Prediction of voluntary activation, strength and endurance of elbow flexors in postpolio patients.

To examine the long-term effects of polio, maximal voluntary strength and voluntary activation of elbow flexor muscles of 177 patients from a postpolio clinic were investigated using twitch interpolation. Muscle endurance was studied in 142 patients during 45 min of submaximal exercise, and predictors of impaired muscle performance were investigated. Twenty-nine of 177 patients (16.4%) had impaired voluntary drive to their elbow flexor muscles, but only 16 (9.0%) had markedly reduced elbow flexor strength, despite 74 (41.8%) reporting they were initially affected in their tested limb and 172 (97.2%) patients reporting new generalized symptoms. Seven patients had impaired muscle endurance in the tests of strength and voluntary drive. During the submaximal exercise, 16 patients (11.3%) had impaired peripheral muscle endurance with normal voluntary activation. These results confirm a low incidence of impaired upper-limb muscle performance in postpolio patients, despite many patients having subjective symptoms consistent with postpolio syndrome. There was an increased relative risk for impaired muscle function in those patients with a subjective decrease in strength in the tested limb, a recent decline in activities of daily living in their tested limb, and who used orthotic devices in their tested limb. Monitoring of function in prior-polio patients with impaired muscle performance may be useful, particularly when combined with investigation of other potential contributory factors to the functional impairment.

Stroke patients: do they have a predilection for extrapyramidal side effects from amiodarone?

This report describes two patients with recent stroke who, upon transfer to the rehabilitation medicine service, were noted to have extrapyramidal features. Both patients were receiving amiodarone for management of atrial fibrillation. When this medication was discontinued, there was slow resolution of extrapyramidal features and an improvement in function. Physicians managing acute stroke patients should be alert for features of amiodarone neurotoxicity, because these side effects may occur more readily in patients with recent neurologic impairment and may impede their progress in rehabilitation.

Objective assessment of spasticity, strength, and function with early exhibition of dantrolene sodium after cerebrovascular accident: a randomized double-blind study.

A double-blind, placebo-controlled trial was conducted to determine whether early exhibition of Dantrium (Dantrolene Sodium) in patients with cerebrovascular accidents, before the onset of significant spasticity, would enhance the functional outcome of rehabilitation. Thirty-eight patients were enrolled in the trial and 31 satisfactorily completed the study. A modified Cybex isokinetic dynamometer was used to gather information on strength and muscle tone. Clinical, functional, and biochemical data were also collected. It was found that Dantrium reduced strength in the unaffected limbs but did not alter strength in the paretic limbs. Dantrium produced no alteration in clinical tone, functional outcome, or biochemical tests at the dosage (200 mg per day) used in this study.

Shoulder shrug--a prognostic sign for recovery of hand movement after stroke.

A new clinical sign with prognostic significance for recovery of hand movements after stroke is described. Thirty-two patients with hemispheric cerebrovascular accident were assessed to determine whether the ability to shrug the hemiplegic shoulder at initial assessment correlated with the recovery of hand movements. The results of 29 of these patients with poor hand movements at initial assessment were analysed. Of 18 patients with absent shoulder shrug, only two patients (11%) showed return of good active movements in the involved hand at final evaluation, whereas eight (73%) of 11 patients who could shrug the hemiplegic shoulder at initial assessment went on to recover good movements in the hand (P = 0.00). In a subgroup of patients who demonstrated only synergistic flexion of fingers in the hemiplegic hand, one of five patients with absent shoulder shrug showed good hand movements at the final assessment in contrast to six of seven patients who initially could shrug the hemiplegic shoulder. Only one of 15 patients who showed total absence of hand movements at the initial assessment had a return of good hand movements. The data suggest that clinical assessment of shoulder shrug is a good prognostic indicator for recovery of voluntary movements in the hemiplegic hand especially when any hand movement, even if it is only synergistic finger flexion, is present at initial assessment. Total absence of hand movements at initial assessment is a poor prognostic sign.

Rehabilitation of elderly lower-extremity amputees.

Eighty elderly amputees who were seen at the Rehabilitation Centre of the Royal South Sydney Hospital during a five-year period between 1974 and 1978, have been reviewed. These included 44 unilateral below-knee amputees, 21 unilateral above-knee amputees, and 15 bilateral amputees. Seventy-nine per cent of these patients were able to use their prostheses successfully, and 84% returned to their own homes after discharge from hospital. Some details of the rehabilitation programme, and types of prosthesis prescribed are discussed.