CONTENTS

From Barbara 1

Blood Type Traits 2

Understanding Muscle Strengths 3

10 Best Nutrition Moves 7

I Forgot (almost) That You

Are Disabled 9

Friends 10

Exercise Your Brain 10

Query 12

New Coping Skills 13

Dues 14

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FROM BARBARA

Don’t know about you, but I do almost all of my banking going through the drive-through window. Well, while doing this last month, I noticed that the March of Dimes “shoes” for their Walk-a-Thon were taped on the window. I had a thought and asked the clerk taking care of me, who was in her early 30’s, if she knew what the March of Dimes was originally started for. After giving me a quizzical look, she said: “No, it’s for birth defects, right?” Well, of course, I had to tell her that it originally was the National Foundation for Infantile Paralysis (then told her that was what they called “polio” back then), and that the phrase “March of Dimes” was coined by comedian Eddie Cantor, during the depression years, when he basically said: If everyone sends in a dime, we will have a “MARCH OF DIMES” to get research done. I remember going every January, ringing doorbells, to collect those “dimes”. After I was married, I became the area chairwoman for the Mother’s March, which took place every January around the time of President FDR’s birthday, and getting women to go around and do the collecting. My girls remember going with me in the apartment house we lived in – they remember the people opening their doors, seeing us, and saying:- “Oh, it’s that time of year again.”, but always giving us some change.

We’re all very thankful that our children, their children, and future generations won’t have to worry about the scrooge of polio, but it’s wrong (at least in my opinion) that they don’t know the background of organizations such as the March of Dimes. I wonder how many other organizations have fallen by the wayside once their cures or preventatives have been found.

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While I was going through several boxes of post-polio articles I came across the following which I thought was quite interesting, so I decided to share it with you. It comes from a December 1995 Daytona Beach Sunday News-Journal article.

BLOOD TYPE TRAITS

TYPE A:-

Positive traits:- Orderly, law-abiding, fastidious, soft-spoken, fashionable, calm.

Negative traits:- Picky, selfish, secretive, pessimistic, inflexible, reckless when drunk.

Suitable careers:- Accountant, librarian, economist, novelist, computer programmer, gossip columnist.

TYPE B:-

Positive traits:- Independent, flexible, candid, sensitive, passionate, persuasive.

Negative traits:- Unpredictable, in-discreet, lazy, impatient, overbearing, can’t wake up.

Suitable careers:- Cook, hairdresser, military leader, talk show host, journalist, golfer.

TYPE AB:-

Positive traits:- Rational, calculating, honest, diplomatic, organized, strong ESP.

Negative traits:- Unforgiving, playboy, easily offended, too conservative, nitpicker, hard to know.

Suitable careers:- Bartender, attorney, teacher, sales representative, social worker, witch.

TYPE O:-

Positive traits:- Healthy, idealistic, goal-oriented, clear-sighted, good at sports, sexy.

Negative traits:- Status-seeking, jealous, greedy, unreliable, obsessive lover, can’t shut up.

Suitable careers:- Banker, politician, gambler, minister, investment broker, baseball player.

Well, if you know your blood type, are these traits accurate. I’d be interested in having you let me know – you can e-mail me your answer at: bgold@iag.net.

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Our thanks, once again, to Mary Clarke Atwood of the Rancho Los Amigos Post-Polio Support Group for giving us reprint permission. This article was in their latest newsletter.

Understanding Muscle Strengths

With Sophia Chun, M.D.

Chief of Post-Polio Service

Rancho Los Amigos National

Rehabilitation Center

Reported by Mary Clarke Atwood

Editorial assistance by Richard Daggett and Sophia Chun, M.D.

This report is based upon Dr. Chun’s December 2003 presentation to the Rancho Los Amigos Post-Polio Support Group in Downey, California. It includes information on diagnosing post-polio syndrome (PPS), the importance of muscle testing (including several ways to test muscle strength), the meaning of muscle grade numbers, exercise, contractures, and bracing.

What is Manual Muscle Testing?

Manual Muscle Testing (MMT) is a method to test the strength of a muscle group by an examiner who provides the opposing force. This method is best used for the weaker muscles - those that are in the 0-3 range.

The person being tested is asked to push or pull against the resistance of a trained examiner. The muscle strength is graded on a 0 to 5 scale. In the past, muscle strength descriptors such as “fair”, “poor”, and “good” were used. The meaning of the numbers is explained in the following table.

It is important to note that this scale does not have equal range between each number such as 1=2=3=4=5. Hence, Grade 1 muscles are less than 5% of normal, Grade 2 muscles are approximately 5 to 10% of normal, Grade 3 muscles are approximately 15 to 20% of normal, and Grade 4 muscles are approximately 40% of normal. (Beasley WC, Quantitative Muscle Testing: Principles and Application to Research and Clinical Studies. Arch Phys Med Rehab 42: 398-425, 1961)

In general, at least a Grade 3 muscle is needed to perform usual function because it is able to move a limb against gravity. However, it is important to know that a Grade 3 muscle does not have much endurance and will tire easily.

Muscle grades can also be defined more specifically by adding a plus or minus sign that designates “something in between”:

Examples: 1, 1+, 2-, 2, 2+, 3- 3, 3+, 4-, 4, 4+, 5.

Muscle Grade 3+ can resist the force of 2 fingers plus gravity.

Do you understand the meaning of muscles grades?

Test yourself…Yes or No

· 4 out of 5 means 80% …………..No

· 3 out of 5 is like getting a “C” in class …………………………..………No

· 5 out of 5 means 100% …………No

· 3 out of 5 for the hip extensor means 20% ………………………….…Yes

Torque Muscle Testing

Another way of measuring muscle strength is Torque testing. This method is best used for testing stronger muscles.

Torque testing uses a machine (like an exercise machine at the gym) to provide the opposing force. This testing is performed under the supervision of a trained examiner. The results in Torque tests are then calculated and the muscle group strength is graded as a percentage of normal rather than the 0-5 scale of MMT.

Why is Muscle Testing Important?

There are 3 reasons why muscle testing is important:

1) To help diagnose PPS

2) To evaluate a person’s muscle/nerve reserve, i.e. determine his ability to exercise and help answer the following questions:

· Which muscles are at high risk for getting weaker with overuse?

· How much can or should a person exercise?

· Which muscles can tolerate exercise and which muscles cannot tolerate exercise?

3) To help the physician prescribe for and advise the patient

· What type of brace and which joint mechanism can substitute specifically for a given muscle that is found to be too weak to perform its function during walking?

· What lifestyle modifications need to be suggested?

· Could it possibly be time for the “chair”?

Muscle Testing Helps Diagnose PPS

A finding of “random patchy weakness” can be determined by thorough manual muscle strength testing and can also help establish that the person has a history of having had acute poliomyelitis. “Random patchy weakness” refers to muscle weakness that does not follow any specific pattern, e.g. one may have right arm and left leg weakness, as opposed to left or right sided weakness as seen in stroke.

The criteria for a diagnosis of post-polio syndrome from the March of Dimes International Conference on Post-Polio Syndrome Identifying Best Practices in Diagnosis & Care, 2001 are:

“1. Prior paralytic poliomyelitis with evidence of motor neuron loss, as confirmed by history of the acute paralytic illness, signs of residual weakness and atrophy of muscles on neurologic examination, and signs of denervation on electromyography (EMG). [Dr. Chun stated that EMG might not be necessary.]

“2. A period of partial or complete functional recovery after acute paralytic poliomyelitis, followed by an interval (usually 15 years or more) of stable neurologic function.

“3. Gradual or sudden onset of progressive and persistent new muscle weakness or abnormal muscle fatigability (decreased endurance), with or without generalized fatigue, muscle atrophy, or muscle and joint pain. (Sudden onset may follow a period of inactivity or trauma or surgery.) Less commonly, symptoms attributed to PPS include new problems with breathing or swallowing.

“4. Symptoms persist for at least a year.

“5. Exclusion of other neurologic, medical and orthopedic problems as causes of symptoms.”

Exercise/Activity Recommendations

Results from manual muscle testing can help a physician advise how much or how little an individual can exercise. Exercise can help maintain and possibly strengthen muscles that are Grades 3+, 4, or 5 as long as a person doesn’t over do it, but exercise can be detrimental/harmful to muscles that are Grade 3 or less. A Grade 3 muscle can move the limb full range against gravity but it has only 15 to 20% of normal strength so it has very little endurance.

Grade 3 to 3+ muscles are considered at high risk because they can get weaker by both too little activity and by too much activity. A person with PPS and Grade 3 to 3+ muscles has a daunting task of trying to find the correct balance to prevent losing muscle strength either from disuse or from overuse. In addition, if a Grade 3 muscle weakens and becomes a Grade 2 muscle it can lead to a decline in function if this is a key muscle.

Grade 2 muscles may need some bracing support, especially in the lower extremities, because they do not have the strength to overcome gravity.

Determining Bracing Needs

There are three key muscle groups that are tested in the lower extremities to help the physician determine the most appropriate type of bracing needed to substitute for the weak muscle groups. These muscles groups are called “key” muscle groups because their strength determines whether a person can walk safely or not:

Hip Extensor muscles (Glutes)

Knee Extensor muscles (Quadriceps/

Quads)

Ankle Plantar Flexor muscles (Gastrocs or calf muscles)

Experience at the Rancho Post-Polio Clinic has shown that the calf muscle often is the first muscle to show signs of overuse weakness in survivors who are walking in the community. A person with weak calf muscles often substitutes for this weakness by locking his knees. This substitution can be functional except that over time, the “locking” of the knees causes an overuse of the knee extensor muscles (quadriceps) and can also lead to low back pain. A person with weak calf muscles can sometimes feel unstable and is not able to stand for very long.

A person with symptoms caused by weak calf muscles as described above is at risk of further overusing the quadriceps muscles, so a physician will prescribe an AFO (ankle-foot-orthosis) specifically designed to substitute for the weak calf muscle. The physician prescribing the brace should understand the patient’s gait and know what type of joint mechanism is needed to substitute for the muscle weakness found in the manual muscle testing. A “wrong” brace can actually cause further overuse resulting in more muscle weakness.

There are very specific joint mechanisms but in general, one should know that a KAFO (knee, ankle, foot orthosis) is used to substitute for weak quadriceps (knee extensors), and that an AFO (ankle, foot orthosis) is used to substitute for weak ankle muscles including the calf muscle. A cane is often the best support for weak hip muscles.

Range of Motion Testing

Range of motion testing for each joint is often done in conjunction with manual muscle testing. This testing helps determine the flexibility of the joints and determines if there are any contractures.

A contracture is the tightening of soft tissue that results in a limited range of motion. Not all contractures or limited range of joints is bad. A good or a “useful” contracture can act like an “internal brace”, while a bad contracture puts a person at a mechanically unstable position.

· An example of a “useful” contracture is Achilles tendon tightness because it can act as an internal ankle brace (AFO).

· An example of a bad contracture is knee flexion contracture, i.e. a permanent bend at the knee. This is a bad contracture because if a person does not have adequate muscles to extend the knee, the knee contracture can cause the knee to buckle.

Some abnormality in range of motion is not always bad. For example, a person who back-knees may benefit by locking the knee for added stability. However, an excessive back-knee or (knee hyperextension) can cause pain in the front of the knee over time.

QUIZ

Based on the information in this report, in the following examples try to determine:

Who can walk safely?

What joints need to be braced?

Who needs to “ride”?

Assume that none of the persons below have any useful contractures.

Person 1: Hip Extensor Grade 5, Knee Extensor Grade 4, and Ankle Plantar Flexor Grade 4

Answer: All key muscles in this person are greater than 4, therefore he can walk safely without a brace.

Person 2: Hip Extensor Grade 5, Knee Extensor Grade 0, and Ankle Plantar Flexor Grade 4

Answer: This person has zero Knee Extensor (Quadriceps); therefore he needs a knee brace (KAFO) to substitute for the inability to lock his knees.

Person 3: Hip Extensor Grade 4, Knee Extensor Grade 5, and Ankle Plantar Flexor Grade 0

Answer: This person has zero Ankle Plantar Flexor (calf muscle); therefore he needs an ankle brace (AFO) to substitute for his weak calf muscle.

Person 4: Hip Extensor Grade 1, Knee Extensor Grade 0, and Ankle Plantar Flexor Grade 2

Answer: All key muscles are less than 3, which are not strong enough to provide support for walking, especially if they do not have any useful contractures. This person needs to ‘ride’.

Person 5: Hip Extensor Grade 0, Knee Extensor Grade 4, and Ankle Plantar Flexor Grade 1

Answer: The only muscle that can help this person walk is the Knee Extensor Muscle (Quadriceps). This person can probably walk, but would need the assistance of a cane and an ankle brace (AFO).

Conclusion

The information in this report should help a person with PPS have a better understanding of muscle testing and what the numbers mean to him. By knowing one’s own muscle grades a person will have a better understanding of how to protect the strength he has.

Muscle testing provides good baseline information. It is not necessary to repeat MMT until a person’s symptoms change. “If you are having new PPS symptoms it means you need to slow down”, said Dr. Chun.

Mary Clarke Atwood

Reprint permission must be obtained directly from Rancho Los Amigos Post-Polio Support Group

RanchoPPSG@hotmail.com

Dr. Sophia Chun is Chief of Post-Polio Service at Rancho Los Amigos National Rehabilitation Center. For more than five years she has worked closely with Dr. Jacquelin Perry who established this polio clinic many decades ago. Dr. Chun has dual board certification in Physical Medicine & Rehabilitation and Internal Medicine. In 1993 she received her M.D. from Loma Linda University and then completed their dual residency program. Her other responsibilities at Rancho Los Amigos include Medical Director of Outpatient Clinic & Rehabilitation Services; Chief, Neuro-medicine Stroke Service; and Director, Women with Disabilities GYN/Wellness Clinic. In 2000 Dr. Chun was named “Physician of The Year” at Rancho Los Amigos National Rehabilitation Center.

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This article is reprinted from USA Weekend, January 16-18, 2004. EAT SMART by Jean Carper. Seemed like some good ideas.

10 BEST NUTRITION MOVES

Every meal can easily include several points on this

no-nonsense list.

Details about specific nutrients are fascinating. But in tracking down the fine points, don’t lose sight of the big picture. Here are 10 solid, sweeping actions that will get you the best nutrition bang in 2004.

w Eat seven to nine servings of fruits and vegetables a day. Antioxidant-packed, they can cut your risk of heart disease up to 70%, diabetes 40%, lung cancer 30% and breast cancer 20%, studies show. Tops in antioxidants: prunes, raisins, blueberries, black-berries, garlic, kale, cranberries, raspberries, strawberries, spinach.

w Eat fatty fish two or three times a week. That provides enough omega-3 fat to help prevent heart disease, arthritis and brain dysfunction. Fish oil protects brain cells, and suppresses inflammation and irregular heartbeats. In a new study, eating fish just once a week cut the risk of Alzheimer’s disease 60%. Best: salmon, sardines (fresh and canned), mackerel, herring.

w Restrict red meat to once or twice a week. Recent evidence ties red meat (beef, pork, veal, lamb) to increased cancer of the colon, pancreas, breast, prostate and kidney. Reason: Carcinogens form in meat during cooking. Worst methods: frying, barbecuing. Best: baking, stewing, boiling, microwaving.

w Eat 25 grams of fiber a day. Most adults eat less than half that. Fiber lowers cholesterol and blood pressure; cuts the risk of heart disease, diabetes and cancer; and helps control weight. Super sources: All-Bran, Fiber One, oat-bran cereals (check labels), dried beans, barley.

w Use olive oil primarily; avoid trans fats. Olive oil is the main choice of people who live the longest and have the least heart disease, cancer and other chronic diseases. Deadliest: trans fats in some margarines and baked goods, such as doughnuts – they clog arteries more than saturated animal fats do.

w Eat “good” carbs. Slash “whites” – bread, sugar, potatoes – that causes rapid spikes in blood sugar. Such foods can double your odds of heart attack, diabetes and certain cancers, and make you fat. Eat carbs that produce a slow rise in blood sugar. Best: legumes (including peanuts); whole-grain, high-fiber breads and cereals; fruits and vegetables.

w Drink three or more cups of tea a day. “Real” tea (not herbal) helps save you from heart disease, cancer, osteoporosis, infection, age-related mental decline, dental cavities and weight gain. In one study, three cups a day cut the risk of heart attack 11%. Brewed caffeinated green tea has the most antioxidants; bottled and instant teas have the least.

w Eat nuts every day. A mere ¾ ounce of nuts (almonds, walnuts, pecans, peanuts) daily slashed the risk of heart disease and diabetes 30% and Parkinson’s disease 43% in Harvard studies. Daily consumption of nuts and peanuts, including peanut butter, helped control weight in other research.

w Shave portions by one-third to half. Gigantic portions are a major cause of weight gain and obesity. In studies, adults given a large serving ate 30% more calories than when given a small one. Kids, too, devoured 25% more calories when served oversized portions. If it isn’t on the plate, you aren’t tempted.

w Take a daily multivitamin/mineral pill. It can erase subtle deficiencies that make you more prone to infections and chronic diseases, including cardio-vascular disease. Cancer and bone fractures. Many leading authorities now urge all adults to take a daily supplement.

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The following article was written by one of our members – Marion Schoeller.

Thanks, Marion.

I Forgot (almost)

That You Are Disabled.

Recently a new friend in my neighborhood made the above state-ment to me. We were discussing entertainment venues and I asked if this venue was accessible. My neighbor said, "I forgot that you are disabled."

Many of us can relate to the fact that we even forget (at least sometimes) that we have a physical disability especially if it is a "hidden disability." It is still tough for me to admit I have a disability even to myself.

As a formerly active person, my limitations seem to be huge compared to my abilities of just what seems like a few years ago. I regularly danced, roller skated, rode bicycles and horses, played tennis and more. I even played wheelchair tennis when I became less ambulatory but had to give that up too. Most post-polios have similar stories.

I've become a spectator rather than a participant in physical sports (but a darned good one at that!). My senses however, seemed to have survived up to this point unscathed. So, I concentrate more in those area. I enjoy live concerts and plays, movies, art, crafts and music festivals, reading, dining out, relaxing by the pool and ocean, watching new and old movies I've missed on DVD instead of VCR, and making a fool of myself with Karoake in public.

I've learned to adapt my life to my changing physical condition. That doesn't mean I like it. Still, it is uplifting when someone says, "I forgot you are disabled."

Marion Schoeller

FECPPSG Editor’s Note:- I know just what Marion is talking about – before PPS made my walking into just going about 100 yards or so, I was able to do the malls, walk the boardwalk (I grew up in Brighton Beach, Brooklyn, NY, and walked from the beginning of the boardwalk all the way past Coney Island, a total of about 5 miles each way), go up and down the subway steps, etc. However, I never was able to walk fast, sooooo every now and then when I would be out with one of my friends (namely, Brenda), she would, inevitably, wind up several feet in front of me. I would then call to her and ask what the rush was and her answer to me each time was that she “Forgot (almost) That You Are Disabled”. In talking with her this morning, after putting Marion’s article into the newsletter and telling her that I was commenting on what used to happen with us, she again told me that she never thinks of me as being disabled. I’m sure that all of us have family and friends that think of us the same way Brenda thinks of me, even thought now, as with Marion, I’ve become a spectator rather than a participant in many ways.

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Found this among some e-mails that I “saved” to use as fillers in the newsletter – thought this was a good one.

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"FRIENDS"

Friends are very special people who accept each other with unconditional caring. They

		The muscle being tested…
0	Zero	has no muscle twitch.
1	Trace	has some muscle twitch that can be felt.
2	Poor	is only able to move the limb when gravity is eliminated.
3	Fair	is able to move the limb against gravity.
4	Good	is able to provide good resistance against the examiner.
5	Normal	is as strong as the maximum resistance provided by the examiner.

FLORIDA EAST COAST POST-POLIO SUPPORT GROUP - Vol. 11 #6

12 Eclipse Trail / Ormond Beach, FL 32174 / 386 676-2435

E-Mail:- bgold@iag.net - Web Site:- home.iag.net/~bgold

MAY / JUNE 2004

WE WISH ALL OUR FRIENDS

A FLOWER FILLED and LOVING MOTHER’S DAY

A SUNNY MEMORIAL WEEKEND

-and-

A FANTASTICALLY LOVING FATHER’S DAY

Rancho Los Amigos National

Rehabilitation Center

What is Manual Muscle Testing?

The muscle being tested…

Torque Muscle Testing

Why is Muscle Testing Important?

Muscle Testing Helps Diagnose PPS

Exercise/Activity Recommendations

Determining Bracing Needs

Range of Motion Testing

QUIZ

Based on the information in this report, in the following examples try to determine:

Who can walk safely?

What joints need to be braced?

Who needs to “ride”?

Conclusion