Clinical Findings of Swallowing Difficulties in Patients with Post-poliomyelitis Syndrome

OBJECTIVE: To evaluate the presence of swallowing difficulties in patients with post-poliomyelitis syndrome (PPS) by characterizing their swallowing patterns with videofluoroscopic swallowing study. METHOD: Eleven patients diagnosed with PPS were enrolled. All subjects answered the self assessment questionnaire for swallowing difficulty and gastric symptoms. We assessed the ability of tongue control, the oral transit time, cricopharyngeal opening time, and pharyngeal transit time. We also assessed the presence of aspiration or penetration and the amount of residue in the vallecular and pyriform sinus by four grade scales. A gastroenterologist examined esophagus, stomach and duodenum through an esophagogastroduodenoscopy. RESULTS: Six patients complained swallowing difficulty and nine patients showed symptoms of esophageal regurgitation. Although finding of penetration or aspiration was not seen, all patients showed swallowing dysfunction in the videofluoroscopic swallowing study. In the esophagogastroduodenoscopy, chronic superficial gastritis was observed in all enrolled patients (n=11) and reflux esophagitis was found in 4 patients (36%). CONCLUSION: About half patients with PPS complained of dysphagia. Routine evaluation of dysphagia with videofluoroscopic swallowing study and esophagogastroduodenoscopy is needed in all patients with PPS due to the low reliability in their subjective symptom.

Clinical Features of Post-Polio Syndrome Patients in Korea

OBJECTIVE: This study was performed to evaluate the prevalence of new neuromuscular symptoms and disabilities and the psychological characteristics-depressioin, anxiety, type A behavior, loneliness, and also to determine any relationships between physical and neuropsychological characteristics in a group of post-polio syndrome (PPS). METHOD: By 70 answered questionnaire, the polio survivors were grouped into PPS and Non- PPS. This questionnaire consisted of questions about acute polio problems; new health problems, fatigue severity scale, visual analog scale, weakness scale, Frenchay activity index, ambulation disability index; socio-economic problems; neuro-psychological inventories, Beck depression index, Spielberger state-trait anxiety inventory, revised UCLA loneliness scale, type A personality score. RESULTS: The median time from polio to the onset of new health problems was 27.6 years. Fatigue, muscle and/or joint pain, weakness in previously affected and unaffected muscles were most common newly appearing problems. The symptoms of PPS was consistent with the distribution of the anterior horn cell; spinal cord, brain stem, cerebral hemisphere, Reticular Activating System (RAS). Neuro-psychological evaluations revealed that fatigue scale was correlated with depression, type A personality. CONCLUSION: In PPS group, pain, weakness, fatigue, autonomous symptoms, decreased concentration were more serious than in Non-PPS group. The fatigue in PPS group was correlated with type A personality, depression, sleep disturbance and concentration problem.

Swallowing Difficulties in Polio Survivors

OBJECTIVE: In patients with a history of acute paralytic poliomyelitis, late progressive muscle weakness, fatigue, pain may arise, a symptom complex of known as post-poliomyelitis syndrome (PPS). Dysphagia may also develop in some PPS patients. The purpose of this study was to assess the presence of is swallowing difficulty in polio survivors and to describe the nature of the swallowing difficulty. METHOD: Polio survivors answered the questionnaire pertaining to swallowing function and received a videofluroscopic evaluation of the oral and pharyngeal phases using 3 consistencies of material: liquid barium; semisolid barium paste; boiled yolk of an egg coated with barium. RESULTS: Of the 16 subjects, 8 had subjective symptoms of swallowing difficulties. All of the 6 PPS patients, regardless of whether they had symptoms of swallowing difficulties, had some abnormal oropharyngeal function through video fluoroscopic swallowing study. CONCLUSION: In patients with post-polio syndrome, there is progressive deterioration of swallowing functions similar to that in the muscles of the limbs. This swallowing dysfunction is not related with their subjective symptoms.