The late effects of Polio Information for Health Care Providers
Poliomyelitis (polio) was previously thought to be a self-limiting disease. Recent research has documented the development of new, previously unexpected symptoms in some people who once had polio. Problems commonly develop about thirty years after the episode of acute infection in people of various ages.
It appears that most of these symptoms are caused by focal degeneration secondary to relative overuse of deficient muscles and nerves. This results in a general lack of strength and endurance, which in turn results in musculoskeletal complaints and respiratory insufficiency. Sleep apnoea and swallowing difficulties may occur due to bulbar involvement. There may also be an inflammatory component to this condition.
The course is relatively slow. Rest appears to improve the condition. Fatigue due to general deconditioning may be managed with individually designed, gentle exercise programmes.
People manifesting obvious residual disability from the acute disease can probably adjust to these added symptoms. Their health practitioners are also likely to be aware of their previous history of polio. The situation may be different for those who have few, if any, obvious sequelae of the disease. Most of the 20,000 - 40,000 Australians who had paralytic polio from 1930 onwards have probably recovered well and obtained a high level of independence. They may not make the connection between a present deterioration in their health and the previous polio infection. Their health practitioners may also be unaware of the possible link. This group is at a greater risk of continued aggravation due to incorrect diagnosis and management.
It is estimated that 4,000 - 26,000 people in Australia already experience the late effects of polio. As the population ages, the number may be anticipated to rise. Social and public health policy makers will need to be aware of certain present and future needs within this group.
The level of awareness in society needs to be raised in order to ensure that people who previously had polio are aware of the condition and its management; and to increase the level of understanding among others. Early energy conservation measures may prevent the onset or worsening of symptoms.
Members of the health professions are largely unaware of the clinical and social perspectives of the late effects of polio. It is essential to provide them with information about the condition, and to do this at undergraduate and postgraduate levels.
People who previously had polio need easy access to expert neuromuscular, postural, respiratory and, possibly, swallowing assessment. This includes assessment for sleep apnoea. They also need assistance with a preventive and/or management programme. At least one specialised centre of evaluation and care is needed in each state of Australia.
For those who are active in the work-force, energy management is essential to prevent deterioration and "bum-out". This may include altered work practice or reduced work hours.
Earning capacity throughout life may have been reduced due to polio, thus limiting the amount of money available at retirement. Early retirement, in particular, may not be a viable option. Insurance companies commonly discriminate against people who previously had polio. Employers are under no obligation to retain staff who are unable to fulfil their expected duties. Family members may have to reduce the amount of remunerated work in order to provide care for the increasingly incapacitated. A reduction in work hours or an inability to remain in a demanding job can have serious financial repercussions. There appears to be a need for a federal scheme of financial assistance to those who need to reduce their work in order to be able to continue a productive existence.
Independent living may become difficult with increasing age and disability, especially for single people. There is a need for uniform, clear-cut guide-lines relating to domiciliary care, home improvements etc. These guidelines must be readily available to the public.
Transport is essential. Financial assistance and tax exemption relating to the purchase of modified equipment, facilities or services need reviewing. Uniform guide-lines are required. Again, these must be easily accessible.
Future studies need to address the issues of the incidence, prevalence, rate of progression and treatment of the late effects of polio. Predictors of the development of symptoms also need to be identified. Obviously funding is required to allow such research to take place.
It can be concluded that the late effects of polio constitute a condition which needs to be taken seriously by health care professionals, social policy makers and the general public. It is expected that the information provided in this book will assist in enlightening health care providers with the ultimate goal of spreading the knowledge throughout the community.
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Document preparation: Chris
Think-tank, Cornwall, United Kingdom.
Created: 7th July 1997
Last modification: 20th January 2010.
Last information content change: 6th June 2000