The Polio Echo

By Janice Castro.

Rosalind Ragans can still remember the contagion ward in a New York City hospital where she spent three months as a victim of the 1944 polio epidemic. Of the nearly 600,000 Americans who were infected by the poliomyelitis virus in this century before the development of vaccines for the disease in the 1950s, about 10% died, while many of the survivors, like Ragans, suffered some degree of paralysis. Stricken at age eleven, she was at first confined to a wheelchair, but gradually recovered enough to lead a normal life. Her slight difficulty in walking and partly paralyzed right arm did not prevent her successful career as an art instructor and painter.

Then, about ten years ago, she noticed that the pain and weakness she had endured as a polio victim were returning. Says she: "My right arm was hanging by my side. I began to get frightened." Seeking help, Ragans visited the Roosevelt Warm Springs Institute for Rehabilitation in Georgia, named for perhaps the most famous polio victim, President Franklin D. Roosevelt. There doctors finally diagnosed her problem: post-poliomyelitis muscular atrophy, an affliction that strikes many former polio patients with symptoms that in some ways mimic the original disease. Across the U.S., PPMA is affecting more and more of the 300,000 American survivors of the great polio epidemics. People who decades ago recovered enough to abandon their crutches, wheelchairs, braces and respirators are now becoming dependent on them again.

Still, because only a handful of Americans now contract polio every year, most doctors practicing in the U.S. have never seen a case. Says Dr. Jacquelin Perry, chief of pathokinesiology at Rancho Los Amigos Medical Center in Downey, Calif.: "No one anticipated this. It has taken us by surprise."

Polio paralyzes its victims by killing off the spinal cord's motor-nerve cells, which control various muscles. In some cases, when muscles in the chest become too weak to function properly, polio victims need mechanical assistance simply to breathe. Though many of the polio victims who survive are left partly paralyzed, they often make dramatic progress. Muscles that had fallen slack begin to work again when healthy nerve cells sprout new connecting fibers and take over the work of cells ravaged by polio.

For polio survivors, it is particularly disheartening, years after recovering, to find that again they cannot climb stairs or even comb their ! hair. Until recently, doctors frequently thought that these postpolio victims were imagining their problems. But as more people began to experience the same crippling aftereffects, it became apparent that PPMA was a physical disorder common to approximately 15% to 20% of former polio patients.

At first, doctors suspected that the polio virus had somehow remained latent in PPMA victims, only to be reactivated. But unlike polio, PPMA is never fatal, and it progresses far more slowly than the original disease. That would seem to rule out the polio virus as the culprit. A more likely cause may be the toll taken on healthy nerve cells by years of overcompensating for those destroyed by the disease. Many polio survivors, says Perry, "are functioning at 50% of their muscle strength most of the time, whereas healthy people stay under 20%." For this reason, the nerve cells of post-polio patients are subjected to extraordinary strain.

In rehabilitation clinics like the Roosevelt Institute, PPMA patients are learning how to cope with their recurring symptoms. Many are able to continue most of their ordinary activities with the help of lightweight braces and portable respirators. Institute doctors also recommend that they simply rest more, which enables them to conserve the energy to carry on. This prescription is alien to most of the patients. "Polio survivors are very strong people," says Frederick Maynard, director of the post-polio clinic at the University of Michigan Medical Center in Ann Arbor. "It goes against their whole approach to life to suddenly take the easy way out." But once they do, he says, "they often feel much better."

With reporting by Cheryl Crooks/Los Angeles and Joyce Leviton/Atlanta )