ANN ARBOR, MI - Most Americans think of polio as a thing of the past. Although the disease has largely been eradicated, about one million Americans are polio survivors. For these men and women who contracted the disease through epidemics of the 1930s, 1940s and 1950s, many are experiencing the late effects of their struggle with polio. The University of Michigan's Post-Polio Clinic is studying the way age and gender are effecting this population.

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"Polio survivors are definitely an under-served population," asserts Sunny Roller, a polio survivor.

Roller contracted polio in the early 1950s when she was four, spending nine months in the hospital recovering from the initial phase of the disease, which included extreme paralysis.

"I went through rehabilitation until I was 18 years old. I had to learn to walk all over again and do as many things as I could for myself," she remembers. "I worked really hard. It almost killed me, but I learned how to come back from that disease."

Roller did 'come back,' but in middle age began experiencing new symptoms of pain, fatigue and weakness. Of the people who contracted polio in the United States from the 1930s on, approximately 40 percent of those still living had paralytic polio like Roller. These are the survivors at higher risk for developing late-effect problems, or post-polio syndrome (PPS).

According to Ann Laidlaw, M.D., a physical medicine and rehabilitation specialist at the U-M Health System, to some degree, researchers don't know what's going to happen to polio survivors as they age. This is why there is increasing focus on understanding the process and, consequently, developing the best forms of treatment.

"It is still not clear how many survivors might show the effects of PPS. Depending on the study, it ranges from 25 percent of survivors up to 75 percent," says Laidlaw.

The extent to which polio survivors will suffer from PPS depends on how seriously they were affected by the original polio attack. Patients who had only minimal symptoms from the original attack and subsequently develop PPS will most likely experience only mild PPS symptoms. People originally hit hard by the polio virus, and left with severe residual weakness, may develop a more severe case of PPS. Those who experienced paralytic polio are most susceptible to severe PPS.

Claire Kalpakjian, Ph.D., believes there may be gender differences in how post-polio syndrome affects men and women. Currently she and other experts are conducting a study looking at the impact of menopause on women who are polio survivors, as well as the differences between men and women who experience the syndrome.

"One of the reasons we want to study this is because there are so many changes that go on in a woman's body. One of our particular concerns is osteoporosis for women with disabilities who may not be as physically active. Women who aren't strengthening their bones by exercise or even walking are at higher risk for developing osteoporosis, and that risk increases as they enter menopause. If you factor in post-polio syndrome, these woman will likely have many special needs," Kalpakjian says.

Patients are seeing the benefit of this expanding scientific knowledge. Roller, who is 55, remembers her first experience with PPS and her attempts to find answers. Almost ten years ago, she started going through the gradual stages of menopause, but also the late effects of polio. Over several years, Roller went to five different physicians looking unsuccessfully for answers about the new, debilitating pains she was experiencing, and solutions for how to deal with PPS. Currently, she is a patient at the U-M Post-Polio Clinic.

"I feel I have more control of my situation now. At least we know a little bit more about what to expect and we know help is there. And, I've helped the medical community learn more about managing, alleviating and even sometimes preventing the late effects of polio," she says.

This study is funded by the International Polio Network.

To find out about research taking place at the University of Michigan Health System call 734-936-7052.

Facts about polio:

• Polio is a virus that has been eradicated with a vaccine introduced in the mid 1950s.
  
• The virus was attracted to the neurons in the spinal cord and brain stem.
  
• Symptoms included headache, neck ache, fever, muscle soreness and weakness and, occasionally muscle paralysis and difficulty breathing.
  
• Nearly 2 million Americans were affected by polio in the 1930s, 1940s and 1950s.
  
• Polio is largely eradicated in countries like the United States, where the polio vaccine is widely available. However, polio can still be found in under-developed regions of the world and among children adopted from these areas.

Facts about post-polio syndrome:

• Post-polio syndrome occurs about 20 years after the initial onset of polio. Those who experienced paralytic polio are more susceptible to post-polio syndrome.
  
• Symptoms include muscle fatigue, muscle atrophy, joint pain, difficulty sleeping or swallowing, and weakness in the limb that was affected by polio, and occasionally in a limb that was thought to be unaffected by polio.
  
• Health professionals are still learning about post-polio syndrome and how it affects people, in order to help guide the development of treatment and to focus on the most significant symptoms.
  
• The U-M Post Polio Clinic addresses the needs of those who once had polio, including assessment, physical rehabilitation and education.

For more information, visit the following Web sites:

U-M Post-Polio Clinic
www.med.umich.edu/pmr/clinical.htm#polio

MEDLINEplus: Polio and Post-Polio Syndrome
www.nlm.nih.gov/medlineplus/polioandpostpoliosyndrome.html

Learn more about U-M's role in the history of polio prevention and treatment
http://www.med.umich.edu/medschool/chm/polioexhibit/index.htm

National Institute of Neurological Disorders and Stroke: Post-Polio Syndrome Fact Sheet
www.ninds.nih.gov/health_and_medical/pubs/post-polio.htm

International Polio Network: Polio and Post-Polio Fact Sheet
www.post-polio.org/ipn/fact.html

International Polio Network: Information about the Late Effects of Polio
www.post-polio.org/ipn/aboutlep.html

Written by Mary Beth Reilly

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