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Many individuals who have had poliomyelitis are now complaining of several new problems attributed to their former illness including muscle atrophy; fatigue; progressive weakness; and muscle, back, and joint pain. This paper critically examines the literature regarding the neuromuscular effects of poliomyelitis. Weakness resulting from poliomyelitis was due to destruction of anterior horn cells. After the illness, muscle strength was partially recovered as a result of several physiologic adaptive mechanisms including terminal sprouting and reinnervation, myofiber hypertrophy, and, possibly, myofiber type transformation. Several pathophysiologic and functional etiologies have been proposed for late neuromuscular deterioration, but none has been proven. In fact, to date, there is no objective evidence documenting progressive loss of strength in polio survivors. Studies attempting to differentiate polio survivors with and without symptoms of deterioration have resulted in conflicting results; however, it appears reasonable to conclude that symptomatic postpolio subjects had a more severe illness with greater loss of neuromuscular function. Exercise may be helpful for many postpolio patients, but the prescription must be tailored to the individual to avoid problems of overuse or excessive fatigue.
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PMID:Late effects of polio: critical review of the literature on neuromuscular function. 192 13

Years after the initial onset of poliomyelitis, patients often report new problems, including fatigue, weakness, pain, breathing difficulty, decreased endurance, problems with swallowing, choking, increased sensitivity to cold, and psychological problems. The premise of this article is that underlying pathophysiology of these problems can be assessed on the basis of a detailed history, a multisystem physical examination, and supplemental information provided by investigative tests. The indications for treatment of the late sequelae of poliomyelitis based on the underlying pathophysiology and the rationale for treatment prescription are explored. Possible outcomes of the assessment include no intervention; prescription of a balance between activity and rest, a reduction in activity, or an increase in activity; interventions to improve postural alignment, prescription of orthoses, and weight control; prescription of walking aids and mobility devices; respiratory care; lifestyle modification; or some combination of these outcomes. If treatment can be directed at the underlying causes of the late sequelae, the possibility of reducing further deterioration and of optimizing function in these patients will likely be enhanced.
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PMID:Clinical decision making in the management of the late sequelae of poliomyelitis. 194 14

We describe a retrospective study of 42 patients admitted to Sunnaas Rehabilitation Hospital with suspect postpolio syndrome over a period of two years. The patients were 32 females and 10 males aged 28-74 years (mean 54 years). 29 were married or cohabitant, 31 had children, and 20 were in paid employment. The mean age at onset of polio was 12 years, with an average interval of 36 years between onset of polio and onset of new problems. The mean duration of new health problems was seven years. The most common such problems were pain in muscles and joints, general fatigue and new weakness of the muscles. 28 of the patients needed personal assistance to carry out everyday activities. 33 had braces, crutches or wheelchair for ambulation. Lung function was moderately reduced and physical working capacity was severely reduced. Physiotherapy, ergotherapy and technical aids were provided for 38 of the patients, 16 received assistance to organizing social support or help at home, 13 were helped to make practical changes in their homes, and eight were provided with a wheelchair. According to this study, most patients with the postpolio syndrome need interdisciplinary evaluation and management in a rehabilitation hospital.
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PMID:[42 patients with post-polio syndrome. A retrospective study from Sunnaas hospital]. 194 38

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.
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PMID:Hypnosis for postpolio syndrome & Type-A behavior. 195 Nov 42

This study was performed to determine whether deficits in muscle strength, work capacity, and ability to recover strength after exhaustion in symptomatic postpolio subjects were due to central inhibition (lassitude) or other physiologic differences. We studied 34 symptomatic polio subjects, 16 asymptomatic polio subjects, and 41 control subjects. Root mean squared electromyography (RMS-EMG) and the median frequency (Fm) of the power spectrum of the quadriceps muscle was determined with surface electrodes during maximal volitional contraction (MVC) of isometric knee extension, an endurance test to exhaustion at 40% of maximal torque, and strength recovery testing that was performed at regular intervals for 10 minutes postexhaustion. Initial Fm during MVC and during the 40% MVC endurance test were similar in all three groups. The Fm decreased during the endurance test and increased during recovery similarly in all three groups. The RMS-EMG also changed in parallel fashion in all three groups during the same procedures. During recovery, a similar degree of RMS-EMG facilitation was seen in all three groups. Thus, reduction in strength, work capacity, and ability to recover from fatiguing exercise do not appear to be related to central factors (lassitude); they are probably related to other factors, such as local muscle fatigue. Each group appears to fatigue and recover in a similar manner electrophysiologically, although symptomatic polio subjects have a deficit in strength recovery, apparently due to local muscular fatigue.
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PMID:Electrophysiologic study of the quadriceps muscles during fatiguing exercise and recovery: a comparison of symptomatic and asymptomatic postpolio patients and controls. 195 24

A survey was conducted to better understand complaints of fatigue in patients previously diagnosed as having polio. Eighty-six individuals with postpolio syndrome and 20 healthy controls completed a questionnaire about their fatigue, the Beck Depression Inventory, and the CAGE questionnaire. The results showed that fatigue in postpolio syndrome usually occurred on a daily basis and increased in severity as the day progressed. Both the study group and controls described their fatigue as tiredness and a lack of energy. However, physical weakness was reported only in the postpolio group. Minimal physical exercise exacerbated fatigue in 48% of the postpolio group, whereas it diminished fatigue in 70% of the controls and in 15% of the postpolio group. Twenty-seven percent of the postpolio group and none of the controls reported mild to moderate depressive symptoms. However, depression, age, alcohol abuse, and employment status did not significantly affect the differences between groups in reported prevalence or description of chronic fatigue. Criteria to separate psychologic from organic causes of fatigue and treatment interventions are discussed.
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PMID:Fatigue in postpolio syndrome. 199 Oct 11

We identified a cohort of 300 individuals who had paralytic polio between 1935 and 1955. All lived in Olmsted County, Minnesota. From the 247 survivors, we selected 50 subjects for detailed historical, functional, psychological, clinical, and electrophysiologic evaluation. Sixty-four percent of these 50 survivors complained of new symptoms of muscle pain, fatigue, and weakness after a period of prolonged stability. This led to changes in lifestyle or activity in only 18%. The likelihood of expressing new complaints was not related to present age or interval since polio, and electrophysiologic testing did not distinguish between those with or without new problems. The development of new difficulties in a limb was most strongly predicted by significant paralysis of that limb at the time of the acute illness. Patients with leg weakness were twice as likely to complain of new problems compared to those with arm weakness. Elevated creatine kinase levels were present only in those with new complaints.
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PMID:Late effects of paralytic poliomyelitis in Olmsted County, Minnesota. 201 Dec 46

Capillary supply and oxidative and glycolytic enzyme activities were determined in muscle biopsies from the tibialis anterior muscle in six prior polio patients and a control group. The polio patients, who had paresis and atrophy, but were able to walk normally by making maximal use of all remaining anterior tibial motor units, showed type I (slow-twitch) muscle fibre predominance with a mean (SD) of 98 (2%) type I fibres versus 81 (8)% in the controls (p less than 0.01) and muscle fibre hypertrophy, the average type I fibre cross-sectional area being 108% (p less than 0.005) larger than in the controls. The number of capillaries per muscle fibre was not significantly different from that in the control group, but with the increased muscle fibre area in the polio patients, the capillary density was significantly lower. The number of capillaries in contact with type I fibres relative to fibre area was 40% lower in the patients than in the controls (p less than 0.005). The levels of citrate synthase and phosphofructokinase were significantly lower (38% and 33%, respectively, p less than 0.05) in the patients than in the controls, indicating decreased oxidative and glycolytic potentials in the muscle fibres of the polio patients. It is proposed that the abnormal high-frequency activation of all remaining motor units during each step cycle recorded in these patients constitutes a stimulus for type I muscle fibre predominance and hypertrophy but that the overall low muscle usage results in a decreased stimulation of capillary proliferation and mitochondrial enzyme synthesis. The low capillary density and decreased oxidative and glycolytic enzyme potentials might be important factors for the development of muscle weakness, fatigue and muscle pain, which are commonly occurring symptoms in patients with prior poliomyelitis.
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PMID:Prior poliomyelitis-reduced capillary supply and metabolic enzyme content in hypertrophic slow-twitch (type I) muscle fibres. 203 Mar 51

About 22% of persons who suffer from acute paralytic poliomyelitis 20 to 30 years ago and were fully rehabilitated with maximal functional recovery began to experience new symptoms termed "Post-polio Sequelae" (PPS). These include unaccustomed fatigue, weakness in muscles previously affected or apparently unaffected, new joint pains, respiratory difficulties and intolerance to cold. Predictors for PPS are development of acute attack of paralytic polio before 10 years of age, involvement of all four limbs and having needed a ventilator during acute stage. The functional decompensation in PPS is presumed to be due to loss of normal neurones by aging and by metabolic fatigue of stressed neurones over passing years. Joint deformities due to muscular imbalance are also responsible for some of the symptoms. Treatment consists of reassurance and use of assistive devices and assistive exercises. The extent of problem of PPS is not known in India.
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PMID:New dimensions to poliomyelitis. 227 68

Overwork weakness has been reported in survivors of poliomyelitis with residual paralysis. Investigators have recently reported that approximately 25% of polio survivors experience functional declines with onset of symptoms of new weakness, fatigue, and muscle pain. The diagnosis of overwork weakness has remained a clinical diagnosis, as previous investigations have failed to uncover reliable, objective, diagnostic methods to confirm the diagnosis in symptomatic individuals. A case is presented in which markedly elevated levels of CPK were present with symptoms of weakness, fatigue, and muscle pain. These levels declined after clinical intervention, with resolution of symptoms. This case represents an overuse syndrome in which muscle fibers were being damaged through overuse. This case further suggests the possible role of serum CPK in the diagnosis of, and in monitoring clinical intervention in, some polio survivors who experience overwork weakness.
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PMID:Overwork weakness with evidence of muscle damage in a patient with residual paralysis from polio. 231 46


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