HISTORY OF POLIO

Polio was a highly infections viral infection that Paralysed or killed 500,000+/yr during the mid 1900’s.  Thanks to the Global Polio Eradication Initiative1988 only type 1 wild poliovirus is still circulating in 3 countries - Nigeria Pakistan and Afghanistan of which there has been 21 wild cases of Polio in 2016 to date (Oct 2016)

The Poliomyelitis virus was highly infectious iinitially causing fever, vomiting and muscle stiffness.

In 1-2% the virus crosses into bloodstream and attacks CNS (spinal fluid, cord, brain) it may then destroy the motor neurons at the anterior horn cells which activate muscles.

Clinical paralysis only occurs when 50%or more motor neurons are killed or damaged

As a result of the polio virus the muscle may develop Myofibre hypertrophy , and a Muscle fibre type transformation occurs from a loss of Type II    (used for producing power  when doing activities such as stand, run, stairs) to Type I      (used for endurance activites such as walking)

As a result of ongoing denervation and re-innervation weak muscles are used at a higher capacity and thus become overloaded, there is also a substitution of strong muscles (with increased energy expenditure for the tasks) rendering them inefficient and the polio body (paralytic) relies on ligaments for stability – compensation.

POLIO IN New Zealand

NZ Since 1962 there have been 7 cases (last in 1998)

Recent epidemiological studies have calculated that there are over 9000 people with Polio living in NZ

Polio terminology has evolved to include

Late effects of Polio - LEOP

Post Polio Syndrome - PPS

Post Polio Muscular Atrophy - PPMA

LEOP it is the definition of late effects of disability due to Polio virus  where there is  weak/imbalanced musculature and as a result cchronic neuro muscular dysfunction resulting in orthopaedic & MSK issues the normal effects of aging are acceleration by polio effects

Many present to healthcare services when there is a failure to maintain function such as new weakness and increased fatigue as they reach a physical tipping point.  Due to ppsychosocial barriers/denial they are often late to present issues and due to the presentation in the 2nd half of life – other injury/illnesses need to be excluded.  The fact that mmisdiagnosis is common supports more awareness as damage can be caused with incorrect treatment choice

POST POLIO SYNDROME is a sub-category of LEOP It is NOT a re-emergence of virus and there is No way to predict who will progress to PPS

PPS is a constellation of symptoms including increased weakness and atrophy, abnormal mm fatigability long after initial infection

Research suggests that there is an increased risk of developing PPS for those who were most severely affected by the initial polio infection and if they were adolescent or adult when contracted, also those who made a greater recovery. Another suggestion is that if a person livin with the LEOP exercising to the point of exhaustion or fatigue may overwork already stressed-out motor neurons and increase risk of post-polio syndrome developing.

It is important to consider that AGEING IN POLIO is accelerated

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