Polio and Postpolio Syndrome

(Infantile Paralysis; Poliomyelitis; Postpolio Syndrome)

Polio, a highly contagious disease, is caused by three different types of polio virus. Most infections are asymptomatic, with illness becoming evident in only about 5 in 100 cases, and then, usually limited to a low-grade fever, malaise, sore throat, and other flu-like symptoms. This manifestation is referred to as abortive polio.

A small percentage of people develop viral, or aseptic meningitis, characterized by severe headache, stiff neck, back and muscle pain, and sometimes muscle spasms or paralysis. Most recover completely, and only in the most severe cases is there permanent paralysis. (The most well-known case of this type was that of President Franklin Delano Roosevelt.)

Polio is now rare in the United States thanks to vaccines introduced in 1955 and 1963. Ironically, use of the live polio virus in an oral vaccine is now responsible for most of the cases in this country -- an average of nine a year. The disease is, however, still common in some developing countries.

In recent years, postpolio syndrome, characterized by fatigue, muscle weakness, pain, and sometimes even paralysis, has been identified among people who decades earlier suffered polio. Of 250,000 polio survivors in the U.S., some 20 to 25 percent are expected to develop the syndrome. The cause is unknown, but some researchers have theorized that aging further depletes nerve cells originally damaged by polio. However, some patients experience atrophy and weakening even of muscles that were not affected earlier. Nor is there any correlation between the severity of the two attacks. Some patients whose initial bouts were mild suffer progressively severe symptoms.

Diagnostic Studies and Procedures

An initial diagnosis of polio can be based on symptoms, but laboratory tests will be ordered to rule out other possible causes. A person who may have postpolio syndrome will undergo electromyography and other muscle tests, as well as a chest X-ray and perhaps pulmonary function tests.

Medical Treatments

There is no effective antiviral treatment against polio; thus, therapy is aimed at relieving symptoms. If breathing is affected, long-term use of a respirator may be necessary. In less severe cases, postural drainage and suction are used to remove accumulations of mucus in bronchial tubes. Sometimes a tracheostomy, an opening in the trachea, is created to function as an airway.

Perhaps the most important aspect of treating polio is medically supervised physical therapy during convalescence. About half of patients with paralytic polio recover completely; 25 percent retain mild disabilities, and 25 percent remain severely handicapped.

Patients with postpolio syndrome are treated by experts in rehabilitation medicine, with the goal of helping them adapt to loss of muscle strength.

Alternative Therapies

Hydrotherapy. Swimming is the best exercise for polio patients. Water temperature should be warm to promote flexibility of muscles and joints. Range-of-motion and stretching exercises also can be done in the water.

Music Therapy. Music has long been part of the programs at New York's Goldwater Memorial Hospital and the Rusk Institute of Rehabilitation Medicine -- leading treatment centers for polio patients -- where it is used to encourage movement and control pain.

Physical and Occupational Therapy. As soon as the acute phase passes, physical and occupational therapists begin working with patients to increase muscle tone and strength. For those who suffer disability, occupational therapists can provide training in how to care for themselves independently even with limited strength and mobility.

Self-Treatment

Extra rest is important both during convalescence from polio and in dealing with postpolio syndrome. While exercise is significant, it is equally important not to overdo it.

Maintaining ideal weight is critical, because excess weight makes it more difficult to get about. When eating, a patient should chew slowly and swallow carefully to avoid choking, especially if respiratory muscles have become weakened. The best eating position is sitting up straight with the head leaning slightly forward. Alcohol should be avoided with meals, because it may further inhibit swallowing.

Anyone who has had polio should avoid sleeping pills and narcotic medications, because these can suppress breathing. Swollen feet and ankles are a common complication in partially or completely paralyzed legs. Support stockings might be considered.

Other Causes of Polio Symptoms

Guillain-Barre syndrome is sometimes confused with polio. Postpolio syndrome can be mistaken for multiple sclerosis and other disorders of the neuromuscular system.