PSYCHOLOGIC CHARACTERISTICS OF Polio SURVIVORS: A PRELIMINARY REPORT
Conrady LJ; Wish JR; Agre JC; Rodriquez AA; Sperling KB.
Department of Counselling, San Francisco State University, USA.
Arch Phys Med Rehabil, June 1989, 70(6), p458-63
Ninety-three men and women with histories of Polio were administered the Symptom Check List-90 Revised (SCL-90R), Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), and a questionnaire about their Polio histories. The SCL-90R and PAIS-SR are measures of emotional and psychosocial functioning. Two samples were used: a clinic sample (n = 71) and a postPolio support group sample (n = 22). Initial results for both on the SCL-90R and PAIS-SR indicated elevated scores on a number of subscales. SCL-90R subscale elevated scores for men included those for somatization, depression, anxiety, hostility, and phobia, whereas for women there were elevations on measures of somatization, depression, anxiety, and psychoticism. Elevations were found in the following subscales on the PAIS-SR (pooling men and women): health care orientation, social environment, and extended family relationships. Men scored slightly, but not significantly, higher than women in the SCL-90R except for the hostility subscale, in which the difference was significant (p less than 0.05). Symptom profiles indicated psychologic distress. Comparisons with variables associated with Polio and its late effects (such as severity of initial Polio, use of an iron lung during initial illness, number of involved limbs etc) were not statistically significant.
Poliomyelitis – Psychology
Attitude to Health; Breast Neoplasms – Psychology; Mental Disorders – Epidemiology; Middle Age; Psychological Tests; Sex Factors; Social Support
MODIFIED AEROBIC WALKING PROGRAM: EFFECT ON PATIENTS WITH POSTPolio SYNDROME
Dean E; Ross J
Sch. of Rehabilitation Medicine, Uni. of British Columbia, Vancouver, Canada.
Arch Phys Med Rehabil, Dec 1988, 69(12), p1033-38
Modified aerobic exercise may have a role in the management of patients with symptoms of postPolio syndrome by improving biomechanical efficiency, alleviating secondary cardiorespiratory and muscular deconditioning, and avoiding some risks associated with traditional strengthening exercises. The effects of a walking program on the functional capacity of patients with symptoms of postPolio syndrome were studied. Three patients participated in full oxygen consumption studies during submaximal treadmill exercise tests before and after an eight-week period. Two patients participated in an eight-week program designed to prolong walking duration while maintaining perceived exertion and discomfort/pain at minimal levels. A third patient was tested before and after eight weeks but did not receive training. The untrained patient showed some reduction in the retest compared with the initial test at all workloads with respect to oxygen consumption, heart rate, and systolic blood pressure, but ratings of perceived exertion and discomfort/pain were comparable for the two tests. Reductions in metabolic responses during the retest could be explained by the effect of habituation to the testing situation. In contrast, the trained patients showed relatively marked reductions in both metabolic and subjective responses after training. These results suggest that patients with symptoms of postPolio syndrome can increase their functional work capacity after a modified aerobic walking program. This improvement reflects improved biomechanical efficiency and possible training effects at the cardiorespiratory and muscular levels. Further research is needed to elucidate the role and interactions of these mechanisms in improving the functional work capacity of patients with chronic neuromuscular dysfunction.
Exercise; Poliomyelitis – Rehabilitation
Adult; Aged; Blood Pressure; Heart Rate; Locomotion; Middle Age; Oxygen Consumption; Work Capacity Evaluation
LATE DENERVATION IN PATIENTS WITH ANTECEDENT PARALYTIC PolioMYELITIS
Cashman NR; Maselli R; Wollmann RL; Roos R; Simon R; Antel JP
N Engl J Med, Jul 2 1987, 317(1), p7-12
The development of new weakness, fatigue, and pain decades after acute Poliomyelitis is a recognized syndrome. We conducted a controlled study of this syndrome by analyzing clinical, electromyographic, and muscle-biopsy features in 18 patients with a history of Poliomyelitis – 13 reporting 1 to 20 years of new weakness and 5 without new symptoms. The patients with new weakness also reported new muscle atrophy (9 of 13) and fatigue (10 of 13), symptoms not reported by the controls. The age at the time of acute Poliomyelitis, severity of Poliomyelitis, residual disability, number of years since acute Poliomyelitis, and age at the time of study were comparable in the weakening and control groups. Evidence of remote denervation consistent with antecedent Poliomyelitis was demonstrated in all patients by electromyography or muscle biopsy or both. In addition, active denervation (as evidenced by spontaneous activity on conventional electromyography, increased jitter on single-fiber electromyography, or atrophic myofibers) was found in 12 patients in the weakening group and in all 5 controls. Immunohistochemical detection of myofibers expressing the neural-cell adhesion molecule corroborated ongoing denervation in both patient groups. When muscle data from both groups were pooled, correlations were observed between the extent of past reinnervation and the degree of ongoing motor-unit instability. We conclude that the extensive reinnervation of denervated muscle that occurs in paralytic Poliomyelitis may be followed by late denervation of the previously reinnervated muscle fibers. Electromyography and muscle-biopsy evidence of ongoing denervation does not distinguish between stable patients with prior paralytic Poliomyelitis and those with new weakness.
Muscles – Physiopathology; Poliomyelitis – Physiopathology – Adult; Biopsy; Electromyography; Fatigue – Etiology; Middle Age; Muscles – Pathology; Neurons – Pathology; Pain – Etiology; Paralysis – Complications; Poliomyelitis – Pathology; Time Factors
THE USE OF NONFATIGUING STRENGTHENING EXERCISES IN POST-Polio SYNDROME
Birth Defects, 1987, 23(4), p335-41
This study has been done to determine if there is any beneficial effect from the use of nonfatiguing strengthening exercises in the presence of post-Polio syndrome. Following accurate identification by EMG of muscles that could be called “post-Polio muscles”, the use of physiopathology by offering nonfatiguing strengthening exercises provided either a maintenance or a beneficial effect to these muscles. Only one muscle demonstrated reduced strength during treatment protocol for reasons unassociated with the project. All other muscles, 31 in 6 patients, demonstrated either maintenance of pretreatment strength (17 muscles), or improvement (14 muscles). We feel that the combination of accurate identification of these muscles, followed by strict adherence to a supervised program of nonfatiguing exercise for a period of at least 3 months, provides help for these patients who have developed recurrent weakness 20 years after normal function following Poliomyelitis.
Exercise Therapy; Fatigue – Prevention and Control; Muscles – Physiopathology; Neuromuscular Diseases – Rehabilitation; Poliomyelitis – Complications
Electromyography; Fatigue – Etiology; Neuromuscular Diseases – Etiology; Poliomyelitis – Rehabilitation; Questionnaires
EMOTIONAL RESPONSES TO THE LATE EFFECTS OF PolioMYELITIS
Birth Defects, 1987, 23(4), p135-43
It is necessary to identify and analyze the unique psychosocial stressors that may be impacting on a person with post-Polio syndrome to facilitate their incorporation of medical and rehabilitation recommendations. It is hoped that the information presented will be used to increase the awareness of the range of emotional responses that people with late effects of Polio may have to enable staff to establish sequential presentation of information and guidelines for changes in energy output and life-style patterns. The suggested interventions are given with the aim of facilitating more rapid integration of treatment regimens that will lead to a better quality of life.
Poliomyelitis – Psychology
Adaptation, Psychological; Adult; Aged; Family; Life Style; Middle Age; Pain – Psychology; Poliomyelitis – Complications; Prospective Studies; Recurrence; Sleep Disorders – Etiology
ACUTE AND LATENT AFFECT OF PolioMYELITIS ON THE MOTOR UNIT AS REVEALED BY ELECTROMYOGRAPHY
Orthopedics, Jul 1985, 8(7), P870-2
When Polio virus attacks the motor neuron it may be completely destroyed, damaged, or unaffected. Muscle fibers of a destroyed motor neuron are orphaned or reinnervated. Nearby functioning motor units will then send terminal axon sprouts to reinnervate the orphaned muscle fibers. If there are too many orphaned muscle fibers and not enough surviving motor units to reinnervate them, the orphaned muscle fibers will continue to fibrillate until they atrophy and die. The resultant effect of Poliomyelitis upon the affected muscle is an overall loss of motor units with the remaining units innervating many more muscle fibers than they originally did. There appears to be a late effect of Polio upon these larger reinnervated motor units. After approximately 20 to 30 years, impulse transmission to the muscle fibers of the large reinnervated motor unit begins to fail. These transmission difficulties increase with age and time from recovery. These late onset transmission abnormalities may be factors in patient complaints of fatigue and progressive weakness.
Motor Neurons – Physiopathology; Neuromuscular Diseases – Etiology; Poliomyelitis – Physiopathology
Aged; Aging; Electromyography; Fatigue – Etiology; Middle Age; Neuromuscular Diseases – Physiopathology; Poliomyelitis – Complications; Synaptic Transmission; Time Factors
Polio RESIDUALS CLINIC: CONDITIONING EXERCISE PROGRAM
Owen RR; Jones D
Orthopedics, Jul 1985, 8(7), p882-3
The additional disability experienced by individuals who had Poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.
Exertion; Outpatient Clinics, Hospital; Poliomyelitis – Rehabilitation
Adult; Cardiovascular System – Physiopathology; Exercise Therapy; Middle Age; Physical Endurance; Poliomyelitis – Complications; Poliomyelitis – Physiopathology; Time Factors.
CHRONIC PARTIAL DENERVATION IS MORE WIDESPREAD THAN IS SUSPECTED CLINICALLY IN PARALYTIC PolioMYELITIS. ELECTROPHYSIOLOGICAL STUDY.
Cruz Martinez A; Perez Conde MC; Ferrer MT
Eur Neurol, 1983, 22(5), p314-21
Clinical evaluation, quantitative analysis of the EMG, and motor unit fiber density were carried out on 34 selected patients that suffered paralytic Poliomyelitis. 50% of the subjects developed a late and slowly progressive weakness. Automatic analysis of the electromyogram showed a great increase in mean amplitude in weak muscles but also in hypertrophic ones, and in other muscles that had normal strength. Increase in mean amplitude and in motor unit fiber density was greater in the weaker muscles. The increased amplitude and motor unit fiber density found in clinically unaffected muscles confirms that neurogenic atrophy is more widespread than is suspected clinically. Thus, the late deterioration of function developed in some of the patients always takes place in muscles which are previously damaged and partially depleted in motor units. Widespread neurogenic involvement of the muscles can play an important role in the late deterioration of these patients.
Muscles – Innervation; Poliomyelitis – Physiopathology – Adolescence; Adult; Aged; Child; Electromyography; Leg – Innervation; Middle Age; Motor Neurons – Physiology; Muscle Contraction; Muscular Atrophy – Physiopathology; Nerve Fibers – Physiopathology; Neural Conduction