Polio is an infectious viral disease that invades the nervous system; it can cause total paralysis in only a matter of hours. Symptoms associated with the virus include fever, vomiting and muscles stiffness, with 1-2% of cases resulting in associated lifelong muscle paralysis.

The World Health Organisation led a public health effort in 1988 to eradicate the disease, this was through administering a highly effective vaccine. In Australia, polio was thankfully eradicated in the year 2000.

Over the years when polio was rife, up to 99% of people with the virus had no signs of illness and to this day, are unaware that they have ever been infected. These symptomless people carried the virus in their intestines where it replicates and could silently spread the ‘Wild Polio’ infection to thousands of others. Unfortunately, Wild polio still exists in Pakistan and Afghanistan.

The polio vaccine continues to be administered to children all around the world as there is a rare risk otherwise of contracting the vaccine-derived poliovirus in unvaccinated communities.

Years after contracting the initial polio infection, increasing numbers of polio survivors will develop a range of symptoms. The time from initial infection to the secondary phase is around 30 years, but this time frame does vary. The onset of these symptoms is generally slow and steady but occasionally they will develop suddenly and progress quickly. It has been reported that symptoms can arise after physical or emotional stresses, or after a period of being immobile, for example, after a period of being unwell or having surgery.

The Late Effects of Polio (LEoP) is a broadly termed neuromuscular condition that can occur in a high percentage (up to 80%) of people with prior exposure to polio as they age. This term encompasses the more known diagnosis of Post Polio Syndrome (PPS). PPS specifically refers to the excessive stress on the remaining neurones which innervate the muscles, meaning people with PPS experience a worsening of their weakness. The LEoP includes the complications involving the aging, wear and tear and overuse of skeletal structures causing osteoarthritis, scoliosis and subsequent reduction in mobility and function.

As late polio symptoms progressively worsen, patient coping mechanisms used for many years may no longer be effective, and the person may not be aware of what and why it is happening. Many people with polio just put their physical decline down to premature aging.

As mentioned, individuals may not have known if they had the poliovirus as a child, only that polio was around and therefore, you can see how coming to the conclusion that you have the late effects of polio can be incredibly difficult! It’s very important to not self-diagnose and put your symptoms down to having the LEoP or PPS. Symptoms can be mild through to moderate and are shared with many other conditions and so you must be carefully assessed by your medical team.

Lasting weakness and muscle imbalance.

• Muscle imbalance may present as obvious differences in the size of a muscle, for example, your left thigh muscle may be bigger than your right. In later years, it may present as osteoarthritis (OA), the ‘wear and tear’ of a joint; symptoms of OA include pain, swelling of a joint and limited range of movement. This, in turn, can often cause one thigh muscle to waste and a size difference to be noticeable.

Difficulty maintaining level of function achieved following the acute polio infection

• Someone may report that they have never been able to run or jump. Someone else may report that getting up from the floor or kneeling has always been difficult for them. As time passes these limitations become more obvious and this can be a tell-tale sign in those individuals who are aware that they had polio as a child.

Someone will notice a new presentation of weakness.

• Someone may report that their usual walk each day is becoming increasingly difficult, they need more seated rests, or they start to experience pain in their hips and knees, most probably because of muscle weakness and therefore altered biomechanics.

Fatigue and Exhaustion

• This is very common and some people find they become exhausted even with minimal activity. This symptom can have a huge impact on independence and quality of life.

Swallowing and breathing

• Some people may start to experience food getting stuck in their throat or breathing and sleep-related breathing problems.

Someone who has been diagnosed with the LEoP may seek out a physiotherapist or occupational therapist for many different reasons. For example, they may find that completing everyday tasks such as standing from a low chair or walking up a flight of stairs is getting more challenging.

They may find that fatigue is a huge issue and is affecting their ability to work. They may find that the weakness in their leg is causing their knee to buckle when walking, increasing their fall risk. They may find that they are having difficulty lifting their arms up above shoulder height, therefore struggling to dress independently or wash their hair. Other reasons why someone may seek therapy intervention is for advice and education around lifestyle modification, weight management and increasing overall activity levels with guidance from a specialist therapist.

It is very important to check if the treating therapist has experience with the LEoP as there are unique considerations in the management of this condition.

A neurological physiotherapist with experience in polio will be able to complete a comprehensive assessment. They can use questionnaires and other assessments to identify your fatigue levels, from which they can work alongside you, problem solve and then tailor a program for you to follow which will look to manage your fatigue and the impact it has on your life.

As previously mentioned, someone with the LEoP may complain of a new onset of muscle weakness. It is important to maintain muscle strength whilst being careful not to overload the muscle. The degree of muscle weakness is important here; you need to tread with caution when trying to strengthen very weak muscles.

Someone else may have a goal around returning to sport, or maintaining the ability to participate in their sport, such as cycling, horse riding, playing golf; a therapist can help you work towards this goal through prescribing specific exercises working on the movements involved in your sport. Therapists can be extremely creative in finding ways to ensure you don’t miss out on the things you enjoy doing most.

Obviously, every person presents differently and is working towards their own goals. A therapist will work with you and guide you on your way to helping you achieve what is important to you. If an individual doesn’t have a goal as such, conversations around the best approach to keeping fit, well and healthy can be incredibly valuable.

At ARC we pride ourselves on our holistic approach to therapy to ensure we are working towards client-specific goals. We have a multidisciplinary team, made up of physiotherapists, occupational therapists, exercise physiologists, neuromuscular orthotist, speech pathologists, clinical psychologists and allied health assistants.

Physiotherapy

Our neurological physiotherapists complete comprehensive biomechanical and neuromuscular assessments; they provide treatment based on impairments found and difficulties reported. A physiotherapy program may consist of strength training, balance and falls prevention, functional retraining and offer advice around the prescription of gait aids and devices.

Occupational therapy

Our team of occupational therapists can offer advice and education around fatigue management, home & workplace modifications, functional training, equipment prescription such as the hire or purchase of wheelchairs, scooters, seats and other assistive devices.

Exercise Physiologists

Our exercise physiology (EP) team assist with the general health and well-being of clients with the LEoP; they guide their clients to help them improve their aerobic capacity and cardiovascular endurance in a safe and effective way. Our EP team can also set up specific strength programs and offer advice and strategies around weight management.

Neuromuscular Orthotics by Orthomotion

Orthomotion offers a service at the ARC clinic. It is a clinical practice specialising in lower limb control orthoses and mobility supports for people living with the effects of neuromuscular conditions. For clients with the LEoP, Orthomotion provide comprehensive assessments and the prescription, trial manufacturing, fitting and modification of orthoses, including ankle-foot orthoses (AFO), knee ankle-foot orthoses (KAFO), spinal & abdominal braces and footwear.

Speech Pathology by Optimal Speech Pathology

At ARC we have speech pathologists on site who can provide comprehensive speech and swallow assessments and ongoing treatment, and bulbar examinations.

If you or someone you know is affected by the late effects of polio or post-polio syndrome, then come and see the team at ARC for an individualised treatment approach working towards improving symptoms, independence and therefore quality of life.

References:

World Health Organization (WHO) Polio Factsheet 2022