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Polio: Managing its late effects in the nursing home

November 1, 2007
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Are you capturing the rehabilitative minutes you earn for post-polio syndrome?

For most Americans today, polio is a vaccine, not a crippling disease. However, in the 1940s and '50s poliomyelitis was an epidemic across the country. In 1952 alone, approximately 50,000 Americans contracted polio, with 12% dying.1 Today an estimated 1.6 million Americans have survived polio's acute infectious stage with disabilities ranging from weakness to paralysis.2

Today, six decades after the polio epidemic, survivors are reporting new and unexpected symptoms related to the disease. Many people who conquered earlier disabilities are now facing the challenges of late-appearing symptoms, called post-polio syndrome (PPS). This received official acknowledgment in 2003, when the Social Security Administration issued a new ruling (SSR 03-1p) defining post-polio sequelae.3

Polio survivors are now entering nursing homes for treatment of comorbidities, such as heart disease and stroke, and injuries such as hip fractures. Understanding PPS symptoms can help nursing home staff capture RUG minutes for therapy while treating this previously underserved population. It is important that facilities specifically ensure consistency between sections G and P of the Minimum Data Set (MDS).

Etiology and Early Effects

Polio is a contagious disease caused by one of three types of polio viruses. Paralysis results in one out of every 200 infections.4 Polio viruses are spread through direct hand-to-hand or hand-to-mouth contact after the virus is excreted in the feces of infected persons. The virus enters humans via the gastrointestinal tract, where it multiplies and spreads through the bloodstream.5

Polio viruses have a special ability to damage anterior horn cells of nerves serving muscle fibers. The nerve may recover. But when a nerve cell dies, the corresponding muscle fiber that it innervated becomes weak or paralyzed. Leg nerves are more often damaged than those in the arm. Muscle wasting is seen as soon as a week after the virus infects a person.6

Muscle fibers infected by polio viruses change internally. Fibers convert from type II, fast-twitching to type I, slow-twitching. In normal people, slow movement, such as walking, requires type I fibers. Faster movement, such as running, demands type II fibers. People whose muscles were affected by polio use both type I and type II fibers for ordinary walking. Those who had polio therefore experience excessive taxing of their muscle fibers.6

Late Effects

As mentioned, people affected by polio decades earlier are increasingly seeking medical attention for a variety of clinical conditions related either to acute infection or its residual deficits.3 PPS symptoms appear from 15-54 years after acute infection. The average reported onset of PPS is 28.8 years. Some PPS symptoms are exhibited in 50–80% of people who had polio.5,6

The most frequently reported late effects of polio are weakness and excessive fatigue, followed by pain, breathing difficulties, swallowing problems, intolerance to cold, cognitive changes, and sleep disturbances.3,5-8

Here's more information about each of these effects:

Weakness. The normal functional losses of aging are heightened for persons with PPS. Motor neurons already impaired decrease at a rate of 2% every decade after age 20 and 5% every decade after age 60.2 Muscles affected by polio have a delay in recovery time after exercise.6

Excessive fatigue. “Hitting the polio wall” is a phrase commonly used to describe PPS fatigue. Polio survivors report that they are exhausted at the end of the day and more so at the end of the workweek. They need the weekend to regain enough strength to return to work on Monday.

Pain. The most commonly reported precipitant to PPS musculoskeletal pain is physical activity. Overuse of muscles leads to pain.7 This is a catch-22 situation where exercise can lead to pain and muscle fatigue which, in turn, necessitates a more sedentary lifestyle that can easily lead to weight gain. Muscles in people with PPS must then work harder when they gain weight. Weight gain also adversely affects joints. In addition, the polio survivor has often compensated for a weakened limb by favoring a stronger one, leading to degenerative joint disease and osteoarthritis in the overused limb.7