Walking deterioration and gait analysis in adults with spastic bilateral cerebral palsy.

Walking deterioration occurs frequently in adults with spastic bilateral cerebral palsy (CP), but their gait characteristics are largely unknown. The study aims were (1) to compare selected gait analysis variables between those reporting and those not reporting walking deterioration, and (2) to characterise the overall gait deviations and classify the gait patterns. Participants (N=16) were recruited from a follow-up study, had spastic bilateral CP, <40 years in 2006, GMFCS levels I-III, and could walk at least 10 m without support. Eight reported walking deterioration (cases) and eight did not (controls). A theoretical framework linking work of walking, fatigue and deterioration in walking was developed. It was hypothesised that higher energy requirements during gait and larger gait deviations would be associated with deterioration in walking. Three-dimensional gait analysis was used to obtain centre of mass work, mechanical joint work, lower limb kinematics, movement analysis profile (MAP), and gait profile scores (GPS). There were no differences between the cases and controls in centre of mass work, joint work, or in the GPS. The largest MAP deviations were seen in sagittal pelvis, hip, and knee angles and foot progression. Crouch and asymmetric gait were common patterns. Walking deterioration could not be explained by these work and kinematic variables. An individual's perception of deterioration in walking is subjective, and may be experienced and interpreted differently across people. Larger, longitudinal studies on the natural history of walking in spastic CP are needed. Qualitative studies on the subjective experiences of walking deterioration are also warranted.

Fatigue in persons who have lived with spinal cord injury for >20 years.

OBJECTIVES: This study aims to assess the prevalence of fatigue among persons who have lived with traumatic spinal cord injury (SCI) for >20 years, and to compare the results with fatigue scores found among the general population (GP). Another objective was to study the association between fatigue and clinical variables, including mental health, among the study population. DESIGN: A cross-sectional study. SETTING: Sunnaas Rehabilitation Hospital (SunRH), Norway. MATERIALS AND METHODS: All SCI survivors (n=237) admitted for rehabilitation at SunRH between 1961 and 1982 were asked to participate. Fatigue was measured with the Fatigue Questionnaire (FQ). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS). Linear regressions were used to examine those variables with the potential to contribute to fatigue. RESULTS: A total of 153 persons responded to the FQ, and in 39 cases the scores were consistent with fatigue. Surprisingly, the prevalence of fatigue (total fatigue (TF)) did not differ between the study population and the norm. However, the results indicated statistically significantly higher score of physical fatigue (PF) and statistically significantly lower score of mental fatigue among the SCI group when compared with the GP. Higher fatigue scores were associated with fatigue-causing pharmaceuticals and with higher scores on the HADS-depression subscale. CONCLUSIONS: The prevalence of fatigue was 25% among persons who had lived with SCI for >20 years, and similar to that in the GP. Our results point to medications and mental health aspects as possible contributors to PF severity in SCI.

Effect of multilayer high-compression bandaging on ankle range of motion and oxygen cost of walking.

OBJECTIVE: To evaluate the effects of multilayer high-compression bandaging on ankle range of motion, oxygen consumption and subjective walking ability in healthy subjects. METHOD: A volunteer sample of 22 healthy subjects (10 women and 12 men; aged 67 [63-83] years) were studied. The intervention included treadmill-walking at self-selected speed with and without multilayer high-compression bandaging (Proforeº), randomly selected. The primary outcome variables were ankle range of motion, oxygen consumption and subjective walking ability. RESULTS: Total ankle range of motion decreased 4% with compression. No change in oxygen cost of walking was observed. Less than half the subjects reported that walking-shoe comfort or walking distance was negatively affected. CONCLUSION: Ankle range of motion decreased with compression but could probably be counteracted with a regular exercise programme. There were no indications that walking with compression was more exhausting than walking without. Appropriate walking shoes could seem important to secure gait efficiency when using compression garments.

The efficacy of rehabilitation for patients with rheumatoid arthritis: comparison between a 4-week rehabilitation programme in a warm and cold climate.

OBJECTIVES: To investigate the long-term effect (week 16) of a 4-week rehabilitation programme for patients with rheumatoid arthritis (RA) and to compare the effect of this intervention given in a Mediterranean or a Norwegian climate. METHODS: A randomized, controlled, parallel group design, where 124 RA patients applying for rehabilitation were randomized to a rehabilitation programme either in Norway or in a Mediterranean climate. The participants were examined clinically immediately before (week 0) and after (week 4) the rehabilitation period as well as in week 16 and answered a mailed questionnaire in week 28. The 28-Joint Disease Activity Score (DAS28), American College of Rheumatology (ACR) response and physical tests were used to measure clinical response. RESULTS: The baseline DAS28 value 4.45 (1.16) was reduced by -0.95 (1.05) in the Mediterranean climate and the baseline DAS28 value 4.18 (1.17) was reduced by -0.37 (0.92) in the Norwegian climate at week 16 (p = 0.003). An ACR20 improvement was achieved in 25% of the patients treated in the Mediterranean climate and in 15% of those treated in the Norwegian climate. Sustained improvement in all ACR core components at week 16 and in patient's assessment of health status at week 28 was found in the patients treated in the Mediterranean climate only. Tests of physical function, the 6-Minute Walk Test (6MWT) and the Timed Up and Go (TUG), showed comparable improvements in patients treated in both climates. CONCLUSIONS: RA patients showed immediate positive effects with regard to disease activity, physical function, and symptoms during a 4-week rehabilitation programme. The effects on disease activity and symptoms were larger and better maintained at least 3 months after rehabilitation in a warm rather than in a cold climate.

Cross-cultural validation of the Pediatric Evaluation of Disability Inventory (PEDI) norms in a randomized Norwegian population.

The Pediatric Evaluation of Disability Inventory (PEDI) is one of the most commonly used assessments for children with a disability. Normative data from the US are used to determine whether a deficit or delay exists with regard to functional skill development. The purpose of this study was to analyse the cross-cultural validity of the PEDI American normative data for a general Norwegian population. A random selection of 174 typically developed Norwegian children between 1.0 and 5.9 years participated. The results for capability and caregiver assistance in the domains of self-care, mobility, and social function ranged from a mean of 38.0-46.8 against an expected 50. The Norwegian sample scored significantly lower than the US reference values for functional skills and caregiver assistance, and the results had less fit, especially for self-care. For mobility and social function, the magnitudes of the differences were smaller than self-care. Specific items deviated, suggesting necessary adjustments for the applicability of the norm-referenced scores of the PEDI in the Norwegian culture. The result of this research confirms other findings of cultural influence of the age norms in PEDI. Even though interpretations of the normative score results must be made with some caution, the option of using the scaled scores of PEDI is useful and recommended to describe and measure abilities and to evaluate change. This finding highlights the importance of cultural validation of norm-referenced tests.

Locomotion skills in adults with cerebral palsy.

OBJECTIVES: To investigate self-reported locomotion skills in persons with cerebral palsy (CP) and to investigate variables potentially associated with deterioration of walking skills. DESIGN: Cross-sectional retrospective survey. SETTING AND SUBJECTS: A multidimensional mailed questionnaire was sent to 766 persons with CP, 18 years or over, without intellectual disabilities, living in Norway. MAIN OUTCOME MEASURES: The questionnaire consisted of demographic and diagnostic items, items on locomotion skills, and physical function (SF-36). RESULTS: In total 406 persons, 51% males and 49% females from 18 to 72 years (mean 34 years, SD 11 years) with all categories of CP responded. Median age for reported walking debut was 3 years, with a range from 1 to 14 years. In total 216 respondents (53%) walked without support, 104 persons (25%) walked with support, 39 persons (10%) had lost their walking skills, and 47 (12%) had never been able to walk. Mean level of physical function (SF-36) was 53 out of 100. There were 97 persons (27%) who reported improvement of walking skills, mainly before 25 years, 102 (28%) reported no change, and 160 (44%) reported deterioration, mainly before 35 years of age. Deterioration was significantly associated with older age, delayed walking debut and severe neurological impairment. Self-reported causes of deterioration were pain, fatigue and lack of adapted physical activity. CONCLUSION: Deterioration of locomotion skills is a significant problem in persons with CP from an early age, documenting the need for life-long follow-up. The predictors above should be investigated in further clinical studies, searching for potential causal pathways.

Treatment of patients with postpolio syndrome in a warm climate.

PURPOSE: Treatment in warm climate of various patient groups including patients with postpolio syndrome is controversial. METHOD: Eighty-eight patients with postpolio syndrome (61 women) were recruited, stratified according to sex, age (above/below 60 years old) and use/not use of electrical wheelchair, and randomized to three groups. Group 1 (n=30) underwent treatment in a rehabilitation centre in Tenerife for four weeks in November/December 1999. Group 2 (n=29) were treated in two similar centres in Norway for the same period of time, while Group 3 (n=29), the control group, followed their ordinary health care programme. All patients were tested at the start of study, and 3 and 6 months later, including physical tests and several questionnaire and qualitative interviews. Patients in Group 1 and 2 were also tested after the rehabilitation period. RESULTS: Group 1 and 2 improved significantly both in physical tests and subjective ratings. The positive effects in Group 1 tended to exceed the positive effects in Group 2, and the effects lasted longer. Six minutes walking distance in the two groups was 347 m and 316 m, respectively, before the treatment period, 429 m and 362 m immediately after, and 431 m and 356 m 3 months later. Subjective rating of pain (VAS-scale) was 42 and 43, respectively, before treatment, 17 and 31 immediately after, and 28 and 44 3-months later. In the control group, only minor changes were found. CONCLUSIONS: The study seems to document a positive effect of treatment of patients with postpolio syndrome in warm climate.

Coping potential and disability--sense of coherence in adults with cerebral palsy.

PURPOSE: The aim of the present study was to investigate sense of coherence (SOC) in adults with cerebral palsy (CP) compared to the general population. METHOD: A questionnaire was sent to a representative sample of adults with CP, including the 3-item version of SOC and items on their life situation and follow-up programmes. The study included persons over 18 years of age with CP and without intellectual disability. The results were compared with the results from a reference group. RESULTS: The 406 respondents with CP (48.5% females, 51.5% males) were 18-72 years of age. The distribution of the different types of CP coincided with international epidemiological studies. Mean SOC was significantly lower in the adults with CP than in the reference group. The largest difference was found in the domain of comprehensibility. The factors most important in relation to SOC were level of education, marital status, life satisfaction and fatigue. CONCLUSIONS: Early experiences of predictability, balance between challenges and personal resources and finding these challenges worthy of investment, are prerequisites for developing sense of coherence. The present study suggests that these factors are less present in early socialization of persons with CP compared to the general population, and underlines the need for follow-up programmes that emphasize existential aspects and coping strategies.

[Physiotherapy after stroke--a randomized controlled trial]. / Fysioterapi etter hjerneslag--en randomisert kontrollert studie.

BACKGROUND: This study examines whether two different physiotherapy regimes used in rehabilitation after acute stroke have any differences in outcome. MATERIAL AND METHODS: A double-blind study of patients with acute first-ever stroke. 61 patients were consecutively included, block-randomized into two groups and stratified according to gender and hemispheric location. Group 1 (33 patients) received physiotherapy in the hospital's stroke unit according to the Motor Relearning Programme (MRP), group 2 (28 patients) according to the Bobath method. Supplemental treatment did not differ. The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL (Activities of Daily Living) Index, and the Nottingham Health Profile (NHP) were used as outcome measures. The following variables were also registered: length of stay in hospital, use of assistive devices for mobility, and patients' accommodation after discharge. RESULTS: Patients treated according to the MRP had shorter stays in hospital compared to those treated according to Bobath (mean 21 days vs. 34 days, p < 0.01). Both groups improved on MAS and SMES, but motor functions improved significantly better in the MPP group. Both groups improved on the Barthel Index; there were no significant differences between the groups, though women treated by MRP improved more than women treated by Bobath. There were no differences between the groups in NHP scores, use of assistive devices or accommodation after discharge. INTERPRETATION: This study indicates that physiotherapy according to the MRP is preferable to the Bobath programme in the rehabilitation of stroke patients.

Fatigue in polio survivors.

OBJECTIVES: Fatigue is commonly reported among polio survivors. The aims of the present study were to examine the incidence of perceived fatigue among a sample of Norwegian polio survivors, and to examine the association between the level of fatigue and sociodemographic and health variables. MATERIALS AND METHODS: A mailed questionnaire containing, among others, Fatigue Questionnaire, Fatigue Severity Scale, sociodemographic and health variables were sent to a representative group of 312 Norwegian polio survivors. 276 subjects (88%) answered the questionnaire. RESULTS: The incidence of fatigue among the polio survivors were considerably higher than in the normative data. Physical fatigue, more than mental fatigue, represented the major problems. Polio subjects who reported severe fatigue had significantly more other diseases and health problems than the normative group. CONCLUSIONS: The diagnosis and treatment of other or related physical conditions should be given higher priority in the management of persons with late effects of poliomyelitis, as these conditions probably can be the reasons for fatigue more than poliomyelitis sequelae alone.

[Voiding problems and urinary tract complications in adolescents and adults with myelomeningocele]. / Vannlatingsproblemer og urinveiskomplikasjoner hos ungdom og voksne med myelomeningocele.

BACKGROUND: The aim of this study was to describe voiding dysfunction and urinary tract complications in a population above 16 years of age with myelomeningocele. MATERIAL AND METHODS: 51 persons were included in the study. Data were obtained by questionnaires, ultrasound and glomerular filtration rate; in those with intact urinary bladder, by cystometry and videocystography. RESULTS: 30 out of 33 persons with intact urinary bladder were incontinent. Those with daily incontinence described this as a major problem. Cystometry concluded with normal detrusor contractions in three, detrusor hyperreflexia in five, and a detrusor hyporeflexia in 25 persons. Three out of 30 had vesicoureteral reflux. Ultrasound showed mild hydronephrosis and/or scarring in three persons. Average glomerular filtration rate was 86% (50-131%). 11 had Bricker diversion and seven continent reservoirs. 15 out of 18 persons with urinary diversion were satisfied with this solution. In persons with urinary diversion, the average glomerular filtration rate was 78% (44-109%). Ultrasound showed hydronephrosis and/or scarring in seven out of 16. Overall, urinary tract infections last year were reported by 56%, and pyelonephritis was more common in those with urinary diversion. INTERPRETATION: Incontinence is a common problem in adults with myelomeningocele. About one third had upper urinary tract changes, but none had renal failure.

[Follow up of urinary tract problems in adults with myelomeningocele]. / Oppfølging av urinveisproblemer hos voksne med myelomeningocele.

BACKGROUND: More than 90% of persons with myelomeningocele have a neurogenic bladder disturbance with incontinence and risk of upper urinary tract deterioration. Both aspects need to be considered when planning treatment and follow-up. MATERIAL AND METHODS: The study is based on review of articles and clinical experience. RESULTS: A thorough examination of the patient's voiding methods and incontinence is necessary. Examinations for renal function, reflux and hydroureteronephrosis as well as cystometry should also be carried out. The results of such examinations, together with an assessment of the patient's motor and cognitive function, as well as motivation, will provide a basis for further treatment and follow-up. We suggest a flow-chart for treatment and follow-up of persons above 16 years of age with myelomeningocele. INTERPRETATION: Patients with myelomeningocele should have a thorough examination and an individual plan for treatment and follow-up of their urinary tract dysfunction. Depending on the pathological findings, routine follow-up should be in done intervals from six months to five years.

[Treatment of patients with postpolio syndrome in warm climate]. / Behandlingsreiser til Syden for pasienter med postpoliosyndrom.

BACKGROUND: Treatment in a warm climate of various patient groups, including patients with postpolio syndrome, is controversial. MATERIAL AND METHODS: 88 patients with postpolio syndrome (61 women) were recruited, stratified according to sex, age (<> 60 years old) and use/non-use of electrical wheelchair, and randomized to three groups. Group 1 (n = 30) underwent treatment in a rehabilitation centre in Tenerife for four weeks in November/December 1999. Group 2 (n = 29) was treated in two similar centres in Norway for the same period of time, while Group 3 (n = 29), the control group, followed their ordinary health care programme. All patients were tested at the start of the study and three and six months later with physical tests and several questionnaire and qualitative interviews. Patients in groups 1 and 2 were also tested after the rehabilitation period. RESULTS: Groups 1 and 2 improved significantly both in physical tests and subjective ratings. The positive effects in group 1 tended to exceed the positive effects in group 2, and the effects lasted longer. Six minutes walking distance in the two groups was 347 metres and 316 metres, respectively before the treatment period, 429 metres and 362 metres immediately after, and 431 metres and 356 metres three months later. Subjective rating of pain (VAS scale) was 42 and 43 respectively before treatment, 17 and 31 immediately after, and 28 and 44 three months later. In the control group, only minor changes were found. INTERPRETATION: The study seems to document a positive effect of treatment of patients with postpolio syndrome in a warm climate.

[Rehabilitation of women with breast cancer]. / Rehabilitering av kvinner med brystkreft.

BACKGROUND: Previous studies on effects of rehabilitation programmes for women with breast cancer are rare, but promising. This study aimed to examine the physical and psychological conditions for these patients before and after a rehabilitation programme at Red Cross Haugland Rehabilitation Centre in Norway. MATERIAL AND METHODS: Included in the study were a total of 50 women, aged 31-66 (mean 49) years, who had undergone surgical treatment, chemotherapy and radiation therapy for cancer mammae stage 1 and 2 (limited to the breast only or spread to the axillary lymph nodes, respectively). They received a three-week rehabilitation programme, followed by a three-month period at home and a one-week follow-up at the rehabilitation centre. Examinations of physical and psychological status were performed before and after the three-week stay and at follow-up. RESULTS: Maximum oxygen uptake increased from 67% to 77% of predicted value, the mental status and subjective rating of life quality improved, the physical activity level increased, and 36 out of 46 subjects returned to their jobs during the three-month follow-up. The women themselves reported subjective positive effects of participating in the programme. INTERPRETATION: Although the present study was non-controlled, the positive results were so promising that further controlled studies should be encouraged, as well as rehabilitation programmes for women with breast cancer.

Depressed immunity and impaired proliferation of hematopoietic progenitor cells in patients with complete spinal cord injury.

The bone marrow is supplied with both sensory and autonomic neurons, but their roles in regulating hematopoietic and immunocompetent cells are unknown. Leukocyte growth and activity in patients with stable and complete spinal cord injuries were studied. The innervation of the bone marrow below the injury level lacked normal supraspinal activity, that is, a decentralized bone marrow. Lymphocyte functions were markedly decreased in injured patients. Long-term colony formation of all hematopoietic cell lineages, including dendritic cells, by decentralized bone marrow cells was substantially reduced. It was concluded that nonspecific and adaptive lymphocyte-mediated immunity and growth of early hematopoietic progenitor cells are impaired in patients with spinal cord injuries. Possibly, this reflects cellular defects caused by the malfunctioning neuronal regulation of immune and bone marrow function.

Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study.

OBJECTIVE: To examine whether two different physiotherapy regimes caused any differences in outcome in rehabilitation after acute stroke. DESIGN: A double-blind study of patients with acute first-ever stroke. Sixty-one patients were consecutively included, block randomized into two groups, and stratified according to gender and hemiplegic site. Group 1 (33 patients) and group 2 (28 patients) had physiotherapy according to Motor Relearning Programme (MRP) and Bobath, respectively. The supplemental treatment did not differ in the two groups. MAIN OUTCOME MEASURES: The Motor Assessment Scale (MAS), the Sødring Motor Evaluation Scale (SMES), the Barthel ADL Index and the Nottingham Health Profile (NHP) were used. The following parameters were also registered: length of stay in the hospital, use of assistive devices for mobility, and the patient's accommodation after discharge from the hospital. RESULTS: Patients treated according to MRP stayed fewer days in hospital than those treated according to Bobath (mean 21 days versus 34 days, p = 0.008). Both groups improved in MAS and SMES, but the improvement in motor function was significantly better in the MRP group. The two groups improved in Barthel ADL Index without significant differences between the groups. However, women treated by MRP improved more in ADL than women treated by Bobath. There were no differences between the groups in the life quality test (NHP), use of assistive devices or accommodation after discharge from the hospital. CONCLUSION: The present study indicates that physiotherapy treatment using the MRP is preferable to that using the Bobath programme in the acute rehabilitation of stroke patients.

Marathon with cystic fibrosis and bilateral lung transplant.

The article presents studies performed before, during and after a marathon run (42,195 m) in a 32-year-old man who underwent a bilateral lung transplantation because of end-stage cystic fibrosis (CF) 15 months prior to the race. Before the run his FEV1 was 81% predicted, compared with 19% predicted before the operation, and his maximal oxygen uptake was 31.9 ml/kg(-1)/min(-1). He completed the New York City Marathon 1998 without major problems in 7 h 8 min 50s. Pulmonary tests, biochemical changes and endocrine responses indicated transient changes, mostly as expected in healthy marathon runners. The case demonstrates that physiological trainability and psychological will power following a successful bilateral lung transplantation can transform a chronically ill CF patient into a robust marathon runner.

Cognitive performance in multiple trauma patients 3 years after injury.

OBJECTIVES: Patients with sequelae from multiple trauma commonly display cognitive disturbances, specifically in the areas of attention and memory. This study was designed to assess cognitive functioning 3 years after severe multiple trauma and to investigate how cognitive performance is related to head injury severity and psychological distress respectively. METHODS: Sixty-eight multiple trauma patients were tested with a screening battery consisting of six neuropsychological tasks 3 years after injury. A measure of psychological distress (20-item General Health Questionnaire, or GHQ-20) was also administered. RESULTS: Patients who neither showed signs of reduced consciousness on admission to the hospital nor reported significant psychological distress at follow-up tended to have normal test performance. In five of the six tasks, cognitive impairment was related to the severity of the traumatic brain injury as measured by the Glasgow Coma Scale (GCS). In both attention span tasks, patients designated as cases by the GHQ had significantly lower scores than noncase patients. These bivariate relationships were upheld in multiple regression analyses, in which age, sex, and GCS and GHQ scores were entered as independent variables. When patients with severe head injuries were excluded from the analyses, GCS scores still contributed to the variance in tests of verbal attention span and delayed recall, but performance on attentional tasks was more strongly related to psychological distress than to GCS scores. CONCLUSIONS: Cognitive deficits in multiple trauma patients were related both to the severity of the traumatic brain injury and to the degree of psychological distress. The strength of the association between brain injury as indicated by GCS scores and cognitive performance differed between different tasks. Neuropsychological testing may assist in differentiating primary organic from secondary psychogenic impairments.

[Rehabilitation with proper physical activities--what happens with patients' quality of life?]. / Rehabiliteringsopphold med tilpasset fysisk aktivitet--hva skjer med pasientenes livskvalitet?

During their rehabilitation stay at Beitostølen Healthsports Centre patients daily participate in varied forms of adapted physical activities, physiotherapy, and leisure and social activities. Support for mental and social problems is offered. A total of 189 patients were invited for quality of life assessment; 132 consented to participate, and 107 completed the investigation. Nottingham Health Profile (NHP), Life Satisfaction Scale (LiSat) and three questions regarding self-rated physical and mental health and disability were used for assessment. For NHP total score, satisfaction with life as a whole (LiSat), and questions regarding self-rated physical/mental health and disability improvements from one month before until three months after the stay were statistically significant. Improvements were also significant for subscales regarding emotional reactions, energy, pain, sleep, sexual life, family life, hobbies/interests, leisure situation and social isolation. Although this study did not include controls, the results indicate that a rehabilitation stay with adapted physical activities improves the quality of life of the patients until at least three months after the stay. Effects are probably mediated through improvement of self-efficacy.

The Norwegian Polio Study 1994: a nation-wide survey of problems in long-standing poliomyelitis.

'The Norwegian Polio Study 1994' was performed to make a nation-wide survey of the medical and social situation, and of the needs of anterior poliomyelitis (polio). A questionnaire, consisting of 133 questions with sub-questions, was sent to a total of 2392 polio victims, most of them registered in 'The National Society of Polio Victims' in Norway. 1449 persons (61%) answered. Sixty-six per cent were between 45 and 64 years of age, 25% were above 64 years and 9% were under 45 years. When specifying new health problems, 85% stated that they had experienced increased weakness in muscles affected by polio, while 58% had experienced increased weakness in previous non-affected muscles. Other health problems related to polio were fatigue during exercise (80%), general fatigue (57%), joint pain (58%), muscular pain (58%) and cold intolerance (62%). The participants indicated an increasing need of aids, but 80% were still independent of help from others and 57% were still employed, fully or part time. Only 17% were satisfied with the public health services for polio survivors, while 67% of those who had undergone comprehensive examination at some central hospital were satisfied. This study indicates an obvious need of building up expertise in multidisciplinary evaluation and treatment of post polio problems in countries where acute polio has been eliminated.