SUBJECTIVE RECOVERY TIME AFTER EXHAUSTING MUSCULAR ACTIVITY IN POSTPOLIO AND CONTROL SUBJECTS:

Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo

Background

A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.

Findings

Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength.

Conclusions

Most acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.

Physical therapist management following rotator cuff repair for a patient with postpolio syndrome

BACKGROUND AND PURPOSE

Postpoliomyelitis sequelae, such as gait instability and progressive weakness, predispose people with postpolio syndrome to secondary disabilities. With aging, people who depend on their upper extremities to accommodate lower-extremity deficits may anticipate overuse injuries. The purpose of this case report is to describe the use of mobilization and exercise in postoperative rehabilitation of rotator cuff surgery on a patient with postpolio syndrome.

CASE DESCRIPTION

A 48-year-old woman with postpolio syndrome had rotator cuff surgical repair followed by physical therapy intervention. Maitland mobilization and mild functional exercises were chosen to avoid triggering fatigue.

OUTCOMES

Measurements taken preoperatively, before and after physical therapy intervention, and 2 years after intervention showed return to independent status with excellent retention.

DISCUSSION

No fatigue or overuse weakness was encountered. This is the first case report to document physical therapy following rotator cuff repair in a patient with postpolio syndrome.

Strength and endurance of knee extensors in subjects after paralytic poliomyelitis

PURPOSE

To compare the strength and endurance of knee extensors in subjects after paralytic poliomyelitis as well as to extend the comparison to healthy subjects.

METHOD

Twenty subjects after poliomyelitis with new symptoms (SYM group), 10 without new symptoms (ASYM group) and 15 healthy controls were included. To determine strength, isometric maximal voluntary contraction (MVC) torque of knee extensors in both legs was determined by Biodex dynamometer at 60 degrees knee angle. To determine endurance, the subjects were asked to maintain force in the knee extensors in the same position, in the range between 40-45% of MVC torque, as long as possible. The 'tensiomyography' method was applied to measure the radial displacement of m. rectus femoris during submaximal continuous electrical stimulation until recording a flat response.

RESULTS

No significant difference in MVC torque and endurance was found between SYM and ASYM group, as well between the duration of m. rectus femoris response of both groups to submaximal electrical stimulation. MVC torque and endurance of knee extensors with 'normal' strength was significantly lower in post-polio subjects compared to healthy controls.

CONCLUSION

Endurance of knee extensor muscles in post-polio subjects is generally and significantly lower than that of knee extensors in healthy subjects, regardless of the implication of normal strength and subjective observations of post-polio subjects.

Muscular effects in late polio

New or increased muscular weakness, fatigue and muscle and joint pain with neuropathic electromyography (EMG) changes in a person with a confirmed history of polio constitute the cardinal symptoms of the post-polio syndrome. Unusual tiredness or fatigue is a common complaint in late polio subjects as is intolerance to cold. Fatigue in polio subjects can have several explanations: emotional fatigue, central nervous system fatigue, 'general' fatigue and/or neuromuscular fatigue. Some studies indicate central fatigue, but it is unclear how often and to which degree there will be a central muscular fatigue. Polio patients are known to be deconditioned (reduced function because of low activity level), and aerobic power is reduced. Defects in the neuromuscular transmission may be present but are not seen in all post-polio subjects with reduction in force and increased fatigability. The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible explanations may be an imperfection in the sarcoplasmatic reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.

Dynamic water exercise in individuals with late poliomyelitis

OBJECTIVE

To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.

DESIGN

Before-after tests.

SETTING

A university hospital department.

PARTICIPANTS

Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).

INTERVENTION

The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).

MAIN OUTCOME MEASURES

Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.

RESULTS

The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.

CONCLUSIONS

A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.