In post-polio syndrome, symptoms typically occur several decades after recovery, after a long latent period. Use of pharmacological agents in post-polio syndrome has, thus far, been disappointing. It is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity. Patient education, health promotion, screening, and energy conservation strategies that include walking with a properly fitting assistive device reduce perceived fatigue and improve posture and function in an individual with post-polio syndrome. Future randomized trials should also address the long-term effects of muscular training in post-polio syndrome, in addition to the treatment of pain and fatigue in these patients.
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• The post-polio population is aging and decreasing in size. Still, there are thousands of post-polio patients who require skilled nursing care with their advancing age and declining function.
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• Fatigued post-polio patients can be considered a distinct subgroup across the fatigue continuum.
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• Diaphragmatic paralysis in post-polio syndrome can be unilateral or bilateral. When unilateral, the prognosis is good, but bilateral diaphragmatic paralysis often has a worse prognosis.
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• Supportive care, self-selected life style changes, and energy conservation strategies still remain the main axiom of therapy.
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• Post-polio patients are at a high risk for falls and fractures.
Historical note and terminology
Poliomyelitis epidemics in the United States came to an abrupt end with the introduction of the inactivated poliomyelitis vaccine (Salk Vaccine) in 1955 and the live attenuated oral polio vaccine (Sabin Vaccine) in 1961 (130; 37). Even though poliomyelitis has been eliminated in much of the world, many patients from prior epidemics were left with severe sequelae and disabilities. These patients became over-achievers by working hard both physically and emotionally to overcome their disabilities (173). Now, many decades after contracting acute poliomyelitis, these survivors are developing new symptoms, collectively referred to as “late effects of poliomyelitis” or the “post-polio syndrome.” Not only are there new physical disabilities with which to cope, but also psychological effects of a second disability from a disease presumably resolved.
The syndrome of late weakness occurring many years after acute poliomyelitis has been recognized for over 100 years. However, it did not receive general public recognition until the large number of cases began to be seen in the 1980s (11; Halstead and 173). In 1875 late weakness occurring years after poliomyelitis was noted by Charcot and other clinicians (34; 44; 140). Between 1875 and 1975 only about 200 cases of post-polio syndrome were described in publications (89). However, since 1975 thousands of cases have been reported (78; 89; 171; 91; 104).
Energized by hope and optimism, the mid 1980s and early 1990s saw a surge of support groups (maximum of 298 in 1990) and clinics (96 in 1990), followed by a steady decline in 2010 (131 support groups and 32 clinics) as the limits of research as well as clinical and self-help initiatives became obvious. Also, the post-polio population is aging and decreasing in size. Still, there are thousands of post-polio patients who require skilled nursing care with their advancing age and declining function (75).