Læknablaðið - 15.05.1992, Blaðsíða 56

210
LÆKNABLAÐIÐ 1992; 78: 210-11
NÝR DOKTOR í LÆKNISFRÆÐI -
GÍSLI EINARSSON
Nýlega kom út sem Supplement númer 25
hjá Scandinavian Journal of Rehabilitation
Medicine doktorsritgerð Gísla Einarssonar sem
hann varði 6. apríl 1990 við Uppsalaháskóla.
Ritgerðin nefnist Muscle Adaptation and
Disabilitv in Late Poliomyelitis og fer ágrip
hér á eftir.
Persons who suffered poliomyelitis 3 or
more decades ago now report functional
decline and symptoms designated as »post-
polio syndrome«. The objects of this
investigation were to identify subjects
fulfilling the criteria of this syndrome,
to describe their motor impairment and
resulting disabilities/handicaps, to study the
adaptive changes in the muscle structure
and effects of a resistance exercise program.
Forty-one late-polio subjects, 40-65 years
old, volunteered for the studies of motor
impairment, subgroups of those volunteered
to further studies of long-term and short-term
adaptations.
Seventy-five per cent of the subjects met
the criteria for the post-polio syndrome.
Complete manual muscle tests and
dynamometer measurements of knee muscle
strength revealed severe motor impainnent
predominantly in the lower extremities, the
strength of the latter correlating to the degree
of mobility handicap. In biopsies from the
vastus lateralis muscle, type grouping was
frequent. Half of the subjects demonstrated
over 70% occurrence of type I fibers with
negative significant correlation to strength
in the female subjects. Cross-section areas
of muscle fibers were on average twice the
normal, with negative significant correlation
to strength values in male subjects. Muscle
enzymatic activity values showed large
individual variations; oxidative activities
(citrate synthase) were low or very low,
while average glycolytic activities were
nearly normal. Macro EMG and single-fiber
EMG ineasurements in the vastus lateralis
muscle demonstrated large macro motor
unit potentials an increased fiber density.
Neuromuscular transmission was disturbed
as identified by jitter and blockings in most
subjects regardless of the occurrence of
new muscular symptoms. A statistically
significant increase in strength (25-30%)
resulted from a 6 weeks’ heavy resistance
exercise program, utilizing a dynamometer,
without any obvious sideeffects. Strength
improvement was maintained for 6-12 months
after training while fatigue index increased. A
substantial impact on intermediate (secondary
or instrumental) ADL, most severely affecting
the quality of mobility, was generally found,
while little effect was found on primary ADL
as revealed by the Katz’ ADL index, the
Functional Status Questionnaire and the WHO
ICIDH Classification of Handicap.