Offsite Articles [Lincolnshire Post-Polio Network Library]

Offsite Articles

IMPORTANT NOTES FOR NEW READERS

Offsite Articles Index
Articles referenced below were freely accessible at the time they were added to this section. Journal or web site access policies may change as time passes and articles can revert to fee-based access either through journal subscription or individual article reprint fees.

"A calculated risk": the Salk polio vaccine field trials of 1954
Dynamic water exercise in individuals with late poliomyelitis
Linking Evidence and Experience: Characteristics and Management of Postpolio Syndrome
Post-Polio Research: The State of the Art, 1998
Post-polio syndrome [under Motor Neuron Disorders (Asymmetric)]
Polio, sequale following paralysis [under Motor neuronopathies]

"A calculated risk": the Salk polio vaccine field trials of 1954
http://www.bmj.com/cgi/content/full/317/7167/1233

Author(s): Marcia Meldrum, DeWitt Stetten memorial fellow in the history of the biomedical sciences.
Article Location: British Medical Journal
Reference: BMJ 1998;317:1233-1236 ( 31 October )
Summary: The polio vaccine field trials of 1954, sponsored by the National Foundation for Infantile Paralysis (March of Dimes), are among the largest and most publicised clinical trials ever undertaken. Across the United States, 623 972 schoolchildren were injected with vaccine or placebo, and more than a million others participated as "observed" controls. The results, announced in 1955, showed good statistical evidence that Jonas Salk's killed virus preparation was 80-90% effective in preventing paralytic poliomyelitis.

The statistical design used in this great experiment was singular, prompting criticism at the time and since. Eighty four test areas in 11 states used the textbook model: in a randomised, blinded design all participating children in the first three grades of school (ages 6-9) received injections of either vaccine or placebo and were observed for evidence of the disease. But 127 test areas in 33 states used an "observed control" design: participating children in the second grade (ages 7-8) received injections of vaccine; no placebo was given, and children in all three grades were then observed for the duration of the polio "season."

The use of the dual protocol illustrates both the power and the limitations of the randomised clinical trial to legitimate therapeutic claims. The placebo controlled trials were necessary to define the Salk vaccine introduced by a lay organisation that has taken an activist position against the counsel of its virological advisersas the product of scientific medicine. The observed control trials were essential to maintaining public support for the vaccine as the product of lay faith and investment in science. Here I examine the process by which the trial design was negotiated and the roles of the several actors.

Dynamic water exercise in individuals with late poliomyelitis
http://www.archives-pmr.org/article/PIIS0003999301413591/fulltext
was http://www.archives-pmr.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=full&id=aapmr0820066
A PDF version is also available.

Author(s): Willen C, Sunnerhagen KS, Grimby G.
Article Location: Archives of Physical Medicine and Rehabilitation.
Reference: Arch Phys Med Rehabil 2001 Jan;82(1):66-72.
Abstract/Summary: Willen C, Stibrant Sunnerhagen K, Grimby G. Dynamic water exercise in individuals with late poliomyelitis. Arch Phys Med Rehabil 2001;82:66-72.
OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.
DESIGN: Before-after tests.
SETTING: A university hospital department.
PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).
INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).
MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.
RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.
CONCLUSIONS: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.
Copyright 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Lincolnshire Post-Polio Library:

Grimby, Gunnar, MD, PhD

Linking Evidence and Experience: Characteristics and Management of Postpolio Syndrome
http://jama.ama-assn.org/cgi/content/extract/284/4/412
was http://jama.ama-assn.org/issues/v284n4/full/jct00011.html
This article is no longer freely accessible, subscription to JAMA being required.

Author(s): Burk Jubelt, MD; James C. Agre, MD.
Published: JAMA Vol. 284 No. 4, July 26, 2000.
Introduction: Postpolio syndrome (PPS) refers to new, late manifestations occurring many years after acute poliomyelitis infection. Over the last 25 years, PPS has become a relatively common problem encountered by primary care physicians. A 1987 National Health Interview Survey estimated that about half of the 640,000 survivors of paralytic poliomyelitis in the United States had new late manifestations of PPS. Subsequent studies in the 1990s have found the occurrence of PPS among patients with previous poliomyelitis to range from 28.5% to 64%. The average time in various reports from the acute poliomyelitis until the onset of PPS is about 35 years, with a range from 8 to 71 years. However, it is unclear if the occurrence of PPS increases with aging, which may be the case based on the most accepted etiologic hypothesis. The large number of PPS cases presently being seen is probably due to the poliomyelitis epidemics of the 1940s and 1950s.

Lincolnshire Post-Polio Library:

Jubelt, Burk.

Post-Polio Research: The State of the Art, 1998
http://newmobility.com/review_article.cfm?id=93&action=browse
was http://www.newmobility.com/query/magazine/articledetail.cfm?date=april-98&recID=93

Also reproduced in Issue No.10 - March 1998 of LINC-PIN
Author: Richard Louis Bruno
Published: New Mobility Magazine, April 1998

"For researchers studying post-polio sequelae (PPS) -- the disabling fatigue, muscle weakness and pain experienced by 76 percent of polio survivors decades after the virus has come and gone -- 1997 was a year of discovery. Some of the new findings are disappointing, and others are even disturbing. But new understanding from this research will become the platform for future treatments, so there's every reason for survivors to keep themselves well-informed."

The article goes on to discuss the following: Brain Waves and Fatigue, IGF-1 and Pyridostigmine, Magnets for Pain, The Damage Done, Typically Type A, Abuse, Then and Now and Treatment of Choice.

	LincsPPN Directory:	The Post-Polio Institute - Englewood (NJ) Hospital and Medical Center
	LincsPPN Directory:	Richard Bruno and Nancy Frick - The Harvest Center
	Lincolnshire Post-Polio Library:	Bruno, Richard L., Ph.D.
	Lincolnshire Post-Polio Library:	Zimmerman, Jerald R., M.D.

Post-polio syndrome [under Motor Neuron Disorders (Asymmetric)]
http://www.neuro.wustl.edu/neuromuscular/motor.html#pps: Summary list of Diagnostic Criteria, Laboratory features and Recommended exercise.

Polio, sequale following paralysis [under Motor neuronopathies]
http://svt.ee.tut.fi/korpinen/emg11.htm#d
Currently Unavailable: Summary list of Etiology, Clinical features, Strategy, Expected abnormal findings, Expected Normal findings and Procedure. Part of a section beginning with Amyotrophic laterals sclerosis (ALS) and ending with Bulbar hereditary motor neuronopathy (Fazio-Londe's disease).
From the expert electromyographer Björn Falck - Erik Stålberg - Leena Korpinen

NOTES

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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 this information 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.

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The Lincolnshire Post-Polio Network takes great care in the transcription of all information that appears at this site. However, we do not accept liability for any damage resulting directly or otherwise from any errors introduced in the transcription. Neither do we accept liability for any damage resulting directly or otherwise from the information available at this site. The opinions expressed in the documents available at this site are those of the individual authors and do not necessarily constitute endorsement or approval by the Lincolnshire Post-Polio Network.

Document preparation: Chris Salter, Original Think-tank, Cornwall, United Kingdom.
Primary Document Reference: <URL:http://www.ott.zynet.co.uk/polio/lincolnshire/library/offsite.html>
Secondary Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/offsite.html>
Last modification: 9th May 2009.
Last information content change: 19th May 2009.