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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.
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).
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. (www.post-polio.org/edu/healthcare)