October 1994

A PERSONALITY PROFILE OF PATIENTS DIAGNOSED WITH POST-POLIO SYNDROME

Clark K; Dinsmore S; Grafman J; Dalakas MC
Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA.

Neurology, Oct 1994, 44(10), p1809-11

Abstract

Post-polio syndrome (PPS) refers to the late development of new neuromuscular symptoms in previously stable poliomyelitis patients. Whether psychological disturbance plays a role in the manifestation of symptoms in these patients is unclear. We examined 22 patients fulfilling the clinical criteria for PPS with the Minnesota Multiphasic Personality Inventory -II (MMPI-II), Beck Depression Inventory, Spielberger State-Trait Anxiety Scales, Chapman and Chapman Psychosis-Proneness Scales, Fatigue Scales, a neurobiological rating scale, and Cognitive Symptoms Self-Report Scales. The overwhelming majority of scale scores were within normal limits, and there was no indication that psychopathologic symptoms were associated with the development or severity of new muscle weakness in PPS patients. Women with PPS had significantly more somatic complaints, but were less socially isolated than men with PPS. This study confirms that the development or severity of new muscle weakness in carefully diagnosed PPS patients is not due to, or influenced by, underlying psychopathology.

Subject Headings

Personality Assessment; Postpoliomyelitis Syndrome - Psychology
Adult; Age of Onset; Depression - Complications; Middle Age; Personality Tests; Sex Factors


^ back to top ^


AUGUST 1994

MUSCLE PERFORMANCE, VOLUNTARY ACTIVATION AND PERCEIVED EFFORT IN NORMAL SUBJECTS AND PATIENTS WITH PRIOR POLIOMYELITIS

Allen GM; Gandevia SC; Neering IR; Hickie I; Jones R; Middleton J
Department of Clinical Neurophysiology, Prince of Wales Hospital, NSW, Australia.

Brain, Aug 1994, 117(4), p661-70

Abstract

Many people previously affected by polio complain of increased fatigue, weakness and pain many years after the initial illness. Although electromyographic abnormalities have been found in these patients, the cause of their increased weakness is not well understood. Previous studies have shown decreased strength and impaired exercise performance in those with prior polio, but the level of voluntary drive to the muscle has not been investigated. The present study investigated maximal voluntary activation without fatigue and both peripheral and central components of muscle fatigue in 21 subjects with poliomyelitis 20-40 years previously, and 20 healthy, age-matched control subjects. Voluntary activation and strength of the elbow flexors were quantified using twitch interpolation during maximal isometric voluntary contractions both at rest, and during fatigue induced by 45 min of repeated isometric contractions. Compared with the control subjects, patients with prior polio had impaired voluntary activation both when the elbow flexors were not fatigued and during fatiguing submaximal exercise. During exercise, polio subjects also had lower twitch amplitudes and increased subjective fatigue. Central and peripheral fatigue were more marked in those with the post-polio syndrome. The impaired voluntary activation with unfatigued muscles in polio subjects indicates that defective central or reflex drive may contribute to their new weakness.

Subject Headings

Muscle Contraction; Muscles - Physiopathology; Poliomyelitis - Physiopathology
Adult; Middle Age; Muscle Fatigue; Muscle Skeletal; Physical Endurance


^ back to top ^


MAY 1994

THE NEUROANATOMY OF POST-POLIO FATIGUE

Bruno RL; Cohen JM; Galski T; Frick NM

Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, Saddlebrook, NJ 07662, USA
Arch Phys Med Rehabil, May 1994, 75(5), p498-504

Abstract

Fatigue is the most commonly reported, most debilitating, and most poorly understood Post-Polio Sequelae (PPS). Postmortem studies of 50 years ago documented frequent and severe poliovirus-induced lesions within the Reticular Activating System (RAS). Recently, neuropsychological testing has documented marked attention deficits in polio survivors reporting severe fatigue. However, neither of these findings has yet been related to the pathophysiology of post-polio fatigue. Magnetic resonance imaging of the brain was performed in 22 polio survivors carefully screened to eliminate the effect of comorbidities. Subjects rated the severity of their daily fatigue and subjective problems with attention, cognition, and memory. Small discrete or multiple punctate areas of hyperintense signal (HS) in the reticular formation, putamen, medial leminiscus, or white matter tracts were imaged in 55% of the subjects reporting high fatigue and in none of those reporting low fatigue. The presence of HS significantly correlated with fatigue severity and subjective problems in attention, concentration, staying awake, recent memory, and thinking clearly. The lack of significant correlations between HS or fatigue severity and age, severity of acute polio, depressive symptoms, or difficulty sleeping militates against these factors as either causing HS or producing fatigue. These preliminary findings suggest that poliovirus-induced lesions in the Brain Activating System may underlie the subjective fatigue and attention deficits reported by polio survivors.

Subject Headings

Brain - Pathology; Postpoliomyelitis Syndrome - Pathology Adult; Demography; Fatigue - Physiopathology; Magnetic Resonance Imaging; Mental Processes; Middle Age; Neuropsychological Tests; Postpoliomyelitis Syndrome - Physiopathology; Postpoliomyelitis Syndrome - Psychology


^ back to top ^


DISABILITY IN POLIOMYELITIS SEQUELAE

Grimby F; Jonsson AL
Department of Rehabilitation Medicine, University of Goteborg, Sweden.
Phys Ther, May 1994, 74(5), p415-24

Abstract

Patients who have been affected by poliomyelitis may develop new symptoms such as muscle weakness, muscle atrophy, muscle or joint pain, and unexplained fatigue several decades after the onset of their poliomyelitis (post-polio syndrome (PPS)). We report on the results of our study of 59 patients with poliomyelitis using a number of instruments for disability assessment, including a 4- to 5- year follow-up. The main impact of disability for most patients is mobility-related activities. Dependence in personal activities of daily living is fairly rare, whereas dependence and difficulties in instrumental activities of daily living (eg cooking, transportation, cleaning, shopping) are more common and also more severe in persons with PPS. Mental health, emotional reactions and social activity, interaction, and isolation are usually less affected, although considerable coping problems may occur, especially in persons with PPS who have new health problems and increasing disabilities. Examples of disabilities, intervention measures, and coping processes are given in with case reports. The importance of a broad and interdisciplinary approach is emphasized, in which impairment as well as disability aspects should be considered in treatment and intervention programs.

Subject Headings

Disability Evaluation; Postpoliomyelitis Syndrome - Diagnosis
Activities of Daily Living; Adaptation, Psychological; Adult; Aged; Emotions; Mental Health; Middle Age; Postpoliomyelitis Syndrome - Psychology; Postpoliomyelitis Syndrome - Rehabilitation; Quality of Life; Social Isolation; Work


^ back to top ^


FEBRUARY 1994

COPING WITH THE LATE EFFECTS: DIFFERENCES BETWEEN DEPRESSED AND NONDEPRESSED POLIO SURVIVORS

Tate D; Kirsch N; Maynard F; Peterson C; Forchheimer M; Roller A; Hansen NDepartment of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA.
Am J Phys Med Rehabil, Feb 1994, 73(1), p27-35

Abstract

This study examined differences between depressed and nondepressed individuals with a history of paralytic poliomyelitis in terms of demographics, health status and coping strategies. The prevalence of distress and depression in this group of 116 polio survivors was determined. Subjects completed the Brief Symptom Inventory, the Coping with Disability Inventory and a questionnaire concerning their polio histories and self-perceptions of health. Medical assessments were performed by physicians. Only 15.8% of the sample had scores indicating depression and elevated distress. Depressed/distressed polio survivors were more likely to: be living alone, be experiencing further health status deterioration, seek professional help, view their health as poor, report greater pain, be less satisfied with their occupational status and their lives in general and exhibit poorer coping outcome behaviours in relation to their disability. Three factors in coping with the late effects of polio were identified through a factor analysis of the Coping with Disability Inventory: positive self-acceptance, information seeking/sharing about the disability and social activism. Differences between depressed/distressed and other polio survivors were found across these factors, with depressed/distressed subjects having significantly lower coping scores. These and other results are discussed.

Subject Headings

Adaptation, Psychological; Depression - Psychology; Postpoliomyelitis Syndrome - Psychology
Attitude to Health; Demography; Middle Age; Quality of Life; Questionnaires; Self Concept


^ back to top ^


OCTOBER 1993

PREVALENCE AND ASSOCIATED FEATURES OF DEPRESSION AND PSYCHOLOGICAL DISTRESS IN POLIO SURVIVORS

Tate DG; Forchheimer M; Kirsch N; Maynard F; Roller A
Department of Physical Medicine and Rehabilitation, University of Michigan Medical Centre, Ann Arbor, USA
Arch Phys Med Rehabil, Oct 1993, 74(10), p1056-60

Abstract

This cross-sectional study examines the prevalence of psychological distress and depression among 116 polio survivors. It investigates demographic, medical, and coping differences between subjects with (n = 17) and without (n = 99) these symptoms. Subjects were administered the Brief Symptom Inventory (BSI), the Coping with Disability Inventory (CDI), and a questionnaire about their polio histories. The BSI provided measures of psychological distress and depression that defined the subgroups. The CDI assessed coping behaviours. BSI scores for the overall sample were within the normal range indicating no major distress, depression, nor elevated somatic complaints. Several significant differences were found between the two subgroups. On average, depressed/distressed subjects reported an increase in pain (p < 0.01) and further deterioration of their medical status since the time of their physical best subsequent to the onset of polio (p < 0.01). They consistently rated their health as poorer than did nondepressed/nondistressed subjects (p < 0.001). They also reported less satisfaction with life and their occupational status (p < 0.001) and displayed poorer coping behaviours combined (p < 0.001). Selected variables such as life satisfaction, pain, decrease in activity, and current living situation accounted for 51% of the variance when predicting distress and depression among this group of polio survivors.

Subject Headings

Depression - Etiology; Poliomyelitis - Psychology; Stress, Psychology - Etiology - Adaptation, Psychological; Cross-sectional Studies; Depression - Epidemiology; Middle Age; Poliomyelitis - Complications; Prevalence; Self Assessment (Psychology); Stress, Psychological - Epidemiology; Survivors - Psychology


^ back to top ^


SEPTEMBER 1993

STIMULATION FREQUENCY-DEPENDENT NEUROMUSCULAR JUNCTION TRANSMISSION DEFECTS IN PATIENTS WITH PRIOR POLIOMYELITIS

Trojan DA; Gendron D; Cashman NR
Department of Neurology, McGill University, Montreal Neurological Institute and Hospital, Quebec, Canada.
J Neurol Sci, Sep 1993, 118(2), p150-7

Abstract

Generalized fatigue and muscle fatiguability are major symptoms of post-poliomyelitis syndrome (PPS), and may be due to neuromuscular junction transmission defects, as suggested by increased jitter on single fiber electromyography (SFEMG). To determine the etiology of this defect, we studied jitter at low (1, 5 Hz) and high (10, 15, 20 Hz) frequency stimulation with stimulation SFEMG in 17 post-polio patients with muscle fatiguability, and in 9 normal controls. In 5 of 17 PPS patients and in 1 of 9 controls, jitter was significantly higher (unpaired t-test, P < 0.05) at high frequency stimulation (HFS). In the remaining PPS patients and controls there was no significant difference in jitter at high and low stimulation frequencies. PPS patients with increased jitter at HFS had a significantly longer time interval since acute polio (mean 48.5 years) than PPS patients without increased jitter at HFS (mean 40 years; P < 0.05), but were not distinguished by other historical or clinical criteria. We conclude that the neuromuscular junction defect in post-polio patients is similar to that observed in amyotrophic lateral sclerosis, and is probably die to ineffective conduction along immature nerve sprouts and exhaustion of acetylcholine stores. The appearance of an increase in jitter with HFS in post-polio patients may be dependent upon time after acute polio.

Subject Headings

Neuromuscular Junction - Physiology; Postpoliomyelitis Syndrome - Physiopathology; Synaptic Transmission - Physiology
Adult; Aged; Electric Stimulation; Electromyography; Middle Age; Motor Neurons - Physiology; Nerve Fibers - Physiology


^ back to top ^


PULMONARY FUNCTION AND SYMPTOM-LIMITED EXERCISE STRESS TESTING IN SUBJECTS WITH LATE SEQUELAE OF POLIOMYELITIS

Stanghelle JK; Festvag L; Aksnes AK
Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
Scand J Rehabil Med, Sep 1993, 25(3), p125-9

Abstract

Sixty-eight subjects, consecutively admitted to our rehabilitation hospital with a presumptive postpolio syndrome, were examined by pulmonary function and symptom-limited exercise stress testing. The purpose of this investigation was to study how many of these subjects could be classified as suffering from cardiorespiratory deconditioning. The subjects had moderately reduced lung function of restrictive type, and none of the subjects had force expiratory volume for one second (FEV1) below 30% of predicted value, indicating that hypoventilation would probably not occur. A pronounced reduction in maximal oxygen uptake (max VO2) was seen, especially in women. The maximal heart rate (max HR) values were above 70% of predicted values in all but one subject, indicating that the subjects might benefit from endurance training. Fifteen subjects had a suspected pulmonary limitation due to the exercise, with the ratio ventilation/maximal voluntary ventilation (V/MVV) above 70%. However, max HR in these subjects did not differ from that in the subjects with the ration V/MVV below 70%. Thirteen other subjects had a ratio V/MVV < 70% but did not achieve respiratory quotient (R) > 1.0 and/or capillary lactate concentration > 4 mmol/l during exercise, indicating that muscular factors limited the exercise. These results indicate that cardiorespiratory deconditioning was considerable in most of our subjects with postpolio syndrome.

Subject Headings

Postpoliomyelitis Syndrome - Physiopathology; Respiratory AirflowAdult; Aged; Exercise Test; Heart Rate; Middle Age;Oxygen Consumption; Respiratory Function Tests


^ back to top ^


APRIL 1993

POLIOMYELITIS AND THE POST-POLIO SYNDROME: EXERCISE CAPACITIES AND ADAPTATION - CURRENT RESEARCH, FUTURE DIRECTIONS, AND WIDESPREAD APPLICABILITY

Birk T
HL Morse Physical Health Research Center, Department of Rehabilitation Medicine, Medical College of Ohio, Toledo 43614, USA
Med Sci Sports Exerc, Apr 1993, 25(4), p466-72

Abstract

Poliomyelitis is an acute viral disease that attacks the brain and the ventral horn of the spinal cord. Damage to the lower motor neurons usually results in atrophy and weakness of muscle groups, perhaps paralysis and possibly deformity. A second type, bulbar poliomyelitis, infects the medulla oblongata and may result in dysfunction of the swallowing mechanism along with respiratory and circulatory distress. Minor forms of poliomyelitis result in fever, sore throat, headache, and upper body stiffness, but leave no significant atrophy or paralysis. The purpose of this paper is to review post-polio syndrome (PPS) as well as the effect of exercise on the symptoms and morphologic adaptations to PPS and where future research efforts should be directed. The most common feature of PPS for over 350,000 afflicted survivors include general fatigue, weakness, and joint/muscle pain. The primary reasons for these symptoms include 1) destruction of the anterior horn cells by the polio virus, leaving fewer motor neurons to in duce muscle contraction; 2) unaffected motor unit enlargement by reinnervation through terminal sprouting; and 3) defective transmission at the neuromuscular junction secondary to failure of terminal axonal sprout. Acute responses to resistive exercise suggest significant muscle strenght decrements in the knee extensors compared with similar aged people without polio. However, limited training investigation indicates significant strength increases for the knee extensors following at least 6 wk of training. Acute aerobic responses also differ significantly from those observed in age-matched control subjects. Chronic aerobic responses to limited training studies suggest significant elevations in maximal oxygen uptake.

Subject Headings
Adaptation, Physiological; Exercise; Postpoliomyelitis Syndrome - Physiopathology
Forecasting; Muscles - Physiopathology; Postpoliomyelitis Syndrome - Classification; Research


^ back to top ^


FEBRUARY 1993

ANTICHOLINESTERASE-RESPONSIVE NEUROMUSCULAR JUNCTION TRANSMISSION DEFECTS IN POST-POLIOMYELITIS FATIGUE

Trojan DA; Gendron D; Cashman NR
Department of Neurology and Neurosurgery, McGill University, Montreal Neurological Institute and Hospital, Quebec, Canada.
J Neurol Sci, Feb 1993, 114(2), p170-7

Abstract

Disabling generalized fatigue and muscle fatiguability are common features of post-poliomyelitis syndrome (PPS). In 17 fatigues PPS patients, we measured jitter on stimulation single-fiber electromyography (S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium. We observed reduction in jitter (defined as a significant difference in jitter means before and after edrophonium, unpaired t-test P< 0.05) in 7 patients, no change in 8, and significant increase in 2 patients. Blinded to their edrophonium results, the 17 patients were treated with pyridostigmine 180 mg/day for 1 month, with subjective improvement of fatigue in 9 patients, and with a significant reduction in mean Hare fatigue scores in the entire group of 17 patients (pre = 2.71, and post = 1.71; Wilcoxan signed rank sum test, P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was significantly associated with pyridostigmine-induced subjective improvement of fatigue (Fisher=s exact test, P < 0.04). A significant reduction in fatigue with pyridostigmine was observed in only the 7 patients who experienced a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum test, P = 0.03). In addition, the 9 pyridostigmine responders experienced a significant reduction in jitter means pre- and post-edrophonium (100% vs. 88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular transmission as measured by jitter on S-SFEMG can improve with edrophonium in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability in some patients with PPS may be due to anticholinesterase-responsive NMJ transmission defect.

Subject Headings
Edrophonium - Pharmacology; Neuromuscular Junction - Physiology; Postpoliomyelitis Syndrome - Physiopathology; Pyridostigmine Bromide - Therapeutic Use; Synaptic Transmission - Physiology
Adult; Aged; Edrophonium - Diagnostic Use; Electric Stimulation; Electromyography; Fatigue; Middle Age; Muscles - Drug Effects; Muscles - Physiology; Muscles - Physiopathology; Neuromuscular Junction - Drug Effects; Postpoliomyelitis Syndrome - Drug Therapy; Reference Values; Synaptic Transmission - Drug Effects


^ back to top ^


NOVEMBER 1992

OSTEOARTHRITIS OF THE HAND AND WRIST IN THE POST POLIOMYELITIS POPULATION

Werner RA; Waring W; Maynard F
Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48109-0042, USA

Arch Phys Med Rehabil, Nov 1992, 73(11), p1069-72

Abstract

People with a chronic motor disability of the legs become increasingly more dependent upon their upper limbs for mobility and self-care skills as they age. Many of them complain of hand and wrist pain. A cross-sectional study of 61 post-poliomyelitis survivors was done to determine the prevalence of osteoarthritis within this population and to determine any inherent risk factors. Each subject underwent a radiographic evaluation of both hands and wrists as well as a detailed physical examination. A questionnaire was used to ascertain a history of hand activity, use of canes/crutches, walkers and wheelchairs. The mean age of the population sample was 49 +/- 6 with a mean duration of disability of 35 +/- 4 years. The prevalence of moderate or severe osteoarthritis of either hand or wrist was 13% whereas the prevalence was 68% when cases with mild arthritic changes were also included. The risk factors associated with hand and wrist osteoarthritis in this population included age, lower limb weakness, use of an assistive device, and severity of disability.

Subject Headings
Hand; Osteoarthritis - Diagnosis; Postpoliomyelitis Syndrome - Complications; Wrist Joint
Activities of Daily Living; Hand - Radiography; Middle Age; Orthopedic Equipment; Physical Examination; Regression Analysis; Risk Factors; Wrist Joint - Radiography


^ back to top ^


JULY 1992

POST-POLIO SYNDROME. AN EMERGING THREAT TO POLIO SURVIVORS

Aston JW Jr
Postgrad Med, Jul 1992, 92(1), p249-56, 260

Abstract

The manifestation of post-polio syndrome typically occur 20 to 40 years after an acute episode of poliomyelitis and are confined to previously unaffected muscles. Because of motor unit remodeling and direct mechanical damage, weakness increases in individual muscles until it exceeds their narrow margin of reserve and becomes clinically apparent. Although the exact cause is not clear, generalized weakness often occurs when several muscles are affected and various postural limb strategies used by the patient are no longer able to compensate for the loss of muscle strength. The mainstays of treatment are life-style changes to avoid overexertion and use of light-weight orthoses and assistive aids to unload the extremities. Exercise and surgery have a limited role in management.

Subject Headings
Family Practice - Methods; Postpoliomyelitis Syndrome
Electromyography; Exercise Therapy; Life Style; Orthotic Devices; Postpoliomyelitis Syndrome - Diagnosis; Postpoliomyelitis Syndrome Etiology; Postpoliomyelitis Syndrome - Therapy; Prognosis; Tendon Transfer


^ back to top ^


ROLE OF ELECTROMYOGRAPHY IN THE DIAGNOSIS OF MOTOR NEURON DISORDERS

Hausmanowa-Petrusewicz I
Neuromuscular Unit, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
Neuropatol Pol, 1992, 30(3-4), p187-97

Abstract

Programming of electromyographic examination in motor neuron diseases is discussed taking into account application of appropriate techniques. The difficulties of correct interpretation of results are stressed. The stages of disintegration and reintegration of affected motor units are described as well as compensatory changes of surviving motor units. A detailed description of EMG dynamics of amyotrophic lateral sclerosis, late post-polio syndrome and of childhood spinal muscular atrophy is given.

Subject Headings
Amyotrophic Lateral Sclerosis - Diagnosis; Electromyography - Methods; Motor Neuron Disease - Diagnosis; Muscular Atrophy, Spinal - Diagnosis
Amyotrophic Lateral Sclerosis - Physiopathology; Branchial Region - Physiopathology; Motor Neuron Disease - Physiopathology; Muscles - Physiopathology; Muscular Atrophy, Spinal - Physiopathology


^ back to top ^

DECEMBER 1991

NEUROMUSCULAR FUNCTION IN POLIO SURVIVORS

Agre JC; Rodriquez AA
Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792, USA
Orthopedics, Dec 1991, 14(12), p1343-7

Abstract

Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greated loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.

Subject Headings
Neuromuscular Diseases - Physiopathology; Postpoliomyelitis Syndrome - Physiopathology
Electromyography; Fatigue - Physiopathology; Isometric Contraction; Motor Endplate - Physiopathology; Muscle Contraction - Physiology; Muscles - Innervation; Physical Endurance


^ back to top ^


NOVEMBER 1991

EFFECT OF MODIFIED AEROBIC TRAINING ON MOVEMENT ENERGETICS IN POLIO SURVIVORS

Dean E; Ross J
School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada.
Orthopedics, Nov 1991, 14(11), p1243-6

Abstract

Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.

Subject Headings

Energy Metabolism; Exercise Therapy - Methods; Postpoliomyelitis Syndrome - Rehabilitation
Adult; Exercise Test; Heart Rate; Lung Volume Measurements; Middle Age; Oxygen Consumption; Postpoliomyelitis Syndrome - physiopathology


^ back to top ^


THE EFFECTS OF NON-FATIGUING RESISTANCE EXERCISE IN SUBJECTS WITH POST-POLIO SYNDROME

Fillyaw MJ; Badger GJ; Goodwin GD; Bradley WG; Fries TJ; Shukla A
Department of Physical Therapy, University of Vermont, Burlington, USA
Orthopedics, Nov 1991, 14(11), p1253-6

Abstract

Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.

Subject Headings
Exercise Therapy - Methods; Postpoliomyelitis Syndrome - Rehabilitation
Middle Age; Muscle Contraction; Patient Compliance; Physical Endurance; Postpoliomyelitis Syndrome - Physiopathology; Postpoliomyelitis Syndrome - Psychology


^ back to top ^


POLIOENCEPHALITIS, STRESS, AND THE ETIOLOGY OF POST-POLIO SEQUELAE.

Bruno RL; Frick NM; Cohen J
Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, East Orange, NJ 07018, USA
Orthopedics, Nov 1991, 14(11), p1269-76

Abstract

Post-mortem neurohistopathologies that document polio virus-induced lesions in reticular formation and hypothalamic, thalamic, peptidergic, and monoaminergic neurons in the brain are reviewed from 158 individuals who contracted polio before 1950. This polioencephalitis was found to occur in every case of poliomyelitis, even those without evidence of damage to spinal motor neurons. These findings, in combination with data from the 1990 National Post-Polio Survey and new magnetic resonance imaging studies documenting post-encephalitis-like lesions in the brains of polio survivors, are used to present two hypotheses: 1) polioencephalitic damage to aging reticular activating system and monoaminergic neurons is responsible for post-polio fatigue, and 2) polioencephalitic damage to enkephalin-producing neurons is responsible for hypersensitivity to pain in polio survivors. In addition, the antimetabolic action of glucocorticoids on polio-damaged, metabolically vulnerable neurons may be responsible for the fatigue and muscle weakness reported by polio survivors during emotional stress.

Subject Headings
Brain - Pathology; Poliomyelitis - Pathology; Postpoliomyelitis Syndrome - Pathology
Fatigue - Metabolism; Glucocorticoids - Metabolism; Magnetic Resonance Imaging; Neurons - Metabolism; Neurons - Pathology; Pain - physiopathology, Reticular Formation - Pathology; Stress - Physiopathology


^ back to top ^


THE PSYCHOLOGY OF POLIO AS A PRELUDE TO POST-POLIO SEQUELAE: BEHAVIOUR MODIFICATION AND PSYCHOTHERAPY

Bruno RL; Frick NM
Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, East Orange, NJ
Orthopedics, Nov 1991, 14(11), P1185-93

Abstract

Even as the physical causes and treatments for post-polio sequelae (PPS) are being identified, psychological symptoms - chronic stress, anxiety, depression, and compulsive, Type A behaviour - are becoming evident in polio survivors. Importantly, these symptoms are not only causing marked distress but are preventing patients from making lifestyle changes necessary to treat their PPS. Neither clinicians nor polio survivors have paid sufficient attention to the acute polio experience, its conditioning of life-long patterns of behaviour, its relationship to the development of PPS, and its effect on the ability of individuals to cope with and treat their new symptoms. We describe the acute polio and post-polio experiences on the basis of patient histories, relate the experience of polio to the development of compulsive, Type A behaviour link these behaviours to the physical and psychological symptoms reported in the National Post-Polio Surveys, and present a multimodal behavioural approach to treatment.

Subject Headings
Behaviour Therapy - Methods; Poliomyelitis - Psychology; Postpoliomyelitis Syndrome - Psychology; Type A Personality
Activities of Daily Living; Helplessness, Learned; Life Style; Postpoliomyelitis Syndrome - Rehabilitation; Psychotherapy - Methods; Social Behaviour; Stress, Psychological - Psychology

^ back to top ^

OCTOBER 1991

CLINICAL DECISION MAKING IN THE MANAGEMENT OF THE LATE SEQUELAE OF POLIOMYELITIS

Dean E
School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada.
Phys Ther, Oct 1991, 71(10), p752-61

Abstract

Years after the initial onset of poliomyelitis, patients often report new problems, including fatigue, weakness, pain, breathing difficulty, decreased endurance, problems with swallowing, choking, increased sensitivity to cold, and psychological problems. The premise of this article is that underlying pathophysiology of these problems can be assessed on the basis of a detailed history, a multisystem physical examination, and supplemental information provided by investigative tests. The indications for treatment of the late sequelae of poliomyelitis based on the underlying pathophysiology and the rationale for treatment prescription are explored. Possible outcomes of the assessment include no intervention; prescription of a balance between activity and rest, a reduction in activity, or an increase in activity; interventions to improve postural alignment, prescription of orthoses, and weight control; prescription of walking aids and mobility devices; respiratory care; lifestyle modification; or some combination of these outcomes. If treatment can be directed at the underlying causes of the late sequelae, the possibility of reducing further deterioration and of optimizing function in these patients will likely be enhanced.

Subject Headings
Disability Evaluation; Postpoliomyelitis Syndrome - Diagnosis
Diagnostic Differential; Life Style; Medical History Taking; Orthopedic Equipment; Physical Examination; Physical Therapy - Methods; Postpoliomyelitis Syndrome - Rehabilitation

^ back to top ^