The basic management principles for individuals with postpolio syndrome include energy conservation and pacing one’s activities. Although basic, these activity modifications may be difficult for some patients to accept.
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.6
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.
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.
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 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.
- 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.
Medications, most of which address fatigue, have been used with only partial success in patients with postpolio syndrome. Contradictory information is reported on the use of antivirals. Some authors have found no significant improvement with antivirals as compared with placebo. Amantadine may act to release dopamine from dopaminergic terminals and other central sites. Corticosteroids have been studied, but with no good results.
Some authors have reported that one of the mechanisms for production of fatigue may be related to neuromuscular junction transmission deficits; however, treatment with anticholinesterases has been successful in only half of the cases; this low success rate has been attributed to the variety of neuromuscular junction defects believed to be present in postpolio syndrome. The mechanism of response to anticholinesterases also is unclear because some patients experience improvement in muscular strength, rather than improvement in fatigability.
Acts in smooth muscle, the CNS, and secretory glands where it blocks action of acetylcholine at parasympathetic sites and facilitates transmission of impulses across the myoneural junction.
60 mg PO tid (in experimentation)
Modulate activity of immune system.7
Immunoglobulin intravenous (Gammagard, Sandoglobulin)
Intravenous immunoglobulin has been recently studied in the treatment of symptoms related to postpolio syndrome. Results show that it could be a supportive treatment option for subgroups of patients with postpolio syndrome. Further studies are needed to investigate this in more detail.
Features that may be relevant to its efficacy include neutralization of circulating myelin antibodies through anti-idiotypic antibodies; down-regulation of proinflammatory cytokines, including IFN-gamma; blockade of Fc receptors on macrophages; suppression of inducer T and B cells and augmentation of suppressor T cells; blockade of the complement cascade; promotion of remyelination; 10% increase in CSF IgG.
2 g/kg IV over 2-5 d
Administer as in adults
Con autorización de Publicación de la Dra Author: Flor M Muñiz,