Monday, 30 March 2015

Polio and Post-Polio Syndrome

Poliomyelitis is an acute, viral, epidemic disease that attacks the motor neurons that control the leg muscles, resulting in paralysis and, therefore, atrophy of the affected muscles. The virus eventually clears itself and one recovers fully, leading a normal and active life. However, up to 40 years later, an individual who had contracted the virus previously can start to develop similar symptoms of fatigue, weakness, and muscle and joint pain that were experienced at the time of contraction. This is known as Post-Polio Syndrome (PPS) and it affects at least one quarter of those initially affected. Other possible symptoms include sleep disorders and intolerance to cold.

Depending on the severity of the virus, varying portions of the leg muscles will be affected, directly affecting one’s functional ability, strength and power. A limp is often present due to muscle loss in the leg, and balance is generally poor on the affected leg. The lack of use of the leg due to weakness further contributes to muscle wasting, thereby exacerbating symptoms.

Exercise is essential in the management of PPS; however, an appropriate and individualised programme is essential for success. The affected motor units may not increase in strength; however, the surrounding unaffected muscles can be strengthened to support and compensate for the affected muscles. Core and upper body strengthening exercises should be included to improve posture and gait (walking pattern). Appropriate whole body exercises should be done to include as many muscle groups as possible and increase physical fitness. Those with PPS are also more susceptible to depression and exercise plays an important role in managing depression, by increasing one’s sense of achievement and well-being. Fatigue is a common symptom amongst people with PPS, so an appropriate intensity with many rests must be prescribed. An individual with PPS should be able to continue with an appropriate exercise programme on a regular basis on his/her own, adjusting the programme accordingly. However, initially it is important to see an appropriate exercise specialist, such as a biokineticist, to be assessed and start an suitable exercise regime.

References
ACSM’s Exercise Management for Person’s with Chronic Diseases and Disabilities

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