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July 2005

By Chris Wolski

Lasting Effects

Polio is a word rarely heard today. Aggressive worldwide vaccinations have put the viral disease on the short list for eradication—a goal the World Health Organization (WHO) had hoped to achieve this year. It is not to be, however. A recent outbreak in Indonesia has shown that the debilitating pathogen is unfortunately alive and virulent. In response to its 50 confirmed cases, the Southeast Asian nation has instituted an aggressive inoculation campaign. A disaster has been averted, but the effects of this outbreak will last for decades.

The last major polio outbreak in the United States occurred in 1952 when about 58,000 Americans were infected by the virus, which most commonly causes paralysis. (The Salk vaccine was introduced in 1954, the Sabin in 1962). More than a half century after this last outbreak, it is estimated that there are more than 1 million Americans who had polio. Of these, about half are suffering from postpolio conditions, which can include uneven limb lengths, limps, and breathing and swallowing difficulties. However, other symptoms such as chronic fatigue and musculoskeletal problems have begun to plague this subgroup of Baby Boomers. Unfortunately, the symptoms are often simply attributed to the aging process and not to the consequences of polio.

Part of the problem is that many practicing physicians live in an America in which polio is a “dead” disease, so they have both little knowledge and practically no experience treating it (the last known United States case of polio—which was a reaction to the oral vaccine—was in 1998). As a chronic condition that needs management, postpolio syndrome is among the diagnoses that physical and occupational therapists are most suited to managing.

Here is another opportunity to both help an underserved and misdiagnosed patient population and make the discipline of physical medicine an invaluable tool in the medical arsenal.

It is not an exaggeration to say that the physical therapist who cannot only assist a physician and a patient in determining whether a postpolio condition exists, but also help in managing it, is worth their weight in gold.

Like physicians, physical and occupational therapists have had little classroom time on polio and its effects. But there are resources available to help them get up to speed. The APTA has established postpolio management guidelines, and organizations, like Post-Polio Health International (post-polio.org), can also help with information.

With the almost daily news articles about the health concerns of the aging Baby Boomer population, it is in every clinician’s best interest to stay abreast of any and all medical conditions affecting their parents and grandparents’ generation.

The better a therapist can serve their patient base—whether they have one or 100 postpolio patients—the better clinician that therapist will become. And, in the end, serving the patient by being the best is what medicine is all about.

—Chris Wolski

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