Lincolnshire Post-Polio Library - A Service of The Lincolnshire Post-Polio Network
The late effects of Polio Information for Health Care Providers
Charlotte Leboeuf

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12 DIAGNOSTIC CONSIDERATIONS IN PATIENTS WHO HAVE HAD POLIO

  1. Has the patient had polio?
  2. If yes -
    What was the approximate localisation and severity of the disease?
  3. What degree of post-convalescent recovery took place?
  4. Are the symptoms clearly related to polio?
  5. If no -
    Can the symptoms be caused by a progression of residual polio?
  6. Are the symptoms consistent with those ascribed to the late effects of polio?
  7. If yes -
    Are the symptoms due to a combination of causes?
  8. How severe is the condition and what is its rate of progression?

QUESTION 1:
HAS THE PATIENT HAD POLIO?

A previous history of polio is often not clear. Investigate the following:

-   a credible history of polio (usually occurence of fever, paresis/paralysis, respiratory problems, hospitalisation);
-   Partial or total recovery;
-   maintained post-convalescent recovery status over several years.

Patients may be unaware of a past history of polio because they:

Some people may also have been incorrectly diagnosed as having polio.

QUESTION 2:
IF YES - WHAT WAS THE APPROXIMATE LOCALISATION AND SEVERITY OF THE DISEASE?

Investigate the following:

-   To what degree did the disease spread in the spinal cord (lower limbs, upper limbs, trunk and respiratory muscles)?
-   Was there central involvement (respiration, deglutition, speech)?

It may be difficult to establish the extent of the acute paralytic disease because:

QUESTION 3:
WHAT DEGREE OF POST-CONVALESCENT RECOVERY TOOK PLACE

A careful history is necessary to establish at what level the individual functioned after the recovery stage peaked. Investigate the following:

-   muscles/joints, lung function, speech, deglutition, circulation and digestion;
-   mobility and activity level;
-   use and extent of use of mechanical aids, degree of independence;
-   continued use and extent of use of professional assistance (e.g. physiotherapy, occupational therapy, podiatry, orthotics, medical supervision).

It may be difficult to establish the amount of recovery which took place because:

In order to obtain objective measures of the neuromuscular integrity it may be necessary to perform EMG studies, Cybex dynamometer tests and measurement of the grip strength. The vital capacity of the lungs can be established through spirometry.

QUESTION 4:
ARE THE SYMPTOMS CLEARLY UNRELATED TO POLIO?

Investigate other possible causes, such as:

-   generalised weakness due to other causes;
-   joint and muscle aches due to an inflammatory condition;
-   muscle weakness due to degenerative muscle or nerve disease;
-   localised pain due to peripheral neuropathy;
-   breathlessness and oedema due to cardiac problem or emphysema;
-   confusion due to mental disturbance;
-   lack of balance due to cerebellar or posterior column disfunction.

QUESTION 5:
IF NO - CAN THE SYMPTOMS BE CAUSED BY A PROGRESSION OF RESIDUAL POLIO?

Is it possible that residual problems may have developed into further disturbances, such as:

-   tendinitis due to excessive use of walking-stick or wheelchair;
-   accelerated degenerative changes due to faulty musculo-skeletal mechanism and excessive weight bearing;
-   pulmonary infection due to diminished vital capacity;
-   undue sensitivity to cold due to circulatory disturbance;
-   heart and lung problems due to pronounced scoliosis;
-   reduced fitness due to physical inactivity;
-   oedema due to venous stasis in lower limbs.
    Useful reading:
  1. Hodges DL, Kumar VN. Postpolio syndrome. Orthopedic Review 1986;15:51-5. [PubMed Abstract]
  2. Frustace SJ. Poliomyelitis: Late and unusual sequelae. Am J Phys Med 1988;66:328-37. [PubMed Abstract]
  3. Jackson RP, Simmons EH, Stripinis D. Coronal and sagittal plane spinal deformities correlating with back pain and pulmonary function in adult idiopathic scoliosis. Spine 1989;14:1391-7. [PubMed Abstract]
  4. Einarsson G, Grimby G. Disability and handicap in late poliomyelitis. Scand J Rehab Med 1990;22:113-21. [PubMed Abstract]
  5. Bruno RL, Johnson JC, Berman WS. Vasomotor abnormalities as post-polio sequelae: Functional and clinical implications. Orthopedics 1985;8:865-9. [PubMed Abstract]

QUESTION 6:
ARE THE SYMPTOMS CONSISTENT WITH THOSE ASCRIBED TO THE LATE EFFECTS OF POLIO?

New symptoms, commonly ascribed to the late effects of polio, may occur following a period of post-convalescent stability (commonly 20-30 years). It appears that a combination of at least two of the following symptoms is most common (1):

Sleep apnoea of central origin may not be detected unless sleep surveillance is undertaken. During the day the voluntary action of respiratory and ancillary muscles may conceal this effect (2). Sleep apnoea is often associated with excessive snoring.

All these symptoms may be intermittent, often associated with overuse.

    References:
  1. Castle House Medical Research Group. The late effects of polio: A descriptive survey of the postpolio syndrome in British Columbia. Prepared for the Post Polio Awareness and Support Society of British Columbia, 1989.
  2. Saltzstein RJ, Melvin JL. Abdominal distension as an indication of post-polio ventilatory insufficiency. Clinical note. Am J Phys Med Rehab 1988;85-6. [PubMed Abstract]

QUESTION 7:
IF YES - ARE THE SYMPTOMS DUE TO A COMBINATION OF CAUSES?

It is possible that a combination of underlying causes results in recurrent or chronic symptoms in people who previously had polio. Consider the following:

-   One problem may aggravate another such as:
new weakness (LEOP) aggravating postural abnormality (RP) causing pain due to abnormal weight bearing;
-   Two problems causing similar symptoms may co-exist, such as:
morning headaches associated with hypercarbia and hypoxia from sleep apnea (LEOP), neck pain and headaches with prolonged driving, sewing or writing due to muscle weakness of neck and shoulder girdle (RP).
    Useful reading:
  1. Frustace SJ. Poliomyelitis: late and unusual sequelae. Am J Phys Med 1988;66:328-37. [PubMed Abstract]
  2. Hodges DL, Kumar VN. Postpolio syndrome. Orthopaedic Review 1986;15:51-5. [PubMed Abstract]

QUESTION 8:
HOW SEVERE IS THE PRESENT CONDITION AND WHAT IS ITS RATE OF PROGRESSION>

Investigate the following:

-   the type and extent of the problem;
-   the severity of the various complaints;
-   the rate of progression since the onset of new symptoms.

A drawing may be useful to keep track of many symptoms, using different colours or codes for areas of paralysis, weakness and pain.

A pain scale or disability index provides a practical and reliable measure of discomfort and lifestyle impairment. The rating can also be used as a reference for further re-assessments.

Objective tests may be required to evaluate:

The progression of the condition can be assessed in the following manner:

Chart assesing condition progression

    References:
  1. Hill R, Robbins AW, Messing R, Arora NS. Sleep apnea syndrome after poliomyelitis. Am Rev Respir Dis 1983;127:129-31 (abstract).
  2. Coelho CA, Ferrento R. Dysphagia in postpolio sequelae: Report of three cases. Arch Phys Med Rehabil 1988;69:634-6.

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Copyright The Lincolnshire Post-Polio Network 1997 - 2010.

This document comprises an index, foreword, introduction and seventeen other sections or subdocuments. Permission for printing copies is granted only on the basis that ALL sections are printed in their entirety and kept together as a single document.

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.
Created: 7th July 1997
Last modification: 20th January 2010.
Last information content change: 6th June 2000

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