Post-Polio Syndrome

• means literally an inflammation of the gray matter of the spinal cord
• destroyed (nerve cells) in anterior horns of spinal cord and brain stem

• surviving motor neurons in brain stem and spinal cord extend new branches called axonal sprouts to re-innervate muscle fibers that have lost their motor nerve supply
• muscular function may be partially, or fully regained if this recovery process is extensive enough
• these new axonal sprouts end up innervating at least several times the number of muscle fibers that an ordinary motor neuron would normally supply

new muscle weakness and other symptoms including problems swallowing, breathing, and sleeping occurring at least 15 years after the initial acute infection and lasting more than a year

• flu-like, generalized exhaustion that may be associated w/ an increased need for rest and difficulty w/ concentration and memory
• Muscular: a decline in muscle strength upon exertion; described as muscle fatigability or lack of endurance

exclusion

• distal degeneration of the overextended motor nueonrs
• surviving motor units cannot sustain the increased metabolic demand to contract more often to achieve the same force of contraction
• the new more fragile terminal axonal sprouts degenerate, producing denervation of the muscle fibers
• neuromuscular junction transmission defects
• relative weakness may lead to joint and muscle misuse and overuse aggravated by normal aging changes and motor neuron loss

• new axonal sprouts are not indefinitely stable but rather degenerate over time due to an overexertion phenomenon resulting once again in denervation of muscle fibers
• Here, the muscle fibers from overly extended motor neurons have been denervated and have ceased to contract

• management of weakness in pps
• strengthening exercise
• aerobic exercise
• stretching to decrease/prevent contractures
• avoidance of specific muscular overuse
• bracing
• weight loss
• assistive devices
• energy conservation

• increased muscle capacity can improve functional capacity
• no proof that muscle overuse is contraindicated
• custom exercise programs dependent on the severity of symptoms and the residual strength of individual muscles
• must carefully determine individual muscle strength as some may already be functioning at max capacity and exercise could be negative
• establish level of peak performance by patient history and start at 50% and slowly increase performance as tolerated w/ rest as needed

• very helpful for those experiencing muscle weakness and fatigue
• orthotic devices including braces
• canes and crutches
• manual and electric WC
• motorized scooters

• energy conservation w/
• increasing convenience and accessibility when doing everyday tasks
• pacing and taking rest breaks during extended activities
• relaxation techniques
• assistive devices
• weight loss

• modifications of lifestyle, environment and tasks
• modalities
• strengthening exercises
• assistive devices
• orthosis
• non-steroidal anti-inflammatory medications

• difficulty adjusting to the re-emergence of problems associated w/ polio after a lifetime of adjustment
• may result in depression and need for education, strategies, and support