Poliomyelitis (infantile paralysis) has been eradicated from nearly every country in the world since the development of the Salk (1955)and Sabin (1961) vaccines. West and Central Africa and South Asia are the remaining principle reservoirs of the wild poliovirus, resulting in 100,000 new paralytic cases per year. The World Health Organization (WHO) has targeted the year 2000 for the complete eradication of acute poliomyelitis.
The WHO estimates there are 12 million people worldwide with some degree of disability caused by poliomyelitis. A 1987 National Center for Health Statistics survey reported over one million survivors in the United States. About 640,000 of them reported paralysis resulting in some form of impairment. Foryears most of these polio survivors lived active lives, their memory of polio long forgotten, their health status stable.
By the late ’70s, polio survivors were noting new problems of fatigue,pain, and additional weakness. By the mid ’80s, health professionals and policymakers recognized these new problems as being real and not “only in the patients’minds.” Studies on this phenomenon called ‘post-polia syndrome” have been (and are still being) conducted in research institutions and medical centers.
Symptoms can include
- Unaccustomed fatigue either rapid muscle tiring or feeling of total body exhaustion.
- New weakness in muscles, both those originally affected and those seemingly unaffected.
- Pain in muscles and/or joints.
- Sleeping problems.
- Breathing difficulties.
- Swallowing problems.
- Decreased ability to tolerate cold temperatures.
- Decline in ability to conduct customary daily activities such as walking, bathing, etc.These general symptoms are experienced in varying degrees, and their progression can be insidious. They should not be dismissed simply as signs of aging alone. Current research indicates that the length of time one has lived with the residuals of polio is as much of a risk factor as chronological age. It also appears that individuals who experienced the most severe original paralysis with the greatest functional recovery are having more problems now than others with less severe original involvement.
The diagnosis is one of exclusion
A definitive test is not yet available. Some of the confusion and doubt among polio survivors, health professionals, and family members is due to the lack of common understanding of terminology. It is helpful to think of post-polio problems in the following categories, remembering that the groupings are not distinct but parts of a continuum.
The largest and most inclusive category is called late effects of polio or polio sequelae and defined as specific new health problems which result from polio caused chronic impairments, e.g., degenerative arthritis of overused joints, carpal tunnel syndrome and other repetitive motion problems, tendinitis, bursitis, failing joint fusions, overstressed joints due to compensatory body mechanics.
Post-polio syndrome is a sub-category of the late effects of polio and is defined as the symptom cluster of new muscle weakness, fatigue, and pain resulting in a decline in functional ability and/or a new disability. Most clinicians use the following criteria to diagnose post-polio syndrome:
- Confirmed history of acute paralytic polio. Many clinicians perform an electromyogram (EMG) to document changes compatible with prior polio.
- Recovery followed by years of stability between onset of polio and onset of new problems which may include: gradual or abrupt onset of weakness in affected, and/or seemingly unaffected muscles, which may or may not be accompanied by excessive fatigue, muscle and/or joint pains, decreased endurance and function, and muscle atrophy.
- Other conditions that might cause the problems listed above must be excluded.
A sub-category of post-polio syndrome is post-polio progressive muscular atrop