 98:113–140.

    Google Scholar 

  9. Siegel H, McCutchen C, Dalakas M, et al.: Physiologic events initiating REM sleep in patients with the postpolio syndrome. Neurology 1999, 52:516–522.

    PubMed  CAS  Google Scholar 

  10. Klein MG, Whyte J, Keenan MA, et al.: The relation between lower extremity strength and shoulder overuse symptoms: a model based on polio survivors. Arch Phys Med Rehabil 2000, 81:789–795.

    Article  PubMed  CAS  Google Scholar 

  11. Vasiliadis H-M, Collet J-P, Shapiro S, et al.: Predictive factors and correlates for pain in postpoliomyelitis syndrome patients. Arch Phys Med Rehab 2002, 83:1109–1115.

    Article  Google Scholar 

  12. Berlly MH, Strauser WW, Hall KM: Fatigue in post-polio syndrome. Arch Phys Med Rehab 1991, 72:115–118.

    CAS  Google Scholar 

  13. Burger H, Marincek CRT: The influence of post-polio syndrome on independence and life satisfaction. Disabil Rehabil 2000, 22:318–322.

    Article  PubMed  CAS  Google Scholar 

  14. Kumakura N, Takayanagi M, Hasegawa T, et al.: Selfassessed secondary difficulties among paralytic poliomyelitis and spinal cord injury survivors in Japan. Arch Phys Med Rehabil 2002, 83:1245–1251.

    Article  PubMed  Google Scholar 

  15. Kidd D, Howard RS, Williams AJ, et al.: Late functional deterioration following paralytic poliomyelitis. Q J Med 1997, 90:189–196.

    CAS  Google Scholar 

  16. Julien J, Leparc-Goffart I, Lina B, et al.: Post-polio syndrome: poliovirus persistence is involved in the pathogenesis. J Neurol 1999, 246:472–276.

    Article  PubMed  CAS  Google Scholar 

  17. Pezeshkpour GH, Dalakas MC: Long-term changes in the spinal cords of patients with old poliomyelitis: signs of continuous disease activity. Arch Neurol 1988, 45:505–508.

    PubMed  CAS  Google Scholar 

  18. Gonzalez H, Khademi M, Andersson M, et al.: Prior poliomyelitis-evidence of cytokine production in the central nervous system. J Neurol Sci 2002, 205:9–13.

    Article  PubMed  CAS  Google Scholar 

  19. Klein MG, Whyte J, Keenan MA, et al.: Changes in strength over time among polio survivors. Arch Phys Med Rehabil 2000, 81:1059–1064.

    Article  PubMed  CAS  Google Scholar 

  20. Jubelt B, Agre JC: Characteristics and management of post-polio syndrome. JAMA 2000, 284:412–414. Focused review of PPS treatment.

    Article  PubMed  CAS  Google Scholar 

  21. Waring WP, Maynard F, Grady W, et al.: Influence of appropriate lower extremity orthotic management on ambulation, pain and fatigue in a post-polio population. Arch Phys Med Rehabil 1989, 70:371–375.

    PubMed  CAS  Google Scholar 

  22. Peach P, Olejnik S: Effect of treatment and noncompliance on post-polio sequelae. Orthopedics 1991, 14:1199–1203.

    PubMed  CAS  Google Scholar 

  23. Willen C, Grimby G: Pain, physical activity, and disability in individuals with late effects of polio. Arch Phys Med Rehabil 1998, 79:915–919.

    Article  PubMed  CAS  Google Scholar 

  24. Agre JC, Rodriquez AA: Intermittent isometric activity: its effect on muscle fatigue in post-polio subjects. Arch Phys Med Rehab 1991, 72:971–977.

    Article  CAS  Google Scholar 

  25. Dalakas MC: Why drugs fail in post-polio syndrome. Neurology 1999, 53:116–117. Review of PPS pharmacologic clinical trials.

    Google Scholar 

  26. Trojan DA, Collet J-P, Shapiro S, et al.: A multicenter, randomized, double-blinded trial of pyridostigmine in post-polio syndrome. Neurology 1999, 53:1225–1233.

    PubMed  CAS  Google Scholar 

  27. Silbergleit AK, Waring WP, Sullivan MJ, et al.: Evaluation, treatment, and follow-up results of post-polio patients with dysphagia. Otolaryngol Head Neck Surg 1991, 104:333–338.

    PubMed  CAS  Google Scholar 

  28. Agre JC, Rodriquez AA, Franke TM, et al.: Low-intensity, alternate-day exercise improves muscle performance without apparent adverse affect in post-polio patients. Am J Phys Med Rehabil 1996, 75:50–58.

    Article  PubMed  CAS  Google Scholar 

  29. Ernstoff B, Wetterqvist H, Kvist H, et al.: The effects of endurance training on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996, 77:843–848.

    Article  PubMed  CAS  Google Scholar 

  30. Spector SA, Gordon PL, Feuerstein IM, et al.: Strength gains without muscle injury after strength training in patients with post-polio muscular atrophy. Muscle Nerve 1996, 19:1282–1290.

    Article  PubMed  CAS  Google Scholar 

  31. Agre JC, Rodriquez AA, Franke TM: Strength, endurance, and work capacity after muscle strengthening exercise in post-polio subjects. Arch Phys Med Rehabil 1997, 78:681–686.

    Article  PubMed  CAS  Google Scholar 

  32. Chan KM, Amirjani N, Sumrain M, et al.: Randomized controlled trial of strength training in post-polio patients. Muscle Nerve 2003, 27:332–338. This randomized trial compared strength training (treated group) with no training (control group). The progressive resistance training program consisted of three sets of eight isometric contractions three times weekly for 12 weeks. This program resulted in a significant improvement in maximum voluntary contractions of the thumb at a 45° angle across the palm.

    Article  PubMed  Google Scholar 

  33. Bach JR: Management of post-polio respiratory sequelae. Ann NY Acad Sci 1995, 753:96–102.

    Article  PubMed  CAS  Google Scholar 

  34. Jones DR, Speier J, Canine K, et al.: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae. JAMA 1989, 261:3255–3258.

    Article  PubMed  CAS  Google Scholar 

  35. Kriz JL, Jones DR, Speier JL, et al.: Cardiorespiratory responses to upper extremity aerobic training by postpolio subject. Arch Phys Med Rehabil 1992, 73:49–54.

    PubMed  CAS  Google Scholar 

  36. Prins JH, Hartung H, Merritt DJ, et al.: Effect of aquatic exercise training in persons with poliomyelitis disability. Sports Med Training Rehabil 1994, 5:29–39.

    Google Scholar 

  37. Willen C, Sunnerhagen KS, Grimby G, et al.: Dynamic water exercise in individuals with late poliomyelitis. Arch Phys Med Rehabil 2001, 82:66–72. In this non-randomized study, the treated PPS patients had improved cardiac conditioning with dynamic non-swimming water exercises.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurology, State University of New York (SUNY) Upstate Medical University, 750 East Adams Street, 13210, Syracuse, NY, USA

    Bruk Jubelt MD

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Jubelt, B. Post-polio syndrome. Curr Treat Options Neurol 6, 87–93 (2004). https://doi.org/10.1007/s11940-004-0018-3

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  • DOI: https://doi.org/10.1007/s11940-004-0018-3

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