The Late Effects of Polio
Survivors of polio may seek your medical advice for new weakness, overwhelming fatigue and/or pain. Some patients may describe these symptoms and "forget" to tell you they had polio. This triad of symptoms is typically presented at least fifteen years after the acute case of poliomyelitis, as the North American, Western European and Australasian experience documents. Individuals, now in their seventh or eighth decade, are facing a combination of new polio problems and aging. Because poliomyelitis has not yet been eradicated from the world, survivors will be seeking assistance for years to come.
As early as 1875, Raymond and Charcot described a polio patient who reported new weakness and atrophy in his right arm – the arm he used excessively due to residual weakness in his left arm. As survivors from the 1950s epidemics sought medical assistance for "tiring more easily," researchers explored these new complaints and, over the years, have developed the following criteria for post-polio syndrome:*
- Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of acute paralytic illness, signs of residual weakness and atrophy of muscles on neurologic examination, and signs of denervation on electromyography (EMG).
- A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neurologic function.
- Gradual or sudden onset of progressive and persistent new muscle weakness or abnormal muscle fatiguability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of inactivity, or trauma or surgery.)
- Less commonly, symptoms attributed to post-polio syndrome include new problems with breathing or swallowing.
- Symptoms persist for at least a year.
- Exclusion of other neurologic, medical, and orthopedic problems as causes of the symptoms.
It is important to note that there are consequences to having had polio that may not fit the criteria. Polio survivors who visit your office may be reporting a variety of neurologic, orthopedic, medical, musculoskeletal, emotional and rehabilitation complaints, all of which need to be methodically addressed and not dismissed simply as signs of aging.
Post-Polio Health International recommends that all polio survivors receive consistent, basic medical evaluations. If a patient's symptoms are not explained and alleviated by general medical approaches and the symptoms persist or worsen, a referral is in order. A physiatrist or neurologist can conduct a neuromuscular evaluation to establish a diagnosis and to recommend a management plan that will be sent to you and your patient.
General Reading
Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database of Systematic Reviews 2015, Issue 5.
Maynard, F.M., & Headley, J.L. (Eds.) (1999). Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors. Saint Louis, MO: Gazette International Networking Institute (now Post-Polio Health International). (www.post-polio.org).
*March of Dimes Birth Defects Foundation. (1999). Identifying Best Practices in Diagnosis & Care. Warm Springs, GA: March of Dimes International Conference on Post-Polio Syndrome. (www.modimes.org)
Headley, J.L., Maynard, F.M., Machell, S.T., Wise, H.H. (2011). Post-Polio Health Care Considerations for Families & Friends. Saint Louis, MO: Post-Polio Health International.
For Physical Therapists and Physical Therapist Assistants
The following three articles were prepared by Marianne T. Weiss, PT, who dedicated many hours of work treating polio survivors and educating fellow physical therapists about the late effects of polio. PHI publishes this part of her comprehensive work to assure that her efforts continue past her much-too-early passing in 2002.
Physical Therapy Examination and Treatment of the Polio Survivor
Presentation for Physical Therapists and Physical Therapist Assistants at Post-Polio Health International's Eighth International and Independent Living Conference, June 2000
Positioning for Comfort during Work, Leisure Activities and Rest
Practical advice for daily living activities.
Becoming an Intelligent Consumer of Physical Therapy Services
Published in Polio Network News, Winter 1993, Vol. 9, No. 1-2
Leslie Drawdy, PT, DPT, from the Tucson area, shares her Physical Therapy — Tips for Successful Treatment of Clients with other physical therapists. Drawdy has seven years of experience as a physical therapist. She also serves on the medical advisory board of Polio Epic (Tucson ). She may be reached at leslie@drawdyonline.com.
Donald A. Neumann, PT, PhD, wrote the following article which was originally published in the Journal of Orthopaedic & Sports Physical Therapy.
Polio: Its Impact on the People of the United States and the Emerging Profession of Physical Therapy
Reproduced from Neumann DA. Polio: Its Impact on the People of the United States and the Emerging Profession of Physical Therapy, J Orthop Sports Phys Ther. 2004; 34(8) 479-492, with permission of the Orthopaedic and Sports Physical Therapy Sections of the American Physical Therapy Association.
For Nurses
It is interesting to note that much is written about the need to educate physicians, physical therapists and occupational therapists, and even psychologists, but nurses are not typically mentioned, but should be. Resources are listed below.
- Alexa Stuifbergen, RN, School of Nursing, The University of Texas at Austin, 1700 Red River, Austin, TX 78701, USA, astuifbergen@mail.utexas.edu, has studied polio survivors for several years and has published the following:
- Harrison T, Stuifbergen A, Barriers that further disablement: A study of survivors of polio., J Neurosci Nurs 33: 3, 160-6, Jun, 2001.
- Becker H, Stuifbergen A, What makes it so hard? Barriers to health promotion experienced by people with multiple sclerosis and polio, Fam Community Health 27: 1, 75-85, Jan-Mar, 2004.
- Stuifbergen AK, Seraphine A, Harrison T, Adachi E, An explanatory model of health promotion and quality of life for persons with post-polio syndrome, Soc Sci Med 60: 2, 383-393, Jan, 2005.
- Stuifbergen A, Secondary conditions and life satisfaction among polio survivors., Rehab Nursing 30: 5, 173-179, Sept-Oct, 2005.
Issues
Anesthesia
PHI has published many articles over the years in the topic of anesthesia. Polio survivors might understandably be wary of receiving anesthesia. However, with the proper precautions and preparation, anesthesia can be safely administered to post-polio patients.
Safe, Successful Surgery Starts with Anesthesia Care
American Society of Anesthesiologists
Important New Paper Published on Anesthesia and Polio (2016)
Selma H. Calmes, MD (retired), Olive View/UCLA Medical Center, Sylmar, California
Update on Anesthesia (2015)
Selma H. Calmes, MD (retired), Olive View/UCLA Medical Center, Sylmar, California
Summary of Anesthesia Issues for Post-Polio Patients
Selma H. Calmes, MD (retired), Olive View/UCLA Medical Center, Sylmar, California
Anesthesia Update: Separating Fact from Fear
Selma H. Calmes, MD (retired), Olive View/UCLA Medical Center, Sylmar, California
Exercise
A Statement about Exercise for Survivors of Polio
Written by the Medical Advisory Committee of Post-Polio Health International and endorsed by 29 post-polio experts. For additional information, read Articles about Exercise for Polio Survivors, collected from past issues of Post-Polio Health.
Other Resources
Post-Polio Syndrome: Identifying Best Practices in Diagnosis & Care
Information from March of Dimes Birth Defects Foundation's International Conference on Post-Polio Syndrome (1999) for health professionals. Send your name and mailing address for a free printed copy in English to PHI (info@post-polio.org).
Reports from Post-Polio Task Force (1997)
A task force of clinicians and researchers who specialized in diagnosing and treating polio survivors with symptoms of post-polio syndrome, as well as patient advocates for survivors of polio, was formed to help promote awareness and advance medical knowledge of the late effects of polio. Although disbanded in 1999 because the research was concluded, the information that was developed for this section of the PHI website remains relevant to this date.
Medical/Clinical Publications about Post-Polio Syndrome and Other Post-Polio Problems