Exercise in Post-Polio Syndrome A New Classification

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Exercise in Post-Polio Syndrome A New
Classification

• Anne C. Gawne, MD
• Director Post-polio Program
• Roosevelt Warm Springs Institute for
  Rehabilitation

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Benefits of Exercise

• Increase strength
• Increase Cardiovascular Fitness
• Decrease Weight and Cholesterol
• Improve sense of Well being

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Rationale/Problems in PPS

• Exercise may be harmful
• Not all limbs are affected equally
• Current protocols dont quantify involvement
• Need to enhance communication between doctor and
  therapists

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How to use Classification

• Determine Classification for each limb
• Prescribe individualized limb-specific exercise
  program, using the least affected limbs
• Follow-up periodically to assess strength and
  function, modifying exercise program as needed

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Classification Elements

• Remote history- Extent of original polio
• Recent History- New neurological Symptoms
• Physical Exam- Musculoskeletal,Neurological
• EMG/NCS- Standard Protocol
• Exercise- Limb Specific Recommendations
• Note-Classification refers to limbs not to person

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NRH Limb Classification For Exercise

• 1 No Polio
• 2 Subclinical Polio
• 3 Clinically Stable Polio
• 4 Clinically Unstable Polio
• 5 Atrophic Polio

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Class 1 - No Polio

• Remote history No weakness
• Recent history No new weakness
• Physical Exam Good to Normal strength
  normal sensation
  and reflexes
• EMG/NCS Normal

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Class 2- Subclinical Polio

• Remote history No weakness or if weak, full
  recovery
• Recent history No new weakness
• Physical Exam Good to normal strength,
  sensation and reflexes
• EMG/NCS Evidence of old Polio

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Class 3 -Clinically Stable Polio

• Remote history Weakness with variable
  recovery
• Recent history No new weakness
• Physical Exam Poor to good strength,
  normal sensation normal to decreased
  reflexes
• EMG/NCS Evidence of old polio

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Class 4- Clinically Unstable Polio

• Remote history Weakness with variable
  recovery
• Recent history New weakness
• Physical Exam Poor to good strength,
  normal sensation and normal to decreased
  reflexes
• EMG/NCS Evidence of old polio

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Class 5- Atrophic Polio

• Remote history Weakness with little
  recovery
• Recent history May have new weakness
• Physical Exam Trace to poor strength,
  atrophy normal sensation and decreased
  reflexes
• EMG/NCS Evidence of old polio decreased
  insertional activity, few motor units

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Summary
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General Exercise Recommendations

• Stretching-Active Range of Motion(AROM) or
  Passive Range of Motion (PROM)
• Warm up
• Strengthening Exercises
• Aerobic Exercises
• Cool Down

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ACSM Exercise Recommendations

• Frequency 3-5 X /Week
• Duration 15-30 Minutes
• Intensity 60-90 Of Maximum Heart Rate
  ( 220-age)

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Class 1 Exercises

• Active ROM/Passive ROM
• Warm Up
• Strengthening Exercises- 3 sets of 10 at 10reps
  max
• Aerobic exercises 3-5 days/week
• 15-30 min at 60-80 of maximum HR
• Cool down

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Class 1 Sample Exercises

• Swimming 25-35 yards/minute
• Walking 5-6 MPH
• Bicycle Riding 12-14 MPH

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Class 2 Exercises

• Warm Up
• Strengthening Exercises- Use modified Class 1
  program
• Active ROM/Passive ROM
• Aerobic exercises 3 days/week 15-20 min at 80
  of maximum HR
• Pacing- Perform 4-5 minutes, rest 1 minute
• Cool down
• Modify if new weakness fatigue or pain

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Class 2 Sample Exercises

• Swimming 25 yards/Min
• Walking 4-5 MPH
• Bicycle riding 10-12 MPH

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Class 3 Exercises

• Warm Up
• Active ROM/Passive ROM
• Strengthening Exercises-Non fatigueing/paced
• Aerobic exercises 3 days/week(alternate) 15 min
  at 60 of maximum HR
• Pacing- Perform2-3 minutes rest 1 minute
• Cool down
• Modify if new weakness fatigue or pain

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Class 3 Sample Exercises

• Swimming 20 Yds/min
• Walking 4MPH
• Bicycle Riding 10MPH

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Class 4 Exercises

• Passive ROM
• Trial of rest to exclude overuse weakness
• Aerobic exercises only in Activities of Daily
  Living (ADLS)
• If overuse is excluded, trial of nonfatiguing,
  paced exercise ( like class 3)

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Class 4 Sample Exercises

• No cardiopulmonary aerobic exercise
• Use of brace, Wheel chair, Scooter
• If overuse weakness excluded trial of
  nonfatigueing exercise

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Class 5 Exercises

• PROM
• Usually Bracing, Wheelchair is needed

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Results of NRH classification of 100 consecutive
patients
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NRH Classification of 100 Patients