Excerpt from the
Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©
To evaluate for post-polio syndrome, one must establish that an individual had paralytic polio (see Poliomyelitis, Acute) and that current symptoms are due to the aftereffects of the remote polio and not due to other medical, orthopedic, or neurologic conditions. A comprehensive evaluation is done by a physician with input from members of a health care team who are experienced in the assessment and management of individuals who have neuromuscular diseases and/or functional limitations. Such a physician may be a physiatrist (specialist in physical medicine and rehabilitation), a neurologist, orthopedic surgeon, internist, or a family physician who has developed a special interest in individuals who have had poliomyelitis. The health care team usually includes rehabilitation professionals, such as physical therapists (PT), occupational therapists (OT), and rehabilitation psychologists.
One can establish that an individual had remote poliomyelitis:
- from review of medical records documenting acute paralytic poliomyelitis;
- by inferring from a classic history of paralytic poliomyelitis that includes a flu-like febrile illness followed by asymmetrical flaccid muscle weakness with some recovery and without accompanying sensory deficits; and/or 3) through electromyographic testing that demonstrates long-standing muscle denervation and reinnervation (see Diagnosis, Post-polio Syndrome).
A post-polio evaluation should include a detailed medical, neuromuscular, orthopedic, and functional history, and a physical examination, followed by appropriate tests to better diagnose the medical causes that may be responsible for new health problems, including fatigue and weakness. These may include blood work (CBC, serum electrolytes, tests of liver and kidney function, a thyroid screen, CPK, ANA, etc.); nerve conduction studies (study of the speed and size of electrical signals carried along nerves) and electromyographic studies (see Electromyography); and appropriate radiological tests which may include x-rays, CT scans, and/or MRI scans. If swallowing is a problem, a modified barium swallow study may be performed (see Swallowing). If breathing is a suspected problem, pulmonary function tests (see Pulmonary Function Tests), an arterial blood gas, and/or a sleep study may be performed. Testing is customized to each individual.
Following the evaluation, the polio survivor (and family, if possible), the evaluating physician, and other appropriate health care providers (PT, OT, speech therapist, pulmonologist, psychologist) should discuss and begin implementation of the management of post-polio syndrome.
The evaluating physician may refer the polio survivor to a specialist to diagnose and treat other suspected conditions found during the evaluation. The results of the examination should be sent to the primary care physician.