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- Title: Pathophysiology
and diagnosis of post-polio syndrome
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Author(s):
Daria A. Trojan, Neil R. Cashman
Original Publication: NeuroRehabilitation 8 (1997) 83-92
Abstract/Extract: Post-poliomyelitis syndrome is defined
as a clinical syndrome of new weakness, fatigue and pain which can occur several
decades following recovery from paralytic poliomyelitis. The cause of this
disorder is still unclear, and many possible etiologies have been proposed.
The most widely accepted etiology was first proposed by Wiechers and Hubbell,
which attributes PPS to a distal degeneration of massively enlarged post-polio
motor units. Other probable contributing factors to the onset of this disease
are the ageing process, and overuse. Currently, there is no specific diagnostic
test for PPS, which continues to be a diagnosis of exclusion in an individual
with symptoms and signs of the disorder. © 1997 Elsevier Science Ireland
Ltd.
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- Title: Poliomyelitis
- Author(s):
D Kidd, AJ Williams, RS Howard
Original Publication: Postgraduate Medical Journal 1996;
72: 641 - 647
Abstract/Extract: 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 postpolio muscular atrophy.
- Title: Poliomyelitis
and the Post-Polio Syndrome
- Author(s):
Burk Jubelt and Judy Drucker.
Original Publication: Chapter 34. Reprinted from Motor
Disorders edited by David S. Younger.
Lippincott Williams & Wilkins, Philadelphia © 1999
Abstract/Extract: In the first half of the this century,
epidemics of poliomyelitis (polio) ravaged the world. In the epidemic of 1952,
over 20,000 Americans developed paralytic polio. With the introduction of
the Salk inactivated polio vaccine (IPV) in 1954 and the Sabin oral polio
vaccine (OPV) in 1961, the number of paralytic cases decreased to a handful
per year. Polio had vanished and no longer was on the consciousness of Americans.
The elimination of polio was a tremendous achievement for science and American
medicine. However, in the late 1970s, survivors of paralytic polio began to
notice new health problems that included fatigue, pain, and new weakness,
thought not to be "real" by the medical establishment. The term "post-polio
syndrome" (PPS) was coined by these patients to emphasize their new health
problems. This chapter reviews acute poliomyelitis and the related PPS.
- Title: Post-Polio
Sequelae: Physiological and Psychological Overview
- Author(s):
Nancy M. Frick, M. Div. and Richard L. Bruno, Ph.D.
Original Publication: Rehabilitation Literature, 1986; 47
(5-6): 106-111.
Abstract/Extract: When the Salk and Sabin vaccines brought
an end to the annual summer nightmare of polio epidemics, most Americans simply
forgot about polio. Even many of those who had paralytic poliomyelitis put
the disease out of their minds once they had achieved maximum recovery of
function. Unfortunately, polio has again forced itself into the nation's consciousness.
Over the past five years, many of those who had polio have been experiencing
new and unexpected symptoms that range in severity from being merely unpleasant
to severely debilitating:
- Title: Post-Polio
Syndrome: Pathophysiology and Clinical Management
- Special Note: This is a long
article (226K). We have also produced a multi-document version comprising
fifteen separate shorter documents which reflect the section headings of the
original article. Multi-document Version
Author(s): Anne Carrington Gawne and Lauro S. Halstead.
Original Publication: Critical Reviews in Physical and Rehabilitation
Medicine, 7(2):147-188 (1995).
Abstract/Extract: Post-polio syndrome (PPS) is a progressive
neuromuscular syndrome characterized by symptoms of weakness, fatigue, pain
in muscles and joints, and breathing and swallowing difficulties. Survivors
of poliomyelitis experience it many years after their initial infection. Although
the etiology for these symptoms is unclear, it may be due to motor unit dysfunction
manifested by deterioration of the peripheral axons and neuromuscular junction,
probably as result of overwork. An estimated 60% of the over 640,000 paralytic
polio survivors in the U.S. may suffer from the late effects of polio. Their
physical and functional rehabilitation care presents a challenge for practitioners
in all disciplines. To evaluate these symptoms, a comprehensive assessment
must be done, as frequently PPS is a diagnosis of exclusion. Care of the patient
with PPS is best carried out by an interdisciplinary team of rehabilitation
specialists. This article reviews the epidemiology, pathophysiology, characteristics,
assessment, and rehabilitation care of the patient with PPS.
- Title: Predictive
Factors for Post-Poliomyelitis Syndrome
- Author(s):
Daria A. Trojan, MD, MSc, Neil R. Cashman, MD, Stanley Shapiro, PhD, Catherine
M. Tansey, MSc, John M. Esdaile, MD
Original Publication: Arch Phys Med Rehabil Vol 75, July
1994, 770-777
Abstract/Extract: Post-poliomyelitis syndrome (PPS) is generally
defined as a clinical syndrome of new weakness, fatigue, and pain in individuals
who have previously recovered from acute paralytic poliomyelitis. The purpose
of this study was to identify, through a case-control study design, factors
that predict subsequent PPS in patients with prior paralytic poliomyelitis.
Among patients attending a university-affiliate hospital post-polio clinic,
"cases" were patients with new weakness and fatigue, and "controls" were patients
without these complaints. A chart review of 353 patients identified 127 cases
and 39 controls. Logistic regression modeling was used to calculate adjusted
and unadjusted odds ratios. In univariate analyses, significant risk factors
for PPS were a greater age at time of presentation to clinic (p=0.01),
a longer time since acute polio (p=0.01), and more weakness at acute
polio (p=0.02). Other significant associated, but not necessarily causal
factors were a recent weight gain (p=0.005), muscle pain (p=0.01)
particularly that associated with exercise (p=0.005), and joint pain
(p=0.04). Multivariate analyses revealed that a model containing age
at presentation to clinic, severity of weakness at acute polio, muscle pain
with exercise, recent weight gain, and joint pain best distinguished cases
from controls. Age at acute polio, degree of recovery after polio, weakness
at best point after polio, physical activity, and sex were not contributing
factors. These findings suggest that the degree of initial motor unit involvement
as measured by weakness at acute polio, and possibly the aging process and
overuse are important in predicting PPS.
© 1994 by the American Congress of Rehabilitation Medicine and the
American Academy of Physical Medicine and Rehabilitation
- Title: Changes
in Post-Polio Survivors Over Five Years: Symptoms and Reactions to Treatments.
- Author(s): Mary T. Westbrook,
PhD
Original Publication: Proceedings of the 12th World Congress,
International Federation of Physical Medicine and Rehabilitation, Sydney,
March 1995.
Abstract/Extract: A group of 176 people with post-polio syndrome,
identified using Ramlow et al's (1992) criteria, took part in a 5 year follow-up
survey. Most reported increased muscle weakness (91%), fatigue (91%), muscle
pain (80%), joint pain (64%) and changes in walking (60%). Increases in other
symptoms occurred in less than half the group. Cramps, sensitivity to cold,
muscle atrophy and muscle twitching were the symptoms most likely to have
stabilised. The average respondent reported greater difficulty in carrying
out 4 of the 8 activities of daily living investigated. Respondents were significantly
less anxious and depressed about their condition at follow-up. Degree of post-polio
changes reported at the time of the first survey was a better predictor of
decline during the five years than were initial polio histories or psycho-social
variables. Health practitioners most likely to have been consulted were general
practitioners and physiotherapists. Specialists in rehabilitation medicine
were rated as providing more beneficial treatment than other medical practitioners.
Treatments reported to provide good symptom relief included massage and water
activities but not exercise. Life style modifications associated with pacing,
reduced activity and rest were particularly effective. Overall 68% of respondents
considered there was much they could do to control post-polio symptoms.
- Title: Health
and Demographic Characteristics of Polio Survivors
- Author(s):
Sandra S. French and G. Sam Sloss
Original Publication: Lincolnshire Post-Polio Library April
1999.
Abstract/Extract: Since 1985, the Louisville and Ashland,
Kentucky chapters of the Polio Survivors Organization have collected questionnaire
data from polio survivors. The questionnaires included data on Social and
demographic data - e.g., age, sex, education, and employment history; Polio
history - e.g., dates, types, and treatments; and Current health problems
- e.g., fatigue, depression, and breathing problems. Respondents include people
from the east coast to the west coast and from states bordering both Canada
and Mexico. The 295 respondents live in 202 different zip code areas with
no more than three people from any one zip code. This article reports on the
data from this sample of polio survivors.
- Title: A
Qualitative Survey of Postpolio Syndrome in the Leeds area
- Author(s): S. A. Arshad,
St. Mary's Hospital, Greenhill Road, Leeds.
Original Publication: Lincolnshire Post-Polio Library 2000.
Abstract/Extract: A qualitative study was carried out between
the months of September and November 1998. Interviews were done on 14 patients
suffering from the post-polio syndrome. They were between the ages of 40 and
72 years and eight males and six females. All of them had polio in childhood,
before the age of 10 years with various impairments. The aim of this study
was to explore possible influences on the perceived quality of life for people
with PPS. This is a pilot case series in descriptive epidemilogy.
- Title: A
Report Into The Consequencies Of Living With Polio For 63,500 Years
- Author(s): Peter Field
Original Publication: 1995
Abstract/Extract: This survey was conducted as a lay study
into the impact on the lives of people who had polio earlier in life, and
also to establish the frequency as well as the severity of the problems attributed
to the "Late Effects of Polio".
- Title: Survey
of the Late Effects of Polio in Lothian
- Author(s):
B. Pentland, D. J. Hellawell, J. Benjamin, R. Prasad
Original Publication: Rehabilitation Studies Unit, Charles
Bell Pavilion, Astley Ainslie Hospital, 33 Grange Loan, Edinburgh EH9 2HL.
January 1999
Abstract/Extract: The Edinburgh Branch of the British Polio
Fellowship (BPF) expressed the concern of members that the medical and related
professions often appeared unfamiliar with the late consequences of polio
and that services were not meeting their needs. In an attempt to determine
the number of people affected and the nature of their experience, this postal
survey was done in 1998. A set of questionnaires were sent to 221 people,
in Edinburgh and the Lothians, who had been identified as suffering polio
in the past from those known to the BPF and hospital records. There were 125
replies which constituted the study population: 60% were female; the median
age was 59 years; and the median time since original diagnosis was 51 years.
- Title: Post-Polio
Population Statistics - A Review
- Author(s): Chris Salter,
Vice-Chairman, Lincolnshire Post-Polio Network.
Original Publication: A Lincolnshire Post-Polio Library Publication.
July 2000
Abstract/Extract:
As can be seen, when trying to determine the number cases of PPS in a population
we are confronted with a number of problems.
- No current statistics of persons currently diagnosed as PPS.
- Estimates of the percentage of cases of prior polio likely to develop
PPS vary considerably. Few if any take into account that a historical
clinical diagnosis of non-paralytic polio does not preclude a diagnosis
of PPS.
- Although in recent years records of notified and confirmed cases of
polio have been maintained by the World Health Authority, records predating
the eradication campaign are more difficult to locate and may be unreliable.
- Estimates of the numbers of cases of prior polio vary considerably and
as with PPS estimates, tend to be limited to so called paralytic polio.
It is worth noting that a 'mild' polio infection may not even be diagnosed
at the time of the infection but may still result in sufficient damage
to cause problems in later life.
- Title: Managing
the Late Effects of Polio from a Life-Course Perspective
- Author(s): Frederick M. Maynard.
Original Publication: Ann N Y Acad Sci 1995 May 25;753:354-360
Abstract/Extract: This paper reviews the implications of
recent research investigations for the management of patients with PPS. It
proposes that current knowledge supports the view that PPS is a secondary
condition frequently occurring during the life course of people with residual
motor impairment from paralytic poliomyelitis and does not support the view
that PPS is a distinct pathological process which should be labeled a disease
or illness.
- Title: Recognizing
Typical Coping Styles Of Polio Survivors Can Improve Re-Rehabilitation
- Author(s):
Frederick M. Maynard, MD and Sunny Roller, MA
Original Publication: Am. J. Phys. Med. Rehabil. Vol. 70,
No. 2, April 1991
Abstract/Extract: During the past ten years many polio survivors
in the U.S. have actively been seeking professional help for a wide range
of new physical problems, commonly referred to as the late effects of polio.
Often these persons require re-rehabilitation in order to continue their accustomed
social roles. In our experience at the Post-Polio Program of the University
of Michigan Medical Center, we have come to recognize among polio survivors
three distinct patterns of emotional reaction to the need for re-rehabilitation.
These patterns appear to result from characteristic styles of living with
a chronic disability. We propose a model for categorizing polio survivors
that is based on our observations. Although it is limited by overgeneralization,
we have found that polio survivors themselves have verbally validated our
proposed categories at many post-polio conferences. A 1963 study of children
with polio and their families also describes early coping behaviors that are
compatible with our model.
- Title: The
Postpolio Syndrome - An Overuse Phenomenon
- Author(s):
Jacquelin Perry, M.D., Gregory Barnes, B.S., R.P.T. and JoAnne K. Gronley,
M.A., R.P.T.
Original Publication: Clinical Orthopaedics and Related Research
Volume 233:145-162; August 1988
Abstract/Extract: Persons with good recovery of function
following their initial poliomyelitis are now, more than 30 years later, experiencing
new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being
the cause of this late functional loss was investigated by dynamic electromyography
(EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing
grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal
(N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps
and calf strength, the patients fell into one of four classes: strong quadriceps
and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and
strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified
EMG; (normalized by the manual muscle test EMG) defined the mean duration
and intensity of the quadriceps soleus, lower gluteus maximus, and long head
of the biceps femoris during walking. Overuse was defined as values greater
than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances
of overuse, normalcy, and sparing. The biceps femoris was the only muscle
with dominant overuse (82%). Quadriceps overuse was next in frequency (53%).
Soleus activity infrequently exceeded normal function (34%), but this still
represented more than twice the intensity and duration of the other muscles.
Gluteus maximus action was also seldom excessive (34%). The patients averaged
two muscles with excessive use during walking. Gait velocity of the SQ/SC
strong group was highest (71% of normal) while the three categories that included
weak muscles had walking speeds in the range of 50% of normal. The finding
of muscle overuse during a single free-speed walking test that does not attain
normal velocity supports the concept of muscle overuse being the cause of
the patient's dysfunction.
- Title: The
Neuroanatomy Of Post-Polio Fatigue
- Author(s):
Richard L. Bruno, Ph.D., Jesse M. Cohen, M.D., Thomas Galski, Ph.D. and Nancy
M. Frick, M.Div.
Abstract/Extract: Fatigue is the most commonly reported,
most debilitating and most poorly understood Post-Polio Sequelae (PPS). Postmortem
studies of fifty years ago documented frequent and severe poliovirus-induced
lesions within the reticular activating system (RAS). Recently, neuropsychological
testing has documented marked attention deficits in polio survivors reporting
severe fatigue. However, neither of these findings has been related to the
pathophysiology of post-polio fatigue. Magnetic resonance imaging of the brain
was performed in 22 polio survivors carefully screened to eliminate the effect
of comorbidities. Subjects rated the severity of their daily fatigue and subjective
problems with attention, cognition and memory. Small discrete or multiple
punctate areas of hyperintense signal (HS) in the reticular formation, putamen,
medial leminiscus or white matter tracts were imaged in 55% of the subjects
reporting high fatigue and in none those reporting low fatigue. The presence
of HS significantly correlated with fatigue severity and subjective problems
in attention, concentration, staying awake, recent memory and thinking clearly.
The lack of significant correlations between HS or fatigue severity and age,
severity of the acute polio, depressive symptoms or difficulty sleeping militates
against these factors as either causing HS or producing fatigue. These preliminary
findings suggest that poliovirus-induced lesions in the RAS may underlie the
subjective fatigue and attention deficits associated with PPS fatigue.
- Title: The
Neuropsychology Of Post-Polio Fatigue
- Author(s):
Richard L. Bruno, Ph.D., Thomas Galski, Ph.D., John DeLuca, Ph.D.
Original Publication: Archives of Physical Medicine and Rehabilitation,
1993; 74: 1061-1065.
Abstract/Extract: To test the hypothesis that post-polio
fatigue and its concomitant cognitive deficits are associated with an impairment
of attention and not of higher-level cognitive processes, six carefully screened
polio survivors were administered a battery of neuropsychological tests. Only
subjects reporting severe fatigue, and not those with mild fatigue, demonstrated
clinically significant deficits on all tests of attention, concentration and
information processing speed while showing no impairments of cognitive ability
or verbal memory. These findings suggest that an impaired ability to maintain
attention and rapidly process complex information appears to be a characteristic
in polio survivors reporting severe fatigue, since these deficits were documented
even when their subjective rating of fatigue was low. This finding supports
the hypothesis that a polio-related impairment of selective attention underlies
polio survivors' subjective experience of fatigue and cognitive problems.
- Title: The
Pathophysiology Of Post-Polio Fatigue:
A Role for the Basal Ganglia in the Generation of Fatigue
- Author(s): Richard L. Bruno,
Ph.D., Robert Sapolsky, Ph.D., Jerald R. Zimmerman, M.D., and Nancy M. Frick,
Lh.D.
Original Publication: The pathophysiology of a central cause
of post-polio fatigue. Annals of the New York Academy of Sciences, 1995; 753:
257-275.
Abstract/Extract: Fatigue is the most commonly reported,
most debilitating and least studied Post-Polio Sequelae (PPS) affecting the
more than 1.63 million American polio survivors. Post-polio fatigue is characterized
by subjective reports of problems with attention, cognition and maintaining
wakefulness, symptoms reminiscent of nearly two dozen outbreaks during this
century of post-viral fatigue syndromes that are related clinically, historically
or anatomically to poliovirus infections. These relationships, and recent
studies that associate post-polio fatigue with clinically significant deficits
on neuropsychologic tests of attention, histopathologic and neuroradiologic
evidence of brain lesions and impaired activation of the hypothalamic-pituitary-adrenal
axis, will be reviewed to described a role for the reticular activating system
and basal ganglia in the pathophysiology of post-polio fatigue. The possibility
of pharmacologic therapy for PPS is also discussed.
- Title: Polioencephalitis
and the Brain Fatigue Generator Model of Post-Viral Fatigue Syndromes
- Author(s):
Richard L. Bruno, Ph.D., Nancy M. Frick, Lh.D., Susan Creange, M.A., Jerald
R. Zimmerman, M.D., and Todd Lewis, Ph.D.
Original Publication: JOURNAL OF CHRONIC FATIGUE SYNDROME,
1996 (in press).
Abstract/Extract: Fatigue is the most commonly reported and
most debilitating Post-Polio Sequelae (PPS) affecting millions of polio survivors
world-wide. Post-polio fatigue is associated with: 1) subjective reports of
difficulty with attention, cognition, word-finding and maintaining wakefulness;
2) clinically significant deficits on neuropsychological tests of information
processing speed and attention; 3) gray and white matter hyperintensities
in the reticular activating system on magnetic resonance imaging of the brain;
4) neuroendocrine evidence of impaired activation of the HPA axis.
- Title: Anticholinesterase-responsive
neuromuscular junction transmission defects in post-poliomyelitis fatigue
- Author(s):
Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Original Publication: Journal of the Neurological Sciences,
114 (1993) 170-177
Abstract/Extract: Disabling generalized fatigue and muscle
fatiguability are common features of post-poliomyelitis syndrome (PPS). In
17 fatigued PPS patients, we measured jitter on stimulation single-fiber electromyography
(S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium.
We observed reduction in jitter (defined as a significant difference in jitter
means before and after edrophonium, unpaired t-test P < 0.05)
in 7 patients, no change in 8, and a significant increase in 2 patients. Blinded
to their edrophonium results, the 17 patients were treated with pyridostigmine
180 mg/day for 1 month, with a subjective improvement of fatigue in 9 patients,
and with a significant reduction in mean Hare fatigue scores in the entire
group of 17 patients (pre=2.71, and post=1.71; Wilcoxan signed rank sum test,
P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was
significantly associated with pyridostigmine-induced subjective improvement
of fatigue (Fisher's exact test, P < 0.04). A significant reduction
in fatigue with pyridostigmine was observed only in the 7 patients who experienced
a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum
test, P=0.03). In addition, the 9 pyridostigmine responders experienced
a significant reduction in jitter means pre- and post-edrophonium (100% vs.
88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular
transmission as measured by jitter on S-SFEMG can improve with edrophonium
in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability
in some patients with PPS may be due to anticholinesterase-responsive NMJ
transmission defects.
- Title: Anticholinesterases
in Post-Poliomyelitis Syndrome
- Author(s):
Daria A. Trojan and Neil R. Cashman
Original Publication: The Post-Polio Syndrome: Advances in
the Pathogenesis and Treatment Volume 753 of the Annals of the New York
Academy of Sciences May 25, 1995
Abstract/Extract: Our studies indicate that a proportion
of fatigued post-poliomyelitis patients can experience an amelioration of
defects in neuromuscular junction transmission and of clinical fatigue with
anticholinesterases. Because S-SFEMG response was significantly associated
with clinical response to anticholinesterases, fatigue in PPS may be caused
by defects in neuromuscular junction transmission in a proportion of patients.
Preliminary studies in a small group of patients indicate that anticholinesterases
may produce their clinical neuromuscular response by producing an increase
in isokinetic strength in a proportion of patients. Our studies provide a
physiological rationale for the use of anticholinesterases in PPS for the
symptom of fatigue. However, further randomized, placebo-controlled, double-blinded
trials are needed to establish definitively the benefits and risks of these
agents.
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- Title: Correlation
of Electrophysiology with Pathology, Pathogenesis, and Anticholinesterase
Therapy in Post-Polio Syndrome
- Author(s):
Neil R. Cashman and Daria A. Trojan
Original Publication: Reprinted from The Post-Polio Syndrome:
Advances in the Pathogenesis and Treatment Volume 753 [pp 138-150] of the
Annals of the New York Academy of Sciences May 25, 1995
Abstract/Extract: A great deal of data has been generated
on PPS, and a great deal more will be generated before we understand the pathophysiology
of this common and disabling disorder. Perhaps now, to guide future work and
direct therapeutic approaches, it is best to think of the symptoms of PPS
as due to two lesions of the motor unit: a "progressive lesion" and a "fluctuating
lesion."
- Title: Stimulation
frequency-dependent neuromuscular junction transmission defects in patients
with prior poliomyelitis
- Author(s):
Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Original Publication: Journal of the Neurological Sciences,
118 (1993) 150-157
Abstract/Extract: Generalized fatigue and muscle fatiguability
are major symptoms of post-poliomyelitis syndrome (PPS), and may be due to
neuromuscular junction transmission defects, as suggested by increased jitter
on single fiber electromyography (SFEMG). To determine the etiology of this
defect, we studied jitter at low (1, 5 Hz) and high (10, 15, 20 Hz) frequency
stimulation with stimulation SFEMG in 17 post-polio patients with muscle fatiguability,
and in 9 normal controls. In 5 of 17 PPS patients and in 1 of 9 controls,
jitter was significantly higher (unpaired t-test, P < 0.05)
at high frequency stimulation (HFS). In the remaining PPS patients and controls
there was no significant difference in jitter at high and low stimulation
frequencies. PPS patients with increased jitter at HFS had a significantly
longer time interval since acute polio (mean 48.5 years) than PPS patients
without increased jitter at HFS (mean 40 years; P < 0.05), but were
not distinguished by other historical or clinical criteria. We conclude that
the neuromuscular junction defect in post-polio patients is similar to that
observed in amyotrophic lateral sclerosis, and is probably due to ineffective
conduction along immature nerve sprouts and exhaustion of acetylcholine stores.
The appearance of an increase in jitter with HFS in post-polio patients may
be dependent upon time after acute polio.
- Title: An
Open Trial of Pyridostigmine in Post-poliomyelitis Syndrome
- Author(s):
Daria A. Trojan and Neil R. Cashman
Original Publication: The Canadian Journal of Neurological
Sciences Volume 22, No. 3 August 1995 223-227
Abstract/Extract:
Background: One of the major symptoms of postpoliomyelitis
syndrome (PPS) is disabling generalized fatigue. Subjects with PPS also
report muscle fatiguability and display electrophysiologic evidence of anticholinesterase-responsive
neuromuscular junction transmission defects, suggesting that anticholinesterase
therapy may be useful in the management of disabling fatigue. Methods:
We initiated an open trial of the oral anticholinesterase pyridostigmine,
up to 180 mg per day, in 27 PPS patients with generalized fatigue and muscle
fatiguability. Response to Pyridostigmine was assessed with the Hare fatigue
scale, the modified Barthel index for activities of daily living, and a
modified Klingman mobility index. Results: Two patients
could not tolerate the medication. After one month of therapy, 16 patients
(64%) reported a reduction in fatigue on the Hare fatigue scale; three of
16 showed improvement on the modified Barthel index for activities of daily
living, and two of 16 experienced improvement on a modified Klingman mobility
index. Pyridostigmine responders were significantly more fatigued than non-responders
on the pre-treatment Hare score, but were not significantly different with
regard to age, sex, age at acute poliomyelitis, or severity of acute poliomyelitis.
Conclusions: Pyridostigmine may be useful in the management
of fatigue in selected patients with PPS. Response to pyridostigmine may
be predicted by severity of pre-treatment fatigue.
- Title: Bromocriptine
In The Treatment Of Post-Polio Fatigue:
A pilot study with implications for the pathophysiology of fatigue
- Author(s): Richard L. Bruno,
Ph.D., Jerald R. Zimmerman, M.D., Susan Creange, M.A., Todd Lewis, Ph.D.,
Terry Molzen, M.A., and Nancy M. Frick, M.Div, Lh.D.
Original Publication: American Journal of Physical Medicine
and Rehabilitation, 1997 (in press)
Abstract/Extract:
Objective: Determine the effectiveness of bromocriptine in the treatment of
severe and disabling post-polio fatigue.
- Title: Fainting
And Fatigue: Causation or Coincidence
- Author(s): Richard L. Bruno,
Ph.D.
Original Publication: CFIDS Chronicle, 1996; 9(2): 37-39.
Abstract/Extract: As the former autonomic nervous system
fellow at New York's Columbia-Presbyterian Medical Center, and in my current
incarnation studying chronic fatigue in polio survivors, I have read with
special interest the reports from Johns Hopkins University describing neurally
mediated hypotension (NMH) in adults and adolescents with CFIDS.
- Title: Effect
of Treatment and Noncompliance on Post-Polio Sequelae
- Author(s): Paul E. Peach,
MD, Stephen Olejnik, PhD
Original Publication: Orthopedics November 1991 Vol 14 No.
11 1199-1203.
Abstract/Extract: In this study of 77 patients with post-polio
sequelae (PPS), symptoms and manual test scores on initial evaluation were
compared with those at subsequent follow-up evaluations. Patients were divided
into three groups based on the degree to which they had complied with clinically
recommended interventions: compliers, partial compliers, and noncompliers.
At the end of the followup period (2.2 ± 1.2 years), the mean muscle
function scores of the entire study group had declined - l.5%, which represented
a decline of -0.7% annually. On follow-up evaluations, the complier group
had realized an improvement or resolution of post-polio symptoms, and also
an improvement in muscle function of +0.6% annually. The partial complier
group had realized either no improvement, or improvement in post-polio symptoms,
but showed a further decline in muscle function of -3.0%, or an annual decline
of -1.3%. The noncomplier group showed either no change, or a worsening of
post-polio symptoms, and also showed a further decline in muscle function
of - 4.1% which represented an annual decline of - 2.0%.
- Title: Polioencephalitis,
Stress And The Etiology Of Post-Polio Sequelae
- Author(s): Richard L. Bruno,
Ph.D., Nancy M. Frick, M.Div., and Jesse Cohen, M.D.
Abstract/Extract: Post-mortum neurohistopathology from 158
individuals who contracted polio before 1950 are reviewed that document polio
virus-induced lesions in reticular formation, hypothalamic, thalamic, peptidergic
and monoaminergic neurons in the brain. This polioencephalitis was found to
occur in every case of poliomyelitis, even those without evidence of damage
to spinal motor neurons. These findings, in combination with data from the
1990 National Post-Polio Survey and new magnetic resonance imaging studies
documenting post-encephalitis-like lesions in the brains of polio survivors,
are used to present hypotheses that polioencephalitic damage 1) to aging reticular
activating system and monoaminergic neurons is responsible for post-polio
fatigue and 2) to enkephalin-producing neurons is responsible for hypersensitivity
to pain in polio survivors. Hypotheses are also presented that the anti-metabolic
action of glucocorticoids on polio-damaged, metabolically vulnerable neurons
is responsible for the fatigue and muscle weakness reported by polio survivors
during emotional stress. Suggestions for the treatment of Post-Polio Sequelae
based on these hypotheses are also presented.
- Title: Postpoliomyelitis
Syndrome: Assessment of Behavioral Features
- Author(s):
Donald L. Freidenberg, David Freeman, Steven J. Huber, Jacquelin Perry, Armin
Fischer, Wilfred G. Van Gorp and Jeffrey L. Cummings
Original Publication: Neuropsychiatry, Neuropsychology, and
Behavioral Neurology Vol. 2, No. 4, pp 272-281. 1989
Abstract/Extract: Postpoliomyelitis syndrome (PPS) is an
increasingly recognized phenomenon characterized by late-onset weakness, pain,
and fatigue. Psychiatric and cognitive disturbances have been noted in postpoliomyelitis
patients, but the relationship of these symptoms to PPS is unknown. We examined
postpoliomyelitis patients with and without PPS using objective neuropsychological
and neuropsychiatric procedures. Our results suggest that disturbances of
mood were common and that subtle cognitive deficits also occured in postpoliomyelitis
patients. However, patients with PPS did not have greater depression or cognitive
deficits compared to postpoliomyelitis patients without PPS.
- Title: Predicting
Hyperactive Behavior as a Cause of Non-Compliance with Rehabilitation:
The Reinforcement Motivation Survey
- Author(s):
Dr. Richard L. Bruno
Abstract/Extract: Non-compliance with therapy is a significant
problem in vocational rehabilitation. Significant amounts of professional
time and money are wasted treating patients who are unwilling or unable to
participate in their own rehabilitation. The client with chronic musculoskeletal
pain - depressed, without energy (i.e., "anergic") and refusing to attend
therapy - is the exemplar of non-compliance. However, clients with chronic
pain and other disabilities demonstrate a different type of non-compliance,
characterized by chronic hyperactivity and refusal to decrease behaviors that
are known to maintain or increase symptoms. To document the occurrence of
hyperactive non-compliance, 80 clients treated for chronic musculo skeletal
pain (CMP) and 41 clients treated for Post-Polio Sequelae (PPS) were studied
prospectively and administered the Beck Depression Inventory (BDI) and the
Reinforcement Motivation Survey (RMS). Forty percent of the CMP clients and
79% of the PPS clients who were discharged from therapy demonstrated hyperactive
non-compliance. CMP clients as a group had significantly elevated BDI and
RMS Type A behavior and Negative Reinforcement Motivation scores, while PPS
clients as a group had elevated Sensitivity to Criticism and Failure scores,
as compared to controls. Significantly elevated Type A behavior and Sensitivity
to Criticism and Failure scores were associated with hyperactive non-compliance
as well as completion of therapy. These findings indicate that hyperactive
non-compliance is an frequent cause of treatment failure in rehabilitation
clients and that the RMS may be of use in identifying potentially non-compliant
clients and the form non-compliance will take. The design of individualized
rehabilitation programs to manage non-compliance and maximize the probability
of completing therapy is described.
- Title: The
Psychology Of Polio As Prelude To Post-Polio Sequelae:
Behavior modification and psychotherapy
- Author(s): Richard L. Bruno,
Ph.D. and Nancy M. Frick, M.Div.
Original Publication: Orthopedics, 1991, 14(11) :1185-1193.
Abstract/Extract: Even as the physical causes and treatments
for Post-Polio Sequelae (PPS) are being identified, psychological symptoms
- chronic stress, anxiety, depression and compulsive, Type A behavior - are
becoming evident in polio survivors. Importantly, these symptoms are not only
themselves causing marked distress but also are preventing patients from making
the lifestyle changes necessary to treat their PPS. Neither clinicians nor
polio survivors have paid sufficient attention to the acute polio experience,
its conditioning of life-long patterns of behavior, its relationship to the
development of PPS and its effect on the ability of individuals to cope with
and treat their new symptoms. This paper describes the acute polio and post-polio
experiences on the basis of patient histories, relates the experience of polio
to the development of compulsive, Type A behavior, links these behaviors to
the physical and psychological symptoms reported in the National Post-Polio
Surveys and presents a multimodal behavioral approach to the treatment of
PPS by describing patients who have been treated by this Post-Polio Service.
- Title: Stress
and "Type A" Behavior as Precipitants of Post-Polio Sequelae:
The Felician/Columbia Survey
- Author(s): Richard L. Bruno,
PhD, and Nancy M. Frick, MDiv, LhD
Original Publication: In LS Halstead and DO Wiechers (Eds.):
Research and Clinical Aspects of the Late Effects of Poliomyelitis. White
Plains: March of Dimes Research Foundation, 1987.
Abstract/Extract: A behavioral profile has begun to emerge
from studies of persons who survived acute poliomyelitis and are now experiencing
post-polio sequelae. Persons who had polio have been shown to be employed
full time at four times the rate of the general disabled population. Persons
who had polio have more years of formal education on average than the general
population, and marry at approximately the same rate as those who are not
disabled. These data, combined with our own experience with thousands of persons
who had polio, indicated that "polio survivors" are competent, hard-driving
and time-conscious overachievers who demand perfection in all aspects of their
personal, professional, and social lives. It appeared that those who survived
polio exhibit "Type A" behavior and would therefore experience chronic emotional
stress.
- Title: Gait
Analysis Techniques
- Author(s): JoAnne K. Gronley
and Jacquelin Perry.
Original Publication: The Journal of American Physical Therapy
Assn. Vol. 63, No. 12, December 1984 1831-1838.
Abstract/Extract: In the gait laboratory at Rancho Los Amigos
Hospital, the emphasis is on patient testing to identify functional problems
and determine the effectiveness of treatment programs. Footswitch stride analysis,
dynamic EMG, energy-cost measurements, force plate, and instrumented motion
analysis are the techniques most often used. Stride data define the temporal
and distance factors of gait. We use this information to classify the patient's
ability to walk and measure response to treatment programs. Inappropriate
muscle action in the patient disabled by an upper motor neuron lesion is identified
with dynamic EMG. Intramuscular wire electrodes are used to differentiate
the action of adjacent muscles. We use the information to localize the source
of abnormal function so that selection of treatment procedures is more precise.
Force and motion data aid in determining the functional requirement and the
muscular response necessary to meet the demand. Determining the optimum mode
of locomotion and developing criteria for program planning have become more
realistic with the aid of energy-cost measurements. Microprocessors and personal
computer systems have made compact and reliable single-concept instrumentation
available for basic gait analysis in the standard clinical environment at
a modest cost. The more elaborate composite systems, however, still require
custom instrumentation and engineering support.
- Title: Gastrointestinal Involvement In The Post-Polio Syndrome
(PPS)
- Our thanks to Tom Walter (TominCal@aol.com) for providing this
article.
Author(s): Assembled by Tom Walter from talks Dr. Sinn Anuras
gave in the early '90's, plus feedback he gave to some local participants.
Abstract/Extract: Gastrointestinal involvement is common
in the post-polio syndrome, and it appears to affect the entire gastrointestinal
tract. Unfortunately, there are only a few studies in this fascinating area.
More extensive studies are needed to understand the pathologic and pathophysiologic
processes in this problem, so that patients can be treated properly. We report
our survey of gastrointestinal symptoms that could affect up to 50 per cent
of the post-polio syndrome patients in this review. We also propose the underlying
pathophysiologic changes, outline the diagnosis and treatment for difficulties
of various parts of the gastrointestinal tract.
- Title: Late
functional deterioration following paralytic poliomyelitis
- Author(s): D. Kidd, R.S.
Howard, A.J. Williams, F.W. Heatley, C.P. Panayiotopoulos and G.T. Spencer
Original Publication: QJ Med 1997; 90: 189 - 196
Abstract/Extract: Many patients with previous poliomyelitis
develop 'post-polio syndrome' (PPS) in which late functional deterioration
follows a period of relative stability. The frequency with which PPS can be
attributed to clearly defined causes remains uncertain. We reviewed 283 newly-referred
patients with previous poliomyelitis seen consecutively over a 4-year period;
239 patients developed symptoms of functional deterioration at a mean of 35
(5-65) years after the paralytic illness. Functional deterioration was associated
with orthopaedic disorders in 170 cases, neurological disorders in 35, respiratory
disorders in 19 and other disorders in 15. Progressive post-polio muscular
atrophy was not observed. Functional deterioration following paralytic poliomyelitis
is common, and associated with orthopaedic, neurological, respiratory and
general medical factors which are potentially treatable.
- Title: Endurance
Training Effect on Individuals With Postpoliomyelitis
- Author(s):
Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar
Grimby, MD, PhD
Original Publication: Arch Phys Med Rehabil 1996;77:843-8.
Abstract/Extract:
Objective: To determine the effects of an endurance training
program on the exercise capacity and muscle structure and function in individuals
with postpolio syndrome.
Design: Preexercise and postexercise testing was performed
with muscle strength evaluations using isokinetic testing as well as hand-held
Myometer. Muscle fatigue was determined by use of isokinetic testing, and
endurance was determined by exercise testing. Enzymatic evaluation was performed
with muscle biopsies taken at the same site; preexercise and postexercise
muscle cross-sectional area was measured by computed tomography. Disability
and psychosocial evaluation was performed by a Functional Status Questionnaire.
Setting: A university.
Subjects: Seventeen postpolio subjects ranging in age
from 39 to 49 years volunteered for a 6-month combined endurance and strength
training program. They had a history of acute poliomyelitis at least 25
years earlier and were able to walk with or without aid.
Intervention: Twelve of the subjects (mean age 42 years)
completed the program, attending an average of 29 sessions, which were offered
for 60 minutes twice a week.
Main Outcome Measures: Strength, endurance, enzymatic
activity, and cross-sectional area were measured 3 months before the beginning
of training, just before training, and at the completion of the exercise
program.
Results: Knee extension was reduced to an average of 60%
of control values and did not change with training. Strength measured with
a hand-held Myometer increased significantly for elbow flexion, wrist extension,
and hip abduction. Exercise test on a bicycle-ergometer showed significant
reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min)
in maximal heart rate with training. The training program could be performed
without major complications and resulted in an increase in muscle strength
in some muscle groups and in work performance with respect to heart rate
at submaximal work load.
© 1996 by the American Congress of Rehabilitation Medicine and
the American Academy of Physical Medicine and Rehabilitation
- Title: Electrophysiology
and Electrodiagnosis of the Post-Polio Motor Unit
- Author(s):
Daria A. Trojan, MD, Daniel Gendron, MD, Neil R. Cashman, MD
Original Publication: Orthopedics December 1991 Vol 14 No
12 1353-1361
Abstract/Extract: Post-poliomyelitis syndrome refers to new
symptoms that may occur years after recovery from poliomyelitis. The most
common of these symptoms are new weakness, fatigue, and pain. This article
describes electrodiagnostic studies -- conventional electromyography (EMG),
single fiber electromyography (SFEMG), and macroelectromyography (macro-EMG)
-- that have provided information on the post-polio motor unit and on the
possible etiology of some post-polio syndrome symptoms. Muscular fatigue,
and indirectly, general fatigue, may be due to neuromuscular junction transmission
defects in some post-polio individuals, as suggested by reduction of the compound
motor action potentials on repetitive stimulation, and increased jitter and
blocking on SFEMG. Progressive weakness and atrophy in post-polio syndrome
is probably due to a distal degeneration of post-polio motor units with resultant
irreversible muscle fiber denervation. Electrodiagnostic evidence of ongoing
denervation includes fibrillation and fasciculation potentials on conventional
EMG, increased jitter and blocking on SFEMG, and smaller macro-EMG amplitudes
in newly weakened postpolio muscles. However, even though electrodiagnostic
studies have provided insight into the possible causes of some postpolio syndrome
symptoms, no specific electrodiagnostic test for the syndrome is currently
available.
- Title: Electrodiagnostic
Findings in 108 Consecutive Patients Referred to a Post-Polio Clinic - The
Value of Routine Electrodiagnostic Studies
- Author(s):
Anne C. Gawne, Bao T. Pham, and Lauro S. Halstead.
Original Publication: The Post-Polio Syndrome: Advances in
the Pathogenesis and Treatment Volume 753 pp 383-385 of the Annals of the
New York Academy of Sciences May 25, 1995.
Abstract/Extract: Many patients with a history of polio develop
new symptoms including weakness, pain, fatigue, and changes in function, or
post-polio syndrome (PPS). Before a diagnosis of PPS is made, other diagnoses
must first be ruled out. Assessment must be done in a comprehensive and coordinated
manner. Therefore, as part of our routine evaluation, we do an electromyogram/nerve
conduction study (EMG/NCS) on every patient. During examinations on our clinic
patients we began to notice (1) electrodiagnostic evidence of polio in limbs
not previously felt to be involved; (2) a normal EMG, or evidence of another
disease; and (3) EMG evidence consistent with additional neurological lesions,
including compression neuropathies, peripheral neuropathies, and radiculopathies.
A prospective study using a routine, standardized four-extremity electrodiagnostic
protocol was done to quantify the frequency of these occurrences.
- Title: Findings
in Post-Poliomyelitis Syndrome
- Author(s):
Jacquelin Perry, M.D., James D. Fontaine, M.D. and Sara Mulroy, PH.D., P.T.,
Downey, California
Original Publication: The Journal of Bone and Joint Surgery
Vol. 77-A, No. 8, August 1995, 1148-1153
Abstract/Extract: 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 obervations support the theory that postpoliomyelitis 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.
- Title: Muscle
Function, Muscle Structure, and Electrophysiology in a Dynamic Perspective
in Late Polio
- Author(s): Gunnar Grimby,
MD, PhD, Erik Stålberg, MD.
Original Publication: Reprinted from POST-POLIO SYNDROME,
edited by Halstead & Grimby, © 1995 Hanley & Belfus, Inc., Philadelphia,
PA. Chapter 2, pp 15-24.
Abstract/Extract: The muscular impairment in patients with
a history of polio varies from none to severe. The relationship between the
degree of initial involvement and the effect of various compensatory mechanisms
determines the clinical picture, which changes dynamically. Early and late
recovery after poliomyelitis depend on a number of factors. Clinical improvement
that appears within a few weeks after the acute phase is probably
due to recovery in the excitability of functional, but not degenerated, motor
neurons. Degeneration of neurons, causing peripheral denervation, is compensated
by collateral sprouting, i.e., by nerve twigs branching off from surviving
motor units overlapping with the denervated ones. This is most likely the
main factor explaining recovery within the first 6-12 months. Another
late compensatory process is the increase in size of the muscle fibers. As
a result of these processes, normal muscle strength and presumably normal
muscle volume can be seen despite a calculated loss exceeding 50% of the number
of motor neurons.
- Title: Muscle
Recovery in Poliomyelitis
- Author(s): W. J. W. Sharrard,
London, England
Original Publication: The Journal of Bone and Joint Surgery,
Vol 37 B, No. 1, February 1955:63-79.
Abstract/Extract:
- The results of a three-year study of recovery in 3,033 lower limb muscles
and 1,905 upper limb muscles in 142 patients are presented.
- The rate of recovery of partly paralysed muscles is the same in all
muscles and muscle groups in the lower or upper limb. Clinical differences
in the ability of individual muscles to recover depend upon the proportions
of their number that remain permanently paralysed.
- The rate of recovery is slowest in adults and most rapid in young children.
- The amount of further recovery to be expected in a muscle can be predicted
from knowledge of its grade at any time after one month from the onset
of the paralysis. Fourteen-fifteenths of the total amount of recovery
takes place by the beginning of the twelfth month; with rare exceptions
individual muscle recovery is complete after twenty-four months.
- Ninety per cent of muscles that are still completely paralysed after
six months remain permanently paralysed.
- The prognosis of a completely paralysed muscle is related to the level
of paralysis in muscles supplied by the same spinal segments.
- Deterioration in power in a muscle is uncommon and, when it occurs,
is associated with the presence of the strong opposing force of antagonist
muscles or of gravity.
- The application of these findings to the management of cases of paralytic
acute anterior poliomyelitis is discussed.
- Title: National
Rehabilitation Hospital Limb Classification for Exercise, Research, and Clinical
Trials in Post-Polio Patients
- Author(s):
Lauro S. Halstead, Anne Carrington Gawne, and Bao T. Pham
Original Publication: The Post-Polio Syndrome: Advances in
the Pathogenesis and Treatment Volume 753 pp 343-353 of the Annals of the
New York Academy of Sciences May 25, 1995.
Abstract/Extract: 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.
- Title: The
Distribution of the Permanent Paralysis in the Lower Limb in Poliomyelitis
A Clinical and Pathological Study
- Author(s): W. J. W. Sharrard,
London, England
Original Publication: The Journal of Bone and Joint Surgery,
Vol 37 B, No. 4, November 1955:540-558.
Abstract/Extract:
Though a striking feature of the paralysis that may result from an attack
of poliomyelitis is its diversity, the belief that some order exists in
the apparently irregular distribution of the permanent paralysis has been
expressed by several authors. Wickman (1913) stated that "although a great
variety of combinations of paralyses are found, certain types appear more
often than others; in the leg the peroneal group and certain muscles of
the thigh -- in my experience the quadriceps femoris especially -- tend
to be implicated." Lovett and Lucas (1908), Lovett (1915, 1917), Jahss (1917),
Mitchell (1925) and Legg (1929, 1937) showed tables indicating the relative
frequency of paralysis and paresis in the muscles of the lower limb. All
show a high incidence of paralysis in tibialis anterior, tibialis posterior,
the long extensors of the toes and the peronei. A lower incidence of paralysis
but a greater combined total of paralyses and pareses is shown in the quadriceps
and in the gluteal muscles. No satisfactory explanation has yet been offered
to account for these findings
It is the object of this paper to review the distribution of paresis and
paralysis in the muscles of the lower limb, to account for its disposition
in terms of the destruction of motor nerve cells in the lumbo-sacral spinal
cord, and to indicate the practical application of the findings in the management
of poliomyelitis.
- Title: Pulmonary
dysfunction and its management in post-polio patients
- Author(s):
John R. Bach and Margaret Tilton
Original Publication: NeuroRehabilitation 8 (1997) 139-153
Abstract/Extract: Respiratory dysfunction is extremely common
and entails considerable risk of morbidity and mortality for individuals with
past poliomyelitis. Although it is usually primarily due to respiratory muscle
weakness, post-poliomyelitis individuals also have a high incidence of scoliosis,
obesity, sleep disordered breathing, and bulbar muscle dysfunction. Although
these factors can result in chronic alveolar hypoventilation (CAH) and frequent
pulmonary complications and hospitalizations, CAH is usually not recognized
until acute respiratory failure complicates an otherwise benign upper respiratory
tract infection. The use of non-invasive inspiratory and expiratory muscle
aids, however, can decrease the risk of acute respiratory failure, hospitalizations
for respiratory complications, and need to resort to tracheal intubation.
Timely introduction of non-invasive intermittent positive pressure ventilation
(IPPV), manually assisted coughing, and mechanical insufflation-exsufflation
(MI-E) and non-invasive blood gas monitoring which can most often be performed
in the home setting, are the principle interventions for avoiding complications
and maintaining optimal quality of life © 1997 Elsevier Science Ireland
Ltd.
- Title: Pulmonary
Dysfunction and Sleep Disordered Breathing as Post-Polio Sequelae: Evaluation
and Management
- Author(s): John R. Bach,
MD and Augusta S. Alba, MD
Original Publication: Orthopedics December 1991 Vol 14 No
12 1329-1337.
Abstract/Extract: Post-polio sequelae can include sleep disordered
breathing and chronic alveolar hypoventilation (CAH). Both conditions develop
insidiously and can render the post-polio survivor susceptible to cardiopulmonary
morbidity and mortality when not treated in a timely and appropriate manner.
These conditions can be diagnosed by a combination of spirometry, noninvasive
blood gas monitoring, and ambulatory polysomnography Sleep disordered breathing
is most frequently managed by nasal continuous positive airway pressure, while
tracheostomy ventilation is the most common treatment for ventilatory failure.
We report the more effective and comfortable techniques recently made available
for managing sleep disordered breathing and the use of noninvasive treatment
options for CAH, respiratory failure, and impaired airway clearance mechanisms.
One hundred forty-three cases are reviewed.
- Title: Airway
Secretion Clearance by Mechanical Exsufflation for Post-Poliomyelitis Ventilator-Assisted
Individuals
- Author(s): John R. Bach,
MD, William H. Smith, Jennifier Michaels, MD, Lou Saporito, BA, Augusta S.
Alba, MD, Rajeev Dayal, BS, Jeffrey Pan, BS
Original Publication: Arch Phys Med Rehabil Vol 74:170-177,
February 1993.
Abstract/Extract: Pulmonary complications from impaired airway
secretion clearance mechanisms are major causes of morbidity and mortality
for post-poliomyelitis individuals. The purpose of this study was to review
the long-term use of manually assisted coughing and mechanical insufflation-exsufflation
(MI-E) by post-poliomyelitis ventilator-assisted individuals (PVAIs) and to
compare the peak cough expiratory flows (PCEF) created during unassisted and
assisted coughing. Twenty-four PVAIs who have used noninvasive methods of
ventilatory support for an average of 27 years, relied on methods of manually
assisted coughing and/or MI-E without complications during intercurrent respiratory
tract infections (RTIs). Nine of the 24 individuals were studied for PCEF.
They had a mean forced vital capacity (FVC) of 0.54 ± 0.47L and a mean
maximum insufflation capacity achieved by air stacking of ventilator insufflations
and glossopharyngeal breathing of 1.7L. The PCEF were as follows: unassisted,
1.78 ± 1.16L/sec; following a maximum assisted insufflation, 3.75 ±
0.73L/sec; with manual assistance by abdominal compression following a maximum
assisted insufflation, 4.64 ± 1.42L/sec; and with MI-E, 6.97 ±
0.89L/sec. We conclude that manually assisted coughing and MI-E are effective
and safe methods of airway secretion clearance for PVAIs with impaired expiratory
muscle function who would otherwise be managed by endotracheal suctioning.
Severely decreased maximum insufflation capacity but not vital capacity indicate
need for a tracheostomy.
© 1993 by the American Congress of Rehabilitation Medicine and the American
Academy of Physical Medicine and Rehabilitation
It is the intention of the Lincolnshire Post-Polio Network to make
all the information we collect available regardless of our views as to it's
content. The inclusion of a document in this library should not therefore be
in any way interpreted as an endorsement.
People who had polio and are experiencing new symptoms need to be assessed
by medical professionals who are experienced in Post-Polio to determine what
is wrong and to give correct advice. We can only make these documents available
to you. YOU must then take what you believe to be relevant
to the medical professional you are seeing. We are collecting and collating
everything we can to enable medical professionals to make informed decisions.
Other medical conditions must be looked for first, Post-Polio Syndrome is by
diagnosis of exclusion.
Whether you are a Polio Survivor, a friend or relation of a Polio Survivor,
or a Medical Professional, we would advise you use this catalogue only to assist
in determining your reading priorities. Every article in this library
is likely to contain information of interest to both Polio Survivors
and Medical Professionals.
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The Lincolnshire Post-Polio
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An Information Service for Polio Survivors and Medical Professionals
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