15.12.1 Introduction
(i) Poliomyelitis is a disease caused by a virus. Whilst the disease has been virtually eliminated from most developed countries by immunisation, it still occasionally occurs in people who have not been immunised. The vast majority of those infected with poliomyelitis have no apparent symptoms at all and recovery is complete. However a minority develop paralytic poliomyelitis. Most of those who have needs resulting from poliomyelitis will have been infected many years ago, and their problems will have been complicated by the natural ageing process.
(ii) The paralytic form of the disease leads to asymmetric (uneven) paralysis without loss of sensation. The paralysis may affect only a few muscle groups or alternatively many. About half of those with paralysis will recover completely, but the remainder will have residual long term disability ranging from mild to severe. Regular physiotherapy and a regime of personal management will reduce long term deterioration.
(iii) Later in life, as ageing results in nerve cell loss, there may be a slow deterioration as the original problems resulting from poliomyelitis are aggravated by the normal ageing process. Muscle wasting may increase and, for example, walking may become impossible. Lung capacity may decrease, and in extreme cases lead to a requirement for breathing assistance during the day or throughout the night.
(iv) In those who have had paralytic poliomyelitis, the daily living and mobility problems are caused by secondary impairments as well as the paralysis itself. Asymmetric growth, particularly when the disease has been contracted in childhood, may cause problems; spinal deformities may occur if the trunk muscles are affected asymmetrically, possibly resulting in poor balance when sitting and reduced lung capacity; contractures of joints may occur from prolonged poor positioning; arthritis may develop as a result of abnormal strain on joints unaffected by the condition; poor circulation and loss of muscle bulk can result in extreme coldness of limbs, which may not be helped by the wearing of extra clothing as this may further reduce movement; obesity may develop through loss of the ability to exercise.
15.12.2 Care Needs and Mobility Considerations
(i) The care and mobility needs resulting from paralysis are described in Chapter 5.
(ii) The care and mobility needs resulting from disabilities due to the secondary impairments will vary considerably, depending on the impairments a person has and the extent to which they have developed. Cases need to be treated individually, although guidance may be found for arthritis in Chapter 6 and some of the details on spinal injury in Chapter 18 may be relevant.
15.12.3 Duration of Needs
Once established, the paralysis is permanent. In the first year following onset, the person may learn new ways of accomplishing tasks, thus increasing independence. The level of independence attained may then be maintained for many years. Thereafter, it is likely that needs will increase with age in those who have established paralytic poliomyelitis.
15.12.4 Further Evidence
If there is difficulty in deciding the degree of a person's disability and the amount of attention or supervision required, a report from a GP or an examining medical practitioner (EMP) should be obtained.