DYNAMIC WATER EXERCISE IN INDIVIDUALS WITH LATE POLIOMYELITIS

Willen C; Sunnerhagen KS; Grimby G

Department of Rehabilitation Medicine, Goteborg University, Goteborg, Sweden
carin.willen@fhs.gu.se

Arch Phys Med Rehabil, Jan 2001, 82(1), 66-72

Abstract

OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minutes general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not effect the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

CONCLUSIONS: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) an can be recommended for this group of individuals.

Subject Headings

Exercise Therapy - Methods; Immersion; Poliomyelitis - Rehabilitation

Adult; Aged; Anaerobic Threshold - Physiology; Equilibrium - Physiology; Heart Rate - Physiology; Middle Age; Oxygen Consumption - Physiology; Poliomyelitis - Physiopathology; Quality of Life; Statistics, Nonparametric; Treatment Outcome; Walking - Physiology

^ back to top ^

PHYSICAL ACTIVITY FOR ELDERLY PERSONS WITH NEUROLOGICAL IMPAIRMENT: A REVIEW

Eldar R; Marincek C

Loewenstein Hospital Rehabilitation Centre, WHO Collaborating Centre for Community-based Rehabilitation, Raanana, Israel

Scand J Rehabil Med, Sep 2000, 32(3), p99-103

Abstract

The paper reviews studies conducted on physical activities and exercise in elderly persons with neurological impairment due to stroke, Guillain-Barre Syndrome, Parkinson's Disease, Multiple Sclerosis, or Post Polio Syndrome. The paper concludes: (i) it is not possible at present to draw conclusions regarding persons with Guillain-Barre Syndrome and Parkinson's Disease; (ii) individuals with Multiple Sclerosis and Post Polio Syndrome benefit from physical activity, but all studies have so far been conducted on those under 65 years of age, and its effect on elderly persons with these diseases is not known; (iii) exercise and customary activities (walking and swimming) should be encouraged and promoted in elderly persons after stroke.

Subject Headings

Cerebrovascular Accident - rehabilitation; Exercise Therapy; Nervous System Diseases - rehabilitation

Age Factors; Aged; Frail Elderly; Guillain-Barre Syndrome - rehabilitation; Life Style; Middle Age; Multiple Sclerosis - rehabilitation; Parkinson Disease - rehabilitation; Poliomyelitis - rehabilitation

^ back to top ^

CHANGES IN STRENGTH OVER TIME AMONG POLIO SURVIVORS

Klein MG; Whyte J; Keenan MA; Esquenazi A; Polansky M

Moss Rehabilitation Research Institute, Philadelphia, PA 19141, USA

Arch Phys Med Rehabil, Aug 2000, 81(8), p1059-64

Abstract

OBJECTIVE: To study changes in the strength of different muscle groups in polio survivors over a period of approximately 9 months.

DESIGN: Longitudinal study.

SETTING: Moss Rehabilitation Research Institute

PARTICIPANTS: One hundred twenty subjects (57 men, 63 women) were studied on three occasions, each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss Post-Polio Management Program, newspaper advertisements, and polio support groups.

MAIN OUTCOME MEASURES: Isometric strength of 30 muscle groups (16 in upper extremities, 14 in lower extremities) was measured, using a hand-held dyanomometer.

RESULTS: Data were analysed in two separate groups: upper-extremity muscles and lower-extremity muscles. Results for the upper-extremity muscles revealed evidence of a significant deterioration in strength. The amount of deterioration differed among muscles and increased with age. There was also evidence of deterioration in strength in the flexor muscle in the ankle, hip, and knee. However, the rate of deterioration in these muscles was not strongly related to age, time since polio, gender, symptom status, or history of residual weakness.

CONCLUSIONS: Strength is deteriorating among polio survivors at a rate higher than that associated with normal aging. This deterioration is not occurring in the extensor, or so-called 'weight-bearing' muscles, but is occurring in many of the upper-extremity muscle groups and in the flexor muscles in the lower extremeties.

Subject Headings

Muscle, Skeletal - Physiopathology; Postpoliomyelitis Syndrome - Rehabilitation

Adult; Aged, 80 and over; Middle Age; Postpoliomyelitis Syndrome - Physiopathology; Time Factors

^ back to top ^

USE OF THE COLLISION TECHNIQUE TO IMPROVE THE ACCURACY OF MOTOR UNIT NUMBER ESTIMATION

Aoyagi Y; Strohschein FJ; Ming Chan K

Division of Neuroscience, 513 Heritage Medical Research Center, University of Alberta, Admonton, T6G 2S2, Alberta, Canada

Clinical Neurophysiology, Jul 2000, 111(7), p1315-9

Abstract

OBJECTIVE: To evaluate the risk of stimulating the same motor axon at different points along the median nerve when using the multiple point stimulation (MPS) technique and how this affects the accuracy of the motor unit number estimate (MUNE).

METHODS: Using the MPS technique, MUNE in the medican innervated intrinsic hand muscles was done on two normal subjects, a patient with carpal tunnel syndrome and one with prior poliomyelitis. The collision technique was then used to confirm whether two motor unit action potentials (MUAPs) with similar configurations and sizes were generated by the same motor unit. A new MUNE was recalculated after the repeated inclusion of the same motor unit had been excluded.

RESULTS: While the risk of stimulating the same motor axon at widely separate locations of the median nerve was negligible in normal subjects, this risk was much higher in patients with a depleted motor neuron pool. This resulted in marked distortion of the calculated size of the average single MUAP and, consequently, inaccuracy of the MUNE.

CONCLUSIONS: The inadvertent inclusion of the same motor units, if not recognized, can markedly affect the accuracy of the MUNE. The collision technique can be useful in minimizing this risk.

Subject Headings

Carpal Tunnel Syndrome - Physiopathology; Median Nerve - Physiology; Median Nerve - Physiopathology; Motor Neurons; Postpoliomyelitis Syndrome - Physiopathology

Action Potentials; Adult; Cell Count; Electric Stimulation; Female; Hand; Human; Male; Middle Age; Motor Neurons - Cytology; Motor Neurons - Physiology; Reproducibility of Results; Sensory Thresholds; Support, Non-US Gov't

^ back to top ^

DYNAMIC WATER EXERCISE IN INDIVIDUALS WITH LATE POLIOMYELITIS

Willen C; Sunnerhagen KS; Grimby G

Department of Rehabilitation Medicine, Goteborg University, Goteborg, Sweden

carin.willen@fhs.gu.se

Arch Phys Med Rehabil, Jan 2001, 82(1), 66-72

Abstract

OBJECTIVE:To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis. DESIGN: Before-after tests.

SETTING: A university hospital department.

PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION: The TG completed a 40-minutes general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP. RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not effect the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

CONCLUSIONS: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.

Subject Headings

Exercise Therapy - Methods; Immersion; Poliomyelitis - Rehabilitation Adult; Anaerobic Threshold - Physiology; Equilibrium - Physiology; Heart Rate - Physiology; Middle Age; Oxygen Consumption - Physiology; Poliomyelitis - Physiopathology; Quality of Life; Statistics, Nonparametric; Treatment Outcome; Walking - Physiology

^ back to top ^

MUSCULAR EFFECTS IN LATE POLIO

Sunnerhagen KS; Grimby G

Department of Rehabilitation Medicine, Goteborg University, Goteborg, Sweden

Acta Physiologica Scandinavica, Mar 2001, 171(3), 335-40

Abstract

New or increased muscular weakness, fatigue and muscle and joint pain with neuropathic electromyography (EMG) changes in a person with a confirmed history of polio constitute the cardinal symptoms of the post-polio syndrome. Unusual tiredness or fatigue is a common complaint in late polio subjects as in intolerance to cold. Fatigue in polio subjects can have several explanations: emotional fatigue, central nervous system fatigue, 'general' fatigue and/or neuromuscular fatigue. Some studies indicate central fatigue, but it is unclear how often and to which degree there will be a central muscular fatigue. Polio patients are known to be deconditioned (reduced function because of low activity level), and aerobic power is reduced. Defects in the neuromuscular transmission may be present but are not seen in all post-polio subjects with reduction in force and increased fatigability. The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.

Subject Headings

Muscle Weakness - Physiopathology; Muscle, Skeletal - Physiopathology; Postpoliomyelitis Syndrome - Physiopathology Electromyography; Muscle Fatigue; Muscle Weakness - Etiology; Muscle Weakness - Psychology; Postpoliomyelitis Syndrome - Diagnosis

^ back to top ^

FATIGUE IN POLIO SURVIVORS

Schanke AK; Stanghelle JK Sunnaas

Rehabilitation Hospital, Research Unit, 1450 Nesoddtangen,

Norway Spinal Cord, May 2001, 39(5), 243-51

Abstract

OBJECTIVES:Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables.

MATERIALS AND METHODS:A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire.

RESULTS:The incidence of fatigue among the polio survivors were considerably higher than in the normal data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group.

CONCLUSIONS:The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.

Subject Headings

Fatigue - Diagnosis; Fatigue - Epidemiology; Poliomyelitis - Epidemiology; Postpoliomyelitis Syndrome - Diagnosis; Postpoliomyelitis Syndrome - Epidemiology Adolescence; Adult; Age Distribution; Aged; Analysis of Variance; Chi-Square Distribution; Comorbidity; Health Surveys; Incidence; Middle Age; Norway - Epidemiology; Poliomyelitis - Diagnosis; Poliomyelitis - Therapy; Questionnaires; Risk Assessment; Severity of Illness Index; Sex Distribution; Sickness Impact Profile; Survivors

^ back to top ^

COMING TO TERMS WITH THE SHIFT IN ONE'S CAPABILITIES: A STUDY OF THE ADAPTIVE PROCESS IN PERSONS WITH POLIOMYELITIS SEQUELAE

Thoren-Jonsson AL

Department of Rehabilitation Medicine, Goteborg University, Sweden

Anna-lisa.thoren-jonsson@rehab.gu.se Disability and Rehabilitation, 20 May 2001, 23(8), 341-51

Abstract

PURPOSE: The main purpose of this paper was to investigate the process of adaptation in persons with poliomyelitis sequelae with reference to daily occupations. In addition, changes in ability in activities of daily living (ADL) and in the use of assistive devices over a 4-5 year period will be described.

METHOD: Qualitative interviews with 22 persons with poliomyelitis sequelae were content analysed according to grounded theory. Ability in personal and instrumental ADL was assessed.

RESULTS: The core category 'coming to a changed approach' towards the shift in one's capabilities describes two integrated processes: one deals with the process of realization and reorganisation; the other consists of six patterns of behaviour in daily occupations. The persons had a high degree of independence in personal ADL, whereas the dependence in cleaning, shopping and transportation was extensive.

CONCLUSIONS: Flexibility in choosing strategies facilitated participation in daily occupations. Requirements for this adaptive pattern were time, energy and ability to solve problems, accessible environments, access to information and support, and readiness to compensate with assistive devices.

Subject Headings

Adaptation, Psychological; Disabled Persons; Poliomyelitis - Rehabilitation Activities of Daily Living; Adult; Aged; Middle Age; Self-Help Devices

^ back to top ^

LONG-TERM FOLLOW-UP OF PATIENTS WITH NONPARALYTIC POLIOMYELITIS

Rekand T; Karlsen B; Langeland N; Aarli JA

Department of Neurology, Unit of Clinical Neurophysiology, Haukeland University Hospital, N-5021 Bergen, Norway

Tiina.Rekand@haukeland.no Arch Phys Med Rehabil, Apr 2002, 83(4), 533-7

Abstract

OBJECTIVE: To examine patients with previous nonparalytic poliomyelitis in search of muscle atrophy, weakness, and other late symptoms of poliomyelitis. DESIGN: A mailed questionnaire followed up with neurologic and neurophysiologic examinations of respondents who reported symptoms possibly related to the late sequelae of polio.

SETTING: Neurology Department at a university hospital.

PARTICIPANTS: Thirty-nine of 47 patients diagnosed with nonparalytic poliomyelitis and hospitalised at a Norwegian Hospital between 1950 and 1954, during the Norwegian polio epidemic.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Electromyography to determine function of the anterior tibialis, vastus lateralis, and biceps brachii muscles; nerve conduction studies of the sural, peroneal, and tibial nerves; motor and sensory nerve conduction velocity, and compound muscle and sensory nerve action potentials, and distal latencies.

RESULTS: Twenty-five of 47 patients (53.2%) reported symptoms possibly related to the late sequelae of poliomyelitis. Eight of 20 examined symptomatic patients had normal neurologic and neurophysiologic findings, whereas 9 others had other medical conditions that could explain the symptoms. Three patients (6.7%) had neurologic and neurophysiologic findings and development of symptoms consistent with motoneuron damage.

CONCLUSION: Some nonparalytic patients may have subclinical acute motoneuron damage with subsequent development and manifestaion of motor weakness and neuromuscular symptoms many years later. These symptoms should be considered a differential diagnosis in patients who have a history of nonparalytic poliomyelitis.

Subject Headings

Disability Evaluation: Motor Neurons - Physiology; Muscle Weakness - Rehabilitation; Muscle Weakness - Physiopathology; Muscle Weakness - Diagnosis; Neural Conduction - Physiology; Neurologic Examination; Poliomyelitis - Rehabilitation; Poliomyelitis - Physiopathology

^ back to top ^

A COMPARISON OF THE EFFECTS OF EXERCISE AND LIFESTYLE MODIFICATION ON THE RESOLUTION OF OVERUSE SYMPTOMS OF THE SHOULDER IN POLIO SURVIVORS: A PRELIMINARY STUDY

Klein MG; Whyte J; Esquenazi A; Keenan MA; Costello R

Moss Rehabilitation Research Institute, Philadelphia, PA 19141 USA mklein@einstein.edu

Arch Phys Med Rehabil, May 2002, 83(5), 708-13

Abstract

OBJECTIVE: To compare the effectiveness of exercise and lifestyle modification therapy in treating shoulder symptoms in polio survivors with lower-extremity weakness.

DESIGN: A randomised parallel group study.

SETTING: Research laboratory.

PARTICIPANTS: Twenty-three subjects recruited from a cohort of 194 polio survivors who had participated in a previous study had bilateral hip-extensor and knee-extensor weakness and reported experiencing shoulder pain on a regular basis with daily activity.

INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups. Members of group 1 were placed on a home exercise program that focused on strengthening the hip and knee extensors. Members of group 2 were instructed in lifestyle modification techniques designed to avoid shoulder overuse. Members of group 3 received both interventions.

MAIN OUTCOME MEASURES: Shoulder symptoms were quantified in terms of number and severity. Isometric strength of bilateral hip and knee extensors was measured with a hand-held dynamometer.

RESULTS: Symptoms improved in all 3 groups. However, members of the exercise-only group (group 1) were the only ones to show a significant difference in both the number and severity of symptoms when pre- and post-treatment values were compared.

CONCLUSIONS: Both exercise and lifestyle modification therapies that focus on reducing stress related to lower-extremity weakness are effective in treating shoulder overuse symptoms in polio survivors. A trend toward greater improvement in shoulder symptoms in subjects who participated in the exercise program and who also showed a trend toward increased knee-extensor strength support muscle strength and/or endurance as a key factor.

Subject Heading

Exercise Therapy; Poliomyelitis - Rehabilitation; Poliomyelitis - Physiopathology; Poliomyelitis - Complications; Shoulder Joint - Physiopathology

^ back to top ^

UPPER-LIMB PAIN IN LONG-TERM POLIOMYELITIS

Koh ES; Williams AJ; Povlsen B

Department of Orthopaedic Surgery, St Thomas' Hospital, London and The Lane Fox Unit, St Thomas' Hospital, London, UK QJM, Jun 2002, 95(6), 389-95

Abstract

BACKGROUND: Late functional deterioration is common in long-term poliomyelitis patients. While upper-limb pain in individual regions is common, its overall prevalence and pattern in long term poliomyelitis is poorly documented.

AIM: To assess the nature of upper-limb pain in these patients and examine its association with dependence on mobility aids (and therefore upper limb 'overuse').

DESIGN: Questionnaire-based survey of patients attending a specialist unit.

METHODS: Questionnaires were sent to 139 patients with know long-term poliomyelitis (mean 49.8 years post polio), attending the Lane Fox Unit outpatient clinic at St Thomas' Hospital between January 1998 and December 1998. There were questions on the nature of the patient's acute illness, limb involvement at initial infection ('polio-affected' limbs), the site and onset of upper-limb pain, hand dominance, previous injuries and surgery, and the use of mobility aids. Limbs that had sustained an injury or undergone surgery, at or preceding onset of upper-limb pain, were excluded from analysis.

RESULTS: Among 103 valid replies, the prevalence of upper-limb pain was 64%. Mobility aids were used by 74%, and were associated with an increased risk of upper-limb pain, while 'polio-affected' limbs were at reduced risk.

DISCUSSION: These date support 'overuse' due to greater mobility aid dependence as a cause of increasing upper-limb pain in long-term poliomyelitis.

^ back to top ^