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. Some of these patients are treated with assisted ventilation devices. More frequent chest infections, because clearance of secretions is reduced.