Polio and Post-Polio Sequelae: The Lived Experience
Dorothy Woods Smith, PhD, RN, AHN-BC, QTTT, Associate Professor Emerita
University of Southern Maine, Portland, ME, 04103
Published in the Journal of Orthopaedic Nursing, Vol.8/No.5, 1989, pp. 24-28
Excerpts from this Journal edition
Treatment for PPS
My concerns are shared by other polio survivors, and are not unfounded. There is general agreement that the vigorous exercise programs, which once helped polio survivors regain function, are contraindicated when weakness and fatigue recur. Both marked aggravation of weakness and permanent loss of function have been reported by people put on vigorous exercise regimens (Halstead and Rossi, 1985). Swimming in warm water is the most widely recommended exercise to promote comfort and flexibility, since cardiorespiratory function can be maintained while mechanical stresses to the musculoskeletal system are minimized. Gentle stretching exercises may also promote comfort. Fatigue and chilling should be avoided and no exercise should be continued past pain, or resumed while pain is present.
Before attempting to treat pain, it is important to determine its origin.
Pain may be associated with years of functional misuse, for example soft tissue problems from weight bearing by the shoulders, and carpal tunnel syndrome from using canes or crutches (Maynard, 1988). This type of pain may be diminished by the use of orthotics and adaptive aids. Inflammatory musculoskeletal pain syndrome will frequently respond well to rest, modified activity, moist or dry heat, or anti-inflammatory drugs. Postwood (1987) reports success treating post-polio musculo-skeletal pain and neuralgias using acupuncture or tricyclic antidepressants to increase the body’s serotonin levels. Other pain relief modalities reported to be meeting with some success include TENS units, ultrasound and neuroprobe treatments, acupuncture and acupressure, therapeutic touch and biofeedback.
Drugs should be used by polio survivors with caution. My own experience with Valium, prescribed in the early seventies for muscle spasm, led to a month’s hospitalization for unremitting muscle spasm. The drug, increased gradually from 10 to 40 mgm. per day when the spasms continued, acted paradoxically, and created not only increased fatigue and pain but also a concomitant depression. I had somehow blamed myself for allowing this to happen until 1987, when I attended the international polio conference in St. Louis, where I first heard that Valium has been associated with increased weakness and increased spasm in some patients. Narcotics and other drugs which can lead to addiction are contraindicated because of the long-term nature of the needs.
There have also been numerous anecdotal reports of respiratory problems associated with the use of curare-type drugs and general anesthesia, and of polio survivors being unable to regain previous levels of muscle strength following surgery.