Polio Place

To evaluate for post-polio syndrome, one must establish that an individual had paralytic polio and that current symptoms are due to the aftereffects of the remote polio and not due to other medical, orthopedic, or neurologic conditions. A comprehensive evaluation is done by a physician with input from members of a health care team who are experienced in the assessment and management of individuals who have neuromuscular diseases and/or functional limitations.

Such a physician may be a physiatrist (specialist in physical medicine and rehabilitation), a neurologist, orthopedic surgeon, internist, or a family physician who has developed a special interest in individuals who have had poliomyelitis. The health care team usually includes rehabilitation professionals, such as physical therapists (PT), occupational therapists (OT), and rehabilitation psychologists.

One can establish that an individual had remote poliomyelitis: 1) from review of medical records documenting acute paralytic poliomyelitis; 2) by inferring from a classic history of paralytic poliomyelitis that includes a flu-like, febrile illness followed by asymmetrical flaccid muscle weakness with some recovery and without accompanying sensory deficits; and/or 3) through electromyographic testing that demonstrates long-standing muscle denervation and reinnervation.

A post-polio evaluation should include a detailed medical, neuromuscular, orthopedic, and functional history, and a physical examination, followed by appropriate tests to better diagnose the medical causes that may be responsible for new health problems, including fatigue and weakness. These may include blood work (CBC, serum electrolytes, tests of liver and kidney function, a thyroid screen, CPK, ANA, etc.); nerve conduction studies (study of the speed and size of electrical signals carried along nerves) and electromyographic studies ; and appropriate radiological tests which may include x-rays, CT scans, and/or MRI scans. If swallowing is a problem, a modified barium swallow study may be performed. If breathing is a suspected problem, pulmonary function tests, an arterial blood gas, and/or a sleep study may be performed. Testing is customized to each individual.

Following the evaluation, the polio survivor (and family, if possible), the evaluating physician, and other appropriate health care providers (PT, OT, speech therapist, pulmonologist, psychologist) should discuss and begin implementation of the management of post-polio syndrome.

The evaluating physician may refer the polio survivor to a specialist to diagnose and treat other suspected conditions found during the evaluation. The results of the examination should be sent to the primary care physician.

Excerpt from PHI's "Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors." © 1999

Evaluación

Para evaluar el síndrome post-poliomielitis, uno debe establecer que un individuo tuvo poliomielitis paralítica [ver GRIS, No. 3] y que los síntomas actuales son debidos a los efectos secundarios de la poliomielitis sufrida tiempo atrás y no debido a otras condiciones médicas, ortopédicas, o neurológicas. Una evaluación comprensiva es hecha por un médico, con la ayuda de miembros de un equipo dedicado al cuidado de la salud, que tengan experiencia en la valoración y el manejo de individuos que con enfermedades neuromusculares y/o limitaciones funcionales. Tal médico puede ser un fisiatra (especialista en medicina física y rehabilitación), un neurólogo, cirujano ortopédico, internista, o un médico general que ha desarrollado un interés especial en los individuos que han tenido poliomielitis. El equipo dedicado al cuidado de la salud incluye generalmente a profesionales de la rehabilitación, tales como terapistas físicos (TF), a los terapistas ocupacionales (TO) y psicólogos de la rehabilitación.

Uno puede establecer que un individuo tuvo poliomielitis tiempo atrás: 1) con una revisión de la historia clínica que documente poliomielitis paralítica aguda; 2) deduciéndolo de una historia clásica de poliomielitis paralítica que incluya una fiebre parecida a la de la gripe, seguida por una debilidad muscular flácida asimétrica con una cierta recuperación sin que la acompañen déficits sensoriales y/o; 3) con una prueba de electromiografía que demuestre denervación y reinervación muscular de larga duración.

Una evaluación post-polio incluye una detallada historia médica, neuromuscular, ortopédica y funcional, y un examen físico, seguido por pruebas adecuadas para diagnosticar mejor las causas medicas que pudieron ser responsables de nuevos problemas de salud, incluyendo fatiga y debilidad. Estas pruebas pueden incluir examen de sangre ( HC[1], suero electrolítico, pruebas de la función hepática y renal, perfil tiroideo, CPK [2], ANA[3], etc.); estudios de la conducción nerviosa (estudio de la velocidad y tamaño de las señales eléctricas que corren a lo largo de los nervios) y estudios electromiográficos (Electromiografía); y los estudios radiológicos apropiados que pueden incluir Rayos X, , TC[4], y/o MRI[5]. Si hay problemas para tragar, puede realizarse un Estudio Modificado de Deglución del Bario (MBSS). Si se sospecha de problemas para respirar, se pueden realizar pruebas de función pulmonar, un análisis de gases en sangre arterial, y/o uno de estudio del sueño. Las pruebas son determinadas de acuerdo a cada individuo.

Después de la evaluación, el sobreviviente de polio (y su familia, si es posible), el médico evaluador y los otros profesionales del cuidado de la salud (TR, TO y terapista del lenguaje, neumólogo, psicólogo) deberían discutir y comenzar la implementación del manejo del síndrome post-polio.

El médico evaluador puede referir al sobreviviente de polio con especialistas para el diagnóstico y tratamiento de las condiciones sospechosas encontradas durante la evaluación. Los resultados del examen deberían ser enviados al médico general.

Excerpt from PHI's "Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors." © 1999

Muscle Power Evaluation and Therapeutic Chart (MPET Chart)
Effective Tool in Post-Polio Management
Mahboon ur Rahman, Peshawar, Pakistan

Brief Description of Work: Muscle power of polio-afflicted children were assisted and evaluated by Oxford Muscle Testing Chart. The chart as a diagnostic tool gives strength of muscles for the purpose of surgical interventions or physical regime.

But the chart could not be used successsfully as it focused only on the diagnostic component and did not give the Therapeutic Regime.  Thus, the need was felt to fill the gap in the Oxford MPET chart and to make it useful in the therapeutic treatment of polio-affected children.  Mahboob School of Physiotherapy took an initiative and its chairman, Dr. Mahboob ur Rahman, redesigned the said chart with the name of MPET chart which also includes the therapeutic component.  The redesigned chart may now be called Mahboob Power Evaluation and Therapeutic (MPET) chart.  It gives therapeutic plan along with the diagnostic or assessment of the muscle power of the polio-affected children.  By using this chart by the therapist, the parents of the children or even the children by themselves can perform the exercise and improve their muscle power.  It has been practiced since the last decade and has proven its worth.

Use of the Chart: The muscle power is mentioned from 0-5, here the physiotherapist will just tick mark with muscle power, as in quadriceps, grade 2, or tibialies posterior, grade 1, whatever may be.

For example, the first column mentions the group of muscles in the MPET chart.  In the second column, after marking the grade for quadriceps in grade 2, then next column, the third, is for Exercise Regime positioning.  The patient may do active exercise on side by elevating the gravity, so the side lying is marked, the fourth column is for exercises to be performed that is active exercises.

By doing these exercises for the next few months (keeping in mind the principle of kinesiology the repetitive exersices enhance muscle power), the muscle power may be increased to grade 3.