POLIO

Polio is the common name for the poliomyelitis virus which has been documented in medical literature for thousands of years. It is a childhood disease that reached epidemic proportions in Europe and North America in the late 1800s and into the 20th century. A vaccination that was discovered in the 1950s has essentially eliminated the disease in developed western nations.  In over 90% of individuals Polio is asymptomatic with no long term damage or side effects. However, in a small percentage of individuals Polio affects the central nervous system (CNS), infecting and destroying motor neurons. This is known as paralytic poliomyelitis; spinal polio being the most common form, bulbar and bulbopinal representing the other types. The difference between the types of polio includes the amount of inflammation, nerve damage and the area of the CNS affected. 

Paralytic poliomyelitis results in muscle weakness and flaccid paralysis. The paralysis is often asymmetrical and the areas of weakness are dependent on the nerves that have been affected. There is no cure for poliomyelitis and treatment is mainly to decrease pain, speed up the recovery process and prevent complications. In many cases the weakened muscles fully recover in six to eight months. However approximately half of the individuals with spinal polio will end up with a mild to severe disability.  With temporary paralysis and prolonged immobility, muscle weakness and other complications will remain in some individuals. These complications may include skeletal and joint deformities, ligament and tendon shortening, leg length discrepancies (if only one limb was affected), osteoporosis, and complications with the lung, heart and other internal organs. Also, if respiratory muscle damage occurs, individuals may have chronic breathing complications.  Treatment for spinal polio includes analgesics for pain, antibiotics, exercise, physical therapy and bracing.

Post polio syndrome (PPS) is a complication of paralytic polio that affects approximately a quarter of individuals. It is characterized by the reoccurrence of weakened muscles that have been previously affected by the disease, as well as the weakening of previously healthy muscles. Symptoms include pain (from bone deformity and joint degeneration), muscle weakness, fatigue and in severe cases muscle atrophy or wasting. Part of the recovery from paralytic polio involves the production of enlarged motor units to compensate for the ones that were destroyed by infection. It is thought that failure of the new enlarged motor neurons may cause new symptoms that occur decades after the initial illness. Severity of PPS is thought to relate to the severity of the initial disease state and the amount of residual disability and weakness that remains. Currently there are no medications that can effectively treat PPS. Exercise has been found to be beneficial in individuals with mild symptoms. Cardiovascular and non-fatiguing strength training improves both strength and muscle function in individuals with PPS. High intensity strength training should be avoided as further muscle weakness may occur.

Scientific literature supports the use of exercise when recovering from Poliomyelitis and PPS. The volume and intensity of exercise training should progress slowly. Some studies use the term non fatiguing exercise when discussing protocols used for individuals with PPS. The concern with high intensity exercise is the possibility of damaging enlarged motor neurons resulting in further instability and muscle weakness.  When an individual has any level of disability it is important to discuss a new exercise training protocol with a physician

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and/or other trained health care providers to ensure safety. With respect to PPS, the literature strongly advises that exercise programs be done under supervision of a trained health care provider to ensure that proper exercise selection and intensity during the workout is achieved.

Whole body vibration (WBV) may benefit an individual with residual deficits from polio, especially if the condition has been stable for several decades. The benefits of WBV include improved muscle strength, bone density, balance, and circulation. For an individual with PPS the condition should be stable and any exercise should be done under the supervision of a trained health care provider. Once cleared by a physician an individual may use WBV at a lower intensity and duration until he/she becomes comfortable on the machine. WBV should be discontinued immediately if an individual notices any deterioration in the strength, the development of new muscle weakness, or if 

experiencing pain. These changes should be discussed with a doctor.  

In general, if an individual experiences any shortness of breath, dizziness or pain while using WBV the exercise should be discontinued immediately.

References

Post-Polio Syndrome Fact Sheet. Retrieved November 27, 2009, from http://www.ninds.nih.gov/disorders/post_polio/detail_post_polio.htm

Poliomyelitis. Retrieved November 27, 2009, from http://en.wikipedia.org/wiki/Poliomyelitis

Oncu, J., Durmaz, B., Karapolat, H. (2009). Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome. Clinical Rehabilitation, 23(2), 155-63.

Chan, K.M, Amirjani, N., Sumrain, M., Clarke, A., Strohschein, F. J. 

(2003). Randomized controlled trial of strength training in post-polio patients, Muscle Nerve, 27(3), 332-8.

Tam, S. L., Archibald, V., Tyreman, N., Gordon, T. (2002). Effect of exercise on stability of chronically enlarged motor units, Muscle Nerve, 25(3), 359-69.

Feldman, R. M. (1985). The use of strengthening exercises in post- polio sequelae. Methods and results, Orthopedics, 8(7), 889-90.

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