Post-Polio Syndrome: Pathophysiology and Clinical Management
Anne Carrington Gawne and Lauro S. Halstead
This article is a comprehensive review of postpolio syndrome (PPS). Although poliomyelitis epidemics came to a dramatic end in most countries with the introduction of the Salk polio vaccination in 1955, acute polio remains a threat in many parts of the third world. In addition, many of those earlier survivors are now developing new problems and face a new challenge to restore strength and function.
In the past, even in the field of rehabilitation, residual motor loss from paralytic polio was generally considered a chronic, stable lesion. Following the acute illness and a period of rehabilitation, patients eventually reached a plateau of neurological and functional recovery that was believed to remain essentially static. However, more recently, research shows that over one half of the survivors of paralytic polio experience new health problems related to their original illness. These problems occur about 30 to 50 years after their initial polio and include new weakness, fatigue, pain, and functional loss. The cause of these new symptoms remains uncertain; however, it appears to be related to motor unit dysfunction manifested by a deterioration of the peripheral axons and the neuromuscular junction.
This review begins with a discussion of the historical and epidemiological aspects of poliomyelitis, as well as the pathophysiology of polio. We examine possible etiologies for the development of PPS. We then review the characteristics of PPS, including physical, electrodiagnostic, and morphologic features. Finally, we discuss the assessment, differential diagnosis, and rehabilitation management of some of the problems that patients experiencing the late effects of polio may face.
© Copyright The Lincolnshire Post-Polio Network
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Original Think-tank, Cornwall,
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Created: 5th June 2000
Last modification: 24th January 2010.