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Sleep disorders in aging polio survivors: A systematic review. Ann Phys Rehabil Med 2020; 63:543-553. [DOI: 10.1016/j.rehab.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 01/28/2023]
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Abstract
Gas exchange between the atmosphere and the human body depends on the lungs and the function of the respiratory pump. The respiratory pump consists of the respiratory control center located in the brain, bony rib cage, diaphragm, and intercostal, accessory, and abdominal muscles. A variety of muscles serve to fine-tune adjustments of ventilation to metabolic demands. Appropriate evaluation and interventions can prevent respiratory complications and prolong life in individuals with neuromuscular diseases. This article discusses normal function of the respiratory pump, general pathophysiologic issues, and abnormalities in more common neuromuscular diseases.
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Affiliation(s)
- Joshua O Benditt
- Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98119, USA.
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3
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Orsini M, Lopes AJ, Guimarães FS, Freitas MRG, Nascimento OJM, Anna Junior MDS, Moreira Filho P, Fiorelli S, Ferreira ACAF, Pupe C, Bastos VHV, Pessoa B, Nogueira CB, Schmidt B, Souza OG, Davidovich ER, Oliveira ASB, Ribeiro P. Currents issues in cardiorespiratory care of patients with post-polio syndrome. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:574-9. [DOI: 10.1590/0004-282x20160072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/06/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.
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Affiliation(s)
- Marco Orsini
- Centro Universitário Augusto Motta, Brasil; Universidade Severino Sombra, Brasil; Universidade Federal do Rio de Janeiro, Brasil
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Han SJ, Lim JY, Suh JH. Obesity and Pulmonary Function in Polio Survivors. Ann Rehabil Med 2016; 39:888-96. [PMID: 26798602 PMCID: PMC4720764 DOI: 10.5535/arm.2015.39.6.888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/25/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To examine the correlation between obesity and pulmonary function in polio survivors. Methods This study was conducted based on a questionnaire survey and physical examination. The questionnaire included gender, age, paralyzed regions, physical activity levels, and accompanying diseases. The physical examination included measuring body mass index, waist circumference, muscle power, total fat amount, body fat percentage, and lean body mass. In addition, pulmonary function was tested based on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), ratio of FEV1 to FVC, and chest circumference. Five university hospitals and a local health clinic participated in this study. Results Pearson and partial correlation coefficients that used data collected from 73 polio survivors showed that obesity had a negative correlation with pulmonary function. Conclusion This study found that pulmonary function has a negative correlation with obesity for polio survivors. Therefore, it is necessary to develop specialized exercise programs to help polio survivors reduce their weight and strengthen their respiratory muscles.
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Affiliation(s)
- Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Suh
- Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Lira CABD, Minozzo FC, Sousa BS, Vancini RL, Andrade MDS, Quadros AAJ, Oliveira ASB, da Silva AC. Lung function in post-poliomyelitis syndrome: a cross-sectional study. J Bras Pneumol 2013; 39:455-60. [PMID: 24068267 PMCID: PMC4075872 DOI: 10.1590/s1806-37132013000400009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 07/22/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE: To compare lung function between patients with post-poliomyelitis syndrome
and those with sequelae of paralytic poliomyelitis (without any signs or
symptoms of post-poliomyelitis syndrome), as well as between patients with
post-poliomyelitis syndrome and healthy controls. METHODS: Twenty-nine male participants were assigned to one of three groups: control;
poliomyelitis (comprising patients who had had paralytic poliomyelitis but
had not developed post-poliomyelitis syndrome); and post-poliomyelitis
syndrome. Volunteers underwent lung function measurements (spirometry and
respiratory muscle strength assessment). RESULTS: The results of the spirometric assessment revealed no significant
differences among the groups except for an approximately 27% lower mean
maximal voluntary ventilation in the post-poliomyelitis syndrome group when
compared with the control group (p = 0.0127). Nevertheless, the maximal
voluntary ventilation values for the post-poliomyelitis group were compared
with those for the Brazilian population and were found to be normal. No
significant differences were observed in respiratory muscle strength among
the groups. CONCLUSIONS: With the exception of lower maximal voluntary ventilation, there was no
significant lung function impairment in outpatients diagnosed with
post-poliomyelitis syndrome when compared with healthy subjects and with
patients with sequelae of poliomyelitis without post-poliomyelitis syndrome.
This is an important clinical finding because it shows that patients with
post-poliomyelitis syndrome can have preserved lung function.
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Benditt JO, Boitano LJ. Pulmonary issues in patients with chronic neuromuscular disease. Am J Respir Crit Care Med 2013; 187:1046-55. [PMID: 23590262 DOI: 10.1164/rccm.201210-1804ci] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with chronic neuromuscular diseases such as spinal cord injury, amyotrophic lateral sclerosis, and muscular dystrophies experience respiratory complications that are cared for by the respiratory practitioner. An organized anatomical approach for evaluation and treatment is helpful to provide appropriate clinical care. Effective noninvasive strategies for management of hypoventilation, sleep-disordered breathing, and cough insufficiency are available for these patients.
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Teramoto A, Yokogushi K, Toki M, Murakami T, Yamashita T. Epidemiological Study and Clinical Characteristics of Poliomyelitis Survivors in Japan. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University: South 1, West 16, Chuo-ku, Sapporo, Hokkaido 0608543, Japan
| | | | - Megumi Toki
- Division of Rehabilitation, Sapporo Medical University
| | | | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University: South 1, West 16, Chuo-ku, Sapporo, Hokkaido 0608543, Japan
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Zespół post-polio: Część I. „Dziedzictwo” zapomnianej choroby, wyzwanie dla lekarzy i pacjentów. Neurol Neurochir Pol 2012; 46:357-71. [DOI: 10.5114/ninp.2012.30269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Relationship Between Perceived Exertion and Physiologic Markers During Arm Exercise With Able-Bodied Participants and Participants With Poliomyelitis. Arch Phys Med Rehabil 2010; 91:273-7. [DOI: 10.1016/j.apmr.2009.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 10/16/2009] [Indexed: 11/24/2022]
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Terao SI, Miura N, Noda A, Yoshida M, Hashizume Y, Ikeda H, Sobue G. Respiratory failure in a patient with antecedent poliomyelitis: Amyotrophic lateral sclerosis or post-polio syndrome? Clin Neurol Neurosurg 2006; 108:670-4. [PMID: 16165267 DOI: 10.1016/j.clineuro.2005.03.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 03/09/2005] [Accepted: 03/13/2005] [Indexed: 12/11/2022]
Abstract
We report a 69-year-old man who developed paralytic poliomyelitis in childhood and then decades later suffered from fatal respiratory failure. Six months before this event, he had progressive weight loss and shortness of breath. He had severe muscular atrophy of the entire right leg as a sequela of the paralytic poliomyelitis. He showed mild weakness of the facial muscle and tongue, dysarthria, and severe muscle atrophy from the neck to proximal upper extremities and trunk, but no obvious pyramidal signs. Electromyogram revealed neurogenic changes in the right leg, and in the paraspinal, sternocleidomastoid, and lingual muscles. There was a slight increase in central motor conduction time from the motor cortex to the lumbar anterior horn. Pulmonary function showed restrictive ventilation dysfunction, which was the eventual cause of death. Some neuropathological features were suggestive of amyotrophic lateral sclerosis (ALS), namely Bunina bodies. In patients with a history of paralytic poliomyelitis who present after a long stable period with advanced fatal respiratory failure, one may consider not only respiratory impairment from post-polio syndrome but also the onset of ALS.
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Affiliation(s)
- Shin-ichi Terao
- Division of General Medicine, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi 480-1195, Japan.
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Farbu E, Gilhus NE, Barnes MP, Borg K, de Visser M, Driessen A, Howard R, Nollet F, Opara J, Stalberg E. EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force. Eur J Neurol 2006; 13:795-801. [PMID: 16879288 DOI: 10.1111/j.1468-1331.2006.01385.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.
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Affiliation(s)
- E Farbu
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway. European Federation of Neurological Society
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Gylfadottir S, Dallimore M, Dean E. The Relation Between Walking Capacity and Clinical Correlates in Survivors of Chronic Spinal Poliomyelitis. Arch Phys Med Rehabil 2006; 87:944-52. [PMID: 16813782 DOI: 10.1016/j.apmr.2006.03.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 02/07/2006] [Accepted: 03/22/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To examine (1) common clinical measures that may influence walking performance in the six-minute walk test (6MWT) in people with chronic poliomyelitis and (2) the test-retest reliability of the 6MWT distance, lower-extremity muscle strength, balance, and balance confidence on separate trials. DESIGN A prospective quasi-experimental study. SETTING University-based postpolio clinic. PARTICIPANTS Nineteen survivors of poliomyelitis (mean age, 62.2+/-1.9y; time since polio onset, 54.4+/-8.79y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES 6MWT distance, rate-pressure product (RPP), Physiological Cost Index (PCI), ratings of perceived exertion (RPE), pain, fatigue, strength, standing balance, balance confidence, limb-length discrepancy, and lung function. RESULTS The 6MWT distance correlated with PCI, pretest pain, lower-extremity muscle strength, balance, balance confidence, corrected leg-length discrepancy, and lung function but not with RPP, RPE, posttest pain, or pretest and posttest fatigue. The PCI correlated with balance confidence and lung function. About 68% of the variance in 6MWT distance was accounted for by balance and pretest pain. The P value was set at .05. CONCLUSIONS With stringent standardization of the 6MWT applied to survivors of poliomyelitis (a neuromuscular condition with a musculoskeletal component), reproducibility was high; hence, test validity and interpretation were enhanced. The 6MWT distance was useful in elucidating the relation between impairment and a functional activity-namely, walking-in survivors of poliomyelitis.
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Abstract
Post-polio syndrome (PPS) is the term used for the new late manifestations that occur in patients 30 to 40 years after the occurrence of acute poliomyelitis. PPS has been recognized for over 100 years, but is more common at the present time because of the large epidemics of poliomyelitis in the 1940s and 1950s. PPS is manifested by neurologic, musculoskeletal, and general manifestations. Neurologic manifestations include new weakness, muscle atrophy, dysphagia, dysphonia, and respiratory failure. Musculoskeletal manifestations include muscle pain, joint pain, spinal spondylosis and scoliosis, and secondary root and peripheral nerve compression. General manifestations include generalized fatigue and cold intolerance. New muscle weakness of a mild-to-moderate degree responds well to a nonfatiguing exercise program and pacing of activity with rest periods to avoid muscle overuse. Generalized fatigue may be treated with energy conservation and weight loss programs and lower extremity orthoses. Pharmacologic agents also may be helpful, but have not been beneficial in controlled trials. Bulbar muscle weakness includes dysphagia, dysphonia, sleep disorders, and chronic respiratory failure. Dysphagia may be improved with instruction on compensatory swallowing techniques. Dysphonia is treated with voice exercise therapy and voice amplification devices. Sleep disorders are treated similarly to sleep disorders in non-PPS patients. Respiratory failure may be treated with continuous positive airway pressure, bilevel positive airway pressure, and nasal ventilation, or tracheotomy and permanent ventilation if necessary. Musculoskeletal (muscle and joint) pain is treated with weight loss, pacing of activities, use of assistive devices, and prescribing anti-inflammatory medications and physical therapy techniques. Cardiopulmonary conditioning can be improved without muscle overuse with cycle or arm ergometer exercise or dynamic aquatic exercise.
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Affiliation(s)
- Bruk Jubelt
- Department of Neurology, State University of New York (SUNY) Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
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15
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Abstract
The act of breathing depends on coordinated activity of the respiratory muscles to generate subatmospheric pressure. This action is compromised by disease states affecting anatomical sites ranging from the cerebral cortex to the alveolar sac. Weakness of the respiratory muscles can dominate the clinical manifestations in the later stages of several primary neurologic and neuromuscular disorders in a manner unique to each disease state. Structural abnormalities of the thoracic cage, such as scoliosis or flail chest, interfere with the action of the respiratory muscles-again in a manner unique to each disease state. The hyperinflation that accompanies diseases of the airways interferes with the ability of the respiratory muscles to generate subatmospheric pressure and it increases the load on the respiratory muscles. Impaired respiratory muscle function is the most severe consequence of several newly described syndromes affecting critically ill patients. Research on the respiratory muscles embraces techniques of molecular biology, integrative physiology, and controlled clinical trials. A detailed understanding of disease states affecting the respiratory muscles is necessary for every physician who practices pulmonary medicine or critical care medicine.
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Affiliation(s)
- Franco Laghi
- Division of Pulmonary and Critical Care Medicine, Edward Hines, Jr. VA Hospital, 111 N. 5th Avenue and Roosevelt Road, Hines, IL 60141, USA.
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Perrin C, Unterborn JN, Ambrosio CD, Hill NS. Pulmonary complications of chronic neuromuscular diseases and their management. Muscle Nerve 2003; 29:5-27. [PMID: 14694494 DOI: 10.1002/mus.10487] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chronic neuromuscular diseases may affect all major respiratory muscles groups including inspiratory, expiratory, and bulbar, and respiratory complications are the major cause of morbidity and mortality. Untreated, many of these diseases lead inexorably to hypercapnic respiratory failure, precipitated in some cases by chronic aspiration and secretion retention or pneumonia, related to impairment of cough and swallowing mechanisms. Many measures are helpful including inhibition of salivation, cough-assist techniques, devices to enhance communication, and physical therapy. In addition, ventilatory assistance is an important part of disease management for patients with advanced neuromuscular disease. Because of its comfort, convenience, and portability advantages, noninvasive positive pressure ventilation (NPPV) has become the modality of first choice for most patients. Patients to receive NPPV should be selected using consensus guidelines, and initiation should be gradual to maximize the chances for success. Attention should be paid to individual preferences for interfaces and early identification of cough impairment that necessitates the use of cough-assist devices. For patients considered unsuitable for noninvasive ventilation, invasive mechanical ventilation should be considered, but only after a frank but compassionate discussion between the patient, family, physician, and other caregivers.
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Affiliation(s)
- Christophe Perrin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, 750 Washington Street, Boston, Massachusetts 02111-1526, USA
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Magi E, Recine C, Klockenbusch B, Cascianini EA. A postoperative respiratory arrest in a post poliomyelitis patient. Anaesthesia 2003; 58:98-9. [PMID: 12492689 DOI: 10.1046/j.1365-2044.2003.296820.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Klefbeck B, Lagerstrand L, Mattsson E. Inspiratory muscle training in patients with prior polio who use part-time assisted ventilation. Arch Phys Med Rehabil 2000; 81:1065-71. [PMID: 10943756 DOI: 10.1053/apmr.2000.7164] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether inspiratory muscle training in patients with prior poliomyelitis (and with symptoms and signs of hypoventilation) who use part-time assisted ventilation could improve symptoms and respiratory muscle function without adverse effects. DESIGN Intervention study with before-after trial. SETTING Training was performed in the patients' homes; assessments were performed at the hospital. PATIENTS Ten prior-polio patients were included. Three of them did not complete the trial, and their data were not included in results of training. INTERVENTION Ten weeks of daily inspiratory muscle training. MAIN OUTCOME MEASURES Spirometry, maximal inspiratory and expiratory pressures, inspiratory muscle endurance, and questions regarding activities of daily living were performed. RESULTS Inspiratory endurance capacity over 5 minutes improved from 10.7 to 16.7cm H2O (p < .05) assessed at 15 on the Borg scale, and most patients improved in activities of daily living. The whole-body endurance capacity remained stable over the studied period. CONCLUSION Inspiratory muscle training and close supervision can increase respiratory muscle endurance and improve well-being in patients with prior polio who use part-time assisted ventilation.
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Affiliation(s)
- B Klefbeck
- Department of Physical Therapy, Karolinska Institute, Huddinge Hospital, Stockholm, Sweden
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Weinberg J, Borg J, Bevegård S, Sinderby C. Respiratory response to exercise in postpolio patients with severe inspiratory muscle dysfunction. Arch Phys Med Rehabil 1999; 80:1095-100. [PMID: 10489015 DOI: 10.1016/s0003-9993(99)90067-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the limiting factors of exercise performance and to analyze the respiratory strategies adopted during exercise in postpolio patients with severe inspiratory muscle dysfunction. PATIENTS Five patients with prior poliomyelitis associated with scoliosis and with respiratory muscle dysfunction (mean vital capacity, 1.74L [range, 1.1 to 2.4]) were studied at rest and during leg or arm cycle exercise. METHODS Gas exchange was examined by arterial blood gases and mass spectrometry of expired air. Ventilatory mechanics were studied by measurement of esophageal and gastric pressures. RESULTS Blood gases at rest were normal, except for subnormal PO2 levels in three patients. In all but one patient, ventilatory insufficiency was the limiting factor for exercise. A compensatory breathing pattern with abdominal muscle recruitment during expiration was present already at rest in three of the patients. The pressures generated by the diaphragm were below fatiguing margins, ie, levels that in healthy subjects can be sustained for at least 45 minutes. CONCLUSIONS The extent of ventilatory dysfunction was not evident in blood gas values at rest; however, it was revealed by blood gas values during the exercise test. Diaphragm fatigue seems to be avoided at the cost of impaired blood gases.
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Affiliation(s)
- J Weinberg
- Division of Neurology, Karolinska Institute, Huddinge University Hospital, Sweden
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Abstract
We studied sleep architecture and sleep apnea pattern in patients with postpolio syndrome (PPS). Ten patients with clinical signs of PPS underwent polysomnographic recording for two consecutive nights. Although sleep efficiency and proportions of sleep stages were within the normal range, sleep architecture was disrupted owing to sleep apnea. Patients with bulbar involvement had more frequent sleep apnea (mean sleep apnea index, 11.09) than patients without (apnea index, 5.88). The former also had significantly more central apnea, which occurred more commonly during non-rapid-eye-movement (NREM) than rapid-eye-movement (REM) sleep, than those without bulbar signs. This finding suggests reduction in forebrain control of compromised bulbar respiratory centers during NREM sleep in PPS.
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Affiliation(s)
- A C Dean
- EEG Section, NINDS, NIH, Bethesda, MD, USA
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Díaz Lobato S, Gómez de Terreros F, García Tejero M, Villasante C, Corral J, Vázquez C, Redondo M, Echavarri C, Martínez J. Programa de detección precoz de insuficiencia respiratoria en la enfermedad de Duchenne: resultados preliminares. Arch Bronconeumol 1996. [DOI: 10.1016/s0300-2896(15)30750-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Knobil K, Becker FS, Harper P, Graf LB, Wolf GT, Martinez FJ. Dyspnea in a patient years after severe poliomyelitis. The role of cardiopulmonary exercise testing. Chest 1994; 105:777-81. [PMID: 8131540 DOI: 10.1378/chest.105.3.777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Dyspnea after polio can occur for a variety of reasons, including neuromuscular disease and upper airway abnormalities resulting from prolonged intubation, including tracheal stenosis, tracheomalacia, and vocal cord paralysis. Routine studies such as spirometry and maximum voluntary ventilation (MVV) measurements can give similar results in these conditions. We present a 50-year-old woman who as a child developed poliomyelitis that required tracheostomy and negative pressure ventilation. Thirty-nine years later, she developed breathlessness with normal spirometry but decreased MVV. The flow volume loop showed flattening of the inspiratory and expiratory limbs, consistent with a fixed upper airway obstruction or neuromuscular weakness. Exercise testing with measurement of exercise flow volume loops and respiratory pressures was performed. The patient was ventilatory limited with increasing end-expiratory lung volume through exercise. Flow volume loops confirmed flow limitation. Respiratory pressures did not change after maximal exercise. Further evaluation confirmed left vocal cord paralysis and tracheomalacia. This patient demonstrates that the causes of dyspnea after poliomyelitis can be multifactorial, and that routine evaluation may fail to elucidate the limiting factor. In this case, exercise testing provided valuable insight into the limiting factor for this patient and provided useful data for counseling and for further management.
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Affiliation(s)
- K Knobil
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor
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Affiliation(s)
- J Escarrabill
- Servicio de Pneumología, Ciudad Sanitaria y Universitaria de Bellvitge, Hospital Prínceps d'Espanya, L'Hospitalet, Barcelona
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Abstract
Principles for evaluating the functional capacity of, and, therefore, exercise testing, chronically-disabled populations such as individuals with a history of poliomyelitis are considerably less well established than those for able-bodied persons. Therefore, we examined the use of indexes of movement economy and cardiorespiratory conditioning based on the results of a submaximal exercise test and oxygen consumption studies in individuals with a history of poliomyelitis. Subjects (n = 48) were categorized into four distinct groups, ie, having normal movement economy and either normal (n = 12) or reduced cardiorespiratory conditioning (n = 11), or having reduced movement economy and either normal (n = 10) or reduced cardiorespiratory conditioning (n = 15). There was no relationship between the indexes of movement economy and cardiorespiratory conditioning (p > 0.05) supporting that these indexes reflected physiologically-distinct entities. Irrespective of movement economy, deconditioned subjects had a reduced forced vital capacity (% predicted) (p < 0.05) and a higher resting heart rate (HR) (p < 0.01) compared to conditioned subjects. The difference in resting HR was attributed to conditioning level rather than initial arousal because resting HR and VO2 were comparable on repeated tests (p > 0.05). Although there was no difference in steady-state HR (% predicted maximum) among the four groups (p > 0.05), VO2 (% pred max) was significantly lower for the deconditioned than the conditioned subjects (p < 0.01). We concluded that determining movement economy and cardiorespiratory conditioning with a submaximal exercise test may enhance assessment and treatment outcome evaluation, hence provide a rational basis for rehabilitation interventions in individuals with a history of poliomyelitis.
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Affiliation(s)
- E Dean
- School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
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Abstract
Breathing is a complicated act that requires sophisticated control mechanisms. The nervous system coordinates 3 fundamentally important components of respiration. The central nervous system has a central pattern generator that, along with appropriate feedback mechanisms, establishes both the resiratory rate and the depth of respirations. The peripheral nervous system facilitates transmission of these respiratory commands to the ventilatory muscles. The nervous system also contributes to the control of airway size. Laryngeal function is coordinated with inspiration, and local nerves in the lung have a major role in determining bronchial patency. Finally, the nervous system acts in incompletely understood ways to regulate perfusion of the lungs and to match local pulmonary blood flow with ventilation. Failure of the nervous system to adequately control these 3 different aspects of respiration may result in lifethreatening illness. Understanding how the nervous system affects control of ventilation, airway patency, and pulmonary perfusion therefore will enable intensivists to recognize and manage the pulmonary complications of neurological disease.
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Affiliation(s)
- Gene L. Colice
- Department of Medicine, Dartmouth Medical School, Hanover, NH
- Chief, Pulmonary Division, VA Medical Center, White River Junction, VT
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28
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Abstract
Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.
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Affiliation(s)
- E Dean
- School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
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29
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