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Late Effects of Poliomyelitis

Post Polio Syndrome

Post Polio Sequelae
An Explanation for Health Professionals

J. M. Walker, PhD, PT, K. Sweet, BSC(Physio)

Leaflet published by Nova Scotia Survivors Support Group
Revised 1996
Lincolnshire Post-Polio Library version by kind permission of J. M. Walker

Post Poliomyelitis Sequelae, Post Polio Syndrome (PPS), or simply, Late Effects of Polio

Poliomyelitis (polio) epidemics occurred in the 1940's and 50's, with first cases in Canada reported in 1927, last, not the result of vaccination, were in 1962. Acute polio still occurs in Africa and Asia so immigrants or visitors may have had acute polio more recently.

In the 1970s, many polio survivors began reporting new problems. That there may be late effects of polio was first recognized in 1875. The more common symptoms are:

Other, although less common symptoms are:

New symptoms are not restricted to muscles known [to be] affected by the polio virus; apparently 'normal' strength muscles may cause problems. If the individual was a child at initial infection, history of involvement may be incomplete.

What is post polio syndrome?

PPS is the diagnosis given when there is:

No single item is diagnostic of PPS. While about 22% of polio survivors develop PPS, most polio survivors will notice some changes in their overall function which can be related to their polio. PPS also is not a permanent state; with appropriate management, another period of stable function may be achieved.

The number of Nova Scotians who are polio survivors is unknown but ranges between 400 and 1200 based on 1994 survey data and the number of reported cases between 1927 and 1962.

Who is more at risk for PPS?

PPS tends to be diagnosed some 30 to 40 years after the initial episode of polio. Not everyone who had polio will start developing PPS at this time. Risk factors are :

Why may some polio survivors develop PPS?

The polio virus affected motor neurones, primarily in the spinal cord and sometimes in the brain stem ('bulbar paralysis'). Some of these neurones were unaffected, some recovered, and others were destroyed by the polio virus. Remaining neurons attempted to take over the function of the cells that had been destroyed.

This meant that these cells had to supply more muscle fibers than usual. Over time this may result in exhaustion of the nerve/muscle complex. Symptoms of PPS also can be mimicked by disuse or under use ofmuscles. Inactivity may result in a loss of strength and a decrease in endurance. The loss of motor neurons that occurs with aging may have a greater impact in polio survivors.

What can be done?

There is no evidence that there is a reactivation of the polio virus. Many of the musculoskeletal complaints can be the result of chronic overuse of polio weakened muscles and joints, mechanical strain due to faulty alignment and can be helped by appropriate health care, lifestyle modifications, medication, ambulatory aids, possibly orthoses, etc. Generally, PPS has a slowly progressive course.

Polio survivors learnt during the initial rehabilitation to push themselves, they followed the motto of "no pain, no gain" in order to achieve as normal a lifestyle as possible. They learnt to live with a level of pain which may have aggravated the problem of overuse. There is no cure, management is directed at slowing the process and alleviating the symptoms.

Overused muscles should not be exercised, but often some muscles have been under used and will respond to a individualized, carefully monitored exercise program. General conditioning by swimming, or walking may be beneficial. Exercise should be supervised by a physical therapist; clients need to recognize when to stop an exercise set or session.

It is important that health professionals listen to polio survivors who have coped with their disability over several decades. Helping the survivor to find solutions to current problems may be achieved by education, counselling, devices, orthoses, psychological support, & life style changes. Symptoms can be reduced and function improved although acceptance of the need to make changes may take time.

The Nova Scotia Polio Survivors Support Group, (c/o Abilities Foundation, Halifax see next panel for address) is a voluntary organization, run by polio survivors to provide mutual support and to share information and coping mechanisms. Literature and videos on PPS are available from the Abilities Foundation.

Bibliography

Berlly MH, Strauser WW, Hall KM. Fatigue in postpolio syndrome. Arch Phys Med Rehabil 72:115-118,1991. [PubMed Abstract]

Birk TJ. Poliomyelitis and the post-polio syndrome: exercise capacities and adaptation current research, future directions, and widespread applicability. Med Sci Sports Exerc 25(4):466-472, 1993. [PubMed Abstract]

Dean E, Ross J. Movement energetics of individuals with a history of poliomyelitis. Arch Phys Med Rehabil 74:478-483, 1993. [PubMed Abstract]

Einarsson G. Muscle adaptation and disability in late poliomyelitis. Scand J Rehab Med Suppl 25:7-76, 1991. [PubMed Abstract]

Halstead LS, Grimby G (eds). Post-Polio Syndrome. Philadelphia, Hanley & Belfus, Inc. 1994

Packer T, Martins I, Krefting L, et al. Activity and post polio fatigue. Orthopedics 14(11): 1223-1226, 1991. [PubMed Abstract]

Perry J, Fleming C. Polio: Long-term problems. Orthopedics 8:877-881, 1985. [PubMed Abstract]

Ramlow J, Alexander M, LaPorte R, et al. Epidemiology of the post-polio syndrome. Am J Epidemiol 136: 769-786, 1992. [PubMed Abstract]

Stejies DG, Kryger MH, Kirk BW, et al. Sleep in postpolio syndrome. Chest 98.133-140, 1990. [PubMed Abstract]

Nova Scotia Polio Survivors Support Group
c/o Abilities Foundation of Nova Scotia
3670 Kempt Rd.
Halifax, N.S. B3K 4X8
(902) 429 3420

J.M.Walker Ph.D., PT
School of Physiotherapy

4th Floor, Forrest Building,
Dalhousie University,
5869 University Ave.,
Halifax, NS Canada B3H 3J5

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Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.
Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/walker/guide_postpoliosequelae_mp.html>
Created: 3rd October 1998
Last modification: 31st January 2010.

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