POST POLIO SYNDROME (PPS) AND ITS EFFECTS ON SWALLOWING BY: LINDSAY JORDAN

POST POLIO SYNDROME (PPS) AND ITS EFFECTS ON SWALLOWING BY: LINDSAY JORDAN

WHAT IS POST POLIO SYNDROME (PPS)? Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors start to experience gradual new weakening in muscles that were previously affected by the polio infection. The most common symptoms include: slowly progressive muscle weakness fatigue (both generalized and muscular) gradual decrease in the size of muscles (muscle atrophy) Some individuals experience only minor symptoms while others develop visible muscle weakness and atrophy. Problems are often more severe on one side of the mouth and throat.

IS IT LIFE THREATENING? Post-polio syndrome is rarely life-threatening, but the symptoms can significantly interfere with an individual's ability to function independently. Respiratory muscle weakness can result in trouble with proper breathing, affecting daytime functions and sleep. ***Weakness in swallowing muscles can result in aspiration of food and liquids into the lungs and lead to pneumonia.

WHY IS THIS IMPORTANT FOR THE SLP? In a series of studies completed at the National Institutes of Health in 1991-1996 by Dr. Barbara Sonies and Dr. Marinos Dalakas, and in other studies, it has been substantiated that new swallowing complaints begin to emerge decades after the initial polio onset. Many people are only mildly aware of any change, and others who deny swallowing problems actually do have symptoms. An informal survey taken in 2003 of 23 persons diagnosed with post-polio syndrome (PPS) indicated that more than half had both new complaints of swallowing difficulty. Of the 500,000 Americans who survived acute polio, more than 125,000 now have post-polio syndrome, in which progressive muscle weakness develops 25 to 30 years after the initial disease.

WHY ARE THERE CHANGES IN SWALLOWING? Muscle OVERuse due to fewer healthy nerve fibers and musclesslow deterioration of head and neck bulbar muscles needed to swallowaffects the once-healthy muscles of face, palate, tongue, throat, lips and larynx Changes making swallowing more difficult may also make speaking more difficult. Why? Because many of the muscles and nerves that control swallowing also control speech and voice!

DYSPHAGIA THERAPY FOR YOUR PATIENT WITH PPS If one side of the body is weaker, use strategies to help swallowing efficiency (i.e. head turn to block weaker side, placement of bolus on stronger side). What other strategies/techniques can you think of?? Increase oral sensation Alter diet to ensure safe swallowing and reduce risk of aspiration (i.e. soft food, encourage small bites and slow eating) Trial different postures and positions Muscle strengthening exercises Biofeedback MAKE SURE STRATEGY IS SAFE BEFORE PAIRING WITH FOOD/LIQUIDS AND OF COURSE, THERAPY WILL BE INDIVIDUALIZED DEPENDING ON RESULTS OF INSTRUMENTAL EXAM AND CLINICAL FINDINGS.

IS PPS PROGRESSIVE? IF SO, WHY WOULD WE USE SOME OF THE ABOVE THERAPIES? YES, IT MAY BE PROGRESSIVE IN SOME CASES; HOWEVER, OUR JOB IS TO IMPROVE SWALLOWING TO ASSIST IN STABILIZING THE SWALLOW TO MAXIMIZE SAFETY TO ENSURE ADEQUATE NUTRITION/HYDRATION.

REFERENCES AND SUGGESTED READINGS Swallowing Difficulty and the Late Effects of Polio Barbara C. Sonies, PhD, CCC, BRS- S, College Park, Maryland, bsonies@hesp.umd.edu http://www.post-polio.org/edu/pphnews/pph26-3sum10p6-9.pdf Post-Polio Patients Have Swallowing Abnormalities that Increase the Risk of Choking http://www.ninds.nih.gov/news_and_events/news_articles pressrelease_postpolio_042491.htm Suggested Readings and Websites: BC Sonies, Speech and Swallowing in Postpolio Syndrome (2004) in (Eds.) Silver JK & Gawne AC, Postpolio Syndrome, Hanley and Belfus, Philadelphia. BC Sonies, Long-term Effects of Post- Polio on Oral-Motor and Swallowing Function. (1995). In (Eds) Halstead LS & Grimby G. Post-Polio Syndrome. Hanley & Belfus, Philadelphia. Board Recognized Specialists in Swallowing and Swallowing Disorders website: www. swallowingdisorders.org American Speech Language Hearing Association, Special Interest Division on Swallowing. Rockville MD, www.asha.org