Overview of Post-Polio Syndrome
This condition is a slowly progressive disorder consisting of muscular atrophy, pain, and fatigue that occurs decades after an acute polio paralytic episode. This syndrome results when the motor neurons that provided re-innervation of muscle fibers begin to prune back their axonal sproutings due to their inability to maintain metabolic activity to the muscle fibers. The loss of muscle innervation results in decreased strength, endurance, and activity. Of those clients who have survived polio, 25% to 40% will experience the effects of post-polio syndrome.1 Loss of lower extremity strength can result in clients overusing their upper extremities to compensate for their loss in function. Clients may begin to be unable to perform daily activities independently and may need to rely more on assistive devices and a wheelchair for mobility. A decrease in daily activities can result in weight gain, which is deleterious for maintaining independence in mobility.2
Comorbidities to Consider
As the syndrome progresses, the client is likely to develop joint pain, myalgias, and fatigue, which may limit daily activities and independence with mobility tasks.
Keys to Examination of Clients
Electromyograms and muscle biopsies are used to confirm loss of muscle innervation.
Functional assessment of independence with transfers and gait may be appropriate for some clients.
Employ a fatigue index to determine a baseline before having a client begin an exercise program.3
Recommended Baseline Testing of Fitness Levels
Type: Walking, treadmill walking, cycle ergometry, aquatic activities
Intensity: Low to moderate intensities, levels 12–15 on a Borg scale
Duration: Start at 10–15 minutes
Frequency: Three times per week
Prescribe an exercise program that matches the client's current level of function to prevent the client from experiencing excessive fatigue and muscle pain.4 Endurance exercise using walking and treadmill walking is the most appropriate for promoting improvements in walking independence. Walking durations of up to 30 minutes, performed three times per week, have been used to improve endurance and to reduce fatigue levels.5 Cycle ergometry and aquatics can be used to improve endurance and promote weight loss. Resistance exercise can be performed using a circuit of weight training, free weights, or resistance bands.4,6 Resistance exercises can be prescribed with light to moderate resistance using one to three sets performed three times per week.6 Regular participation in an exercise program is an important component for maintaining health, function, and quality of life in clients with post-polio syndrome.1,2