The following are pertinent references that may be helpful for doctors or
patients suffering from Post Polio Syndrome. For links to informative
sites on the internet click on the following: Post Polio
Syndrome - Internet Resources
Chang, C ;Huang, S ;Varied clinical patterns, physical activities, muscle
enzymes, electromyographic and histologic findings in patients with post-polio
syndrome in TaiwanSpinal Cord. 2001 Oct; 39(10):
526-31
ABSTRACT: STUDY DESIGN: A study of the clinical features, physical activity,
muscle enzyme, electromyography and histopathological alternations of muscles
in patients with post-polio syndrome (PPS). OBJECTIVE: To assess the varied
patterns of PPS in Taiwan. SETTING: Taiwan. METHODS: Thirty-one patients
who fulfill the inclusion criteria of PPS were selected for study. Clinical
features, physical activity scale, serum concentrations of creatine kinase,
electromyography and histopathological alterations of muscles were assessed
and correlated to the causes of PPS patients. RESULTS: Patients with PPS
in Taiwan are relatively young, with a mean age of 39.3 years. Elevated concentration
of creatine kinase was found predominantly in male patients with higher physical
activities. Electromyographic examinations as well as histological tests
of affected muscles revealed prominent evidence of chronic and active denervation
with reinnervation in PPS patients. CONCLUSION: Patients with PPS in Taiwan
are young. Thus, PPS should not be attributed to aging. Physical attrition
with degradation of nerve terminals is considered the main cause of this
disease.
Klein MG, Whyte J, Keenan MA, Esquenazi A, Polansky M. Changes in
strength over time among polio survivors. Arch Phys Med Rehabil.
2000 Aug;81(8):1059-64.
Moss Rehabilitation Research Institute, Philadelphia, PA 19141, USA.
OBJECTIVE: To study changes in the strength of different muscle groups in
polio survivors over a period of approximately 9 months. DESIGN: Longitudinal
study. SETTING: Moss Rehabilitation Research Institute. PARTICIPANTS: One
hundred twenty subjects (57 men, 63 women) were studied on three occasions,
each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss
Post-Polio Management Program. newspaper advertisements, and polio support
groups. MAIN OUTCOME MEASURES: Isometric strength of 30 muscle groups (16
in upper extremities, 14 in lower extremities) was measured, using a hand-held
dynamometer. RESULTS: Data were analyzed in two separate groups: upper-extremity
muscles and lower-extremity muscles. Results for the upper-extremity muscles
revealed evidence of a significant deterioration in strength. The amount
of deterioration differed among muscles and increased with age. There was
also evidence of deterioration in strength in the flexor muscles in the ankle,
hip, and knee. However, the rate of deterioration in these muscles was not
strongly related to age, time since polio, gender, symptom status, or history
of residual weakness. CONCLUSIONS: Strength is deteriorating among polio
survivors at a rate higher than that associated with normal aging. This deterioration
is not occurring in the extensor, or so-called "weight-bearing" muscles,
but is occurring in many of the upper-extremity muscle groups and in the
flexor muscles in the lower extremities.
Stanghelle, J ;Festvåg, L ;Postpolio syndrome: a 5 year follow-upSpinal Cord. 1997 Aug; 35(8): 503-8
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.
Vallbona C, Hazlewood CF, Jurida G. Response of pain to static magnetic
fields in postpolio patients: a double-blind pilot study. Arch Phys
Med Rehabil. 1997 Nov;78(11):1200-3.
Department of Family and Community Medicine, Baylor College of Medicine,
Houston, TX 77030, USA.
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.
Mizuno M, Quistorff B, Theorell H, Theorell M, Chance B. Effects of oral
supplementation of coenzyme Q10 on 31P-NMR detected skeletal muscle energy
metabolism in middle-aged post-polio subjects and normal volunteers.
Mol Aspects Med. 1997;18 Suppl:S291-8.
Department of Medical Biochemistry and Genetics, Panum Institute, University
of Copenhagen, Denmark.
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.
Rodriquez, A ;Agre, J ;Harmon, R ;Franke, T ;Swiggum, E ;Curt, J ;Electromyographic
and neuromuscular variables in post-polio subjects Archives
Of Physical Medicine And Rehabilitation. 1995 Nov; 76(11):
989-93
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.
Bougie, J. ;Cassidy, J. ;Donat, J. ;Post-Polio Syndrome-A Case ReportJournal of the Neuromusculoskeletal System. 1994 Sum; 2(2): 75-8
ABSTRACT: Post-polio syndrome (PPS) is the name given to late symptoms of
pain, and fatigue experienced by patients who were afflicted with poliomyelitis.
Although cases have been reported in the literature since the 1800s, PPS
is capturing more attention in recent years. This is due to the sheer numbers
of survivors from the last epidemic reporting new difficulties. The diagnosis
is complex because the symptoms are similar to many musculoskeletal problems.
There is no definitive test to confirm the diagnosis, and primary care providers
must suspect PPS in patients who have a history of polio.
Nakajima M, Kuwabara S, Uchino F, Hirayama K. [Enhanced regeneration
of terminal axons after hyperbaric oxygen therapy in a patient resembling
progressive postpoliomyelitis muscular atrophy] [Article in Japanese]
Rinsho Shinkeigaku. 1994 Jan;34(1):48-51.
Department of Neurology, School of Medicine, Chiba University.
We found an electromyographical proof of reconstruction of the motor nerve
terminals following hyperbaric oxygen therapy. A 38-year-old man who had
been partially recovered for thirty four months from acute onset paraplegia
following a gastrointestinal infection developed progressive muscular atrophy
and weakness of the lower limbs, and was first admitted to our hospital.
Cerebrospinal fluid examination was normal and nerve conduction studies showed
small compound muscle action potentials without an evidence of segmental
demyelination. There were ample fibrillation potentials on electromyography.
Single fiber electromyography (SFEMG) showed increased fiber density, abnormal
jitter and blockings without neurogenic jitter, which were similar to findings
in post-poliomyelitis syndrome. He was treated by hyperbaric oxygen consisting
of two hour exposures to pressures of two atmospheres breathing 100% oxygen.
These exposures continued for a month daily, and thereafter once a week for
one year. Clinical improvement of the weakness and a decrease in amount of
fibrillation potentials occurred on and after a month after treatment. We
found significant changes on SFEMG a year later. There were increased fiber
densities and decreased mean values of consecutive differences. These changes
indicate diminished degeneration and enhanced regeneration of the terminal
axons. We think that hyperbaric oxygen has a beneficial effect on oxygen
metabolism of remaining motoneurons which may not be able to maintain excessive
metabolic demands of all their sprouting axons.
Birk, T. ;Poliomyelitis and the Post-Polio Syndrome: Exercise Capabilities
and Adaptation--Current Research, Future Directions, and Widespread ApplicabilityMedicine & Science In Sports & Exercise. 1993 Apr; 25(4):
466-72
ABSTRACT: Polimyelitis is an acute viral disease that attacks the brain and
the ventral horn of the spinal cord. Damage to the lower motor neurons usually
results in atrophy and weakness of muscle groups, perhaps paralysis and possibly
deformity. A second type, bulbar poliomyelitis, infects the medulla oblongata
and may result in dysfunction of the swallowing mechanism along with respiratory
and circulatory distress. Minor forms of poliomyelitis result in fever, sore
throat, headache, and upper body stiffness, but leave no significant atrophy
or paralysis. The purpose of this paper is review post-polio syndrome (PPS)
as well as the effect of exercise on the symptoms and morphologic adaptations
to PPS and where future research efforts should be directed. The most common
features of PPS for over 350,000 afflicted survivors include general fatigue,
weakness, and joint/muscle pain. The primary reasons for these symptoms include
1) destruction of the anterior horn cells by the polio virus, leaving fewer
motor neurons to induce muscle contraction; 2) unaffected motor unit
enlargement by reinnervation through terminal sprouting; and 3) defective
transmission at the neuromuscular junction secondary to failure of termial
axonal sprout. Acute responses to resistive exercise suggest significant
muscle strength decrements in the knee extensors following at least 6 wk
of training. Acute aerobic responses also differ significantly from those
observed in aged-matched control subjects. Chronic aerobic responses to limited
training studies suggest significant elevations in maximal oxygen uptake.
Although fatigue during physical activity may be a combination of central
and peripheral factors, it is speculated that for the person with PPS the
cause is more peripheral. Current and future research directed at determining
the site of fatigue will result in treatment programs optimizing various
exercise modalities and conservation of energy.
Currie, D ;Gershkoff, A ;Cifu, D ;Geriatric rehabilitation. 3. Mid- and
late-life effects of early-life disabilities Archives of Physical
Medicine and Rehabilitation. 1993 May; 74(5-S): S413-6
ABSTRACT: This self-directed learning module highlights mid- and late-life
effects of early-life disabilities. It is part of the chapter on geriatric
rehabilitation in the Self-Directed Medical Knowledge Program for practitioners
and trainees in physical medicine and rehabilitation. This article contains
information on how to evaluate, prevent, and manage late complications seen
in adults and older adults with cerebral palsy, spina bifida, spinal cord
injury, multiple sclerosis, juvenile rheumatoid arthritis, and early-life
amputations, including psychosocial and other quality-of-life issues. New
advances in post-polio syndrome are also covered.
Perry, J ;Mulroy, S ;Renwick, S ;The relationship of lower extremity strength
and gait parameters in patients with post-polio syndromeArchives
of Physical Medicine and Rehabilitation. 1993 Feb; 74(2): 165-9
ABSTRACT: Relationships between lower extremity strength and stride characteristics
were studied in 24 patients with post-polio syndrome. Maximum isometric torques
were measured in the ankle plantar flexors, hip and knee extensors, and hip
abductors. Gait velocity, stride length, and cadence were recorded during
free and fast walking. Step-wise regression analysis was performed to determine
which muscle groups best predicted ambulatory function. Plantar flexion torque
was the best predictor of velocity (r = .55 free walking and r = .76 fast)
and cadence (r = .46 free and r = .58 fast). The combination of plantar flexion
and hip abduction torques was the best predictor of fast stride length (r
= .78). These findings emphasize the important role of the plantar flexor
muscles in gait. Knee extension torque was the poorest predictor for each
of the gait parameters. Several patients demonstrated gait deviations that
minimized the penalty of quadriceps weakness. Without a contracture or an
orthosis, however, no adequate substitution exists for weak plantar flexion.
Coelho CA, Ferranti R Incidence and nature of dysphagia in
polio survivors. Arch Phys Med Rehabil. 1991 Dec;72(13):1071-5.
Department of Communication Disorders, Gaylord Hospital, Wallingford, CT
06492.
Questionnaires pertaining to swallowing function were mailed to 220 members
of postpolio support groups in Connecticut. Of the 109 responses, 80 individuals
reported having no difficulty with swallowing, while 29 reported having either
intermittent or consistent swallowing problems. Twenty-one of the 29 were
seen for videofluoroscopic swallowing studies and pulmonary function testing.
The swallowing studies showed that 43% of these individuals had difficulty
with bolus control, 19% with delayed swallow response, and 81% with decreased
pharyngeal transit. Although none of these individuals were observed to aspirate,
two were judged to be at significant risk. Incidence of dysphagia within
the group of polio survivors was estimated to be approximately 18%. Seventeen
of the 20 postpolio subjects with dysphagia also demonstrated decreased breathing
capacity. Although moderately to severely depressed values in the pulmonary
function measures accompanied moderate dysphagia in certain postpolio individuals,
reduced values in these same measures were also present in individuals with
minimal swallowing dysfunction. Therefore, although impaired breathing may
complicate swallowing dysfunction and vice versa, it does not appear that
one can be predicated from the other. Management of dysphagia in postpolio
individuals is discussed.
Hammond DC. Hypnosis for postpolio syndrome & Type-A behavior.
Am J Clin Hypn. 1991 Jul;34(1):38-45.
University of Utah School of Medicine.
Many of the hundreds of thousands of survivors of polio are now developing
postpolio syndrome. Symptoms include progressive muscle weakness, fatigue,
decreased endurance, joint and muscle pain, weight gain, respiratory difficulties,
and sleep disturbance, often precipitated or exacerbated by a Type-A Personality
pattern. A postpolio patient with Type-A Personality was taught self-hypnosis
as a vital component of treatment. Pre-post testing included the Profile
of Mood States, the State-Trait Anxiety Inventory, the State-Trait Anger
Inventory, and the Personal Orientation Inventory; the patient's spouse was
interviewed during the follow-up. At the 6-month follow-up, improvements
were documented in pain level, depression, self-regard, self-acceptance,
capacity for intimate contact, time competence (living in the present), confusion,
anxiety, insomnia, and in trait and state anger. Only a mild improvement
occurred in fatigue, and no improvement was found in weight control. Follow-up
at 12 months confirmed the maintenance of improvements. Self-hypnosis training
may prove extremely helpful for postpolio patients and may prove helpful
in modifying central characteristics of Type-A Personality.
Westbrook, M. ; Clients' Evaluations of Chiropractic Treatment for Post
Polio SyndromeJournal of the Australian Chiropractic Association.
1990 Dec; 20(4): 143-51
ABSTRACT: The late effects of poliomyelitis were virtually unrecognised until
recently. The rapidly expanding medical and self-help literature have ignored
chiropractic as a potential treatment. A survey of 304 people with post polio
symptoms revealed that after medical practitioners and physiotherapists,
chiropractors were the health practitioners to be rated as very helpful.
Chiropactic provided symptom relief for relatively more clients. Chiropractic
was more likely to be sought later, and throught lay referral, than were
other treatments. It is suggested that information about post polio syndrome
and cinical experiences with clients needs to be more widely disseminated
among chiropractors' so that treatment outcomes for the many thousands with
this chronic disability can be maximised.
Dean, E. ;Ross, J. ;Macintyre, D. ; A Rejoinder to "Exercise Programs
for Patients with Post-Polio Syndrom: A Case Report"--A Short CommunicationPhysical Therapy.1989 Aug; 69(8): 695-698
ABSTRACT: This communication response to the article by Michael T Gross and
Schuch entitled "Exercise Programs for Patients with Post-Polio Syndrome:
A Case Report" published in the January 1989 issue of Physical Therapy. The
investigators examined effects of a rigorous isokinetic training program
on peak torque of the knee flexor and extensor muscles of a post-polio patient.
The literature on post-polio syndrome, however, does not support the use
of either conventional muscle strengthening regimens or rigorous isokinetic
exercise programs in the management of post-polio syndrome. In addition,
based on the observation that there was no appreciable increase in muscle
strength in either the affected or the apparently unaffected leg, the investigators
concluded that their rigorous exercise program was not deleterious. The lack
of a normal training response, however, is consistent with bilateral muscle
fatigue secondary to overuse rather than muscle weakness secondary to disuse.
This result is consistent with the need for a balance between rest and low-intensity
exercise, which will help to maintain or ehnace function while slowing rather
than hastening further deterioration. We hope that this rejoinder clarifies
some of the misconceptions that may arise from the Gross and Schuch article
and that physical therapists consider very carefully the rationale for any
type of exercise program for post-polio patients.
Gross, M. ;Schuch, C. ;Exercise Programs for Patients with Post-Polio
Syndrome: a Case ReportPhysical Therapy. 1989 Jan; 69(1):
72-6
ABSTRACT: Several authors have reported on post-polio syndrome, indicating
a in muscle strength in individuals years after the onset of poliomyelitis.
These reports include suggestions that strenuous exercise programs are contraindicated
and may have deleterious effects for patients with post-polio syndrome. The
purpose of this case study was to examine the effects of an aggressive, six-week
isokinetic exercise program on a 59-year-old patient with post-polio syndrome.
Peak torque values were assessed before and during the exercise program,
and 6 and 22 weeks following cessation of the exercise program. The results
indicate no deleterious effects secondary to the exercise program. The authors
suggest future research strategies to investigate the efficacy of exercise
programs for patients with post-polio syndrome.
Twist, D. ;Ma, D. ;Physical Therapy Management of the Patient with Post-Polio
Syndrome: A Case ReportPhysical Therapy. 1986 Sep; 66(9): 1403-6
ABSTRACT: This case report documents the treatment of a patient who experienced
progressive muscle weakness and a decrease in function over time that did
not appear to be related to any secondary neuromuscular disease. We discuss
the relationship between age and maximal muscle function in addition to some
general guidelines for rehabilitation. This type of patient can represent
a challenge for the physical therapist. This case report, however, illustrates
the degree of muscular and functional recovery that can result with a physical
therapy program aimed at reducing levels and intensity of exercise, daily
activity, and stress. Such a combination of short-term goals appears to be
essential to the successful management of a patient with post-polio syndrome.
Post Polio Syndrome Central Excellent and large selection of Post Polio Syndrome Links . http://skally.net/ppsc/
The Lincolnshire Post-Polio Network An Information Service for Polio Survivors and Medical Professionals
69 Woodvale Avenue
Lincoln, Lincolnshire, LN6 3RD United Kingdom
Tel: +44 (0)1522 888601
Fax: +44 (0)1522 885115 http://www.zynet.co.uk/ott/polio/lincolnshire/