The late effects of Polio Information for Health Care Providers
Charlotte Leboeuf

9 PREVALENCE OF NEW SYMPTOMS AND PROGNOSIS

An estimated minimum number of 20,000 - 40,000 Australians had paralytic polio between the 1930s and 1960s. The number of survivors who presently experience symptoms of the late effects of polio or who are expected to develop such symptoms in the future is unknown.

Surveys have reported figures which vary with the methodology and the type of population which was studied. As many as 65% of a sample, which was obtained from a list of acute polio patients at the Mayo Clinic in the U.S., were found to experience new symptoms according to a mail survey augmented by an additional detailed neurological and electrophysiologic evaluation (1). This percentage is considerably higher than Codd's figure of 22%, which was obtained through an earlier mail and telephone survey of the same population (2). If the same percentages apply in Australia, an estimated number of 4,000 - 26,000 individuals presently experience the late effects of polio.

The prevalence of various complaints also differs between studies. Pain, fatigue and weakness seem to be most commonly reported (between 42% and 87%) according to descriptive surveys and clinical examination studies (3-7).

Muscle cramps (45%) and muscle twitching (41%) were commonly reported in a survey of Australian postpolio support group members (7).

Interestingly, two studies reported sensory changes or loss in approximately 1/3 of the study group (3,4). Sleep disturbances were equally common (5,6) and also occurred in cases without obvious prior bulbar involvement (6). Respiration (5) and eating/swallowing (3) were problems for approximately 25% of the subjects. Speech was also reported to be affected (7,8).

Most of the surveyed Australian post-polio support group population reported recent changes in ordinary activities of daily living (9). The majority (74%) reported a deterioration in meeting the physical demands of their job, household chores or daily activities. Other examples of reported areas of decline are: climbing stairs (68%), walking on level surface (55%), getting in and out of bed (32%), taking a shower or bath (31%), getting dressed (28%), using the toilet (18%) and feeding oneself (7%).

Of those who were currently employed, 42% had been forced to change jobs or to modify their employment. Sixteen percent of the sample had had to retire early or obtain a pension.

It is not known to what degree these symptoms compare with those experienced by the normal population nor is it known how they compare with those of people with minimal, moderate and severe physical disability from other causes than previous polio.

Little is known about the speed of deterioration but it appears that a small but fairly steady neuromuscular decline takes place in all people who previously had polio regardless of whether or not they experience symptoms (6,10). Spells of rapid deterioration or periods of remission may also occur. With rest and appropriate assistance, the prognosis is thought to be relatively good (11).

References:

1. Windebank AJ. Conclusions from Omstead County. Polio Network News 1989;5:3-5.
2. Codd MB, Mulder DW, Kurland LT et al. Poliomyelitis in Rochester, Minnesota, 1935-1955: Epidemiology and longterm sequelae: a preliminary report. In: Halstead LS, Wiechers DO (eds). Late effects of poliomyelitis. Miami Symposia Doundation, Inc. 1985:121-34.
3. Halstead LS, Rossi CD. New problems in old polio patients: Results of a survey of 539 polio survivors. Orthopedics 1985;8:845-50. [PubMed Abstract]
4. Agre JC, Rodriguez AA, Sperling KB. Symptoms and clinical impressions of patients seen in a postpolio clinic. Arch Phys Med Rehabil 1989;70:367-70. [PubMed Abstract]
5. Rankmore D, Oake W. Ontario March of Dimes Survey: Late effects of poliomyelitis. Ontario March of Dimes, Provincial Office, 60 Overlea Boulevard, Toronto, Ontario M4H 1B6 (1985).
6. Cosgrove JL, Alexander MA, Kitts EL et al. Late effects of poliomyelitis. Arch Phys Med Rehab 1987;68:4-7. [PubMed Abstract]
7. Westbrook MT. Clients' evaluation of chiropractic treatment for post polio syndrome. J Aust Chiropractors' Assoc (In press).
8. Cannon S, Arbor A, Ritter FN. Vocal cord paralysis in postpoliomyelitis syndrome. Laryngoscope 1987;97:981-3. [PubMed Abstract]
9. Westbrook MT. A survey of post polio sequelae: Manifestations, effects on people's lives and responses to treatment (Unpublished document). Cumberland College of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 2141 (1990).
10. Dalakas MC, Elder G, Hallat M et al. A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl Med 1986;314:959-63. [PubMed Abstract]
11. Peach PE. Overwork weakness with evidence of muscle damage in a patient with residual paralysis from polio. Arch Phys Med Rehabil 1990;71:248-50. [PubMed Abstract]

© Copyright The Lincolnshire Post-Polio Network 1997 1998 1999 2000 2001 2002

This document comprises an index, foreword, introduction and seventeen other sections or subdocuments. Permission for printing copies is granted only on the basis that ALL sections are printed in their entirety and kept together as a single document.

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.
Primary Document Reference: <URL:http://www.ott.zynet.co.uk/polio/lincolnshire/library/australia/leop/sectn_09.html>
Alternate Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/australia/leop/sectn_09.html>
Created: 7th July 1997
Last modification: 9th January 2002
Last information content change: 6th June 2000