web contact: pietsch@indiana.edu
Note: 146 abstracts follow; use the FIND or SEARCH function of your computer to find specific aspects of pps.
<1>
Unique Identifier 98251434
Authors: Wekre LL. Stanghelle JK. Lobben B. Oyhaugen S.
Institution: Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
Title: The Norwegian Polio Study 1994: a nation-wide survey of problems in long-standing poliomyelitis.
Source Spinal Cord. 36(4):280-4, 1998 Apr.
Abstract: 'The Norwegian Polio Study 1994' was performed to make a nation-wide survey of the medical and social situation, and of the needs of anterior poliomyelitis (polio). A questionnaire, consisting of 133 questions with sub-questions, was sent to a total of 2392 polio victims, most of them registered in 'The National Society of Polio Victims' in Norway. 1449 persons (61%) answered. Sixty-six per cent were between 45 and 64 years of age, 25% were above 64 years and 9% were under 45 years. When specifying new health problems, 85% stated that they had experienced increased weakness in muscles affected by polio, while 58% had experienced increased weakness in previous non-affected muscles. Other health problems related to polio were fatigue during exercise (80%), general fatigue (57%), joint pain (58%), muscular pain (58%) and cold intolerance (62%). The participants indicated an increasing need of aids, but 80% were still independent of help from others and 57% were still employed, fully or part time. Only 17% were satisfied with the public health services for polio survivors, while 67% of those who had undergone comprehensive examination at some central hospital were satisfied. This study indicates an obvious need of building up expertise in multidisciplinary evaluation and treatment of post polio problems in countries where acute polio has been eliminated.
<2>
Unique Identifier 98211846
Authors: Weintraub MI.
Title: Magnetotherapy: a new intervention? [letter; comment].
Comments Comment on: Arch Phys Med Rehabil 1997 Nov;78(11):1200-3
Source Archives of Physical Medicine & Rehabilitation. 79(4):469-70, 1998 Apr.
<3>
Unique Identifier 98032053
Authors: Vallbona C. Hazlewood CF. Jurida G.
Institution: Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Title: Response of pain to static magnetic fields in postpolio patients: a double-blind pilot study [see comments].
Comments Comment in: Arch Phys Med Rehabil 1998 Apr;79(4):469-70
Source Archives of Physical Medicine & Rehabilitation. 78(11):1200-3, 1997 Nov.
Abstract: OBJECTIVE: To determine if the chronic pain frequently presented by postpolio patients can be relieved by application of magnetic fields applied directly over an identified pain trigger point. DESIGN: Double-blind randomized clinical trial. SETTING: The postpolio clinic of a large rehabilitation hospital. PATIENTS: Fifty patients with diagnosed postpolio syndrome who reported muscular or arthritic-like pain. INTERVENTION: Application of active or placebo 300 to 500 Gauss magnetic devices to the affected area for 45 minutes. MAIN OUTCOME MEASURE: Score on the McGill Pain Questionnaire. RESULTS: Patients who received the active device experienced an average pain score decrease of 4.4 +/- 3.1 (p < .0001) on a 10-point scale. Those with the placebo devices experienced a decrease of 1.1 +/- 1.6 points (p < .005). The proportion of patients in the active-device group who reported a pain score decrease greater than the average placebo effect was 76%, compared with 19% in the placebo-device group (p < .0001). CONCLUSIONS: The application of a device delivering static magnetic fields of 300 to 500 Gauss over a pain trigger point results in significant and prompt relief of pain in postpolio subjects.
<4>
Unique Identifier 98289498
Authors: Samii A. Lopez-Devine J. Wasserman EM. Dalakas MC. Clark K. Grafman J. Hallett M.
Institution: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1428, USA.
Title: Normal postexercise facilitation and depression of motor evoked potentials in postpolio patients.
Source Muscle & Nerve. 21(7):948-50, 1998 Jul.
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 that of the baseline amplitude, indicating similar postexercise depression. We conclude that the intracortical component of central fatigue is normal in postpolio patients.
<5>
Unique Identifier 98289487
Authors: Roeleveld K. Sandberg A. Stalberg EV. Stegeman DF.
Institution: Department of Clinical Neurophysiology, University Hospital Nijmegen, The Netherlands.
Title: Motor unit size estimation of enlarged motor units with surface electromyography.
Source Muscle & Nerve. 21(7):878-86, 1998 Jul.
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 enlarged 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.
<6>
Unique Identifier 98252229
Authors: Robinson LR. Hillel AD. Waugh PF.
Institution: Department of Rehabilitation Medicine, University of Washington, Seattle, USA.
Title: New laryngeal muscle weakness in post-polio syndrome.
Source Laryngoscope. 108(5):732-4, 1998 May.
Abstract: The authors describe the clinical presentations of post-polio laryngeal muscle weakness in three patients with prior polio infection who presented with new complaints including slowly progressive dyspnea, dysphagia, and/or hoarseness. Evaluations by laryngeal videostroboscopy and electromyography revealed vocal cord abductor and/or adductor weakness, recurrent posterior glottic web in one case, and, in the two patients who agreed to electromyography, evidence of prior denervation and reinnervation in laryngeal muscles. Treatment was directed at attempting to maintain an airway and optimize vocal quality. One patient benefitted from tracheostomy, one benefitted from vocal cord medialization, and one benefitted from resection of interarytenoid scarring. The authors conclude that diagnosis of laryngeal post-polio syndrome is facilitated by laryngeal electromyography. Interventions directed at maintaining an appropriate airway and optimizing vocal quality may be helpful.
<7>
Unique Identifier 98263748
Authors: Tollen A. Ahlstrom G.
Institution: Department of Caring Sciences, University of Orebro, Sweden.
Title: Assessment Instrument for Problem-focused Coping. Reliability test of APC. Part 1.
Source Scandinavian Journal of Caring Sciences. 12(1):18-24, 1998.
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 a period of 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.
<8>
Unique Identifier 98244761
Authors: Dean AC. Graham BA. Dalakas M. Sato S.
Institution: EEG Section, NINDS, NIH, Bethesda, MD, USA.
Title: Sleep apnea in patients with postpolio syndrome.
Source Annals of Neurology. 43(5):661-4, 1998 May.
Abstract: We studied sleep architecture and sleep apnea pattern in patients with postpolio syndrome (PPS). Ten patients with clinical signs of PPS underwent polysomnographic recording for two consecutive nights. Although sleep efficiency and proportions of sleep stages were within the normal range, sleep architecture was disrupted owing to sleep apnea. Patients with bulbar involvement had more frequent sleep apnea (mean sleep apnea index, 11.09) than patients without (apnea index, 5.88). The former also had significantly more central apnea, which occurred more commonly during non-rapid-eye-movement (NREM) than rapid-eye-movement (REM) sleep, than those without bulbar signs. This finding suggests reduction in forebrain control of compromised bulbar respiratory centers during NREM sleep in PPS.
<9>
Unique Identifier 98193963
Authors: Halstead LS.
Institution: National Rehabilitation Hospital in Washington, D.C., USA.
Title: Post-polio syndrome.
Source Scientific American. 278(4):42-7, 1998 Apr.
<10>
Unique Identifier 98192476
Authors: Ivanyi B. Redekop W. de Jongh R. de Visser M.
Institution: Department of Rehabilitation Medicine, University of Groningen, The Netherlands.
Title: Computed tomographic study of the skeletal musculature of the lower body in 45 postpolio patients.
Source Muscle & Nerve. 21(4):540-2, 1998 Apr.
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.
<11>
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Unique Identifier 98172769
Authors: Hsu AA. Staats BA.
Institution: Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, MN 55905, USA.
Title: "Postpolio" sequelae and sleep-related disordered breathing.
Source Mayo Clinic Proceedings. 73(3):216-24, 1998 Mar.
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 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 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.
<12>
Unique Identifier 98141478
Authors: Bach JR. Rajaraman R. Ballanger F. Tzeng AC. Ishikawa Y. Kulessa R. Bansal T.
Institution: Department of Physical Medicine and Rehabilitation, UMDNJ-The New Jersey Medical School, University Hospital, Newark 07103, USA.
Title: Neuromuscular ventilatory insufficiency: effect of home mechanical ventilator use v oxygen therapy on pneumonia and hospitalization rates.
Source American Journal of Physical Medicine & Rehabilitation. 77(1):8-19, 1998 Jan-Feb.
Abstract: The purpose of this study was to determine rates of pneumonia and hospitalization for patients receiving oxygen therapy, patients having indwelling tracheostomy tubes, and those using tracheostomy or noninvasive methods of home mechanical ventilation. Six hundred eighty-four users of assisted ventilation for 13,751 patient-years or 19.8 years per patient were surveyed by mail and twice by telephone over a span of four years. Pneumonia and hospitalization rates were significantly higher for ventilator users with chronic obstructive pulmonary disease or with neuromuscular ventilatory insufficiency and gastrostomy tubes than for ventilator users with neuromuscular ventilatory insufficiency without gastrostomy tubes. Of the latter group, more than 90% of the pneumonias and hospitalizations were triggered by otherwise benign intercurrent upper respiratory tract infections. Oxygen therapy was associated with a significantly (P < 0.001) higher rate of pneumonias and hospitalizations than that seen for untreated patients after initial episodes of respiratory distress or during the use of either tracheostomy intermittent positive pressure ventilation or noninvasive ventilatory assistance methods. The lowest pneumonia and hospitalization rates (P < 0.001) were by full-time, noninvasive intermittent positive pressure ventilation users. We conclude that oxygen therapy is not an effective substitute for assisted ventilation for patients with primarily ventilatory insufficiency. Noninvasive ventilatory aids can be used effectively for up to full-time ventilatory support for patients with neuromuscular conditions whose bulbar muscle function is adequate to avert the need for gastrostomy tube placement.
<13>
Unique Identifier 98105167
Authors: Spencer RP. Mittal P.
Institution: Department of Nuclear Medicine, University of Connecticut Health Center, Farmington 06030, USA.
Title: Reticuloendothelial "activation" noted after splenectomy for ITP and presence of a post-poliomyelitis asymmetry.
Source Clinical Nuclear Medicine. 23(1):8-9, 1998 Jan.
Abstract: A radiocolloid study was carried out, after splenectomy, in a 75-year-old man who had idiopathic thrombocytopenic purpura. The patient, who did not have an increase in platelet counts after spleen removal or after platelet infusions, showed radiocolloid accumulation in the lungs and in the bone marrow. This suggested some "activation" of reticuloendothelial cells, perhaps by circulating immune complexes. The left femur (site of an episode of poliomyelitis many years previously) had less radiocolloid uptake than the right.
<14>
Unique Identifier 98002999
Authors: LaBan MM. Taylor RS.
Title: Flat back and postpolio syndromes [letter; comment].
Comments Comment on: Arch Phys Med Rehabil 1997 Mar;78(3):324-6
Source Archives of Physical Medicine & Rehabilitation. 78(8):894-5, 1997 Aug.
<15>
Unique Identifier 97238021
Authors: Ring D. Vaccaro AR. Scuderi G. Klein G. Green D. Garfin SR.
Institution: Department of Orthopedic Surgery, University of California at San Diego School of Medicine, USA.
Title: An association between the flat back and postpolio syndromes: a report of three cases [see comments].
Comments Comment in: Arch Phys Med Rehabil 1997 Aug;78(8):894-5
Source Archives of Physical Medicine & Rehabilitation. 78(3):324-6, 1997 Mar.
Abstract: The cases of three patients with a history of paralytic poliomyelitis in childhood who developed the flat back syndrome before or after spinal fusion for degenerative disease as adults were reviewed. The flat back syndrome, a combination of an inability to stand erect because of forward flexion of the trunk and pain in the low back and/or legs, typically occurs in the setting of decreased lumbar lordosis as a result of distraction instrumentation of the spine for scoliosis, vertebral fracture, or degenerative disease. Focus was placed on determining the factors responsible for the development and/or persistence of the flat back syndrome in these patients despite maintenance of, or partial operative restoration of, lumbar lordosis. Considering the essential role that the trunk extensor musculature plays in maintaining upright posture, it may be that a new onset of weakness (postpolio syndrome) in this musculature represents a major contributing factor to the flat back syndrome in these patients. Spine surgeons considering operative procedures in patients with a remote history of paralytic poliomyelitis should be aware of the possible increased risk of the flat back syndrome in this population of patients.
<16>
Unique Identifier 98072968
Authors: Heim M. Yaacobi E. Azaria M.
Institution: Lewis National Rehabilitation Institute, Department of Orthopedic Rehabilitation, Tel Aviv University, Israel.
Title: A pilot study to determine the efficiency of lightweight carbon fibre orthoses in the management of patients suffering from post-poliomyelitis syndrome.
Source Clinical Rehabilitation. 11(4):302-5, 1997 Nov.
Abstract: OBJECTIVES: To assess the usage of carbon fibre orthoses in assisting post-polio syndrome patients who reported advancing weakness and difficulty in maintaining their independent ambulatory status. DESIGN AND INTERVENTIONS: Carbon fibre orthoses that are 30% lighter than metal braces were constructed. SUBJECTS: Thirty patients who complained of difficulty in maintaining their ambulation using long-leg braces were provided with lightweight orthoses. RESULTS: Seventy per cent of the patients reported satisfaction with their braces. There were, however, problems in construction and use. CONCLUSIONS: Ambulation can be preserved in some patients who report advancing weakness because of post-polio syndrome.
<17>
Unique Identifier 98007320
Authors: Ananian SG. Bezrukov VM. Avetisian EK.
Title: [A new method for the surgical treatment of patients with paralysis of the tongue]. [Russian]
Source Stomatologiia. 76(5):18-21, 1997.
<18>
Unique Identifier 97439975
Authors: Hoshino S. Hayashi A. Ohkoshi N. Mizusawa H. Shoji S.
Institution: Department of Neurology, University of Tsukuba.
Title: [A case of post-poliomyelitis muscular atrophy with cranial nerve signs and widespread muscular atrophy of the extremities]. [Japanese]
Source Rinsho Shinkeigaku - Clinical Neurology. 37(5):407-9, 1997 May.
Abstract: Here we report a case of a 56-year-old male with post-poliomyelitis muscular atrophy (PPMA), who presented with cranial nerve signs and widespread atrophy of the extremities. He had suffered from poliomyelitis at the age of 2 years. After recovery from the acute stage, the paralysis remained in his left arm. He noticed muscle weakness of the right upper and lower extremities at the age of 45 years and the muscle atrophy progressed to his arms, hip and thigh at the age of 55 years. Neurological examination revealed muscle atrophy of the neck and disturbance of left V, VIII, IX, X and bilateral XI cranial nerves. We diagnosed this case as PPMA from his history and electromyographic and muscle biopsy findings which suggested chronic denervation. Among the 21 PPMA cases in the past in which the acute poliomyelitis had resulted in paralysis of the only one limb, ours was the only case that had muscle atrophy of all the limbs. Cranial nerve involvement is known to occur in acute poliomyelitis; therefore, there is a possibility that the involvement of the cranial nerves in our case might be a delayed progressive symptoms.
<19>
Unique Identifier 98048848
Authors: Dai F. Zhang RZ.
Institution: Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine, Beijing.
Title: [Social burden caused by poliomyelitis]. [Chinese]
Source Chung-Hua Liu Hsing Ping Hsueh Tsa Chih Chinese Journal of Epidemiology. 17(6):353-5, 1996 Dec.
Abstract: Social burden caused by paralyzed poliomyelitis was analysed, using data from a Sampling Survey of Handicapped People in China, in 1987. The study results showed: 29.94% of 1707 handicapped polio victims aged 6 or over were not able to go to school; 44.23% of them could not take care of their daily life; 36.32% of them could not play out-door and do shopping; 2.58% of them could not normally communicate with others. 84.53% of the 1487 handicapped victims caused by polio aged 15 or over wholly or partly lost their working ability. We also compared handicapped people's employment rate and the status of marriage with non-handicapped people. Data showed that the employment rate and the number of married handicapped polio victims were remarkably lower then those non-handicapped people.
<20>
Unique Identifier 98019761
Authors: Faraj AA.
Institution: Orthopaedic Department, Medical City, Baghdad Teaching Hospital, Iraq.
Title: Modified Jones procedure for post-polio claw hallux deformity.
Source Journal of Foot & Ankle Surgery. 36(5):356-9, 1997 Sep-Oct.
Abstract: A prospective study was carried out on 12 patients with postpoliomyelitis clawing of the hallux treated by a modified Jones procedure using Kirschner wire for the interphalangeal joint fusion. The purpose of this study was to evaluate the outcome of a modified Jones procedure in the treatment of postpolio claw hallux deformity. All the patients had symptoms related to the claw hallux deformity; foot biomechanics and gait were affected. Patients were assessed both pre- and postoperatively using Axer's criteria. Mean follow-up was 32 months. Ten patients had very good results and two patients had fair results. The transferred extensor hallucis longus became loose in two patients who had a coexistent tight Achilles tendon. Recurrence of medial cavus deformity occurred 3 months after the operation in both of these patients. This was treated by shortening the transferred extensor hallucis longus after elongating the tight Achilles tendon. No pseudoarthrosis of the interphalangeal joint was identified. When the Jones procedure is performed, the motor power of the extensor hallucis longus should be Medical Research Council Grade V before transfer. The Achilles tendon should be evaluated for equinus preoperatively and lengthened when equinus deformity is present in order to avoid residual foot deformities.
<21>
Unique Identifier 98017865
Authors: Nolan P. Beeston P.
Institution: Prince Charles Hospital, Queensland.
Title: Post polio syndrome. The late sequelae of poliomyelitis. [Review] [7 refs]
Source Australian Family Physician. 26(9):1055-9, 1997 Sep.
Abstract: Patients who in earlier life suffered from acute poliomyelitis are reporting new and disabling symptoms that have been variously labelled the 'late sequelae' or 'post polio syndrome'. Systematic review of such patients has identified specific categories of disability. A practical investigation and management plan for such patients presenting to a general practitioner is proposed. [References: 7]
<22>
Unique Identifier 98025603
Authors: Barthlen GM.
Institution: Sleep Laboratory, University of Freiburg Medical Center, Germany.
Title: Nocturnal respiratory failure as an indication of noninvasive ventilation in the patient with neuromuscular disease. [Review] [14 refs]
Source Respiration. 64 Suppl 1:35-8, 1997.
Abstract: Patients with neuromuscular disease may suffer from nocturnal respiratory failure despite normal daytime respiratory function. The physiological reduction in muscle tone during sleep may be life-threatening in a patient with impaired muscle strength. Nocturnal respiratory failure may occur in patients with the postpolio syndrome, amyotrophic lateral sclerosis, myasthenia gravis, myotonic dystrophy, and muscular dystrophy. Diagnosis of obstructive, central and mixed apneas, hypopneas, and hypoventilation is best made using polysomnography. Therapeutic options include noninvasive ventilation such as continuous positive airway pressure, bilevel positive airway pressure, intermittent positive pressure ventilation and, rarely, tracheostomy, oxygen, or protriptyline. Evaluation by a sleep specialist should be initiated in any neuromuscular patient with nocturnal symptoms such as air hunger, intermittent snoring or breathing, orthopnea, cyanosis, restlessness, and insomnia. Daytime symptoms may include morning drowsiness, headaches and excessive daytime sleepiness. Polycythemia, hypertension, and signs of heart failure may also be seen. Effective treatment is available, and may improve the quality of life, and possibly increase survival. [References: 14]
<23>
Unique Identifier 98000197
Authors: Nordgren B. Falck B. Stalberg E. Ronquist G. Waldenstrom A. Ahlstrom H. Hemmingson A.
Institution: Department of Rehabilitation Medicine, Neurocentrum, University Hospital, Uppsala, Sweden.
Title: Postpolio muscular dysfunction: relationships between muscle energy metabolism, subjective symptoms, magnetic resonance imaging, electromyography, and muscle strength.
Source Muscle & Nerve. 20(11):1341-51, 1997 Nov.
Abstract: Eleven patients with previous polio were studied. The concentration of energy-related metabolites and energy charge was measured from the vastus lateralis muscle, as was isometric muscle strength of knee extension. Cross-sectional area of the quadriceps femoris muscle was calculated from magnetic resonance imaging. Reinnervation was studied using macroelectromyography. Muscle weakness, pain, and newly acquired muscle weakness in the legs was estimated by the patients. The findings in the legs in which the patients experienced new loss of muscle function were compared with the stable legs. There were no significant differences between these groups in any of the objectively measured variables. Only hip pain correlated with new loss of muscle function. Creatine phosphate was decreased in 5 patients. The symptoms and subjective muscle strength did not correlate with any of the objective measurements. There were no significant relationships between energy-related metabolites and postpolio symptoms.
<24>
Unique Identifier 97411571
Authors: Mizuno M. Quistorff B. Theorell H. Theorell M. Chance B.
Institution: Department of Medical Biochemistry and Genetics, Panum Institute, University of Copenhagen, Denmark.
Title: Effects of oral supplementation of coenzyme Q10 on 31P-NMR detected skeletal muscle energy metabolism in middle-aged post-polio subjects and normal volunteers.
Source Molecular Aspects of Medicine. 18 Suppl:S291-8, 1997.
Abstract: The effects of oral supplementation of 100 mg coenzyme Q10 (CoQ10) for 6 months on muscle energy metabolism during exercise and recovery were evaluated in middle-aged post-polio (n = 3) and healthy subjects (n = 4) by the use of phosphorus-31 nuclear magnetic resonance spectroscopy. The metabolic response to isometric plantar flexion at 60% of maximal voluntary contraction force (MVC) for 1.5 min was determined in gastrocnemius muscles before, after 3- (3MO) and 6-month (6MO) of CoQ10 supplementation. The MVC of plantar flexion was unchanged following CoQ10 supplementation. The resting Pi/PCr ratio in gastrocnemius muscles of all subjects decreased after 3MO- and 6MO-CoQ10 (P < 0.05). The post-polio individuals showed a progressive decrease in this ratio, while less pronounced changes were observed in the control subjects. Similarly, the post-polio individuals showed a lower Pi/PCr ratio at the end of 60% MVC in both 3MO- and 6MO-CoQ10, whereas no change in the ratio was observed in the control subjects. A less pronounced decrease in muscle pH was observed at the end of 60% MVC in both 3MO- and 6MO-CoQ10 in the post-polio individuals, but not in the control subjects. No systematic difference in end-exercise ATP was observed between the three phases in both groups. The half-time of recovery for PCr decreased in all subjects after 6MO-CoQ10 supplementation (P < 0.05). The results suggest that CoQ10 supplementation affects muscle energy metabolism in post-polio individuals to a greater extent than in control subjects. The mechanism for this effect is not clear, but may involve an effect of CoQ10 on peripheral circulation in the calf muscles, its action in mitochondrial oxidative phosphorylation and/or its antioxidant potential.
<25>
Unique Identifier 97456954
Authors: Mulroy SJ. Lassen KD. Chambers SH. Perry J.
Institution: Pathokinesiology Laboratory, Rancho Los Amigos Medical Center, Downey, CA 90242, USA.
Title: The ability of male and female clinicians to effectively test knee extension strength using manual muscle testing.
Source Journal of Orthopaedic & Sports Physical Therapy. 26(4):192-9, 1997 Oct.
Abstract: It has been suggested that the accuracy of manual muscle testing is dependent on examiner strength. Our purpose was to relate male and female clinicians' upper extremity strength to their ability to challenge the quadriceps and detect weakness in patients using manual muscle testing. Quadriceps muscles of seven men and 12 women with postpoliomyelitis were tested manually by a male and female clinician while forces were recorded with a hand-held dynamometer. Patients' maximal isometric knee extension force was recorded with a Lido dynamometer and clinicians' maximal vertical push force was recorded with the hand-held dynamometer. Manual muscle testing forces, patient maximum quadriceps forces, and examiner push forces were compared with repeated measures analysis of variance. Female examiners' maximal vertical push force (235.7 +/- 54.3 N) was not significantly different from either female or male patients' maximal quadriceps force (166.8 +/- 66.7 N and 341.6 +/- 123.7 N) but was only 60% and 40% of the isometric knee extension forces generated by a group of normal women and men. Male examiners were significantly stronger (357.0 +/- 93.4 N) than the female but not the male patients and produced 90% and 60% of the normal isometric quadriceps forces for women and men. Examiners gave appropriate grades in 30 of 38 tests. Examiner strength limits detection of moderate quadriceps weakness with manual resistance. Most of the muscle test grades, however, were appropriate, given the examiner's upper extremity strength. Clinicians using manual muscle testing should determine their maximal vertical push force and the extent of weakness they can detect.
<26>
Unique Identifier 98014614
Authors: Creange SJ. Bruno RL.
Institution: Postpolio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, Saddle Brook, New Jersey 07663, USA.
Title: Compliance with treatment for postpolio sequelae: effect of type A behavior, self-concept, and loneliness.
Source American Journal of Physical Medicine & Rehabilitation. 76(5):378-82, 1997 Sep-Oct.
Abstract: To examine the effect of Type A behavior, self-concept, and loneliness on completion of and compliance with a postpolio sequelae treatment program, all 204 individuals who had been evaluated by the Postpolio Service were mailed the Postpolio Fatigue Questionnaire, the revised UCLA Loneliness Scale, and the Tennessee Self-Concept Scale. Patients were also asked to rate the frequency of assistive device use, their engaging in self-care activities, and requesting physical assistance from others; they had previously been administered the brief Type A Scale. Of the 46 respondents, 63% had completed the Postpolio Sequelae treatment program (completers), and 37% had either been discharged for noncompliance or refused treatment (noncompleters). Wheelchair use was significantly positively correlated with age at the time of contracting polio, number of limbs affected by polio, the Loneliness score, and months since leaving the treatment program, but significantly negatively correlated with Social Self and Family Self scores on the Tennessee Self-Concept Scale. Family Self score was significantly negatively correlated with crutch use but significantly positively correlated with asking co-workers for assistance. The frequency of taking two 15-minute breaks each day was significantly negatively correlated with a Type A score. Noncompleters reported a 61% increase in muscle weakness compared with a 1% decrease for completers. These results indicate that Type A behavior must be decreased so polio survivors complete and comply with a postpolio sequelae treatment program, be able to make necessary lifestyle changes, and possibly feel less lonely. Friends and family members must help polio survivors to accept lifestyle changes and support new assistive device use if patients are to feel valuable within their families and society and treat their postpolio sequelae.
<27>
Unique Identifier 97249829
Authors: Tjensvoll AB. Gilhus NE.
Institution: Nevrologisk avdeling, Haukeland Sykehus, Bergen.
Title: [The post-poliomyelitis syndrome--a real complication. A poliomyelitis material from the Haukeland hospital]. [Norwegian]
Source Tidsskrift for Den Norske Laegeforening. 117(4):510-3, 1997 Feb 10.
Abstract: Over a four-year period, all in-patients at our department with the diagnosis of polio-sequelae were clinically examined for development of new neuromuscular deficit. 19 out of 125 patients (15%) had developed a postpolio syndrome. All 19 had acquired additional functional deficit and 17 new, localized pareses. Five patients had developed polio-related hypoventilation. The mean time from acute poliomyelitis to debut of the post-polio syndrome was 39 years. The post-polio syndrome occurred in patients with severe pareses in the acute stage, but was not related to age, sex or specific epidemic. Most of the 106 other patients had similar subjective complaints but did not have any clinical signs indicating new neuromuscular deficit. 67 of these patients had tendinitis and/or myalgia and 83 had chronic pain. Whereas many patients have progressive symptoms many years after poliomyelitis, only a minority develop the post-polio syndrome.
<28>
Unique Identifier 97249828
Authors: Stanghelle JK. Festvag LV.
Institution: Sunnaas sykehus, Nesoddtangen.
Title: [Five year follow-up of patients with postpoliomyelitis syndrome (see comments)]. [Norwegian]
Comments Comment in: Tidsskr Nor Laegeforen 1997 Apr 30;117(11):1645
Source Tidsskrift for Den Norske Laegeforening. 117(4):504-7, 1997 Feb 10.
Abstract: The purpose of this investigation was to study subjective symptoms, medical and social situation, pulmonary function and physical work capacity over a period of 3-5 years in patients with post-polio syndrome. We assessed a consecutive series of 68 patients admitted to our hospital because of post-polio syndrome, and re-assessed 63 of these patients 3-5 years later; 43 women and 20 men with mean age 55 +/- 10 (1 SD) years at the second evaluation. The patients answered a questionnaire about their subjective symptoms and medical and social situation, and underwent spirometry and symptom-limited exercise stress testing. Most patients experienced more serious symptoms and physical disability connected with their polio, while the majority reported that their psychological health was unchanged or had improved. Lung function was on average moderately reduced and of restrictive type, and only minor changes were found over the 3-5 years. A pronounced reduction in peak oxygen uptake was seen at the first evaluation, especially in women (59% of predicted). At the second examination, peak oxygen uptake was further reduced, especially in men, more than predicted by increasing age. The body weight and body mass index of the patients increased significantly during the same period. These results indicate that subjective symptoms and physical disability connected with polio increased with increasing age in these patients with post-polio syndrome, and cardio-respiratory deconditioning and weight gain also became more serious problems in most patients. The psychological status of the patients remained stable, however, or improved, possibly due to our comprehensive re-rehabilitation and educational programme.
<29>
Unique Identifier 97249827
Authors: Wekre LL. Stanghelle JK. Lobben B. Oyhaugen S.
Institution: Sunnaas sykehus, Nesoddtangen.
Title: [Polio victims in Norway. Results of a national study 1994]. [Norwegian]
Source Tidsskrift for Den Norske Laegeforening. 117(4):500-4, 1997 Feb 10.
Abstract: "The Norwegian Polio Study 1994" was conducted in order to survey the medical and social situation and the needs of polio victims. A questionnaire consisting of 133 questions with subquestions was sent to a total of 2,392 polio victims in Norway. 1,449 persons responded, of whom 66% were between 45 and 64 years of age. When specifying new health problems, between 55% and 85% stated that they had experienced increasing weakness of the muscles affected by polio, weakness in previously non-affected muscles, fatigue, intolerance to cold and/or pain in muscles and joints. Only 17% were satisfied with the public health services for polio victims. On the other hand, 67% of those who had undergone a comprehensive evaluation and had been treated at a central hospital were satisfied. The study indicates an obvious need to build up expertise in multidisciplinary evaluation and treatment of post-polio victims.
<30>
Unique Identifier 97184737
Authors: Midgren B.
Institution: Dept of Lung Medicine, University Hospital, Lund, Sweden.
Title: Lung function and clinical outcome in postpolio patients: a prospective cohort study during 11 years.
Source European Respiratory Journal. 10(1):146-9, 1997 Jan.
Abstract: The object of this investigation was to prospectively study the annual decline in lung function in a cohort of postpolio patients, and to determine the usefulness of initial lung function tests in the prediction of a subsequent poor outcome. Cross-sectional data were analysed in 55 patients from the total cohort of 350 survivors of poliomyelitis in our admission area of 550,000 inhabitants. Longitudinal data (> 5 yrs, average 8.9 yrs) were available for 31 patients. Seventeen of the patients had a poor outcome (13 were started on domiciliary artificial ventilation and five died from respiratory failure; with one overlap). At the time of entry to the study (on average 4.3 years before the poor outcome), these patients had a lower vital capacity (VC) (43 vs 65% of predicted; p < 0.01) and arterial oxygen tension (Pa,O2) (9.9 vs 11 kPa; p < 0.05) and a higher arterial carbon dioxide tension (Pa,CO2) (6.0 vs 5.0 kPa; p < 0.01). They also had a more rapid increase in Pa,CO2 (0.3 vs 0.03 kPa.yr-1; p < 0.01), but the difference in decline in VC (40 vs 30 mL.yr-1) was not significant. Initial VC < 50% of predicted and/or Pa,CO2 > 6 kPa was associated with a poor prognosis. In conclusion, annual decline in vital capacity was not abnormally rapid but annual increase in arterial carbon dioxide tension was higher in patients with a poor outcome. Initial determination of vital capacity and initial and repeated blood gas analysis appear to be useful in identifying high-risk postpolio patients.
<31>
Unique Identifier 97188153
Authors: Gadoth N. Kesler A.
Title: [Post-polio syndrome--an update]. [Review] [53 refs] [Hebrew]
Source Harefuah. 132(2):124-7, 1997 Jan 15.
<32>
Unique Identifier 97194463
Authors: Kemp BJ. Adams BM. Campbell ML.
Institution: Rehabilitation Research and Training Center on Aging With Disability, Rancho Los Amigos Medical Center/University of Southern California, Downey, USA.
Title: Depression and life satisfaction in aging polio survivors versus age-matched controls: relation to postpolio syndrome, family functioning, and attitude toward disability.
Source Archives of Physical Medicine & Rehabilitation. 78(2):187-92, 1997 Feb.
Abstract: OBJECTIVE: To compare depressive symptoms and life satisfaction in aging polio survivors with age-matched controls and to relate these outcomes to scores to psychosocial and disability-related variables. DESIGN: A planned medical, functional, and psychosocial study with multivariate analyses. SETTING: A large, urban rehabilitation center. PARTICIPANTS: A volunteer sample of 121 polio survivors and an age-matched control group of 60 people with similar sociodemographic backgrounds. MAIN OUTCOMES: Depression as measured by the Geriatric Depression Scale and an 11-item life satisfaction scale. RESULTS: The prevalence of depressive disorders was not significantly different in the two groups, although the postpolio group tended to have more symptomatology and an overall depressive disorder prevalence of 28%. Some life satisfaction scale scores were significantly lower in the postpolio group, especially those concerned with health. People with postpolio syndrome scored significantly higher on depression scales and lower on some life satisfaction scales than people with a history of polio but without postpolio syndrome. Several psychosocial variables, most notably family functioning and attitude toward disability, helped to mediate this effect. Among people with significant depression, there was little, evidence of adequate treatment in the community. CONCLUSIONS: Postpolio by itself does not relate to higher depression scores or lower life satisfaction. Postpolio syndrome has some relation to depression, but family functioning and attitude toward disability are more important. There is a need for better community-based psychological services.
<33>
Unique Identifier 97123696
Authors: Arya SC.
Title: Poliovirus genomic sequences in the central nervous systems of patients with postpolio syndrome [letter; comment].
Comments Comment on: J Clin Microbiol 1996 Aug;34(8):2023-6
Source Journal of Clinical Microbiology. 35(1):334-5, 1997 Jan.
<34>
Unique Identifier 97430485
Authors: Netzer N. Sorichter S. Bosch W. Werner P. Lehmann M.
Institution: Abteilung Pneumologie, Medizinische Universitatsklinik Freiburg.
Title: [The clinical use of an individually fitted nasal mask ("Freiburg Respiratory Mask") within the scope of a case report of controlled BiPAP ventilation]. [German]
Source Pneumologie. 51 Suppl 3:798-801, 1997 Aug.
Abstract: PURPOSE: Noninvasive mechanical ventilation with nasal or face mask using either BiPAP or IPPV (intermittent positive pressure ventilation) modes is meanwhile the standard type of mechanical ventilation instead of endotracheal intubation or tracheostomy in many patients with chronic and acute respiratory failure. However, problems occur very often in noninvasive mechanical ventilation due to mask problems with leakage of air out of the mask or erasions and necrosis of the skin by constant pressure through the mask frame. Hence, some clinical work groups developed customized molded masks mostly in cooperation with dentistry labs. These masks, however, are often very expensive and take several weeks to be manufactured. Our aim was to develop an inexpensive (less than 600 USS) and easy-(in one day)-to-produce customized nasal mask, the so-called "Freiburg nasal mask". We wish to show by a case report the clinical efficacy of this customized mask in severe respiratory failure. CASE AND METHOD: A 52 y old women (BMI 19, nonsmoker) suffering from a severe hypercapnic respiratory failure (PCO2 over 100 mmHg) due to a severe kyphoscoliosis as result of a postpoliosyndrome and already on controlled nasal BiPAP with a standard respironics nasal mask, was referred to our clinic as an emergency case. After not succeeding to normalise blood gases and clinical status of the patient in mechanical ventilation on BiPAP mode and additional 2 lit/min of oxygen insufflation via the mask (patient was refusing invasive ventilation) for 12 days due to mask leakage and mask discomfort we made a mould of the patients face. Using this mould in a vacuum process the two EVA polymers Erkoflex and Erkodent were combined to build up the customized mask over the mould on the same day. In the first three days using the customized mask in the patient PCO2 decreased below 70 mmHg, on the 8th day after starting with the customized mask, blood gases almost normalised. Patient compliance in using the BiPAP device increased from 8 h a day to 16 h a day. CONCLUSION: This case shows that sometimes due to leakage of air in standard nasal masks noninvasive mechanical ventilation may fail in patients with severe respiratory failure. Therefore, in these patients customized moulded nasal or face masks should be used instead of standard masks. We think that the Freiburg nasal mask is an example of an easy to produce and nonexpensive customized mask and may be used in such patients, as this case report shows.
<35>
Unique Identifier 97450285
Authors: Rodriquez AA. Agre JC. Franke TM.
Institution: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison, USA.
Title: Electromyographic and neuromuscular variables in unstable postpolio subjects, stable postpolio subjects, and control subjects.
Source Archives of Physical Medicine & Rehabilitation. 78(9):986-91, 1997 Sep.
Abstract: OBJECTIVE: To compare strength and endurance variables obtained in the quadriceps muscles of postpolio and control subjects over a 7-year interval with macro and single fiber electromyography (EMG) variables. DESIGN: A controlled inception cohort study. SETTING: Neuromuscular research laboratory of a university hospital. SUBJECTS: A cohort of 23 postpolio and 14 control subjects. All postpolio subjects had a history, physical examination, and EMG consistent with previous poliomyelitis, and had greater than antigravity strength in the quadriceps muscle tested. Unstable postpolio subjects acknowledged new quadriceps weakness over the 7-year period of the study (n = 11), and stable postpolio subjects denied new weakness of the quadriceps over the same period (n = 12). MAIN OUTCOME MEASURES: All subjects had tests of neuromuscular function of the quadriceps muscles at the onset of this study and yearly over a 7-year period. EMG variables were determined on a separate day after the seventh year of neuromuscular measurements. Neuromuscular variables measured were isometric knee extension peak torque, isometric endurance (time to inability to maintain knee extensor contraction at 40% of maximal torque), tension time index (TTI) (product of isometric endurance time and 40% of maximal torque), and recovery of torque at 10 minutes after the endurance test. EMG variables were macro EMG and single fiber EMG (jitter, fiber density, and percent blocking). RESULTS AND CONCLUSIONS: Unstable postpolio subjects did not lose strength more rapidly than stable postpolio subjects or control subjects. Unstable postpolio subjects were significantly weaker, had decreased TTI, larger macro EMG amplitude, greater jitter, blocking, and fiber density in comparison with stable postpolio subjects (all p < .05). Strength was negatively correlated with macro EMG amplitude in the stable postpolio group (p < .05). The slope of the regression line of strength over 7 years did not correlate (p > .05) with neuromuscular or EMG variables in control, stable, or unstable postpolio subjects.
<36>
Unique Identifier 97413271
Authors: Stanghelle JK. Festvag LV.
Institution: Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
Title: Postpolio syndrome: a 5 year follow-up.
Source Spinal Cord. 35(8):503-8, 1997 Aug.
Abstract: The purpose of this investigation was to study subjective symptoms, medical and social situation, pulmonary function and physical work capacity during a period of 3-5 years in patients with the postpolio syndrome. We evaluated 68 patients consecutively admitted to our hospital because of postpolio syndrome, and re-evaluated 63 of the same patients 3-5 years later, 43 women and 20 men with mean age 55 +/- 10 (1 SD) years at the second evaluation. The patients answered a questionnaire about their subjective symptoms and medical and social situation, and underwent spirometry as well as symptom-limited exercise stress testing. Most patients experienced increasing symptoms and physical disability related to their polio, while the majority reported that their mental health were unchanged or improved. The lung function was in average moderately reduced of restrictive type, and only minor changes were found during the 3-5 years. A pronounced reduction in peak oxygen uptake was seen at the first evaluation, especially in women. At the second examination, peak oxygen uptake was further decreased, especially in men, more than predicted from increasing age. The patients increased their body mass index significantly during the same period. These results indicate that subjective symptoms and physical disability related to polio increased with increasing age in these patients with the post-polio syndrome, and cardiorespiratory deconditioning and weight gain also became increasing problems in most patients. However, the mental status of the patients remained stable or improved, possibly due to our comprehensive re-rehabilitation and educational programme.
<37>
Unique Identifier 97372203
Authors: Ross MA.
Institution: Department of Neurology, University of Iowa College of Medicine, Iowa City, Iowa 52240, USA.
Title: Acquired motor neuron disorders. [Review] [78 refs]
Source Neurologic Clinics. 15(3):481-500, 1997 Aug.
Abstract: The acquired motor neuron disorders are a heterogeneous group of conditions in which motor neuron degeneration or dysfunction produces the predominant manifestation of weakness, while the sensory system is clinically spared. The disorders most commonly seen in clinical practice are amyotrophic lateral sclerosis, late manifestations of poliomyelitis, and lower motor neuron syndromes, including motor neuropathy. Less often, acquired motor neuron disorders may complicate metabolic, toxic, or systemic disorders. The pathogenesis of most acquired motor neuron disorders is poorly understood, and treatment is mainly supportive; however clues to understanding the pathogenesis of amyotrophic lateral sclerosis are emerging, and new pharmacologic therapies are available. There is a growing sense of hope that combinations of drugs that are currently being tested may impact the survival of amyotrophic lateral sclerosis. [References: 78]
<38>
Unique Identifier 97355262
Authors: LeCompte CM.
Title: Post polio syndrome: an update for the primary health care provider. [Review] [46 refs]
Source Nurse Practitioner. 22(6):133-6, 139, 142-6 passim, 1997 Jun.
Abstract: Post Polio Syndrome, or PPS, is defined as a clinical syndrome of new weakness, fatigue, and pain in people who have previously recovered from acute paralytic poliomyelitis. Other common symptoms include cold intolerance, dysphagia, dyspnea, and overuse syndromes. PPS afflicts an estimated 50% of polio survivors, a population estimated at 1.6 million people, and begins roughly 30 years after the acute disease. The main impact of PPS is on mobility related activities affecting one's daily routine. With an insidious onset, and several differential diagnoses for each symptom, PPS can be difficult to diagnose and to validate. However, once identified, there are treatment plans and many avenues of support for this disabling syndrome. The purpose of this article is to provide an overview of the pathophysiology of both acute paralytic poliomyelitis as well as PPS. This article also reviews the current literature concerning the etiology and pathophysiology of both poliomyelitis and PPS, symptom evaluation and differential diagnoses, and treatment recommendations. The psychosocial impact and care of the client are also identified, and several resources for support and education of both the client and provider are provided. [References: 46]
<39>
Unique Identifier 97389786
Authors: Fohlman J. Friman G. Tuvemo T.
Institution: Infektionskliniken, Akademiska sjukhuset, Uppsala.
Title: [Enterovirus infections in new disguise]. [Review] [66 refs] [Swedish]
Source Lakartidningen. 94(28-29):2555-60, 1997 Jul 9.
Abstract: Enteroviruses (Coxsackie A and B, echovirus, poliovirus) belong to a group of small RNA-viruses, picomavirus, which are widespread in nature. Enteroviruses cause a number of wellknown diseases and symptoms in humans, from subclinical infections and the common cold to poliomyelitis with paralysis. The development of polio vaccines is the greatest accomplishment within the field of enterovirus research and the background work was awarded the Nobel prize in 1954. New knowledge implies that enteroviruses play a more important part in the morbidity panorama than was previously thought. Chronic (persistent) enteroviruses were formerly unknown. Serologic and molecular biology techniques have now demonstrated that enteroviral genomes, in certain situations, persist after the primary infection (which is often silent). Persistent enteroviral infection or recurrent infections and/or virus-stimulated autoimmunity might contribute to the development of diseases with hitherto unexplained pathogenesis, such as post polio syndrome, dilated cardiomyopathy, juvenile (type 1) diabetes and possibly some cases of chronic fatigue syndrome. [References: 66]
<40>
Unique Identifier 97372813
Authors: Agre JC. Rodriquez AA. Franke TM.
Institution: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison, USA.
Title: Strength, endurance, and work capacity after muscle strengthening exercise in postpolio subjects.
Source Archives of Physical Medicine & Rehabilitation. 78(7):681-6, 1997 Jul.
Abstract: OBJECTIVE: To determine whether a 12-week home quadriceps muscle strengthening exercise program would increase muscle strength, isometric endurance, and tension time index (TTI) in postpolio syndrome subjects without adversely affecting the surviving motor units or the muscle. DESIGN: A longitudinal study to investigate the effect of a 12-week exercise program on neuromuscular function and electromyographic variables. SETTING: Neuromuscular laboratory of a university hospital. SUBJECTS: Seven subjects were recruited from a cohort of 12 subjects who had participated in a previous exercise study. All subjects had greater than antigravity strength of the quadriceps. Upon completion of a postpolio questionnaire, all acknowledged common postpolio syndrome symptoms such as new fatigue, pain, and weakness; 6 of the 7 acknowledged new strength decline. INTERVENTION: On Mondays and Thursdays subjects performed three sets of four maximal isometric contractions of the quadriceps held for 5 seconds each. On Tuesdays and Fridays subjects performed three sets of 12 dynamic knee extension exercises with ankle weights. MAIN OUTCOME MEASURES: Neuromuscular variables of the quadriceps muscles were measured at the beginning and completion of the exercise program and included: isokinetic peak torque (ISOKPT, at 60 degrees/sec angular velocity) and total work performed of four contractions (ISOKTW), isometric peak torque (MVC), endurance (EDUR, time subject could hold isometric contraction at 40% of the initial MVC), isometric tension time index (TTI, product of endurance time and torque at 40% of MVC), and initial and final ankle weight (WGT, kg) lifted. Electromyographic variables included: fiber density (FD), jitter (MCD), and blocking (BLK) from single fiber assessment and median macro amplitude (MACRO). Serum creatine kinase (CK) was also measured initially and at 4-week intervals throughout the study. RESULTS: The following variables significantly (p < .05) increased: WGT by 47%, ISOKPT, 15%, ISOKTW, 15%; MVC, 36%; EDUR, 21%; TTI, 18%. The following variables did not significantly (p > .05) change: FD, MCD, BLK, MACRO, and CK. CONCLUSIONS: This home exercise program significantly increased strength, endurance, and TTI without apparently adversely affecting the motor units or the muscle, as the EMG and CK variables did not change.
<41>
[Use Link to view the full text]
Unique Identifier 97356328
Authors: Thorsteinsson G.
Institution: Department of Physical Medicine and Rehabilitation, Mayo Clinic Jacksonville, FL 32224, USA.
Title: Management of postpolio syndrome. [Review] [67 refs]
Source Mayo Clinic Proceedings. 72(7):627-38, 1997 Jul.
Abstract: Recent research has shed light on the pathogenesis of the postpolio syndrome and has helped explain its symptoms and the rationale for management. The aim of this article is to familiarize physicians with this syndrome. The history, acute infection, definition, and diagnosis are discussed, as well as the various symptoms and their management. People with postpolio syndrome can educate health professionals about this condition and can help others inflicted with this syndrome. Thus far, no cure is available. A correct diagnosis is important, and the physician must realize that severe comorbidities tend to afflict people with this syndrome. Numerous management options are available to help these people enjoy a high quality of life. [References: 67]
<42>
Unique Identifier 97279980
Authors: Schanke AK.
Institution: Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
Title: Psychological distress, social support and coping behaviour among polio survivors: a 5-year perspective on 63 polio patients.
Source Disability & Rehabilitation. 19(3):108-16, 1997 Mar.
Abstract: The aim of the study was to seek knowledge of psychological and psychosocial aspects of coping with late effects of polio. Sixty-three polio survivors, 43 women and 20 men (mean age 55.3 years) 3-5 years ago former inpatients at the Post-Polio Program at Sunnaas Rehabilitation Hospital, participated in the study. In addition to a semi-structured interview-guide, the Hospital Anxiety and Depression scale (HAD), the Sickness Impact Profile (SIP), Cope-Scale, Brief Type-A Questionnaire (BTAQ) and the Fatigue Severity Scale (FSS) were used. As a measure of physical status, we used working capacity defined as peak O2 (oxygen) uptake. Levels of working capacity did not correlate significantly with any psychological variables, and the subjects reporting improved psychological health over the last 3-5 years did not have higher levels of working capacity or less physical decrement. A significant correlation was found between self-reported fatigue. psychological variables and social support. Compared to previous studies, low psychological distress, normal type-A scores, high adjustment and problem-focused coping characterized the respondents, pointing to the importance of timing in psychosocial research of post-polio.
<43>
Unique Identifier 97335887
Authors: Brautaset NJ. Bjorholt PG.
Title: [Postpoliomyelitis syndrome (letter; comment)]. [Norwegian]
Comments Comment on: Tidsskr Nor Laegeforen 1997 Feb 10;117(4):504-7
Source Tidsskrift for Den Norske Laegeforening. 117(11):1645, 1997 Apr 30.
<44>
Unique Identifier 97297660
Authors: Allen GM. Gandevia AS. Middleton J.
Institution: Prince of Wales Medical Research Institute, Sydney, Australia.
Title: Quantitative assessments of elbow flexor muscle performance using twitch interpolation in post-polio patients: no evidence for deterioration.
Source Brain. 120 ( Pt 4):663-72, 1997 Apr.
Abstract: A large number of patients previously affected by polio have symptoms, including increased weakness and fatigue, which are collectively known as a post-polio syndrome. Prospective measurements of strength and endurance using twitch interpolation in post-polio patients are lacking and hence the exact rate of decline in muscle function in these patients is not well defined. We therefore measured performance of the elbow flexor muscles twice, at a mean of 2.5 years apart in a group of selected post-polio subjects (Group A, n = 13) and matched control subjects (n = 11), and in a second group of unselected polio patients from a post-polio clinic (Group B, n = 40) at a mean of 1.7 years apart. All subjects performed 10 attempted maximal voluntary isometric contractions of the elbow flexor muscles, during which voluntary activation of the elbow flexor muscles was measured using a sensitive form of twitch interpolation. The first group of selected polio subjects (Group A) and matched control subjects also performed 45 min of submaximal exercise. During this time, at 5-min intervals, maximal voluntary force, voluntary activation and the amplitude of twitch responses to single and paired stimuli were measured in order to investigate central and peripheral components of muscle fatigue. There was no change in the polio patients' strength, voluntary activation or peripheral muscle endurance between testing sessions, despite an 80% probability of detecting a 2.5% change per year in these variables. The unselected group of patients from the post-polio clinic (Group B) showed no change in maximal voluntary strength or voluntary activation between the first and second test. There was an absence of decline in muscle performance in these polio patients over the test interval, despite a subjective deterioration in muscle function consistent with the 'post-polio syndrome'. This supports the view that symptoms of the post-polio syndrome are not due to a progressive neuronal dysfunction.
<45>
Unique Identifier 96377155
Authors: Agre JC.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, USA.
Title: Rationale for treatment of new fatigue. [Review] [35 refs]
Source Disability & Rehabilitation. 18(6):307-10, 1996 Jun.
<46>
Unique Identifier 96377154
Authors: Grimby G.
Institution: Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Goteborgs Universitet, Sweden.
Title: Symptoms, disability, muscular structure and function, and electromyographic evaluation of post-polio individuals at 4-5 years of follow-up.
Source Disability & Rehabilitation. 18(6):306-7, 1996 Jun.
<47>
Unique Identifier 96335680
Authors: Muir P. Nicholson F. Spencer GT. Ajetunmobi JF. Starkey WG. Khan M. Archard LC. Cairns NJ. Anderson VE. Leigh PN. Howard RS. Banatvala JE.
Institution: Department of Virology, United Medical and Dental Schools of Guy's and St Thomas's Hospitals, London SE1 7EH, UK.
Title: Enterovirus infection of the central nervous system of humans: lack of association with chronic neurological disease.
Source Journal of General Virology. 77 ( Pt 7):1469-76, 1996 Jul.
Abstract: We have searched, using a sensitive nested-PCR, for enterovirus RNA in cerebrospinal fluid and post mortem central nervous system (CNS) tissue from patients with previous poliomyelitis with or without late functional deterioration, patients with motor neuron disease (MND), and control patients with other neurological disease or without neurological disease. Enterovirus RNA was detected in patients with previous poliomyelitis and MND, but also in control patients with and without neurological disease. Our results do not provide any evidence that such enterovirus infection is related to late functional deterioration in patients with previous poliomyelitis, which could be attributed to other medical conditions in most instances, and do not support the hypothesis that MND is associated with enterovirus infection of the CNS. Nucleotide sequence analysis of enterovirus RNA sequences detected indicated that enteroviruses detected were of the non-polio type.
<48>
Unique Identifier 96222798
Authors: Bartfeld H. Ma D.
Institution: Post-Polio Syndrome Research Center, New York University Medical Center, N.Y., USA.
Title: Recognizing post-polio syndrome. [Review] [6 refs]
Source Hospital Practice (Office Edition). 31(5):95-7, 101-3, 107 passim, 1996 May 15.
Abstract: The disorder consists of fatigue accompanied by new muscle weakness and muscle pain or, for patients whose acute polio had included bulbar involvement, new difficulty in swallowing or change in voice. The epidemiology remains unclear, fueling anxiety among polio survivors. Yet its course is not drastically progressive, and impairment is usually limited. [References: 6]
<49>
Unique Identifier 97274461
Authors: Douglas M.
Title: Transcultural nursing clinical incident: what do you think? What do you do?.
Source Journal of Transcultural Nursing. 8(1):37-8, 1996 Jul-Dec.
<50>
Unique Identifier 97159889
Authors: Krupp LB. Pollina DA.
Institution: Department of Neurology, State University of New York at Stony Brook 11794-8121, USA.
Title: Mechanisms and management of fatigue in progressive neurological disorders. [Review] [42 refs]
Source Current Opinion in Neurology. 9(6):456-60, 1996 Dec.
Abstract: Fatigue in neurologic disorders has been examined in several important studies over the past year. These reports suggest that fatigue is a common and often profoundly debilitating symptom. Assessment and treatment of fatigue requires a multidisciplinary approach. [References: 42]
<51>
Unique Identifier 97198775
Authors: Diamant DS. Hillen H.
Institution: Madonna Rehabilitation Hospital, Lincoln, NE 68506, USA.
Title: A survey of post polio syndrome in Nebraska.
Source Nebraska Medical Journal. 81(12):412-5, 1996 Dec.
<52>
Unique Identifier 97109238
Authors: Stiff GJ. Haray PN. Foster ME.
Institution: Department of Surgery, East Glamorgan NHS Trust, Mid Glamorgan, UK.
Title: Faecal incontinence following childhood poliomyelitis. [Review] [4 refs]
Source International Journal of Colorectal Disease. 11(5):259-60, 1996.
<53>
Unique Identifier 97062911
Authors: Shahcheraghi GH. Javid M. Zeighami B.
Institution: Nemazee Hospital, Shiraz, Iran.
Title: Hamstring tendon transfer for quadriceps femoris paralysis.
Source Journal of Pediatric Orthopedics. 16(6):765-8, 1996 Nov-Dec.
Abstract: Fifteen cases of paralysis of the quadriceps muscles secondary to poliomyelitis were managed by hamstring tendon transfers with an average follow-up of 48 months. Results of 13.5% excellent, 73% good, and 13.5% fair were obtained, according to an objective scoring system. Significant improvement in gait pattern, relief from brace use, or "hand-on-thigh" ambulation was seen in all cases. A mean extension lag of 30 degrees was observed in patients examined in the sitting position. Lack of active terminal knee flexion, prohibiting comfortable floor sitting, was the main untoward effect and the source of complaint in four patients.
<54>
Unique Identifier 97082252
Authors: Culebras A.
Institution: Neurology Service, Veterans Affairs Medical Center, Syracuse, New York, USA.
Title: Sleep and neuromuscular disorders. [Review] [41 refs]
Source Neurologic Clinics. 14(4):791-805, 1996 Nov.
Abstract: Polysomnographic evaluation in the sleep laboratory is recommended for patients with neuromuscular disorders who develop symptoms and sign of sleep-wake abnormality or nocturnal respiratory failure. Nocturnal sleep-related ventilatory alterations may occur in disproportion to the severity of the neuromuscular disorder. Diaphragmatic paralysis occurring in the context of a neuromuscular disorder is often an overlooked complication. Failure to thrive, daytime tiredness, and incapacitating fatigue may be the result of a potentially correctable sleep-related abnormality and not due to relentless progression of the neuromuscular condition. Application of CPAP and BiPAP and administration of supplemental oxygen are relatively simple, noninvasive, ambulatory, therapeutic maneuvers that may correct sleep-related ventilatory alterations in patients with neuromuscular disorders. [References: 41]
<55>
Unique Identifier 97395184
Authors: Jimulia TR. Vaidya SV.
Institution: Department of Orthopaedics, Seth G.S. Medical College, Parel, Mumbai.
Title: Opponensplasty--a rare complication and its prevention.
Source Journal of the Association of Physicians of India. 44(8):569-70, 1996 Aug.
<56>
Unique Identifier 97352238
Authors: Dai F. Zhang RZ.
Institution: Institute of Epidemiology & Microbiology, Chinese Academy of Preventive Medicine, Beijing.
Title: [Economic burden of poliomyelitis]. [Chinese]
Source Chung-Hua Liu Hsing Ping Hsueh Tsa Chih Chinese Journal of Epidemiology. 17(3):169-71, 1996 Jun.
Abstract: Economic burden that caused by paralyzed and fatal poliomyelitis was described to provide basic data for evaluation. The study showed: the average costs for treatment, recovery and rehabilitation were 1612.6 yuan, 921.9 yuan and 1112.2 yuan per case, respectively. The total economic loss due to all new victims and handicapped cases of polio was 1.99 billion yuan in 1993 in China.
<57>
Unique Identifier 97266564
Authors: Sonies BC.
Institution: Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA.
Title: Dysphagia and post-polio syndrome: past, present, and future. [Review] [53 refs]
Source Seminars in Neurology. 16(4):365-70, 1996 Dec.
Abstract: Swallowing difficulties, oral motor weakness, and oral pharyngeal paralysis have been reported in the historical literature on polio and post-polio. Attention to this finding was minimal in the original epidemics as many persons with bulbar polio who may have been dysphagic did not survive. Swallowing was often supplemented by artificial feeding for those who were placed in respirators. Although swallowing difficulty was often present in the acute stages of the initial attack, it usually subsided or disappeared after several weeks. In cases in which bulbar polio was diagnosed, swallowing impairment may have lingered, but most survivors learned to produce compensatory maneuvers to aid them to swallow and did not complain of difficulty. In the recent decades of the 20th century, many persons who had believed themselves fully recovered from the insult of polio began to experience new symptoms; among them were new or heightened complaints of swallowing difficulty. Studies of these patients with PPS have revealed that dysphagia is not only present but may be progressive, and suggest that there is a slowly progressive deterioration of the bulbar neurons of PPS patients underlying the finding of new or exacerbated swallowing signs. Patients with PPS should be referred to speech-language pathologists for evaluation of voice, phonatory-respiratory, and swallowing function and initiation of appropriate remediation strategies to avoid the potential negative consequences of dysphagia. [References: 53]
<58>
Unique Identifier 97039481
Authors: Tollback A. Soderlund V. Jakobsson F. Fransson A. Borg K. Borg J.
Institution: Department of Neurology, Karolinska Hospital, Stockholm, Sweden.
Title: Magnetic resonance imaging of lower extremity muscles and isokinetic strength in foot dorsiflexors in patients with prior polio.
Source Scandinavian Journal of Rehabilitation Medicine. 28(3):115-23, 1996 Sep.
Abstract: The thigh and lower leg of six patients with prior polio were examined using magnetic resonance imaging (MRI), and the strength of their weak foot dorsiflexors was measured isokinetically. Spinecho images of the lower extremities were visually evaluated on a semi-quantitative four-point scale, and T1 and T2 relaxation times of the lower leg anterior compartment were analysed. There were prominent MRI signs of randomly distributed muscle degeneration. The high signal intensity changes in the affected muscles on T1-weighted images and T1 and T2 values indicated replacement of muscle fibres with fat and the accumulation of tissue water, respectively. MRI findings were compared with isokinetic strength in foot dorsiflexor muscles. Foot dorsiflexor peak torque values at 30 deg/s ranged from 6 to 29 Nm. There was no significant correlation between MRI visual scoring, T1 and T2 relaxation times and peak torque values at 30 deg/s. However, the most severe MRI changes with visual scoring and T2 relaxation times were observed in the patients with the most pronounced muscle weakness.
<59>
Unique Identifier 97056335
Authors: Johnson VY. Hubbard D. Vordermark JS.
Title: Urologic manifestations of postpolio syndrome.
Source Journal of Wound, Ostomy, & Continence Nursing. 23(4):218-23, 1996 Jul.
Abstract: To determine the character and prevalence of bladder dysfunction among persons with a history of polio, we conducted a survey of randomly selected polio survivors. The survey solicited information on the acute episode of polio and the nature of late-onset neurologic symptoms that could be attributed to postpolio syndrome. There were 242 female and 88 male respondents to the study. Symptoms attributable to postpolio syndrome were present in 87.2% of female subjects and 73.9% of male subjects. Respondents with postpolio syndrome had a significantly greater prevalence of urologic symptoms than seen among respondents without postpolio syndrome, although no dominant pattern of voiding dysfunction was noted. The early onset of erectile dysfunction was more common among male subjects with postpolio syndrome than among male subjects without postpolio syndrome. Genuine stress incontinence was seen in 36.3% of the survey population. Sixteen women with postpolio syndrome underwent surgical repair for urinary incontinence, with a success rate of 60.5%. Bladder disorders are common among persons with PPS, but further clinical and urodynamic data are necessary to define the nature and magnitude of this dysfunction.
<60>
Unique Identifier 97099634
Authors: Kidd D. Williams AJ. Howard RS.
Institution: Department of Neurology, St Thomas' Hospital, London, UK.
Title: Poliomyelitis. [Review] [57 refs]
Source Postgraduate Medical Journal. 72(853):641-7, 1996 Nov.
Abstract: 1996 is polio awareness year. This paper reviews the clinical syndrome of acute paralytic poliomyelitis and its sequelae. We discuss epidemiological studies of the syndrome of late functional deterioration many years after the acute infection and the current hypotheses of the pathophysiology of such disorders. Recent evidence has suggested that potentially treatable factors may be implicated in the majority of such patients and it is therefore important to exclude such disorders before attributing late functional deterioration to progressive post-polio muscular atrophy. [References: 57]
<61>
Unique Identifier 97065996
Authors: Bruno RL.
Title: Post-polio syndrome [letter; comment].
Comments Comment on: Neurology 1996 Jan;46(1):80-4
Source Neurology. 47(5):1359-60, 1996 Nov.
<62>
Unique Identifier 96415998
Authors: Leparc-Goffart I. Julien J. Fuchs F. Janatova I. Aymard M. Kopecka H.
Institution: Laboratoire de Virologie, Centre National de Reference des Enterovirus, Lyon, France. leparc:cismsun.univ-lyon1.fr
Title: Evidence of presence of poliovirus genomic sequences in cerebrospinal fluid from patients with postpolio syndrome [see comments].
Comments Comment in: J Clin Microbiol 1997 Jan;35(1):334-5
Source Journal of Clinical Microbiology. 34(8):2023-6, 1996 Aug.
Abstract: The postpolio syndrome (PPS) is characterized by new neuromuscular symptoms occurring 30 to 40 years after the acute episode of poliomyelitis paralysis. The presence of the poliovirus RNA genome in the cerebrospinal fluid from 10 patients with PPS and from 23 control patients was sought by using reverse transcription and a PCR specific for polioviruses and/or other enteroviruses. Poliovirus-specific genomic sequences in the 5' untranslated region and in the capsid region (VP1) were detected by reverse transcription PCR in 5 of 10 patients with PPS but in none of the control patients. Sequencing confirmed the presence of mutated poliovirus sequences. This finding suggests persistent viral infection in the central nervous system related to the presence of poliovirus genomes.
<63>
Unique Identifier 97027577
Authors: Bruno RL. Zimmerman JR. Creange SJ. Lewis T. Molzen T. Frick NM.
Institution: Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, Saddle Brook, New Jersey, USA.
Title: Bromocriptine in the treatment of post-polio fatigue: a pilot study with implications for the pathophysiology of fatigue.
Source American Journal of Physical Medicine & Rehabilitation. 75(5):340-7, 1996 Sep-Oct.
Abstract: Fatigue is the most commonly reported and most disabling of all post-polio sequelae (PPS). Bromocriptine mesylate (Parlodel) was employed in a placebo-controlled trial in five survivors of paralytic polio who continued to report moderate to severe daily fatigue after complying with the conservative treatments prescribed for PPS. Placebo was given for 4 wk followed by increasing doses of bromocriptine mesylate, administered at 12:00 pm for 28 days, which reached a total dose of 12.5 mg/day. Three subjects reported marked symptom improvement on bromocriptine but not on placebo. Their reported difficulty with attention, concentration, word finding, mind wandering, memory, thinking clearly, and fatigue on awakening was significantly negatively correlated with days on bromocriptine but not with days on placebo. Before the drug trial began, responders had clinically impaired performance on neuropsychologic tests of attention and information processing speed, more than twice as many hyperintensities on magnetic resonance imaging of the brain, abnormally low fasting adrenocorticotropic hormone levels, and nearly double the mean plasma prolactin level compared with nonresponders. The implications of these findings for the pathophysiology of fatigue are discussed. A double-blind, placebo-controlled, multicenter study will be needed to confirm bromocriptine's efficacy in treating attentionally and neurophysiologically impaired polio survivors whose severe and disabling fatigue does not respond to conservative therapies.
<64>
Unique Identifier 96428378
Authors: van Kralingen KW. Ivanyi B. van Keimpema AR. Venmans BJ. de Visser M. Postmus PE.
Institution: Department of Pulmonology, Free University Hospital, Amsterdam, The Netherlands.
Title: Sleep complaints in postpolio syndrome.
Source Archives of Physical Medicine & Rehabilitation. 77(6):609-11, 1996 Jun.
Abstract: OBJECTIVE: This study evaluated the prevalence of sleep-related and sleep-disordered-breathing (SDB)-related complaints in a group of postpolio patients compared with healthy controls. DESIGN: A questionnaire, consisting of the validated Sleep Wake Experience List (SWEL), and a list of questions pertaining to sleep-disordered breathing (SDB), was mailed to a group of 43 postpolio patients. PARTICIPANTS: The patient group consisted of 43 former polio patients who had been evaluated at a neuromuscular disease clinic in a tertiary referral center for new complaints of progressive muscle weakness. The patients were requested to select two healthy controls from their neighborhood who also filled out a questionnaire. RESULTS: In the group of postpolio patients the frequency of tiredness on waking up and during the day, headache on waking up, daytime sleepiness, and restless legs was significantly higher compared with the control group. Complaints specifically related to SDB, such as apneas and snoring, were not mentioned significantly more often by the postpolio patients. CONCLUSION: Up to half of postpolio patients report complaints of disordered sleep, which is likely to influence daytime functioning. Further studies, including sleep studies into SDB and restless legs, are necessary to elucidate the causes for these complaints.
<65>
Unique Identifier 97010851
Authors: Grimby G. Kvist H. Grangard U.
Institution: Department of Rehabilitation Medicine, University of Goteborg, Sahlgrenska University Hospital, Sweden.
Title: Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio.
Source Archives of Physical Medicine & Rehabilitation. 77(10):1044-8, 1996 Oct.
Abstract: OBJECTIVE: To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period. DESIGN: Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness. SETTING: University hospital. SUBJECTS: Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization. OUTCOME MEASUREMENTS: Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer. RESULTS: Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05). CONCLUSION: The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.
<66>
Unique Identifier 96377156
Authors: Halstead L. Gawne AC.
Institution: Post-Polio Program, National Rehabilitation Hospital, Washington, DC, USA.
Title: NRH proposal for limb classification and exercise prescription.
Source Disability & Rehabilitation. 18(6):311-6, 1996 Jun.
<67>
Unique Identifier 96377153
Authors: Agre JC.
Institution: University of Wisconsin-Madison Medical School, USA.
Title: Symposium on post-polio syndrome.
Source Disability & Rehabilitation. 18(6):305-6, 1996 Jun.
<68>
Unique Identifier 96401537
Authors: Borg K.
Institution: Department of Neurology, Karolinska Hospital, Stockholm, Sweden.
Title: Post-polio muscle dysfunction 29th ENMC workshop 14-16 October 1994, Naarden, the Netherlands.
Source Neuromuscular Disorders. 6(1):75-80, 1996 Jan.
<69>
Unique Identifier 96335853
Authors: Dai ZW. Li FJ. Shen YG.
Institution: Anhui Provincial Hygiene and Epidemic Prevention Station, Hefei.
Title: [Screening on lameness caused by poliomyelitis in Anhui Province]. [Chinese]
Source Chung-Hua Liu Hsing Ping Hsueh Tsa Chih Chinese Journal of Epidemiology. 17(2):80-2, 1996 Apr.
Abstract: In 1992, a screening of poliomyelitis caused lameness among children under 15 years of age was conducted to verify whether poliomyelitis has been absent in Anhui. A total number of 7,639 cases were diagnosed as poliomyelitis caused lameness. The prevalence rate was 0.44%, the rate was higher in plains than in hilly and mountainous areas. Rate was higher in ural than in urban areas. The disease mainly occurred in children at age below 3. The result showed that there were two epidemic peaks during 1976-1991, but the incidence rate tended to be declining. The incidence rate was the lowest in 1991. Many cases were not reported during 1976-1988.
<70>
Unique Identifier 96303053
Authors: Faraj AA.
Institution: Department of Orthopaedic Surgery, Baghdad Medical School, Iraq.
Title: Talonavicular joint arthrodesis for paralytic post poliomyelitis forefoot instability.
Source Journal of Foot & Ankle Surgery. 35(2):166-8, 1996 Mar-Apr.
Abstract: A 17-year-old patient presented with paralytic valgus left foot deformity after poliomyelitis. Forefoot instability resulted from the transfer of peroneus brevis to the second metatarsal bone. This was secondary to a medial gapping of the talonavicular joint as a result of unbalanced pull of the transferred tendon. Talonavicular arthrodesis following a medial-based wedge articular resection has corrected the deformity.
<71>
Unique Identifier 96335943
Authors: Shi N.
Institution: Xiamen Hospital of Traditional Chinese Medicine.
Title: 3-directional penetration needling for the treatment of paralysis.
Source Journal of Traditional Chinese Medicine. 16(1):37-40, 1996 Mar.
<72>
Unique Identifier 96345002
Authors: Habel M. Strong P.
Title: The late effects of poliomyelitis: nursing interventions for a unique patient population. [Review] [32 refs]
Source MEDSURG Nursing. 5(2):77-84; quiz 85-6, 1996 Apr.
Abstract: Over half a million Americans who had paralytic poliomyelitis as children or young adults are at risk for experiencing the unexpected late effects of post-poliomyelitis syndrome (PPS). When hospitalized or treated for a variety of conditions requiring medical or surgical interventions, these individuals present challenges which include life-threatening complications. [References: 32]
<73>
Unique Identifier 96251869
Authors: Nollet F. Ivanyi B. de Visser M. de Jong BA.
Institution: Academisch Ziekenhuis Vrije Universiteit, afd. Revalidatie, Amsterdam.
Title: [Post-polio syndrome; the limit of neuromuscular adaptation?]. [Review] [39 refs] [Dutch]
Source Nederlands Tijdschrift voor Geneeskunde. 140(22):1169-73, 1996 Jun 1.
<74>
Unique Identifier 96234514
Authors: Pahnke J. Bullemer F. Karg O.
Institution: Pneumologische Klinik im Zentralkrankenhaus Gauting.
Title: [Advantages and disadvantages of invasive and noninvasive artificial respiration exemplified by a patient with postpolio syndrome]. [German]
Source Medizinische Klinik. 91 Suppl 2:68-9, 1996 Apr 12.
<75>
Unique Identifier 96264744
Authors: Agre JC. Rodriquez AA. Franke TM. Swiggum ER. Harmon RL. Curt JT.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, 53791, USA.
Title: Low-intensity, alternate-day exercise improves muscle performance without apparent adverse effect in postpolio patients.
Source American Journal of Physical Medicine & Rehabilitation. 75(1):50-8, 1996 Jan-Feb.
Abstract: The purpose of this study was to examine the effect of a low-intensity, alternate-day, 12 wk quadriceps muscle-strengthening exercise program on muscle strength and muscle and motor unit integrity in 12 postpolio patients. Patients performed six to ten repetitions of a 5-s duration knee extension exercise with ankle weights. After completing six repetitions, patients rated the perceived exertion (RPE) in the exercised muscle. The patient continued repetitions until RPE was >/= 17 or ten repetitions were performed. The weight was increased the next exercise day whenever the RPE was < 17 after ten repetitions. Before and after the training program, median macroamplitude as well as jitter and blocking were determined electromyographically (EMG), serum creatine kinase (CK) was measured, and quadriceps muscle strength was assessed. The ankle weight lifted after 2 wk of training and at the end of the program were also recorded. Although the ankle weight lifted at the end of the program significantly (P < 0.05) increased from a mean +/- SD of 7.1 +/- 2.7 to 11.2 +/- 4.7 kg, the dynametrically determined muscle strength measures did not significantly (P > 0.05) increase. The EMG and the serum CK variables also did not significantly (P >0.05) change as a result of the exercise program. We conclude that performance was improved, as demonstrated by an increase in the amount of weight the patients lifted in the exercise program. No evidence was found to show that this program adversely affected the motor units or the muscle as the EMG and CK did not change.
<76>
Unique Identifier 96239242
Authors: Zapp JJ.
Title: Postpoliomyelitis pain treated with gabapentin [letter].
Source American Family Physician. 53(8):2442, 2445, 1996 Jun.
<77>
Unique Identifier 96199962
Authors: Benini L. Sembenini C. Bulighin GM. Polo A. Ederle A. Zambito A. Vantini I.
Institution: Department of Gastroenterology, Rehabilitation Hospital of Valeggio Sul Mincio, University of Verona, Italy.
Title: Achalasia. A possible late cause of postpolio dysphagia. [Review] [20 refs]
Source Digestive Diseases & Sciences. 41(3):516-8, 1996 Mar.
Abstract: The aim of this paper is to describe a patient with severe postpolio problems who developed achalasia. A 66-year-old patient came to our observation for severe dysphagia. He had suffered from paralytic poliomyelitis at the age of 7 months and had severe residual deficits. At the age of 62 he presented with sudden pain localized in the distribution of the C4 and C5 dermatomes and an inability to abduct the left arm. At the time, he experienced only occasional and mild dysphagia; his esophagus was not dilated and emptied normally. Over the following months his muscular function improved, but dysphagia worsened. We found a megaesophagus with a sigmoid appearance and the manometric features of achalasia. Pneumatic dilatation produced good resolution of dysphagia. A year later manometry showed the reappearance of peristalsis after all wet swallows. In patients with postpolio dysphagia, the possible presence of achalasia must be considered. [References: 20]
<78>
Unique Identifier 96195501
Authors: Ivanyi B. Nelemans PJ. de Jongh R. Ongerboer de Visser BW. de Visser M.
Institution: Graduate School of Neurosciences Amsterdam, Department of Neurology, The Netherlands.
Title: Muscle strength in postpolio patients: a prospective follow-up study.
Source Muscle & Nerve. 19(6):738-42, 1996 Jun.
Abstract: Forty-three former polio patients now complaining of new progressive muscle weakness (symptomatic patients) plus 13 former polio patients without new neuromuscular complaints were included in the study. The symptomatic patients reported high frequencies of other neuromuscular complaints and a decline in their functional level. Most frequent complaints were general fatigue, low backache, and muscle pain (97.7%, 86%, and 79.1%, respectively) and a decline in the ability to walk (80%). In a prospective follow-up averaging 2.1 years, the muscle strength of 26 muscles in all four limbs of each patient was assessed by manual muscle testing and was also measured isometrically using a handheld dynamometer. During the follow-up period, we did not find a significant decrease in muscle strength in the symptomatic patients as compared to patients without new neuromuscular complaints.
<79>
Unique Identifier 96179329
Authors: Rodriguez AA. Agre JC. Franke TM. Swiggum ER. Curt JT.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, Madison 53792, USA.
Title: Acoustic myography during isometric fatigue in postpolio and control subjects [see comments].
Comments Comment in: Muscle Nerve 1997 Feb;20(2):251-3
Source Muscle & Nerve. 19(3):384-7, 1996 Mar.
<80>
Unique Identifier 96144074
Authors: Grehl O. Muller-Naendrup C. Jenni W.
Institution: Klinik SVK fur neurologische Rehabilitation, Leukerbad.
Title: [Postpolio syndrome: retrospective study in a former polio clinic]. [German]
Source Schweizerische Rundschau fur Medizin Praxis. 85(1-2):14-20, 1996 Jan 3.
Abstract: Delayed consequences of polio virus infection are of growing interest because of the increasing incidence of new symptoms in patients who previously had poliomyelitis. We examined 121 patients with an earlier diagnosis of acute anterior poliomyelitis for features of the postpolio syndrome using the criteria of Halstead and found evidence of the syndrome in 68.07% of the patients. Meaningful management of these patients requires recognition of the clinical features of the condition and a collaborative approach involving physicians, physiotherapists, psychotherapists and social workers.
<81>
Unique Identifier 95336062
Authors: Agre JC.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School 53792, USA.
Title: The role of exercise in the patient with post-polio syndrome. [Review] [60 refs]
Source Annals of the New York Academy of Sciences. 753:321-34, 1995 May 25.
Abstract: Recent studies have shown that judicious exercise can improve muscle strength, cardiorespiratory fitness, and the efficiency of ambulation in post-polio patients. It may also add to the patient's sense of well-being. These benefits appear to occur when the patients stay within reasonable bounds while exercising in order to avoid overuse problems. In particular, the patients should be instructed to avoid activities that cause increasing muscle or joint pain or excessive fatigue, either during or after their exercise program. The literature indicates that exercise within these constraints leads to a number of beneficial physiologic and psychologic adaptations in patients with post-polio syndrome. Judicious exercise should be viewed as important adjuvant in the overall therapeutic program of the patient. Patients seen in post-polio clinics frequently complain of new fatigue, weakness, muscle pain, and/or joint pain. The most frequent complaints involving activities of daily living include new difficulties with walking and stair climbing. The therapeutic benefit of exercise in these patients to minimize or reverse decline in function is an important question frequently asked by patients with post-polio syndrome. In the general population, physical activity is known to be an important adjunct to good health, bestowing both physiologic and psychologic benefits leading to a reduction in the risk to develop a number of serious ailments as well as leading to better psychological adjustment. On the other hand, limitation in physical activity results in a number of deleterious effects. Patients with post-polio syndrome have unique problems, however, which need to be considered when prescribing an exercise program for an individual patient. A number of functional etiologies for declining function have been hypothesized including disuse weakness, overuse weakness, weight gain, and chronic weakness. Because of the variability in which the motor neurons to different muscle groups may have been affected in a particular patient, both asymmetric and scattered weakness may be present. The challenge in prescribing exercise for the patient with post-polio syndrome comes in recognizing these unique factors in each patient and modifying the prescription accordingly. One must protect muscles and joints experiencing the adverse effects of overuse or body areas with very significant chronic weakness (in general, in areas where the muscles have less than antigravity strength on manual muscle testing) while exercising those body areas experiencing the deleterious effects of disuse. Weight gain is to be avoided if at all possible in this population, because increased weight only leads to further difficulty in the performance of daily activities.(ABSTRACT TRUNCATED AT 400 WORDS) [References: 60]
<82>
[Use Link to view the full text]
Unique Identifier 95370315
Authors: Perry J. Fontaine JD. Mulroy S.
Institution: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey, California 90242, USA.
Title: Findings in post-poliomyelitis syndrome. Weakness of muscles of the calf as a source of late pain and fatigue of muscles of the thigh after poliomyelitis.
Source Journal of Bone & Joint Surgery - American Volume. 77(8):1148-53, 1995 Aug.
Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing. Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris, the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded. The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution. These observations support the theory that post-poliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment--based on the early identification of overuse of muscles and ligamentous strain--should aim at modification of lifestyle and include use of a brace.
<83>
Unique Identifier 95336035
Authors: Dalakas MC.
Institution: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Opening remarks. On post-polio syndrome and in honor of Dr. Albert B. Sabin.
Source Annals of the New York Academy of Sciences. 753:xi-xiv, 1995 May 25.
<84>
Unique Identifier 96195359
Authors: Agre JC. Grimby G. Rodriquez AA. Einarsson G. Swiggum ER. Franke TM.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, USA.
Title: A comparison of symptoms between Swedish and American post-polio individuals and assessment of lower limb strength--a four-year cohort study.
Source Scandinavian Journal of Rehabilitation Medicine. 27(3):183-92, 1995 Sep.
Abstract: A cohort study with initial and 4-year follow-up evaluations was performed in 78 post-polio volunteers aged 34-65 years at the time of enrolment in the study, which was made to compare post-polio individuals living in Sweden and the United States, to determine whether lower limb musculature becomes weaker over time, and to determine whether individuals with complaints of post-polio syndrome, new weakness, fatigue, walking or stair climbing difficulty were weaker or lost more strength over a 4-year interval than those individuals without such complaints. Dynametrically-measured knee extensor and flexor strength and questionnaire data were obtained initially and 4 years later. The two cohorts were fairly similar, though they differed in weight gain. The Americans gained significantly (p < 0.05) more weight than the Swedish subjects. Both groups lost significant (p < 0.05) knee extensor strength (approximately 8%), but the loss was not significantly (p < 0.05) different between the groups. Knee flexor strength did not change significantly (p < 0.05) over time. Subjects acknowledging new strength loss were not significantly (p < 0.05) weaker than those denying strength loss; however, they lost significantly (p < 0.05) more isometric knee extensor strength than the other individuals. Subjects acknowledging new fatigue, walking or stair climbing difficulty were significantly (p < 0.05) weaker in both muscle groups than those without such complaints. Subjects acknowledging post-polio syndrome were significantly (p < 0.05) weaker than those denying this symptom, but the amount of loss of strength over time was not significantly (p < 0.05) different. We conclude that the two cohorts were quite similar. Knee extensor strength decreased during the study interval. Individuals acknowledging post-polio syndrome had weaker knee extensor musculature. Subjects with new fatigue, walking difficulty, or stair climbing difficulty were weaker in both the knee extensors and the knee flexors than the other subjects. Subjects reporting new muscle weakness also had a greater decline in isometric knee extensor strength during the study interval than those without such complaint.
<85>
Unique Identifier 96169801
Authors: Bednarik J. Kadanka Z. Vohanka S.
Institution: Neurologicka klinika FN, Brno-Bohunice.
Title: [Postpoliomyelitis syndrome and progressive postpoliomyelitis muscular atrophy]. [Review] [25 refs] [Czech]
Source Casopis Lekaru Ceskych. 134(23):746-8, 1995 Dec 6.
Abstract: New complaints of patients after poliomyelitis following after decades of a stabilized condition are described by the term postpoliomyelitic syndrome (PPS). They affect at least half the patients after poliomyelitis. The best defined picture from a broad spectrum of new complaints is so-called progressive postpoliomyelitic atrophy (PPMA). The authors review contemporary knowledge of the etiopathogenesis of PPS and PPMA and their possible therapy. [References: 25]
<86>
Unique Identifier 96129987
Authors: Bruno RL.
Institution: Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, Saddle Brook, NJ 07663, USA.
Title: The 45th annual John Stanley Coulter Lecture. Post-polio sequelae and the paradigms of the 50s: Newtie, Ozzie, and Harriet versus paradigms of caring and a future for rehabilitation in America.
Source Archives of Physical Medicine & Rehabilitation. 76(12):1093-6, 1995 Dec.
<87>
Unique Identifier 96043529
Authors: Rodriquez AA. Agre JC. Harmon RL. Franke TM. Swiggum ER. Curt JT.
Institution: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School 53792, USA.
Title: Electromyographic and neuromuscular variables in post-polio subjects.
Source Archives of Physical Medicine & Rehabilitation. 76(11):989-93, 1995 Nov.
Abstract: OBJECTIVE: Post-polio subjects experience functional deterioration many years after developing acute poliomyelitis and have been shown previously to have a deficit in strength recovery after isometric activity. This study characterized the size and stability of the motor units in a group of post-polio subjects with macro and single fiber electromyography (EMG) and correlated these variables with isometric strength, endurance, "work capacity," and strength recovery after fatiguing isometric exercise. DESIGN: A cohort of 12 post-polio subjects was tested for neuromuscular function. Electromyographic variables were determined on a separate day. SETTING: Volunteers were recruited from the community and tested in our neuromuscular research laboratory. SUBJECTS: A volunteer sample was obtained from advertisements. All subjects acknowledged post-polio syndrome symptoms. MAIN OUTCOME MEASURES: Neuromuscular variables were isometric knee extension peak torque, endurance (time to exhaustion) at 40% of maximal torque, tension time index, and recovery of torque at 10 minutes. Electromyographic variables were macro EMG and single fiber EMG (percent blocking and jitter). RESULTS: Macro EMG amplitude was ninefold the control value, and both jitter and blocking were greatly increased in comparison to control values. Isometric strength significantly (p < .05) correlated negatively with macro EMG amplitude. CONCLUSIONS: The weakest subjects had the greatest number of muscle fibers within the motor unit (as measured by macro EMG amplitude). Jitter and blocking did not correlate with neuromuscular function.
<88>
Unique Identifier 96098998
Authors: Pal'chik AB. Katsuk LI. Igoshina MA. Martynova NV. Nikulina VI.
Title: [Late complications of poliomyelitis]. [Russian]
Source Zhurnal Nevropatologii i Psikhiatrii Imeni S - S - Korsakova. 95(2):32-6, 1995.
Abstract: We examined 73 31-55-year-old postpoliomyelitis patients who had paralytic form of the disease before the age of 11. It was found that progression of neuro-muscular signs (pareses, atrophies, myalgias), typical for postpoliomyelitis muscular atrophy (PMA) emerged in 43 patients. Classical statistical analysis of clinical and electromyographical data and special statistical method of extreme parameter grouping confirmed PMA only in 8 out of the above 43; 3 forms of postpoliomyelitis syndrome were recognised.
<89>
Unique Identifier 96026695
Authors: Standley JM.
Title: To test or refer: what are the benefits? [letter; comment].
Comments Comment on: Can Fam Physician 1995 Apr;41:669-72
Source Canadian Family Physician. 41:1289, 1291, 1293, 1995 Aug.
<90>
Unique Identifier 96033851
Authors: Botting CH. Chetwynd J.
Institution: Christchurch School of Medicine.
Title: The challenge of the continuing effects of poliomyelitis in New Zealand. [Review] [26 refs]
Source New Zealand Medical Journal. 108(1008):386-8, 1995 Sep 22.
<91>
Unique Identifier 96023660
Authors: Faraj AA.
Institution: Orthopedic Department, Medical City, Baghdad Medical College, Iraq.
Title: Review of Elmslie's triple arthrodesis for post-polio pes calcaneovalgus deformity.
Source Journal of Foot & Ankle Surgery. 34(3):319-21, 1995 May-Jun.
Abstract: Twelve patients with residual talipes calcaneovalgus deformity due to poliomyelitis were reviewed. A two-stage Elmslie's arthrodesis was performed on nine patients with rigid deformity. Tendon transfer (peroneus brevis in one, peroneus brevis and longus in two) to the tendo Achillis insertion is used to correct the calcaneus deformity, after reduction of the calcaneus in the subtalar joint, using a Steinmann pin passed through the calcaneus. Good results were obtained in patients treated by arthrodesis. However, the deformity recurred in patients treated only with tendon transfer.
<92>
Unique Identifier 95336047
Authors: Miller DC.
Institution: Department of Pathology, New York University Medical Center, New York 10016, USA.
Title: Post-polio syndrome spinal cord pathology. Case report with immunopathology.
Source Annals of the New York Academy of Sciences. 753:186-93, 1995 May 25.
Abstract: Post-polio syndrome (PPS) describes the clinical onset of progressive muscular weakness many years after survival of acute paralytic poliomyelitis, often in muscle groups clinically unaffected by the original disease process. Prior pathologic descriptions of this often disabling, but not usually fatal, syndrome have been scanty. These have emphasized the presence of persistent or new inflammation in the meninges, spinal cord, and muscles of affected patients. The inflammation suggests several pathogenetic hypotheses, including persistent active poliovirus infection, autoimmune attack on central and peripheral nervous system elements, or increased vulnerability of poliovirus-damaged tissue to new infections. We have recently examined the central nervous system from a PPS patient. The cord showed focal perivascular intraparenchymal chronic inflammatory infiltrates. Immunoperoxidase staining demonstrated that the infiltrates were virtually pure populations of B lymphocytes (immunopositive with antibody L26, and immunonegative with the T cell marker UCHL1 as well as the macrophage marker HAM56). There were rare macrophages (HAM56 immunopositive) and no T cells. The character of the infiltrates suggests that PPS could be an autoimmune disorder mediated by antibodies produced in situ, and not by a cell-mediated process. Additional important pathological features were the presence in the anterior horns of axonal spheroids and of moderate Wallerian degeneration in the lateral columns. The brain was entirely unremarkable, with no detectable cell loss of gliosis in the internal capsules or precentral gyri.
<93>
Unique Identifier 95388094
Authors: Kaminski HJ. Tresser N. Hogan RE. Martin E.
Institution: Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Title: Spinal cord histopathology in long-term survivors of poliomyelitis.
Source Muscle & Nerve. 18(10):1208-9, 1995 Oct.
<94>
Unique Identifier 95375598
Authors: Fraser DM.
Title: Is there treatment for postpolio syndrome? [letter].
Source Canadian Family Physician. 41:1158, 1995 Jul.
<95>
Unique Identifier 95375596
Authors: Walker JM.
Title: Recognizing postpolio syndrome [letter; comment].
Comments Comment on: Can Fam Physician 1995 Apr;41:637-40, 643-5
Source Canadian Family Physician. 41:1155-7, 1995 Jul.
<96>
Unique Identifier 95368882
Authors: DiCesare PE. Young S. Perry J. Baumgarten M.
Institution: Hospital for Joint Diseases Orthopaedic Institute, New York, NY 10003, USA.
Title: Perimalleolar tendon transfer to the os calcis for triceps surae insufficiency in patients with postpolio syndrome.
Source Clinical Orthopaedics & Related Research. (310):111-9, 1995 Jan.
Abstract: Twelve patients (14 feet) with the diagnosis of postpolio syndrome underwent patients-specific transfer of perimalleolar tendons to the os calcis for triceps surae insufficiency. One to 5 tendons were transferred, for a resulting mean muscle strength of Grade 3 at a mean followup of 2.7 years. At final followup, 7 patients were restudied with ankle plantar flexion torque measurements, range of motion, and gait analysis. Patients reported subjective improvements in endurance (86%), pain (90%), and ambulatory distance (50%). No progression of foot deformity was noted. Three of 5 patients became brace free. After tendon transfer, patients recorded increased ankle plantar flexion torque strength (80%) and an increase in 1 grade of muscle strength (29%). There was no significant change in gait velocity, stride length, or heeloff time between pre- and postoperative gait analysis. No tenodesis effect was observed. In conclusion, perimalleolar tendon transfers for triceps surae insufficiency in postpolio patients was effective in decreasing subjective complaints, arresting progressive foot deformity caused by muscle imbalance, and increasing plantar flexion strength, whereas the results of gait analysis failed to show significant improvement.
<97>
Unique Identifier 95358673
Authors: Sunnerhagen KS. Bengtsson BA. Lundberg PA. Landin K. Lindstedt G. Grimby G.
Institution: Department of Rehabilitation Medicine, Sahlgrenska University Hospital, University of Goteborg, Sweden.
Title: Normal concentrations of serum insulin-like growth factor-1 in late polio.
Source Archives of Physical Medicine & Rehabilitation. 76(8):732-5, 1995 Aug.
Abstract: A recent study of 10 men with postpolio syndrome indicated a low secretion of growth hormone (GH) as reflected by serum insulin-like growth factor-I (IGF-1). Therefore, 87 patients were studied, 17 to 71 years after acute poliomyelitis, of whom 65% reported the occurrence of new or increased weakness (ie, during the last 2 years) in muscles previously affected by polio. Serum IGF-1 concentrations in the patients were compared with those found in a reference population comprising 392 randomly selected individuals. No differences from the reference population values were observed. No correlation was found between IGF-1 concentrations and the severity of the original polio affliction, the recovery status, the need for ambulation aids, or the presence of new symptoms. The results do not indicate a need for GH substitution treatment of patients with postpolio syndrome.
<98>
Unique Identifier 95336085
Authors: Bach JR.
Institution: Department of Physical Medicine and Rehabilitation, University of Medicine & Dentistry of New Jersey-New Jersey Medical School, University Hospital, Newark 07103, USA.
Title: Management of post-polio respiratory sequelae.
Source Annals of the New York Academy of Sciences. 753:96-102, 1995 May 25.
Abstract: Post-poliomyelitis respiratory impairment is extremely common and entails considerable risk of morbidity and mortality. Respiratory muscle weakness is the primary etiological factor but post-poliomyelitis individuals (PPIs) also have a high incidence of scoliosis, obesity, sleep disordered breathing, and bulbar muscle dysfunction, all of which can add to the risk. One hundred forty-five PPIs were managed by noninvasive alternatives to intermittent positive pressure ventilation (IPPV) via an indwelling tracheostomy. When properly managed in this manner, acute respiratory failure requiring hospitalization, tracheal intubation, and bronchoscopies were avoided. Timely introduction of mouthpiece IPPV, nasal IPPV, manually and mechanically assisted coughing, and noninvasive blood gas monitoring in the home were the principal techniques used for optimizing quality of life and for avoiding complications.
<99>
Unique Identifier 95336084
Authors: Sonies BC. Dalakas MC.
Institution: Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Progression of oral-motor and swallowing symptoms in the post-polio syndrome.
Source Annals of the New York Academy of Sciences. 753:87-95, 1995 May 25.
<100>
Unique Identifier 95336083
Authors: Windebank AJ. Litchy WJ. Daube JR.
Institution: Mayo Clinic, Department of Neurology, Rochester, Minnesota 55905, USA.
Title: Prospective cohort study of polio survivors in Olmsted County, Minnesota.
Source Annals of the New York Academy of Sciences. 753:81-6, 1995 May 25.
<101>
Unique Identifier 95336082
Authors: Dalakas MC.
Institution: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: The post-polio syndrome as an evolved clinical entity. Definition and clinical description. [Review] [63 refs]
Source Annals of the New York Academy of Sciences. 753:68-80, 1995 May 25.
Abstract: Post-polio syndrome (PPS) refers to the new neuromuscular symptoms that occur at least 15 years after stability in patients with prior acute paralytic polio-myelitis. They include: (1) new muscle weakness and atrophy in the limbs, the bulbar or the respiratory muscles [post-poliomyelitis muscular atrophy (PPMA)] and (2) excessive muscle fatigue and diminished physical endurance. PPS is a clinical diagnosis that requires exclusion of all other medical, neurological, orthopedic or psychiatric diseases that could explain the cause of the new symptoms. Routine electromyography is useful to confirm chronic and ongoing denervation and exclude neuropathies. Muscle biopsy, single fiber electromyography (EMG), macro-EMG, serum antibody titers to polio virus, and spinal fluid studies are very useful research tools but they are rarely needed to establish the clinical diagnosis. PPS is a slowly progressive phenomenon with periods of stability that vary from 3 to 10 years. Current evidence indicates that PPS is the evolution of a subclinically ongoing motor neuron dysfunction that begins after the time of the acute polio. It is clinically manifested as PPS when the well-compensated reinnervating process crosses a critical threshold beyond which the remaining motor neurons cannot maintain the innervation to all the muscle fibers within their motor unit territory. [References: 63]
<102>
Unique Identifier 95336080
Authors: Leon-Monzon ME. Illa I. Dalakas MC.
Institution: Medical Neurology Branch, National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Expression of poliovirus receptor in human spinal cord and muscle.
Source Annals of the New York Academy of Sciences. 753:48-57, 1995 May 25.
Abstract: Because a prerequisite for infection of a cell with the poliovirus is the presence of poliovirus receptor (PVR), we examined its tissue localization in the human muscle, spinal cord, and muscle cultures using a specific monoclonal antibody against PVR in immunocytochemical studies on serial sections. We found weak expression of PVR in the motor neurons but not the axons. In normal muscle, PVR was expressed at the end plate as confirmed by immunolocalization in serial sections with alpha-bungarotoxin. In neurogenic conditions and in myopathies, PVR was found in occasional denervated muscle fibers and in several regenerating ones. Human myotubes expressed PVR and were susceptible to the poliovirus infection. We conclude that PVR is present at the motor end-plate that can serve as one of the routes of entry of the virus to the motor neurons. The presence of PVR in the regenerating muscle fibers is in accord with clinical observations that muscle injuries can predispose patients to paralytic poliomyelitis.
<103>
Unique Identifier 95336079
Authors: Gandevia SC. Allen GM. Neering IR. Middleton J. Jones R.
Institution: Prince of Wales Medical Research Institute, New South Wales, Sydney, Australia.
Title: Strength, voluntary drive, and endurance during isometric contractions in prior polio subjects.
Source Annals of the New York Academy of Sciences. 753:408-9, 1995 May 25.
<104>
Unique Identifier 95336078
Authors: Dowhaniuk M. Schentag CT.
Institution: Post-Polio Clinic, West Park Hospital, Toronto, Canada.
Title: Dysphagia in individuals with no history of bulbar polio.
Source Annals of the New York Academy of Sciences. 753:405-7, 1995 May 25.
<105>
Unique Identifier 95336077
Authors: Spector SA. Gordon PL. Yildiz E. Sivakumar K. Hurley BF. Dalakas MC.
Institution: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Effect of strength training in patients with post-polio syndrome. A preliminary report.
Source Annals of the New York Academy of Sciences. 753:402-4, 1995 May 25.
<106>
Unique Identifier 95336076
Authors: Sivakumar K. Sinnwell T. Yildiz E. McLaughlin A. Dalakas MC.
Institution: National Institute for Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1382, USA.
Title: Study of fatigue in muscles of patients with post-polio syndrome by in vivo [31P]magnetic resonance spectroscopy. A metabolic cause for fatigue.
Source Annals of the New York Academy of Sciences. 753:397-401, 1995 May 25.
<107>
Unique Identifier 95336075
Authors: Luciano CA. Sivakumar K. Spector SA. Dalakas MC.
Institution: Electromyography Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Reinnervation in clinically unaffected muscles of patients with prior paralytic poliomyelitis. Correlation between macroelectromyography and histology.
Source Annals of the New York Academy of Sciences. 753:394-6, 1995 May 25.
<108>
Unique Identifier 95336074
Authors: Kaminski HJ. Tresser N. Hogan RE. Martin E.
Institution: Department of Neurology, Cleveland Veterans Affairs Medical Center, Ohio 44106, USA.
Title: Pathological analysis of spinal cords from survivors of poliomyelitis.
Source Annals of the New York Academy of Sciences. 753:390-3, 1995 May 25.
<109>
Unique Identifier 95336073
Authors: Shetty KR. Gupta KL. Agre JC. Rudman IW. Rudman D.
Institution: Department of Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
Title: Effect of human growth hormone on muscle function in post-polio syndrome.
Source Annals of the New York Academy of Sciences. 753:386-9, 1995 May 25.
<110>
Unique Identifier 95336072
Authors: Gawne AC. Pham BT. Halstead LS.
Institution: Post-Polio Program, National Rehabilitation Hospital, Washington, DC 20010-2949, USA.
Title: Electrodiagnostic findings in 108 consecutive patients referred to a post-polio clinic. The value of routine electrodiagnostic studies.
Source Annals of the New York Academy of Sciences. 753:383-5, 1995 May 25.
<111>
Unique Identifier 95336070
Authors: Nee L. Dambrosia J. Bern E. Eldridge R. Dalakas MC.
Institution: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
Title: Post-polio syndrome in twins and their siblings. Evidence that post-polio syndrome can develop in patients with nonparalytic polio.
Source Annals of the New York Academy of Sciences. 753:378-80, 1995 May 25.
<112>
Unique Identifier 95336069
Authors: Illa I. Leon-Monzon M. Agboatwalla M. Ilyas A. Latov N. Dalakas MC.
Institution: Neuromuscular Diseases Section, NINDS, NIH, Bethesda, Maryland 20892-1382, USA.
Title: Antiganglioside antibodies in patients with acute polio and post-polio syndrome.
Source Annals of the New York Academy of Sciences. 753:374-7, 1995 May 25.
<113>
Unique Identifier 95336067
Authors: Freistadt MS. Stoltz DA. Eberle KE.
Institution: Department of Microbiology, Immunology and Parasitology, Louisiana State University Medical Center, New Orleans 70112, USA.
Title: Role of poliovirus receptors in the spread of the infection.
Source Annals of the New York Academy of Sciences. 753:37-47, 1995 May 25.
Abstract: Although the poliovirus receptor (PVR) has been cloned, lack of knowledge of its precise tissue distribution makes assessment of its role in mediating poliomyelitis difficult. Our recent work demonstrated that PVR is expressed on human monocytes and that primary human blood cells can support PV replication. In the current work, we demonstrate that CD14-positive cells (monocytes) support PV replication but that only a minority (< 10%) of the cells become infected. In other preliminary studies, immunocytochemical analyses of human brain tissue demonstrated the presence of PVR in the olfactory bulb, a tissue thought to not support PV replication. Thus, it appears that some apparently "ectopic" sites of PVR expression may in fact be sites for PV replication, whereas other sites may indeed be restricted. The ability of monocytes to replicate PV may pertain to some unexplained phenomena in PV pathogenesis, such as the specific cell type carrying out the initial round of replication in the gut, sites of extraneural replication and transport of the virus into the CNS. Preliminary studies with monocytes from post-polio syndrome patients showed no difference in the levels of PVR relative to control monocytes. In other preliminary work, PVR was shown to be phosphorylated and its expression on monocytes increased by treatment with gamma-interferon. The normal function of PVR is likely to be involved in monocyte function during immune activation.
<114>
Unique Identifier 95336065
Authors: Maynard FM.
Institution: Case Western Reserve University, Department of Physical Medicine and Rehabilitation, Cleveland, Ohio 44109-1998, USA.
Title: Managing the late effects of polio from a life-course perspective. [Review] [12 refs]
Source Annals of the New York Academy of Sciences. 753:354-60, 1995 May 25.
<115>
Unique Identifier 95336064
Authors: Halstead LS. Gawne AC. Pham BT.
Institution: Post-Polio Program, National Rehabilitation Hospital, Washington, DC 20010-2949, USA.
Title: National rehabilitation hospital limb classification for exercise, research, and clinical trials in post-polio patients.
Source Annals of the New York Academy of Sciences. 753:343-53, 1995 May 25.
Abstract: A need exists for an objective classification of polio patients for clinical and research purposes that takes into account the focal, asymmetric, and frequent subclinical nature of polio lesions. In order to prescribe a safe, effective exercise program, we developed a five-level (Classes I-V) limb-specific classification system based on remote and recent history, physical examination, and a four-extremity electrodiagnostic study (EMG/NCS). Class I limbs have no history of remote or recent weakness, normal strength, and a normal EMG. Class II limbs have no history of remote or recent weakness (or if remote history of weakness, full recovery occurred), normal strength and EMG evidence of prior anterior horn cell disease (AHCD). Class III limbs have a history of remote weakness with variable recovery, no new weakness, decreased strength, and EMG evidence of prior AHCD. Class IV limbs have a history of remote weakness with variable recovery, new clinical weakness, decreased strength, and EMG evidence of AHCD. Class V limbs have a history of severe weakness with little-to-no recovery, severely decreased strength and atrophy, and few-to-no motor units on EMG. In a prospective study of 400 limbs in 100 consecutive post-polio patients attending our clinic, 94 (23%) limbs were Class I, 88 (22%) were Class II, 95 (24%) were Class III, 75 (19%) were Class IV, and 48 (12%) were Class V. Guidelines for the use of this classification in a clinical/research setting are presented along with sample case histories and class-specific exercise recommendations.
<116>
Unique Identifier 95336061
Authors: Dalakas MC.
Institution: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1382, USA.
Title: How to design a