Diagnosing Post-Polio Syndrome (PPS)
Post-Polio Syndrome (PPS)
What is post-polio syndrome?
“Polio was an epidemic in the United States in the 1940s and 1950s. People in the United States do not often contract polio because of the development of a polio vaccine which was developed in 1955 by Jonas Salk and an oral vaccine in 1962 by Albert Sabin. Vaccinated individuals cannot host a virus which makes it unable to replicate and spread. The polio virus is still active in some areas of the world. Improved sanitation measures have also helped to control it.
Poliomyelitis or polio is a contagious virus that enters the body. It is spread in respiratory droplets and through solid body waste. Most individuals who have polio will have flu-like symptoms. Rarely, polio affects the motor nerves (nerves that control movement) of the body especially in the spinal cord. This can be a sensation of tingling (paresthesia), an infection in the covering of brain and spinal cord (meningitis), or weakness in the muscles of the body (paralysis). Motor nerves are affected by polio which can lead to paralysis anywhere in the body with decreased movement seen in the arms and legs and most notably in the muscles that control breathing.
Some individuals survived the polio epidemic. Those with motor nerve damage may have some residual movement deficits. To accommodate the loss of movement, affected nerve fibers develop new nerve-end terminals (dendrites) that will connect with other nearby muscle fibers. The result is functional movement recovery. This process is a representation of neuroplasticity or the ability of the nervous system to recover by developing nerve buds to improve the strength of the polio affected nerve fibers and muscles. After the initial polio episode, the individual can have partial to what appears to be a full recovery.”
“Over time, some individuals with a history of polio which affected the motor nerves may develop new muscle pain, weakness, or paralysis 10 to 40 years after the original polio episode. This is post-polio syndrome (PPS). Years later, the overused motor nerves become unable to keep up with movement demands which results in their slow deterioration. There may be some improvement a second time, but eventually, the nerve terminals slowly malfunction without further recovery. Progressive weakness and paralysis can occur.”
“Post-polio syndrome is not contagious. It is not a re-activation of the virus but rather an effect of deterioration of the replacement or supplemental nerves.”
Diagnosing Post-Polio Syndrome
Your healthcare provider will perform a complete physical examination and health history. They will be differentiating your symptoms from other neurological issues. Clues to PPS include a history of polio specifically affecting the motor nerves followed by partial or complete recovery for a period of 10 years or more.
The history of PPS includes a new onset of slowly progressive muscle weakness, decreased endurance, muscle atrophy, muscle and/or joint pain and fatigue. Typically, later developing symptoms include breathing or swallowing issues. Onset of PPS is gradual but inactivity from trauma or surgery can make the symptoms appear suddenly. Even though you see your healthcare provider early, a diagnosis of PPS is typically not made until symptoms have been in process for a minimum of a year.
Questions about other health concerns that could be similar to PPS symptoms will be asked. These include issues with depression which affect activity levels or functional issues such as joint pain from use of braces or crutches. Some of the symptoms of PPS are stand-alone medical conditions, such as breathing dysfunction or scoliosis, and are therefore not conclusive symptoms for PPS.
Included in your healthcare professional’s physical examination is manual muscle testing (MMT) where the strength of each of your major muscle groups is assessed and rated. This is done by the provider in their office at a usual visit. You are asked to push or pull muscle groups against the resistance of the examiner.
Some instruments may be used for more precise measurements.
An electromyography (EMG) test is done to establish motor neuron loss. This is performed on any muscle of the body by using a sensor or needle to assess electrical conduction to the muscle by the nerve. Nerve conduction studies (NCS) may or may not be done depending on individual circumstances.
Imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) of the spine can follow progression of PPS.
A muscle biopsy might be done to exclude other diagnoses.
There are no laboratory blood tests used to diagnose PPS.
There is no test that predicts which survivor of polio with affected motor nerves is at risk for PPS.”
Complete article: www.christopherreeve.org/living-with-paralysis/health/causes-of-paralysis/post-polio-syndrome-poliomyelitis