Polio and Mobility
Assessment and Treatment of Shoulder Dysfunction in Post-Polio and Elderly Populations -- Part I
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Mary Klein, PhD, Principal Investigator;
Alberto Esquenazi, MD; Mary Ann Keenan, MD, Co-investigators
Shoulder pain is common in the post-polio population. Similar symptom patterns are seen in older adults who have no history
of polio, but who do have lower extremity impairments. The shoulder pain is thought to result from repetitive use of the arms
to assist with weight-bearing during mobility and transfer activities when there is significant weakness in one or more of
the muscles in the lower extremities. The increased stress on the upper extremities during these activities results in symptoms
of shoulder overuse. Currently, there is controversy as to whether a strengthening program will be an effective treatment
for shoulder overuse in ambulatory people with disabilities and whether the treatment for shoulder overuse in these individuals
should be directed at the lower and /or upper extremities.
In this project, subjects with shoulder pain potentially attributable to overuse will participate in a 16-week treatment program.
Subjects will be randomly assigned to either an exercise group or a relaxation therapy group. Each member of the exercise
group will receive an individualized program that includes exercises for both the upper and lower extremities, while the members
of the relaxation therapy group will be taught techniques for reducing stress. Researchers will also collect data on pain,
strength, activity level and health-related quality of life. The objective of this project is to determine whether physicians
can recommend exercise to effectively treat upper-extremity overuse problems in ambulatory people with lower-extremity disabilities.
Treatment of Shoulder Dysfunction in Polio Survivors and Elder Adults with Lower- Extremity Impairment -- Part II
Mary Klein, PhD, Principal Investigator;
Alberto Esquenazi, MD; Mary Ann Keenan, MD, Co-investigators
In our previous research on polio survivors, we determined that shoulder pain was one of the most frequent overuse symptoms
seen in the post-polio population. We developed a predictive model of shoulder pain that demonstrated that lower-extremity
weakness and weight were associated with the presence of shoulder overuse symptoms. This suggested that these symptoms may
arise from use of the upper extremities to compensate for lower-extremity weakness during mobility-related tasks like transferring
from a sitting position to a standing position. Although numerous articles have been published on the importance of exercise
and physical activity in promoting health and preventing disease, there are still many unanswered questions about whether
exercise can be used to effectively treat or even prevent the development of secondary disabilities, particularly those related
to overuse.
In this project, subjects with shoulder pain potentially attributable to overuse will be randomly assigned to one of two 16-week
exercise programs. One program will involve exercises for the upper extremities only and the other will involve exercise for
the lower extremities only. Data on the changes in shoulder symptoms, strength, and activity level will be collected. Subjects
will also undergo a detailed evaluation of their behavior and muscle activity in the Gait and Motion Analysis Lab. The objective
is to determine whether the strengthening program resulted in a reduction of the upper-extremity loading or the stress on
the arms due to weight-bearing during a chair rise task.
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