History Of Poliomyelitis Research Articles

Movement energetics of individuals with a history of poliomyelitis.

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.

Movement Energetics of Individuals with a History of Poliomyelitis

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 = 10) 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 p 2 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), Vo 2 (% pred max) was significantly lower for the deconditioned than the conditioned subjects ( p

Surgical management of gonarthrosis in patients with poliomyelitis

The authors reviewed nine cases of degenerative disease of the knee in patients with a history of poliomyelitis. All patients were treated with a cemented total knee arthroplasty. The average follow-up period was 6.8 years (range, 6 months to 13 years), and the average follow-up knee score using the Hospital for Special Surgery rating scale was 70. Three of the patients required revision total knee arthroplasty to a more constrained implant. Pain relief was predictably very good and knee stability was initially improved. However, many of the patients suffered a decline in ambulatory ability with time.

Pulmonary Function in Individuals with a History of Poliomyelitis

We examined the relationship between the lung function of 74 individuals with a history of poliomyelitis and reports of shortness of breath during activities of daily living, and the presence of post-polio sequelae risk factors. First, we studied the spirometry of 60 individuals (group 1) and second, we studied the relationship between the spirometry of an additional 14 individuals (group 2) and their respiratory muscle strength (Pimax and Pemax). In both groups, we examined the relationship between factors associated with post-polio sequelae including ventilation at polio-onset, having contracted polio after the age of 10, and having had polio for over 35 years; and lung function. In group 1, the FEV1 and FVC were lower for individuals with shortness of breath than individuals without (p less than 0.01). With respect to risk factors, FEV1 and FVC were lower in individuals who were ventilated at polio-onset, in individuals who contracted polio over 10 years of age, and in individuals who had had polio for less, rather than more than 35 years (p less than 0.05). The results for group 2 were comparable to group 1. In addition, the observed Pimax and Pemax were significantly lower than predicted values (p less than 0.05). Although FEV1 and FVC were positively correlated with both Pimax and Pemax (p less than 0.05), Pemax was disproportionately impaired compared to Pimax (40 +/- 12.1 and 82 +/- 38.8 percent predicted respectively). We conclude that individuals with a history of poliomyelitis can have compromised lung function irrespective of shortness of breath, that risk factors such as ventilation at polio-onset and polio-onset after 10 years of age can help predict those at risk of respiratory compromise, and that the measurement of respiratory muscle strength and of Pemax in particular, can augment the assessment of lung function of these individuals. Such assessment may avert respiratory complications in the post poliomyelitis population including those secondary to health care interventions.

Functional recovery. A major risk factor for the development of postpoliomyelitis muscular atrophy.

A retrospective study was undertaken to identify potential risk factors for the development of progressive postpoliomyelitis muscular atrophy (PPMA). Patients with PPMA (n = 57) were compared with patients with a history of poliomyelitis but without a history of progressive weakness (n = 49). Patients who later developed PPMA had histories of more widespread acute paralysis, but relatively greater functional recovery. They were less disabled, and reported higher recent activity levels. Seventy-nine percent of the total variance between the PPMA and control groups could be accounted for by recovery alone (ie, severity minus disability). Functional recovery is generally attributed to reinnervation of sarcomeres by collateral sprouting from surviving lower motor neurons. Since degree of recovery predicts the risk of developing PPMA, our findings suggest that enlarged motor units may carry an increased susceptibility for dysfunction and/or degeneration.

Late denervation in patients with antecedent paralytic poliomyelitis.

The development of new weakness, fatigue, and pain decades after acute paralytic poliomyelitis is a recognized syndrome. We conducted a controlled study of this syndrome by analyzing clinical, electromyographic, and muscle-biopsy features in 18 patients with a history of poliomyelitis--13 reporting 1 to 20 years of new weakness and 5 without new symptoms. The patients with new weakness also reported new muscle atrophy (9 of 13) and fatigue (10 of 13), symptoms not reported by the controls. The age at the time of acute poliomyelitis, severity of poliomyelitis, residual disability, number of years since acute poliomyelitis, and age at the time of study were comparable in the weakening and control groups. Evidence of remote denervation consistent with antecedent poliomyelitis was demonstrated in all patients by electromyography or muscle biopsy or both. In addition, active denervation (as evidenced by spontaneous activity on conventional electromyography, increased jitter on single-fiber electromyography, or atrophic myofibers) was found in 12 patients in the weakening group and in all 5 controls. Immunohistochemical detection of myofibers expressing the neural-cell adhesion molecule corroborated ongoing denervation in both patient groups. When muscle data from both groups were pooled, correlations were observed between the extent of past reinnervation and the degree of ongoing motor-unit instability. We conclude that the extensive reinnervation of denervated muscle that occurs in paralytic poliomyelitis may be followed by late denervation of the previously reinnervated muscle fibers. Electromyographic and muscle-biopsy evidence of ongoing denervation does not distinguish between stable patients with prior paralytic poliomyelitis and those with new weakness.

Antiviral therapy.

Recently conventional viruses such as measles and rubella and unconventional infectious agents have been implicated as the cause of chronic, debilitating neurologic ailments’. This suggests that other nervous system diseases such as multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS) are likely to be due to a virus. In the case of ALS it has been thought that polio virus would be a logical etiologic candidate since both poliomyelitis and ALS share striking clinical similarities[2]. In both disorders the brunt of the pathologic process is primarily borne by the motor neuron. Further, some patients with poliomyelitis go on to develop weakness and wasting many years after their initial illness[3]. These reports have prompted epidemiologists to study the incidence of ALS in patients with a history of poliomyelitis. Poskanzer and his colleagues have reported an association between the two diseases[4]. Immunologic support for a relationship between ALS and polio rests on the finding that lymphocytes from ALS patients may be sensitized to polio antigen[5]. However, serum and CSF antibodies to polio are not disproportionately elevated in persons with ALS[6]. Although a number of attempts have been made to isolate a virus, including polio from ALS tissues, this has not been successful nor have attempts to transmit ALS to an animal host[7].KeywordsMultiple SclerosisAmyotrophic Lateral SclerosisThymidine KinaseAmyotrophic Lateral Sclerosis PatientViral EtiologyThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

A History of Poliomyelitis

A History of Poliomyelitis

A correction in Paul's "A history of poliomyelitis".

Excerpt As an old friend of the late Dr. Paul it is disturbing to have to correct any item of fact in so splendid a history of poliomyelitis (1) as he has compiled. When the error concerns an impor...

A History of Poliomyelitis

A History of Poliomyelitis

A Chapter in Medical History: A History of Poliomyelitis . John R. Paul. Yale University Press, New Haven, Conn., 1971. xx, 486 pp., illus. $15. Yale Studies in the History of Science and Medicine.

A Chapter in Medical History: <i>A History of Poliomyelitis</i> . John R. Paul. Yale University Press, New Haven, Conn., 1971. xx, 486 pp., illus. $15. Yale Studies in the History of Science and Medicine.

Book ReviewA History of Poliomyelitis: Yale studies in the history of science and medicine — 6.

Book ReviewA History of Poliomyelitis: Yale studies in the history of science and medicine — 6.

A History of Poliomyelitis

The conquest of polio is one of the dramatic achievements of 20th-century medicine, and Dr. Paul's narrative provides an exciting and informative account of the complex story. Dr. Paul himself played an important part in the ultimate success, and in addition he has known intimately most of the investigators whose work he describes. His concluding words are consequently all the more significant, for he indicates that we do not yet have completely triumphant success story. The road will lead uphill for many years to come. The great accomplishments of the 1950s and 1960s came about only after long and disheartening struggles, brilliant inspiration, pursuit of clues that belied their promise, errors and false turnings, tragic accidents, personal rivalries. Yet they all led to a happy culmination. Dr. Paul has been a clinical investigator, devoting his talents to the study of the human patient. This contrasts with the purely laboratory

MIGRATION OF A METALLIC PIN FROM THE HUMERUS INTO THE LUNG.

THIS presentation describes the migration of a Steinmann pin from the right humerus into the right lung of a twelve-year-old child, followed by its successful removal. Although previously reported, such cases are sufficiently unusual to merit reiterating. Case Report A 12-year-old girl was admitted for the 7th time to the Hospital of the University of Pennsylvania on March 17, 1963, with a history of poliomyelitis at 3 years of age and residual paralysis of the right upper extremity. The previous 6 admissions had been for surgical procedures designed to allow more useful function of the right arm. These admissions are . . .

The laboratory in the study of enterovirus epidemics.

THE HISTORY of poliomyelitis provides a classic example of a changing epidemic pattern. A hundred years ago poliomyelitis was a rare sporadic malady; 50 years ago it was a recognized cause of epidemics in urban temperate zone populations, and in recent years it has been described the world around as potentially epidemic in both temperate and tropic zones and in both urban and rural populations. This change in pattern of overt poliomyelitis has been attributed to improving mass hygiene and living standards. However, clinical and epidemiologic investigations have provided little insight into the natural mechanisms responsible for the change in poliomyelitis ecology. In the past 20 years, rapid improvement of virologic methods has provided new laboratory tools for investigation of poliomyelitis. The successful adaptation of certain prototype polioviruses to mice prompted the use of this host for primary isolation of virus, which in turn introduced the virologist to the Coxsackie viruses. More recently, the application of cell cultures to the study of poliomyelitis resulted in the identification of ECHO viruses. Thus, change in virologic methods has uncovered whole new groups of agents which share many physical and epidemiological properties with polioviruses.1-3 These agents, the group A and B Coxsackie and ECHO viruses, have been grouped with polioviruses under the general term enteroviruses. Initially, these new agents were considered only fellow travelers with polioviruses, or as normal intestinal flora, but evidence soon accumulated associating these other enteroviruses with pleurodynia, herpangina, various exanthems, myocarditis, pericarditis, aseptic meningitis, and occasionally the syndrome of flaccid lower motor neuron paralysis.4-6 Thus it is difficult to study poliomyelitis in the field without encountering these other enteroviruses, and questions concerning the ecology of polioviruses now automatically include these other agents as well.

History of poliomyelitis in Cornwall and Devon.

(/) Cornwall and Devon are pre-eminently the counties of England, and are visited by large numbers every summer. Most of the visitors spend their holiday in a coastal resort but many stay inland in a farmhouse or camp. It seems reasonable to suppose that, if importation of infection is a . potent factor in the origin of epidemics, the seaside towns should show some pre ponderance of cases over the years. (//) The two counties had one of the earliest severe epidemics of poliomyelitis recorded in England?that of 1911. In that year

NEUTRALIZING ANTIBODIES AGAINST MOUSE-ADAPTED LANSING STRAIN OF POLIOMYELITIS VIRUS IN THE SERA OF ACUTE AND CONVALESCENT CASES AND NORMAL INDIVIDUALS

The present communication deals with a survey of neutralizing antibodies to mouse-adapted Lansing strain of poliomyelitis virus in the sera of acute, convalescent, and normal individuals during a 1946 epidemic. Two-phase sera were obtained from residents of Ontario and British Columbia and convalescent and normal sera from Quebec. In the sera of 17 out of 35 Ontario patients neutralizing antibodies were demonstrable during the acute stage. In four of these seropositive individuals, there was an increase in the neutralizing titer during convalescence and in three patients there was a notable drop in the titer. The remaining 18 patients were found to be seronegative during both the acute and convalescent stages. Sera from six out of nine British Columbia patients, likewise contained neutralizing antibodies to the Lansing strain of virus during the acute stage. In four of these the titer remained unchanged during convalescence, in one the titer decreased, and another patient became seronegative. Of the remaining three, two continued to be seronegative and one became seropositive during convalescence. Positive neutralization reactions were obtained with 17 out of 44 convalescent sera from Ontario and 62 out of 146 convalescent sera from Quebec Sera from 51 children without history of poliomyelitis and 100 adult sera taken at random from specimens submitted for Wassermann tests were obtained from Quebec. Of the children's sera 43%, and of the adults’, 48%, contained neutralizing antibodies. The results obtained closely agree with those reported by American workers.

PROBLEMS IN THE NATURAL HISTORY OF POLIOMYELITIS

Excerpt The people who have worked for many years gathering information on the natural history of poliomyelitis are more impressed with the tremendous amount that remains to be learned than with wh...

Poliomyelitis: III. Results of in vitro Neutralization Tests on Serums of Both Treated and Untreated Poliomyelitic Patients

patients who have recovered from poliomyelitis have been shown experimentally to possess neutralizing antiviral substances, it has been more or less taken for granted that all such serums should contain these substances. In a sudden outbreak of the disease, there is seldom time nor the available monkeys to make a detailed examination for the neutralizing ability of each serum. It is usually presumed that since the donor has recovered from an attack of poliomyelitis the serum has a certain neutralizing value. Probable differences in the potency of each serum are conceded, however, so that a pool of several is usually advocated. Evidence for this has recently been given by Brodie,1 who reported that pooled serums from various groups may vary considerably in their strength. Since the results of the use of antipoliomyelitic serums have been variable and often disappointing in spite of early administration, it seems likely that these differences should be attributed to the variability in the antiviral substances of the different serums. Many writers have recently shown that such substances may also be present in the blood of normal persons who have no history of poliomyelitis (Aycock and Kramer,2 Fairbrother and Brown,3 Shaughnessy, Harmon and Gordon,1

LETHARGIC ENCEPHALITIS

It is of more than ordinary interest that within the last dozen years at least two epidemic diseases, affecting chiefly the central nervous system, have prevailed widely in Europe and America. The first is poliomyelitis, which since 1907 has passed through several phases in the United States and culminated in the outbreak of unparalleled severity, centering in New York State, in 1916. The second is lethargic encephalitis, apparently only recently introduced in and already widely distributed through this country. It is highly desirable that the main facts known about the latter disease should be given publicity; and it may well be that the experience, often of tragic nature, gained with poliomyelitis, may serve us in dealing more effectively with the encephalitis peril. Hence, by way of introduction, I shall sketch the recent history of poliomyelitis. POLIOMYELITIS The occurrence of poliomyelitis in America and generally in Europe beginning in 1907 followed,