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Best Post Polio Syndrome Treatment in Delhi

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What is Post Polio Syndrome ?

Post-Polio Syndrome (PPS) is a condition that affects some individuals decades after their initial recovery from poliomyelitis (polio), a viral infection that attacks the nervous system. It is characterized by new or worsening muscle weakness, pain, and fatigue.

Causes

The exact cause of PPS is not fully understood, but the leading theory involves the long-term effects on motor neurons that were partially damaged by the original poliovirus infection.

  • Motor Neuron Deterioration: When polio infects the body, it damages or destroys motor neurons in the spinal cord, which transmit signals from the brain to the muscles. To compensate for lost neurons, the surviving motor neurons sprout new nerve endings (axons) to “reinnervate” muscle fibers that have lost their nerve supply. This allows for recovery of strength.
  • Overuse and Stress: Over decades, these enlarged motor units (a single motor neuron and all the muscle fibers it innervates) are working harder than normal to compensate for the initial damage. The constant metabolic stress on these overworked neurons is thought to eventually lead to their deterioration and the loss of their newly sprouted nerve endings. This results in new muscle weakness, fatigue, and pain.
Symptoms

PPS symptoms typically appear 15 to 40 years after the initial polio infection and often develop gradually. They can vary widely in severity and combination:

  • New or Worsening Muscle Weakness: This is the most common and often disabling symptom. It can affect muscles previously weakened by polio, as well as muscles that seemed unaffected. The weakness is often asymmetric (affecting one side more than the other) and progressive.
  • Fatigue: This is a profound and debilitating tiredness that is disproportionate to the activity performed. It can be physical (muscle fatigue) or central (brain fatigue), affecting concentration and memory.
  • Muscle and Joint Pain: Chronic pain often results from weakened muscles, joint instability, compensatory movements, and musculoskeletal abnormalities.
  • Muscle Atrophy (Wasting): Muscles affected by new weakness may shrink.
  • Decreased Endurance: Reduced ability to sustain physical activity.
  • Breathing and Swallowing Problems (Bulbar involvement): If the muscles involved in these functions are affected, it can lead to shortness of breath, sleep apnea, difficulty chewing or swallowing, and an increased risk of aspiration pneumonia.
  • Cold Intolerance: Many individuals with PPS report increased sensitivity to cold temperatures.
  • Sleep Disorders: Sleep apnea is common due to weakened respiratory muscles.
  • Difficulty with Daily Activities: The combination of weakness, fatigue, and pain can significantly impact mobility, self-care, and occupational tasks.
Advanced Physiotherapy for Post-Polio Syndrome
  • Assessment:-
    • Muscle Strength and Endurance Testing: Often using manual muscle testing and functional tests, being careful not to over-fatigue the patient.
    • Gait Analysis: Observing walking patterns and identifying compensatory strategies.
    • Balance and Proprioception Assessment.
    • Joint Range of Motion and Flexibility Assessment.
    • Assessment of Assistive Device Needs: Canes, crutches, walkers, orthoses (braces), or wheelchairs.
    • Breathing Pattern Assessment: Especially if respiratory issues are suspected.
  • Principles of Physiotherapy in PPS:-
    • Flexibility and Stretching: Gentle stretching to maintain joint range of motion and prevent contractures, but avoiding overstretching weakened muscles.
    • Low-Impact Aerobic Conditioning: If tolerated, activities like swimming, cycling (stationary), or gentle walking to improve cardiovascular health without excessive fatigue. Monitoring heart rate and perceived exertion is crucial.
  • Advanced Physiotherapy Techniques
    • Manual Therapy :
      • Gentle Soft Tissue Mobilization: To address muscle tightness, spasms, and pain, and to improve local circulation. Deep or aggressive massage should be avoided over very weak muscles due to the risk of overfatigue.
      • Joint Mobilization: Gentle techniques to maintain or restore joint mobility if stiffness is present, always respecting fatigue levels.
  • Neuromuscular Electrical Stimulation (NMES): Can be used cautiously on very weak muscles to facilitate muscle contraction and re-education, but careful monitoring for fatigue is essential.
  • Functional Retraining:
    • Gait Training: Focus on energy-efficient walking patterns, often incorporating assistive devices.
    • Transfer Training: Teaching safe and efficient ways to move between surfaces (e.g., bed to chair).
  • Respiratory Physiotherapy: For individuals with breathing difficulties:
    • Breathing Exercises: Diaphragmatic breathing to improve lung capacity.
    • Assisted Cough Techniques: To clear secretions.
    • Postural Drainage: To aid in secretion clearance.
    • Education on Sleep Apnea Management: Including CPAP use if prescribed.
  • Pain Management Strategies: Besides exercise and manual therapy, this can include modalities like TENS (Transcutaneous Electrical Nerve Stimulation), heat/cold therapy, and education on positioning.

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