PTOTCohortJournal of rehabilitation medicine2025

The presence of unknown polio engagement confirmed by electromyography and muscle testing.

Waleed Al-Najjar, David Krabbe, Joakim Strandberg and 1 others

PMID 39780467

WHAT IT FOUND

Electromyography revealed chronic muscle denervation in legs where patients reported no weakness.

This unawareness masked significant functional deficits, including slower walking speeds and lower muscle strength compared to those aware of their impairment. Clinicians should test both limbs even if symptoms appear unilateral.

Key findings

01EMG identified chronic muscle denervation in the lower limbs of 44% of individuals who reported no previous engagement with polio in that limb.

02Patients unaware of their weakness had significantly slower maximum walking speeds and lower muscle strength indices than those aware of their impairment.

03Wheelchair dependence was significantly higher in the aware group (21%) compared to the unaware group (6%).

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

The study relied on self-reported symptoms from the acute phase of polio, which may be subject to recall bias. Muscle strength measurements were limited to lower limbs, and hip muscle groups were excluded due to feasibility issues. The cross-sectional design cannot establish causality between unawareness and functional decline. Data were missing for some participants due to refusal, inability to perform tests, or lack of EMG records.

Declared interests

No specific conflicts of interest or funding sources were declared in the provided text.

The easy way to misread this

Do not assume that a patient's lack of reported weakness indicates normal muscle function. The study shows that many patients with EMG-confirmed denervation are unaware of their deficits, which may mask underlying functional impairments and increase the risk of overuse.

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