For more than thirty years, Dr. Richard L. Bruno has studied and treated nearly 6,000 polio survivors and is the world's leading expert on Post-Polio Sequelae (PPS).
PPS are the unexpected and often disabling symptoms -- overwhelming fatigue, muscle weakness, muscle and joint pain, sleep disorders, heightened sensitivity to anesthesia, cold intolerance and difficulty swallowing and breathing -- that occur in non-paralytic and paralytic polio survivors in midlife. Read MIA FARROW'S POST-POLIO LETTER and learn how the International Centre for Polio Education can help you not just survive, but thrive, with PPS.
PPS on the TODAY Show
The Dr. David Bodian
The International Centre for Polio Education "David Bodian Memorial Award" is named after Dr. David Bodian, whose research in the 1940's explained how the poliovirus damaged the brain and spinal cord and set the stage for PPS. Bodian is an unsung hero of PPS who guided Dr. Jonas Salk to develop the first polio vaccine.
Former Senators Bill Bradley, Senator Arlen Specter, singer Maureen McGovern and actress Mia Farrow are among those who have received The David Bodian Memorial Award.
Richard L(ouis) Bruno is internationally known as the world's foremost expert on Post-Polio Sequelae (PPS, also known as "post-polio syndrome"), the unexpected and often disabling symptoms -- overwhelming fatigue, muscle weakness, muscle and joint pain, sleep disorders, heightened sensitivity to anesthesia, cold intolerance, and difficulty swallowing and breathing -- that occur in 75% of paralytic and 40% of non-paralytic polio survivors about 35 years after the poliovirus attack. (1)
Bruno, a research and clinical psychophysiologist trained at the New York State Psychiatric Institute, began studying PPS and treating polio survivors in 1982, when he was a fellow in the Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons. (2) In 1984, Bruno organized and is chairperson of the International Post-Polio Task Force, which promotes PPS research, education and treatment in 25 countries. (3)
Bruno left Columbia and, in 1989, created and directed the Post-Polio Rehabilitation and Research Service at Kessler Institute for Rehabilitation, the first center for the study and comprehensive treatment of PPS (4), and in 1998 created The Post-Polio Institute at Englewood Hospital and Medical Center (5), which was closed in 2010. Bruno is now director of the International Centre for Polio Education, the new home of the International Post-Polio Task Force. (6)
Bruno's work has documented previously unrecognized characteristics of polio survivors and PPS symptoms:
* Intolerance to cold that causes muscle weakness and pain in polio survivors (7)
* The occurrence of muscle contractions throughout the body that can disturb sleep in polio survivors (8)
* Polio survivors' "Type A" behavior that promotes PPS symptoms. (9)
* Polio survivors' childhood and physical and emotional abuse lead to Type A behavior, denial of PPS and refusing treatment for PPS. (10)
* Poliovirus damage to the vagus nerve and brain stem can cause gastroparesis and vaso-vagal symptoms in polio survivors. (11)
* Difficulty with attention, memory and word finding are PPS symptom and are not symptom of dementia. (12)
* Poliovirus-damage to the brain stem's "Brain Activating System" and a loss of dopamine-producing neurons is the underlying cause of polio survivors' profound fatigue, the most common and most disabling PPS symptom. (13)
* Poliovirus damage to brain stem and spinal cord neurons causes to be polio survivors to be more sensitive to the effects of anesthetics and twice as sensitive to pain. (14)
* Building on the work of Dr. David Bodian, (15) Bruno described the presence of extensive poliovirus damage throughout the brain and spinal cord even in cases of "non-paralytic" polio and in muscles seemingly unaffected by the poliovirus, calculating that there are 150,000 undiagnosed polio survivors in the US. (16)
Dr. Alan McComas' clinical confirmation (18) of David Bodian's findings from autopsies of polio survivors and monkeys infected with polio (that polio survivors had to lose more than 60% of motor neurons for weakness to be apparent), McComas' finding that untreated polio survivors with muscle weakness were losing motor neurons at a rate of 7% per year, (18) and his own clinical experience and international surveys of more than 2,000 polio survivors, convinced Bruno that exercise - an additional load on the reduced number of remaining, poliovirus-damaged neurons - was contraindicated in the treatment of PPS: "When patients were recovering from polio, we made them exercise their muscles and told them to 'Use it or Lose it.' Now it is just the opposite. The byword is "Conserve to Preserve." (19)
Bruno concluded that PPS was neither a "disease" nor related to a lingering poliovirus infection, but "is caused when nerves damaged earlier by the poliovirus become tired and overworked." (20) ''However," he warns, "ALL OTHER diagnoses must be excluded before a diagnosis of PPS can be made.'" (1)
What is more, polio-related problems themselves, e.g., sleep disorders, must be treated before a diagnosis of post-polio fatigue can be made. (8)
"Dr. Bruno said his studies have indicated that symptoms can be reduced quite a bit if polio survivors take two 15-minute breaks during the day, and put their feet up and rest." (21) Unfortunately, Type A behavior and fear of abuse, as polio survivors experienced in childhood, must be addressed through behavioral psychotherapy before most polio survivors are ready to change their lifestyles, use discarded assistive devices and "Conserve to Preserve." (9, 10)
To educate polio survivors and the medical community, Bruno edited three special issues of the journal "Orthopedics" devoted to PPS (22). He also distilled and translated his scientific work into lay language and, in 2002, published The Polio Paradox: What You Need To Know. (23) To treat polio survivors' stress and reduce Type A behavior, Bruno also wrote How To Stop Being Vampire Bait: Your Personal Stress Annihilation Program in 2004. (24) He has also written The Polio Survivors Handbook, series of monographs for polio survivors on the cause and treatment of PPS (e.g., 25) and, for many years, wrote monthly as columns about PPS for "New Mobility" ("The Post-Polio Forum") (26) and "ACTION" ("T'N'T for Polio Survivors"). (27) His new book, The Post-Polio Anthology, is in press.
As part of his efforts to educate about PPS, Bruno has been interviewed by "Newsweek", "The New York Times" and "USA Today." He has appeared on NBC's "Today" Show and ABC's "Good Morning America", on CNN, the "CBS Evening News," ABC News "Nightline," on the BBC, CBC, National Public Radio and on The Discovery Channel and The Learning Channel. (28)
ADVOCATE AND ADVISER
Polio survivors themselves, the medical profession and government health agencies around the world have been unaware of PPS and needs of polio survivors. Bruno serves as adviser to post-polio support groups on four continents.
In 1987, Bruno was first asked to advise the U.S. Congress on post-polio related issues and successfully lobbied for a Post-Polio Clinic at the then-new National Rehabilitation Hospital. (29) In 1985, he helped to draft the Social Security Disability Insurance (SSDI) regulations for PPS and, with Senators Tom Harkin and Bill Bradley, won their release in 1987. (30) In 2003, Bruno drafted and, with Congressman Steve Rothman and Senator Arlen Specter, won release of the Social Security Ruling for Post-Polio Sequelae to stop denials of SSDI for PPS. (28) Bruno also drafted the Department of Veterans Affairs policy on the treatment of service members who have PPS and has advised the Departments of State and Justice on disability-related issues (17, 30)
In 2006, both the House of Representatives and the Senate passed proclamations drafted by Bruno naming 2006 as "THE YEAR OF POLIO AWARENESS," sponsored by Congressman Steve Rothman and Senator Arlen Specter (31) Congressman Rothman recognized Bruno on the House floor: "I also want to take this opportunity to recognize my constituent, a very tireless worker on behalf of those suffering the aftereffects of polio, Dr. Richard Bruno. As the director of the Post-Polio Institute and International Center for Post-Polio Education and Research, and chairperson of the International Post-Polio Task Force, Dr. Bruno is at the forefront of the movement to educate parents about the need to vaccinate their children against this debilitating virus. This resolution, Madam Chairman, would not be on the floor today without Doctor Bruno's help. I am grateful for his work and commitment to this cause." (31)
In 2013, Bruno was asked by the Indian Parliament to create a program for the diagnosis and treatment of India's eight million polio survivors who are developing PPS. Bruno is developing Internet Post-Polio Clinics, the first to be held in Gujarat Hospital, where he will train local doctors and then oversee their evaluation and treatment of individual patients via video link to India. Bruno's training materials and the evaluation and treatment sessions will be recorded and made available via the Indian Medical Association website.
In 2007, while reviewing data from the Centers for Disease Control, Bruno became aware that polio vaccination in the U.S. had dropped since 2005, especially among the poor. Bruno was very concerned because there had been five cases of polio in unvaccinated Minnesota children in 2005 and a case of polio imported from Mexico. Bruno warned on Minnesota Public Radio: "We start getting not just five cases as in Minnesota, but 50 or 500 cases of polio. Parents are going to wake up and say, 'We should be vaccinating.'" (32)
Bruno was afraid that unvaccinated children in cities with large immigrant populations would be vulnerable to exposure to a visitor carrying the poliovirus, as had just happened in Australia: "The CDC estimates that nearly 93% of US children 19-35 months old are vaccinated against polio. Ninety-three percent sounds good, until you realize that leaves more than one million toddlers unvaccinated. What is worse, toddlers below the poverty line have even lower polio vaccination rates, 89.5% in Newark and 87% in New York City, a rate equal to Asian countries that include Cambodia, Mongolia and Vietnam. These statistics are especially frightening considering the ease of air travel to the US from Pakistan, Afghanistan, India and Nigeria, where polio has never come under control, and from the ten African and Asian nations that were polio-free but where the poliovirus has been reintroduced. What will happen when a healthy-appearing but polio-infected international traveler lands at an airport and travels through a poor community? Every American child must receive all four doses of the injectable, inactivated polio vaccine. America's polio epidemic could be just a plane ride away." (33)
The International Post-Polio Task Force then created The National Immunization for Polio Prevention in Infants and Toddlers -- or "NIPP IT" -- Campaign to promote polio vaccination in every state. Polio vaccination rates have increased, but the Bush administration refused Bruno's request that travelers from polio endemic countries provide proof of polio immunization before allowing entry into the U.S.
Bruno also advocated for universal polio vaccination and lobbied against a bill in the New Jersey Legislature that would allow parents to forgo polio vaccination because of a "personal opposition" to vaccines: "There's no reason why every child in America shouldn't be vaccinated against polio. Parents should demand it, and school districts should demand that every kid that comes into kindergarten be vaccinated against polio and all diseases." (34) The "personal opposition" to vaccines bill never passed.
LINK BETWEEN POST-POLIO FATIGUE AND CHRONIC FATIGUE SYNDROME
Bruno's work finding damage to the brain activating system as a result of poliovirus-damage to brain stem neurons led to his "Brain Fatigue Generator" model of post-viral fatigue syndromes. (13) Using poliovirus-damage to the brain activating system as a model, Bruno described other viruses that did similar damage to the same brain areas attacked by the poliovirus and therefore also could cause chronic fatigue. (35) His post-polio research found that fatigue was associated with clinically impaired attention on neuropsychological testing, a blunted ACTH response to stress and white and gray matter lesions on MRI in the brain's activating system, findings indistinguishable from those in patients with chronic fatigue syndrome (CFS). (35)
In 1999, Bruno performed the first study of the psychophysiology of chronic fatigue in children and adolescents, confirming that chronic fatigue is related to impaired attention that is likely due to brain activating system damage, findings presented to the N.I.H. State of the Art Workshop on Chronic Fatigue in Adolescents. (36) Bruno served on the Committee on Standards for the Evaluation and Treatment of Chronic Fatigue Syndrome and wrote "Rehabilitation of CFS: A Multidisciplinary Approach" for the 2002 Consensus Manual for the Management of Chronic Fatigue Syndrome published by the New Jersey Academy of Medicine. (37)
BEYOND POLIO AND POST-POLIO SEQUELAE
Bruno's interests and research reach beyond polio and PPS, including the physiology and pharmacology of depression (38), the cause and treatment of chronic pain (39), the prediction of behavior and treatment outcomes in patients with chronic pain and brain injuries (40), the societal response to disability (41) and Buddhism in relation to coping with disability (42). Bruno is also the reluctant expert on the psychopathology of "apotemnophillia," a condition in which non-disabled individuals are attracted to those with disabilities, pretend to be disabled and want to become disabled. (43) Bruno's work has been published in journals as varied as Stroke, Biofeedback and Self-Regulation, the Journal of Chronic Fatigue Syndrome, Neurology, Disability and Society, the Journal of Clinical Psychiatry, Psychophysiology, Sexuality and Disability, the American Journal of Medicine, Annals of the New York Academy of Sciences and all three American journals of physical medicine and rehabilitation.
HONORS AND AWARDS
Bruno has received numerous honors for his work, including the New Jersey Pride Award in Health (44), inclusion in nine Who's Who publications and a Doctor of Humanics degree honoris causa from Springfield College. (45) Bruno also was selected to present the 45th Annual John Stanley Coulter Lecture to the annual meeting of the American Congress of Rehabilitation Medicine entitled, "Post-Polio Sequelae and the paradigms of the '50's: Newtie, Ozzie and Harriet versus paradigms of caring and a future for rehabilitation in America." (46)
1) Social Security Ruling, SSR 03-1p.; Titles II and XVI: Development and Evaluation of Disability Claims Involving Postpolio Sequelae. Federal Register: July 2, 2003 Volume 68, Number 127.
7) Bruno RL, Johnson JC, Berman WS. Vasomotor abnormalities as Post-Polio Sequelae. Orthopedics, 1985; 8 (7): 865-869.
8) Bruno RL, Frick NM, Creange SJ. Nocturnal generalized myoclonus as a post-polio sequelae. Archives of Physical Medicine and Rehabilitation, 1995; 76: 594. Bruno RL. Abnormal movements in sleep as a Post-Polio Sequelae (CME article). American Journal of Physical Medicine and Rehabilitation, 1998; 77: 339-343.
9) http://www.nytimes.com/1998/11/10/health/scientist-at-work-nancy-frick-a-first-person-study-of-polio-s-painful-legacy.html?pagewanted=all&src=pm. Bruno RL, Frick NM. Stress and "Type A" behavior as precipitants of Post-Polio Sequelae. Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains: March of Dimes Research Foundation, 1987. Bruno RL, Frick NM. The psychology of polio as prelude to Post-Polio Sequelae: Behavior modification and psychotherapy. Orthopedics, 1991; 14 (11): 1185-1193.
10) Creange SJ, Bruno RL. Compliance with treatment for Post-Polio Sequelae: Effect of Type A behavior, self-concept and loneliness. American Journal of Physical Medicine and Rehabilitation, 1997; 76: 378-382.
11) Bruno RL, Frick NM. Parasympathetic abnormalities as post-polio sequelae. Archives of Physical Medicine and Rehabilitation, 1995; 76: 594. Bruno RL. Chronic fatigue, fainting and autonomic dysfunction: Further similarities between post-polio fatigue and Chronic Fatigue Syndrome? Journal of Chronic Fatigue Syndrome, 1997; 3: 107-117.
12) Bruno RL. et al. The neuropsychology of post-polio fatigue. Archives of Physical Medicine and Rehabilitation, 1993; 74: 1061-1065. Bruno RL, Zimmerman JR. Word finding difficulty as a Post-Polio Sequelae. American Journal of Physical Medicine and Rehabilitation, 2000; 79:343-348.
13) Bruno RL, Sapolsky R, Frick NM. The pathophysiology of a central cause of post-polio fatigue. Annals of the New York Academy of Sciences, 1995; 753: 257-275.
14) Bruno RL, et al. Motor and sensory functioning with changing ambient temperature in post-polio subjects. Late Effects of Poliomyelitis. Miami: Symposia Foundation, 1985.
15) Bodian, D. Histopathological basis of clinical findings in poliomyelitis. Am. J. Med, 1949; 6: 563-578.
16) Bruno RL. Paralytic versus "non-paralytic polio:" A distinction without a difference? American Journal of Physical Medicine and Rehabilitation, 1999; 79: 4-12
19) Maugh, Thomas, Los Angeles Times, June 5, 2001. http://www.postpolio.org/latimesart1.htm. http://www.livestrong.com/article/467193-leg-exercises-for-polio-survivors/
20) Voice of America Special English Health Report. August 28, 2002. http://www.voanews.com/specialenglish/archive/2002-08/a-2002-08-23-10-1.cfm
21) The Infinite Mind. National Public Radio. March 8, 1999. http://www.lcmedia.com/mind998.htm
22) Bruno RL. Post-Polio Sequelae (Editorial). Orthopedics, 1985; 8 (7): 884.
23) The Polio Paradox. Warner Books, 2002 (ISBN 0446690694). http://www.publishersweekly.com/978-0-446-52907-5.
24) Bruno RL. How to Stop Being Vampire Bait: Your Personal Stress Annihilation Program. NY: Random Harvest, 2004. http://www.postpolioinfo.com/vampire.php
25) Bruno RL. Preventing complications in polio survivors undergoing surgery and other procedures requiring anesthesia.Post-Polio Sequelae Monograph Series. NY: Random Harvest, 2011; 11 (1): 1-6. http://www.postpolioinfo.com/library.php
31) http://thomas.loc.gov/cgi-bin/query/z?r109:H19SE6-0028. http://www.house.gov/rothman/news_releases/2006/sept19.htm
35) Bruno RL, et al. Parallels between post-polio fatigue and chronic fatigue syndrome: A common pathophysiology? American Journal of Medicine, 1998; 105 (3A): 66-73.
37) Bruno RL Rehabilitation of CFS: A multidisciplinary, behavioral approach. In J. John and J. Oleske (Eds.) A Consensus Manual for the Primary Care and Management of Chronic Fatigue Syndrome. Trenton: The Academy of Medicine of New Jersey, 2002.
38) Bruno RL, Myers SJ, Glassman AH. A correlational study of cardiovascular autonomic activity and unipolar depression. Biological Psychiatry, 1983; 18 (2): 227-235; Glassman AH, Walsh BT, Roose SP, Rosenfeld R, Bruno RL, et al. Factors related to orthostatic hypotension associated with tricyclic antidepressants. Journal of Clinical Psychiatry, 1982; 43 (5): 35-38.
39) Bruno RL, Myers SJ, Cote LJ, Janal MN. Abnormal vascular reflex activity in reflex sympathetic dystrophy syndrome. Archives of Physical Medicine and Rehabilitation, 1983; 64 (10): 483;
40) Bruno RL. Predicting pain management program outcome: The Reinforcement Motivation Survey. Journal of Rehabilitation; 1995; 61 (2): 50 - 57; Galski T, Ehle HT, Bruno RL. An assessment of measures to predict the outcome of driving evaluations in patients with cerebral damage. American Journal of Occupational Therapy, 1990; 44: 709-713; Galski T, Bruno RL, Zorowitz R, Walker JE. Predicting length of stay, functional outcome and aftercare in the rehabilitation of stroke patients: The dominant role of higher order cognition. Stroke, 1993; 24: 1794-1800; Galski T, Palasz J, Bruno RL, Walker JE. Predicting physical and verbal aggression on a brain trauma unit. Archives of Physical Medicine and Rehabilitation, 1994; 75: 380-383.
41) Bruno RL. "Beating" the tribal drum: Rejecting disability stereotypes and preventing self-discrimination. Disability and Society, 1999; 14:855-857; Bruno RL. Disabled man: Oxymoron or ubermensch? New Mobility, 1995; 6: 42-43.
42) Bruno RL. Buddhism plus disability: One "step" closer to Nirvana? New Mobility, 1999; 10: 32-37.
43) Bruno RL. Devotees, pretenders and wannabes: Two cases of factitious disability disorder. Journal of Sexuality and Disability, 1997; 15: 243-260.
44) NEW JERSEY Magazine, May, 1993.