LETTER P: POST POLIO SYNDROME
India, once considered to be one of the toughest places globally to eradicate polio, has surpassed more than 3 successful years of eradication. Polio survivors in India form the largest and most recognizable single group of people with disability. Unlike the developed world, India’s survivors are mostly young. Many individuals with polio are coping and enduring a new face of this disease which is sadly neither documented nor addressed. Polio virus attacks specific neurons in the brainstem and the anterior horn cells of the spinal cord, generally resulting in the death of a substantial fraction of the motor neurons controlling muscles.
Polio comes in three phases namely acute viral infection phase, recovery phase, and a life-long stable phase. However, recently over the past few decades many polio survivors have reported new symptoms, such as muscle/joint pain, weakness, muscular or generalized fatigue, decline in physical function on healthy muscles or deficient muscles previously affected by polio, and this has been termed as a fourth phase known as post-polio syndrome(PPS). It received a medical title by WHO(World Health Organization) in the year 2010.
Diagnosing PPS can be difficult since it heavily relies on the exclusion of other conditions. The previous history of polio, long recovery and gradual onset of new physical problems lead to its confirmation. Addressing these problems seconds the foremost challenge of its awareness, which is almost negligible and adding up to the crisis.
Physiotherapy is known to provide substantial relief in this condition, with the main emphasis on simple exercises and lifestyle modifications. Exercises in the form of active exercises, passive gentle stretches, arm or leg cycling(depending on the involvement), all in sets of few repetitions interspersed with rest breaks to avoid undue fatigue over already weak muscles.
Overall aim -use the muscles, but judiciously. For those who cannot follow exercises, can be advised lifestyle modifications, that consist of energy conservation techniques and activity pacing, both causing decreased physical demands and building adequate energy reserves to prevent problems of muscle as well as generalized fatigue.
Activity pacing is nothing but balancing of daily activities with rest periods incorporated and break-down of larger activities into smaller frequent bouts. Energy conservation is the adoption of energy efficient strategies that reduce the overall requirement of a task and consequently, fatigue. Simple advises such as maintaining healthy body weight and sleep hours can also be beneficial. All these health benefits are also supported by research-based evidence, and no matter how massive the health risk maybe, trivial and consistent efforts towards the same, along with the appropriate guidance of the physiotherapist can turn out to be favorable.
Particularly with the myriad of obstacles such as stigma, social barriers, accessibility issues, already standing in the way of polio survivors, a bright ray of hope awaits these long-forgotten people living with the effects of polio, day in and day out in spite of its major eradication milestone.
This article is written by a Ph.D. Scholar physiotherapist, who has done extensive research on post-polio syndrome.
Dr. Srishti Sharma[PT], MPT-Rehabilitation, Ph.D. Scholar,Assistant professor, C.M Patel College of Physiotherapy, Gandhinagar.