Focus - Post-Polio Syndrome

Focus – Post-Polio Syndrome

Poliomyelitis, commonly referred to as ‘polio,’ is a neuromuscular disease caused by the poliovirus invading the nerve cells (motor neurons) of the spinal cord, often resulting in weakness or paralysis of the limbs and, in some cases, the muscles controlling speech, swallowing, and breathing. Poliomyelitis was a worldwide epidemic from 1840 until the early 1950s.² It is estimated that twenty million people worldwide were affected during this time. The last major polio epidemic in 1952 affected 58,000 people in the United States alone. The injectable polio vaccine (IPV), developed by Jonas E. Salk, was in use by 1955, and the oral polio vaccine (OPV), developed by Albert B. Sabin, began use in 1962. These two vaccines greatly reduced the incidence of the disease in the US, and by 1963 there were only 363 new cases of polio in the U.S.³

In the following years, however, polio still plagued those already affected. In the late 1970s, large numbers of polio survivors started to report that they were “tiring more easily.” Other symptoms reported included muscle weakness with or without loss of muscle bulk, muscle pain and twitching, sleeping problems, breathing difficulties, cold intolerance, joint pain, and a noticeable decline in the ability to carry out routine activities.

Factors thought to increase risk for developing PPS⁵

A more severe initial infection
Onset of polio as an adolescent or adult, rather than as a young child
Greater health recovery after acute polio may place additional stress on remaining motor neurons.
Performing physical activity to the point of exhaustion may overwork already stressed motor neurons.

According to estimates by the National Center for Health Statistics, more than 440,000 polio survivors in the United States may be at risk for developing PPS 7, and that population is aging.

Polio survivors reported that their symptoms progressed slowly, starting anywhere from ten to forty years after the initial infection.⁴ Medical professionals labeled this phenomenon Post-Polio Syndrome (PPS). It is believed that to compensate for neuron damage caused by polio, the remaining neurons sprouted new fibers. These new fibers promoted muscle recovery, but also placed additional stress on the nerve cell body. Over the years, this stress may lead to the gradual deterioration of the sprouted fibers and, eventually, the neuron itself. In these cases, symptoms return or worsen.⁶

Treatment
There are currently no effective pharmaceutical or specific treatments for PPS. Polio survivors were initially advised to preserve their muscles and strength by avoiding exercise. Medical professionals later observed that decreased use of muscles and joints could actually result in the same symptoms as overuse or misuse. A number of controlled studies demonstrated that non-fatiguing exercises actually improved muscle strength. Exercise is more likely to benefit those muscle groups that were least affected by polio. An experienced health care professional can prescribe an individualized exercise regime tailored to include appropriate muscle groups. Cardio-pulmonary endurance training is generally considered more effective than strengthening exercises, but any exercise should be discontinued if it causes excessive fatigue or weakness.⁷

Self-Management Recommendations for the Farmer or Rancher with PPS⁸
While there is no cure or pharmaceutical treatment for PPS, the farmer/rancher with PPS can have some control over symptoms. A few recommendations are:

Limit activities that cause pain or fatigue. Know your body’s strengths and weaknesses--moderation is key. Try not to over-exert muscles during times of peak work, such as planting/harvesting; instead, ask for or hire help.
Protect your lungs. Avoid animal confinement areas and areas where organic dust, mold, microbes, pesticides, herbicides, or chemical fumes or particles may be airborne. If work must be done in an animal confinement area, consider practices that will reduce airborne dusts. Examples may include selecting feed that produces less dust and mechanical feeding to reduce manual work and greater separation from the feed. If a respiratory infection develops, seek treatment immediately.
Stay warm. Cold increases muscle fatigue. Keep your work area and home at a comfortable temperature, and dress in layers when working outdoors.
Pace yourself. Take a nap or at least rest at regular intervals. Conserve energy and use assistive devices that reduce stress to muscles and joints.
Avoid falls. Remove clutter from home and work area. Wear good shoes and avoid slippery or icy surfaces. Use assistive devices such as canes with interchangeable tips for different walking surfaces.
Develop a healthier lifestyle. Eat a balanced diet, stop smoking, decrease caffeine intake, and strive for seven to eight hours of sleep nightly.
Get support. Accept the help of friends and family, and consider joining a PPS support group to find out how others manage their challenges.

To Find a Support Group:
- Polio Experience Network.
- Post-Polio Heath International.

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Section 1: Client Story Section 2: Focus Section 3: Assistive Technology Notes	Section 4: State Project Feature Section 5: References Section 6: Contacts