What is post-polio syndrome?

Polio was an epidemic in the United claims in the 1940s and also 1950s. Human being in the united States carry out not often contract polio due to the fact that of the breakthrough of a polio vaccine which was occurred in 1955 by Jonas Salk and an oral vaccine in 1962 by Albert Sabin. Vaccinated individuals cannot organize a virus which renders it can not to replicate and spread. The polio virus is still active in some locations of the world. Improved sanitation steps have also helped to manage it.

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Poliomyelitis or polio is a contagious virus the enters the body. That is spread out in respiratory droplets and through solid human body waste. Most individuals who have actually polio will have flu-like symptoms. Rarely, polio influence the engine nerves (nerves that regulate movement) of the body particularly in the spinal cord. This can be a sensation of study abroad (paresthesia), an epidemic in the spanning of brain and spinal cord (meningitis), or weak in the muscle of the human body (paralysis). Motor nerves are influenced by polio which have the right to lead come paralysis everywhere in the body with reduced movement seen in the arms and legs and also most notably in the muscles that regulate breathing.

Some people survived the polio epidemic. Those through motor nerve damage may have some residual movement deficits. Come accommodate the ns of movement, impacted nerve fibers develop brand-new nerve-end terminals (dendrites) the will affix with other nearby muscle fibers. The result is functional motion recovery. This procedure is a representation of neuroplasticity or the capability of the nervous system to recoup by developing nerve buds to improve the strength of the polio impacted nerve fibers and muscles. ~ the initial polio episode, the individual can have partial to what shows up to it is in a full recovery.

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Over time, some individuals with a background of polio which affected the engine nerves might develop brand-new muscle pain, weakness, or paralysis 10 come 40 years after the original polio episode. This is post-polio syndrome (PPS). Years later, the overused motor nerves end up being unable to save up with motion demands which results in their slow deterioration. There may be some innovation a 2nd time, yet eventually, the nerve terminals slowly breakdown without more recovery. Steady weakness and paralysis deserve to occur.

It is necessary to keep in mind that only a small variety of individuals develop post-polio syndrome. Those that endured polio without motor nerve involvement do not construct PPS. Post-polio syndrome is no contagious. The is no a re-activation that the virus yet rather an result of destruction of the instead of or supplemental nerves.

Symptoms and Risk determinants of Post-Polio Syndrome

Post-polio syndrome has tendency to construct slowly with alternating periods that stability adhered to by increasing symptoms. The development of PPS occurs over time.

PPS occurs in individuals with a background of polio that included motor nerve involvement. That is commonly not life-threatening unless breathing is influenced and untreated. Individuals differ in amount of impacted function. Some will have mild instances of PPS with minor adaptions while others will have actually more far-ranging issues requiring transforms in lifestyle.

Symptoms incorporate some or all of these factors:

progressive weakness in muscles and jointspain in muscles and jointsbody/mind fatigue and exhaustion through minimal activityloss the appetitefevermuscle atrophy (wasting)bone distortions such as scoliosis (curving the the spine)breathing issuessleep disorders, insomnia, sleep apneaswallowing issuescold temperature intolerance, occasionally intolerance to warmth

Risk components for Post-Polio Syndrome

Risk determinants for PPS encompass a higher incidence in those individuals who had a significant initial food of polio with motor nerve involvement. If restore of duty was great or wonderful from the early stage polio event, an ext stress is put on the supplementing nerves which can lead to post-polio syndrome engine nerve failure. Advance of polio later in life together a teenager or adult can relate come a higher risk of PPS because the sprouting nerve terminals room slower to build as people age. Overexercising come the suggest of muscle fatigue can be a trigger for PPS if you have a background of polio v motor nerve involvement.

complications of Post-Polio Syndrome

Issues that result from PPS count on ar of injury to the nerve such as in the spinal cord, in the body or both. Complications arise together weakness progresses. This are several of the an essential issues.

Falls: muscle weakness have the right to lead come balance problems, slipping or getting your toe caught under a rug or stairs step. Falls can have actually profound consequences such as pulled muscles, bruising, and also broken bones.Difficulty swallowing: individuals with PPS the affects oral motor task such as chewing and also swallowing can lead come nutritional issues and also dehydration. Poor oral motor control can result in pneumonia if food is misdirected right into the lungs.Breathing: problems arise because of weak chest and ab muscles. This can reduce the ability to develop a solid cough to clean airway i which deserve to lead to pneumonia. Muscular changes can bring about breathing issues such as sleep apnea or chronic respiratory failure.Muscle and also skeletal structure: alters from strong muscles pulling the body against weaker muscles can result in structure bone changes leading difficulty in body positioning, discomfort, pain, contractures, difficulty in hygiene. Muscular changes can bring about breathing issues such as sleep apnea or chronic respiratory tract failure and also pressure injury. Scoliosis, a adjust in the structural positioning of the spine affects the body’s ability to breathe deeply and effectively.Neurogenic bowel and bladder: nerve miscommunications readjust your ability to toilet. Bowel and bladder programs deserve to be developed to store your body healthy. This programs minimize complications and maintain continence if removed is challenged.Bone mineral density: reductions indigenous skeletal changes or inactivity can develop osteopenia (low bone mass) or osteoporosis (extremely short bone mass).Assistive device: issues such as braces and also splints rubbing ~ above the skin or usage of crutches deserve to lead to press injury and joint pain.

Diagnosing Post-Polio Syndrome

Your health care provider will carry out a finish physical examination and health history. They will be separating your symptoms from other neurological issues. Hints to PPS incorporate a background of polio particularly affecting the motor nerves complied with by partial or complete recovery because that a duration of 10 years or more.

The background of PPS includes a brand-new onset the slowly steady muscle weakness, reduced endurance, muscle atrophy, muscle and/or share pain and also fatigue. Typically, later occurring symptoms incorporate breathing or swallowing issues. Onset of PPS is gradual however inactivity from trauma or surgery deserve to make the symptoms show up suddenly. Even though you watch your health care provider early, a diagnosis the PPS is typically not made till symptoms have actually been in process for a minimum that a year.

Questions around other health concerns that could be comparable to PPS symptoms will certainly be asked. These include concerns with depression i beg your pardon affect activity levels or functional concerns such together joint ache from use of braces or crutches. Some of the symptoms of PPS are stand-alone medical conditions, such as breathing dysfunction or scoliosis, and are therefore not conclusive symptoms because that PPS.

Included in your medical care professional’s physical examination is hands-on muscle experimentation (MMT) wherein the toughness of each of your significant muscle groups is assessed and also rated. This is done by the provider in their office at a usual visit. You space asked to press or pull muscle groups against the resistance of the examiner. Some instruments may be provided for much more precise measurements.

An electromyography (EMG) test is done to create motor neuron loss. This is perform on any type of muscle of the human body by using a sensor or needle to assess electric conduction to the muscle through the nerve. Nerve conduction research studies (NCS) may or might not be done depending on individual circumstances.

Imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) the the spine can follow progression of PPS.

A muscle biopsy might be done to exclude other diagnoses.

There are no laboratory blood tests provided to diagnose PPS.

There is no test that predicts i beg your pardon survivor that polio with impacted motor nerves is at hazard for PPS.

Rehabilitation because that Post-Polio Syndrome

Treatment for PPS counts on individual issues. Rehabilitation program are arisen for the unique needs of the individual escape on problems that develop and also prevention strategies.

Energy conservation is the focus of rehabilitation tactics for individuals with post-polio syndrome. This may involve some transforms in lifestyle. You may need to include rest periods right into your day come ensure you space not overexerting your muscles. It may be necessary to usage adaptive devices for mobility. Probably you can walk some distance but become fatigued as soon as doing so. Making use of adaptive tools such together a wheelchair for distance use could make your day an ext functional once you are not fatigued native walking. The goal is come not exhaustion your muscles to the point of creating an ext nerve damage. Preserve a healthy and balanced weight to alleviate your workload.

Avoid drops by wearing effectively fitted shoes, pick up clutter specifically on the floor, usage handrails as soon as going increase or under stairs, eliminate throw rugs, protect against slippery or icy walkways, usage mobility aids as necessary for safety.

Exercise is an essential to health, but over-exerting muscles leader to raised muscle fatigue. Much less strenuous exercises deserve to be provided to save your muscles useful without overexertion. Light swimming is a an excellent total body exercise. Cardiopulmonary exercise is preferred to fatiguing strengthening exercise. An exercise arrangement should be occurred that will prevent ache, fatigue, and also weakness. The exercise program need to be tailored to your requirements to incorporate muscles to be strengthened, muscle to prevent exertion and also frequency that the program.

Strengthening oral motor skills is helpful. Tucking your chin when swallowing deserve to be helpful to prevent choking. Exercises deserve to be carry out to help increase your oral muscles for speaking, eating, and swallowing. These deserve to increase your communication capacity as well regarding protect your airway when eating.

Breathing is a an essential activity. Lessened ventilation affects your body v fatigue and also mental acuity. Use of sleep apnea gadgets should be initiated if the is one issue. This is helpful to stop cardiac complications. Mechanically ventilation that is used continuously or for remainder periods can be provided. There space a range of mechanically ventilation devices that have the right to be used. Some call for intubation however many others carry out not. Your health care team can discover the kind of machine that is ideal for your needs. Prevent smoking to store your lung healthy. Report respiratory infections timeless for quick treatment. Store up to day with flu and also pneumonia vaccines.

Pain manage using analgesics or nerve ache medication may be helpful. Because that some, anti-inflammatory medications have been helpful. If nerve pains is an issue, gabapentin (Neurontin) and pregabalin (Lyrica) and low sheep anti-seizure medication and low dose anti-depressants are useful.

Body temperature is influenced by PPS. Stay heat by keeping your environment at a comfortable temperature, dress in layers; if law aquatic therapy, use a cook pool. Save a comfortable temperature in the summer months but avoid overdoing air air conditioning to avoid cold intolerance.

Those who will be involved with your care are:

Your Primary healthcare Provider will take care of your everyday needs. Castle will overview you in the treatment of basic healthcare issues.

A Neuromuscular doctor Specialist is a specially education neurological doctor who will take the lead around issues the PPS. This person will follow your progression to provide the best treatments because that PPS.

A Pulmonary medical Specialist deserve to assist with assessing breathing ability and equipment that might be required, if any.

Physical Therapists will administer therapy to gently rise your strength and also balance. They can assist with power conservation principles. The physics therapist can aid you select mobility aids, if needed.

Occupational Therapists will aid with adaptations to increase your role in day-to-day living both with gentle strengthening and also adaptive equipment. They can assist with energy conservation techniques.

Speech Therapists can assist with improving oral motor function and decided clarity if these space issues. This separation, personal, instance will assist you learn exactly how to keep your airway clear.

Respiratory Therapists will assist with strengthening your breathing capacity as fine as aid you find out to usage the correct devices if breath is an issue.

A Psychologist, Counselor or social Worker can assist through adaption come chronic illness. They can aid provide an abilities to attend to issues as they to happen and provide strategies to resolve challenges before occurring.

Rehabilitation Specialty Registered Nurses can assist with understanding your symptoms, treatments, medication, and management of an individual care such as bowel and bladder programs, if needed. Lock will assist you with translating information from various other specialists into your life.

Insurance case Managers are professionals who will assist with translate into of what your payor/health insurer will help with throughout your rehabilitation.

staying clear of Post-Polio Syndrome

Post-polio syndrome establishes in people who have survived polio that impacted motor nerves. There is no vaccine or other medication that have the right to prevent post-polio syndrome nor is there a way to predict that will construct it. Risk determinants are indications of possibility, not straight indicators of development of the syndrome.

If you made it through polio that influenced your motor nerves (those because that movement and breathing), you have the right to implement energy conservation techniques and also conservative exercise maybe to slow the beginning of PPS. This is not a proven prevention due to the fact that no one knows who will develop PPS and also who will certainly not.

The finest prevention of PPS is to avoid gaining polio. This can be excellent by getting the polio vaccine. There room two species of vaccine the are provided to children. One is the dental poliovirus vaccine (OPV) the is given about the world. In the unified States, only the inactivated poliovirus vaccine (IPC) series has been given because the year 2000. The polio vaccines prepare the human body to hit poliovirus must exposure occur. It provides protection the 99% if the entire series of vaccinations are completed.

research study of Post-Polio Syndrome

The variety of studies of post-polio syndrome space vast. Initially, scientists started looking in ~ the resource and reasons of PPS specifically of the motor neurons without and after polio consisting of the neuron junction to the muscles. They continue to pursue and also understanding of the source of PPS. Immunological studies of polio resulting due to inflammation as an immune solution is additionally under review.

The after-effects of PPS such as exhaustion are gift researched to understand the causes and also to develop treatments the will assist in enhancements of top quality of life and also function.

Preliminary studies have been perform with various treatments in ~ the nationwide Institutes of wellness Preliminary studies means there were tiny numbers that participants v these start studies. The outcomes space not however demonstrated for basic use. The preliminary research studies are detailed below through outcomes. More research will be conducted.

Drug

Outcome

Prednisone

Some individuals provided improvement, however these results were not far-reaching (no more than chance)

Intravenous Immunoglobulin

May reduce pain and increase quality of life

Lamotrigine (an anticonvulsant drug)

Possibly reliable in dealing with fatigue, but a bigger study demands to it is in conducted, evidence not conclusive.

Facts about Post-Polio Syndrome

Post-polio syndrome is not contagious. It is not resulted in by a virus. That is the an outcome of previously damaged nerves indigenous the initial polio event.

Over 12 million people, an international have been affected by polio as shown by the CDC.

There is no central system because that reporting post-polio syndrome, but it is estimated that 300,000 individuals are survivors the polio in the united States and also have soft to serious symptoms.

Of the 300,000 survivors that polio, the is approximated that the one fourth to one fifty percent may construct some kind of post-polio symptoms.

It appears that individuals who had actually severe situations of motor nerves impacted by polio might be more likely to develop post-polio syndrome.

resources

If you are looking for much more information about post-polio syndrome or have a details question, our info Specialists are obtainable business weekdays, Monday v Friday, toll-free in ~ 800-539-7309 native 9:00 am to 8:00 pm EST.

Additionally, the Reeve foundation maintains a post-polio fact sheet with extr resources from trusted Reeve structure sources. Inspect out our repository of reality sheets on hundreds of topics varying from state resources to an additional complications that paralysis.

We encourage you come reach the end to post-polio support groups and organizations, including associations which features news, study support, and also resources, national network of support groups, clinics, and also specialty hospitals.

Post-Polio wellness International

Centers for condition Control and also Prevention

National academy of Neurological Disorders and also Stroke (NINDS)

https://www.ninds.nih.gov/Disorders/All-Disorders/Post-Polio-Syndrome-Information-Page

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Post-Polio-Syndrome-Fact-Sheet

National organization for Rare obstacle (NORD)

additional Reading

Bromberg MB, Waring WP. Neurologically common patients v suspected postpoliomyelitis syndrome: electromyographic assessment of previous denervation. Arch Phys Med Rehabil. 1991 Jun;72(7):493-7. PMID: 2059122.

Curtis A, Lee JS, Kaltsakas G, Auyeung V, shaw S, Hart N, Steier J. The value of a post-polio syndrome self-management programme. J Thorac Dis. 2020 Oct;12(Suppl 2):S153-S162. Doi: 10.21037/jtd-cus-2020-009. PMID: 33214920; PMCID: PMC7642628.

Ghavanini MR, Ghavanini AA. Fibrillation potentials and also positive spicy waves in patients with antecedent paralytic poliomyelitis. Electromyogr Clin Neurophysiol. 1998 Dec;38(8):455-8. PMID: 9842478.

Halstead LS. Assessment and also differential diagnosis because that post-polio syndrome. Orthopedics. 1991 Nov;14(11):1209-17. PMID: 1758788.

Lo JK, Robinson LR. Postpolio syndrome and the late impacts of poliomyelitis. Component 1. Pathogenesis, biomechanical considerations, diagnosis, and also investigations. Muscle Nerve. 2018 Dec;58(6):751-759. Doi: 10.1002/mus.26168. Epub 2018 Aug 22. PMID: 29752819.

Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: part 2. Treatment, management, and also prognosis. Muscle Nerve. 2018 Dec;58(6):760-769. Doi: 10.1002/mus.26167. Epub 2018 Aug 23. PMID: 29752826.

Jonathan Ramlow, Michael Alexander, Ronald LaPorte, Caroline Kaufmann, Lewis Kuller, epidemiology of the post-polio syndrome. American newspaper of Epidemiology, Volume 136, concern 7, 1 October 1992, Pages 769–786, https://doi.org/10.1093/aje/136.7.769

Sheth NP, Keenan MA. Orthopedic surgical procedure considerations in post-polio syndrome. To be J Orthop (Belle Mead NJ). 2007 Jul;36(7):348-53. PMID: 17694181.

Trojan DA, Gendron D, Cashman NR. Electrophysiology and electrodiagnosis the the post-polio engine unit. Orthopedics. 1991 Dec;14(12):1353-61. PMID: 1784551.

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Voorn EL, Koopman FS, Brehm MA, Beelen A, de Haan A, Gerrits KH, Nollet F. Aerobic exercise training in post-polio syndrome: process evaluation that a randomized managed trial. PLoS One. 2016 Jul 15;11(7):e0159280. Doi: 10.1371/journal.pone.0159280. Erratum in: PLoS One. 2018 jan 30;13(1):e0192338. PMID: 27419388; PMCID: PMC4946776.