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Natasha Zouaoui

Period 3
10-22-16
Polio Research Paper
The senior project includes attending the polio support group and interviewing
people that have polio. With their consent it will include their stories of how they
overcame the struggles they had to deal with in their life. These interviews will be
recorded, edited together, and posted on youtube. The main focus of this project is to
talk about how polio affects someones daily life and how post polio syndrome affects
people physically, psychologically, and socially. Polio is very rare in the United States
and it is not that well known. With this project, it will accomplish raising awareness of
this disease. Polio is very interesting and it will help people understand other peoples
perspectives with this disease. Another main goal for this project is to bring more
knowledge, understanding, and share the stories of such strong people and open
peoples eyes to become more appreciative of what they have.

Poliomyelitis is a neuromuscular disease also known as infantile paralysis which is


caused by the poliovirus. The infection occurs by fecal or oral contamination. The virus
replicates in the gastrointestinal tract and is carried by the blood throughout the body. In
1%-2% of the infections, the poliovirus invades the nerve cells of the spinal cord. The

muscles connected to the damaged or destroyed nerve cells can no longer properly
function, resulting in weakness or paralysis of the limbs, as well as the muscles
controlling speech, swallowing, and breathing. Polio dates back to at least 1350 BC.
Major epidemics occurred in Stockholm, Sweden in 1887, 1905, and 1911. It also
occurred in the United States in 1894. In 1916, the great New York epidemic killed 6,000
people and left 27,000 disabled. In 1991, the last case of polio was reported in Latin
America and the Caribbean. The largest number of cases ever reported in the United
States was over 58,000 in 1952 (International Polio Network). Although endemic polio
transmission is now geographically restricted, wild poliovirus importations have
continued to paralyse children in polio-free areas. Between 1999 and mid-2003, a total
of 12 importations were detected with over 70 children paralysed in Africa, Asia, Europe,
and the Western Pacific. In the first nine months of 2003 alone, the virus from the
northern Nigeria reservoir reinfected Burkina Faso, Chad, Ghana, Togo and part of
Niger. Polio-free states were also affected within Nigeria such as Lagos, requiring an
international immunization response (Global Polio Eradication Initiative, and World
Health Organization).

No disease struck as much attention or terror as polio. Polio hit with no warning or
any way of telling who would get it and who would be spared. It killed some of its victims
and left others in wheelchairs, crutches, leg braces, breathing devices, and deformed

limbs (Oshinsky 5). At its worst, polio causes irreversible paralysis which most often
occurs in the legs. The majority of deaths occurred when the breathing muscles were
immobilized, a condition known as bulbar polio, in which the brain stem is badly
damaged (Oshinsky 9). Other major symptoms includes inordinate fatigue, new muscle
weakness with or without loss of muscle bulk, and muscle pain with possible muscle
twitching. Other symptoms include sleeping problems, breathing difficulties, decreased
ability to tolerate cold temperatures, joint pain, and a big decline in the ability to carry
out normal activities (International Polio Network). More than 50% of the individuals
with polio had pain every day, mostly during physical activity. The mean VAS score for
daily pain intensity was 55mm, range 0 to 93mm. In the lower limbs, their cramping
pain was the most common pain characteristic in polio-affected limbs. In the upper limbs
and in the trunk, aching pain was the most common pain characteristic, especially in the
polio-affected areas (Willn and Grimby).

Post-polio syndrome is a condition that affects polio survivors years after recovery
from an initial acute attack of the poliomyelitis virus. Most often, polio survivors start to
experience gradual new weakening in muscles that were previously affected by the
polio infection and also in muscles that were unaffected by the virus. The most common
symptoms include slowly progressive muscle weakness, fatigue, and a gradual
decrease in the size of muscles. It is also common to have pain from joint degeneration

and increasing skeletal deformities such as scoliosis from the weakness and muscle
weakness and atrophy. Post polio syndrome is a slowly progressive phenomenon with
periods of stability that vary from 3 to 10 years. Current evidence indicates that it is the
evolution of a subclinically ongoing motor neuron dysfunction that begins after the time
of the acute polio (Dalakas). Post polio syndrome can interfere significantly with the
individuals ability to function independently. For instance, respiratory muscle weakness
can result in trouble with proper breathing, affecting daytime functions and sleep.
Weakness in swallowing muscles leads to pneumonia (Post-Polio Syndrome Fact
Sheet). The difficulty is usually high in the throat or below the throat. The polio virus
damages the bulbar neurons that control the vagus nerve, which activates and
coordinates muscles from your throat down to your stomach (Bruno). The cause of post
polio syndrome appears to be related to the degeneration of individual nerve terminals
in the motor units. A motor unit is formed by a nerve cell in the spinal cord or brain stem
and the muscle fibers it activates. The polio virus attacks specific neurons in the
brainstem and spinal cord. In an effort to compensate for the loss of these motor
neurons, surviving cells sprout new nerve-end terminals and connect with other muscle
fibers. Years of high use of these recovered but overly extended motor units adds more
stress to the motor neurons, which over time loses the ability to maintain increased work
demands. This results in the slow deterioration of the neurons, which leads to loss of
muscle strength. Restoration of nerve function may occur in some fibers a second time,

but eventually nerve terminals malfunction and permanent weakness occurs. This
explains why it occurs after a delay and has a slow and progressive course. Physicians
look for motor neuron loss, partial or complete recovery from the effects of paralytic
poliomyelitis, decreased endurance, and neuromuscular, medical, and skeletal
abnormalities when diagnosing post polio syndrome (Post-Polio Syndrome Fact Sheet).

From a psychological perspective, post polio can be negative, as reflected in distress


and depression (Kemp and Krause). Polio survivors are also highly stressed, since their
Type A personality score was 18 points higher than in non-disabled controls.
Psychological stress can also cause muscle weakness. Motor neurons in the spinal
cord that survived the original polio infection have been overworking so they are
metabolically vulnerable. The release of cortisol during psychological stress in polio
survivors could cause the motor neurons to function poorly and produce muscle
weakness and fatigue (Frick). Polioencephalitis induced damage to the hypothalamus
may psychologically predispose people who had polio to develop the hard-driving,
highly stressed Type A Personality. It also damages other brain areas, such as the
periaqueductal gray. This damage may decrease the production of endorphins and
explains why people with polio are twice as sensitive to pain. Polio survivors feel
inflammatory musculoskeletal pain, back pain, arthritis in wrists, small sensory nerve
endings around hips, flu like muscle pain, and emotional pain (Green). Socially, patients

with polio feel the loneliest resulting in poorer self esteem. They have a behavior and
sensitivity to criticism and failure, leading them to feel bad about themselves. Using
crutches or a wheelchair makes them feel like they are painting a bulls-eye on their
chest and it makes them feel different and get abused for being disabled (Bruno).

Polio struck without warning and was able to cripple or kill its victims within hours.
Poliomyelitis deserves its reputation as one of the worlds most feared diseases. At its
peak, polio has paralyzed and killed over half a million victims every year in almost
every country on earth. There is no cure for polio and it gets worse overtime. For most
of our history, we have been completely defenceless against it. Stuck with the pain and
hardships, polio victims should be recognized and commemorated for what they have
been through.

Works Cited
Bruno, Richard Louis. "Post-Polio Research: The State of the Art, 1998." (1998): n. pag.
Web. 6 Oct. 2016.
Dalakas, Marinos C. "The postpolio syndrome as an evolved clinical entity." Annals of
the New York Academy of Sciences 753.1 (1995): 68-80.
Frick, Bruno. "Polioencephalitis: Explaining Post-Polio Fatigue and Pain." Kessler
Institute For Rehabilitation, Inc. (1989): n. pag. Proceedings of the Society of
Behavorial Medicine. Web. 6 Oct. 2016.
Global Polio Eradication Initiative, and World Health Organization. "Global polio

eradication initiative: strategic plan 2004-2008." (2003).


Green, Caroleanne. "Polioencephalitis: Explaining Post-Polio Fatigue, Type A Behavior
& Pain." National Polio Care Advocates (n.d.): n. pag. Web. 6 Oct. 2016.
J. Kemp, Bryan, and J. Stuart Krause. "Depression and life satisfaction among people
ageing with post-polio and spinal cord injury." Disability and Rehabilitation 21.5-6
(1999): 241-249.
Oshinsky, David M. "Polio: an American story." (2005).
"Polio & Post-Polio Fact Sheet." International Polio Network, n.d. Web. 5 Oct. 2016.
<http://www.post-polio.org/>.
"Post-Polio Syndrome Fact Sheet." U.S National Library of Medicine. U.S. National
Library of Medicine, n.d. Web. 06 Oct. 2016.
<http://www.ninds.nih.gov/disorders/post_polio/detail_post_polio.htm>.
Willn, Carin, and Gunnar Grimby. "Pain, physical activity, and disability in individuals
with late effects of polio." Archives of physical medicine and rehabilitation 79.8
(1998): 915-919.