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Polio (poliomyelitis)

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Related Terms
  • Abortive poliomyelitis, bulbar polio, bulbospinal polio, Heine-Medin disease, infantile paralysis, nonparalytic poliomyelitis, paralytic poliomyelitis, poliomyelitis, poliovirus, post-polio syndrome, spinal polio, subclinical poliomyelitis, vaccination.

Background
  • Poliomyelitis is a contagious disease caused by infection with the polio virus. The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and spreads throughout the blood and lymph systems. The virus is transmitted by direct person-to-person contact, through contaminated water and food, by contact with infected fluids from the nose or mouth, or by contact with infected feces. This occurs commonly in areas where sanitation is inadequate. People carrying the polio virus can spread the virus for weeks in their feces, even if they do not experience any symptoms. Polio only affects humans.
  • Approximately 95% of polio infections are subclinical infections, which may present with flu-like symptoms or no symptoms at all. The other 5% of cases occur when the virus infects the central nervous system, which may cause temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles, and feet. Complications from prolonged immobility may involve the lungs, kidneys, and heart and may be fatal.
  • Polio has been a health problem throughout recorded history. Between 1840 and the 1950s, polio was a worldwide epidemic, particularly in Europe, North America, Australia, and New Zealand. In 1952, the worst polio epidemic that occurred in the United States affected approximately 58,000 people, mostly children. Children that survived were often paralyzed. According to the World Health Organization (WHO), there are now 10-20 million polio survivors worldwide.
  • The polio vaccine was developed in the 1950s. In the United States, the last case of naturally occurring polio happened in 1979. Organizations including the WHO, the United Nations Children's Fund (UNICEF), and Rotary International are involved in massive vaccination campaigns to eliminate the polio virus. These efforts have reduced the number of annual diagnosed cases by 99%, from 350,000 cases in 1988 to 483 cases In 2001.
  • Today, most people in developed countries are immunized against the polio virus and are not exposed to the disease. Persons that are not immunized, have weak immune systems, and travel to places where polio outbreaks are common are at risk for developing polio.
  • There is no cure for polio. The goal of treatment is to control symptoms and prevent complications. Some forms of polio do not require treatment; however, severe forms may require orthopedic surgery. Common treatments include physical therapy, braces, and corrective shoes.
  • The most effective way to prevent polio infection is vaccination. The polio vaccine is over 90% effective in providing immunity to the polio virus. Most children in developed countries are routinely vaccinated. However, outbreaks still occur in the developed world, usually in groups of people who have not been vaccinated.

Signs and symptoms
  • General:
  • Approximately 95% of polio infections are subclinical infections, which may present with flu-like symptoms or no symptoms at all. The other 5% of cases occur when the virus infects the central nervous system, which may cause temporary or permanent paralysis. Symptoms usually develop within 1-2 weeks after being infected with the virus, although it may take up to one month.
  • Subclinical poliomyelitis:
  • Subclinical poliomyelitis does not involve the central nervous system. Patients with this type of polio recover completely. Patients with subclinical polio infection might not have symptoms, or their symptoms may last 72 hours or less. Symptoms may include sore throat, fever, nausea, vomiting, stomach pain, constipation, diarrhea, weakness, or headache.
  • Poliomyelitis involving the central nervous system:
  • Nonparalytic poliomyelitis: When a polio infection affects the central nervous system, most patients do not suffer paralysis but do experience aseptic meningitis. In these patients, symptoms include headache; neck, back, abdominal, and arm or leg pain; fever; vomiting; weakness; diarrhea; exhaustion; sore throat; muscle stiffness; muscle tenderness and/or spasm; skin rash or lesion with pain; and irritability. After experiencing symptoms for 2-10 days, these patients recover completely.
  • Paralytic poliomyelitis: Less than one percent of polio cases result in paralysis. Symptoms of paralytic polio include high fever, headache, stiffness in the back and neck, muscle pain and weakness, sensitivity to touch, difficulty swallowing, loss of certain reflexes, paresthesia (pins and needles), irritability, drooling, a bloated feeling in the abdomen, breathing difficulty, constipation, difficulty urinating, and flaccid paralysis (loose and floppy limbs), which is often worse on one side of the body than the other. Paralysis generally develops 1-10 days after early symptoms begin, progresses for 2-3 days, and is usually complete by the time the fever breaks.
  • There are three types of paralytic poliomyelitis: spinal, bulbar, and bulbospinal. Spinal polio is the most common form of paralytic poliomyelitis. In this type, the polio virus infects the cells in the spinal cord, which are responsible for the movement of muscles in the chest, trunk, arms, and legs. Without nerve stimulation, these muscles become weak and poorly controlled. They quickly become completely paralyzed, which may be associated with fever and muscle pain. The paralysis may have a different pattern on each side of the body. Depending on the extent of nerve damage, the paralysis may be temporary or permanent. About half of patients with spinal polio recover fully, 25 percent recover with mild disability, and the rest become severely disabled. Spinal polio is rarely fatal.
  • About 2% of cases of paralytic polio are classified as bulbar polio. In this type, the polio virus infects the bulbar region of the brain stem (composed of the cerebellum, medulla, and pons) and destroys nerve cells. When these nerves cannot function, the patient experiences difficulty breathing, speaking, and swallowing. Symptoms of encephalitis, or brain inflammation, may occur, as well as facial weakness, double vision, difficulty chewing, and difficulty breathing, which may lead to respiratory arrest. An inability to swallow may cause suffocation. Pulmonary edema (fluid in the lungs) and shock are also possible, which may cause death.
  • Bulbospinal polio, also called respiratory polio, occurs in about 19% of all paralytic polio cases. This type has both bulbar and spinal symptoms. It can lead to paralysis of the arms and legs and may also affect swallowing and cause heart problems. Patients with bulbospinal polio experience paralysis of the diaphragm, which is necessary for breathing. These patients may not be able to breathe without the assistance of a ventilator.

Diagnosis
  • General: Diagnosis by a health provider may be based on symptoms including neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. Abnormal reflexes and difficulty lifting the head or legs when lying flat on the back may occur. Bodily fluids may be tested for the presence of the polio virus. Sudden onset of paralysis in arms or legs without sensory or cognitive loss may indicate paralytic poliomyelitis. A rare condition with similar symptoms called nonpoliovirus poliomyelitis may result from infections with nonpoliovirus enteroviruses. A differential diagnosis may be made based on additional testing, including antibody testing, a spinal tap, and/or viral cultures.
  • Antibody testing: Blood may be drawn to test for levels of antibodies to the polio virus, which occurs early in the course of infection.
  • Lumbar puncture: A sample of cerebrospinal fluid may be collected by a lumbar puncture (spinal tap) to determine if a patient has a polio infection of the central nervous system.
  • Viral cultures: Samples of throat washings, stools, or cerebrospinal fluid may be taken and tested for the presence of the poliovirus.

Complications
  • General: About 95% of polio cases occur without major symptoms or complications. However, when the infection occurs in the central nervous system, temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles, and feet may occur. Complications from prolonged immobility may involve the lungs, kidneys, and heart and may be fatal.
  • Cardiovascular problems: Patients with polio may develop high blood pressure or myocarditis (inflammation of the heart muscle). A rare complication of polio is cor pulmonale, also called pulmonary heart disease. In cor pulmonale, the right ventricle of the heart becomes enlarged due to increased resistance or high blood pressure in the lungs.
  • Encephalitis: Encephalitis, an inflammation of the brain tissue, occurs rarely in polio patients and is most common in infants. Symptoms include confusion, changes in mental status, headaches, fever, seizures, and spastic paralysis.
  • Lung problems: Patients with certain types of polio experience paralysis of the diaphragm, which is necessary for breathing. The patient may not be able to breathe without the assistance of a ventilator. Death may occur due to aspiration pneumonia (inflammation of lungs and airways due to breathing in a foreign substance), pulmonary edema (fluid in the lungs), or suffocation caused by the inability to swallow. Many of the lung complications may be exacerbated by cardiac problems.
  • Musculoskeletal problems: Some forms of polio may cause restricted movement of arms and legs, skeletal deformities, tightening of the joints, osteoporosis, and increased likelihood of bone fractures. In some cases, the growth of an affected leg is slowed by polio, while the other leg continues to grow normally. This causes one leg to be longer than the other, leading to scoliosis (deformities of the spine). Equinus foot is a foot deformity that develops when the muscles that pull the toes downward are working, but those that pull it upward are not. As a result, the foot drops towards the ground and affected persons cannot walk normally.
  • Paralysis: Paralysis caused by polio infection may be temporary or permanent. In the case of temporary paralysis, nerve impulses return to the paralyzed muscle within a month, and recovery is usually complete in 6-8 months. Paralysis remaining after one year may be permanent.
  • Post-polio syndrome: About 25% of patients who survive paralytic polio in childhood develop post-polio syndrome (PPS), also called post-polio sequelae, usually 30 or more years after their initial disease. Symptoms include weak muscles or joints, extreme fatigue, pain, muscle loss, breathing or swallowing problems, sleep-related breathing disorders (e.g., sleep apnea), decreased tolerance of cold temperatures, and paralysis. It is not clear what causes PPS, but it may be related to inflammation caused by either overuse or disuse of nerve cells previously infected by poliovirus. Patients with PPS are not contagious.
  • Vaccine-associated paralytic poliomyelitis (VAPP): In rare cases, the oral poliovirus vaccine (OPV) may cause paralytic polio. VAPP affects approximately two out of every one million children vaccinated. Many developed countries do not vaccinate with this type of polio vaccine to avoid the risk of VAPP.
  • Other: Other complications that may be associated with certain types of polio infection include kidney stones, urinary tract infections, shock, and paralytic ileus (loss of intestinal function). The use of braces or wheelchairs may cause nerve compression and blood circulation problems caused by the pooling of blood in paralyzed legs.

Treatment
  • General: There is no cure for polio. The goal of treatment is to control symptoms and to prevent complications. Some forms of polio require no treatment. However, severe forms may require orthopedic surgery. Common treatments include physical therapy, braces, and corrective shoes. Antiviral drugs are being studied for effectiveness against poliovirus; however, further research in this area is needed.
  • Antibiotics: Antibiotics are not effective against the polio virus itself but may be prescribed in patients that have coexisting infections, such as a urinary tract infection.
  • Bethanechol: Bethanechol may be used in polio patients who experience urinary retention.
  • Braces or corrective shoes: In cases of paralytic polio, leg braces and corrective shoes may be used to assist in proper walking. Patients who wear braces should also participate in physical therapy to prevent muscle damage associated with a lack of use.
  • Lifestyle changes: Bed rest may be advised for patients with severe forms of polio.
  • Moist heat: The use of heating pads and warm towels may be advised in patients with polio who experience muscle pain and spasms.
  • Nutritional changes: A nutritious diet is critical for patients with polio, to give the body all the resources that it needs to fight off the infection.
  • Painkillers: Painkillers may be given to manage symptoms, including headache, muscle pain, and muscle spasms. Narcotics are usually avoided due to an increased risk of breathing difficulties.
  • Physical therapy: Patients with paralytic polio may benefit from moderate exercise to prevent deformity and loss of muscle function. Swimming may benefit patients who experience pain and muscle weakness.
  • Portable ventilators: Jacket-type negative-pressure ventilators worn over the chest and abdomen assist patients with polio who are not able to breathe unassisted. In some cases, ventilator use may be temporary, although some patients may need to use them for the rest of their lives.
  • Surgery: In severe polio cases, orthopedic surgery may be performed to help recover muscle strength and function.
  • Treatments for post-polio syndrome: Post-polio syndrome may occur decades after a polio infection has run its course. Treatments available for patients with post-polio syndrome include pyridostigmine, immunoglobulin, coenzyme Q10, and physical therapy.

Integrative therapies
  • Note: There is currently no known cure for polio. The integrative therapies listed below may help reduce symptoms associated with a polio infection, such as pain and fatigue. However, these treatments have not been clinically proven to be effective in polio patients.
  • Traditional or theoretical uses lacking sufficient evidence:
  • Acupressure, shiatsu: Acupressure is used around the world for relaxation, wellness promotion, and the treatment of many health problems. Many traditional Asian medical philosophies consider health to be a state of balance in the body that is maintained by the flow of life energy along specific meridians. A disease is believed to occur when the energy flow is too low, too high, or blocked. Acupressure aims to restore normal life energy flow using finger and palm pressure, stretching, massaging, and other bodywork techniques. During acupressure, finger pressure is applied to specific acupoints on the body. It is believed that there are 12 primary channels and eight additional pathways circulating life energy throughout the body, maintaining the balance of "yin" and "yang." According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • With proper training, acupressure appears to be safe if self-administered or administered by an experienced therapist. No serious long-term complications have been reported, according to scientific data. Cases of hand nerve injury, herpes zoster ("shingles"), carotid dissection, and retinal and cerebral artery embolism have been reported after shiatsu massage. Forceful acupressure may cause bruising.
  • Acupuncture: Acupuncture originated 5,000 years ago in China. Today it is commonly used throughout the world. Chinese medicine theory holds that the human body contains a network of energy pathways through which vital energy, called "qi" (also spelled "chi"), circulates. These pathways are called "meridians." The meridians contain specific "points" that function like gates, allowing qi to flow through the body. Needles are inserted into these points to regulate the flow of qi. Illness and symptoms are thought to be caused by problems in the circulation of qi through the meridians. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Needles must be sterile in order to avoid disease transmission. Avoid in patients with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, or neurological disorders, or in those taking anticoagulants (drugs that increase the risk of bleeding). Avoid on areas that have received radiation therapy. Avoid during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics, or those with a history of seizures. Avoid electroacupuncture in those with arrhythmia (irregular heartbeat) or pacemakers.
  • Alexander technique: The Alexander technique is an educational program that teaches movement patterns and postures. The technique is used to improve coordination and balance, reduce tension, relieve pain, alleviate fatigue, improve medical conditions, and promote well-being. Although the Alexander technique is used to treat many medical conditions, including back pain, posture, and balance, there is currently little high-quality scientific evidence available on its efficacy. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • No serious side effects have been reported. It has been suggested that the technique may be less effective in patients with learning disabilities or mental illnesses. The Alexander technique has been used safely in pregnant women.
  • Aromatherapy: Aromatherapy refers to many different therapies that use essential oils. The oils are sprayed in the air, inhaled, or applied to the skin. Essential oils are usually mixed with a "carrier" oil, usually a vegetable oil (like soy, evening primrose, or almond), or alcohol. Massage is often used to deliver oils into the body and is considered the most effective method. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Essential oils should be administered in a carrier oil to avoid toxicity. Avoid in those with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant. Reported side effects include abortion, allergic contact dermatitis, agitation, depression, drowsiness, eye irritation, headache, increased risk of cancer (with long-term use), kidney damage, liver damage, nausea, sensitivity to sunlight, skin rash, and toxic effects on the brain.
  • Biofeedback: Biofeedback is a technique for purportedly helping an individual become conscious of otherwise unconscious body processes. Through conveying information about blood pressure, heart rate, skin temperature, galvanic skin response (sweating), and muscle tension in real time, biofeedback aims to raise awareness and conscious control of the related physiological (natural biological) processes. In essence, biofeedback attempts to use the mind to control the body. According to secondary sources, this therapy may promote relaxation and increase oxygen flow to muscles in polio survivors and in those affected by post-polio syndrome.
  • Although biofeedback is generally considered safe, consult with a qualified healthcare professional before making decisions about new therapies and/or related health conditions. Biofeedback may interfere with the use of some medications, such as insulin. Behavioral modification therapies should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses.
  • Chiropractic: Chiropractic care focuses on how the relationship between musculoskeletal structure (mainly the spine) and bodily function (mainly the nervous system) affects health. Chiropractors use many techniques, including spinal manipulative therapy, diet, exercise, X-rays, and interferential and electrogalvanic muscle stimulation. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Use extra caution during cervical adjustments. Use cautiously with acute arthritis, conditions that cause decreased bone mineralization, brittle bone disease, bone-softening conditions, bleeding disorders, or migraines. Use cautiously with the risk of tumors or cancers. Avoid with symptoms of vertebrobasilar vascular insufficiency (a type of brain circulation problem), aneurysms, unstable spondylolisthesis (a type of spine alignment problem), or arthritis. Avoid with agents that increase the risk of bleeding. Avoid in areas of paraspinal tissue after surgery. Avoid if pregnant or breastfeeding, due to a lack of scientific data. Reported side effects include blood clots in the spine; bone fractures; decreased blood pressure; headache; heart attack; increased risk of stroke; muscle spasms, sprains, or strains: nerve damage; fatigue; stiffness; and death.
  • Craniosacral therapy: Craniosacral therapy is a form of therapeutic manipulation that is designed to enhance the craniosacral system, which is made up of the cranium (skull bones), cerebrospinal fluid (the fluid that flows through the brain and spinal column), the meninges (membranes around the brain and spinal cord), and the sacrum (bones of the lower back). Craniosacral therapy was developed in the 1970s by Dr. John Upledger, based on the theories and principles developed in the early 1900s by Dr. William Sutherland. Dr. Sutherland's idea was that the relationships and motions of the bones in the craniosacral system lay at the core of the body's functioning and vital energy. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Safety data for craniosacral therapy are currently lacking. Craniosacral therapy should not be relied on as the sole treatment for potentially severe conditions, and it should not delay consultation with a qualified healthcare provider. Although the movements of this technique are usually gentle, there may be a small risk of stroke, nervous system damage, bleeding in the head, bulging in the blood vessels of the brain (called intracranial aneurysm), or increased pressure in the brain. Use cautiously in patients with recent head trauma or skull fracture, those with diseases that affect the brain or spinal cord, those with conditions in which a change in pressure in the brain would be dangerous, and in patients with blood-clotting disorders. It has been proposed that craniosacral therapy may interact with agents used for diabetes, epilepsy, or psychiatric disorders, although scientific evidence is lacking. Use cautiously in patients who may drive or operate machinery after craniosacral therapy, due to reports of deep relaxation and light-headedness. Avoid in children younger than two years old. There is not enough evidence to determine if craniosacral therapy is safe during pregnancy or breastfeeding. Side effects may include diarrhea, headache, opisthotonus (muscle spasms in which the head, neck, and spine hyperextend), confusion, dizziness, double vision, loss of consciousness, trigeminal nerve damage, underactive pituitary gland, brain stem dysfunction, seizures, and increased anger. Side effects have been reported in patients with traumatic brain syndrome.
  • Guided imagery: Throughout history, many cultures have used imagery for therapeutic purposes, including the Navajos, ancient Egyptians, Greeks, and Chinese. Religions such as Hinduism and Judaism have also practiced imagery. In modern times, the term "guided imagery" may be used to refer to a number of techniques, including metaphor, story telling, fantasy, game playing, dream interpretation, drawing, visualization, active imagination, or direct suggestion using imagery. Therapeutic guided imagery may be used to help patients relax and focus on images associated with personal issues they are confronting. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified healthcare provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety, or emotional upset, because imagery may trigger these symptoms. In patients feeling unusually anxious while practicing guided imagery, or with a history of trauma or abuse, speaking with a qualified healthcare provider before practicing guided imagery is suggested. In theory, excessive inward focusing may cause preexisting psychological problems or personality disorders to surface.
  • Healing touch: Healing touch (HT) is a combination of hands-on and off-body techniques to influence the flow of energy through a person's biofield. It was developed by Janet Mentgen. HT and the Krieger-Kunz Method of Therapeutic Touch seem to be the most common forms of biofield therapies or energy-based therapy involving the practitioner's use of mental intention and the placement of hands in specific sequences either on the body or above it in the recipient's energy field. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
  • Hydrotherapy: Water has been used medicinally for thousands of years, with traditions rooted in ancient China, Japan, India, Rome, Greece, the Americas, and the Middle East. Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. According to secondary sources, this therapy may ease pain and muscle spasms in polio survivors and in those affected by post-polio syndrome.
  • Sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy should be avoided, particularly with heart disease or lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, or open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician before starting hydrotherapy. Reported side effects include bacterial skin infections (such as with Pseudomonas aeruginosa or Staphylococcus aureus), dermatitis, dehydration, and low blood sodium levels.
  • Hypnotherapy: Hypnosis is a trance-like state in which a person becomes more aware and focused and is more open to suggestion. Hypnotherapy has been used to treat health conditions or to change behaviors. Hypnosis-like practices can be found in ancient Egypt, Babylon, Greece, Persia, Britain, Scandinavia, America, Africa, India, and China. Modern Western hypnotherapy is often traced to the Austrian physician Franz Anton Mesmer. According to secondary sources, this therapy may improve relaxation and pain relief in polio survivors and in those affected by post-polio syndrome.
  • Use cautiously with mental illnesses, such as psychosis, schizophrenia, manic depression, multiple personality disorder, or dissociative disorders. Use cautiously with seizure disorders. Reported side effects include changes in skin temperature, heart rate, intestinal secretions, and immune response; decreased blood pressure and brain wave patterns; disturbing memories; and false memories.
  • Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. It was suggested by ancient Egyptian priests and by Hippocrates in the fourth century BC. The 15th century Swiss physician and alchemist Paracelsus theorized that magnets may be able to attract diseases and leach them from the body. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. According to secondary sources, this therapy may improve pain in polio survivors and in those affected by post-polio syndrome.
  • Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, hepatic artery infusion pumps, or other implanted electrical devices. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions and should not delay the time to diagnosis or treatment with more proven methods. Use of magnets may interact with various medications. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment. Reported side effects include dizziness, nausea, poor wound healing, or bleeding.
  • Massage: Various forms of therapeutic superficial tissue manipulation have been practiced for thousands of years across cultures. Interest in massage surged in the 1970s, particularly in athletes, as a complementary therapy to promote well-being, relaxation, pain reduction, stress relief, musculoskeletal injury healing, and sleep enhancement, and to improve quality of life. A common goal of therapy is to "help the body heal itself." Touch is fundamental to massage therapy and is used by therapists to locate painful or tense areas, to determine how much pressure to apply, and to establish a therapeutic relationship with clients. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Avoid with bleeding disorders or low platelet counts, or if on blood-thinning medications (such as heparin or warfarin (Coumadin®)). Areas where there are fractures, weakened bones from osteoporosis or cancer, open or healing skin wounds, skin infections, recent surgery, or blood clots should not be massaged. Use cautiously if there is a history of physical abuse or if pregnant or breastfeeding. Massage should not be used as a substitute for more proven therapies for medical conditions. Massage should not cause pain to the client. Reported side effects include allergies, bruising, discomfort, fractures, liver hematoma (internal bruising), skin irritation, and swelling of massaged tissues.
  • Meditation: Various forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern philosophical and religious practices. In modern times, numerous meditation types are in use, often outside of their original religious and cultural contexts. A common goal is to attain a state of "thoughtless awareness" of sensations and mental activities occurring at the present moment. Meditation is often popularly perceived as any activity through which a person's attention is focused on a repetitious thought or word. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting a program of meditation and should explore how meditation may or may not fit in with their current treatment plan. Use cautiously in patients with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies and should not be used as the sole approach to illnesses. Reported side effects include anxiety, depression, disorientation, episodes of mania or depersonalization, and seizure.
  • Myofascial release: Myofascial release involves a gentle form of stretching and compression. The therapy, also known as soft tissue mobilization or MFR, releases the uneven tightness in injured fasciae. A fascia is the dense, tough tissue that surrounds and covers the body's organs, muscles, and bones. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Polarity therapy: Energy-based bodywork and education are used to promote energetic and cleansing principles of eating and increased self-awareness. Polarity therapy was initially developed in the 1940s by Randolph Stone. It is commonly used for back pain, chronic headaches, chronic fatigue, digestive complaints, fibromyalgia, osteoarthritis pain, respiratory problems, and stress-related illnesses. Polarity therapy has also been employed to heal postsurgical wounds, to decrease adhesion formation, and to help patients regain range of motion in their muscles and joints after surgery. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Polarity therapy is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. According to the available literature, serious adverse effects have not been reported in association with polarity therapy.
  • Qi gong: Qi gong is an ancient type of traditional Chinese medicine (TCM) that has been used for thousands of years. It is traditionally used for spiritual enlightenment, medical care, and self-defense. Qi gong is meant to be in balance with the environment and has been described as "a way of working with life energy." In TCM, Qi gong is used to treat conditions such as cancer, chronic fatigue syndrome, osteoporosis (bone loss), high blood pressure, stomach ulcers, and asthma. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Qi gong is generally considered to be safe when learned from a qualified instructor and practiced in moderation. In cases of potentially serious medical conditions, Qi gong should not be used in place of more proven therapies. Caution is advised in patients with diabetes, hypoglycemia, bleeding disorders, or low blood pressure, or in patients taking agents for these disorders. Caution is advised in immune-compromised individuals, pregnant or breastfeeding women, patients with preexisting psychoses, or vulnerable individuals without a psychiatric history. Reported side effects include abnormal psychosomatic responses, allergic skin reaction, immune effects, increased risk of bleeding, lower blood sugar levels, lower blood pressure, and mental disorder.
  • Reiki: Reiki is a Buddhist practice that is approximately 2,500 years old. The name "reiki" is derived from two Japanese words: rei meaning "universal spirit" and ki meaning "life energy." Mention of reiki can be found in the Tibetan sutras and in ancient records of cosmology and philosophy. Hichau Mikao Usui, a Japanese physician and Buddhist monk, revitalized the practice of reiki in the 19th Century. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Relaxation therapy: Relaxation techniques include behavioral therapeutic approaches that differ widely in philosophy, methodology, and practice. The primary goal is usually nondirected relaxation. Most techniques share the components of repetitive focus (on a word, sound, prayer phrase, body sensation, or muscular activity), adoption of a passive attitude towards intruding thoughts, and return to the focus. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Avoid with psychiatric disorders such as schizophrenia or psychosis. Jacobson relaxation (flexing specific muscles, holding that position, then relaxing the muscles) should be used cautiously with illnesses such as heart disease, high blood pressure, or musculoskeletal injury. Relaxation therapy is not recommended as the sole treatment approach for potentially serious medical conditions and should not delay the time to diagnosis or treatment with more proven techniques. Reported side effects include autogenic charges (sudden, unexpected emotional experiences including pain, heart palpitations, muscle twitching, crying spells, or increased blood pressure), heightened anxiety, and/or depression.
  • Spiritual healing: The use of spiritual healing can be traced as far back as the New Testament of the Bible. In modern times, a number of therapeutic techniques involve spiritual aspects, and there is overlap between these different approaches. Individuals and organizations involved with spiritual healing may use many different approaches and styles. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions and should not delay the time it takes to consider more proven therapies. When spiritual healing leads to delays in medical treatment, disease symptoms may worsen. Spiritual healing may be unsafe to use in individuals who may be inclined to self-blame or shame if they do not get the desired results from spiritual healing. Spiritual healing techniques appear to be otherwise safe. Many medical traditions include spiritual aspects as a part of their overall approaches to ill patients.
  • Tai chi: Tai chi is a system of movements and positions believed to have been developed in 12th Century China. Tai chi techniques aim to address the body and mind as an interconnected system and are traditionally believed to have mental and physical health benefits, such as improved posture, balance, flexibility, and strength. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome. Ai chi, an aquatic version of tai chi, may be especially beneficial.
  • Avoid with severe osteoporosis or joint problems, acute back pain, sprains, or fractures. Avoid during active infections, right after a meal, or when very tired. Some believe that visualization of energy flow below the waist during menstruation may increase menstrual bleeding. Straining downwards or holding low postures should be avoided during pregnancy and by people with inguinal hernias. Some tai chi practitioners believe that practicing for too long or using too much intention may direct the flow of qi (chi) inappropriately, possibly resulting in physical or emotional illness. Tai chi should not be used as a substitute for more proven therapies for potentially serious conditions. Advancing too quickly while studying tai chi may increase the risk of injury. Reported side effects include chest pain, dizziness, headache, severe pain, shortness of breath, sore muscles, and sprains.
  • Traditional Chinese medicine (TCM): Chinese medicine is a broad term encompassing many different modalities and traditions of healing. They share a common heritage of technique or theory rooted in ancient Chinese philosophy (Taoism), elements of which are believed to date back over 5,000 years. The first recorded use of TCM is said to have been around 2,000 years ago. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Chinese herbs can be potent and may interact with other herbs, foods, or drugs. Using Chinese herbs may further complicate an existing health condition. There have been reports of adverse effects; a qualified healthcare practitioner, including a pharmacist, should be consulted before taking any herbal products. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Aristolochic acid, found in some Chinese herbal remedies, may cause kidney damage. Avoid ginseng if pregnant or breastfeeding.
  • Trager therapy: Trager therapy is a technique that integrates gentle massage and nonstrenuous exercises intended to help the body's muscles relax. Through these methods, Trager therapists work to help their patients achieve a state of body awareness, which is known as "psychophysical integration." Trager therapy emphasizes self-awareness of muscles, joints, and physical postures. The goal of the treatment is to assist patients in changing unconscious habits of posture that cause many of the symptoms they are experiencing. Trager theory is based on the idea that accumulated tension is slowly dissipated as body awareness increases. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Pregnant women, patients who have a history of thromboembolism (blood clots), or patients who have had joint surgery in the previous three months should not receive Trager therapy. Trager therapy is not appropriate for joints that are swollen due to rheumatoid arthritis. Some patients with a history of anxiety or psychological trauma may become anxious as relaxation increases during the session. Patients should communicate these feelings to the Trager practitioner and discuss any psychological history before the session begins. Patients with a history of fatigue or severe muscle tension may feel sore for up to a day after a session. The soreness is thought to be caused by the accumulated tension that has decreased as a result of the therapy.
  • Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a noninvasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. According to secondary sources, this therapy may improve pain in polio survivors and in those affected by post-polio syndrome.
  • Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, such as neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding. Reported side effects include agitation, allergic skin reactions, burns, contact dermatitis, dizziness, edema, headache, hives, increased hair growth, increased heart rate, lung atelectasis (collapse), muscle aches, nausea, pain, paresthesias (abnormal sensations), redness, reduced blood pressure, seizures, skin irritation, unpleasant sensations at and away from the site of TENS, and welts.
  • Trigger point therapy: Trigger point therapy is used by many healthcare practitioners, including medical doctors, osteopaths, chiropractors, and massage therapists, to relieve pain and dysfunction while re-educating the muscles into pain-free habits. Trigger points are discrete, focal, hyperirritable spots located in skeletal muscle. The spots may be painful on compression and associated with referred pain and tenderness, motor dysfunction, and autonomic phenomena. Some common causes of trigger points are sustained injuries, poor posture, and overexertion. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Use cautiously with local or systemic infection, anticoagulation or bleeding disorders, or acute muscle trauma. Avoid aspirin ingestion within three days of injection. Avoid with extreme fear of needles, large bruises, phlebitis, varicose veins, undiagnosed lumps, or open wounds. Avoid if allergic to anesthetic agents (mainly caused by aminoester agents). Use cautiously during pregnancy. Reported side effects include alterations in salivary consistency; cardiac effects that may range from extreme bradycardia and ventricular arrhythmia to refractory cardiac arrest; cutaneous toxicity; fainting; hematomas; hemiplegia; hyperpigmentation; skeletal muscle toxicity; myotoxicity; pneumocephalus; pneumothorax; respiratory depression; soreness; subcutaneous fat atrophy; thinning of the skin; and weakness of the swallowing, speech, and facial muscles.
  • Visualization: Visualization involves the controlled use of mental images for therapeutic purposes. It has been proposed that the use of imagery in visualization may correct unhealthy attitudes or views. People who practice this mind-body technique call on memory and imagination. In some regards, visualization is similar to hypnosis or hypnotherapy. The technique is usually practiced alone. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Visualization is generally regarded as safe in most people, although safety has not been thoroughly studied. In theory, inward focusing may cause preexisting psychological disorders to surface. Use of visualization should not delay the time it takes to see a healthcare provider for potentially severe medical conditions.
  • Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Yoga has been described as "the union of mind, body, and spirit," which addresses physical, mental, intellectual, emotional, and spiritual dimensions for the purpose of an overall harmonious state of being. Healthy individuals with the aim of achieving relaxation, fitness, and a healthy lifestyle often practice yoga. According to secondary sources, this therapy may improve pain and fatigue in polio survivors and in those affected by post-polio syndrome.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Yoga should not be used as a substitute for standard care, especially for potentially dangerous ailments such as asthma. Patients should seek the guidance of a qualified healthcare provider before embarking on any regimen of treatment. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy. Reported side effects (although rare) include blurred vision, death (due to mouth-to-mouth yoga), eye damage, nerve or vertebral disc damage, stroke or blood vessel blockage, worsening of glaucoma, and lung and breathing problems.

Prevention
  • General: The most effective way to prevent polio infection is to be vaccinated. The polio vaccine is over 90% effective in providing immunity to the polio virus. Organizations including the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and Rotary International are involved in massive vaccination campaigns to eliminate the polio virus worldwide. Most children in developed countries are routinely vaccinated. However, outbreaks still occur in the developed world, usually in groups of people who have not been vaccinated. Prevention though vaccination is also necessary for people travelling to a region where polio is common.
  • Improved public sanitation and personal hygiene: The polio virus is transmitted through the feces and body fluids of people that have a polio infection. These people may not experience symptoms but may still be contagious. Improved public sanitation and careful personal hygiene may reduce the spread of poliovirus where there is an outbreak. However, sanitation and personal hygiene do not replace vaccination, or they must be used in conjunction with vaccination.
  • Vaccination: There are two types of polio vaccines: the live, attenuated oral poliovirus vaccine (OPV) and the inactivated poliovirus vaccine (IPV). OPV is widely used in developing countries. Advantages of OPV are that it is cheaper than IPV, that it may be given orally, and that it is easy to administer and transport. The major disadvantage of OPV is that there is a slight risk of vaccine-associated paralytic poliomyelitis (VAPP), caused in rare cases by the inactivated virus in the vaccine reverting to an active form. VAPP affects approximately two out of every one million children vaccinated.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Boyer FC, Tiffreau V, Rapin A, et al. Post-polio syndrome: Pathophysiological hypotheses, diagnosis criteria, drug therapy. Ann Phys Rehabil Med. 2010 Feb;53(1):34-41.
  2. Bruce Aylward R, Sutter RW, Cochi SL, et al. Risk management in a polio-free world. Risk Anal. 2006 Dec;26(6):1441-8.
  3. Chumakov K, Ehrenfeld E, Wimmer E, et al. Vaccination against polio should not be stopped. Nat Rev Microbiol. 2007 Dec;5(12):952-8.
  4. Collett MS, Neyts J, Modlin JF. A case for developing antiviral drugs against polio. Antiviral Res. 2008 Sep;79(3):179-87.
  5. Ehrenfeld E, Modlin J, Chumakov K. Future of polio vaccines. Expert Rev Vaccines. 2009 Jul;8(7):899-905.
  6. Heinsbroek E, Ruitenberg EJ. The global introduction of inactivated polio vaccine can circumvent the oral polio vaccine paradox. Vaccine. 2010 May 14;28(22):3778-83.
  7. National Institutes of Health.
  8. Natural Standard: The Authority on Integrative Medicine.
  9. Obregón R, Chitnis K, Morry C, et al. Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan. Bull World Health Organ. 2009 Aug;87(8):624-30.
  10. Paul Y. Why polio has not been eradicated in India despite many remedial interventions? Vaccine. 2009 Jun 8;27(28):3700-3.
  11. Singh P, Das JK, Dutta PK. Eradicating polio: it's feasibility in near future? J Commun Dis. 2008 Dec;40(4):225-32.
  12. Tiffreau V, Rapin A, Serafi R, et al. Post-polio syndrome and rehabilitation. Ann Phys Rehabil Med. 2010 Feb;53(1):42-50.

Causes
  • General: Poliomyelitis is a disease caused by infection with the polio virus. The virus enters through the mouth and nose, multiplies in the throat and intestinal tract, and spreads through the blood and lymph systems. The virus is transmitted by direct person-to-person contact, by contact with infected fluids from the nose or mouth, or by contact with infected feces. Poliovirus may be transmitted through contaminated water and food or through direct contact with someone infected with the virus. This occurs commonly in areas where sanitation is inadequate. Polio only affects humans. Polio is a highly contagious disease. People carrying the polio virus can spread the virus for weeks in their feces, even if they do not experience any symptoms.
  • Serotypes: A serotype is a slight variation of a bacteria or virus. Three serotypes of poliovirus have been identified. They are poliovirus type 1 (PV1), type 2 (PV2), and type 3 (PV3). All three are extremely contagious and produce the same symptoms. PV1 is the most common. The highest rates of paralysis (one in 200) are associated with PV1, and the lowest rates (one in 2,000) are associated with PV2. Once a person has had polio once, he or she develops immunity against one serotype and will not get it again, although this does not provide protection against other serotypes. The polio vaccine is effective against all three serotypes.
  • Paralytic polio: In less than 1% of polio infections, poliovirus spreads along the central nervous system. The virus multiplies in nerve cells within the central nervous system, which damages the nerve cells, ultimately resulting in paralysis. The molecular mechanisms that cause paralytic polio are unclear.

Risk factors
  • General: Most people in developed countries are immunized against the polio virus and are not exposed to the disease. Persons that are not immunized, those that have a weak immune system, and those that travel to places where polio outbreaks are common are at risk of developing polio. A person with polio is most contagious a week before and a week after his or her symptoms first appear. In some cases, however, a person may remain contagious for up to 17 weeks.
  • Age: Children and the elderly are more at risk of contracting a polio infection. Following adolescence, the likelihood of developing paralytic polio increases with age, as does the extent of paralysis. In children under five years old, paralysis of one leg is most common. In adults, extensive paralysis of the chest and abdomen, also affecting both arms and legs, is more likely.
  • Lack of immunization: Polio vaccinations are available worldwide. Parents that choose not to vaccinate their children against polio put their children at risk of polio infection. Unvaccinated people that are at the greatest risk include those that are in direct contact with patients with poliovirus and researchers that handle laboratory specimens that contain live poliovirus.

Types of the disease
  • Subclinical poliomyelitis:
  • Subclinical poliomyelitis, or abortive poliomyelitis, is an illness that does not involve the central nervous system. Patients with this type of polio recover completely. About 95% of polio infections fall into this category.
  • Poliomyelitis involving the central nervous system:
  • Nonparalytic poliomyelitis: When a polio infection affects the central nervous system, over 99% of polio patients do not suffer paralysis but do experience aseptic meningitis. In these patients, symptoms include headache; neck, back, abdominal, and arm or leg pain; fever; vomiting; weakness; and irritability. After experiencing symptoms for 2-10 days, these patients recover completely.
  • Paralytic poliomyelitis: Less than one percent of polio cases result in paralysis. In these cases, the muscles become weak and poorly controlled, and finally completely paralyzed (called acute flaccid paralysis). Paralytic polio has several types, based on the part of the body that is affected: the spinal cord (called spinal polio), the brainstem (called bulbar polio), or both (called bulbospinal polio).

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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