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# JAN’S ACCOMMODATION FACT SHEET SERIES

**Job Accommodations for People with**

**Post-Polio Syndrome (PPS)**

Polio (poliomyelitis) is a disorder caused by a viral infection (poliovirus) that can affect the whole body, including muscles and nerves. Severe cases may cause permanent paralysis or death. Polio occurs worldwide; however, no cases of polio have been reported in the United States in recent years (the last case of non-vaccine related polio acquired in the United States was in 1979).

The following background information is from the National Institute of Neurological Disorders and Stroke (NINDS):

**What is post-polio syndrome?**

PPS is a condition that affects polio survivors anywhere from 10 to 40 years after recovery from an initial paralytic attack of the poliomyelitis virus. PPS is characterized by a further weakening of muscles that were previously affected by the polio infection. Symptoms include fatigue, slowly progressive muscle weakness and, at times, muscular atrophy. Joint pain and increasing skeletal deformities such as scoliosis are common. Some patients experience only minor symptoms, while others develop spinal muscular atrophy, and very rarely, what appears to be, but is not, a form of amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. PPS is rarely life-threatening. 

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, who were left with severe residual weakness, may develop a more severe case of PPS with a greater loss of muscle function, difficulty in swallowing, and more periods of fatigue.

People who are polio survivors often ask if there is a way to prevent PPS. Presently, no prevention has been found. But doctors recommend that polio survivors follow standard healthy lifestyle practices: consuming a well-balanced diet, exercising in moderation, and visiting a doctor regularly.

**What causes PPS?**

PPS is caused by the death of individual nerve terminals in the motor units that remain after the initial attack of polio. This deterioration of individual nerve terminals might be an outcome of the recovery process from the acute polio attack. During this recovery process, in an effort to compensate for the loss of nerve cells (neurons), surviving motor neurons sprout new endings to restore function to muscles. This results in large motor units that may add stress to the neuronal cell body. As a result of this rejuvenation, the individual may have normal-functioning muscles for some time. But after a number of years, the motor neurons with excessive sprouting may not be able to maintain the metabolic demands of all their new sprouts, and a slow deterioration of the individual terminals may result. 

Restoration of nerve function may occur in some fibers a second time, but eventually nerve terminals are destroyed and permanent weakness occurs. This hypothesis is consistent with PPS's slow, stepwise, unpredictable course. Through years of studies, scientists at the NINDS have shown that PPS is a very slowly progressing condition marked by long periods of stability.

**How common is PPS?**

More than 300,000 polio survivors in the United States may be at risk for PPS. Doctors are unable to establish a firm incidence rate, but they estimate that the condition affects 25 percent to 50 percent of these survivors, or possibly more depending on how the disorder is defined.

The following is a quick overview of some of the job accommodations that might be useful for people with PPS.  For a more in depth discussion, access JAN's publications at http://askjan.org/media/atoz.htm.  To discuss an accommodation situation with a consultant, contact JAN directly.

**Activities of Daily Living:**

· Allow use of a personal attendant at work

· Allow use of a service animal at work

· Make sure the facility is accessible

· Move workstation closer to the restroom

· Allow longer breaks

· Refer to appropriate community services 

**Fatigue/Weakness:**

· Reduce or eliminate physical exertion and workplace stress 

· Schedule periodic rest breaks away from the workstation

· Allow a flexible work schedule and flexible use of leave time and work from home

· Implement ergonomic workstation design

· Provide a scooter or other mobility aid if walking cannot be reduced

**Gross Motor Impairment:**

*Work-site Accessibility*

· Provide parking close to the work-site and/or an accessible entrance

· Install automatic door openers

· Provide an accessible restroom and break room

· Provide an accessible route of travel to other work areas 

*Workstation Accessibility*

· Adjust desk height if wheelchair or scooter is used

· Make sure materials and equipment are within reach range

· Move workstation close to other work areas, office equipment, and break rooms

**Resources Specifically for People with Post-Polio Syndrome**

**Atlanta Post-Polio Association**

P.O. Box 250566

Atlanta, GA 30325

Direct: (404)350-7631

http://www.atlantapostpolio.com

**Gazette International Network Institute**

4207 Lindell Boulevard, #110

St. Louis, MO 63108-2930

Direct: (314)534-0475

TTY: (314)534-5070

info@post-polio.org 

http://www.post-polio.org

**March of Dimes Birth Defects Foundation**

1275 Mamaroneck Avenue 

White Plains , NY 10605

Toll Free: (888)663-4637

Direct: (914)997-4488

http://www.modimes.org

**North Central Florida Post-Polio Support Group**

7180 SW 182nd Court

Dunnellon, FL 34432

http://www.postpoliosupport.com

**National Institute of Neurological Disorders and Stroke**

P.O. Box 5801

Bethesda, MD 80824

Toll Free: (800)352-9424

Direct: (301)496-5981

TTY: (301)468-5981

http://www.ninds.nih.gov/index.htm

**Polio Connection of America**

PO Box 182

Howard Beach, NY 11414

info@polioconnectionofamerrica.org

http://www.geocities.com/w1066w

Updated 3/23/10. 

This document was developed by the Job Accommodation Network, funded by a contract agreement from the U.S. Department of Labor, Office of Disability Employment Policy (DOL079RP20426). The opinions expressed herein do not necessarily reflect the position or policy of the U.S. Department of Labor. Nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Department of Labor.

Fact Sheet Series

Job Accommodations for People with Post-Polio Syndrome