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.     

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.     

Post-polio syndrome. An emerging threat to polio survivors.

The manifestations of post-polio syndrome typically occur 20 to 40 years after an acute episode of poliomyelitis and are confined to previously affected muscles. Because of motor unit remodeling and direct mechanical damage, weakness increases in individual muscles until it exceeds their narrow margin of reserve and becomes clinically apparent. Although the exact cause is not clear, generalized weakness often occurs when several muscles are affected and various postural limb strategies used by the patient are no longer able to compensate for the loss of muscle strength. The mainstays of treatment are life-style changes to avoid overexertion and use of light-weight orthoses and assistive aids to unload the extremities. Exercise and surgery have a limited role in management.     

Musculoskeletal pain in polio survivors and strength-matched controls

OBJECTIVES: To determine whether a significant difference exists between musculoskeletal symptoms of polio survivors and those of older adults with no history of polio, and to determine if activity level and strength predict pain in either group. DESIGN: Matched research design. SETTING: A research laboratory in a rehabilitation setting. PARTICIPANTS: Fifty-four polio survivors and 54 adults with no history of polio were matched for gender, race, and bilateral knee extensor strength and selected from a cohort of 316 subjects who participated in a study on the relation between activity level and health status. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Location and severity of musculoskeletal pain, activity frequency and intensity level, maximum voluntary isometric strength, and physical performance measures. RESULTS: Polio survivors reported significantly more symptoms than the matched controls ( P <.05). Symptom status among the polio survivors was strongly associated with performance strain, perceived exertion, and activity intensity. Although the polio survivors had activity frequencies and habitual walking speeds that were similar to those from the matched controls, there was evidence that they performed activities at higher intensity levels. CONCLUSIONS: Activity level is a factor in the development of musculoskeletal symptoms in polio survivors. Polio survivors who perform at higher intensity levels are more likely to have moderate to severe pain and more mobility difficulties.     

Neuromuscular function in polio survivors at one-year follow-up

Many polio survivors complain of progressive loss of strength, work capacity, endurance, and ability to recover from fatiguing activity. These variables were measured initially and one year later in the quadriceps muscles of 28 symptomatic and 16 asymptomatic persons who had polio and 38 control individuals. Peak knee extension torque was measured isokinetically and isometrically. Endurance, or the amount of time the subject could maintain isometric torque at 40% of maximal torque, was measured. Work capacity was determined as the product of isometric torque and endurance time. Recovery of strength was measured at regular intervals for ten minutes after the endurance test. Statistical analysis was done by repeated measures ANOVA. Although the initial measures showed significant deficits in mean peak torque, work capacity, and recovery of strength in symptomatic postpolio subjects, no significant changes were found one year later in any of the variables. We conclude that symptomatic postpolio subjects do not lose significant neuromuscular function in one year.     

Changes in strength over time among polio survivors

OBJECTIVE: To study changes in the strength of different muscle groups in polio survivors over a period of approximately 9 months. DESIGN: Longitudinal study. SETTING: Moss Rehabilitation Research Institute. PARTICIPANTS: One hundred twenty subjects (57 men, 63 women) were studied on three occasions, each 3 to 5 months apart. Subjects were recruited through the Einstein-Moss Post-Polio Management Program. newspaper advertisements, and polio support groups. MAIN OUTCOME MEASURES: Isometric strength of 30 muscle groups (16 in upper extremities, 14 in lower extremities) was measured, using a hand-held dynamometer. RESULTS: Data were analyzed in two separate groups: upper-extremity muscles and lower-extremity muscles. Results for the upper-extremity muscles revealed evidence of a significant deterioration in strength. The amount of deterioration differed among muscles and increased with age. There was also evidence of deterioration in strength in the flexor muscles in the ankle, hip, and knee. However, the rate of deterioration in these muscles was not strongly related to age, time since polio, gender, symptom status, or history of residual weakness. CONCLUSIONS: Strength is deteriorating among polio survivors at a rate higher than that associated with normal aging. This deterioration is not occurring in the extensor, or so-called "weight-bearing" muscles, but is occurring in many of the upper-extremity muscle groups and in the flexor muscles in the lower extremities.     

Results of a survey of 201 polio survivors

We present the results of a survey on the late effects of poliomyelitis in 201 persons. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from poliomyelitis to onset of new problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with development of these late effects of polio were (1) hospitalization (P less than 0.00001), (2) age greater than 10 years (P less than 0.00001), (3) ventilator use (P less than 0.0029), and (4) paralytic involvement of all four limbs (P less than 0.0240). The differential diagnosis of these new problems, implications for treatment, and areas for future research are discussed.     

Life purpose: effect on functional decline and quality of life in polio survivors.

This article explores the protective effects that finding a purpose in life has on the level of physical and mental impairment and overall quality of life. Results were gathered from a national sample of 2,153 polio survivors. Although the combined social and physical experience of living with the disabling effects of polio has been associated with accelerated aging due to an increased allostatic load, finding a purpose in life may diminish these effects. The findings of this study indicate that purpose in life is associated with less perceived decline in health. Moreover, purpose in life is predictive of better quality of life despite levels of physical and mental impairment. Rehabilitation nurses should consider ways to help persons with polio maintain activities and interests that promote their sense of purpose in life.     

Incidence and nature of epidemic nosocomial infections.

Nosocomial bloodstream infections continue to be a major cause of morbidity and mortality. Approximately 8% of all nosocomial infections reported in the United States are primarily bloodstream infections. These infections prolong hospital length of stay, increase mortality, and raise the overall cost of healthcare. A contaminated infusate administered through a central venous catheter is one of the commonly identified causes of nosocomial bacteremia. In most cases, contamination of the infusate occurs extrinsically during manipulation of the fluid before its administration to the patient. Failure to use aseptic technique and poor hand washing often are the cause. In addition to improved staff education, surveillance for nosocomial bloodstream infections continues to be the cornerstone of prevention.     

Incidence and related factors of dysphagia in stroke patients

AIM：To investigate the incidence and related factors of dysphagia in stroke patients. METHODS:Water drinking test were applied to 100 patients who received continuously by neurology and rehabilitation department after their condition was stable. RESULTS:Dyshagia incidence of the 100 cases of stroke patients was 33%.CONCLUSION:Analysis of related factors indicates that incidence of dysphagia has no relationship with sex,age,positipn of the lesion and complications, but shows correlation with status of consciousness,cognitive skill,character of the lesion, position,course,exercise ability, daily life activites. buccofacial apraxia,speech apraxia and aphasia.     

脑卒中患者摄食-吞咽障碍的发病及相关因素

INTRODUCTIONClinically，strokenotonlycaninducemotion，languageandcognitivedisorders，butalsocanleadtodysphagia犤１－２犦．Duringacutestage，itiseasytoleadtomisdeglutationpneumoniaifingestingfoodnotproperly．Andifhavingdysphagiaforalongtime，malnutritionwilloccurandaffecttherehabilitationeffectandqualityoflife犤３犦．Inourresearch，weevaluatedandanalysedtheingestionfunctionofthe１００strokepatientswhocontinuouslyreceivedbyhospitalandourresultsareasfollowing．MATERIALSANDMETHODSMate…     

Psychologic characteristics of polio survivors: a preliminary report

Ninety-three men and women with histories of polio were administered the Symptom Check List-90 Revised (SCL-90R), Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), and a questionnaire about their polio histories. The SCL-90R and PAIS-SR are measures of emotional and psychosocial functioning. Two samples were used: a clinic sample (n = 71) and a postpolio support group sample (n = 22). Initial results for both on the SCL-90R and PAIS-SR indicated elevated scores on a number of subscales. SCL-90R subscale elevated scores for men included those for somatization, depression, anxiety, hostility, and phobia, whereas for women there were elevations on measures of somatization, depression, anxiety, and psychoticism. Elevations were found in the following subscales on the PAIS-SR (pooling men and women): health care orientation, social environment, and extended family relationships. Men scored slightly, but not significantly, higher than women in the SCL-90R except for the hostility subscale, in which the difference was significant (p less than 0.05). Symptom profiles indicated psychologic distress. Comparisons with variables associated with polio and its late effects (such as severity of initial polio, use of an iron lung during initial illness, number of involved limbs, etc) were not statistically significant.     

脑卒中患者的摄食-吞咽障碍

目的：研究脑卒中患者进食－吞咽障碍的发展情况和有关因素。方法：应用日本洼田俊夫的饮水试验对连续入住神经内科和康复科的100例脑卒中患者，在病情稳定后进行评价。结果：100例脑卒中患者进食－吞咽障碍的发生率达33％。相关因素分析显示，吞咽功能障碍的发展与患者的性别、年龄、病变所在侧别和有无伴发疾病无关，与患者的意识程度、认知功能、病变的性质、部位、病程、运动功能、日常生活活动和颜面失用、言语失用、失语症有关。     

Actual and perceived activity levels in polio survivors and older controls: a longitudinal study

Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A. Actual and perceived activity levels in polio survivors and older controls: a longitudinal study.

Objective

To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.

Design

Longitudinal study.

Setting

A research clinic and the community.

Participants

Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.

Interventions

Not applicable.

Main Outcome Measures

Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.

Results

Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.

Conclusions

Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.     

Factor structure of the PANAS and the relationship between positive and negative affect in polio survivors

Aim.?This study examined the psychometric properties of the positive and negative affect schedule (PANAS) in a post-polio sample and the relationship of these affect the dimensions.

Method.?Exploratory factor analysis (EFA) was performed with sample 1 (randomly selected from the total sample), to examine the underlying dimensions of the PANAS. Confirmatory factor analyses (CFA) were performed with samples 2 and 1 to assess the fit of the models to the data. Model fit tests were based on the χ² likelihood ratio test, comparative fit index (CFI), and root mean square estimate of approximation (RMSEA).

Results.?In the EFA phase, two factors were extracted and oblique rotation was applied to interpret pattern of loadings. In the CFA phase, both samples 1 and 2, model fit tests demonstrated that the models were unsatisfactory and indicated poor fit of the model to the observed data. Post-hoc model fitting of three error correlations as indicated by modification indices, proved a better fit for both samples.

Conclusions.?The results of the factor analyses suggested the possibility of a third dimension reflecting negative affect and that affect may consist of more than two general dimensions in the context of disability. In post-polio population, some of the symptoms of negative affect may be caused by physical symptoms that are related to the disability experience.     

Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness

Introduction  

Dysphagia is common among survivors of critical illness who required mechanical ventilation during treatment. The risk factors associated with the development of postextubation dysphagia, and the effects of dysphagia on patient outcomes, have been relatively unexplored.