DISABILITY AND QUALITY OF LIFE IN INDIVIDUALS WITH POSTPOLIO SYNDROME

Ahlstrom G; Karlsson U
Research and Development Unit, Psychiatry and Habilitation, Orebro Medical Centre Hospital, Sweden.
gerd.ahlstrom@orebroll.se
Disabil Rehabil, Jun 15 2000, 22(9), p416-22

Abstract

PURPOSE: The purpose of the study is to investigate disability and quality of life in individuals with the characteristic symptoms of postpolio syndrome. METHOD: Disability is assessed by means of the self-report activities of daily living instrument, and quality of life by means of Kaasa=s questionnaire and the quality of life profile.

RESULTS: The 39 subjects have on average lived with polio sequelae for 52 years. Their main difficulties are with moving, lifting and carrying. This means restricted mobility, sedentary activities and a need to prioritize. Half of them feel that polio has lessened their possibilities in life, and a quarter have still not accepted the limitations polio has involved. Nevertheless the majority report a high level of psychosocial well-being, and almost a quarter say that living with polio has meant personal development and strength. We found a significant correlation between on the one hand disability with regard to ambulation, arm strength and finger strength on the self-report ADL, and on the other hand the number of negative problems on the quality of life profile (0.33-0.45).

CONCLUSION: The latter instrument needs further testing before its validity can be determined with certainty.


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ELECTROPHYSIOLOGIC EVALUATION OF MUSCLE FATIGUE DEVELOPMENT AND RECOVERY IN LATE POLIO

Department of Rehabilitation Medicine, Goteborg University, Sweden.
Arch Phys Med Rehabil, Jun 2000, 81(6), p770-6

Abstract

OBJECTIVES: To study aspects of fatigue in late-polio patients and healthy controls. We hypothesized that late-polio subjects would develop more peripheral fatigue, assessed with surface electromyography (EMG), and that no major differences would exist between the two groups in neuromuscular junction transmission.

DESIGN: Case-control study.

SETTING: University hospital laboratory.

SUBJECTS: Ten patients with a history of polio (mean age, 54 years, SD = 5; mean time since polio onset, 49 years, SD = 7) and a matched control group (mean age, 52 years, SD = 8).

METHODS: A protocol with a stepwise force increase up to 80% of maximal voluntary contraction ending with an 8-minute recovery period was performed twice, first with surface EMG and then with electrical stimulation and surface-recorded evoked M-response.

MAIN OUTCOME MEASURES: Surface EMG analysis of voluntary activity and evoked M-response.

RESULTS: No significant differences existed between groups in the relative decrease during the fatigue protocol. The recovery of force was slower in the late-polio subjects. A reduction in the root mean square (RMS) value during recovery was seen in the polio group, although a normalization of the mean power frequency (MPF) was seen in both groups.

CONCLUSION: The weakness during the fatigue procedure was not caused by neuromuscular blockade, because electrical nerve stimulation evoked a normal response. The weakness after exercise was the result of slow recovery that may reflect both central and peripheral fatigue.

Subject Headings
Muscle Contraction; Muscle Fatigue - Physiology; Postpoliomyelitis Syndrome - Physiopathology


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THE RELATION BETWEEN LOWER EXTREMITY STRENGTH AND SHOULDER OVERUSE SYMPTOMS: A MODEL BASED ON POLIO SURVIVORS

Klein MG; Whyte J; Keenan MA; Esquenazi A; Polansky M
Albert Einstein Medical Center, Philadelphia, PA, USA
Arch Phys Med Rehabil, Jun 2000, 81(6), p789-95

Abstract

OBJECTIVE: To determine the relation between lower extremity weakness and shoulder overuse symptoms among polio survivors. We predicted that individuals with moderate weakness in their leg extensor muscles would use their arms to help compensate for this weakness and would be at high risk for developing symptoms of shoulder overuse.

DESIGN: A cohort study of polio survivors recruited from the Einstein-Moss Postpolio Management Program (Philadelphia), the community, and the surrounding region.

SETTING: A research laboratory at Moss Rehabilitation Research Institute, Philadelphia, PA.

PARTICIPANTS: One hundred ninety-four polio survivors. Demographic and medical history date, symptom data, and strength data were obtained for each.

MAIN OUTCOME MEASURES: Presence or absence of shoulder symptoms and ratings of pain by visual analogue scale were recorded. Strength was measured using a hand-held dynamometer and manual muscle testing.

RESULTS: Shoulder symptoms could be grouped into two distinct clusters based on the type of testing used for assessment. Symptoms elicited by palpation were present in 26% of the subjects and were strongly related to knee extensor strength and weight. These symptoms were more common in women than men (42% and 10%, respectively). Symptoms elicited by resistance tests were present in 33% of the subjects and were seen with equal frequency in both sexes. These symptoms were also related to lower extremity strength, but the specific relationship was not as clear as for the palpation-related symptoms.

CONCLUSIONS: Lower extremity weakness predisposes individuals to shoulder overuse symptoms. Sex and body weight are contributing factors. These results may be generalized to other populations with lower extremity weakness, including the elderly.

Subject Headings
Cumulative Trauma Disorders - Etiology; Leg - Physiology; Muscle Weakness - Pathophysiology; Postpoliomyelitis Syndrome - Rehabilitation; Shoulder


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MAY 2000

THE INFLUENCE OF POST-POLIO SYNDROME ON INDEPENDENCE AND LIFE SATISFACTION

Burger H; Marincek C
Institute for Rehabilitation, Ljubljana, Slovenia.
helena.burger@mail.irrs.si
Disabil Rehabil, May 10 2000, 22(7), p318-22

Abstract

PURPOSE: The aim of the study was to find out the influence of the new symptoms on life satisfaction and independent living and the most frequent disabilities in patients with post-polio syndrome that are affecting the satisfaction and independence.

METHOD: A questionnaire was sent to all the post-polio survivors (207) who visited the Rehabilitation Institute in Ljubljana at least once in the last ten years. We got 100 answers, which were analysed by SPSS (statistical package for social sciences).

RESULTS: Sixty nine reported that they had new symptoms that may be classified as post-polio syndrome.

CONCLUSIONS: We have found that the new symptoms in post-polio survivors, which may be classified as post-polio syndrome, increased their walking and climbing stairs disability, increased their disability to perform daily activities and also decreased their satisfaction with life.


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APRIL 2000

A NEUROPSYCHOLOGICAL STUDY OF THE POSTPOLIO SYNDROME: SUPPORT FOR DEPRESSION WITHOUT NEUROPSYCHOLOGICAL IMPAIRMENT

Hazendonk KM; Crowe SF
School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia.
Neuropsychiatry Neuropsychol Behav Neurol, Apr 2000, 13(2), 112-8

Abstract

OBJECTIVE: this study aimed to examine cognitive functioning in postpolio syndrome (PPS) after controlling for the effects of depression and illness behaviour.

BACKGROUND: Few studies have investigated the possible cognitive sequelae of PPS, despite widespread documented subjective complaints of >mental fatigue.

METHOD: A total of 23 PPS sufferers, 20 polio survivors without PPS, and 22 matched controls were compared using the Beck Depression Inventory-II; the Illness Behaviour Questionnaire; a chronic fatigue syndrome symptom checklist; and several measures of memory, attention, and concentration, including the Brown-Petersen Task, Stroop Test, Austin Maze, California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, and Symbol-Digit Modalities Test.

RESULTS: In those participants with a medically confirmed diagnosis of PPS, there was a significantly higher level of depressive and hypochondriacal symptomatology as compared with the other two groups. Nevertheless, no significant differences existed between the three groups on neuropsychological measures.

CONCLUSIONS: These results indicate that the attention and memory difficulties reported by PPS sufferers may be linked to the physical or psychological manifestations of the illness rather than to objective decrements in cognitive performance.

Subject Headings
Cognition Disorders - Diagnosis; Depressive Disorder - Diagnosis; Neuropsychological Tests - Statistics & Numerical Data; Postpoliomyelitis Syndrome - Diagnosis
Adult; Aged; Cognition Disorders - Epidemiology; Comorbidity; Depressive Disorder - Epidemiology; Diagnosis, Differential; Fatigue Syndrome, Chronic - Diagnosis; Fatigue Syndrome, Chronic - Epidemiology


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MARCH 2000

RISK OF SYMPTOMS RELATED TO LATE EFFECTS OF POLIOMYELITIS

Rekand T; Albrektsen G; Langeland N; Aarli JA
Department of Neurology, Haukeland Hospital, Bergen, Norway.
Acta Neurological Scandinavica, Mar 2000, 101(3), p153-8

Abstract

OBJECTIVE: To compare the risk of developing symptoms related to late effects of poliomyelitis between polio patients and persons of similar age and sex without a history of poliomyelitis.

MATERIAL AND METHODS: The study comprised information on 148 patients with prior poliomyelitis and 115 persons with no history of poliomyelitis. Information was obtained by questionnaire and analyzed by multiple logistic regression method.

RESULTS: The risk of experiencing two or more symptoms was significantly higher among the polio patients than among the persons without history of poliomyelitis. The elevation in risk was less pronounced in the nonparalytic group (OR = 2.35; 95% CI = 0.92-5.97) than the group with permanent muscular weakness (OR = 8.84; 95% CI = 4.32-18.09).

CONCLUSIONS: Although symptoms defined in the PPS are unspecific and may occur in the general population, the risk for developing such symptoms are higher among the polio victims. The difference in risk among nonparalytic and paralytic patients may depend on the extent of motor neuron damage in the acute stage.

Subject Headings
Poliomyelitis - Epidemiology
Aged, 80 and over; Catchment Area (Health); Middle Age, Muscle Weakness - Diagnosis; Muscle Weakness - Epidemiology; Norway - Epidemiology; Paresis - Diagnosis; Paresis - Epidemiology; Poliomyelitis - Diagnosis; Postpoliomyelitis Syndrome - Diagnosis; Postpoliomyelitis Syndrome - Epidemiology; Questionnaires; Risk Factors


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NEUROMUSCULAR REHABILITATION AND ELECTRODIAGNOSIS. 4. SPECIALIZED NEUROPATHY

Agre JC; Sliwa JA
Howard Young Medical Center, Woodruff, WI 54568, USA.
Archives of Physical Medicine and Rehabilitation, Mar 2000, 81(3 Suppl 1), pS27-31; quiz S36-44

Abstract

This self-directed learning module briefly highlights the differential diagnosis for acute weakness in patients with acute respiratory failure requiring prolonged mechanical ventilation. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article includes a discussion on the role of exercise in the treatment of patients with the late effects of poliomyelitis or with acute inflammatory demyelinating polyradiculoneuropathy.

Subject Headings
Neuromuscular Diseases - Diagnosis; Neuromuscular Diseases - Rehabilitation; Poliomyelitis - Rehabilitation; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating - Diagnosis; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating - Rehabilitation
Disease; Asthma - Complications; Asthma - Physiopathology; Diagnosis, Differential; Exercise Therapy; Muscle Weakness; Neuromuscular Diseases - Etiology; Patient Care Planning; Poliomyelitis - Complications; Poliomyelitis - Physiopathology; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating - Etiology; Respiration, Artificial; Respiratory Insufficiency - Diagnosis; Respiratory Insufficiency - Etiology; Respiratory Insufficiency - Physiopathology


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FEBURARY 2000

ILLNESS NARRATIVES OF PERSONS WITH POST-POLIO SYNDROME

Wenneberg S; Ahlstrom G
Department of Caring Sciences, University of Orebro, Sweden.
Journal of Advanced Nursing, Feb 2000, 31(2), p354-61

Abstract

This qualitative study investigated the lifetime illness experience of individuals with the >late effects= of polio or post-polio syndrome. Fifteen individuals were interviewed twice about their illness experience and the interviews were transcribed verbatim. The empirical material first underwent a categorization process. The preliminary categories generated through this analysis were then condensed into broader categories which in the final analysis gave rise to the following temporal pattern or stages of the illness experience: (1) the acute phase of polio and subsequent treatment and care; (2) rehabilitation and care at institutions for the disabled; (3) adaptation to a new life; (4) living with the post-polio syndrome today, and finally (5) memories of the past and apprehensions concerning the future. In spite of the difficult experiences of falling ill and slowly recovering from a life-threatening disease, these individuals have had a good life and accomplished most of their ambitions in the areas of work and family life. Their present psychosocial situation is complicated by the symptoms of the post-polio syndrome which make them more vulnerable to stress, but they are able to handle this burden except when any added strain makes it overwhelming. This potential vulnerability may sometimes express itself as a sudden flashback to traumatic polio experiences and it is therefore important that nurses are aware of the illness history of this patient group.

Subject Headings
Postpoliomyelitis Syndrome - Psychology; Sick Role
Interviews - Methods; Life Change Events; Middle Age; Time Factors


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JANUARY 2000

NONPARALYTIC POLIO AND POSTPOLIO SYNDROME

Halstead LS; Silver JK
National Rehabilitation Hospital, Washington, DC 20010, USA.
Am J Phys Med Rehabil, Jan-Feb 2000, 79(1), p13-18

Abstract

We describe four cases of postpolio syndrome with typical histories, physical examination results, and electrodiagnostic evidence of extensive anterior horn cell disease, as well as the putative pathophysiology of postpolio syndrome in persons with histories of nonparalytic polio and the diagnostic implications for individuals older than 40 years of age who are experiencing unexplained new weakness, fatigue, and muscle or joint pain. Although the diagnosis of postpolio syndrome traditionally has required a remote history of paralytic polio, many persons such as the ones described here with typical symptoms of postpolio syndrome have no clear history of paralytic disease and are being misdiagnosed. With this in mind, we believe that the diagnostic criteria for postpolio syndrome should be modified to include the following: a history of remote paralytic polio or findings on history, physical examination results, and laboratory studies compatible with poliovirus damage of the central nervous system earlier in life.

Subject Headings
Postpoliomyelitis Syndrome - Diagnosis
Adult; Aged; Case Report; Electromyography; Female; Human; Male; Middle Age; Postpoliomyelitis Syndrome - Physiopathology


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POST-POLIO SYNDROME: ASSESSMENTS, PATHOPHYSIOLOGY AND PROGRESSION

Gandevia SC; Allen GM; Middleton J
Prince of Wales Medical Research Institute, Randwick, Sydney, NSW, Australia.
Disability and Rehabilitation, Jan 10-20 2000, 22(1-2), p38-42

Abstract

While there have been many reports of the decline in motor function in patients with prior-polio, there have been few reports of quantitative changes in muscle function and the pathophysiological mechanisms for the deterioration are poorly understood. This paper describes the establishment of a postpolio clinic and the principles adopted in quantitative muscle testing using twitch interpolation. Peripheral endurance and /or voluntary drive to muscles is impaired in about 30% of prior-polio patients attending the clinic. Progression of these deficits is slow and not easily predicted by factors associated with the original illness.

Subject Headings
Postpoliomyelitis Syndrome - Rehabilitation
Care Facilities; Disability Evaluation; Disease Progression; New South Wales; Postpoliomyelitis Syndrome - Diagnosis; Postpoliomyelitis Syndrome - Physiopathology


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DECEMBER 1999

PHYSICAL PERFORMANCE IN INDIVIDUALS WITH LATE EFFECTS OF POLIO

Willen C; Cider A; Sunnerhagen KS
Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.
Scand J Rehabil Med, Dec 1999, 31(4), p244-9

Abstract

The aim of this study was to evaluate physical performance in individuals with late effects of polio; specifically, to evaluate the effects of reduced muscle strength in the lower limbs. Thirty-two individuals seen at the polio clinic at Sahlgrenska University Hospital, Goteborg, Sweden, participated in the study. Each subject performed a bicycle exercise test in which peak oxygen uptake and anaerobic threshold were determined. Muscle strength in the quadriceps and the hamstrings were measured on an isokinetic dynamometer. Reductions in peak workload, peak oxygen uptake and predicted heart rate were seen. The anaerobic threshold was within or slightly lower than normal limits in relation to predicted maximal oxygen uptake, indicating that the cardio-respiratory system was not limiting performance. The muscle testing demonstrated a significantly lower ability to perform muscle actions compared with individuals from a reference group, and strong correlations were found between muscle strength peak VO2 and peak workload, respectively. Adjusted peripheral muscle endurance training might improve the work capacity in those individuals with weak leg muscles and low oxygen uptake, while individuals with relatively good muscle strength would improve their aerobic fitness in a general fitness program.

Subject Headings
Physical Fitness - Physiology - PH; Postpoliomyelitis Syndrome - Diagnosis - DI
Adult; Anaerobic Threshold - Physiology - PH; Confidence Intervals; Exercise Test - Methods - MT; Exercise Test - Statistical and Numerical Data; Leg - Physiopathology - PP; Middle Age; Muscle, Skeletal - Physiopathology - PP; Oxygen Consumption - Physiology - PH; Postpoliomyelitis Syndrome - Physiopathology - PP; Pulmonary Gas Exchange - Physiology - PH; Statistics, Nonparametric


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NOVEMBER 1999

COMPARISON BETWEEN CONCENTRIC NEEDLE EMG AND MACRO EMG IN PATIENTS WITH A HISTORY OF POLIO

Sandberg A; Hansson B; Stalberg E
Department of Clinical Neurophysiology, Neurocentre, University Hospital, Uppsala, Sweden.
arne.sandberg@nc.uas.lul.se
Clin Neurophysiol, Nov 1999, 110(11), 1900-8

Abstract

OBJECTIVES: Acute poliomyelitis causes degeneration of anterior horn cells, followed by denervation. Reinnervation and muscle fibre hypertrophy are mechanisms that compensate this loss of neurones. Concentric needle EMG (CNEMG) and macro EMG are two methods to assess the magnitude of initial involvement and the compensatory reinnervation. The aim of this study is to explore the difference between CNEMG and macro EMG describing the status of the motor unit in patients previously affected by polio.

METHODS: Macro and concentric needle EMG investigations were performed in 261 muscles in 121 patients with a remote history of polio.

RESULTS: CNEMG was abnormal in 211 muscles, macro EMG was abnormal in 246 muscles. The macro amplitude was 3-4 times >more abnormal= than CNEMG amplitude relative to the reference values. CNEMG duration was less abnormal and showed only weak correlation with macro amplitudes. The most likely explanation for the difference in magnitude of deviation from reference values for CNEMG and macro EMG, is a more pronounced >phase cancellation= between single fibre action potentials in CNEMG. This is supported by simulation studies reported here.

CONCLUSIONS: In conclusion macro EMG better reflects the size of the motor unit than the CNEMG. For detection of concomitant disorders, CNEMG is the method of choice.

Subject Headings
Electromyography - Instrumentation; Muscle, Skeletal - Physiopathology; Poliomyelitis - Physiopathology
Action Potentials - Physiology; Electric Stimulation; Electrodes; Middle Age; Motor Neurons - Physiology; Muscle Fibers - Physiology


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SEPTEMBER 1999

RESPIRATORY RESPONSE TO EXERCISE IN POSTPOLIO PATIENTS WITH SEVERE INSPIRATORY MUSCLE DYSFUNCTION

Weinberg J; Borg J; Bevegard S; Sinderby C
Division of Neurology, Karolinska Institute, Huddinge University Hospital, Sweden.
Arch Phys Med Rehabil, Sep 1999, 80(9), p1095-100

Abstract

OBJECTIVES: To evaluate the limiting factors of exercise performance and to analyze the respiratory strategies adopted during exercise in postpolio patients with severe inspiratory muscle dysfunction.

PATIENTS: Five patients with prior poliomyelitis associated with scoliosis and with respiratory muscle dysfunction (mean vital capacity, 1.74L (range, 1.1 to 2.4)) were studied at rest and during leg or arm cycle exercise.

METHODS: Gas exchange was examined by arterial blood gases and mass spectrometry of expired air. Ventilatory mechanics were studied by measurement of esophageal and gastric pressures.

RESULTS: Blood gases at rest were normal, except for subnormal PO2 levels in three patients. In all but one patient, ventilatory insufficiency was the limiting factor for exercise. A compensatory breathing pattern with abdominal muscle recruitment during expiration was present already at rest in three of the patients. The pressures generated by the diaphragm were below fatiguing margins, ie, levels that in healthy subjects can be sustained for at least 45 minutes.

CONCLUSIONS: The extent of ventilatory dysfunction was not evident in blood gas values at rest; however, it was revealed by blood gas values during the exercise test. Diaphragm fatigue seems to be avoided at the cost of impaired blood gases.

Subject Headings
Exercise Test; Postpoliomyelitis Syndrome - Rehabilitation; Respiratory Paralysis - Rehabilitation
Adult; Carbon Dioxide - Blood; Middle Age; Oxygen - Blood; Postpoliomyelitis Syndrome - Diagnosis; Postpoliomyelitis Syndrome - Physiopathology; Pulmonary Gas Exchange - Physiology; Respiratory Mechanics - Physiology; Respiratory Muscles - Physiopathology; Respiratory Paralysis - Diagnosis; Respiratory Paralysis - Physiopathology; Scoliosis - Diagnosis; Scoliosis - Physiopathology; Scoliosis - Rehabilitation; Vital Capacity - Physiology


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AUGUST 1999

MANAGING OCCUPATIONS IN EVERYDAY LIFE TO ACHIEVE ADAPTATION

Jonsson AL; Moller A; Grimby G
Department of Rehabilitation Medicine, Goteborg University, Sahlgrenska University Hospital, Sweden.
Am J Occup Ther, Jul-Aug 1999, 53(4), p353-62

Abstract

OBJECTIVE: The aim of this qualitative study was to gain a deeper understanding of how persons with poliomyelitis sequelae manage their daily occupations in order to adapt to environmental demands. This was a study of adaptive processes and capability in everyday life.

METHOD: Interviews with 22 persons with poliomyelitis sequelae were content analyzed according to grounded theory.

RESULTS: The analysis yielded 18 concepts describing adaptive strategies of participants. The strategies were arranged in six general groups: utilizing physical capability, influencing emotions, altering pattern of occupations, promoting concrete problem-solving, influencing relations, and facilitating future activities.

CONCLUSION: The strategies were interwoven, revealing different ways of reaching an adaptive balance in daily occupations for the present and the future.

Subject Headings
} Activities of Daily Living; Adaptation, Psychological; Attitude to Health; Disabled Persons - Psychology; Occupations; Poliomyelitis - Physiopathology; Poliomyelitis - Psychology; Postpoliomyelitis Syndrome - Physiopathology; Postpoliomyelitis Syndrome - Parasitology
Adult; Aged; Emotions; Exercise Therapy; Middle Age; Occupational Therapy; Poliomyelitis - Rehabilitation; Postpoliomyelitis Syndrome - Rehabilitation; Problem Solving; Questionnaires; Self-Help Devices


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JUNE 1999

COPING WITH CHRONIC ILLNESS: A QUALITATIVE STUDY OF COPING WITH POSTPOLIO SYNDROME

Hansson B; Ahlstrom G
Department of Caring Sciences, University of Orebro, Sweden.
Int J Nurs Stud, Jun 1999, 36(3), p255-62

Abstract

The study describes how 24 people with postpolio syndrome (PPS) cope with their problems. Two qualitative interviews were conducted, 6 weeks apart. The interviews were analysed inductively. It was found that the participants experienced many types of illness-related problems in their everyday lives. Furthermore, they describe the progressive deterioration in terms of a general weakness, fatigue and pain - these adding to the emotional stress. A variety of coping strategies are employed and the result of the analysis shows it to be impossible to carry out a clearly differentiated grouping into problem-focused and emotion-focused. By and large the participants have learnt to live with the changes and feel that they have a >good life in spite of everything.

Subject Headings
Adaptation, Psychological; Postpoliomyelitis Syndrome - Psychology
Adult; Aged; Attitude to Health; Chronic Disease; Dyspnea - Etiology; Dyspnea - Psychology; Emotions; Fatigue - Etiology; Fatigue - Psychology; Middle Age; Muscle Weakness - Etiology; Muscle Weakness - Psychology; Pain - Etiology; Pain - Psychology; Postpoliomyelitis Syndrome - Complications; Postpoliomyelitis Syndrome - Nursing; Social Behaviour; Social Support; Stress, Psychological - Nursing; Stress, Psychological - Psychology


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MAY 1999

DEPRESSION AND LIFE SATISFACTION AMONG PEOPLE AGEING WITH POST-POLIO AND SPINAL CORD INJURY

Kemp BJ; Krause JS
Rehabilitation Research and Training Center On Aging With Spinal Cord Injury, Rancho Los Amigos Medical Center, Downey, CA 90242, USA
Disabil Rehabil, May-Jun 1999, 21 (5-6), p241-9

Abstract

PURPOSE AND BACKGROUND: Attention has recently begun to focus on the ageing of individuals with disability, not only as a long-term follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a pscyhosocial perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression.

METHODS: This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 non-disabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomology and an 10-item life satisfaction scale with four-point ratings on each item used.

RESULTS: Life satisfaction varied by the group, with non-disabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomology.

CONCLUSION: The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.

Subject Headings
Attitude to Health; Depression; Disabled Persons - Psychology; Personal Satisfaction; Poliomyelitis - Psychology; Spinal Cord Injuries - Psychology
Adaptation, Psychological; Adult; Age Factors; Time Factors


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REORGANIZATION OF CORTICAL MOTOR AREA IN PRIOR POLIO PATIENTS

Oliveri M; Brighina F; La Bua V; Buffa D; Aloisio A; Fierro B
Institute of Neuropsychiatry, University of Palermo, Italy
Clin Neurophysiol, May 1999, 110(5), p806-12

Abstract

OBJECTIVE: Focal transcranial magnetic stimulation (TMS) was used to study the motor maps of upper limb muscles in 7 adult patients with a history of paralytic poliomyelitis. The aim of the study was to verify the potential for long-term cortical reorganization of a selective peripheral motor neuron lesion suffered early in life.

METHODS: Patient selection was based on the prevalent involvement of proximal muscles in only one of the upper limbs. Motor evoked potentials (MEPs) were recorded from deltoid and abductor pollicis brevis (APB) muscles. Each muscle map was characterized by are (no. of excitable positions), volume (the sum of MEP amplitudes at all scalp positions), maximal amplitude (the highest MEP recorded).

RESULTS: In the patients, the mean area, volume and maximal amplitudes were significantly greater in affected vs contralateral deltoid (P<0.05) and vs controls (P<0.01). No significant differences were found in APB map parameters. The APB/deltoid ratio for area was lower in the affected compared with the unaffected side and controls (P = 0.06). Cortical reorganization was not significantly correlated with motor performance.

CONCLUSION: These findings are consistent with a rearrangement in human motor pathways targeting muscles affected by a lower motor neuron lesion.

Subject Headings
Motor Cortex - Physiopathology; Poliomyelitis - Physiopathology
Adult; Brain Mapping; Electroencephalography; Magnetics; Middle Age


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PROBLEM-FOCUSED COPING AND SATISFACTION WITH ACTIVITIES OF DAILY LIVING IN INDIVIDUALS WITH MUSCULAR DYSTROPHY AND POSTPOLIO SYNDROME

Natterlund B; Ahlstrom G
Department of Caring Sciences, University of Orebro, Sweden.
birgitta.natterlund@ivo.hoe.se
Scand J Caring Sci, 1999, 13(1), p26-32

Abstract

The problems, problem-focused coping and satisfaction with activities of daily living in a total of 119 persons with muscular weakness are described. The study encompasses three groups: 33 persons with various types of muscular dystrophy, 46 with myotonic dystrophy and 40 with symptoms relating to the post-polio syndrome. A self-report instrument for Assessment of Problem-focused Coping (APC) was used. Most of the problems reported were connected with mobility and transportation and work, but the subjects used problem-focused coping relatively infrequently and few differences were found between the different groups or between the sexes. The most widely used problem-focused coping strategy was >Devices and tricks=. The highest degree of satisfaction was noted for personal care and the lowest for mobility and transportation. The APC provides information about patients= evaluation of everyday situations, forming a complement to functional measurements in the field of rehabilitation.

Subject Headings

Activities of Daily Living; Adaptation, Psychological; Muscular Dystrophy - Psychology; Myotonia Atrophica - Psychology; Nursing Assessment - Methods; Patient Satisfaction; Postpoliomyelitis Syndrome - Psychology; Problem Solving; Questionnaires - Standards
Employment - Psychology; Leisure Activities - Psychology; Middle Age; Muscular Dystrophy - Physiopathology; Muscular Dystrophy - Rehabilitation; Myotonia Atrophica - Physiopathology; Myotonia Atrophica - Rehabilitation; Postpoliomyelitis Syndrome - Physiopathology; Postpoliomyelitis Syndrome - Rehabilitation; Reproducibility of Results


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DECEMBER 1998

1998 ISEK CONGRESS KEYNOTE LECTURE: MOTOR UNITS: HOW MANY, HOW LARGE, WHAT KIND? INTERNATIONAL SOCIETY OF ELECTROPHYSIOLOGY AND KINESIOLOGY

McComas AJ
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Electromyogr Kinesiol, Dec 1998, 8(6), p392-402

Abstract

There are now at least nine methods for motor unit number estimation (MUNE) in living human muscles. All methods are based on the comparison of an average single motor unit potential (or twitch) with the response of the whole muscle. Such estimations have been performed for proximal and distal muscles of the arm and leg in healthy subjects and in patients with various neuromuscular disorders. In healthy subjects there is a loss of motor units which is most evident in distal muscles and after the age of 60 years. Substantial losses of motor units have been measured in patients with ALS, post-polio symptoms, and diabetic peripheral neuropathies. In contrast, normal MUNEs have been found in approximately half of patients with persisting obstetric brachial palsies. The sizes of motor units show considerable variations within the same muscle and also between muscles; very large units are usually present in severe partial denervation. Although many motor unit properties are largely governed by motoneurons, some exhibit less plasticity in humans than in other mammals.

Subject Headings
Motor Neurons - Physiology; Muscle Contraction - Physiology; Muscle, Skeletal - Physiology
Adolescence; Adult; Aged; Aged, 80 and over; Child; Electromyography; Middle Age; Motor Neurons - Cytology; Muscle Fibers - Cytology; Muscle Fibers - Physiology; Muscle, Skeletal - Cytology; Muscle, Skeletal - Innervation; Neuromuscular Diseases - Pathology; Neuromuscular Diseases - Physiopathology


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FIBRILLATION POTENTIALS AND POSITIVE SHARP WAVES IN PATIENTS WITH ANTECEDENT PARALYTIC POLIOMYELITIS

Ghavanini MR; Ghavanini AA
Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Iran.
Electromyogr Clin Neurophysiol, Dec 1998, 38(8), p455-8

Abstract

The diagnosis of post-polio syndrome depends not only on clinical signs, but on sophisticated laboratory tests such as histochemical muscle biopsy and immunochemical studies which are very expensive and not available in all laboratories. From eighty-eight previous poliomyelitis victims, muscles with grade 4 or lower strength were examined electromyographically for fibrillation potentials and positive sharp waves. There were on muscles with grade III or IV fibrillation potential and positive sharp waves, 8 with grade I (3.7%) and 7 with grade II (3.2%). Fibrillation potentials were more frequent in muscles with lower grade of strength. The minimum time interval between primary insult and the time of evaluation for patients who had sign of denervation was 36 months. This was 28 months for patients who had no sign of denervation. So we can conclude that denervation beyond this time in muscles with power greater than 3/5 is highly suggestive of a new process rather than primary insult in patients with new atrophy or fatigue.

Subject Headings
Muscle, Skeletal - Physiopathology; Poliomyelitis - Physiopathology; Postpoliomyelitis Syndrome - Diagnosis
Adolescence; Adult; Child; Child, Preschool; Electromyography; Middle Age; Poliomyelitis - Complications; Postpoliomyelitis Syndrome - Physiopathology


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FIBRILLATION POTENTIALS AND POSITIVE SHARP WAVES IN PATIENTS WITH ANTECEDENT PARALYTIC POLIOMYELITIS

Ghavanini MR; Ghavanini AA
Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Iran.
Electromyogr Clin Neurophysiol, Dec 1998, 38(8), p455-8

Abstract

The diagnosis of post-polio syndrome depends not only on clinical signs, but on sophisticated laboratory tests such as histochemical muscle biopsy and immunochemical studies which are very expensive and not available in all laboratories. From eighty-eight previous poliomyelitis victims, muscles with grade 4 or lower strength were examined electromyographically for fibrillation potentials and positive sharp waves. There were on muscles with grade III or IV fibrillation potential and positive sharp waves, 8 with grade I (3.7%) and 7 with grade II (3.2%). Fibrillation potentials were more frequent in muscles with lower grade of strength. The minimum time interval between primary insult and the time of evaluation for patients who had sign of denervation was 36 months. This was 28 months for patients who had no sign of denervation. So we can conclude that denervation beyond this time in muscles with power greater than 3/5 is highly suggestive of a new process rather than primary insult in patients with new atrophy or fatigue.

Subject Headings
Muscle, Skeletal - Physiopathology; Poliomyelitis - Physiopathology; Postpoliomyelitis Syndrome - Diagnosis
Adolescence; Adult; Child; Child, Preschool; Electromyography; Middle Age; Poliomyelitis - Complications; Postpoliomyelitis Syndrome - Physiopathology


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POWER SPECTRUM OF THE SURFACE EMG IN POST-POLIO SYNDROME

Cywinska-Wasilewska G; Ober JJ; Koczocik-Przedpelska J
Institute of Orthopedic Surgery and Rehabilitation, Medical Faculty of Poznan, Poland.
Electromyogr Clin Neurophysiol, Dec 1998, 38(8), p463-6

Abstract

We evaluated the surface EMG of m. rectus fem., m. tibialis ant. and m. peroneus long. using power density spectral analysis. The frequency distributions were calculated using the fast Fourier transformation for 0-250 Hz. The results of PPS patients were compared to physiological state by ranking in five to 50 Hz subranges. In cases of healthy subjects the maximum signal power falls on 50-100 Hz subrange, the minimum on 200-250 Hz. Depending on severity of pathological symptoms, the PPS patients showed 2 different types of neuromuscular compensations. More severe pathology caused the spectrum shifts toward the higher frequencies, where the lighter cases manifest the spectrum shifts toward the lower frequencies.

Subject Headings
Muscle, Skeletal - Physiopathology; Postpoliomyelitis Syndrome - Physiopathology
Adult; Electromyography; Fourier Analysis; Leg


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NOVEMBER 1998

AN 8-YEAR LONGITUDINAL STUDY OF MUSCLE STRENGTH, MUSCLE FIBER SIZE, AND DYNAMIC ELECTROMYOGRAM IN INDIVIDUALS WITH LATE POLIO

Grimby G; Stalberg E; Sandberg A; Stibrant Sunnerhagen K
Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Goteborg University, Sweden.
Muscle Nerve, Nov 1998, 21(11), p1428-37

Abstract

Twenty-one subjects with polio 24 to 51 years prior to the first examination were studied on three occasions, each 4 years apart with measurements of muscle strength and endurance for knee extension, macro EMG, and muscle biopsy from vastus lateralis. On average the muscle strength decreased during the 8-year follow-up by 9-15%. Endurance decreased during the observation period. The muscle fiber area was markedly increased in most subjects. There was a decrease in the capillarization during the follow-up. Macro EMG was increased in all subjects (range 3-42 times control) and increased in 20 legs during the 8-year follow-up, but showed a decrease in 8 of 9 legs with an approximative breakpoint when macro MUPs were around 20 times the normal size. Thus, evidence of ongoing denervation/reinnervation as well as of failing capacity to maintain large motor units was demonstrated. SFEMG showed a moderate degree of disturbed neuromuscular transmission.

Subject Headings
Electromyography; Motor Neurons - Virology; Muscle Fibers - Enzymology; Muscle, Skeletal - Physiology; Poliomyelitis - Physiopathology
Adult; Aged; Biopsy; Citrate (si)-Synthase - Analysis; Knee Joint - Physiology; Longitudinal Studies; Middle Age; Motor Neurons - Physiology; Muscle Contraction - Physiology; Muscle Fibers - Pathology; Muscle Weakness - Physiopathology; Muscle, Skeletal - Innervation; Muscle, Skeletal - Pathology; Physical Endurance - Physiology; Torque


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RIMMED VACUOLES WITH BETA-AMYLOID AND UBIQUITINATED FILAMENTOUS DEPOSITS IN THE MUSCLES OF PATIENTS WITH LONG-STANDING DENERVATION (POSTPOLIOMYELITIS MUSCULAR ATROPHY): SIMILARITIES WITH INCLUSION BODY MYOSITIS

Semino-Mora C; Dalakas MC
Neuromuscular Diseases Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA.
Hum Pathol, Oct 1998, 29(10), p1128-33

Abstract

In the chronically denervated muscles of patients with prior paralytic poliomyelitis, there are secondary myopathic features, including endomysial inflammation and rare vacuolated fibers. To assess the frequency and characteristics of the vacuoles and their similarities with those seen in inclusion body myositis (IBM), we examined 58 muscle biopsy specimens from patients with prior paralytic poliomyelitis for (1) the presence of rimmed vacuoles; (2) acid-phosphatase reactivity; (3) Congo-red-positive amyloid deposits; (4) electron microscopy, searching for tubulofilaments; and (5) immunoelectron microscopy, using antibodies against beta-amyloid and ubiquitin. We found vacuolated muscle fibers in 18 of 58 (31%) biopsies, with a mean frequency of 2.06 +/- 0.42 fibers per specimen. The vacuoles contained acid phosphatase-positive material in 6 of the 18 (33.30%) specimens and stained positive for Congo red in five (27.80%). By immunoelectron microscopy, the vacuoles contained 5.17 +/- 0.13 nm fibrils and 14.9 +/- 0.31 nm filaments that immunoreacted with antibodies to beta-amyloid and ubiquitin in a pattern identical to the one seen in IBM. We conclude that vacuolated muscle fibers containing filamentous inclusions positive for amyloid and ubiquitin are not unique to IBM and the other vacuolar myopathies but can also occur in a chronic neurogenic condition, such as postpoliomyelitis. The chronicity of the underlying disease, rather than the cause, may lead to vacuolar formation, amyloid deposition, and accumulation of ubiquitinated filaments.

Subject Headings
Amyloid beta-Protein - Analysis; Muscles - Pathology; Myositis, Inclusion Body - Pathology; Postpoliomyelitis Syndrome - Pathology; Ubiquitin - Analysis; Vacuoles - Pathology
Biopsy; Congo Red; Denervation; Immunohistochemistry; Microscopy, Electron; Microscopy, Immunoelectron; Middle Age; Muscle Fibers - Pathology


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OCTOBER 1998

ANTINEUROFILAMENT ANTIBODIES IN POSTPOLIO SYNDROME

Drory VE; Shapira A; Korczyn AD; Shavit S; Kushnir M; Michaelson DM; Chapman J
Department of Neurology, Sourasky Medical Center, Tel-Aviv, Israel.
Neurology, Oct 1998, 51(4), p1193-5

Abstract

We determined the levels of antineurofilament antibodies in 29 patients with postpolio syndrome (PPS), 26 stable postpolio (PP) patient, 22 patients with ALS, and 20 normal controls (NCs). Patients with PPS had higher antibody levels to cholinergic neurofilaments than did all other groups. PP patients and those with ALS had antibody levels similar to those of NCs. The antibody binding level showed no relation to the age of the patients, duration of disease, or motor score.

Subject Headings
Autoantibodies - Blood; Neurofilament Proteins - Immunology; Postpoliomyelitis Syndrome - Immunology
Adult; Amyotrophic Lateral Sclerosis - Immunology; Cholinergic Fibers - Immunology; Middle Age; Spinal Cord - Cytology; Spinal Cord - Immunology


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AUGUST 1998

PAIN, PHYSICAL ACTIVITY, AND DISABILITY IN INDIVIDUALS WITH LATE EFFECTS OF POLIO

Willen C; Grimby G
Department of Rehabilitation Medicine, Goteborg University, Sweden.
Arch Phys Med Rehabil, Aug 1998, 79(8), p915-9

Abstract

OBJECTIVE: The aim of this study was to provide a description of pain and its relationship to the effects of polio, physical activity, and disability.

DESIGN: Assessment instruments used were: a pain questionnaire, a pain drawing, a visual analogue scale (VAS), a 30-m walk indoors, isokinetic muscle strength, serum creatine kinase concentration, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

SUBJECTS: Thirty-two consecutive individuals with late effects of polio.

RESULTS: More than 50% of the individuals had pain every day, mostly during physical activity. The mean VAS score for daily pain intensity was 55mm, range 0 to 93mm. In the lower limbs cramping pain was the most common pain characteristic in both polio-affected and non-polio-affected limbs. In the upper limbs and in the trunk, aching pain was the most common pain characteristic, especially in the polio-affected areas. The degree of muscle weakness had no correlation to pain experience. The walking test demonstrated a relatively small difference between spontaneous and maximal walking speed. The NHP questionnaire demonstrated that all six dimensions (energy, pain, physical mobility, sleep, emotional reactions, and social isolation) were affected. The dimensions pain and physical mobility both strongly correlated with energy.

CONCLUSIONS: There is a relationship between physical activity in daily life and experience of pain. In many postpolio individuals who experience a high level of pain, spontaneous and maximal walking speed are approximately the same. It is strongly recommended that individuals with late effects of polio, experiencing aching and especially cramping pain, modify their level of physical activity.

Subject Headings
Activities of Daily Living; Disabled Persons; Exercise; Pain - Etiology; Postpoliomyelitis Syndrome - Complications; Postpoliomyelitis Syndrome - Physiopathology
Adult; Aged; Case-Control Studies; Creatine Kinase - Blood; Exercise Test; Middle Age; Pain Measurement; Postpoliomyelitis Syndrome - Enzymology; Questionnaires; Walking


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JULY 1998

MOTOR UNIT SIZE ESTIMATION OF ENLARGED MOTOR UNITS WITH SURFACE ELECTROMYOGRAPHY

Roeleveld K; Sandberg A; Stahlberg EV; Stegeman DF
Department of Clinical Neurophysiology, University Hospital Nijmegen, The Netherlands.
Muscle Nerve, Jul 1998, 21(7), p878-86

Abstract

Surface EMG is hardly used to estimate motor unit (MU) characteristics, while its non-invasiveness is less stressful for patients and allows multi-electrode recordings to investigate different sites of the muscle and MU. The present study compares motor unit potentials (MUPs) obtained with surface EMG and macro EMG during voluntary contraction of the biceps brachii muscle of patients with enlarge MUs caused by prior poliomyelitis. Averaged surface MUPs were obtained by means of needle EMG (SMUP1) and surface EMG (SMUP2) triggering. The MUPs area and peak amplitudes correlated well when comparing the macro MUP and SMUP1 of the same MUs. When MU populations of different patients were compared, the SMUP1s and SMUP2s were equally sensitive to pathology as macro MUPs. In this, the late non-propagating positive wave (only present in unipolar recordings) is more robust than the triphasic propagating wave. Therefore, surface EMG can be used for detecting enlarged MUs.

Subject Headings
Motor Neurons - Physiology; Muscle Fibers - Physiology; Muscle, Skeletal - Innervation; Postpoliomyelitis Syndrome - Physiopathology
Adult; Aged; Analysis of Variance; Electromyography - Methods; Electromyography - Standards; Middle Age; Muscle Fibers - Pathology; Muscle, Skeletal - Pathology; Muscle, Skeletal - Virology; Reference Values


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NORMAL POSTEXERCISE FACILITATION AND DEPRESSION OF MOTOR EVOKED POTENTIALS IN POSTPOLIO PATIENTS

Samii A; Lopez-Devine J; Wasserman EM; Dalakas MC; Clark K; Grafman J; Hallett M
Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1428, USA
Muscle Nerve, Jul 1998, 21(7), p948-50

Abstract

We studied the effects of exercise on motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation in healthy subjects and postpolio patients. Subjects performed repeated sets of isometric exercise until the muscle fatigued. In both groups, the mean MEP amplitude immediately after each exercise set was approximately twice that of the baseline amplitude, indicating similar postexercise facilitation, and after fatigue was approximately half of the baseline amplitude, indicating similar postexercise depression. We conclude that the intracortical component of central fatigue is normal in postpolio patients.

Subject Headings
Evoked Potentials, Motor - Physiology; Exertion - Physiology; Muscle Contraction - Physiology; Muscle Fatigue - Physiology; Postpoliomyelitis Syndrome - Physiopathology
Adult; Middle Age


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APRIL 1998

COMPUTED TOMOGRAPHIC STUDY OF THE SKELETAL MUSCULATURE OF THE LOWER BODY IN 45 POSTPOLIO PATIENTS

Ivanyi B; Redekop W; de Jongh R; de Visser M
Department of Rehabilitation Medicine, University of Groningen, The Netherlands.
Muscle Nerve, Apr 1998, 21(4), p540-2

Abstract

Muscle computed tomography (CT) and muscle strength assessment of the pelvic girdle and leg muscles were performed in 32 postpolio patients experiencing new muscle weakness, and in 13 postpolio patients with stable neuromuscular condition. Muscles of the postpolio patients experiencing new muscle weakness showed significantly more CT scan abnormalities as compared with the stable postpolio patients. No other features discriminative of symptomatic postpolio patients were found. In individual patients, muscle CT scan evaluation is a useful adjunct to muscle strength assessment.

Subject Headings
Muscle, Skeletal - Radiography; Poliomyelitis - Radiography; Postpoliomyelitis Syndrome - Radiography
Adult; Middle Age; Muscle, Skeletal - Physiopathology; Poliomyelitis - Physiopathology; Postpoliomyelitis Syndrome - Physiopathology; Tomography, X-Ray Computed


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MARCH 1998

SUBJECTIVE RECOVERY TIME AFTER EXHAUSTING MUSCULAR ACTIVITY IN POSTPOLIO AND CONTROL SUBJECTS

Agre JC; Rodriquez AA; Franke TM
Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison 53792, USA
Am J Phys Med Rehabil, Mar-Apr 1998, 77(2), p140-4

Abstract

The purpose of this study was to determine whether the time to subjectively fully recover after the performance of exhausting muscular exercise was greater in unstable postpolio as compared with stable postpolio or control subjects. Twenty-five unstable (those complaining of declining muscle strength) postpolio, 16 stable (those denying declining muscle strength) postpolio, and 25 control subjects performed an isometric contraction of the knee extensor (quadriceps femoris) musculature at 40% of maximal torque until they were no longer able to do so. Five-second maximal effort contractions were made every 30 s through 2 min after the time of failure was reached and then at 1-min intervals through 10 min after failure was reached. Subjects reported the duration of time required to subjectively fully recover from this activity. Choices of "less than 1 day", "1 day", "2 days", etc, up to "greater than 2 wk" were given to the subjects for their response. Analysis was by nonparametric ANOVA and appropriate post hoc comparison procedures. Unstable postpolio subjects reported a greater recovery time than either the stable postpolio or control subjects (mean +/- SD of 2.6 +/- 3.0 days, 0.6 +/- 1.0 days and 0.7 +/- 1.1 days, respectively, P < 0.05). Thus, the reported recovery time from exhausting isometric muscular exercise was found to be greater in unstable postpolio subjects than stable postpolio or control subjects. The cause for this finding is unknown and requires further investigation.

Subject Headings
Exercise Tolerance - Physiology; Isometric Contraction - Physiology; Muscle Fatigue - Physiology; Poliomyelitis - Physiopathology
Adult; Analysis of Variance; Case-Control Studies; Chronic Disease; Disease Progression; Exercise Test; Knee Joint; Middle Age; Statistics, Nonparametric; Time Factors


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"POSTPOLIO" SEQUELAE AND SLEEP-RELATED DISORDERED BREATHING

Hsu AA, Staats BA
Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, MN 55905, USA
Mayo Clin Proc, Mar 1998, 73(3), p216-24

Abstract

OBJECTIVE: To analyze the clinical manifestations and various types of sleep-related disordered breathing (SRDB) in patients with a history of poliomyelitis and with current "postpolio" sequelae (PPS).

MATERIAL AND METHOD: We retrospectively reviewed the medical records of 108 consecutive patients with PPS and sleep disturbances encountered during an 11-year period at Mayo Clinic Rochester and abstracted the features of acute polio, PPS, and results of sleep evaluation (overnight oximetry or polysomnography). Only those patients who were not receiving ventilatory support were included in the study.

RESULTS: The features of PPS were dyspnea, fatigue, new weakness, and musculoskeletal pain. Of the 108 patients, 35 fulfilled the inclusion criteria. Sleep evaluations revealed three general types of sleep disturbances: obstructive sleep apnea (group O, N = 19), hypoventilation (group H, N = 7); and both (group OH, N = 9). The mean apnea/hypopnea index was 37, 4, and 16 per hour in patients in groups O, H and OH respectively (P < 0.05), and the mean arterial carbon dioxide tension was 39, 60 and 55 mm Hg in these respective study groups (P < 0.05). The overall mean age at onset of symptoms of SRDB was 47 years, and the mean latent period after acute polio was 37 years. Hypersomnolence was the commonest SRDB symptom, present in 32 of the 35 patients. Snoring was noted in 100% of the patients in group O, 0% in group H, and 67% in group OH. Patients in group O were obese and had normal lung function. Patients in group H tended to have normal weights and a history of diffuse neurologic deficits involving the trunk during the acute episode of polio. Scoliosis, restricted lung function, cor pulmonale, and decreased maximal respiratory pressures were common in patients in group H. Patients in group OH had overlapping features of those in groups O and H.

CONCLUSION: In patients with PPS, we identified three patterns of sleep disturbances - obstructive sleep apnea, hypoventilation, and a combination of both. These groups are characterized by clinical features and by results of arterial blood gas determinations, overnight oximetry, and polysomnography. SRDB is a late sequela of poliomyelitis, and clinical evaluation should include information about sleep.

Subject Headings
Hypoventilation - Etiology; Postpoliomyelitis Syndrome - Complications; Postpoliomyelitis Syndrome - Diagnosis; Sleep Apnea Syndromes - Etiology Carbon Dioxide - Blood; Hypoventilation - Physiopathology; Middle Age; Oximetry; Oxygen - Blood; Polysomnography; Postpoliomyelitis Syndrome - Physiopathology; Respiratory Function Tests; Retrospective Studies; Sleep Apnea Syndromes - Physiopathology


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FEBURARY 1998

FATIGUE: DEFINITIONS, MECHANISMS, AND PARADIGMS FOR STUDY

Dalakas MC; Mock V; Hawkins MJ
The National Institute for Neurological Disorders and Stroke, Bethesda, MD, USA
Semin Oncol, Feb 1998, 25(1 Suppl 1), p48-53

Abstract

Interferon-alpha (IFN-alpha) therapy is frequently associated with significant fatigue, which is often the dominant dose-limiting side effect. The fatigue associated with IFN-alpha therapy is usually dose related, worsens with continued therapy, and is associated with significant depression. Although the direct cause of IFN-alpha-induced fatigue is unknown, it is possible that neuromuscular fatigue, similar to that observed in patients with postpolio syndrome, is one component of this syndrome. The induction of proinflammatory cytokines observed in patients treated with IFN-alpha is consistent with a possible mechanism of neuromuscular pathology that could manifest as fatigue. Further research using established techniques for the study of neuromuscular fatigue is needed to test this hypothesis. Understanding the etiology of IFN-alpha-induced fatigue is the first step toward developing effective therapeutic interventions. Nonpharmacologic interventions for fatigue have begun to be seriously evaluated in cancer patients and patients receiving IFN-alpha therapy. Pharmacologic interventions for neuromuscular fatigue also are being investigated.

Subject Headings
Fatigue - Etiology; Interferon-alpha - Adverse Effects
Fatigue - Therapy; Neuromuscular Junction - Physiology


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ASSESSMENT INSTRUMENT FOR PROBLEM-FOCUSED COPING. RELIABILITY TEST OF APC. PART 1

Tollen A; Ahlstrom G
Department of Caring Sciences, University of Orebro, Sweden.
Scand J Caring Sci, 1998, 12(1), p18-24

Abstract

A new self-report instrument, the Assessment Instrument of Problem-focused Coping (APC) developed from qualitative interviews, is described. This instrument provides knowledge of the patients= own competence in coping with activities of daily living (ADL), the patients= own assessment of what they experience as problems, and the extent to which they are satisfied with their ADL. The purpose of the study was to test the reliability of the instrument with regard to intra-rater reliability and internal consistency. The study group comprised 40 patients with muscular weakness and other symptoms relating to the postpolio syndrome. The result showed an acceptable internal consistency (alpha 0.70), which confirms the construct validity of the instrument. The test-retest showed that the stability over time varied from low to high for a total of 28 items. At the same time, it is evident that the instrument does not achieve the aim of being a good evaluation instrument, because the stability over a period of time was unsatisfactory. The test-retest should be repeated with a larger test group in future research projects.

Subject Headings
Adaptation, Psychological; Nursing Assessment - Methods; Nursing Assessment - Standards; Postpoliomyelitis Syndrome - Psychology; Problem Solving
Activities of Daily Living; Aged; Aged, 80 and over; Middle Age; Nursing Methodology Research; Observer Variation; Postpoliomyelitis Syndrome - Rehabilitation; Psychometrics; Reproducibility of Results; Time Factors.

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