Post-polio syndrome (PPS, or post-poliomyelitis syndrome or post-polio sequelae) is a condition that affects approximately 25–50% of people who previously contracted poliomyelitis—a viral infection of the nervous system—after the initial infection. It is considered a “new” condition as opposed to a relapse or return of polio. Typically the symptoms appear 15–30 years after recovery from the original paralytic attack, at an age of 35 to 60. Symptoms include acute or increased muscular weakness, pain in the muscles, and fatigue. The same symptoms may also occur years after a non-paralytic polio (NPP) infection. Less commonly, survivors may have new sleep/breathing/swallowing problems and some survivors also may experience muscle atrophy or muscle wasting.
B. General Information
Polio was once one of the most feared diseases in America, responsible for paralysis and death. Shortly after polio reached its peak in the early 1950s, the inactivated polio vaccine was introduced and greatly reduced polio’s spread. Today, few people in developed countries contract paralytic polio, thanks to the vaccine. But, according to some studies, up to almost half the people who had polio at a young age may experience certain effects of the disease many years later — post-polio syndrome.
The criteria for diagnosing post-polio syndrome have evolved over the last 20 years. The United States National Institute of Neurological Disorders and Stroke (NINDS) lists the following for a diagnosis of post-polio syndrome:
- Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neuromuscular examination, and signs of nerve damage on electromyography (EMG). Rarely, people have subclinical paralytic polio, described as a loss of motor neurons during acute polio, but with no obvious deficit. Prior polio must be confirmed with an EMG because a reported history of non-paralytic polio may be inaccurate.
- A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neuromuscular function.
- Gradual onset of progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. The onset may follow trauma, surgery, or a period of inactivity, and can appear to be sudden. Symptoms also can include new problems with breathing or swallowing.
- Symptoms that persist for at least a year.
Although exact numbers are not available, it has been estimated that there are 300,000 polio survivors in the United States and that one-fourth to one-half of them may ultimately develop some degree of post-polio syndrome.
C. Social Security Administration — SSA-POMS: DI 245880.010 – Evaluation of post-polio
The listing criteria under Social Security Medical Listing 11.11 – Anterior Poliomyelitis, may be applied both to cases of static polio (where there has been no reported worsening after initial recovery) and to cases presenting with postpolio sequelae. All documented postpolio sequelae must be considered, either alone or in combination, to determine whether the medical criteria of listing 11.11, or any other listing, have been met or equaled. If the impairment is not found to meet or equal a listed impairment, the impact of the impairment and related symptoms must be evaluated by determining your residual function capacity. Your impairment(s) will then be evaluated under the Five-Step Sequential Evaluation Process
Most post-polio sequelae are stable or slowly progressing disorders. The medical evidence should support an expected duration of at least 12 or more months. However, to evaluate under the provisions of Social Security Medical listing 11.11, your impairment must involve:
A. Persistent difficulty with swallowing or breathing; or
B. Unintelligible speech; or
C. Significant and persistent disorganization of motor function in two extremities, resulting in sustained disturbance of gross and dexterous movements, or gait and station. Persistent disorganization of motor function can be in the form of paresis or paralysis, tremor or other involuntary movements, ataxia and sensory disturbances (any or all of which may be due to cerebral, cerebellar, brain stem, spinal cord, or peripheral nerve dysfunction), which occur singly or in various combinations. The assessment of impairment depends on the degree of interference with your locomotion and/or interference with the use of your fingers, hands and arms.
Your representative can help you determine whether your post-polio syndrome is severe enough for you to qualify for disability benefits under the Social Security Administration.