Efectividad del ejercicio terapéutico y drenaje linfático manual en personas con síndrome pospoliomielitis que presentan sobrepeso y adiposidad abdominal: serie de casos / Effectiveness of exercise therapy and manual lymphatic drainage in people with post-polio syndrome who are overweight and abdominal adiposity: Case series

Antecedentes y objetivo En España casi 800.000 personas con discapacidad reconocen que no practican ejercicio, como por ejemplo, las personas que sufren un síndrome pospoliomielitis. Estas personas presentan secuelas como fatiga, debilidad y dolor muscular que, unidas a su sobrepeso y adiposidad abdominal, favorecen la presencia de alteraciones musculoesqueléticas. El objetivo de este estudio es valorar los efectos del ejercicio terapéutico y del drenaje linfático manual en una serie de casos de personas con síndrome pospoliomielitis que presentan sobrepeso y adiposidad abdominal. Descripción de los casos Ocho pacientes con síndrome pospoliomielitis, sobrepeso y adiposidad abdominal fueron incluidos. El protocolo se basó en un programa de ejercicio terapéutico progresivo, 3 veces al día, y una sesión de drenaje linfático manual según el método Vodder, una vez a la semana, durante 9 semanas. Peso e índice de masa corporal, valoración antropométrica de los pliegues cutáneos y perímetros, calidad de vida, actividad física en personas con discapacidad y cuestionario de satisfacción fueron las variables analizadas al inicio y a la finalización del programa. Resultados y discusión Los resultados muestran diferencias estadísticamente significativas respecto al peso (p=0,034) e índice de masa corporal (p=0,031), pliegues iliocrestales derecho (p=0,003) e izquierdo (p=0,007) y perímetros de cadera (p=0,005) y de cintura (p=0,024). Conclusión La combinación de ejercicio terapéutico y drenaje linfático manual en personas con síndrome pospoliomielitis podría ser útil para reducir el sobrepeso y la adiposidad a nivel abdomina (AU)

Background and objective In Spain, almost 800,000 people with disabilities do not exercise, such as, for example, people suffering post-polio syndrome. This population reports sequelae such as fatigue, weakness and muscle pain, accompanied by overweight and abdominal adiposity which play an important role in the presence of musculoskeletal disorders. The combination of exercise therapy and manual lymphatic drainage would be beneficial in these people. The objective of this study is to assess the effects of exercise therapy and manual lymphatic drainage in a case series of people with post-polio syndrome who are overweight and abdominal adiposity. Case description Eight patients with post-polio syndrome, overweight and with abdominal adiposity were included. The protocol consisted of a progressive abdominal exercise programme, three times a day and a lymphatic drainage session according to the Vodder method once a week for nine weeks. Weight and body mass index, anthropometric assessment of skin folds and perimeters, health questionnaire, physical activity in people with disabilities and satisfaction questionnaire were analysed at the baseline and after the programme. Results and discussion The results show statistically significant differences in weight (p=.034) and body mass index (p=.031), right (p=.003) and left iliac-crest skin folds (p=.007), and hip (p=.005) and waist perimeters (p=.024). A combination of exercise therapy and manual lymphatic drainage could be useful to reduce overweight and abdominal adiposity in people with post-polio syndrome (AU)

Inappropriate/d bodies: Reorganizing the terms of life and death.

The aim of this article is to offer insight into the different meanings of death that pierce the lives of people with disabilities and to discuss how those meanings are formed through a close connection with their bodies. To do that, I take an anthropological approach to trace the life paths of two individuals from a southern Latin American metropolis, exploring their embodied experiences of disability. Based on their accounts, I look at how their bodies are affected by specific conditions of stigma, dispossession, and social death, but also how, as "inappropriate/d" bodies, they rise above the logic of difference and move from a state of "absence" to a state of "presence" in the social world.

The impact of the epidemic of Heine-Medina disese on the development of rehabilitation in Poland.

The work presents pioneering activities of Polish orthopedists in the interwar period who were the first to propose methods of surgical and physical treatment of the effects of poliomyelitis. It also discusses the activities undertaken by the Ministry of Health and the National Rehabilitation Specialist, prof Wiktor Dega, in the early 1950s in order to fight the effects of the Heine-Medin disease epidemic in Poland. They worked on the creation of a network of rehabilitation centres throughout the country, training of medical personnel, development of uniform procedures that would provide the patient with appropriate treatment in the acute state of the disease and during the following years of its consequences. In addition to treating, it was possible for the sick children to get a profession that would allow them to start working. The authors show that dealing with the effects of Heine-Medin disease had a significant impact on the development of rehabilitation in Poland.

University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953-80.

Following Canada's largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta's fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.

Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study.

BACKGROUND: Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country. OBJECTIVE: This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors. CONCLUSION: The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.

Comparison of two 6-minute walk tests to assess walking capacity in polio survivors.

OBJECTIVE: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed. DESIGN: Observational study. PARTICIPANTS: Thirty-three polio survivors, able to walk ≥ 150 m. METHODS: On the same day participants performed a 6MWT and a WECT, which were repeated 1-3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed. RESULTS: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p< 0.001. Furthermore, during the 6MWT, patients continuously slowed down (-6%), while during the WECT speed dropped only slightly during the first 2 min, by -1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively. CONCLUSION: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning.

OBJECTIVE: To determine the impact of postpolio-syndrome on quality of life in polio survivors. METHODS: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. RESULTS: Total manual muscle testing score was 26.19±13.24 (median: 29) in postpolio-syndrome group and 30.08±8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. CONCLUSIONS: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.

The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study.

BACKGROUND: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait. AIM: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs. METHOD: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters. RESULTS: Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence. CONCLUSIONS: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced. The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.

Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics.

PURPOSE: The aim of this study was to describe experiences of attitudes in the society of Sierra Leone from the perspective of individuals with poliomyelitis and people with amputations using orthotic or prosthetic devices. METHODS: Individual interviews were conducted using open-ended questions. Twelve participants with amputations or polio were included. Content analysis was applied to the data. RESULTS: The following six themes emerged during data analysis: Experience of negative attitudes; Neglected and respected by family; Traditional beliefs; The importance of assistive devices; People with disability struggle with poverty; and The need for governmental and international support. CONCLUSIONS: In Sierra Leone, people with disabilities face severe discrimination. They need to be included, recognized, and supported to a greater extent by the society, the community, and the family, as well as by the government and international organizations. Traditional beliefs have a negative impact on people with physical disabilities and are an important cause of discrimination in Sierra Leone. Prosthetic and orthotic devices are vital for people with physical disability and offer increased dignity. Prosthetic and orthotic services need to be accessible and affordable. Poverty affects access to education, employment, and health care for Sierra Leoneans with physical disabilities, forcing them to resort to begging to cover basic living needs. Implications for Rehabilitation In Sierra Leone, traditional beliefs related to disability and public attitudes need to change in order to protect the human rights of people with disabilities. Increased public awareness of disability and implementation of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) at different levels in society is needed. To increase access to prosthetic and orthotic services in Sierra Leone, these services need to be affordable and related costs, such as transport, need to be covered by support. Increased access to education, employment, and financial support could contribute to an improved standard of living for people with physical disabilities. Governmental and international support is needed to decrease attitudinal and environmental barriers for people with disabilities in Sierra Leone.

The effects of a home-based arm ergometry exercise programme on physical fitness, fatigue and activity in Polio survivors: a randomised controlled trial.

OBJECTIVE: To investigate the effect of an eight-week home-based arm ergometry aerobic exercise programme on physical fitness, fatigue, activity and quality of life in Polio Survivors. DESIGN: An assessor blinded randomised controlled trial. SETTING: Home-based exercise. SUBJECTS: Fifty-five Polio survivors randomised to exercise or control groups. INTERVENTION: Home-based arm ergometry at an intensity of 50%-70% maximum heart rate, compared with usual physiotherapy care. MAIN MEASURES: The Six-minute Arm Test, Fatigue Severity Scale, Physical Activity Scale for Individuals with Physical Disabilities and SF-36. Assessments were completed at baseline and at eight weeks. RESULTS: There was no significant difference in the primary outcome, exercising heart rate during the Six-minute Arm Test, between the groups at follow-up [97.6 (SD10.1) compared to 102.4 (SD13.7) beats per minute ( P=0.20)]. Blood pressure was significantly lower in the intervention group at follow-up [systolic blood pressure 132(18.6)mmHg compared to 144.1(14.6)mmHg ( P=0.002)]. There were no between group differences in the Fatigue Severity Scale ( P=0.25) or Physical Activity Scale for Individuals with Physical Disabilities ( P=0.49), with a small difference in SF-36 physical component score ( P=0.04). CONCLUSIONS: This home-based arm ergometry programme successfully facilitated aerobic exercise in Polio Survivors, but did not result in a significant change in physical fitness, measured by the Six-minute Arm Test.

The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study.

BACKGROUND: Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. OBJECTIVE: The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. STUDY DESIGN: Quasi-experimental design. METHODS: Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. RESULTS: Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. CONCLUSION: The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. CLINICAL RELEVANCE: This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities.

Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975.

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

[The medical, social and institutional challenges resulting from poliomyelitis: comprehensive rehabilitation in Argentina in the mid-twentieth century]. / Los desafíos médicos, sociales e institucionales que dejó la poliomielitis: la rehabilitación integral en la Argentina de mediados del siglo XX.

Poliomyelitis on an epidemic scale gave rise to several challenges, one of which was the rehabilitation from the after-effects on many of the people who suffered from the disease. Paralysis and the ways it transformed the concept of physical rehabilitation (where the objective was only to restore the mobility of the affected muscles) and comprehensive rehabilitation that included social, educational and professional aspects in Argentina in the mid-twentieth century are the themes addressed in this article. It uses the methodology of institutional history that interacts in an ongoing manner with the history of health and disease.

Políticas sanitarias locales puestas a prueba: consultores, expertos, misiones internacionales y poliomielitis en España, 1950-1975 / Local health policies under the microscope: consultants, experts, international missions and poliomyelitis in Spain, 1950-1975

Este trabajo analisa las misiones de expertos de organismos sanitarios internacionales en España destinadas a informar sobre la situación, las actividades realizadas y las intervenciones necesarias en la lucha contra la discapacidad física de los niños. El Plan España-23 fue el instrumento utilizado por la OMS y otras agencias para poner en marcha el proceso de cambio en un país en transformación durante la larga etapa de vigencia de la dictadura franquista. El trabajo utiliza como fuentes informes inéditos de expertos de la OMS, que fueron resultado de visitas realizadas al país entre 1950 y 1975. El abordaje metodológico consistió en un análisis del discurso que se encuentra en las fuentes y su contextualización en los marcos historiográficos pertinentes.

One of the main focuses of analysis of this paper concerns the missions of international health agency experts to Spain to report on the situation, the activities in the fight against physical disabilities in children and on the actions taken to cope with the problem. The Spain-23 Plan was the instrument used by WHO and other agencies to start the process of change in a country undergoing a period of transformation under the enduring Franco dictatorship. As key sources, the paper uses unpublished reports of WHO experts on the subject, which resulted from visits to the country between 1950 and 1975. The methodological approach consists of an analysis of discourses from primary sources within the historiographical framework.

Struggling to be part of Swedish society: Strategies used by immigrants with late effects of polio.

OBJECTIVE: To explore and describe strategies in daily occupations among immigrants with late effects of polio. METHOD: The strategies were explored by interviews with 12 immigrants from Eastern Africa with late effects of polio. Sampling and data analysis was carried out according to grounded theory. RESULTS: The participants struggled for occupational participation and normality in an effort to participate in, and be part of, society. The study identified 14 strategies used by the immigrants in their daily occupations. The strategies can be presented in the following four categories: managing physical capacity; promoting occupational performance; strategies for gaining respect; and preparing the ground for one's existence. The participants struggled to find a balance between physical capacity and meaningful occupations, conception of their own and others' norms and values, and living conditions in Swedish society. The strategies were related to the participants' will to manage daily occupations, maintain social relationships, and be part of society. CONCLUSIONS: The strategies revealed that the participants strive to participate in occupations and society. This study reinforces the importance of occupation for immigrants with disability. The results highlight the need for adequate health care and rehabilitation but should also alert other social institutions.

Hydrokinesitherapy program using the Halliwick method on strength endurance and flexibility in a person with poliomyelitis sequelae / Hidrocinesiterapia usando el método Halliwick sobre la resistencia a la fuerza y flexibilidad en persona con secuelas de poliomielitis

This case study attempts to determine the effect of a hydrokinesitherapy program by means of the Halliwick method on physical fitness in a female aged 35 years with poliomyelitis sequelae. The intervention followed sixteen weeks of hydrokinesitherapy during 70 minutes, five times a week, where we carried out exercises from the Halliwick method. There was an assessment both before and after the application. Strength endurance and flexibility were determined according to a senior fitness test protocol. The results showed positive improvements when carrying out the exercises from the Halliwick method and the percentage change (Δ%) of strength endurance increase 361.5% in the right arm and 300% in the left arm. Flexibility increased 2 cm in the right shoulder and 10 cm in the left shoulder. In conclusion the subject was able to improve the performance of Halliwick exercises while showing an increase in strength endurance and flexibility (AU)

El estudio de caso, determina el efecto de un programa de hidrocinesiterapia usando el método Halliwick sobre la resistencia a la fuerza y la flexibilidad en una mujer de 35 años con secuelas de poliomielitis. La intervención consistió en 16 semanas de hidrocinesiterapia de 70 minutos, 5 veces por semana, mediante el método Halliwick evaluándolo antes y después; La resistencia a la fuerza y la flexibilidad se determinaron por el protocolo senior fitness test. Se mejoró el desempeño en los ejercicio del método Halliwick y el porcentaje de cambio (Δ%) en la resistencia a la fuerza (361.5 % brazo derecho y 300% brazo izquierdo), la flexibilidad se incrementó 2 cm en el hombro derecho y 20 cm en el hombro izquierdo. En conclusión la paciente mejoro el desempeñó en el método Halliwick, mostrando incremento en la resistencia a la fuerza y la flexibilidad (AU)

Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness.

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group. Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with a DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6 min walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires. Compared with shoes-only, walking with the DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p < 0.05). Furthermore, walking energy cost was lower (-7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were significantly more satisfied, felt safer, and less exhausted with the DR-AFO, compared to shoes-only (p < 0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO. In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.