National rehabilitation hospital limb classification for exercise, research, and clinical trials in post-polio patients.

A need exists for an objective classification of polio patients for clinical and research purposes that takes into account the focal, asymmetric, and frequent subclinical nature of polio lesions. In order to prescribe a safe, effective exercise program, we developed a five-level (Classes I-V) limb-specific classification system based on remote and recent history, physical examination, and a four-extremity electrodiagnostic study (EMG/NCS). Class I limbs have no history of remote or recent weakness, normal strength, and a normal EMG. Class II limbs have no history of remote or recent weakness (or if remote history of weakness, full recovery occurred), normal strength and EMG evidence of prior anterior horn cell disease (AHCD). Class III limbs have a history of remote weakness with variable recovery, no new weakness, decreased strength, and EMG evidence of prior AHCD. Class IV limbs have a history of remote weakness with variable recovery, new clinical weakness, decreased strength, and EMG evidence of AHCD. Class V limbs have a history of severe weakness with little-to-no recovery, severely decreased strength and atrophy, and few-to-no motor units on EMG. In a prospective study of 400 limbs in 100 consecutive post-polio patients attending our clinic, 94 (23%) limbs were Class I, 88 (22%) were Class II, 95 (24%) were Class III, 75 (19%) were Class IV, and 48 (12%) were Class V. Guidelines for the use of this classification in a clinical/research setting are presented along with sample case histories and class-specific exercise recommendations.

Poliomyelitis and the post-polio syndrome: exercise capacities and adaptation--current research, future directions, and widespread applicability.

Poliomyelitis 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 to 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 terminal axonal sprout. Acute responses to resistive exercise suggest significant muscle strength decrements in the knee extensors compared with similar aged people without polio. However, limited training investigation indicates significant strength increases for 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.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo proton magnetic resonance spectroscopy (MRS) study of post polio residual paralysis (PPRP) patients.

In-vivo proton MR spectroscopy carried out on post polio residual paralysis (PPRP) patients indicate that the presence or absence of intra-myocellular lipids (IMCL) is related to the severity of the paralysis. It is observed that mildly paralyzed patients are comparable (p > 0.05) with the control subjects in relation to the presence of IMCL, while moderate and severely paralysed patients are comparable (p > 0.05) in relation to the absence of IMCL. In addition, there is reduction or complete absence of creatine, carnitine and choline metabolites in severely paralyzed patients. The ability to detect noninvasively the subtle differences in in vivo, the lipid compartments of muscle may prove to be a valuable tool in understanding the pathogenesis of muscle diseases. This could open up the possibilities in designing effective rehabilitative exercise programs or development of new drug therapies.

[The International Classification of Diseases, the Family of International Classifications, the ICD-11, and post-polio syndrome]. / A Classificação Internacional de Doenças, a Família de Classificações Internacionais, a CID-11 e a Síndrome Pós-Poliomielite.

The first International Classification of Diseases (ICD) was approved in 1893 and since then it has been periodically reviewed. The last, 10th revision (ICD-10), was approved in 1989. Since 1989, it was possible to update from ICD revisions, which did not happen before. The next revision (ICD-11) would probably be published in 2015. In 1989, mechanisms were established to update ICD-10, through the creation of the Morbidity Reference Group (MbRG) in 1997 and the Update and Revision Committee (URC) in 2000. The Morbidity Reference Group (MbRG) was created in 2007 to discuss in more detail the issues to update morbidity. A specific code in ICD was not included in the revision of ICD-10 in 1989 for the post-polio syndrome (PPS). However, the ICD new code G14 for PPS was included in ICD-10 since 2010.

Disability and functional assessment in former polio patients with and without postpolio syndrome.

OBJECTIVES: To compare perceived health problems and disability in former polio subjects with postpolio syndrome (PPS) and those without postpolio syndrome (non-PPS), and to evaluate perceived health problems, disability, physical performance, and muscle strength. DESIGN: Cross-sectional survey; partially blinded data collection. SUBJECTS: One hundred three former polio subjects, aged 32 to 60yrs. This volunteer sample came from referrals and patient contacts. Criterion for PPS: new muscle weakness among symptoms. MAIN OUTCOME MEASURES: Nottingham Health Profile (NHP), adapted D-code of the International Classification of Impairments, Disabilities and Handicaps, performance test, and muscle strength assessment. RESULTS: PPS subjects (n = 76) showed higher scores (p < .001) than non-PPS subjects (n = 27) within the NHP categories of physical mobility, energy, and pain. On a 16-item Polio Problems List, 78% of PPS subjects selected fatigue as their major problem, followed by walking outdoors (46%) and climbing stairs (41%). The disabilities of PPS subjects were mainly seen in physical and social functioning. No differences in manually tested strength were found between patient groups. PPS subjects needed significantly more time for the performance test than non-PPS subjects and their perceived exertion was higher. Perceived health problems (NHP-PhysMobility) correlated significantly with physical disability (r = .66), performance-time (r = .54), and muscle strength (r = .38). With linear regression analysis, 54% of the NHP-PhysMobility score could be explained by the performance test (time and exertion), presence of PPS, and muscle strength, whereas strength itself explained only 14% of the NHP-PhysMobility score. CONCLUSIONS: PPS subjects are more prone to fatigue and have more physical mobility problems than non-PPS subjects. In former polio patients, measurements of perceived health problems and performance tests are the most appropriate instruments for functional evaluation.

[Late complications of poliomyelitis]. / Pozdnie oslozhneniia poliomielita.

We examined 73 31-55-year-old postpoliomyelitis patients who had paralytic form of the disease before the age of 11. It was found that progression of neuro-muscular signs (pareses, atrophies, myalgias), typical for postpoliomyelitis muscular atrophy (PMA) emerged in 43 patients. Classical statistical analysis of clinical and electromyographical data and special statistical method of extreme parameter grouping confirmed PMA only in 8 out of the above 43; 3 forms of postpoliomyelitis syndrome were recognised.

[Modern carbon fibre orthoses in the management of polio patients--a critical evaluation of the functional aspects]. / Moderne Karbonfaser-Orthetik für Polio-Patienten - Kritische Auswertung nach funktionellen Aspekten -

AIM: Evaluation of practicability and functional benefit with modern carbon fibre knee ankle foot orthoses in polio patients. METHODS: In a retrospective analysis, fifty-five (55) polio patients between the ages of 42 and 80 years who had been provided with a carbon fibre orthoses for a minimum of three months, were asked about their acceptance as well as changes in functional capacity and comfort. RESULTS: Clear improvements were shown in walking, sitting and automobile driving as well as comfort and dressing/undressing of the orthoses. Through the use of these new orthoses, the maximum walking distance increased significantly--at least partially due to less weight (40%). 95% of all treated patients were very satisfied or satisfied. CONCLUSION: The use of carbon fibre material in the orthotic treatment of polio patients seems to be supported by the positive results of our study.

Applicability, validity, and reliability of the Piper Fatigue Scale in postpolio patients.

OBJECTIVE: To identify a scale that is potentially applicable for measuring the fatigue in postpolio patients and to evaluate its validity and reliability in this population. DESIGN: Interview survey of 64 individuals with postpolio syndrome and 25 healthy controls of similar age range, with retest in a subset of postpolio patients. The sample was recruited from a postpolio support group, a postpolio clinic, and the general community. Subjects completed the Piper Fatigue Scale, the Beck Depression Inventory, and the Chalder Fatigue Questionnaire during the interview. RESULTS: Face and content validity of the Piper Fatigue Scale was established by a team of experts and by a group of postpolio patients. The postpolio subjects had significantly higher Piper Fatigue Scale scores than the healthy control subjects (P < 0.001), demonstrating extreme groups validity. Convergent validity was shown with a strong positive correlation between Piper Fatigue Scale scores and Chalder Fatigue Questionnaire scores (r = 0.80). Reliability was also demonstrated with the Piper Fatigue Scale's high internal consistency (alpha = 0.98) and strong test-retest agreement (intraclass correlation coefficient = 0.98). CONCLUSIONS: The Piper Fatigue Scale is a valid and reliable tool for measuring postpolio fatigue. This scale may be useful in other studies of postpolio fatigue, including those gauging the effectiveness of various treatments for this fatigue.