4/23/2016

Managing symptoms of Post Polio


The British Polio Fellowship

Staying as healthy as possible means combining self-management techniques, such as pacing, with symptom management such as healthy eating and weight control.

Conserve it and preserve it!

When you first had Polio, you may have been told “use it or lose it”, even if this meant you acted in a way that made you feel pain or very tired. We now know that it’s much easier and better for you to learn new ways of coping with PPS. This can be summed up as “conserve it and preserve it”. One way to conserve your energy is through pacing.

What is pacing?

Pacing is a method of learning to recognise your own individual and manageable baseline of activity, so you always stop what you are doing before you become exhausted. By always stopping before you are tired, you may be able to continue for longer.
Pacing means that most activities can be broken up into smaller ones with rests in between.
For example, if you swap between several different jobs or repetitive activities you will be using different muscles and resting others. If a job cannot be broken up it may need to be done a completely different way. You may need help from another person, or may realise that the job was not necessary after all.
For example, several smaller trips to a supermarket may be easier than one large shop, but if just driving to the supermarket and back is tiring, then maybe it is time to have home deliveries.
When managing PPS symptoms it is worth considering the following: pacechange or stop.

In summary

Try to live your life so you feel as fit and healthy as possible most of the time, and then see how you can fit family, work, activities and friends into it. Adapting and finding new ways to do things has always been part of living with Polio. The same goes for living with PPS.

Planning your time

Here are some questions to help you pace:
  • How much can I do in one day and what is most important?
  • What do I really enjoy doing?
  • What is not important and can be cut out?
  • Have I allowed time to rest?
  • Have I organised my home or workplace so that the things I need most often are the easiest to get?
  • Have I arranged comfortable seating for any task that can be done sitting?
The Pacing for Activity and Exercise leaflet, written with advice from the physiotherapy department of the Lane Fox Unit at St Thomas’ Hospital in London, includes further information about pacing and how to work out a baseline of activity. Contact Support Services for a copy.
Please talk to your doctor or physiotherapist before you start an exercise programme.

Controlling weight and eating healthily

Being overweight can be a further strain on weakening muscles and will not help your energy levels and general health. Losing weight is a good idea and can help reduce PPS symptoms.
While regular exercise is a good way of controlling weight, it might not be possible for you.
Following a sensible and healthy eating plan will help to reduce weight and improve health. It is important to eat a healthy balanced diet including foods that provide slow released energy over longer periods.
For information on how to manage a healthy diet, order our Healthy Eating Booklet by contacting our Support Service Team.
You could ask your GP to refer you to a dietitian.
Post Polio Litaff, Association A.C _APPLAC Mexico

The Polio Crusade

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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here