Inappropriate/d bodies: Reorganizing the terms of life and death

The aim of this article is to offer insight into the different meanings of death that pierce the lives of people with disabilities and to discuss how those meanings are formed through a close connection with their bodies. To do that, I take an anthropological approach to trace the life paths of two individuals from a southern Latin American metropolis, exploring their embodied experiences of disability. Based on their accounts, I look at how their bodies are affected by specific conditions of stigma, dispossession, and social death, but also how, as "inappropriate/d" bodies, they rise above the logic of difference and move from a state of "absence" to a state of "presence" in the social world.

University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953-80

Following Canada's largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta's fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.

Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study

BACKGROUND

Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country.

OBJECTIVE

This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors.

CONCLUSION

The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.

The 1945 St Helena Poliomyelitis Epidemic after 40 Years

Twenty-six of the 28 patients known to have been paralysed by poliomyelitis on St Helena over 40 years ago were traced. All had led fulfilled lives. Nine had since died but no deaths were attributable to the disease. The satisfactory outcome of these people's lives was due to a combination of factors. Initially early diagnosis and immediate appropriate treatment minimized contracture formation. Early intensive rehabilitation and return of the patient in an upright and ambulant position to a caring community established the pattern of their future lives. The later lack of surveillance resulted in six of the patients reverting to crawling and only two still using their calipers. In remote and poor areas appliances where possible should be made and maintained locally.

[The medical, social and institutional challenges resulting from poliomyelitis: comprehensive rehabilitation in Argentina in the mid-twentieth century]

Poliomyelitis on an epidemic scale gave rise to several challenges, one of which was the rehabilitation from the after-effects on many of the people who suffered from the disease. Paralysis and the ways it transformed the concept of physical rehabilitation (where the objective was only to restore the mobility of the affected muscles) and comprehensive rehabilitation that included social, educational and professional aspects in Argentina in the mid-twentieth century are the themes addressed in this article. It uses the methodology of institutional history that interacts in an ongoing manner with the history of health and disease.

Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

Coming to terms with the shift in one's capabilities: a study of the adaptive process in persons with poliomyelitis sequelae

PURPOSE

The main purpose of this paper was to investigate the process of adaptation in persons with poliomyelitis sequelae with reference to daily occupations. In addition, changes in ability in activities in daily living (ADL) and in the use of assistive devices over a 4-5 year period will be described.

METHOD

Qualitative interviews with 22 persons with poliomyelitis sequelae were content analysed according to grounded theory. Ability in personal and instrumental ADL was assessed.

RESULTS

The core category 'coming to a changed approach' towards the shift in one's capabilities describes two integrated processes: one deals with the process of realization and reorganization; the other consists of six patterns of behaviour in daily occupations. The persons had a high degree of independence in personal ADL, whereas the dependence in cleaning, shopping and transportation was extensive.

CONCLUSIONS

Flexibility in choosing strategies facilitated participation in daily occupations. Requirements for this adaptive pattern were time, energy and ability to solve problems, accessible environments, access to information and support, and readiness to compensate with assistive devices.

A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis

OBJECTIVES

To determine (1) the forces and moments passing through knee-ankle-foot orthoses (KAFOs) during walking and (2) the accuracy with which these loads can be measured using conventional gait analysis techniques.

DESIGN

Comparative case series.

SETTING

Rehabilitation facility with human movement laboratory (gait lab).

PARTICIPANTS

Four patients with poliomyelitis wearing KAFOs.

INTERVENTIONS

KAFOs were instrumented with a load cell, and walking data were concurrently collected using conventional gait analysis.

MAIN OUTCOME MEASURES

Load measurements and gait parameters.

RESULTS

Predominant orthotic loads (knee joint forces and moments) were composed of knee flexion moments and axial compression forces. With conventional gait analysis, peak knee joint moments were substantially underestimated compared with those directly measured using the load cell. Defining the knee axis anatomically versus at the orthotic axis, tracking it dynamically, and compensating for each patient's corrected knee flexion contracture resulted in considerable improvements in the gait lab estimates of knee joint moments.

CONCLUSIONS

A practical method that directly measures moments and forces in conventional KAFOs has been applied to show that conventional gait analysis techniques substantially underestimate knee joint moments in the KAFOs of persons with poliomyelitis. Underestimation of orthotic loads could result in underdesigned orthotic components and ultimately higher incidence of component failure in clinical applications.

Teamworking post-polio

People with post-polio syndrome are used to getting on with their lives, but healthcare staff can identify their needs by careful assessment.

Carbon fibre reinforced plastic knee-ankle-foot orthosis with a partially flexible thigh cuff: a modification for comfort while sitting on a toilet seat

At the request of a polio survivor, a partially flexible thigh cuff made of leather and canvas for a carbon KAFO was devised to allow the wearer to feel more comfortable while sitting on a toilet seat. The original, acrylic resin, thigh cuff was partially excised to make an opening (15x10 cm), which was stuffed with rubber sponge, and was sealed with leather and canvas. The opening's surround was vertically and horizontally reinforced with carbon fibres. This modification provided relief to the polio survivor from the discomfort previously experienced while sitting on a toilet seat, and satisfied her needs in daily life.

Vaccine-associated paralytic poliomyelitis: a case report of flaccid monoparesis after oral polio vaccine

This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after the onset of paralysis. Hypotonic monoparesis (GIV/V), hypotonia and atrophy on the left lower extremity, and ipsilateral claw foot persisted for more than 18 months, while we followed him with rehabilitation therapy. This is the first case of officially approved, recipient vaccine-associated paralytic poliomyelitis in Korea.

Secondary conditions and life satisfaction among polio survivors

Persons living with the effects of polio are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. The purpose of this study was to explore the frequency of selected secondary conditions, factors associated with these conditions, and the relationship between secondary conditions and quality of life among polio survivors. Data from a large convenience sample (N = 2,153) indicate that secondary conditions are prevalent and associated with decreased life satisfaction. Prompt identification and treatment of secondary conditions before they progress to greater impairment and/or disability and attention to an overall healthful lifestyle is important to preserve function and maintain quality of life of polio survivors.

A Hermeneutic Phenomenological Analysis of Aging with a Childhood Onset Disability

In this qualitative study, we combined multiple interviews, field notes, life history review charts, and demographic questions to explore the life course experiences of 25 women, ages 55 to 65 years, who developed impairments due to paralytic polio during childhood. Based on a hermeneutic phenomenological methodology using thematic analysis, multiple themes emerged that traced their lives from childhood to later adulthood. The women described how they pushed their bodies and dismissed their physical decline as long as possible. The women's early experiences combined with the culturally defined role expectations for women to influence their perceptions of how to react to changing physical abilities with age.

Braces, wheelchairs, and iron lungs: the paralyzed body and the machinery of rehabilitation in the polio epidemics

The successful fund raising appeals of the March of Dimes employed images of cute crippled children standing on braces and forearm crutches, sitting in wheelchairs, or confined to iron lungs. Those who had to use these devices as a result of polio, however, were often stigmatized as cripples. American cultural antipathy to these assistive devices meant that polio survivors often had to overcome an emotional and psychological resistance to using them. Whatever their fears, polio survivors quickly discovered the functionality of braces and wheelchairs. By confronting the cultural stigma associated with these devices and in some sense embracing these mechanical "friends," polio survivors compensated for their paralyzed bodies and became active in the wider world of home, school and work.

Long term outcome after poliomyelitis in different health and social conditions

OBJECTIVE

To examine and compare the long term outcome after polio in an east European and a west European country with different access to rehabilitation and with different medical and social conditions.

DESIGN AND SETTING

The patients who were acutely hospitalised for polio 1950-54 in the University Hospital in Bergen, Norway and 1958 in the University Hospital in Tartu, Estonia received the mailed questionnaire in the period between January 1998 and December 1998.

PATIENTS

Patient files concerning 334 patients hospitalised in Tartu and 243 patients hospitalised in Bergen were obtained; of these 128 Estonian and 148 Norwegian patients were re-examined.

MAIN RESULTS

Despite more pronounced disability in the acute stage, significantly more Norwegian patients were working full time and part time in 1998 (p<0.0001) and also through the period 1958-1998. In both countries, 30% of patients had manual work and 18% changed profession during their career. Low income (below 50% of national average) was reported by 73% of Estonian and 35% of Norwegian patients (p<0.0001). Except for the odds ratio for muscular pain of 1.89 (95%CI =1.14 to 3.14) for Norwegian patients, new symptoms indicating late progression did not differ. Norwegian patients were more independent with significantly less need for assistance in housekeeping (p=0.02), whereas the use of orthopaedic devices did not differ.

CONCLUSIONS

The long term outcome after polio is different in eastern and western Europe. Access to continuous rehabilitation seems to maintain physical independence in polio patients, improves their ability to earn their own income, and lessens the need for disability pensions.

Cardiac risk factors in polio survivors

OBJECTIVE

To assess the prevalence of dyslipidemia and other risk factors for coronary heart disease in a sample of polio survivors with and without postpoliomyelitis syndrome.

DESIGN

Retrospective chart review.

SETTING

A multidisciplinary outpatient postpolio clinic.

PARTICIPANTS

Eighty-eight consecutive symptomatic postpolio patients, 50 women (mean age, 59.0y; range, 36-81y) and 38 men (mean age, 61.2y; range, 44-83y).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Presence of risk factors for coronary heart disease: clinical atherosclerotic disease, male age >or=45 years or female age >or=55 years, history of hypertension (blood pressure >or=140/90mmHg or on antihypertensive medication), diabetes mellitus, cigarette smoking, and high-density lipoprotein (HDL) less than 35mg/dL. Obesity (body mass index [BMI], >25kg/m(2)) was assessed as an intervention target. Laboratory values included fasting total cholesterol, HDL, low-density lipoprotein, triglycerides, and glucose.

RESULTS

Of the total sample, 61.3% had dyslipidemia. Average HDL cholesterol ratio was 4.01 (women, 3.68; men, 4.55). Forty-four patients (50%) had a history of hypertension or had elevated blood pressure. Seven patients (8%) had a history of diabetes or had elevated fasting blood glucose (>110). Eighteen patients (20.4%) were smokers or had a history of smoking; 9 continued to smoke and 9 had quit smoking. Twenty-five patients (28.4%) were overweight (BMI, >25kg/m(2)). Forty-one patients (46.5%) had more than 1 risk factor for coronary heart disease. Nine of the total sample (10.2%) had a history of heart disease ranging from atrial fibrillation to angina. Only 19 patients had a previous diagnosis of dyslipidemia and only 12 were on a lipid-lowering medication.

CONCLUSION

Polio patients have a high prevalence of dyslipidemia. The study sample supports the National Cholesterol Education Program's Adult Treatment Panel III statements that hypercholesterolemia is underdiagnosed and undertreated. The postpolio population carries a high prevalence of 2 or more coronary heart disease risk factors. Evaluation and rehabilitation of polio patients should include screening for dyslipidemia and education about elimination of controllable risk factors.

[Modern carbon fibre orthoses in the management of polio patients--a critical evaluation of the functional aspects]

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.

Franklin D. Roosevelt: diagnosis, clinical course, and rehabilitation from poliomyelitis

In this case report, we examine Franklin Delano Roosevelt's prognosis, clinical course, and rehabilitation from poliomyelitis, and we examine the criticisms of errors in his diagnosis and management on the basis of current knowledge of the pathophysiology of poliomyelitis. Medical and historical records reveal the onset of severe paralysis, which progressed over several days, with minimal improvement in hips and lower limbs, but recovery of facial, upper limb, and upper trunk muscles. There is no scientific basis for assertions of mismanagement that led to more severe paralysis; the paralysis was most likely caused by strenuous activities in the preparalytic phase of his illness.

Quality of life, life satisfaction, and spirituality: comparing outcomes between rehabilitation and cancer patients

OBJECTIVE

To determine differences in quality of life, life satisfaction, and spirituality across different patient groups and to determine what factors may relate to these three outcomes across rehabilitation and cancer patients.

DESIGN

Subjects were first stratified by five diagnostic groupings. Patient data were then regrouped for additional analytic purposes into two large cohorts. All subjects completed questionnaires once. Differences in scores and correlations were computed, and regression models were specified.

RESULTS

Group differences were found across the quality of life measures used in the study. There were also differences in life satisfaction and spiritual well-being. Spirituality was found to be associated with both quality of life and life satisfaction, although it was not a significant predictor in a multivariate context.

CONCLUSIONS

In general, subjects with prostate cancer reported higher scores across all measures. Spirituality showed a strong association with both life satisfaction and quality of life, and it was a significant predictor of life satisfaction among rehabilitation subjects. Factors such as age, marital status, and work status, in addition to specific dimensions of quality of life, such as social functioning and functional well-being, were found to be associated with total quality of life.

Education, occupation, and perception of health amongst previous polio patients compared to their siblings

Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950-1954 epidemic cohort, or from a cohort of hospital-admitted rehabilitation patients. Ninety-four paralytic patients and 74 non-paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi-square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full-time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full-time employment rate amongst the paralytic patients, only 52% of this group being employed full-time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.

A comparison of the effects of exercise and lifestyle modification on the resolution of overuse symptoms of the shoulder in polio survivors: a preliminary study

OBJECTIVE

To compare the effectiveness of exercise and lifestyle modification therapy in treating shoulder symptoms in polio survivors with lower-extremity weakness.

DESIGN

A randomized parallel group study.

SETTING

Research laboratory.

PARTICIPANTS

Twenty-three subjects recruited from a cohort of 194 polio survivors who had participated in a previous study had bilateral hip-extensor and knee-extensor weakness and reported experiencing shoulder pain on a regular basis with daily activity.

INTERVENTIONS

Subjects were randomly assigned to 1 of 3 treatment groups. Members of group 1 were placed on a home exercise program that focused on strengthening their hip and knee extensors. Members of group 2 were instructed in lifestyle modification techniques designed to avoid shoulder overuse. Members of group 3 received both interventions.

MAIN OUTCOME MEASURES

Shoulder symptoms were quantified in terms of number and severity. Isometric strength of bilateral hip and knee extensors was measured with a hand-held dynamometer.

RESULTS

Symptoms improved in all 3 groups. However, members of the exercise-only group (group 1) were the only ones to show a significant difference in both number and severity of symptoms when pre- and posttreatment values were compared.

CONCLUSIONS

Both exercise and lifestyle modification therapies that focus on reducing the stress related to lower-extremity weakness are effective in treating shoulder overuse symptoms in polio survivors. A trend toward greater improvement in shoulder symptoms in subjects who participated in the exercise program and who also showed a trend toward increased knee-extensor strength supports muscle strength and/or endurance as a key factor.

Long-term follow-up of patients with nonparalytic poliomyelitis

OBJECTIVE

To examine patients with previous nonparalytic poliomyelitis in search of muscle atrophy, weakness, and other late symptoms of poliomyelitis.

DESIGN

A mailed questionnaire followed up with neurologic and neurophysiologic examinations of respondents who reported symptoms possibly related to the late sequelae of polio.

SETTING

Neurology department at a university hospital.

PARTICIPANTS

Thirty-nine of 47 patients diagnosed with nonparalytic poliomyelitis and hospitalized at a Norwegian hospital between 1950 and 1954, during the Norwegian polio epidemic.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Electromyography to determine function of the anterior tibialis, vastus lateralis, and biceps brachii muscles; nerve conduction studies of the sural, peroneal, and tibial nerves; motor and sensory nerve conduction velocity, and compound muscle and sensory nerve action potentials, and distal latencies.

RESULTS

Twenty-five of 47 patients (53.2%) reported symptoms possibly related to the late sequelae of poliomyelitis. Eight of 20 examined symptomatic patients had normal neurologic and neurophysiologic findings, whereas 9 others had other medical conditions that could explain the symptoms. Three patients (6.7%) had neurologic and neurophysiologic findings and development of symptoms consistent with motoneuron damage.

CONCLUSION

Some nonparalytic patients may have subclinical acute motoneuron damage with subsequent development and manifestation of motor weakness and neuromuscular symptoms many years later. These symptoms should be considered a differential diagnosis in patients who have a history of nonparalytic poliomyelitis.

[The history of poliomyelitis in Norway--disease, society and patients]

The first epidemic of poliomyelitis in Norway was reported in 1868. Over the course of the 20th century, a total of 23,000 cases of acute poliomyelitis were registered, and the disease caused much suffering and fear before vaccination was introduced in 1956. After 1960, treatment and rehabilitation facilities for polio patients were gradually converted to other uses. Today there are 5,000-10,000 persons with sequelae poliomyelitis in Norway, many of them suffering from late effects of poliomyelitis, so-called postpolio syndrome. Thus there is still a need for multidisciplinary services for these patients, even though the poliovirus could be eradicated in a few years' time.

Submaximal exercise capacity and maximal power output in polio subjects

OBJECTIVES

To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.

DESIGN

Cross-sectional survey.

SETTING

University hospital.

PARTICIPANTS

Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.

RESULTS

The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.

CONCLUSION

The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.

Physiological response to the ambulatory performance of hand-rim and arm-crank propulsion systems

Two types of propulsion systems-the hand rim (HR) and the arm crank (AC)-are commonly used in wheelchair ambulation. The purpose of this study was to investigate the physiological response of the two propulsion systems under actual locomotive condition by the actual users. The energetics of locomotion manual wheelchair (HR propulsion) and arm-propelled three-wheeled chairs (AC-propelled) at their free chosen speed (FCS) were studied and compared. Thirty-four male subjects with dysfunctioning lower limbs; 17 manual wheelchair users and 17 arm-propelled three-wheeled chairs regular users volunteered to participate in the study. Speed (m.min-1), oxygen uptake (1 x min(-1)) and heart rate (b x min(-1)) were monitored during steady-state ambulation at FCS for 5 min. Oxygen consumption (VO2, ml x kg(-1) min(-1)), oxygen cost (VO2, ml x kg(-1) m(-1)), net locomotive energy cost (kcal kg(-1) km(-1)) and physiological cost index (b x m(-1)) were derived. The FCS of the AC propelled device is remarkably higher than the HR system, and the magnitude of the physiological variables of the AC propulsion system was significantly lower (p<0.001) in relation to the HR propulsion system, as revealed from the results of t test for two sample means at a significance level p=0.001. It can be inferred from the result that the AC propulsion system could be used for long distance rides with a higher speed required for outdoor ambulation and that the HR propulsion system is suitable only for indoor use, because of its excellent maneuverability where short-duration low-velocity ambulation is required.

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.

The polio narratives: dialogues with FDR

As a group of accounts that span the decades from the mid-1940s to the present, the published polio narratives enable us to align their shifting perceptions of disability with social, cultural, and technological change. This paper identifies two distinct groups of narratives. Authors of the first group, writing between the mid-1930s and mid-1950s--a period of relative prosperity, conformity, and homogeneity--were uncomfortable with radical movements, diversity, and conflict; their narratives typically told of either full or substantial recovery. Beginning in the mid-1950s--the period of both McCarthy and the Civil Rights movement--a second wave of narratives begins to tell stories of partial to serious disability; typically, they reflect on a lifetime of coping with chronic disability. Both sets of narratives, however, represent a dialogue with Franklin Delano Roosevelt. Roosevelt himself, journalists, and the National Foundation for Infantile Paralysis all helped to create and promote a core polio narrative featuring FDR's triumph over disease and disability that would become a national myth. Yet while the early narratives reinforced the core elements of the Roosevelt myth, the later ones began to challenge them.

Appliances and surgery for poliomyelitis in developing countries

Death before maturity is the usual fate of the untreated crawling crippled child in developing countries. Most children with poliomyelitis, however, when upright and walking with supports or following surgery, are accepted by the community, educated by parents and relatives, and employable when they reach maturity. It is more economical to prevent 100 polio cases than to treat one hopelessly crippled child. It is often quicker to straighten 100 deformed limbs by simple subcutaneous surgeries than to treat a single patient with complicated procedures. It costs less for 100 crawling paralyzed children to walk in simple, locally made braces and clogs, than for 1 patient to be mobile in expensive imported appliances and boots. It is essential to educate or rehabilitate patients in addition to making them mobile. The final aim should be patients returned to their own village or town, accepted and integrated into their own communities, and earning their own living among their own friends. This chapter is discussed in further detail in both English and French in my Website, <www.worldortho.com>. This site also includes comprehensive information on both the manufacture of the simple appliances described and various surgical details. This information is also available on CD-ROM.

Physical activity for elderly persons with neurological impairment: a review

The paper reviews studies conducted on physical activities and exercise in elderly persons with neurological impairment due to stroke, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis or post-polio syndrome. The paper concludes: (i) it is not possible at present to draw conclusions regarding persons with Guillain-Barre syndrome and Parkinson's disease; (ii) individuals with multiple sclerosis and post-polio syndrome benefit from physical activity, but all studies have so far been conducted on those under 65 years of age, and its effect on elderly persons with these diseases is not known; (iii) exercise and customary activities (walking and swimming) should be encouraged and promoted in elderly persons after stroke.

Inspiratory muscle training in patients with prior polio who use part-time assisted ventilation

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.

Neuromuscular rehabilitation and electrodiagnosis. 4. Specialized neuropathy

This self-directed learning module briefly highlights the differential diagnosis for acute weakness in patients with acute respiratory failure requiring prolonged mechanical ventilation. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article includes a discussion on the role of exercise in the treatment of patients with the late effects of poliomyelitis or with acute inflammatory demyelinating polyradiculoneuropathy.

An insole pressure measurement system: repeatability of postural data

This study analyzed the ability of an in-shoe plantar pressure measurement system to provide repeatable measurements of postural sway data for both healthy and clinical patients. Each participant's in-shoe pressure data were recorded for three trials during each test session during quiet stance. Healthy individuals (n = 9) participated on three consecutive days while clinical participants (n = 5) were tested on one day. Nine response variables were measured to assess their postural stability. Intrasubject measures were evaluated using the Kerlinger reliability procedure. Values provided directly by the Parotec System for a single day of testing yielded the following average coefficients: r = 0.95 (left), r = 0.97 (right) with mean coefficient values from the three day tests of: r = 0.98 (left), r = 0.98 (right). Variables calculated from raw data on a single day produced mean coefficients of: r = 0.77 (left), r = 0.76 (right) and over three days of: r = 0.65 (left), r = 0.66 (right). The ability to record highly reproducible data of postural sway parameters should assist clinicians to treat patients more confidently for balance deficiencies.

Depression in children with hemophilic arthropathy and poliomyelitis: a preliminary report

The aim of this study was to evaluate children with chronic disorders like hemophilia and poliomyelitis from the psychological perspective, to determine the frequency of depression, to identify the risk factors and to investigate the relation between disability and depression. Thirty-five patients with disability due to poliomyelitis and 12 patients with hemophilic arthropathy were included in the study. Thirty-six healthy children from the district schools served as controls. The Children's Depression Inventory (CDI) was used to assess the extent of depression. For the hemophilia group, joint scores proposed by the World Federation of Hemophilia were used to assess the degree of joint involvement. The poliomyelitis group was evaluated according to the level of ambulation and the need for orthoses. The CDI score was 10.57 +/- 5.87 in the poliomyelitis group, 11.00 +/- 5.64 in the hemophilic arthropathy group and 8.39 +/- 3.78 in the control group, but the difference was not statistically significant. Four of 35 patients with poliomyelitis (11.4%) and two of 12 hemophilic arthropathy patients (16%) exhibited depression. None of the children in the control group had depression. Since depression interferes with both medical compliance and rehabilitation potential, early diagnosis and treatment is important. Therefore, evaluation of the psychological status of chronically ill children must be a part of the rehabilitation program.

Prediction of walking possibility in crawling children in poliomyelitis

Crawling is one of the most common modes of ambulating in children with severe paralysis and deformities in poliomyelitis. Restoring upright posture and bipedal gait, although desirable, has its own limitations due to various factors. Fifty-three children below the age of 12 years (29 boys and 24 girls) crawling due to post-poliomyelitis residual paralysis were assessed for the genesis of crawling as a mode of ambulating. The patterns of crawling were classified according to Cross's classification. Paralyzed muscles and deformities in definite combinations were found responsible for each type of crawling. Trunk muscles, gluteus maximus, quadriceps, hamstrings, tibialis anterior, and triceps surae were identified as muscles crucial for walking in order of priority. At least antigravity power in these muscles was necessary for an upright posture and walking with support. Various combinations of treatment modalities were used to correct the deformities before fitting an orthosis and instituting gait training. Thirty-four children became outdoor walkers, 14 indoor walkers, and five remained nonwalkers. The most favorable patterns of crawling for restoration of upright posture were true quadruped progression (30 cases) and infant-like crawl (14 cases). Average follow-up was 17 months (range, 6 months to 5 years).

Managing occupations in everyday life to achieve adaptation

OBJECTIVE

The aim of this qualitative study was to gain a deeper understanding of how persons with poliomyelitis sequelae manage their daily occupations in order to adapt to environmental demands. This was a study of adaptive processes and capability in everyday life.

METHOD

Interviews with 22 persons with poliomyelitis sequelae were content analyzed according to grounded theory.

RESULTS

The analysis yielded 18 concepts describing adaptive strategies of participants. The strategies were arranged in six general groups: utilizing physical capability, influencing emotions, altering pattern of occupations, promoting concrete problem-solving, influencing relations, and facilitating future activities.

CONCLUSION

The strategies were interwoven, revealing different ways of reaching an adaptive balance in daily occupations for the present and the future.

The Norwegian Polio Study 1994 part II: early experiences of polio and later psychosocial well-being

STUDY DESIGN

The Norwegian Polio Study 1994 was a nation-wide survey of the medical and psychosocial situation of polio survivors.

METHOD

A questionnaire, consisting of 133 questions with sub-questions, was sent to a total of 2392 polio victims, most of them registered in 'The National Society of Polio Victims' in Norway. 1449 (61%) answered.

OBJECTIVES

To investigate the relationship between early polio experiences, such as duration of hospitalization and perceived support, and later psychosocial well-being.

RESULTS

Three hundred and ninety-one persons (27%) reported they had been psychologically harmed by the treatment received at the time they contracted polio (Harmed group), while 1053 persons (73%) did not (Non-Harmed group). Persons in the Harmed group were significantly younger at polio onset, were hospitalized for a longer period and had less parental visit and support. Today they use more medication, report more pain, general fatigue, sleep disturbance and concentration problems, more psychosocial distress, less satisfaction with life and less social support than persons in the Non-Harmed group.

CONCLUSIONS

The results demonstrate that a subgroup of polio survivors has been vulnerable from childhood, with possible consequences for their physical, psychological and social wellbeing later in life. Recommendations for long-life treatment of children with similar diseases should include follow-up not only of their physical disabilities, but also on psychological and psychosocial needs.