Pathophysiology of muscular changes in post-polio syndrome and consequences for physical mobility

A large proportion of the estimated 10-20 million polio survivors worldwide can be expected to experience symptoms of further neuromuscular decline for many decades to come as they develop post-polio syndrome (PPS). Chapter 1 in Section A contains an overview of the insights into PPS as they stood at the start of this thesis. It describes how the lack of knowledge of pathophysiology and the unpredictability of the rate or extent of the continued decline in PPS creates challenges for development of successful intervention strategies.
The aims of this thesis are to:
• Gain more insight into pathophysiological mechanisms underlying loss of muscle strength in PPS by investigating changes in muscle architecture, long-term changes in MU-size, presence of inflammatory markers, and the relationship between these findings and long-term changes in muscle strength.
• Assess the long-term rate of decline in physical mobility in relation to strength decline and to investigate potential predictors of the rate of deterioration of physical mobility in PPS.
• Establish the magnitude and severity of the problem of falling, the circumstances of falls and associated factors in polio survivors in the context of their neuromuscular decline and physical mobility problems.
Section B focusses on the pathophysiology of muscle changes in PPS, in particular of muscle weakness, and Section C on physical mobility problems in relation to muscle weakness in polio survivors.