Functional manual muscle testing is a necessary part of diagnostic procedures in the field of neuromuscular disorders. They were essential tools in the early evaluation of polio patients. The muscle weakness model allowed the examiner to determine the type and location of a neuromuscular injury. Specific muscle weakness helped indicate which spinal motor neurons were involved. Although polio has been eradicated in most of the world, it is still endemic in some countries and poses a serious health threat. In 2003, a polio epidemic in Nigeria spread to neighboring countries, putting 15 million children at risk. In the first six months of 2004, five times more children in Central and West Africa were paralyzed by polio than in the same period in 2003. The emergence of West Nile virus (WNV) in the Western Hemisphere is also of great concern. . According to the Centers for Disease Control and Prevention, 9006 cases of WNV infection were reported in 2003. This was more than double the 4,156 cases reported in 2002. West Nile virus can cause a polio-like syndrome of muscle weakness and paralysis, because it attacks the same motor cells in the spinal cord that are attacked by polio. Richard Bruno states that "nearly 1% of people affected by WNV have paralysis, almost the same percentage as those affected by the polio virus".


Although most doctors in the United States have never seen neuromuscular weakness and paralysis acute poliomyelitis, many of them are now dealing with former polio patients experiencing new muscle weakness, pain, fatigue and decreased stamina. Known as post-polio syndrome (PPS), these polio side effects can occur 10 to 40 years after the initial attack (38). "The World Health Organization estimates that between 10 and 20 million polio survivors are alive worldwide and some estimates suggest that between 4 and 8 million of them can obtain PPS "(39). Nearly 2 million Americans alive today had polio 50 years ago. Estimates vary, but up to 50% of these people may have PPS. Many of these former patients had regained good strength and mobility and considered themselves cured. The recurrence of old weaknesses and the emergence of new weaknesses can be extremely challenging and difficult, both psychologically and physically, for the patient. Many people who had felt they had overcome the disease when they were able to get rid of braces, supports, canes and wheelchairs are now told that these same aids may again be needed to protect and preserve existing strength. However, unlike previous treatments, the goal may no longer be to regain muscle strength. Instead, the weakness associated with PPS is often the result of overuse and long-term muscle replacement. To restore muscle balance and preserve strength, treatment usually involves some limitation or reduction in activity and the use of protective aids.


The diagnosis of PPS is established by excluding other neuromuscular disorders. People who had polio For many years it can present a wide variety of symptoms. This constellation of symptoms can mimic or overlap with those of other disorders, such as multiple sclerosis, amyotrophic lateral sclerosis, Gullain-BarrĂ© syndrome, fibromyalgia and osteoarthritis. Lauro Halstead, MD, believes the new weakness is the hallmark symptom of PPS. When new weakness appears in muscles previously affected by polio and / or in muscles that were thought not to be affected originally, it may or may not be accompanied by other symptoms. This is a crucial point to recognize: a patient may have PPS even if the only symptom is a new weakness. There is some controversy regarding the exact role and value of manual muscle testing in evaluating patients with PPS. The debate centers on the argument that such a test only measures strength at the time of the test, while the problem for patients may not be so much a loss of strength, but a loss of the ability to maintain strength after exercise or strength. effort. There is increased muscle fatigue, leading to more frequent episodes of gradual progressive weakness or weakness.

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