Post-Polio Syndrome: Issues and Strategies for Rehabilitation Counselors. (Post-Polio Syndrome)

Vocational planning with persons who have chronic health conditions is a complex process and creates many unique challenges for rehabilitation professionals. Finding and maintaining employment is often a considerable task for people experiencing unpredictable symptoms and progressive limitations.. A counselor's knowledge and understanding of the individual's chronic illness is critical to promoting successful vocational assessment and placement. Many counselors may lack information about Post-Polio Syndrome due to limited rehabilitation information about the disorder (e.g., see Eisenberg, Glueckauf, & Zaretsky, 1999; Falvo, 1991; Livneh & Antonak, 1997). Following the successful vaccines developed in the 1950s to immunize individuals from polio, it has been regarded by most people as a disease of the past (Halstead, 1998; Perry, Barnes, & Gronley, 1988). In addition, many persons who were originally diagnosed with polio prior to that decade believed that their major challenges with the illness were behind them. Unfortunately, many of these individuals are facing secondary disabilities stemming from their earlier polio ordeal and are now experiencing a reoccurrence of old symptoms as well as the development of new problems and functional limitations. It has been estimated that nearly one-half of the 1.63 million Americans who were diagnosed with polio are now reporting new and unexpected problems (Bruno & Frick, 1991; Halstead, 1998). Despite the growing numbers of persons being affected, little literature for rehabilitation is currently available. Consequently, the purpose of this articles is to review the medical, psychosocial, and vocational aspects of post-polio syndrome. In addition, recommendations are offered for rehabilitation practice and research concerning vocational planning and counseling. Medical Aspects Although polio has been a known disorder for hundreds of years, the first epidemic was reported in Europe and North America in the mid to late 1800s (Jubelt & Drucker, 1999). Subsequent epidemics occurred which caused disability and death for thousands of people (Halstead, 1998). From their literature review, Jubelt and Drucker report that the poliovirus infection is characterized by flu-like symptoms which include nausea, cramps, pain, fever, and headache. More significant symptoms appear 1-3 days after these minor symptoms, including paralytic polio and meningitis. The poliovirus infects the spinal cord anterior horn cells and other motor neuron cells. Within a few weeks, recovery of either partial or full abilities typically occurs. During the 1980s, persons who had survived polio began to note new symptoms and unexpected problems related to fatigue and muscle weakness. These symptoms have been identified as post-polio syndrome. Although the reporting of such problems was not new, it took both the medical profession and those with the disease by surprise (Bruno & Frick, 1991; Jubelt & Drucker, 1999). While it is not clear what exactly causes post-polio problems, physicians believe that it is not a reactivation of the original virus. Rather as Frick and Bruno (1986) report, there are several hypotheses regarding the cause of the new symptoms. One hypothesis is that the reduction of the number of anterior horn cells at the initial onset of the poliovirus is a factor. Subsequently, the normal aging process further reduces the remaining anterior horn cells so that those remaining are no longer able to overcome the deficits created originally by the virus. This reduction of anterior horn cells has resulted in decreased functioning across several areas including stamina and strength. A second explanation centers on the idea that overuse and fatigue of originally weakened muscles has contributed to the current difficulties. With the uncertainty surrounding the cause and relative lack of knowledge about this disorder, persons who have post-polio syndrome may experience frustration and fear as they begin to address their symptoms. …