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Chronic denervation syndromes such as the post-polio syndrome are associated with progressive muscle weakness and fatigue after motoneuron death. Neither the etiology nor the management of these syndromes is clear. To address this issue, we partially denervated rat hindlimb muscles for 1 or 12 months and examined whether chronically enlarged motor units (MUs) become destabilized with time and further destabilized by daily running on exercise wheels. MU enlargement, measured electrophysiologically and morphologically was significantly reduced at 12 months in extensively denervated muscles, and to a lesser extent in moderately denervated muscles, as compared to the findings at 1 month. A 1-month period of running exercise further reduced the size of the chronically enlarged MUs in the extensively denervated muscles. We have therefore (1) successfully established a rat model of time-related MU size reduction, in which destabilization of chronically enlarged MUs results in loss of axonal terminals, and (2) demonstrated that nonphysiological activity has small but significant effects of further destabilizing the chronically enlarged MUs.
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PMID:Effect of exercise on stability of chronically enlarged motor units. 1187 Jul 12

Eighty former poliomyelitis patients and the sibling nearest in age and of same sex were examined with matched-pair analysis to evaluate the effect of previous poliomyelitis (polio) on social factors and general health. Fifty-four pairs with women (68 %), and 26 pairs with men (32 %) with a mean age 60.4 years were included. Data were collected by questionnaire. There was no significant difference in length of education between patients and siblings (categories < 8 years, 8-12 years, and > 12 years). Employment rate at age 40 years was 78 % for patients and 88 % for siblings (full-time or part-time); this difference was not significant. Educational options were considered to have been excellent by 38 % of the patients and 26 % of the siblings (not significant), with a fair agreement within the pairs (kappa=0.31). There was no significant difference regarding professional options; rated as excellent by 33 % of patients, and 28 % of siblings, with a fair agreement (kappa=0.25) also for this issue. Perception of general health today expressed on a horizontal VAS-scale (0-10) was significantly lower among the patients than the siblings, mean values of 5.8 and 6.8 (P < 0.001) respectively. Patients also reported a lower quality of life (P=0.03), and less energy for leisure activities (P=0.008). Post polio symptoms like muscular and articular pain, and abnormal tiredness were more common among patients than siblings, whereas there was no difference regarding coexisting illness. In conclusion, polio patients and their siblings reckoned their educational and professional options to have been at the same level. The patients were well educated and employed to the same degree up to the age of 40 years, but now at a higher age reported reduced general health.
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PMID:Former poliomyelitis as a health and socioeconomic factor. A paired sibling study. 1196 44

Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950-1954 epidemic cohort, or from a cohort of hospital-admitted rehabilitation patients. Ninety-four paralytic patients and 74 non-paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi-square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full-time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full-time employment rate amongst the paralytic patients, only 52% of this group being employed full-time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.
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PMID:Education, occupation, and perception of health amongst previous polio patients compared to their siblings. 1198 31

New or increased symptoms often appear decades after the onset of polio. The definition of post polio syndrome (PPS) is: a confirmed history of polio, an interval of functional stability after initial recovery, non-disuse increased muscle weakness, and other complaints such as increased general fatigue and pain. Loss of motor units is compensated by collateral re-innervation and hypertrophy of muscle fibre. An elevenfold times increase in the motor unit region can be seen, and around double the muscle fibre area, corresponding to a fivefold increase in the number of muscle fibres in the motor unit. When loss of motor neurons can no longer be compensated for, muscle strength will decrease. Respiratory problems are present in a minority, but these need special attention and intervention. Evaluation and support through a special polio clinic is of value. The trainability varies according to the type and degree of polio changes. There may be a need for technical aids, especially for mobility, but time must be allowed for patients to accept reduced physical activity and changes in life habits recommended.
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PMID:[Post-polio syndrome--symptomatology and measures]. 1205 Oct 46

About 80,000 polio survivors are still living 40 years after the last polio epidemics in Germany. Of these 40-70% have developed the so called post-polio syndrome (PPS) decades after the infection. The main symptoms of PPS are decreasing strength in voluntary muscles, pain and fatigue which occur spontaneously but may also be induced by physical stress and general illness. We report the case of a 79-year-old male who developed hypercapnia due to ventilatory failure which necessitated reintubation several times after cholecystectomy. The medical history revealed that he had had poliomyelitis at the age of 8 years. There was only a slight residual handicap from this infection which included mild pareses of the left limbs but had remained stable for about 70 years. Electromyography revealed signs of chronic neurogenic changes in muscles of the left upper limb as well as in the pectoralis major. The diagnostic criteria of a post-polio syndrome were fulfilled and other neuromuscular diseases were excluded. The patient could be discharged from intensive care only after treatment by intermittent positive pressure ventilation via a facial mask. This case report shows that even patients who have a mild handicap after poliomyelitis can develop weaning problems. A PPS can exacerbate with inclusion of respiratory muscles in critically ill patients.
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PMID:[40 years after the last polio epidemic. Postpolio syndrome as a cause of "weaning failure"]. 1212 9

In studies conducted on polio survivors with late effects of poliomyelitis, new fatigue is frequently reported. The main purpose of the present study was to examine the characteristics of polio survivors reporting severe fatigue versus those reporting mild or no fatigue. From a survey among 276 representative Norwegian polio survivors, we recruited all patients with mild/no fatigue and those with severe fatigue, without other diseases than poliomyelitis. Out of 276 polio survivors, 43 reported mild, 113 moderate and 118 severe fatigue (2 were missing). Only 12 with mild fatigue, 21 with moderate and 14 with severe fatigue had no other diseases and health problems related to fatigue. Six of these patients with mild/no and 9 with severe fatigue, and 16 healthy persons participated in the study. The subjects were assessed with the Fatigue Questionnaire, Fatigue Severity Scale, Visual Analog Scale for pain and fatigue, SCL-90-R, cognitive tests, event-related brain potentials (ERPs), blood and urine parameters, spirometry, exercise and muscle strength tests, 24-hour pulse registration, Sunnaas ADL-index and the Rivermead Mobility Index. The group with severe fatigue had significantly more elevated scores on SCL-90-R, measuring obsessive-compulsive behaviour, depression and anxiety than both the mild fatigue group and the controls. They also had higher scores on the somatization scale than the control group. No other test results showed significant differences between the mild/no and the severe fatigue polio groups. The present results give no support to the hypothesis of "brain fatigue in polio survivors, assessed by cognitive tests or ERPs. Moreover, the physical test results did not correspond to perceived fatigue. Thus, the only characteristics distinguishing polio survivors with severe fatigue from those with mild/no fatigue in this study were psychological characteristics. However, a larger group of polio survivors suffer from additional diseases, and such diseases should be ruled out during a comprehensive rehabilitation program.
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PMID:Mild versus severe fatigue in polio survivors: special characteristics. 1239 41

New loss of function among patients with previous polio is frequently reported and has several causes. All patients referred to the Department of Neurology, Haukeland University Hospital, Bergen, for 13 months during 2000-2001 with diagnosis late effects of polio were examined prospectively to identify their symptoms and loss of function. Eighty-five patients aged 47-91 years with mean of 61 years were included. The most common complaints were pain (44%), muscular weakness (27%), and fatigue (16%). Muscular weakness occurred in lower limbs in 75%, in respiratory muscles in only 5%. Walking in stairs was impaired in 72% and outdoor walking in 65%. Seventeen patients (19%) reported no loss of function. Post-polio syndrome was diagnosed in 26% of the patients. Polio-related loss of function including cervical and lumbosacral radiculopathies, mononeuropathies and degenerative joint disease were found in an additional 53%. Eleven patients (13%) had distinct non-polio-related disorders that caused new loss of function. The remaining 8% had a stable condition. In conclusion, the majority of polio patients who seek hospital, experience a new loss of function because of polio-related disorders. A careful neurological examination is necessary to identify the correct diagnosis and treatment.
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PMID:Post-polio syndrome and total health status in a prospective hospital study. 1282 93

Poliomyelitis has recently been identified as a cause of muscle weakness in patients with West Nile virus (WNV) infection. However, the clinical spectrum of WNV-associated weakness has not been described. We reviewed data on 13 patients with WNV infection. Patients with muscle weakness were classified into one of three distinct groups based on clinical features. Group 1 comprised five patients who developed acute flaccid paralysis, four with meningoencephalitis and one without fever or other signs of infection. Paralysis was asymmetric, and involved from one to four limbs in individual patients. Electrodiagnostic studies confirmed involvement of anterior horn cells or motor axons. Group 2 involved two patients without meningoencephalitis who developed severe but reversible muscle weakness that recovered completely within weeks. Muscle weakness involved both lower limbs in one patient and one upper limb in the other. Group 3 consisted of two patients who experienced subjective weakness and disabling fatigue, but had no objective muscle weakness on examination. In addition to the three distinct groups, two other patients developed exaggerated weakness in the distribution of preexisting lower motor neuron dysfunction. We conclude that the clinical spectrum of WNV-associated muscle weakness ranges from acute flaccid paralysis, with or without fever or meningoencephalitis, to disabling fatigue. Also, preexisting dysfunction may predispose anterior horn cells to additional injury from WNV. Awareness of this spectrum will help to avoid erroneous diagnoses and inappropriate treatment.
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PMID:Clinical spectrum of muscle weakness in human West Nile virus infection. 1292 89

In surgical procedures for the improvement of function in lower extremities paralyzed by poliomyelitis, even the best that can be done will fall far short of normal function. But choosing and carrying out the operation best suited to the paralytic situation of the patient and to the kinds of function that will benefit him most, often can make the patients more self-sufficient, can make improvements that enable him to walk farther with less fatigue, to balance without support, to walk without grotesque limping, or that sometimes permit discarding a brace. Sometimes improving his ability to carry out even seemingly minor tasks of personal care is a definite positive service which to the patient is a boon.
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PMID:Surgical treatment for poliomyelitis paralysis; principles of reconstruction of the lower extremities. 1338 90

Perceptions of barriers to health promotion were examined in three groups of individuals with disabilities: (1) those with multiple sclerosis, (2) those with postpolio syndrome, and (3) polio survivors without postpolio syndrome. While there were small statistically significant differences among the three groups, all rated fatigue and impairment as their most frequent problems. For all groups, financial and interpersonal resources contributed significantly to the prediction of barriers, after accounting for perceived impairment. The findings suggest that health professionals should explore thoroughly the nature of individuals' perceived barriers to staying healthy, so that they can target their health-promoting interventions most effectively.
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PMID:What makes it so hard? Barriers to health promotion experienced by people with multiple sclerosis and polio. 1472 4


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