What is Post Polio Syndrome?
Post-Polio Syndrome (PPS) refers to a range of symptoms experienced by the polio survivor.
- Chronic fatigue including physical tiredness and brain fatigue
- Muscle and joint problems including, muscle weakness, pain in muscles and joints, post exercise fatigue, changes in gait and increased tendency to fall, cramps and muscle twitching
- Respiratory problems including breathlessness on exertion, spontaneous breathlessness, respiratory infection and sleep apnoea, cramps and muscle twitching requiring new use of splints walking aids and wheelchairs
- Swallowing and speech difficulties of intermittent nature.
Dr Bruno of the Post-Polio Institute, Englewood Hospital and Medical Centre (New Jersey), reported that fatigue is the most commonly reported, debilitating symptom of Post-Polio Syndrome. He found that 91% of polio survivors reported new or increased fatigue, 41% reported fatigue significantly interfering with performing or completing work, and 25% reported fatigue interfering with self-care activities.
Brain fatigue includes problems with concentration, attention and memory. MRI scans reveal the presence of ‘white spots’ in the brains of polio survivors which relate to such cognitive and neurological problems.
What causes Post Polio Syndrome?
Research shows that several causes favour the development of PPS.
Working together these are:
The polio virus
The virus damaged more motor neurons than was realised at the time of the infection. For those who experienced paralysis, 90% of nerve cells in the spinal cord were damaged by the virus and half of those died. These damaged neurons sent out new sprouts to turn on muscle fibres enabling many polio survivors to walk again. However, these surviving neurons become less able to deal with the demands placed on them and so are less able to manufacture acetylcholine.
Furthermore, Dr. Bruno of the Post-Polio Institute, Englewood Hospital and Medical Centre (New Jersey), has shown that the production of chemicals in the brain is also disrupted by the polio virus giving rise to cognitive problems – particularly under stress.
The Type A personality
Polio survivors tend to push themselves to the limit and neglect the need for rest thereby contributing further damage to an already weakened and ageing nervous system.
Survivors of polio pushed themselves physically and mentally to recover from polio and often over exercised their weakened muscles to the point of exhaustion. They can no longer afford to do this.
Other causes such as the effects of low blood sugar, medical treatment and ageing on weakened neurons – all play a part in the development of PPS.
How can Post Polio Syndrome be diagnosed?
Diagnosis is typically based on the following criteria:
- A history of paralytic/non paralytic poliomyelitis
- Partial recovery of motor function and functional stability for at least 15 years
- Development of new symptoms such as pain, weakness, fatigue, cognitive problems
- No other illness to account for the symptoms (diagnosis by exclusion).
WHAT TREATMENT IS AVAILABLE?
Polio survivors have weakened nervous systems, and so it is important to protect the nervous system by avoiding or using the following drugs with caution:
- Beta Blockers e.g. propranolol.
- Benzo diazepines e.g. diazepam.
- Other central nervous system depressants e.g. oxazepam.
- Muscle relaxants e.g. orphenadrine, diazepam.
- Local and general anesthetics can also cause problems.
Patients should be advised to conserve energy by slowing down and using aids such as calipers and wheelchairs.
Gentle stretching exercises and relaxation techniques are beneficial.
Referrals to occupational therapists, physiotherapists, and dieticians are important, and alternative therapies such as massage and acupuncture have proved to be helpful.