Patients who survived
the polio epidemic of the 1950s, many now elderly, are developing new symptoms
of weakness, fatigue, and musculoskeletal pain. It is estimated that between
60% and 80% of the 640,000 polio survivors are experiencing the phe-nomenon
known as post-polio syndrome. Men and women appear to be equally at risk
(Chasens & Umlauf, 2000).
The exact cause of
post-polio syndrome is not known, but re-searchers suspect that with aging or
muscle overuse the neurons not destroyed originally by the poliovirus cannot
continue gen-erating axon sprouts. These new terminal axon sprouts
reinner-vated the affected muscles following the initial insult but may be more
vulnerable as the body ages (Chasens & Umlauf, 2000).
No specific diagnostic
test exists for this syndrome. The clinical diagnosis is made on the basis of
the history and physical exami-nation and exclusion of other medical conditions
that may be causing the new symptoms. Patients report a history of paralytic
poliomyelitis with partial or complete recovery of function with a plateau of
function for at least 10 years and then the recurrence of symptoms (Chasens
& Umlauf, 2000; Chasens, Umlauf, Valappil et al., 2001).
No specific medical or
surgical treatment is available for this syndrome, and therefore nursing plays
a pivotal role in the team approach to assisting patients and families in
dealing with the symptoms of progressive loss of muscle strength and
significant fatigue. Other health care professionals who may assist in patient
care include physical, occupational, speech, and respiratory ther-apists.
Nursing interventions are aimed at slowing the loss of strength and maintaining
the patient‚Äôs physical, psychological, and social well-being.
Patients need to plan
and coordinate activities to conserve energy and reduce fatigue. Rest periods
should be planned and assistive devices used to reduce weakness and fatigue.
Important activities should be planned for the morning, as fatigue often
increases in the afternoon and evening (Chasens & Umlauf, 2000).
One study investigated
the barriers (internal and external en-vironmental phenomena) that created
further disability in polio survivors (Harrison & Stuifbergen, 2001).
Disability, the inabil-ity to perform societal roles, was correlated with
perceived barri-ers to health but not with functional limitations, comorbidity,
or secondary conditions. Secondary conditions were correlated with the number of
years that the patient had lived with the condition.
Pain in muscles and joints may be a problem.
Nonpharmaco-logic techniques such as the application of heat and cold are most
appropriate because these patients tend to have strong reactions to medications
(Chasens & Umlouf, 2000).
Maintaining a balance between adequate nutritional intake
yet avoiding excess calories that can lead to obesity in this seden-tary group
of patients is a challenge. Pulmonary hygiene and ad-equate fluid intake can
help with airway management. Several interventions can improve sleep, including
limiting caffeine in-take before bedtime and assessing for nocturia. If
nocturia is an issue, the patient needs to be evaluated for obstructive sleep
apnea (Chasens et al., 2001). Supportive ventilation may be appropri-ate with
continuous positive airway pressure if sleep apnea is a problem.
Bone density testing in patients with post-polio syndrome
has demonstrated low bone mass and osteoporosis. Thus, the impor-tance of
identifying risks, preventing falls, and treating osteo-porosis must be
discussed with patients and families. The nurse also needs to remind patients
and family members of the need for health promotion activities and health