PPS Refers to a range of symptoms experienced by the polio survivor. These include: Chronic fatigue which involves physical tiredness and brain fatigue. Dr. Bruno of the Post Polio Institute, Englewood Hospital (New Jersey) and Medical Centre, reports that "Fatigue is the most commonly reported, debilitating symptom. 91% of polio survivors report new or increased fatigue. 41% reported fatigue significantly interfering with performing or completing work and 25% reported fatigue interfering with self care activities." Brain fatigue includes problems with concentration, attention and memory. MRI scans reveal the presence of "white spots" in the brains of polio survivors which relate to such cognitive and neurological problems. Muscle and joint problems: muscle weakness, pain in muscles and joints, post exercise fatigue, changes in gait and increased tendency to fall, cramps and muscle twitching. Respiratory problems: breathlessness on exertion, spontaneous breathlessness, respiratory infection and sleep apnoea Swallowing and speech difficulties of intermittent nature. How can PPS be diagnosed? Diagnosis is typically based on the following criteria: A history of paralytic/non paralytic poliomyelitis Partial recovery of motor function and functional stability for at least 15 years Development of new symptoms such as pain, weakness, fatigue, cognitive problems No other illness to account for the symptoms (diagnosis by exclusion) What causes PPS? Research shows that several causes favour the development of PPS. Working together these are: The polio virus - it damaged more motor neurons than was realised at the time of the infection. For those who experienced paralysis, 90% of nerve cells in the spinal cord were damaged by the virus and half of those died. These damaged neurons sent out new sprouts to turn on muscle fibres. This sprouting enabled many polio survivors to walk again. Unfortunately the polio damaged and over sprouted neurons have been doing too much double and triple duty. As Dr. Halstead says, "neurons that normally drive 20 muscle cells. Basically this is a demand they are not designed to sustain". The surviving neurons are less able to manufacture acetylcholine and this probably gives rise to the muscle fatigue of PPS. Post polio muscles certainly need longer to recover than normal muscles from activity. Furthermore Dr. Bruno has shown that the production of chemicals in the brain was also disrupted by the polio virus giving rise to cognitive problems - particularly when stress. The Type A personality - polio survivors tend to push themselves to the limit and neglect the need for rest thereby contributing further damage to an already weakened and ageing nervous system. Survivors of polio were encouraged to push themselves physically and mentally to recover from polio and often to over exercise their weakened muscles to the point of exhaustion. They can no longer afford to do this for, as Dr. Bruno says "going for the burn means that nerves are burning out". Other Causes such as the effects of low blood sugar, medical treatment and ageing on weakened neurons - all play a part in the development of PPS. Treatment Protocol Medics need to encourage protection of the polio survivors weakened nervous system: Ensure that the following drugs are avoided or used with caution - Beta Blockers, e.g. propranolol. Benzo diazepines, e.g. diazepam. Other central nervous system depressants, e.g. oxazepam. Muscle relaxants, e.g. orphenadrine, diazepam. Local and general anesthetics can also cause problems. Advise patients to conserve energy by slowing down, simplifying environment, using aids such as calipers and wheelchairs. Gentle stretching exercises and relaxation techniques are beneficial. Referrals to occupational therapists, physiotherapists, and dieticians are important and alternative therapies such as massage and acupuncture have proved to be helpful. Offer the telephone number of a local PPS support group. These provide much needed information and advise on many matters relevant to the polio survivor.