Post-poliomyelitis sequelae: A pathophysiologic basis for management

Management of the late sequelae of poliomyelitis is based on their underlying pathophysiology and on a limited number of research reports. The key elements of management including the history, assessment and possible interventions are described in this article. The indications for intervention and its parameters are determined on an individual basis to maximise the benefit-to-risk ratio. Heavy resistive or exhaustive exercise, for example, cannot be supported physiologically as a means of preserving function in most patients. However rest, pacing of activities, lifestyle modification, orthotic fitting, weight control, use of aids and devices should be of value. Despite the importance of rest, inactivity is associated with detrimental side effects which can be accentuated in the patient with the sequelae of poliomyelitis. Research is needed to establish criteria for prescribing therapeutic interventions including rest and low-intensity exercise for the post-poliomyelitis population.