Lauro S. Halstead

National Rehabilitation Hospital Limb Classification for Exercise, Research, and Clinical Trials in Post‐Polio Patients

A need exists for an objective classification of polio patients for clinical and research purposes that takes into account the focal, asymmetric, and frequent subclinical nature of polio lesions. In order to prescribe a safe, effective exercise program, we developed a five-level (Classes I-V) limb-specific classification system based on remote and recent history, physical examination, and a four-extremity electrodiagnostic study (EMG/NCS). Class I limbs have no history of remote or recent weakness, normal strength, and a normal EMG. Class II limbs have no history of remote or recent weakness (or if remote history of weakness, full recovery occurred), normal strength and EMG evidence of prior anterior horn cell disease (AHCD). Class III limbs have a history of remote weakness with variable recovery, no new weakness, decreased strength, and EMG evidence of prior AHCD. Class IV limbs have a history of remote weakness with variable recovery, new clinical weakness, decreased strength, and EMG evidence of AHCD. Class V limbs have a history of severe weakness with little-to-no recovery, severely decreased strength and atrophy, and few-to-no motor units on EMG. In a prospective study of 400 limbs in 100 consecutive post-polio patients attending our clinic, 94 (23%) limbs were Class I, 88 (22%) were Class II, 95 (24%) were Class III, 75 (19%) were Class IV, and 48 (12%) were Class V. Guidelines for the use of this classification in a clinical/research setting are presented along with sample case histories and class-specific exercise recommendations.

A Brief History of Postpolio Syndrome in the United States

This is an overview of the history of the late effects of polio in this country from 1980 to the present in the context of the broader and much longer history of acute poliomyelitis. Books, articles, conference proceedings, and other relevant historical resources that dealt with polio-related issues from January 1, 1980, through December 31, 2009, were reviewed. The mean number of articles published per year was calculated for 5-year intervals beginning in 1980; the number of postpolio support groups and polio-dedicated clinics was compiled from directories published annually by Post-Polio Health International at 5-year intervals from 1985 to 2010. Beginning in the mid-1980s, the number of articles published each year increased dramatically, peaking during the years 1995 to 1999 when a mean of 48.2 articles were published each year. This figure steadily declined over the next 14 years. Support groups and clinics showed a similar pattern of rise and fall, with a maximum of 298 support groups and 96 clinics in 1990 and a decline to 131 and 32, respectively, by 2010. During the 1980s and early 1990s, there was a period of optimism that energized research, clinical, and self-help initiatives. As the limits of these efforts became apparent during the late 1990s and early 2000s, resources and activities declined as the postpolio community continued to age and decrease in size. Regardless of these trends, there are still thousands of survivors who continue to require skilled physiatric management as they cope with advancing age and declining function.

Poster 249: Experience With Younger Patients in a Post-Polio Clinic: A Case Series

ity strength in all 4 limbs, persistent hyponatremia, hypertension, and poor oral intake. After 6 weeks, she demonstrated most dramatic improvements in cognition and mobility, with a total FIM score of 60. She experienced another episode of AIP during rehabilitation. Discussion: This is the first reported case, to our knowledge, of AIP management in an IRF. Through comprehensive interdisciplinary management, function and control of AIP improved. This required weaning of, adjustments to, or avoidance of many medications; modification to nutrition; judicious progression of strengthening and activities; environmental changes; and development of a home management plan. FIM score improvement was most notable in cognition and mobility/locomotion. Although the pathophysiology for the neurologic complaints is not well understood, significant recovery is anticipated. Conclusions: Inpatient rehabilitation supports the continuum of care for patients with AIP including transition into the community. AIP is rare and often confused with more typical neurologic conditions. Comprehensive interdisciplinary rehabilitation plays an important role in AIP management.

Poster 77: Diaphragm Dysfunction due to Remote Poliomyelitis in a Patient with Unexplained Dyspnea: A Case Report

was intact to light touch, pinprick, proprioception and vibration. Reflexes were reduced on the left biceps and deltoid. He had hyperreflexia on the left triceps and scapular muscles. Hoffmann’s was positive on the left. MRI of the cervical spine showed a large disk osteophyte complex occupying the right half of the spinal canal at C5-6. There was an abnormal hyperintense signal at this level, which was slightly increased compared to the prior study. Electromyography revealed normal sensory and motor nerve conduction studies. Fibrillations and positive sharp waves were present in the left deltoid and biceps. Setting: Inpatient acute rehabilitation unit. Results: Physical examination and electrodiagnostic studies revealed C5 nerve root involvement. Discussion: Postoperative paresis of the upper extremity occurs in 14.9% of patients following cervical laminectomy. Physical findings and EMG/NCV results revealed C5 radiculopathy. Several theories have been proposed regarding the cause of postoperative C5 palsy; however, none have been proven until the present time. Conclusions: A careful neurological examination, radiographic work-up and electromyography with nerve conduction studies may be helpful in the diagnosis of postoperative C5 nerve root palsy. Further investigations are needed to determine the pathophysiology. Patients with C5 palsy would benefit from continued rehabilitation since it is a transient weakness and most patients have been reported to recover.