Post-poliomyelitis sequelae in the elderly

A pilot study of falls, fear of falling, activity levels and fall prevention actions in older people with polio

BACKGROUND AND AIMS

Polio survivors are ageing, and reporting new complications including falls. The aims of this study were: 1) to determine the frequency of falls, circumstances surrounding them, and the consequences of falls in older people who have polio; and 2) to investigate the range of fall prevention interventions undertaken to reduce the individual's risk of falling.

METHODS

A survey was conducted of members of the Eastern Polio Support Group of Victoria. Twenty-eight respondents (70%; 7 male, 21 female) had a mean age of 66 years and an average duration of 57 years since the onset of polio. The survey addressed demographic data, mobility, frequency and description of falls over the last 12 months, their consequences, and community services utilized. The Modified Falls Efficacy Scale (MFES) and Human Activity Profile (HAP) were also completed. Comparative data on the MFES and HAP were obtained from age- and gender-matched healthy community-dwelling older people.

RESULTS

Fourteen respondents (50%) reported one or more falls over the past 12 months, half reporting multiple falls. Two-thirds of falls occurred while walking. Of those who fell, 67% did not require medical attention. The highest percentage of injuries were bruises or grazes (44%), with one fracture reported. Sixty-one percent reported being fearful of falling, with an average MFES of 7.4 (+/-2.0), compared with the average of 9.7 (+/-0.5) for the age- and gender-matched controls (p<0.05). Only 5 of the respondents reported changing their level of activity as the result of a fall. A significant difference was identified on the Adjusted Activity Score (AAS) of the HAP between polio non-fallers (mean 56.3+/-19.1), polio fallers (mean 40.1+/-15.6) and age- and gender-matched controls (mean 73.5+/-10.3) (F2,46=25.5, p=0.000). The median number of fall prevention activities undertaken in the previous 12 months was one, 11 of the 28 respondents undertaking two or more. The most common interventions implemented were vision checks (42%) and review of medications by a doctor (25%).

CONCLUSIONS

A high rate of falling, fear of falling and low activity levels exist in older people with polio. There is a need for further research and clinical programs to reduce falls and injuries in this group.

A study of symptom distress, health locus of control, and coping resources of aging post-polio survivors

Nearly one-half of the estimated 1.63 million American patients who survived the polio epidemics of the 1940s and 1950s are re-experiencing symptoms of the acute illness. This exploratory study of 125 aging post-polio survivors examined the differences of symptom distress, health locus of control, and coping resources for survivors who had and those who had not incurred a chronic physical disability following the acute phase of poliomyelitis. The Symptom Rating Test, the Multidimensional Health Locus of Control Scale, and the Coping Resources Inventory were used. No significant differences were found between disability groups concerning symptom distress, health locus of control, or coping resources. However, significant negative correlations were found between coping resources and both the quantity and severity of symptom distress. The differences found between perceived health locus of control and both coping resources and symptom distress were marginally significant.

Reliability of Cybex II isokinetic evaluations of torque in post-poliomyelitis syndrome

The aim of this study was to ascertain the reliability of isokinetic strength measurements in a population of post-poliomyelitis subjects (PPS). Eight subjects (four males and females, mean age of 47.5 +/- 10 and 56.8 +/- 16 years, respectively) were evaluated, on a weekly basis for three weeks at approximately the same time of day. During each test session the knee flexors and extensors (bilaterally, where possible) were evaluated. Subjects became familiar with the equipment prior to recording three maximal contractions at the four test velocities (1.05, 2.09, 3.14, 4.18rads.s-1). A two-minute rest period was allowed between sets of contractions. The variables of peak torque, angle of peak torque, torque at specific joint angles (0.79 and 1.05rads), total contractile work, maximum power, and average power were measured on-line with the Cybex II a system using a commercially available software package. In both muscle groups, all the variables were significantly weaker on the most affected, but testable limb (p < 0.01) in subjects where both limbs could be tested (n = 5). Peak torque and total work of the quadriceps were observed to decrease with increasing velocity of movement. The effects of velocity were less apparent in the hamstrings. Average and maximum power developed by the knee extensors and flexors increased with increasing velocity of movement. Reliability of performance over three test sessions was confirmed by the intraclass correlation coefficient (ICC) values derived from the univariate ANOVAs calculated for each of the above variables (> 0.80).(ABSTRACT TRUNCATED AT 250 WORDS)

Postpolio syndrome

The recurrence of symptoms many years after the rehabilitation of individuals who survived the acute illness, poliomyelitis, is a major concern. The purpose of this article is to provide information to the nurse practitioner (NP), who, as a primary health care provider, may be the first health professional to encounter persons with such complaints. Although no cure has been identified, diagnosis and treatment is available and is important to the psychosocial well-being of those who suffer from postpolio syndrome. This article reviews research on the syndrome including etiology, pathophysiology, symptoms and management, psychological issues, and the role of the aging process. Some areas where further research is indicated are also identified.