NeuroRehabilitation - Volume 8, issue 2

Authors: Trojan, Daria A.

Article Type: Introduction

DOI: 10.3233/NRE-1997-8201

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 71-71, 1997

Authors: Gawne, Anne C. | Halstead, Lauro S.

Article Type: Research Article

Abstract: Paralytic poliomyelitis has plagued mankind for centuries. The incidence of acute paralytic poliomyelitis dramatically declined in 1955 only after the introduction of the inactivated polio vaccine. Post-Polio Syndrome (PPS) was described as early as the 1870s, but was not clearly recognized by the medical community until the early 1980s. This article reviews the history and epidemiology of acute paralytic poliomyelitis, as well as post-polio syndrome, from its early description by Charcot and others in 1875, to the modern roots of PPS research in 1954. Finally, we will describe the presenting features of PPS, in both clinical and population studies which …represent two very different ‘faces’ of post-polio. Show more

Keywords: Paralytic poliomyelitis, Post-polio syndrome, Epidemiology of polio and post-polio syndrome, Clinical features of post-polio syndrome

DOI: 10.3233/NRE-1997-8202

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 73-81, 1997

Authors: Trojan, Daria A. | Cashman, Neil R.

Article Type: Research Article

Abstract: 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. Show more

Keywords: Poliomyelitis, Diagnosis, Pathophysiology

DOI: 10.3233/NRE-1997-8203

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 83-92, 1997

Authors: Trojan, Daria A. | Finch, Lois

Article Type: Research Article

Abstract: Many patients with post-poliomyelitis syndrome can benefit from a management program. When a post-polio patient presents with new symptoms, it is first essential to identify and treat other medical and neurological conditions which could produce these symptoms. New weakness can be managed with exercise (stretching, strengthening, and aerobic), avoidance of muscular overuse, weight loss, orthoses, and assistive devices. Fatigue can be managed with energy conservation techniques, lifestyle changes, pacing, regular rest periods or naps during the day, amitriptyline to improve sleep, and possibly pyridostigmine (trial in progress). The management of pain is dependent upon its cause. The treatment of post-polio …muscular pain can include activity reduction, pacing (rest periods during activity), moist heat, ice, and stretching, use of assistive devices, and life style modifications. Fibromylagia can be treated with amitriptyline, cyclobenzaprine, and aerobic exercise. Joint and soft tissue abnormalities can be managed with modification of extremity use, physiotherapy, orthoses, assistive devices, non-steroidal anti-inflammatory medications, and rarely steroid injections and surgery. Superimposed neurological disorders may produce pain, and should be identified and treated. The identification and treatment of pulmonary dysfunction in a post-polio patient is an important aspect of management, and is discussed elsewhere in this issue. Dysphagia can be managed with diet changes, use of special breathing and swallowing techniques, monitoring fatigue and taking larger meals earlier and smaller meals later, and avoiding eating when fatigued. The management of psychosocial difficulties usually requires an interdisciplinary approach, and may include a post-polio support group, social worker, psychologist, and psychiatrist. Show more

Keywords: Poliomyelitis, Rehabilitation, Exercise, Treatment

DOI: 10.3233/NRE-1997-8204

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 93-105, 1997

Authors: Agre, James C. | Rodriquez, Arthur A.

Article Type: Research Article

Abstract: Many post-polio individuals note new musculoskeletal and neuromuscular symptoms. In general, post-polio individuals are found to be weaker than non-postpolio individuals. Muscle weakness appears to play a role in functional limitations in post-polio individuals, especially for such activities as walking and stair climbing. Many post-polio individuals also have deficits in muscular work capacity and strength recovery following activity. Importantly, post-polio individuals are known to have normal perception of local muscle fatigue during activity. The perception of fatigue within the working muscle can be used to modify activity and to assist the individual in the avoidance of excessive local fatigue during …exercise and performance of activities of daily living. Recent studies have shown that judicious exercise can improve muscle strength, range of motion, cardiorespiratory fitness, efficiency of ambulation as well as add to the patient's sense of well-being. These benefits appear to occur when activity and exercise are kept within reasonable limits in order to avoid excessive muscular fatigue and/or joint or muscle pain. It is suggested that post-polio patients be instructed to avoid activities that cause increasing muscle or joint pain or excessive fatigue, either during or after their exercise program as the performance of activity at too high a level may lead to overuse/overwork problems. The recent literature indicates that exercise within the constraints of fatigue and pain leads to a number of beneficial physiologic adaptations. Judicious exercise should be viewed as an adjuvant in the overall therapeutic program of the post-polio patient, when the individual has the physiologic capacity to exercise. Show more

Keywords: Neuromuscular disease, Post-polio syndrome, Muscle, Strength, Exercise

DOI: 10.3233/NRE-1997-8205

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 107-118, 1997

Authors: Perry, Jacquelin | Clark, Darrell

Article Type: Research Article

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to …one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution. An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design. Show more

Keywords: Orthotics, Post-polio, Gait, Biomechanics

DOI: 10.3233/NRE-1997-8206

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 119-138, 1997

Authors: Bach, John R. | Tilton, Margaret

Article Type: Research Article

Abstract: 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. Show more

Keywords: Poliomyelitis, Artificial ventilation, Obstructive sleep apnea syndrome, Rehabilitation

DOI: 10.3233/NRE-1997-8207

Citation: NeuroRehabilitation, vol. 8, no. 2, pp. 139-153, 1997