Other activities of daily living such as bathing, dressing and using the toilet may become difficult, depending on the muscle groups involved. Many patients adapt by developing new techniques that preferentially use the unaffected muscles. Box 1 . Increasing weakness in the limb previously affected by polio. Pain in the muscle with use.
Muscle cramps at rest.
Fatigue on performing physical activities. Some patients report new weakness in a limb or muscle group they had previously considered normal. The onset of PPS unmasks this subclinical polio, and the limb becomes weak. A small number of patients may develop dysphagia because of new weakness in the bulbar musculature. Detailed barium studies have shown that many more have a subclinical involvement of the swallowing mechanism.