Post-Polio Syndrome Treatment And Prevention

What is polio and how does it impact human lives?

Polio, short for poliomyelitis, is a highly infectious and deadly viral disease caused by infection with poliovirus. It primarily affects the gastroenteric system causing inflammation and, in severe cases leading to paralysis. Although it often manifests as an asymptomatic condition, in some cases the infection spreads across the central nervous system, causing non-paralytic meningitis (infection of the brain and spinal cord) or paralytic poliomyelitis.¹ This is a highly contagious disease spread through faecal-oral transmission from infected individuals. Polio mostly affects children under the age of five, although it can be contracted at any age. Before the development of polio vaccines, polio was a major public health concern worldwide. Epidemics of polio would occur regularly affecting thousands of children and adults each year. The disease had a profound impact on human lives due to the consequent disability and paralysis which caused social stigma in the affected individuals. The development and widespread administration of the polio vaccine, coupled with the establishment of the Global Polio Eradication Initiative (GPEI) spearheaded by several international organisations to eradicate the disease, revolutionised disease prevention and control efforts.² According to the World Health Organisation (WHO), the number of reported cases has declined by 99% since the launch of GPEI in 1988³. Although there is a dramatic decrease in polio incidence now, it has not been completely eradicated. It remains endemic in some countries due to improper healthcare systems or inaccessibility to vaccines.

Understanding post-polio syndrome

For survivors of polio, the challenge does not end with the initial infection; Post-Polio Syndrome (PPS) can develop years after recovery manifesting with new physical and neurological symptoms. While there is no cure for PPS, there are strategies that can be implemented to manage symptoms and prevent complications. PPS is a condition that affects individuals who have previously contracted polio. It usually manifests after at least 15 years of the initial acute paralytic poliomyelitis, causing a resurgence of symptoms like muscle weakness, atrophy (muscle loss), fatigue, joint pain, cold intolerance, and respiratory difficulties.⁴ The underlying cause of PPS is not clearly understood, but it is believed to be related to the degeneration of the neurons that were previously damaged by the poliovirus.

What are the risk factors for developing post-polio syndrome?

Several risk factors have been identified that may increase the likelihood of developing PPS. These risk factors include:⁵

The severity of the previous infection:

Individuals who have experienced acute polio infection, particularly with severe symptoms or paralysis during the initial illness, are at an increased risk of developing PPS later in life. The extent of muscle and nerve damage caused during the acute phase of infection may also influence the risk of developing PPS.

Age

Individuals who were very young at the time of acute polio infection, particularly those who contracted the virus during childhood, may have a higher risk of developing PPS in adulthood.

Degree of functional recovery

Patients who had partial recovery or persistent weakness following the initial illness may be at increased risk of developing PPS symptoms compared to those who fully recovered.

Overuse of muscles affected by Polio

Overuse or excessive strain on muscles affected by polio during the acute phase of infection may contribute to the development of PPS. Activities that place undue stress on weakened muscles, such as repetitive or high-impact exercises, may accelerate the degeneration of motor neurons and exacerbate symptoms of PPS. This coupled with physical or emotional stressors, such as illness, injury, surgery, or psychological stress, may trigger or exacerbate symptoms of PPS.

Lifestyle factors

Lifestyle factors, such as smoking, obesity, sedentary behaviour, and poor nutrition, may impact the risk of developing PPS. Underlying health conditions and comorbidities, such as osteoarthritis, osteoporosis, cardiovascular disease, or respiratory dysfunction, may exacerbate symptoms of PPS and increase the overall burden of disability.

What are the most common symptoms associated with post-polio syndrome?

• Muscle weakness
• Muscle fatigue
• Muscle and joint pain
• Muscle atrophy (loss of muscle mass)
• Joint stiffness
• Muscle twitching (fasciculations)
• Difficulty breathing
• Sleep disturbances
• Swallowing difficulties (dysphagia)
• Cognitive changes
• Emotional distress

What are the treatment options available for post-polio syndrome?

While there is no specific treatment to cure PPS, various therapeutic intervention strategies can manage the disease progression and enhance functional abilities. The main aim is to manage symptoms, improve the patient's quality of life and prevent complications.⁶

Physical therapy

A tailored exercise program designed by a physical therapist to suit your specific needs can help strengthen weakened muscles, improve mobility, and alleviate pain. Low-impact exercises such as swimming, cycling, and gentle stretching can be particularly beneficial. Physical therapy can help reduce pain, optimise functional abilities, and prevent further muscle deterioration.

Occupational therapy

Occupational therapists can provide strategies to conserve energy, adapt to daily activities, and use assistive devices to maximise independence and minimise fatigue. Occupational therapy focuses on improving functional skills and enhancing the quality of life for patients with PPS. Braces, orthotics (external devices to support the neuromuscular and skeletal systems, such as braces), and mobility aids such as canes, walkers, or wheelchairs may be prescribed to support weakened muscles, improve stability, and reduce the risk of falls.

Medications

Pain management strategies may include over-the-counter or prescription medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be prescribed to alleviate pain and reduce inflammation associated with PPS. In some cases, medications such as anticonvulsants or antidepressants may be recommended to manage neuropathic (nerve) pain or improve sleep quality.

Respiratory support

Patients with PPS may experience respiratory complications such as sleep apnoea (when you stop breathing temporarily during sleep) or respiratory muscle weakness. Continuous positive airway pressure (CPAP) devices or nighttime ventilators can help improve breathing during sleep, while pulmonary rehabilitation programs may enhance lung function and respiratory muscle strength.

Pain management techniques

Complementary therapies such as acupuncture, massage therapy, or transcutaneous electrical nerve stimulation (TENS) may provide relief from muscle pain and discomfort associated with PPS. Psychological interventions such as cognitive-behavioural therapy (CBT) can also help individuals cope with chronic pain and improve overall well-being.

Psychological support

Coping with the challenges of PPS can be emotionally taxing, leading to feelings of frustration, anxiety, or depression. Psychological support from therapists, counsellors, or support groups can provide emotional validation, coping strategies, and a sense of community for individuals living with PPS.

Nutritional support

Maintaining a balanced diet rich in nutrients is essential for optimising muscle function, promoting tissue repair, and preventing complications such as osteoporosis or malnutrition. Registered dietitians can provide personalised dietary recommendations based on individual needs and preferences.

What are the potential complications associated with PPS?

• Progressive muscle weakness can lead to increased difficulty in mobility and functional independence
• Functional decline may impact activities of daily living and may require the use of assistive devices
• Chronic muscle weakness and imbalance may result in joint problems such as arthritis and stiffness
• Respiratory muscle weakness can cause difficulty in breathing and increase the risk of respiratory infections
• Swallowing difficulties may lead to aspiration, choking, or malnutrition
• Chronic fatigue can significantly impact daily functioning and quality of life
• Emotional distress, including anxiety and depression, may result from living with a chronic condition such as PPS
• Muscle weakness and mobility impairments increase the risk of falls and fall-related injuries
• Medication side effects 
• Prolonged immobility can lead to secondary complications such as pressure ulcers and cardiovascular disease

How can complications associated with PPS be prevented?

While PPS cannot be prevented entirely, certain strategies can help minimise the risk of complications and maintain optimal health:

Maintaining a healthy lifestyle

Eating a balanced diet, engaging in regular exercise, and maintaining a healthy weight can support overall physical health and reduce the strain on weakened muscles and joints.

Conservation of energy

Learning to pace activities, prioritise tasks, and take frequent breaks can prevent overexertion, conserve energy levels, minimise fatigue and reduce the risk of symptom exacerbation.

Avoiding overuse of weak muscles

Being mindful of activities that may strain weakened muscles or joints, and avoiding repetitive motions or heavy lifting that could lead to injury or exacerbate symptoms.

Regular monitoring

Staying proactive by monitoring symptoms and seeking medical attention if new or worsening symptoms develop can help prevent complications from occurring or worsening. Regular check-ups with healthcare providers can help identify potential complications early and facilitate timely interventions.

Adaptation to home and work environments

Making modifications to your home and work environments can improve accessibility, reduce fall risks, and accommodate any mobility or functional limitations. This may include installing handrails, ramps, or other adaptive equipment to facilitate independence and safety.

Empowering polio survivors

Living with PPS can present significant challenges, but it's essential for polio survivors to know that they are not alone. By staying informed about PPS, adopting proactive self-care strategies, and seeking support from healthcare professionals and support groups, individuals with PPS can continue to lead fulfilling and meaningful lives. With the right strategies, treatment and preventive measures in place, polio survivors can navigate the journey of post-polio syndrome with resilience, strength, and optimism. By incorporating physical therapy, medications, respiratory support, and lifestyle modifications into their care plan, patients with PPS can optimise their quality of life and maintain independence.