A practical approach to the late effects of Polio
Charlotte Leboeuf

11 HOW DO I KNOW IF I HAVE THE LATE EFFECTS OF POLIO?

Unfortunately, there is no specific test which will determine if the symptoms you may experience are related to the late effects of polio. As the diagnosis must be made through exclusion of other possible causes it is necessary to examine critically all symptoms in order to exclude residual polio, ageing and other health problems.

Do not forget that other people throughout life also experience discomfort and disease. All your problems cannot necessarily be ascribed to the late effects of polio!

• First of all, you must find out if you really had polio. This is probably the case if you can recall (or have been told) that you had fever, at least some muscle weakness, pain and cramps in muscles, and perhaps difficulty breathing. If you were also hospitalised and the time corresponds with a period of one of the polio epidemics, it is likely that you had polio.

  Some people who had acute polio were not properly diagnosed, for example if the infection was very mild, if there was no medical personnel available to make the diagnosis or if it occurred outside the period of the epidemics. On the other hand, others may have been incorrectly diagnosed as having polio, when in fact they had some other condition.

• Secondly, you must try to establish the extent of the infection. Were you only mildly affected? Can you remember any muscle weakness or breathing difficulty?

  Destruction of motor neurones in the spinal cord could have resulted in muscle weakness or paralysis in one or both legs or both arms, in the back (difficult to straighten your back) or in the chest (some breathing difficulties).

  The polio virus may have been active in the brain stem as well. Can you recall more severe problems, such as difficulty in breathing, swallowing and/or speaking? Perhaps you had respiratory assistance.

  Old medical records may be available relating to the presence and severity of your acute polio infection.

• Thirdly, you need to determine the extent of maximum recovery, i.e. how well everything functioned when your recovery "peaked".

• Fourthly, you must establish if you have developed new symptoms from one or several of the following groups:
  • unexpected loss of muscle strength and endurance;
  • pain in muscles and joints;
  • breathing, swallowing and/or speech problems.

  (See chapter 5 for symptoms and chapter 6 for activities of daily living.)

• You will probably need further assessment by a doctor, whose job it is to exclude other possible causes of your discomfort. Don't forget that you may also have a combination of underlying causes, some or all of which may be unrelated to LEOP.
  
  Some tests may be necessary:
  • The extent of damage to your motor neurones can be assessed with electromyography (EMG) but it will not give any information relating to the late effects of polio.
  • The strength of some of your muscles can be objectively measured e.g. with a Cybex machine. Endurance relates to the number of movements that you can repeat before your muscles fatigue.
  • The vital capacity (=the amount of air that you can expel from your lungs following full inspiration) will give some information of the state of your lungs and the strength of your chest muscles.
  • Observation of your breathing during sleep may be necessary if you know or suspect that you experience sleep apnoea (25).
  • Sometimes it is necessary to examine the throat for changes in speech and swallowing. It is possible to take X-rays during swallowing, to see if there are any problems (26).
  • If you experience residual weakness you are probably used to seeing your orthotist for regular assessment of your need for orthotic support. Orthotics can protect your muscles and joints from becoming worse with excessive wear and tear. If the late effects of polio result in weakened muscles you may require an assessment for orthotic support, even if you did not need such devices after recovery from the acute disease. (For a definition of "Orthotist" and "Orthotics" see page 34)

• Finally, if it has been established that you are likely to be experiencing the late effects of polio, it is important that you keep track of your symptoms and their rate of progression so you can relate your health status to your management program.

  It could be useful if you develop the habit of making systematic observations of your symptoms of LEOP in a diary. A pain (and weakness) drawing can show which areas of your body are vulnerable. An example is shown in Fig. 1.

  Fig. 1. Drawing of symptoms

  This person has drawn in an area of pain around the right knee, a feeling of weakness of the right thigh and cramps running down the front of the left leg. You can invent your own symbols. Keep them simple and consistent. It can be very confusing with too many symptoms on the same drawing.

  You can also list activities that you have problems with and grade the difficulties on a scale e.g. from 1 to 10. See Fig. 2 for an example. Put a date on these records. Try not to become an obsessed hypochondriac who bores friends and health professionals with endless details of a myriad of symptoms!

  Fig. 2. Activity list

  This is an example of some activities this person had problems with. You can invent your own list. Put a cross somewhere on the line between 1 ("can't do") and 10 ("no problems") according to the difficulty you experience. This will enable you to obtain some measure of your degree of disability. You can then compare your ratings over time.

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

This document comprises an index, introduction and sixteen 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.
Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/australia/paleop/sectn_11.html>
Created: 30th December 1997
Last modification: 6th June 2000