KESSLER INSTITUTE FOR REHABILITATION, INC.
300 Market Street Saddle Brook, New Jersey 07663 U.S.A. (201) 368-6057
Note. Professor Bruno has relocated and his new email address is PPSENG@AOL.COM. For further details see The Post-Polio Institute Englewood (NJ) Hospital and Medical Center in our Specialist Clinics Directory.
POST-POLIO REHABILITATION AND RESEARCH SERVICE Office of the
21 February 1997
Dear Polio Survivor:
1) You were asked if you have evidence that you in fact had polio.
|[Fill in here your past history of Polio]
2) You have been told that one had to have significant damage from the polio and muscle atrophy to have PPS.
|Neither the severity of the original polio infection nor muscle
atrophy, either due to the original polio or late-onset atrophy - are required
for the diagnosis nor are predictors of PPS. The postmortem studies of
Professor David Bodian of Johns Hopkins University in the 1940's showed that
anyone who had paralytic polio lost on average 50% of their anterior horn cells
but required the death more than 60% to demonstrate any paralysis (Bodian D.
Histopathological basis of clinical findings in poliomyelitis. American
Journal of Medicine, 1949; 6: 563-578.)
|However, Bodian also found that at least 90% of all anterior horn
cells were in some way affected during the polio infection (Bodian D. 1947.
Poliomyelitis: Neuropathologic observations in relation to motor symptoms.
Journal of the American Medical Association, 1947, 134:1148-1154).
|With regard to the prediction of PPS, our research and that of
other investigations (see Klingman, et al. Functional Recovery: A major risk
factor for the development of PPS. American Journal of Physical Medicine
and Rehabilitation, 1988, 45:645-647) show that it is the degree of
original paralysis plus the degree of recovery that predicts PPS. Klingman
showed that 79% of the variance of PPS symptoms "could be accounted for by
|Our research has also shown that physical overexertion is also a
primary factor in triggering PPS in 96% of subjects in the first American
National Survey of Polio Survivors (Bruno RL, Frick NM:
Stress and "type A" behavior as precipitants of
post-polio sequelae. In: Halstead LS, Wiechers DO (eds): Research and
Clinical Aspects of the Late Effects of Poliomyelitis. White Plains, NY,
March of Dimes, 1987, pp. 145-155).
3) You have been told you must use your limbs and that, if you did not, then the muscles would wither away.
|This advice is particularly inscrutable. All of the world's medical
research and clinical literature on the treatment of PPS shows that persisting
in physical exertion in the face of new symptoms, and especially the
prescription of exercise, continue the downward progression of PPS.
|The recommendations for energy conservation and assistive device
use provided you are just right (see Young GR.
Energy conservation, occupational therapy and the treatment of post-polio
sequelae. Orthopedics, 1991; 14:1233-1239). A two-year follow-up
study of patients treated by the Roosevelt Institute at Warm Springs showed
that patients who refuse to implement such suggestion have pain and fatigue
increase and lose more than 2% of muscle strength per year (Peach PE, Olejnik S. Effect of treatment and
non-compliance on post-polio sequelae. Orthopedics, 1991;13:1199
-1203). Patients who implemented energy conservation and assistive
device use actually gained muscle strength over time.
|Our just-completed follow-up study of patients treated by the
Kessler Post-Polio Service since 1990 shows a 76% increase in muscle weakness
over 16 months in patients who refuse to implement energy conservation and
assistive device use. Patients who do implement these suggestion report a 21%
decrease in muscle weakness.
4) You have been told that PPS is all conjecture and that PPS is not a problem in Lincolnshire.
|I would have readily agreed that PPS was all conjecture in 1983.
But after four international symposia and thirteen years of research published
in journals including Neurology, the Archives of Physical Medicine and
Rehabilitation, the American Journal of Physical Medicine and Rehabilitation,
the Journal of Rehabilitation, the Journal of the American Medical Association,
and the Annals of the New York Academy of Science, there is no longer any
conjecture about the reality of PPS.
|With regard to the prevalence of PPS in the U.K., 74,280 cases of
polio had been reported to the U.K. Communicable Disease Surveillance Centre
between 1912 and 1961. As in the United States, the ratio of polio cases to
actual notification of the C.D.S.C. was quite low before the large epidemics of
the late 1940's, your government describing notification as "far from
|The cases of polio reported to our Centers for Disease Control was
480,000 during the same period, with notification also being described as
unreliable since U.S. physicians were not required to notify the C.D.C. of
polio cases until 1952. It is not surprising then that 1987 U.S. Department of
Public Health National Health Interview Survey calculated that there were 1.63
million Americans alive today who had had polio. It is likely that the actual
number of living survivors of polio in the U.K. is closer to 250,000.
|With regard to the prevalence of PPS, the recent survey of the
membership of the British Polio Fellowship found the incidence of PPS to be
77%. Therefore, between 57,000 and 192,000 British polio survivors are
experiencing the same symptoms that you report.
I cannot encourage you strongly enough to be physically examined and to immediately implement all of the recommendations made by your Doctor and your occupational therapist and any other ideas of which you can conceive to save your remaining polio damaged motor neurons.
I hope I have answered your questions and concerns. I encourage you to obtain and show the articles I have referenced herein to your physicians. Please contact me if you, your physicians or therapists have further questions.
Professor Richard L. Bruno
Department of Physical Medicine and Rehabilitation
New Jersey Medical School
University of Medicine and Dentistry of New Jersey
Director Post-Polio Rehabilitation and Research Service
Kessler Institute for Rehabilitation
Chairperson, International Post-Polio Task Force.
Registered Charity No. 1064177
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Original Think-tank, Cornwall,
Document Reference: <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/library/kessler/letter.html>
Created: 31st July 1997
Last modification: 30th January 2010.