Trauma as a trigger for PPS?
Eddie Bollenbach

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Date: Sun, 28 Apr 2002 13:13:28 -0400
From: "Eddie Bollenbach" <edward.bollenbach
Subject: Re: [PPM] Trauma as a trigger for PPS

If you ask a large number of Polio Suvivors if their development of PPS had an event associated with it more would say yes than no. We've seen this in several surveys including our own. However, a pertinent question to ask is what does it mean? Taking the assumption that the event, especially if it is an injury or emotional trauma, is the cause of PPS begs a few questions, the foremost being that significant numbers (though less) do not connect an event with the onset of PPS. Further, when we think about our best knowledge of what PPS is, trauma, in and of itself, is an unlikely cause.

When I think of this question I can see a number of possibilities that fit in with our current understanding of PPS. First of all PPS, as most experience it, is essentially a loss of strength and endurance in muscle. The process that explains the loss can be debated but the essential problem is loss, however it occurs and regardless of etiology. Also, the loss is not abrupt. It occurs slowly. Some have measured loss as low as 1% per year while others have gotten higher numbers. (as an aside I believe it extremely difficult to measure muscle strength loss, due exclusively to PPS, and follow it through time but that's another story).

It is clear that the process of losing strength has been occuring for a time prior to a person noticing PPS. If an individual is weaker he or she is more likely to fall or have an accident. In recovering one would notice they are not recovering as quickly or that it is much more difficult to substitute other muscles in daily living. So one would say PPS is associated with the event.

Several say the triggering event is emotional. For example, the death of a loved one. If we have been losing physical reserves we also lose emotional reserves. When you are anxious your state can be measured by muscle tension. As a matter of fact it is impossible to be anxious and have a relaxed forehead. This demonstrates how closely mind and body interact. So again, if PPS is hidden but progressing, weakness associated with emotional stress is likely because of muscle overuse instigated by muscle tension. One then feels exhausted. Earlier in life the same stressful event would not result in as much overall strain.

The third thing is that our minds work by association. If you take a memory course you will be shown how to associate things. In college I learned how to memorize a list of objects in 10 seconds and recall them for weeks. It amazed people (usually in a bar) but it was simple association. What is my point? Well, you will remember how tired you were at a particular time if something else of significance to you happens at the same time.

Anyway, to sum, I don't think trauma, either emotional or physical triggers PPS. I think it often unmasks it. We are much more likely to remember severe fatigue or weakness if it occurs coupled to a significant event or injury.

Eddie
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