NOTES FOR NEW READERS
Articles referenced below were freely accessible at the time they were
added to this section. Journal or web site access policies may change
as time passes and articles can revert to fee-based access either
through journal subscription or individual article reprint fees.
calculated risk": the Salk polio vaccine field trials of 1954
- Author(s): Marcia Meldrum,
DeWitt Stetten memorial fellow in the history of the biomedical
Article Location: British Medical
Reference: BMJ 1998;317:1233-1236 ( 31
Summary: The polio vaccine field
trials of 1954, sponsored by the National Foundation for Infantile
Paralysis (March of Dimes), are among the largest and most publicised
clinical trials ever undertaken. Across the United States, 623 972
schoolchildren were injected with vaccine or placebo, and more than a
million others participated as "observed" controls. The results,
announced in 1955, showed good statistical evidence that Jonas Salk's
killed virus preparation was 80-90% effective in preventing paralytic
The statistical design used in this great experiment was
singular, prompting criticism at the time and since. Eighty four test
areas in 11 states used the textbook model: in a randomised, blinded
design all participating children in the first three grades of school
(ages 6-9) received injections of either vaccine or placebo and were
observed for evidence of the disease. But 127 test areas in 33 states
used an "observed control" design: participating children in the second
grade (ages 7-8) received injections of vaccine; no placebo was given,
and children in all three grades were then observed for the duration of
the polio "season."
The use of the dual protocol illustrates both the power
and the limitations of the randomised clinical trial to legitimate
therapeutic claims. The placebo controlled trials were necessary to
define the Salk vaccine introduced by a lay organisation that has taken
an activist position against the counsel of its virological advisersas
the product of scientific medicine. The observed control trials were
essential to maintaining public support for the vaccine as the product
of lay faith and investment in science. Here I examine the process by
which the trial design was negotiated and the roles of the several
water exercise in individuals with late poliomyelitis
A PDF version is also available.
- Author(s): Willen C,
Sunnerhagen KS, Grimby G.
Article Location: Archives of Physical
Medicine and Rehabilitation.
Reference: Arch Phys Med Rehabil 2001
Abstract/Summary: Willen C, Stibrant
Sunnerhagen K, Grimby G. Dynamic water exercise in individuals with
late poliomyelitis. Arch Phys Med Rehabil 2001;82:66-72.
OBJECTIVE: To evaluate the specific effects of general dynamic water
exercise in individuals with late effects of poliomyelitis.
DESIGN: Before-after tests.
SETTING: A university hospital department.
PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15
assigned to the training group (TG) and 13 to the control group (CG).
INTERVENTION: The TG completed a 40-minute general fitness training
session in warm water twice weekly. Assessment instruments included the
bicycle ergometer test, isokinetic muscle strength, a 30-meter walk
indoors, Berg balance scale, a pain drawing, a visual analog scale, the
Physical Activity Scale for the Elderly, and the Nottingham Health
MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake,
peak heart rate (HR), muscle function in knee extensors and flexors,
and pain dimension of the NHP.
RESULTS: The average training period was 5 months; compliance was 75%
(range, 55-98). No negative effects were seen. The exercise did not
influence the peak work load, peak oxygen uptake, or muscle function in
knee extensors compared with the controls. However, a decreased HR at
the same individual work load was seen, as well as a significantly
lower distress in the dimension pain of the NHP. Qualitative aspects
such as increased well-being, pain relief, and increased physical
fitness were reported.
CONCLUSIONS: A program of nonswimming dynamic exercises in heated water
has a positive impact on individuals with late effects of polio, with a
decreased HR at exercise, less pain, and a subjective positive
experience. The program was well tolerated (no adverse effects were
reported) and can be recommended for this group of individuals.
Copyright 2001 by the American Congress of Rehabilitation Medicine and
the American Academy of Physical Medicine and Rehabilitation.
Evidence and Experience: Characteristics and Management of Postpolio
article is no longer freely accessible, subscription to JAMA being
- Author(s): Burk Jubelt, MD;
James C. Agre, MD.
Published: JAMA Vol. 284 No. 4, July
Introduction: Postpolio syndrome (PPS)
refers to new, late manifestations occurring many years after acute
poliomyelitis infection. Over the last 25 years, PPS has become a
relatively common problem encountered by primary care physicians. A
1987 National Health Interview Survey estimated that about half of the
640,000 survivors of paralytic poliomyelitis in the United States had
new late manifestations of PPS. Subsequent studies in the 1990s have
found the occurrence of PPS among patients with previous poliomyelitis
to range from 28.5% to 64%. The average time in various reports from
the acute poliomyelitis until the onset of PPS is about 35 years, with
a range from 8 to 71 years. However, it is unclear if the occurrence of
PPS increases with aging, which may be the case based on the most
accepted etiologic hypothesis. The large number of PPS cases presently
being seen is probably due to the poliomyelitis epidemics of the 1940s
Research: The State of the Art, 1998
- Also reproduced in Issue No.10 - March
1998 of LINC-PIN
Author: Richard Louis Bruno
Published: New Mobility Magazine,
"For researchers studying post-polio sequelae (PPS) -- the
disabling fatigue, muscle weakness and pain experienced by 76 percent
of polio survivors decades after the virus has come and gone -- 1997
was a year of discovery. Some of the new findings are disappointing,
and others are even disturbing. But new understanding from this
research will become the platform for future treatments, so there's
every reason for survivors to keep themselves well-informed."
The article goes on to discuss the following: Brain
Waves and Fatigue, IGF-1 and Pyridostigmine,
Magnets for Pain, The Damage Done,
Typically Type A, Abuse, Then and
Now and Treatment of Choice.
syndrome [under Motor Neuron Disorders (Asymmetric)]
- Summary list of Diagnostic Criteria, Laboratory features
and Recommended exercise.
sequale following paralysis [under Motor neuronopathies]
- Summary list of Etiology, Clinical features, Strategy,
Expected abnormal findings, Expected Normal findings and Procedure.
Part of a section beginning with Amyotrophic laterals sclerosis (ALS)
and ending with Bulbar hereditary motor neuronopathy (Fazio-Londe's
From the expert electromyographer Björn Falck - Erik
Stålberg - Leena Korpinen
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Last modification: 9th May 2009.
Last information content change: 19th May 2009.