Post-polio syndrome (PPS) is a condition that occurs in those who have recovered from poliomyelitis, characterized by new muscular weakness, fatigue, and pain. This syndrome arises from complications such as the slow and progressive recovery phase after initial polio infection which leads to residual motor issues, potentially aggravated years later. Rehabilitation strategies include non-fatiguing exercises aimed at improving muscle strength and preventing falls.

1. Post-polio syndrome
Dr. Asir John Samuel, PhD (Physiotherapy), MPT (Neurosciences and Paediatric Neurology), BPT, BSc (Psychology), DYScEd, MAcu,
Additional Professor,
Yenepoya Physiotherapy College
Yenepoya (Deemed to be University),
Mangalore, Karnataka

2. Poliomyelitis
• Acute anterior poliomyelitis
• Enterovirus
• Inactivated - Poliovirus vaccine (Salk)
• Attenuated - Poliovirus vaccine (Sabin)

3. Polio
• Poliovirus - motoneurons of the anterior horn cells of
the spinal cord or the brainstem,
• Asymmetric muscular paralysis, with varying degrees of
severity, reaching its peak in 48 hours
• Might be associated to a respiratory and bulbar
affection.
• Slow and progressive “recovery” phase

4. Progression
• Motor improvement - reinnervation process -
denervated by the initial acute polio infection
• Brainstem and spinal cord motor neurons develop
new branches, or axonal sprouts generating
enlarged motor neurons
• Process cannot affect all denervated fibers,
explaining the residual motor sequelae

5. Post-polio syndrome
• Secondary aggravation of the neuromuscular
impairments several years after the acute infection
by the Poliovirus
• Charcot
• In 1984 coined term “Post-polio syndrome (PPS)”

6. Post-polio syndrome - features
• New muscular weakness
• Fatigue
• Pain
• Onset or aggravation of muscle atrophy
• Cold intolerance
• Sleep disorders
• Dysphonia or dysphagia
• Respiratory deficiency

7. Pathology
• Overuse of the denervation-reinnervation process
of these enlarged motor units
• Defect in neuromuscular conduction along
immature nerve sprouts
• Auto-immune inflammatory processes
• Residual Poliovirus and its reactivation

8. Rehabilitation
• Non-fatiguing strengthening and exercises,
• Isokinetic
• Isometric
• Endurance muscular training
• Prevent falls