Outcomes of Research or Clinical Trials Activity Levels Acute Flaccid Paralysis Ageing Anaerobic Threshold Anaesthesia Assistive Technology Brain Cardiorespiratory Cardiovascular Clinical Evaluation Cold Intolerance Complementary Therapies Continence Coping Styles and Strategies Cultural Context Diagnosis and Management Differential Diagnosis Drugs Dysphagia Dysphonia Epidemiology Exercise Falls Fatigue Fractures Gender Differences Immune Response Inflammation Late Effects of Polio Muscle Strength Muscular Atrophy Orthoses Pain Polio Immunisation Post-Polio Motor Unit Psychology Quality of Life Renal Complications Respiratory Complications and Management Restless Legs Syndrome Sleep Analaysis Surgery Vitality Vocational Implications

Effective More Research Required Not Effective
Category: Fatigue

Title: A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis
Author: Tersteeg IM (1), Koopman FS, Stolwijk-Swüste JM, Beelen A, Nollet F; CARPA Study Group
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2011 Jun;92(6):899-904. doi: 10.1016/j.apmr.2011.01.005
Publication Year and Month: 2011 06

Abstract: OBJECTIVES: To study the severity and 5-year course of fatigue in patients with late-onset sequelae of poliomyelitis (LOSP) and to identify physical and psychosocial determinants of fatigue.

DESIGN: Prospective cohort study with 5 measurements over 5 years.

SETTING: University hospital.

PARTICIPANTS: Patients with LOSP (N=168); 89% of the subjects completed the study.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Fatigue assessed with the Fatigue Severity Scale (FSS). Potential determinants were perceived physical functioning, bodily pain and mental health, extent of paresis, walking capacity, comorbidity, sleeping disorders, coping, and social support. Associations were investigated by multivariable longitudinal analysis using generalized estimating equations.

RESULTS: The mean FSS score ± SD at baseline was 5.1±1.4, which did not change significantly during the 5-year follow-up. Reduced physical functioning, increased bodily pain, reduced sleep quality, more psychologic distress, and higher task-oriented coping were independently associated with fatigue. The extent of paresis and walking capacity were strongly associated with physical functioning.

Conclusions: Fatigue is severe and persistent in patients with LOSP due to physical and psychologic factors, which has implications for counseling and treatment. In addition to the commonly applied interventions targeting physical aspects, psychologic interventions are a potential area for reducing fatigue.

Outcome of Research: Effective

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Category: Muscle Strength

Title: A comparison of symptoms between Swedish and American post-polio individuals and assessment of lower-limb strength- a four year cohort study.
Author: Agre, J., Grimby, G., Rodriguez, A., Einarsson, G., Swiggum, E. & Franke, T.
Affiliation: Agre- Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Scandanavian Journal of Rehabilitation Medicine. 1995;27(3):183-92
Publication Year and Month: 1995 09

Abstract: A cohort study with initial and 4-year follow-up evaluations was performed in 78 post-polio volunteers aged 34-65 years at the time of enrolment in the study, which was made to compare post-polio individuals living in Sweden and the United States, to determine whether lower limb musculature becomes weaker over time, and to determine whether individuals with complaints of post-polio syndrome, new weakness, fatigue, walking or stair climbing difficulty were weaker or lost more strength over a 4-year interval than those individuals without such complaints. Dynametrically-measured knee extensor and flexor strength and questionnaire data were obtained initially and 4 years later. The two cohorts were fairly similar, though they differed in weight gain. The Americans gained significantly (p < 0.05) more weight than the Swedish subjects. Both groups lost significant (p < 0.05) knee extensor strength (approximately 8%), but the loss was not significantly (p < 0.05) different between the groups. Knee flexor strength did not change significantly (p < 0.05) over time. Subjects acknowledging new strength loss were not significantly (p < 0.05) weaker than those denying strength loss; however, they lost significantly (p < 0.05) more isometric knee extensor strength than the other individuals. Subjects acknowledging new fatigue, walking or stair climbing difficulty were significantly (p < 0.05) weaker in both muscle groups than those without such complaints. Subjects acknowledging post-polio syndrome were significantly (p < 0.05) weaker than those denying this symptom, but the amount of loss of strength over time was not significantly (p < 0.05) different. We conclude that the two cohorts were quite similar. Knee extensor strength decreased during the study interval. Individuals acknowledging post-polio syndrome had weaker knee extensor musculature. Subjects with new fatigue, walking difficulty, or stair climbing difficulty were weaker in both the knee extensors and the knee flexors than the other subjects. Subjects reporting new muscle weakness also had a greater decline in isometric knee extensor strength during the study interval than those without such complaint.

Conclusions: Knee extensor strength decreased during the study interval. Individuals acknowledging post-polio syndrome had weaker knee extensor musculature. Subjects with new fatigue, walking difficulty, or stair climbing difficulty were weaker in both the knee extensors and the knee flexors than the other subjects. Subjects reporting new muscle weakness also had a greater decline in isometric knee extensor strength during the study interval than those without such complaint.

Outcome of Research: Effective

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Comments (if any): Fatigue, perceived weakness, reduced walking capacity and difficulty climbing stairs correlate with reduced measured knee extensor and flexor strength.

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Category: Diagnosis and Management

Title: A positive turning point in life -- how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme
Author: Larsson Lund M (1), Lexell J
Affiliation: (1) Department of Community Medicine and Rehabilitation, Occupational Therapy , Umeå University, Umeå, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Jun;42(6):559-65. doi: 10.2340/16501977-0559
Publication Year and Month: 2010 06

Abstract: OBJECTIVE: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme.

PARTICIPANTS: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme.

METHODS: Qualitative research interviews analysed using the constant comparative method of grounded theory.

RESULTS: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence.

Conclusions: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their management of daily activities and in their view of their late effects of polio, their future and their self.

Outcome of Research: Effective

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Category: Coping Styles and Strategies

Title: Aging With Long-Term Mobility Impairment: Maintaining Activities of Daily Living via Selection, Optimization, and Compensation
Author: Remillard, E.T., Bailey Fausset, C., Fain, W.B.
Affiliation: Georgia Institute of Technology, Atlanta, Georgia 30318
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The Gerontologist, gnx186, https://doi.org/10.1093/geront/gnx186
Publication Year and Month: 2017 11

Abstract: There is a growing number of adults with long-term mobility impairment aging into the older adult population. Little is known about the experiences of these individuals in maintaining activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as they face age-related changes in addition to a pre-existing mobility impairment.

Research Design and Methods
Through in-home interviews with 21 participants (ages 52–86) with long-term mobility impairment, the present study employed a qualitative description design to explore perceptions of how and why select ADL/IADL routines (e.g., bed transfer, toileting) have changed over time. The selection, optimization, and compensation (SOC) model was used as a framework to organize participants’ adaptations.

Results
Among the ADL/IADL routine changes mentioned, elective selection strategies, in which a person continues to work at maintaining a task, were more frequently endorsed than loss-based selection strategies, in which a person does a task less or gets help from someone. Findings suggest that this population is actively adapting their routines to preserve their involvement in, and frequency of doing, these ADLs/IADLs. Counter to expectation, perceived age-related changes underlying activity routine changes were subtle and generally did not include sensory and cognitive declines.

Discussion and Implications
Findings provide insights into the difficulties adults with long-term mobility impairment experience as they age, as well as the adaptations they employ to overcome those challenges. Results highlight the need for customizable, mobility supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span.

Conclusions: Despite challenges, this population is actively adapting their routines to maintain ADLs/IADLs and preserve their involvement in, and frequency of doing, these activities. For older adults with long-term mobility impairment, age-related changes underlying ADL/IADL routine changes are often subtle and can be difficult for individuals to identify and articulate about themselves. More research is necessary to understand the aging trajectories among this understudied population. Results highlight the need for customizable, supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span to promote independence at home.

Innovations in design and technology hold great potential to empower individuals aging with mobility impairment to maintain everyday activities and thrive. However, access to supportive devices, equipment, and housing remains a barrier for many individuals in this population. Income and insurance coverage are just a few of the factors that could limit one’s options for overcoming ADL/IADL challenges in the home. There is a need for convergence among aging and disability services, which tend to operate in silos, serving older adults, or people with disabilities; this divide is echoed in how supportive devices and equipment are accessed, delivered, and paid for in terms of eligibility and insurance. By moving from a model that emphasizes aging or disability, to one that addresses impairment as a spectrum, practitioners, and policy makers can better meet the needs of a diverse older adult population (Putnam, 2014).

Outcome of Research: Effective

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Category: Sleep Analysis

Title: Analysis of sleep characteristics in post-polio syndrome patients
Author: Silva TM (1), Moreira GA, Quadros AA, Pradella-Hallinan M, Tufik S, Oliveira AS
Affiliation: (1) Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. [email protected]
Journal: Arquivos de Neuropsiquiatria
Citation: Arq Neuropsiquiatr. 2010 Aug;68(4):535-40
Publication Year and Month: 2010 08

Abstract: The main post-polio syndrome (PPS) symptoms are new weakness, new atrophy, fatigue, pain and sleep disturbances. Polysomnography is the gold standard for sleep analysis.

OBJECTIVE: To analyze sleep patterns in PPS patients.

METHOD: Sixty patients (mean age 46.8+/-11.3 years) at the Federal University of São Paulo (UNIFESP/EPM) complaining of sleep disturbances were evaluated by means of polysomnography, performed at the Sleep Institute.

RESULTS: Sleep efficiency was lower due to high sleep latency and arousal index. The apnea and hypopnea index (AHI) and the periodic limb movements (PLM) index were higher. Sleep architecture was also impaired. There were no abnormalities of oxygen saturation, carbon dioxide levels, respiratory rate or heart rate.

Conclusions: New post-polio sleep disturbances were isolated symptoms. It appears that these symptoms were not due to post-polio features, but rather, that they were due to dysfunction of the surviving motor neurons in the brainstem. Abnormal dopamine production, which is responsible for many sleep-related breathing disorders and abnormal movements, may also have been implicated in the present findings.

Outcome of Research: Effective

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Category: Women's Health

Title: Caesarean Section in Post-polio Patient
Author: de Oliveira AR, Schutz Martinelli E, Lisiane L.
Affiliation: Roth and Roth Anesthesia Clinic, Rio Grande do Sul, Brazil
Hospital Moinhos de Vento, Rio Grande do Sul, Brazil
Hospital Nossa Senhora Conceicao, Rio Grande do Sul, Brazil
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Clinical Research in Anesthesiology
J Clin Res Anaesthesiol 2018; 1(1):1-2
Publication Year and Month: 2018 01

Abstract: A 26-year-old primigravida patient, ASA I, 39-week gestation, presented with 24 h premature rupture of membranes, without active labor. She had been in anesthetic pre-operative clinic 2 weeks before and had described poliomyelitis with 1 year old and complete recovering in childhood. With 16-year-old, she was submitted to appendicectomy through spinal anesthesia presenting weakness in entire body for approximately 24 h. At physical examination, the only sign was shorter tibial tendon of both legs.
For the cesarean, after volume expansion with cristaloids, the choice was an epidural anesthesia with 15mg of bupivacaine 0.3% (without epinephrine) and morphine 2 mg. “The surgery was initiated after 4min of blockade with T4 sensitive level reached. Hypotension and tachycardia were corrected with metaraminol 1 mg.” After 50 min, the procedure was finished with the same metameric level of anesthesia, but with cardiovascular stability. The entire recovering from anesthesia has occurred after 11h. An elevated consume of analgesics (nonsteroidal inflammatory drugs and opioids) and antiemetics was observed.

Conclusions: Ultimately, the decision to use general or regional anesthesia should be made on an individual patient basis weighing the risks and benefits. This case report describes some of the fewest practical guidelines available about regional anesthesia in post-polio patients with minimal sequelae. The importance of communications about these cases and the anesthetic conduct in this setting needs more debate to
optimize the facilities in another similar case.

Outcome of Research: Effective

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Category: Women's Health

Title: Cesarean delivery under ultrasound-guided spinal anesthesia [corrected] in a parturient with poliomyelitis and Harrington instrumentation.
Author: Costello, JF, Balki, M.
Affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, Ontario, Canada
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Canadian Journal of Anesthesia
Can J Anaesth. 2008 Dec;55(12):889
Publication Year and Month: 2008 12

Abstract: PURPOSE:
To describe the anesthetic implications, and management of a medically complex parturient, who presented for Cesarean delivery (CD). The patient had poliomyelitis complicated with severe kyphoscoliosis, which had been treated with extensive spinal surgery. We used ultrasound guidance to facilitate successful spinal analgesia and anesthesia.

CLINICAL FEATURES:
A 27-yr-old woman, with a history of poliomyelitis and moderate restrictive lung disease secondary to kyphoscoliosis, presented at 38 weeks gestation for elective CD because of cephalopelvic disproportion. The woman had Harrington rods in situ from the level of the second thoracic vertebra, to the level of the fourth lumbar vertebra. Ultrasound guidance enabled one intervertebral space to be visualized (L5-S1), 3 cm from the expected spinal midline, and spinal anesthesia was performed at this interspace without any complications. A healthy infant was delivered, and the mother recovered uneventfully.

CONCLUSIONS:
Spinal anesthesia can be effectively performed in patients with poliomyelitis and severe kyphoscoliosis, that has been treated with extensive Harrington instrumentation. To facilitate regional techniques in such patients, bedside ultrasound may be greatly beneficial in identifying the correct spinal interspace.

Conclusions: This case illustrates several points: first, the benefit of ultrasound in the placement of a spinal block in a patient with abnormal spinal anatomy; second, the choice of anesthetic technique in pregnant patients with poliomyelitits; and third, the management of a pregnant patient with severe kyphoscoliosis, spinal surgery, and restrictive lung disease.

Outcome of Research: Effective

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Category: Activity Levels

Title: Change in physical mobility over 10 years in post-polio syndrome.
Author: Bickerstaffe, A., Beelen, A., Nollet, F.
Affiliation: Department of Rehabilitation, Academic Medical Centre, The Netherlands
Journal: Neuromuscular Disorders
Citation: Bickerstaffe, A., Beelen, A., Nollet, F. (2015) Change in physical mobility over 10 years in post-polio syndrome. Neuromuscular Disorders. 25(3):225-30
Publication Year and Month: 2015 03

Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.

Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.

Outcome of Research: Effective

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Category: Diagnosis and Management

Title: Characteristics of Patients at First Visit to a Polio Clinic in Sweden
Author: Skough Vreede, K. and Sunnerhagen, K.S.
Affiliation: Goteborg University
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: PLoS One
Skough Vreede, K. and Sunnerhagen, K.S. (2016) Characteristics of Patients at First Visit to a Polio Clinic in Sweden. PLoS One. https://doi.org/10.1371/journal.pone.0150286

Publication Year and Month: 2016 03

Abstract: Aim
Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957.

Design
A consecutive cohort study.

Patients
Prior polio patients.

Methods
All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study.

Results
More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61–71% slower, and were 53–77% weaker in muscle strength of the knee and foot as well as grip strength.

Conclusion
The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years.

Conclusions: Polio in lower extremities was more common than polio in upper extremities, verified both
by EMG and clinical classification. This is in accordance with earlier studies. Polio in lower
extremities was also classified as clinically unstable or severely atrophic to a higher extent than
polio in upper extremities (as shown in Fig 1). This is in accordance with an earlier study by
Sandberg et al [20] indicating a more pronounced ongoing denervation-reinnervation process
over time in a lower extremity muscle compared to upper extremity muscle (tibialis anterior
and biceps brachii respectively). The same pattern was also seen in patients studied in Minnesota where patients with leg weakness were twice as likely to complain of new problems compared to those with arm weakness [10].

The ongoing denervation-reinnervation process in patients with PPS results in larger motor
units.When motor-unit size has reached an upper limit, further losses of neurons can no longer
be compensated for and this results in increased muscle weakness [21]. The patients
showed to be stronger in isometric endurance compared to normal population. This may be
explained by the fact that the patients were weaker than the normal population in isometric
peak torque, which the measure of isometric endurance was based on. An increase in type I
(slow) muscle fibres has also been described in prior polio patients [22–23] and may be due to
a transition of type II (fast) to type I (slow).

An important study limitation were seen in the classification of polio as polio were classified
for left and right arm and leg, respectively, and not per muscle group. This can explain why a
polio affected leg in some cases was stronger compared to normal values as the muscles
involved in the strength measured i.e. knee flexion and knee extension muscles may not be
affected of polio. And the same is applicable regarding muscle strength of the foot as well as
grip strength. Data of muscle strength from some of the subjects were missing for different reasons i.e. they may have just not had time to participate, or refused to participate and some were too weak to perform the strength test. Some of the patients with muscle strength data missing, tried to perform the test, but were too weak to get a result. In the future, the use of ultrasound may be used to assess muscle function [24]. This would give the possibility to have more information of muscle function since this does not require that the patient has muscle strength to overcome gravity, which is a requirement for isokinetic testing.

Outcome of Research: Effective

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Category: Exercise

Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09

Abstract: 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.

Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.

Outcome of Research: Effective

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Category: Exercise

Title: Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter?
Author: Whitehead BR, Blaxton JM
Affiliation: 1 Behavioral Sciences Department, University of Michigan-Dearborn.
2 Department of Psychology, University of Notre Dame, Indiana.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Gerontologist. 2017 Nov 10;57(6):1062-1071
Publication Year and Month: 2017 11

Abstract: PURPOSE OF THE STUDY:
There is little debate that maintaining some level of physical activity in later life conveys positive benefits both physically and psychologically. What is less understood is the extent to which the type of activity or the length of time spent doing it matters when it comes to these benefits on the daily level. Here, we investigated (a) whether the presence of daily purposeful exercise (Exercise) or non-exercise physical activity (Activity) is sufficient for experiencing day-level benefits, or if time spent matters, and (b) whether there are differential well-being benefits of Exercise and Activity on the daily level.

DESIGN AND METHODS:
Older adults (N = 127; aged 60-95, Mage = 79.4) filled out surveys for 14 days, reporting daily Exercise and Activity behaviors as well as Positive and Negative Affect (PA/NA), Perceived Stress (PS), Perceived Health (PH), and Sleep Quality (SQ).

RESULTS:
Multilevel regression models showed that for purposeful exercise, more time spent was beneficial for PA, NA, and PH, but for PS, only the presence of exercise was important (time did not matter). For non-exercise activity, time did not have as great an influence as presence-doing any form of activity was beneficial for both PA and SQ. Exercise and Activity had largely independent (additive) effects.

Conclusions: Results reveal that both purposeful exercise and non-exercise activity convey independent daily well-being benefits, and that for some aspects of daily well-being, duration does matter. Findings can be applied in the development of physical activity education or engagement programs for older adults.

Outcome of Research: Effective

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Category: Exercise

Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01

Abstract: 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 Profile (NHP).

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.

Outcome of Research: Effective.

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Category: Speech Pathology

Title: Dysphonia as the initial presenting symptom in post-polio syndrome: a case report
Author: Ference, T. & Cutler, J.
Affiliation: Miller School of Medicine, University of Miami, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Ference, T. & Cutler, J. (2017) Dysphonia as the initial presenting symptom in post-polio syndrome: a case report. Research on Chronic Diseases. Accessed at: https://www.openaccessjournals.com/articles/dysphonia-as-the-initial-presenting-symptom-in-postpolio-syndrome-a-case-report.pdf
Publication Year and Month: 2017 01

Abstract: Otolaryngology examination revealed normal range of motion of vocal cords. Gastric causes of hoarseness were excluded. CT of the chest was negative. The speech pathologist concluded the hoarseness was due to fatigued abdominal muscles weakened from post-polio syndrome. Physical therapy for abdominal and core strengthening and speech therapy for energy conservation techniques were implemented with discemable improvement of voice function. An abdominal binder was prescribed to be worn throughout the day to support the abdominal and diaphragmatic musculature.

Conclusions: In treating post-polio syndrome patients with hoarse voice a multidisciplinary team can help maximize and preserve function. Weakness of the abdominal muscles, diaphragm, and laryngeal muscles should be considered in persons with history of polio.

Outcome of Research: Effective

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Category: Inflammation

Title: Elevated expression of prostaglandin E2 synthetic pathway in skeletal muscle of prior polio patients
Author: Melin E (1), Lindroos E, Lundberg IE, Borg K, Korotkova M
Affiliation: (1) Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, 18288 Stockholm, Sweden. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2014 Jan;46(1):67-72. doi: 10.2340/16501977-1230
Publication Year and Month: 2014 01

Abstract: OBJECTIVE: The aim of this study was to investigate signs of inflammation in muscle of patients with prior polio, since the main symptoms in these patients are muscle pain, weakness and fatigue. In the context of pain and inflammation, the prostaglandin E2 pathway is of interest. Prostaglandin E2 has many biological actions and is a mediator of inflammation and pain.

PATIENTS AND METHODS: Skeletal muscle biopsies from 8 patients with prior polio and post-polio symptoms, presenting with pain and muscular weakness, and from 6 healthy controls were studied. Immunohistochemistry, conventional microscopy, and computerized image analysis were performed.

RESULTS: There was statistically significant higher expression of enzymes of the prostaglandin E2 synthetic pathway, in muscle from patients, compared with controls. Expression of prostaglandin enzymes was mainly in scattered cells and blood vessels, and may indicate an inflammatory process of the muscle, which could be secondary to systemic inflammation.

Conclusions: This data may indicate an inflammatory process in muscle of prior polio patients. Up-regulation of the prostaglandin E2 pathway reveals a potential background to the pain experienced by these patients, and may provide opportunities for directed pharmacological and physical therapies, which could lead to better outcomes of rehabilitation interventions.

Outcome of Research: Effective

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Category: Polio Immunisation

Title: Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data
Author: Andrew F. Brouwer, Joseph N. S. Eisenberg, Connor D. Pomeroy, Lester M. Shulman, Musa Hindiyeh, Yossi Manor, Itamar Grotto, James S. Koopman, and Marisa C. Eisenberg
Affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Proceedings of the National Academy of Sciences Nov 2018, 115 (45) E10625-E10633
Publication Year and Month: 2018 11

Abstract: Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013–2014, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used this approach to estimate the epidemic curve and transmission dynamics, as well as assess alternate vaccination scenarios. Our analysis estimates the outbreak peaked in late June, much earlier than previous estimates derived from analysis of stool samples, although the exact epidemic trajectory remains uncertain. We estimate the basic reproduction number was 1.62 (95% CI 1.04–2.02). Model estimates indicate that 59% (95% CI 9–77%) of susceptible individuals (primarily children under 10 years old) were infected with WPV1 over a little more than six months, mostly before the vaccination campaign onset, and that the vaccination campaign averted 10% (95% CI 1–24%) of WPV1 infections. As we approach global polio eradication, environmental monitoring with qPCR can be used as a highly sensitive method to enhance disease surveillance.

Conclusions: Our analytic approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.

Outcome of Research: Effective

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Category: Assistive Technology, Orthoses

Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08

Abstract: BACKGROUND: Compared to able-bodied subjects, subjects with post-polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry.

OBJECTIVES: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop-locked knee-ankle-foot orthosis or a newly developed powered knee-ankle-foot orthosis.

STUDY DESIGN: Quasi experimental study.

METHODS: Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis.

RESULTS: There were no significant differences in the gait symmetry index of step length (p = 0.085), stance time (p = 0.082), double-limb support time (p = 0.929), or speed of walking (p = 0.325) between the two test conditions. However, using the new powered knee-ankle-foot orthosis improved the symmetry index in step width (p = 0.037), swing time (p = 0.014), stance phase percentage (p = 0.008), and knee flexion during swing phase (p ⩽ 0.001) compared to wearing the drop-locked knee-ankle-foot orthosis.

Conclusions: The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase.

CLINICAL RELEVANCE: A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis.

Outcome of Research: Effective

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Category: Diagnosis and Management

Title: Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center
Author: Quadros AA (1), Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, Pereira RD, Ramos PE, Abe G, Oliveira AS
Affiliation: (1) Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo (Unifesp), São Paulo SP, Brazil - [email protected]
Journal: Arquivos de Neuro-psiquiatria
Citation: Arq Neuropsiquiatr. 2012 Aug;70(8):571-3
Publication Year and Month: 2012 08

Abstract: OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders.

METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms.

RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%).

Conclusions: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.

Outcome of Research: Effective

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Category: Orthoses

Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07

Abstract: The objective was to identify gait patterns in polio survivors with calf muscle weakness and associate them to underlying lower extremity impairments, which are expected to help in the search for an optimal orthosis.

Unilaterally affected patients underwent barefoot 3D-gait analyses. Gait pattern clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.

Conclusions:

Outcome of Research: Effective

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Comments (if any): There are many differences in gait patterns and it can be difficult to detect the forces and weight distribution from observation. 3D gait analysis appears to be more effective in combination with physical examination of muscle weakness in prescription of effective orthoses.

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Category: Complementary Therapies

Title: Immediate and Long-Term Effects of Qigong on Cold Intolerance in Patients with Post-Poliomyelitis Syndrome
Author: Ramos, PS, Abe, GC, Pradella-Hallinan, M, Quadros, AAJ, Tao, T, Oliveira, ASB.
Affiliation: Federal University of Sao Paulo, Brazil
Tianjin University of Traditional Chinese Medicine (TUTCM), Tianjin, China.
Department of Tuina and Orthopedics, Tuina and Orthopedics Clinic, The First Teaching Hospital, Tianjin, China.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Scientific Research
2018 Vol1(1). DOI:10.4236/health.2017.101004
Publication Year and Month: 2018 01

Abstract: Post-poliomyelitis syndrome (PPS) is a disorder in individuals who have had poliomyelitis, characterized by new muscle weakness and often associated with other symptoms, including cold intolerance (CI). Qigong is a Traditional Chinese Medicine technique to adjust energy and blood circulation. Objective: To verify the effects and late repercussions of Qigong on CI complaints in PPS patients. Methods: PPS patients (n = 22, 14 females, 8 males; ages 35 - 60) performed Qigong exercises in 40-minute sessions, three times per week, for three consecutive months. They were evaluated at baseline, the end of treatment and every three months for a year using a visual analogue scale adapted for CI (VAS-cold). Results: The systemic VAS-cold scores exhibited significant differences between the baseline, the end of treatment and throughout 12 months of follow-up. Conclusion: The CI scores were low and bearable at the end of intervention and for the following 12 months without activity.

Conclusions: We found that following DQ training, the complaints of CI exhibited statistically significant improvement in all the participants, and the sensitivity to cold exhibited low scores and bearable levels at the end of intervention and in the evaluations performed during the following 12 months.

Outcome of Research: Effective

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Category: Polio Immunisation

Title: Immunogenicity of two different sequential schedules of inactivated polio vaccine followed by oral polio vaccine versus oral polio vaccine alone in healthy infants in China
Author: Li RC (1), Li CG (2), Wang HB (3), Luo HM (3), Li YP (1), Wang JF (2), Ying ZF (2), Yu WZ (3), Shu JD (4), Wen N (3), Vidor E (5)
Affiliation: (1) Guangxi Center for Disease Prevention and Control, Nanning, China; (2) National Institutes for Food and Drug Control (NIFDC), Beijing, China; (3) Chinese Center for Disease Control and Prevention, Beijing, China; (4) Sanofi Pasteur, Beijing, China; (5) Sanofi Pasteur, Lyon, France
Journal: Journal of the Pediatric Infectious Diseases Society
Citation: J Pediatric Infect Dis Soc. 2015 Apr 16. pii: piv017
Publication Year and Month: 2015 04

Abstract: BACKGROUND: Two vaccination schedules where inactivated polio vaccine (IPV) was followed by oral polio vaccine (OPV) were compared to an OPV-only schedule.

METHODS: Healthy Chinese infants received a 3-dose primary series of IPV-OPV-OPV (Group A), IPV-IPV-OPV (Group B), or OPV-OPV-OPV (Group C) at 2, 3, and 4 months of age. At pre-Dose 1, 1-month, and 14-months post-Dose 3, polio 1, 2, and 3 antibody titers were assessed by virus-neutralizing antibody assay with Sabin or wild-type strains. Adverse events were monitored.

RESULTS: Anti-polio 1, 2, and 3 titers were ≥8 (1/dil) in >99% of participants, and Group A and Group B were noninferior to Group C at 1-month post-Dose 3 as assessed by Sabin strain-based assay (SSBA). In Group A 1-month post-Dose 3, there was no geometric mean antibody titers (GMT) differences for types 1 and 3; type 2 GMTs were ≈3-fold higher by wild-type strain-based assay (WTBA) versus SSBA. For Group B, GMTs were ≈1.7- and 3.6-fold higher for types 1 and 2 via WTBA, while type 3 GMTs were similar. For Group C, GMTs were ≈6.3- and 2-fold higher for types 1 and 3 with SSBA, and type 2 GMTs were similar. Antibodies persisted in >96.6% of participants. Adverse event incidence in each group was similar.

Conclusions: A primary series of 1 or 2 IPV doses followed by 2 or 1 OPV doses was immunogenic and noninferior to an OPV-only arm. SSBA was better at detecting antibodies elicited by OPV with antibody titers correlated to the number of OPV doses (NCT01475539 - https://clinicaltrials.gov/ct2/show/study/NCT01475539).

Outcome of Research: Effective

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Category: Drugs

Title: Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders
Author: Östlund G (1), Broman L, Werhagen L, Borg K
Affiliation: (1) Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, 3rd floor, SE-182 88 Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2015 Aug 18. doi: 10.2340/16501977-1985
Publication Year and Month: 2015 08

Abstract: OBJECTIVE: To define and characterize responders and non-responders in a group of 124 patients with post-polio syndrome who received a single treatment with intravenous immunoglobulin.

DESIGN: Open trial, prospective follow-up study.

METHODS: Clinical examination and data from medical records. Short Form 36 (SF-36), Physical Activity Scale for the Elderly (PASE) and visual analogue scale (VAS) measured quality of life, physical activity and intensity of pain, respectively. Data were obtained before treatment and at 6-month follow-up.

RESULTS: Two responder groups were identified with the outcome SF-36 Vitality and 3 with Bodily pain, respectively. Forty-five percent were positive-responders, identified before treatment by reduced physical function, muscle atrophy in the lower extremities, higher levels of fatigue and pain, and a VAS pain score above 20. Negative-responders were identified by good physical function and mental health, lesser muscle atrophy in the lower extremities, and low levels of fatigue and pain.

Conclusions: Intravenous immunoglobulin is a biological intervention, and therefore it is important to be able to identify responders and non-responders. In order to maximize a positive outcome it is suggested that patients with a high level of fatigue and/or pain and reduced physical function are selected.

Outcome of Research: Effective

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Category: Drugs

Title: IVIG treatment in post-polio patients: evaluation of responders
Author: Ostlund G (1), Broman L, Werhagen L, Borg K
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Building 39, 3rd floor, 182 88 Stockholm, Sweden
Journal: Journal of Neurology
Citation: J Neurol. 2012 Dec;259(12):2571-8. doi: 10.1007/s00415-012-6538-y. Epub 2012 May 17
Publication Year and Month: 2012 05

Abstract: The aim of this work is to evaluate the outcome of IVIG treatment in patients with post-polio syndrome (PPS) and to identify responders. The study included 113 PPS patients who had received one IVIG treatment in an open trial, prospective follow-up study. Clinical examination was performed and clinical data were retrieved from medical records. The short form 36 (SF-36), physical activity scale for the elderly (PASE), and the visual analogue scale (VAS) were used as measurements of quality of life, physical activity, and the intensity of pain. Data before treatment and at 6-month follow-up were collected. Analysis was performed in subgroups based on demographic and medical parameters. A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. A trend was found in patients with PPS as the only diagnosis. IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. Age below 65 years, paresis in the lower extremities, and lack of concomitant disorders may be the main indicators for a future identification of responders.

Conclusions:

Outcome of Research: Effective

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Category: Diagnosis and Management

Title: Life-long morbidity among Danes with Poliomyelitis
Author: Nielsen NM, Rostgaard K, Askgaard D, Skinhoj P Aaby P.
Affiliation: Statens Serum Insitut, Copenhagen, Denmark
National University Hospital, Cpenhagen, Denmark
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil 2004; 85:385-91
Publication Year and Month: 2004 03

Abstract: Abstract
OBJECTIVE:
To estimate long-term morbidity in a cohort of Danish poliomyelitis patients.

DESIGN:
A historical prospective cohort study of 27,047 persons.

SETTING:
Denmark.

PARTICIPANTS:
A total of 5421 persons hospitalized for poliomyelitis between 1919 to 1954 in Copenhagen, Denmark, and 21,626 age- and gender-matched Danes. Participants were followed up on average for 20.6 years, yielding a total of 555,884 person-years of follow-up.

INTERVENTIONS:
Not applicable.

MAIN OUTCOME MEASURES:
The exposed (poliomyelitis) cohort and the unexposed (control) cohort were followed up for somatic hospitalization from 1977 to 1999 in the Danish Hospital Discharge Register. The incidence rate ratio (IRR) was calculated as the ratio between the incidence rate of disease in the exposed and unexposed cohorts.

RESULTS:
Overall, polio patients had a 1.2- to 1.3-fold increased risk of being hospitalized with pulmonary diseases, heart diseases, gastrointestinal disorders, or diseases of the locomotive apparatus. Among paralytic polio patients, long-term morbidity seems to be associated with the acute severity of poliomyelitis, as well as young age at infection. Paralytic patients, who contracted respiratory polio under the age of 5, had the highest risk of being hospitalized with lung diseases (IRR=7.26; 95% confidence interval [CI], 3.06-18.33), diseases of the locomotive apparatus (IRR=4.05; 95% CI, 1.66-9.86), heart diseases (IRR=1.70; 95% CI, 0.65-3.98), and diseases of the digestive system (IRR= 2.23; 95% CI, 1.03-4.62). Surprisingly, patients without paralyses, especially women, also had an increased morbidity.

CONCLUSIONS:
Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.

Conclusions: Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.

Outcome of Research: Effective

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Category: Post-Polio Motor Unit

Title: Loss of motor unit size and quadriceps strength over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), van Dijk JP (2), Beelen A (3), Zwarts MJ (4), Nollet F (5)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected]; (2) Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Postbus 910, 6500 HB Nijmegen, The Netherlands; Epilepsy Centre Kempenhaeghe, Postbus 61, 5590 AB Heeze, The Netherlands. Electronic address: [email protected]; (3) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected]; (4) Epilepsy Centre Kempenhaeghe, Postbus 61, 5590 AB Heeze, The Netherlands. Electronic address: [email protected]; (5) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected]
Journal: Clinical Neurophysiology
Citation: Clin Neurophysiol. 2014 Jun;125(6):1255-60. doi: 10.1016/j.clinph.2013.11.003
Publication Year and Month: 2014 06

Abstract: OBJECTIVE: To investigate whether strength decline in post-polio syndrome (PPS) results from excessive distal axonal degeneration of enlarged motor units.

METHODS: We assessed changes over 10 years in isometric quadriceps strength, mean motor unit action potential (MUAP) size, root mean squared (RMS) amplitude, and level of interference (LOI) in 47 patients with PPS and 12 healthy controls, using high density surface EMG. At baseline, all patients had symptomatic quadriceps dysfunction, evidenced by transmission defects on single-fibre EMG.

RESULTS: MU size and strength declined significantly by 20% and 15%, respectively in patients with PPS. Those with the largest initial MU sizes exhibited the greatest losses of mean MU size (27%) and proportional decreases in quadriceps strength (23%). Initial strength, change in LOI and change in RMS amplitude together explained 35% of the variability in strength changes in patients. MU size of controls did not change, although they lost 29% strength.

SIGNIFICANCE: This long term follow-up study provides evidence that size diminution of enlarged MUs combined with a reduced number of active MUs contributes to the gradual strength decline in PPS.

Conclusions: MU size and strength declined concomitantly in a homogeneous cohort of patients with PPS and quadriceps dysfunction.

Outcome of Research: Effective

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Category: Polio Immunisation

Title: Next generation inactivated polio vaccine manufacturing to support post polio-eradication biosafety goals
Author: Thomassen YE (1), van 't Oever AG (1), van Oijen MG (1), Wijffels RH (2), van der Pol LA (1), Bakker WA (1)
Affiliation: (1) Institute for Translational Vaccinology (Intravacc), Bilthoven, The Netherlands; (2) Bioprocess Engineering, Wageningen University, Wageningen, The Netherlands
Journal: Public Library of Science
Citation: PLoS One. 2013 Dec 12;8(12):e83374. doi: 10.1371/journal.pone.0083374
Publication Year and Month: 2013 12

Abstract: Worldwide efforts to eradicate polio caused a tipping point in polio vaccination strategies. A switch from the oral polio vaccine, which can cause circulating and virulent vaccine derived polioviruses, to inactivated polio vaccines (IPV) is scheduled. Moreover, a manufacturing process, using attenuated virus strains instead of wild-type polioviruses, is demanded to enhance worldwide production of IPV, especially in low- and middle income countries. Therefore, development of an IPV from attenuated (Sabin) poliovirus strains (sIPV) was pursued. Starting from the current IPV production process based on wild type Salk strains, adaptations, such as lower virus cultivation temperature, were implemented. sIPV was produced at industrial scale followed by formulation of both plain and aluminium adjuvanted sIPV. The final products met the quality criteria, were immunogenic in rats, showed no toxicity in rabbits and could be released for testing in the clinic. Concluding, sIPV was developed to manufacturing scale. The technology can be transferred worldwide to support post polio-eradication biosafety goals.

Conclusions:

Outcome of Research: Effective

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Category: Diagnosis and Management

Title: Post-poliomyelitis syndrome as a possible viral disease
Author: Baj A (1), Colombo M (1), Headley JL (2), McFarlane JR (3), Liethof MA (4), Toniolo A (5)
Affiliation: (1) Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy; (2) Post-Polio Health International, Saint Louis, Missouri, USA; (3) European Polio Union, Huldenberg, Belgium; (4) Polio Australia Incorporated, Kew, Victoria, Australia; (5) Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy. Electronic address: [email protected]
Journal: International Journal of Infectious Diseases
Citation: Int J Infect Dis. 2015 May 1;35:107-116. doi: 10.1016/j.ijid.2015.04.018
Publication Year and Month: 2015 05

Abstract: This review summarizes current concepts on post-polio syndrome (PPS), a condition that may arise in polio survivors after partial or complete functional recovery followed by a prolonged interval of stable neurological function. PPS affects 15-20 million people worldwide. Epidemiological data are reported, together with the pathogenic pathways that possibly lead to the progressive degeneration and loss of neuromuscular motor units. As a consequence of PPS, polio survivors experience new weakness, generalized fatigue, atrophy of previously unaffected muscles, and a physical decline that may culminate in the loss of independent life. Emphasis is given to the possible pathogenic role of persistent poliovirus infection and chronic inflammation. These factors could contribute to the neurological and physical decline in polio survivors. A perspective is then given on novel anti-poliovirus compounds and monoclonal antibodies that have been developed to contribute to the final phases of polio eradication. These agents could also be useful for the treatment or prevention of PPS. Some of these compounds/antibodies are in early clinical development. Finally, current clinical trials for PPS are reported. In this area, the intravenous infusion of normal human immunoglobulins appears both feasible and promising.

Conclusions:

Outcome of Research: Effective.

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Category: Women's Health

Title: Pregnancy following Poliomyelitis
Author: Daw E, Chandler G.
Affiliation: University of Dundee, Scotland
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Postgraduate Medical Journal
Postgrad Med J. 1976; 52:492-496
Publication Year and Month: 1981 08

Abstract: A review of forty-nine pregnancies in thirty-seven patients who had previously suffered from poliomyelitis found that obstetric complications were proportional to the clinical disabilities of the patient. A simple test of unilateral weight-bearing gives a good clue as to whether pelvic asymmetry is present.

Conclusions:

Outcome of Research: Effective

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Category: Women's Health

Title: Pregnancy, delivery and perinatal outcome in female survivors of polio.
Author: Veiby G, Daltveit AK, Gilhus NE.
Affiliation: Department of Clinical Medicine, University of Bergen, Norway
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of the Neurological Sciences
J Neurol Sci. 2007 Jul 15;258(1-2):27-32.
Publication Year and Month: 2007 07

Abstract: OBJECTIVE:
To investigate possible effects on pregnancy, delivery and perinatal outcome in female survivors of polio.

METHODS:
In a cohort design, data from the national population based Medical Birth Registry of Norway (MBRN) were used to compare all 2495 births recorded 1967-1998 by female survivors of polio with all 1.9 mill non-polio deliveries. The results were adjusted for time period, maternal age, and birth order by unconditional logistic regression, with effects presented as adjusted Odds Ratios (OR) with a corresponding 95% Confidence Interval (CI) and p values.

RESULTS:
Female polio survivors had a higher occurrence of pre-eclampsia (3.4% vs. 2.8%, p=0.003, OR=1.4, CI=1.1-1.7), gestational proteinuria (1.3% vs. 0.5%, p<0.001, OR=2.0, CI=1.4-2.8), renal disease prior to pregnancy (1.4% vs. 0.9%, p=0.001, OR=1.8, CI=1.2-2.5), vaginal bleeding (3.8% vs. 2.0%, p<0.001, OR=1.7, CI=1.4-2.1), and urinary tract infection during pregnancy (3.5% vs. 2.4%, p<0.001, OR=1.7, CI=1.4-2.1). Deliveries complicated by obstruction of the birth process were more common in the polio group (6.1% vs. 2.0%, p<0.001, OR=4.8, CI=4.0-5.6), and cesarean section was performed at a higher rate throughout the time period (13.2% vs. 8.3%, p<0.001, OR=2.7, CI=2.4-3.1). Infants of polio mothers had a lower mean birth weight (3383 g vs. 3483 g, p<0.001), and more often had a birth weight below 2500 g (6.9% vs. 5.2%, p=0.001, OR=1.3, CI=1.1-1.5). There was no difference regarding pregnancy length. The risk of perinatal death was increased (2.1% vs. 1.1%, p=0.05, OR=1.3, CI=1.0-1.7).

CONCLUSION:
Pregnancy in female survivors of polio is associated with an increased risk for complications during pregnancy and delivery, as well as an adverse perinatal outcome. Awareness towards risk factors should improve pre-natal care and possibly prevent complications.

Conclusions: Pregnancy in female survivors of polio is associated with an increased risk for complications during pregnancy and delivery, as well as an adverse perinatal outcome. Awareness towards risk factors should improve pre-natal care and possibly prevent complications.

Outcome of Research: Effective

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Category: Quality of Life

Title: Quality of life in Swedish patients with post-polio syndrome with a focus on age and sex
Author: Jung TD (1), Broman L, Stibrant-Sunnerhagen K, Gonzalez H, Borg K
Affiliation: (1) Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyds Hospital, Stockholm; Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2014 Jun;37(2):173-9. doi: 10.1097/MRR.0000000000000052
Publication Year and Month: 2014 06

Abstract: To investigate the health-related quality of life (QOL) in Swedish patients with post-polio syndrome (PPS), with a focus on sex and age. A total of 364 patients were recruited from five Swedish post-polio clinics. Analysis was carried out using SF-36 and data were compared with those of a normal population. QOL was significantly lower in PPS patients for all eight subdomains and the two main scores (physical compound score and mental compound score) when compared with the controls. Male patients had a significantly higher QOL than female patients for all subdomains and also for mental compound score and physical compound score, a phenomenon also observed in the normal population. There was a decrease in QOL in the physical domains and an increase in vitality with age. PPS decreases health-related QOL in both sexes, more in female patients. QOL for physical domains decreases whereas vitality increases with age in both sexes.

Conclusions:

Outcome of Research: Effective

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Category: Muscle Strength

Title: Quantitative muscle ultrasound and quadriceps strength in patients with post-polio syndrome
Author: Bickerstaffe A (1), Beelen A, Zwarts MJ, Nollet F, van Dijk JP
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Muscle & Nerve
Citation: Muscle Nerve. 2015 Jan;51(1):24-9. doi: 10.1002/mus.24272
Publication Year and Month: 2015 01

Abstract: INTRODUCTION: We investigated whether muscle ultrasound can distinguish muscles affected by post-polio syndrome (PPS) from healthy muscles and whether severity of ultrasound abnormalities is associated with muscle strength.

METHODS: Echo intensity, muscle thickness, and isometric strength of the quadriceps muscles were measured in 48 patients with PPS and 12 healthy controls.

RESULTS: Patients with PPS had significantly higher echo intensity and lower muscle thickness than healthy controls. In patients, both echo intensity and muscle thickness were associated independently with muscle strength. A combined measure of echo intensity and muscle thickness was more strongly related to muscle strength than either parameter alone.

Conclusions: Quantitative ultrasound distinguishes healthy muscles from those affected by PPS, and measures of muscle quality and quantity are associated with muscle strength. Hence, ultrasound could be a useful tool for assessing disease severity and monitoring changes resulting from disease progression or clinical intervention in patients with PPS.

Outcome of Research: Effective

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Category: Clinical Evaluation

Title: Quantitative muscle ultrasound and quadriceps strength in patients with post-polio syndrome.
Author: Bickerstaffe, A., Beelen, A., Zwarts, M.J., Nollet, F., van Dijk, J.P.
Affiliation: Department of Rehabilitation, Academic Medical Center, The Netherlands
Journal: Muscle & Nerve
Citation: Bickerstaffe, A et al (2015) Quantitative muscle ultrasound and quadriceps strength in patients with post-polio syndrome. Muscle and Nerve. 51(1):24-9
Publication Year and Month: 2015 01

Abstract: INTRODUCTION:
We investigated whether muscle ultrasound can distinguish muscles affected by post-polio syndrome (PPS) from healthy muscles and whether severity of ultrasound abnormalities is associated with muscle strength.
METHODS:
Echo intensity, muscle thickness, and isometric strength of the quadriceps muscles were measured in 48 patients with PPS and 12 healthy controls.
RESULTS:
Patients with PPS had significantly higher echo intensity and lower muscle thickness than healthy controls. In patients, both echo intensity and muscle thickness were associated independently with muscle strength. A combined measure of echo intensity and muscle thickness was more strongly related to muscle strength than either parameter alone.
CONCLUSIONS:
Quantitative ultrasound distinguishes healthy muscles from those affected by PPS, and measures of muscle quality and quantity are associated with muscle strength. Hence, ultrasound could be a useful tool for assessing disease severity and monitoring changes resulting from disease progression or clinical intervention in patients with PPS.

Conclusions:
Ultrasound can be effective to assess and monitor changes in muscle properties of a patient with post-polio syndrome.

Outcome of Research: Effective

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Category: Muscle Strength

Title: Reliability of contractile properties of the knee extensor muscles in individuals with post-polio syndrome.
Author: Voorn, E.L., Brehm, M.A., Beelen, A., de Haan, A., Nollet, F., Gerrits, K.H.L.


Affiliation: University of Amsterdam
Journal:
Citation: PLos One
Voorn, E.L., Brehm, M.A., Beelen, A., de Haan, A., Nollet, F., Gerrits, K.H.L. (2014) Reliability of contractile properties of the knee extensor muscles in individuals with post-polio syndrome. PLoS One. Jul 14;9(7):e101660. doi: 10.1371/journal.pone.0101660
Publication Year and Month: 2014 07

Abstract: Objective
To assess the reliability of contractile properties of the knee extensor muscles in 23 individuals with post-polio syndrome (PPS) and 18 age-matched healthy individuals.

Methods
Contractile properties of the knee extensors were assessed from repeated electrically evoked contractions on 2 separate days, with the use of a fixed dynamometer. Reliability was determined for fatigue resistance, rate of torque development (MRTD), and early and late relaxation time (RT50 and RT25), using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM, expressed as % of the mean).

Results
In both groups, reliability for fatigue resistance was good, with high ICCs (>0.90) and small SEM values (PPS: 7.1%, healthy individuals: 7.0%). Reliability for contractile speed indices varied, with the best values found for RT50 (ICCs>0.82, SEM values <2.8%). We found no systematic differences between test and retest occasions, except for RT50 in healthy subjects (p = 0.016).

Conclusions
In PPS and healthy individuals, the reliability of fatigue resistance, as obtained from electrically evoked contractions is high. The reliability of contractile speed is only moderate, except for RT50 in PPS, demonstrating high reliability.

Significance
This was the first study to examine the reliability of electrically evoked contractile properties in individuals with PPS. Our results demonstrate its potential to study mechanisms underlying muscle fatigue in PPS and to evaluate changes in contractile properties over time in response to interventions or from natural course.

Conclusions: Both in individuals with PPS and in healthy individuals, the reliability of fatigue resistance, as obtained from electrically evoked contractions of the knee extensor muscles is high. The reliability of contractile speed indices is only moderate, except for RT50 in PPS, demonstrating high reliability. Considering these results, the assessment of contractile properties in PPS is sufficiently reliable to identify those patients with impaired contractile functioning of their knee extensor muscles, and, accordingly, to evaluate changes over time or following interventions in this patient group. Based on its potential in PPS, future research may also focus on the feasibility of this method in other slowly progressive neuromuscular diseases where muscle fatigue is a major problem.

Outcome of Research: Effective

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Category: Renal Complications

Title: Renal failure in a patient with postpolio syndrome and a normal creatinine level
Author: Leming MK (1), Breyer MJ
Affiliation: (1) Department of Emergency Medicine, Christiana Care Health System, Newark, DE 19718, USA. [email protected]
Journal: The American Journal of Emergency Medicine
Citation: Am J Emerg Med. 2012 Jan;30(1):247.e1-3. doi: 10.1016/j.ajem.2010.07.026
Publication Year and Month: 2012 01

Abstract: Patients with renal failure who are taking trimethoprim have an increased risk of developing hyperkalemia, which can cause muscle weakness. In patients with postpolio syndrome, a normal creatinine level could be abnormally high, renal failure is possible because of lack of creatinine production, and the muscle weakness from resultant hyperkalemia could be more severe because of their underlying condition. This abnormally high creatinine level has been termed from this point relative renal failure. The objective of the study was to review a case in which relative renal failure and hyperkalemia caused muscle weakness that manifested as shortness of breath and confusion with electrocardiographic changes. A dehydrated patient with relative renal failure and postpolio syndrome had taken trimethoprim-sulfamethoxazole that caused symptomatic hyperkalemia. The patient presented with muscle weakness, shortness of breath, and confusion, with her postpolio syndrome compounding the situation and likely making the muscle weakness more severe. A patient on trimethoprim with renal failure is at an increased risk of developing hyperkalemia. Patients with postpolio syndrome could have severe muscle weakness from the hyperkalemia and could have renal failure even with a normal creatinine level. This case report will remind treating physicians to evaluate such patients for hyperkalemia if they present with muscle weakness, especially if the patient has renal failure and is on trimethoprim.

Conclusions:

Outcome of Research: Effective

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Category: Drugs

Title: Response of postpoliomyelitis patients to bisphosphonate treatment
Author: Alvarez A (1), Kremer R, Weiss DR, Benedetti A, Haziza M, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2010 Dec;2(12):1094-103. doi: 10.1016/j.pmrj.2010.08.009.
Publication Year and Month: 2010 12

Abstract: OBJECTIVE: To evaluate (1) the rate of change of bone mineral density (BMD) at the hip in postpolio patients treated with bisphosphonates compared with the rate of change in BMD in (a) postpolio patients not treated with bisphosphonates and (b) non-postpolio patients treated with bisphosphonates; and (2) to compare the fracture rate in postpolio patients before and after treatment.

DESIGN: Retrospective chart review.

SETTING: University-affiliated hospital postpolio clinic and bone metabolism clinic.

PARTICIPANTS: Patients with at least 2 BMD assessments. We included 144 postpolio patients and 112 non-postpolio patients. For the fracture analysis, 32 postpolio patients with a history of fractures and treatment with bisphosphonates were included.

METHODS: The effect of treatment on BMD in postpolio patients was analyzed with use of a multiple linear regression model and a mixed effects model, with the rate of change in hip BMD and the change in BMD from baseline, respectively, as the dependent variables. The effect of treatment on occurrence of fractures in postpolio patients was analyzed with use of conditional logistic regression and Poisson regression.

MAIN OUTCOME MEASURES: BMD measurements at the femoral neck (g/cm²) and occurrence of fractures before and after initiation of treatment.

RESULTS: In an adjusted model, postpolio patients treated with bisphosphonates (54/144) had a greater rate of change in BMD (0.031 g/cm²/year; 95% confidence interval 0.010-0.052) compared with nontreated postpolio patients. The effect of treatment in postpolio patients was similar to that in non-postpolio patients. Evidence indicated that treated postpolio patients have a lower risk of fracture after treatment (odds ratio 0.3, P = .046; rate ratio 0.4, P = .183).

Conclusions: In this retrospective study, it was found that treatment with oral bisphosphonates significantly increases BMD at the hip in postpolio patients. The effect of bisphosphonate treatment appears to be similar in postpolio patients compared with a control group without polio. Treatment with bisphosphonates may have a protective effect on fracture risk in this population.

Outcome of Research: Effective

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Category: Restless Legs Syndrome

Title: Restless legs syndrome in patients with sequelae of poliomyelitis
Author: Kumru H (1), Portell E (2), Barrio M (2), Santamaria J (3)
Affiliation: (1) Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain; Univ Autonoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain; (2) Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain; Univ Autonoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain; (3) Hospital Clinic, Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
Journal: Parkinsonism & Related Disorders
Citation: Parkinsonism Relat Disord. 2014 Oct;20(10):1056-8. doi: 10.1016/j.parkreldis.2014.06.014
Publication Year and Month: 2014 06

Abstract: BACKGROUND: No studies have examined the association between RLS and the sequelae of poliomyelitis (PM). We studied the frequency and severity of RLS in a group of consecutive patients with the sequelae of poliomyelitis (PM) and the effect of treatment with dopaminergic drugs.

METHODS: A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on sex, age, age at onset, site affected by PM, disease duration of PM, and history of post-polio syndrome (pPS) was obtained in a cohort of 52 PM patients.

RESULT: The mean age was 55.9 ± 6.5 years; 39 patients had post-polio syndrome (75%). RLS was diagnosed in 21 (40.4%) patients. Sixteen of the 21 patients (76.2%) with RLS had pPS, which was similar to the non-RLS group (74.2% patients with pPS). RLS symptoms were very severe in 5 patients, severe in 13, moderate in 2 and mild in 1. Nineteen of the 21 patients with RLS had symptoms predominantly in the more affected lower limb (90% of patients). Sixteen patients received dopaminergic agonist treatment with a significant reduction in their scores on the RLS severity scale from 28.3 ± 4.7 to 6.9 ± 7.3 (p < 0.001).

DISCUSSION: RLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs.

Conclusions:

Outcome of Research: Effective

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Category: Exercise

Title: Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome.
Author: Oncu J, Durmaz B, Karapolat H.
Affiliation: Ege University Medical Faculty Physical Medicine and Rehabilitation Department, Izmir, Turkey.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Clin Rehabil. 2009 Feb;23(2):155-63
Publication Year and Month: 2009 02

Abstract: OBJECTIVE:
To investigate and compare the impact of hospital and home exercise programmes on aerobic capacity, fatigue, and quality of life in patients with post-polio syndrome.

DESIGN:
A prospective, randomized controlled trial.

SETTING:
Department of Physical Medicine and Rehabilitation, University Hospital.

SUBJECTS:
Thirty-two patients were divided into two groups for either hospital- or home-based aerobic exercise programme.

MAIN OUTCOME MEASURES:
Patients were assessed before and after the rehabilitation programme, with respect to functional capacity (pVo2), fatigue (Fatigue Severity Scale, Fatigue Impact Scale) and quality of life (Nottingham Heath Profile).

RESULTS:
After the exercise programme, improvement was observed in the hospital exercise group compared to a pre-exercise period in all Nottingham Heath Profile scores (except sleep scores), pVo2, Fatigue Severity Scale and Fatigue Impact Scale (cognitive, physical, psychosocial, total) (P<0.05). In contrast, in the home exercise group a decrease was observed in pVo2 scores after the rehabilitation programme, compared to a pre-rehabilitation period (P<0.05). In addition, a significant improvement was observed in the home exercise group after the rehabilitation programme in all parameters excluding Fatigue Impact Scale-physical, Fatigue Impact Scale-psychosocial, and Nottingham Heath Profile-sleep (P<0.05). When the two exercise groups were compared, improvement was observed in the hospital exercise group compared to the home exercise group in pVo2 and Fatigue Severity Scale-total, Fatigue Impact Scale-physical, Fatigue Impact Scale-psychosocial, Fatigue Impact Scale-total, and Nottingham Heath Profile-energy scores (P<0.05).

Conclusions: CONCLUSION:
Fatigue and quality of life were both improved in the home and hospital exercise groups. An increase was also found in the functional capacity in the hospital exercise group. A regular exercise programme is beneficial to patients with post-polio syndrome.

Outcome of Research: Effective

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Category: Respiratory Complications and Management

Title: Sleep-disordered breathing in neuromuscular disease
Author: Aboussouan LS
Affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
Journal: American Journal of Respiratory and Critical Care Medicine
Citation: Am J Respir Crit Care Med. 2015 May 1;191(9):979-89. doi: 10.1164/rccm.201412-2224CI
Publication Year and Month: 2015 05

Abstract: Sleep-disordered breathing in neuromuscular diseases is due to an exaggerated reduction in lung volumes during supine sleep, a compromised physiologic adaptation to sleep, and specific features of the diseases that may promote upper airway collapse or heart failure. The normal decrease in the rib cage contribution to the tidal volume during phasic REM sleep becomes a critical vulnerability, resulting in saw-tooth oxygen desaturation possibly representing the earliest manifestation of respiratory muscle weakness. Hypoventilation can occur in REM sleep and progress into non-REM sleep, with continuous desaturation and hypercarbia. Specific characteristics of neuromuscular disorders, such as pharyngeal neuropathy or weakness, macroglossia, bulbar manifestations, or low lung volumes, predispose patients to the development of obstructive events. Central sleep-disordered breathing can occur with associated cardiomyopathy (e.g., dystrophies) or from instability in the control of breathing due to diaphragm weakness. Mitigating factors such as recruitment of accessory respiratory muscles, reduction in REM sleep, and loss of normal REM atonia in some individuals may partially protect against sleep-disordered breathing. Noninvasive ventilation, a standard-of-care management option for sleep-disordered breathing, can itself trigger specific sleep-disordered breathing events including air leaks, patient-ventilator asynchrony, central sleep apnea, and glottic closure. These events increase arousals, reduce adherence, and impair sleep architecture. Polysomnography plays an important role in addressing pitfalls in the diagnosis of sleep-disordered breathing in neuromuscular diseases, identifying sleep-disordered breathing triggered by noninvasive ventilation, and optimizing noninvasive ventilation settings.

Conclusions:

Outcome of Research: Effective.

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Category: Muscle Strength

Title: Strength, endurance, and work capacity after muscle strengthening exercise in postpolio subjects
Author: Agre JC, Rodriquez AA, Franke TM
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison, USA
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1997 Jul; 78(7):681-6
Publication Year and Month: 1997 07

Abstract: OBJECTIVE: To determine whether a 12-week home quadriceps muscle strengthening exercise program would increase muscle strength, isometric endurance, and tension time index (TTI) in postpolio syndrome subjects without adversely affecting the surviving motor units or the muscle.

DESIGN: A longitudinal study to investigate the effect of a 12-week exercise program on neuromuscular function and electromyographic variables.

SETTING: Neuromuscular laboratory of a university hospital.

SUBJECTS: Seven subjects were recruited from a cohort of 12 subjects who had participated in a previous exercise study. All subjects had greater than antigravity strength of the quadriceps. Upon completion of a postpolio questionnaire, all acknowledged common postpolio syndrome symptoms such as new fatigue, pain, and weakness; 6 of the 7 acknowledged new strength decline.

INTERVENTION: On Mondays and Thursdays subjects performed three sets of four maximal isometric contractions of the quadriceps held for 5 seconds each. On Tuesdays and Fridays subjects performed three sets of 12 dynamic knee extension exercises with ankle weights.

MAIN OUTCOME MEASURES: Neuromuscular variables of the quadriceps muscles were measured at the beginning and completion of the exercise program and included: isokinetic peak torque (ISOKPT, at 60 degrees/sec angular velocity) and total work performed of four contractions (ISOKTW), isometric peak torque (MVC), endurance (EDUR, time subject could hold isometric contraction at 40% of the initial MVC), isometric tension time index (TTI, product of endurance time and torque at 40% of MVC), and initial and final ankle weight (WGT, kg) lifted. Electromyographic variables included: fiber density (FD), jitter (MCD), and blocking (BLK) from single fiber assessment and median macro amplitude (MACRO). Serum creatine kinase (CK) was also measured initially and at 4-week intervals throughout the study.

RESULTS: The following variables significantly (p < .05) increased: WGT by 47%, ISOKPT, 15%, ISOKTW, 15%; MVC, 36%; EDUR, 21%; TTI, 18%. The following variables did not significantly (p > .05) change: FD, MCD, BLK, MACRO, and CK.

Conclusions: This home exercise program significantly increased strength, endurance, and TTI without apparently adversely affecting the motor units or the muscle, as the EMG and CK variables did not change.

Outcome of Research: Effective

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Category: Diagnosis and Management

Title: Stroke Risk in Poliomyelitis Survivors: A Nationwide Population-Based Study
Author: Wu C-H, Liou T-H, Chen H-H, Sun T-Y, Chen K-H, Chang K-H
Affiliation: Wu, Sun, KH Chang: Chung-Yuan Christian University
Liou: Shuang Ho Hospital and Taipei Medical University, Taipei
HH Chen; Chang: Wan Fang Hospital
Chang: Taipei Medical University, Taipei
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 93, Issue 12, Pages 2184–2188
Publication Year and Month: 2012 12

Abstract: Objectives
To assess the prevalence and risk of stroke among adults with polio and controls.

Design
A prospective, probability-sampling, 6-year population-based cohort study.

Setting
A National Health Insurance Research Database consisting of 316,355 randomly selected enrollees. The database is related to a National Health Insurance program with more than 22 million participants.

Participants
After excluding patients under 40 years of age, polio patients (N=212) (mean age ± SD, 54.0±10.2y; 57.1% men) were identified from the database from January 1, 2003 to December 31, 2008. For each polio patient, 2 age- and sex-matched patients were recruited as controls. Control patients did not have any neuromuscular diseases commonly found in childhood. The frequencies of patients with potential risk factors for stroke were assessed.

Intervention
None.

Main Outcome Measure
The prevalence and the adjusted odds ratio of ischemic stroke among polio patients and the controls were estimated.

Results
Polio patients had a higher prevalence of stroke (10.8% vs 2.4%, P<.001) than the controls. Polio patients with hypertension had a much higher prevalence of stroke (23.0%). The risk of stroke was higher for polio patients compared with the controls, yielding an adjusted odds ratio of 4.17 (95% confidence interval, 1.84–9.45, P<.001). Polio was a significant risk factor for stroke independent from hypertension, diabetes mellitus, hyperlipidemia, and cardiac diseases.

Conclusions
Adults with polio had a high prevalence of ischemic stroke. Polio was an additional risk factor for stroke. Polio patients with hypertension might potentiate the risk of stroke. Developing a health promotion program, suitable for polio patients, to increase participation in activities and exercises may be essential, especially for polio patients with hypertension.

Conclusions:

Outcome of Research: Effective

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Category: Women's Health

Title: Successful Use of Succinylcholine for Cesarean Delivery in a Patient with Postpolio Syndrome [letter to the Editor]
Author: Connelly NR, Abbott TC.
Affiliation: Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts.
Journal: Anesthesiology
Citation: Anesthesiology 6 2008, Vol.108, 1151-1152. doi:10.1097/ALN.0b013e318173eb78
Publication Year and Month: 2008 06

Abstract: There have been a few reports over the years using succinylcholine in patients with pathology similar to that seen in PPS. For example, succinylcholine-induced hyperkalemia and circulatory collapse were reported in a patient with acute idiopathic anterior horn cell disease4; the serum potassium during this cardiac arrest was 7.9 mEq/l. Another study of denervated baboons found an increase in intravascular potassium up to 5.5 mEq/l.5 PPS is similar in pathophysiology to the baboon denervation study, and one could assume that hyperkalemia could also be seen in PPS patients. There have been numerous reports of hyperkalemia in patients with neuromuscular disease.4–8 It would have been informative to have had the prepotassium and postpotassium measurements from the patient in the report of Wernet et al. 1 to determine the magnitude and time frame of the increase of serum potassium.
The avoidance of neuraxial anesthesia was also discussed by Wernet et al. Successful neuraxial anesthesia in patients with PPS has been reported without adverse complications.9,10 Many clinicians provide regional anesthesia for labor and delivery in patients with a history of PPS.11
If general anesthesia needs to be induced, the potential hazard of using succinylcholine in patients with PPS has been acknowledged.12 If the need for rapid sequence induction exists in a PPS patient, we believe one should choose a short-acting nondepolarizing muscle relaxant in lieu of succinylcholine; the only caveat would be to consider using a decreased dose because of the increase risk of muscular weakness.13
The mere fact that succinylcholine was used in the current case does not preclude the possible occurrence of severe, acute hyperkalemia in subsequent cases in patients with PPS.

Conclusions: We do not believe that one can conclude from this single case that succinylcholine should be used in patients with PPS.

Outcome of Research: Effective

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Category: Sleep

Title: Transcranial direct current stimulation (tDCS) for sleep disturbances and fatigue in patients with post-polio syndrome
Author: Acler M (1), Bocci T, Valenti D, Turri M, Priori A, Bertolasi L
Affiliation: (1) Sezione di Neurologia, Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy
Journal: Restorative Neurology and Neuroscience
Citation: Restor Neurol Neurosci. 2013;31(5):661-8. doi: 10.3233/RNN-130321
Publication Year and Month: 2013

Abstract: PURPOSE: Post-polio syndrome develops about 20-40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Here, we assessed whether transcranial direct current stimulation (tDCS) improves sleep and fatigue symptoms in patients with post-polio syndrome.

METHODS: We enrolled 32 patients with a diagnosis of post-polio syndrome. tDCS (1.5 mA, 15 min) was delivered by a direct current stimulator connected to three electrodes: two anodal electrodes on the scalp over the right and left pre-motor cortex and the other above the left shoulder (cathode). 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (daily for five days a week, for three weeks) on clinical scales (Short Form Health Survey [SF-36], Piper Fatigue Scale [PFS], Fatigue Severity Scale [FSS], 101-Point Numerical Rating [PNR-101], Hamilton Rating Scale for Depression [HRSD], Pittsburgh Sleep Quality Index [PSQI]) at baseline (T0) and three weeks later (T1).

RESULTS: At T1 SF-36 sub-items physical functioning, role physical, vitality, social functioning and role emotional improved significantly more in patients who received tDCS (p < 0.01) than in sham-treated patients. Also, PSQI scores improved more in treated patients (p < 0.05, two-way ANOVA with "stimulation" and "time" as factors: p < 0.01). tDCS-induced benefits were more pronounced in patients who were younger at primary infection (p < 0.05).

Conclusions: Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.

Outcome of Research: Effective

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Category: Surgery

Title: Ultrasound-Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient With Postpolio Syndrome: A Case Report
Author: Troy Henning DO, Daniel Lueders MD, Kate Chang, Lynda Yang MD
Affiliation: Swedish Medical Group, Swedish Spine, Sports and Musculoskeletal Medicine, 1600 E. Jefferson Street, Suite 300, Seattle, WA 98122
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM&R Volume 10, Issue 10, October 2018, Pages 1115-1118

Publication Year and Month: 2018 10

Abstract: The prevalence of carpal tunnel syndrome (CTS) in patients with postpolio syndrome occurs at a rate of 22%. Irrespective of those with CTS, 74% of postpolio patients weight bear through their arms for ambulation or transfers. As open carpal tunnel release is performed along the weight-bearing region of the wrist, their functional independence may be altered while recovering. This case demonstrates that ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.

Conclusions: Ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.

Outcome of Research: Effective

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There are currently 42 research papers whose outcomes are rated as “effective”.

Category: Activity Levels

Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Diagnostics, 11 September 2018
Publication Year and Month: 2018 09

Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.

Conclusions:

Outcome of Research: More research required

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Category: Complementary Therapies

Title: A randomized controlled trial of coenzyme Q10 for fatigue in the late-onset sequelae of poliomyelitis
Author: Peel MM (1), Cooke M (1), Lewis-Peel HJ (1), Lea RA (2), Moyle W (1)
Affiliation: (1) NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia; (2) Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Journal: Complementary Therapies in Medicine
Citation: Complementary Therapies in Medicine 23 (2015), pp. 789-793; DOI information: 10.1016/j.ctim.2015.09.002

Publication Year and Month: 2015 12

Abstract: OBJECTIVE: To determine if coenzyme Q10 alleviates fatigue in the late-onset sequelae of poliomyelitis.

DESIGN: Parallel-group, randomized, placebo-controlled trial.

BACKGROUND SETTING: Coenzyme Q10 has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue.

PARTICIPANTS: Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded.

METHOD: Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q10 or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome.

RESULTS: Of 103 participants, 54 were assigned to receive coenzyme Q10 and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q10 was safe and well-tolerated.

The registration number for the clinical trial is ACTRN 12612000552886.

Conclusions: A daily dose of 100 mg coenzyme Q10 for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis.

Outcome of Research: More research required

Availability of Paper: Paid subscription required to view or download full text.

Comments (if any): The results of this trial were found to be inconclusive.

Separately, a review on muscle pain associated with statin medication (reference below) discussed the challenges differentiating muscle pain, eliciting changes at the mitochondria (“powerhouse” of muscle cells) from Co-enzyme Q10 and the interactions diet can have in producing the changes. Interestingly, the author also questioned the dosage often used in studies of 100mg (including this one) may not be sufficient to create the change from the supplement. This highlights the need for further research, and potentially re-visiting previous studies that looked at co-enzyme Q10 supplementation.
Taylor, BA. Does Coenzyme Q10 Supplementation Mitigate Statin-Associated Muscle Symptoms? Pharmacological and Methodological Considerations. Am J Cardiovasc Drugs. 2018;18(2):75-82.

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Category: Polio Immunisation

Title: A systematic review of the worldwide prevalence of survivors of poliomyelitis reported in 31 studies
Author: Kelly M Jones, Shivanthi Balalla, Alice Theadom, Gordon Jackman, Valery L Feigin
Affiliation: National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland, New Zealand
Polio New Zealand Inc., New Plymouth, New Zealand
Correspondence to
Dr Kelly M Jones; [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: BMJ Open 2017;7:e015470. doi: 10.1136/bmjopen-2016-015470
Publication Year and Month: 2017

Abstract: Background Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis.

Methods Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates.

Results Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years.

Conclusions: These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates.

Outcome of Research: More research required

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Category: Surgery

Title: A Two-Stage Foot Repair in a 55-Year-Old Man with Poliomyelitis
Author: Daniel Pollack
Affiliation: Department of Podiatric Surgery, Wyckoff Heights Medical Center, 374 Stockholm Ave, Brooklyn, NY;Madison Podiatry, 52 Skyline Drive, Ringwood, NJ 07456
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of the American Podiatric Medical Association Volume 108, Issue 1 (January 2018)
Publication Year and Month: 2018 01

Abstract: A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub–first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure. The second stage corrected the osseous deformity with a dorsiflexory wedge osteotomy of the first metatarsal. The ulceration has remained closed since the procedures, with complete resolution of pain.

Conclusions:

Outcome of Research: More research required

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Category: Pain

Title: Activity pacing in chronic pain: concepts, evidence, and future directions
Author: Nielson WR, Jensen MP, Karsdorp PA, Vlaeyen JW.
Affiliation: St Joseph's Health Care London, Lawson Research Institute, London, ON, Canada. [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The Clinical Journal of Pain, 2013 May;29(5):461-8. doi: 10.1097/AJP.0b013e3182608561
Publication Year and Month: 2013 05

Abstract: BACKGROUND:
Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.

OBJECTIVE:
To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.

METHODS:
A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.

RESULTS:
The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.

Conclusions: DISCUSSION:
Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.

Outcome of Research: More research required

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Category: Pain

Title: Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis.
Author: Andrews NE, Strong J, Meredith PJ.
Affiliation: Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia. [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 2012 Nov;93(11):2109-2121.e7. doi: 10.1016/j.apmr.2012.05.029
Publication Year and Month: 2012 11

Abstract: OBJECTIVE:
To systematically review the associations between different approaches to activity (ie, activity pacing, avoidance, or endurance) and indicators of patient functioning in chronic pain samples.

DATA SOURCES:
A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011.

STUDY SELECTION:
To be included, studies had to (1) be written in English, (2) report on an adult chronic pain sample, and (3) report a correlation coefficient between at least 1 measure of 1 of the 3 "approach to activity" variables and an indicator of patient functioning.

DATA EXTRACTION:
Two reviewers independently screened abstracts and full-text articles for eligibility and extracted the data. Results of correlation analyses were grouped on the basis of measure of approach to activity (pacing/avoidance/endurance) and the criterion variable measured (pain/physical functioning/psychological functioning), resulting in 9 categories. Random-effects modeling was then used to pool data across studies in each category.

DATA SYNTHESIS:
Forty-one studies were eligible for inclusion. Results demonstrated that avoidance of activity was consistently associated with more pain, poorer psychological functioning, and more physical disability. While enduring with activity was associated with enhanced physical and psychological functioning, these relationships appeared to be dependent on the measure used, with measures more reflective of persisting with activities to the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing was generally linked to better psychological functioning but more pain and disability.

Conclusions: Although causation cannot be determined, results of this study suggest that both avoidance of activity and overactivity are associated with poorer patient outcomes. Unexpected results relating to pacing may reflect either the ineffectiveness of pacing if not used to gradually increase an individual's activity level or the notion that individuals with better psychological functioning but more pain and disability are more inclined to pace activity.

Outcome of Research: More research required

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Category: Anaesthesia

Title: Anesthetic considerations for patients with postpolio syndrome: a case report.
Author: Wheeler D
Affiliation: Little Rock Anesthesia Services, Little Rock, Arkansas, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: AANA J. 2011 Oct;79(5):408-10.
Publication Year and Month: 2011 10

Abstract: Postpolio syndrome is a disorder related to the recurrence of neuromuscular symptoms in survivors of paralytic poliomyelitis. A comprehensive understanding of the pathophysiology is necessary for the anesthesia provider to develop a safe anesthetic plan. This case report discusses the anesthetic challenges and considerations in patients with postpolio syndrome, focusing on the importance of careful pharmacologic dosing of opioids, and neuromuscular agents as well as perioperative and postoperative issues related to aspiration risks, cold intolerance, and positioning.

Conclusions:

Outcome of Research: More research required

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Category: Orthoses

Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China

Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China

Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Mechatronics Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08

Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.

Conclusions:

Outcome of Research: More research required

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Category: Polio Immunisation

Title: Applying the concept of peptide uniqueness to anti-polio vaccination
Author: Kanduc D (1), Fasano C (1), Capone G (1), Pesce Delfino A (2), Calabrò M (2), Polimeno L (2)
Affiliation: (1) Department of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, 70126 Bari, Italy; (2) Department of Emergency and Organ Transplantation (DETO), University of Bari, 70124 Bari, Italy
Journal: Journal of Immunology Research
Citation: J Immunol Res. 2015;2015:541282. Epub 2015 Oct 19
Publication Year and Month: 2015 10

Abstract: BACKGROUND: Although rare, adverse events may associate with anti-poliovirus vaccination thus possibly hampering global polio eradication worldwide.

OBJECTIVE: To design peptide-based anti-polio vaccines exempt from potential cross-reactivity risks and possibly able to reduce rare potential adverse events such as the postvaccine paralytic poliomyelitis due to the tendency of the poliovirus genome to mutate.

METHODS: Proteins from poliovirus type 1, strain Mahoney, were analyzed for amino acid sequence identity to the human proteome at the pentapeptide level, searching for sequences that (1) have zero percent of identity to human proteins, (2) are potentially endowed with an immunologic potential, and (3) are highly conserved among poliovirus strains.

RESULTS: Sequence analyses produced a set of consensus epitopic peptides potentially able to generate specific anti-polio immune responses exempt from cross-reactivity with the human host.

Conclusions: Peptide sequences unique to poliovirus proteins and conserved among polio strains might help formulate a specific and universal anti-polio vaccine able to react with multiple viral strains and exempt from the burden of possible cross-reactions with human proteins. As an additional advantage, using a peptide-based vaccine instead of current anti-polio DNA vaccines would eliminate the rare post-polio poliomyelitis cases and other disabling symptoms that may appear following vaccination.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

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Category: Post-Polio Motor Unit

Title: Are the nonparalytic muscles of polio survivors free from the risk of post-polio syndrome?
Author: K.Sawada, M.Horii, D.Imoto, Y.Mikami, T.Kubo
Affiliation: Kyoto Prefectural University of Medicine, Department of Rehabilitation Medicine, Kyoto, Japan
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 61, Supplement, July 2018, Page e263
Publication Year and Month: 2018 07

Abstract: Introduction/Background
The aim of this study was to reveal the relation between the neurogenetic change in the nonparalytic muscles in upper and lower limbs of Polio survivors and the later muscle strength decline.

Material and method
Retrospective study. We looked back the data of electromyography (EMG) of Polio survivors in our Polio clinic (average age: 58.9). Muscles whose strength at EMG had been normal were extracted. We looked up the muscle strength at EMG time and two years later from medical record.

Results
The subjects were 23 deltoid (middle strand), 40 biceps branchii, 36 triceps branchii, 24 vastus lateralis, 19 tibialis anterior, and gastrocnemius (medial head). The ratio of neurogenic change subject (giant spike or interference pattern reduction) was, 30.4%, 25.0%, 36.1%, 62.5%, 47.4%, and 73.7%, respectively. In neurogenic change group of Biceps, 50.0% showed decline in their muscle strength. In non-neurogenic change group of Deltoid, 25.0% showed decline in their muscle strength.

Conclusions: Conclusion
Present study suggested that some muscle strength decline may be caused by Post-polio syndrome (PPS), and that EMG might be the most useful tool for the risk detection of PPS, especially for Biceps branchii. On the other hand, the fact that 25% of Deltoid non-neurogenic change group showed muscle strength decline was not understood in this study. Pain or disuse from disorder in shoulder joint might possibly be as a cause.

Outcome of Research: More research required

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Category: Drugs

Title: Beneficial Effect of Medical Cannabis in the Treatment of a Pharmacoresistant Nausea Associated with a Somatoform Disorder in a Patient with Post-Polio Syndrome
Author: Markus Bleckwenn, Klaus Weckbecker, Sebastian Voss
Affiliation: Markus Bleckwenn  Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Klaus Weckbecker  Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Sebastian Voss  Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Dtsch Med Wochenschr. 2018 Mar;143(5):344-348
Publication Year and Month: 2018 03

Abstract: HISTORY AND CLINICAL FINDINGS:
We report a 79-year-old patient with post-polio syndrome (PPS). In the course of this disease, recurrent upper abdominal pain and a therapy-resistant nausea developed without vomiting. In addition, the patient was limited by the combination of muscular weakness, obesity, dietary-treated diabetes and a degenerative spinal cord injury significantly in its mobility and physical capacity.

INVESTIGATIONS AND DIAGNOSIS:
Despite extensive diagnostics, no somatic cause could be found neither for the nausea nor for the upper abdominal pain. Due to the psychological stress within the scope of the PPS, the development of a somatoform autonomic function disorder of the upper gastrointestinal tract may have occurred.

TREATMENT AND COURSE:
Even under combination therapy of antiemetic and pain-modulating drugs, no adequate symptom control could be achieved. In the absence of therapy alternatives and increasing psychological strain the patient was prescribed medical cannabis. Under the therapy there was a relief of the nausea symptoms and decreased pain.

Conclusions: CONCLUSION:
Cannabis is a treatment option for treatment-resistant symptoms as part of a PPS.

Outcome of Research: More research required

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Category: Respiratory Complications and Management

Title: Bi-level positive airway pressure ventilation maintains adequate ventilation in post-polio patients with respiratory failure.
Author: Gillis-Haegerstrand C, Markström A, Barle H.
Affiliation: Department of Anaesthesiology and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Acta Anaesthesiologica Scandinavica 2006 May;50(5):580-5
Publication Year and Month: 2006 05

Abstract: BACKGROUND:
Patients suffering from post-polio syndrome still contribute significantly to the number of patients with chronic respiratory failure requiring home mechanical ventilation (HMV). Many of these patients are treated either with invasive (tracheostomy) or non-invasive (nasal mask) controlled mechanical ventilation i.e. volume-controlled ventilation (VCV). In this group of patients, we have previously shown that bi-level pressure support ventilation (bi-level PSV) decreases the oxygen cost of breathing. The aim of this study was to compare the effect of bi-level PSV, with special regard to the adequacy of ventilation and the oxygen cost of breathing, during the patients' ordinary VCV and spontaneous breathing.

METHODS:
Eight post-polio patients on nocturnal VCV were investigated. Five of them were tracheostomized and three of them used a nasal mask. Work of breathing was analysed by assessing differences in oxygen consumption (VO2) using indirect calorimetry. Blood gases were obtained regularly to assess adequacy of ventilation.

RESULTS:
Bi-level PSV decreases the oxygen cost of breathing in post-polio patients with respiratory failure without decreasing ventilation efficiency. Furthermore, PaCO2 decreased significantly using this mode of ventilation (P < 0.05).

Conclusions: In this study, it was shown that bi-level PSV reduces the oxygen cost of breathing and gave a significant decrease in PaCO2 in PPS patients. These data suggest that bi-level PSV ventilation maintains adequate ventilation in patients who suffer from post-polio syndrome with respiratory failure.

Outcome of Research: More research required

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Category: Orthoses

Title: Biomechanical abnormalities of post-polio patients and the implications for orthotic management.
Author: Perry J, Clark D
Affiliation: Rancho Los Amigos Medical Center, 7601 East Imperial Highway, Bldg. 304, Downey, CA 90242, USA.
Journal: NeuroRehabilitation
Citation: 1997;8(2):119-38
Publication Year and Month: 1997

Abstract: Muscle weakness resulting from the combined effects of acute and late motor neuron pathology is the basic cause of post-polio dysfunction. Through their normal sensation and moter control, post-polio patients minimize their disability by useful substitutions. Orthoses are needed only when these substitutions either are inadequate or result in muscle or joint overuse. The areas most commonly showing late disability are the lower extremities, shoulders and low-back. In the lower extremities, the major muscle groups are the hip extensors and abductors, the knee extensors (quadriceps), ankle plantar flexors and dorsi flexors. Each group has a specific function which relates to one of the basic tasks of walking, weight acceptance, single limb support and swing. To determine orthotic needs, polio gait deviations representing useful substitutions must be differentiated from symptomatic dysfunction. Weight acceptance utilizes the quadriceps, hip extensors and hip abductors to establish a stable limb and provide shock absorbing mechanics. Substitutions to preserve weight bearing stability include sacrifice of normal shock absorbing knee flexion for quadriceps weakness, backward or lateral trunk lean for hip extensor and abductor weakness. Knee pain, excessive hyperextension and flexion contractures are indications for orthotic assistance with a KAFO. Orthotic designs relate to the type of knee joint (off-set, free, locked) and completeness of the AFO component. Low-back pain from hip substitutions or over use of the hip muscles requires a walking aid. Single limb support is the period when the limb and body advance over the supporting foot. The key muscle group is the soleus-gastrocnemius complex. Swing involves lifting and advancing the unloaded limb. While all three joints flex simultaneously, the hip flexors and ankle dorsi flexors are the critical muscles. A drop foot from ankle dorsiflexor weakness is the common disability. Excessive hip flexion is the usual substitution.

Conclusions: An orthosis which assists dorsiflexion without obstructing loading response plantar flexion is the most functional design.

Outcome of Research: More research required

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Category: Falls and Bone Density

Title: Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio
Author: Beth Grill PT, DPT, NCSa, Pamela K. Levangie PT, DSc, DPT, FAPTA, Maria ColeOTR/L, Darren Rosenberg DO, Leah Jensen PT, DPT
Affiliation: Spaulding Outpatient Center Framingham, MA

MGH Institute of Health Professions, Boston, MA; and 500 Lexington Street, Unit 3, Woburn, MA 01801

Spaulding Outpatient Center Framingham, MA

Spaulding Outpatient Center Framingham, MA

Spaulding Outpatient Center Framingham, MA
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Available online 7 September 2018
Publication Year and Month: 2018 09

Abstract: Background
Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) deficiencies related to muscle weakness. Where weakness is asymmetrical, bone densitometry (BDt) measured only on the stronger LE may misclassify BMD.

Objective
To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck.

Design
Retrospective study.

Setting
Outpatient postpolio center.

Participants
Patients >18 years old with complete relevant data.

Main Outcome Measures
BDt T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score.

Results
Forty-three subjects had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had BDt only on their weaker LE and 14 (32.5%) had BDt only on their stronger LE. Of the 15 subjects with BDt done on both femoral necks, T scores (mean [standard deviation]) were lower in the weaker LE (–1.73 [1.09]) than the stronger LE (–0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively).

Conclusions: In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group.

Outcome of Research: More research required

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Category:

Title: Cancer risk in a cohort of polio survivors
Author: Neilsen NM, Wohlfahrt J, Aaby P, et al.
Affiliation: Department of Epidemiology, National University, Copenhagen, Denmark
Department of Infectious Diseases, National University, Copenhagen, Denmark
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: International Journal of Cancer (2001). 92, pp.605–608
Publication Year and Month: 2000 11

Abstract: Poliomyelitis has hypothetically been associated with an increased risk of central nervous system (CNS) tumors. The present study was performed to examine not only the risk of CNS tumors but also the overall risk of cancer among a cohort of 5,883 polio patients. Patients diagnosed with acute poliomyelitis in the Danish capital, Copenhagen, between 1919 and 1954 were identified and followed with respect to cancer.

Information on vital status and cancer diagnoses was obtained through linkage with the Danish Civil Registration System and the Danish Cancer Registry, respectively. The ratio of observed number of cancers to the number expected from population-based incidence rates, i.e., the standardized incidence ratio (SIR), served as measure of the relative cancer risk.

Overall, 717 cases of cancer were observed among 5,883 polio patients during 249,084 person-years of follow-up vs. an expected number of 645 (SIR 5 1.11 [95% confidence
interval 1.03 to 1.20])). The increased risk was restricted to female polio patients (SIR 5 1.18 [1.07 to 1.30]), among whom the risk was particularly high for breast cancer (SIR 5 1.35 [1.12 to 1.61]) and for skin cancer (SIR 5 1.66 [1.32 to 2.07]). The risk of breast cancer was highest among women with a history of paralytic polio (SIR 5 1.62 [1.24 to 2.10]). The observed number of CNS tumors did not exceed the expected (SIR 5 1.09 [0.72 to 1.60]).

Women diagnosed with poliomyelitis, in particular paralytic polio, may be at increased risk of breast cancer. There was no association between malignancies of the CNS and poliomyelitis.

Conclusions:

Outcome of Research: More research required

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Category: Exercise

Title: Cardiorespiratory responses to upper extremity aerobic training by postpolio subjects
Author: Kriz, J.L., Jones, D.R., Speier, J.L., Canine, J.K., Owen, R.R., Serfass, R.C.
Affiliation: Sister Kenny Institute
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Kriz, J.L., Jones, D.R., Speier, J.L., Canine, J.K., Owen, R.R., Serfass, R.C. (1992) Cardiorespiratory responses to upper extremity aerobic training by postpolio subjects. Arch Phys Med Rehabil. 73(1): 49-54
Publication Year and Month: 1992 01

Abstract: The cardiorespiratory responses of ten postpolio subjects participating in a 16-week upper extremity aerobic exercise program were compared to ten non-exercised controls. The subjects trained three times a week for 20 minutes per session. Exercise intensity was prescribed at 70% to 75% of heart rate reserve plus resting heart rate. Dependent variables were resting heart rate, maximal heart rate, resting and immediate-post-exercise systolic and diastolic blood pressures, maximal oxygen consumption, maximal carbon dioxide production, minute ventilation, respiratory exchange ratio, power, and exercise time. After training, the exercise group was superior to the control group in oxygen consumption, carbon dioxide production, minute ventilation, power, and exercise time. There was no reported loss of muscle strength. It was concluded that postpolio subjects can safely achieve an increase in aerobic capacity with a properly modified upper extremity exercise program. This improvement is comparable to that demonstrated by able-bodied adults.

Conclusions: Postpolio subjects can safely achieve an increase in aerobic capacity with a properly modified upper extremity exercise program. This improvement is comparable to that demonstrated by able-bodied adults.

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: Changes in macro electromyography over time in patients with a history of polio: a comparison of 2 muscles.
Author: Sandberg A, Stalberg E
Affiliation: Department of Clinical Neurophysiology, Uppsala University Hospital, ing 85, 3 tr., S-751 85 Uppsala, Sweden.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 2004 Jul;85(7):1174-82.
Publication Year and Month: 2004 07

Abstract: OBJECTIVE:
To investigate whether changes over time are different in a weight-bearing leg muscle than in a less heavily used arm muscle.

DESIGN:
Prospective study.

SETTING:
University hospital laboratory.

PARTICIPANTS:
Twenty-three patients with a history of poliomyelitis.

INTERVENTION:
Two investigations were performed 5 years apart, using macro electromyography and the patients' own assessments of symptoms in the tibial anterior and the biceps brachii muscles. Test-retest of macro electromyography was performed in controls and in patients with old polio.

MAIN OUTCOME MEASURES:
Macro motor unit potential (MUP) and symptoms in the tibial anterior and biceps brachii over time.

RESULTS:
The macro MUP amplitude increased by 24% (P<.05) in the tibial anterior but was unchanged in the biceps brachii muscle.

Conclusions: CONCLUSIONS:
An increase in the macro MUP amplitude of the tibial anterior muscle, but not of the biceps brachii, most likely indicates a more pronounced ongoing denervation-reinnervation process over time in the tibial anterior. This difference could be activity dependent, but other factors cannot be excluded.

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Category: Fatigue

Title: Circadian fatigue or unrecognized restless legs syndrome? The post-polio syndrome model
Author: Romigi A, Maestri M
Affiliation: Neurophysiopathology Unit, Department of Systems Medicine, Sleep Medicine Centre, Tor Vergata University and Hospital , Rome , Italy ; IRCCS Neuromed , Pozzilli , Italy; Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy.
Journal: Frontiers in Neurology
Citation: Front Neurol. 2014 Jul 7;5:115. doi: 10.3389/fneur.2014.00115
Publication Year and Month: 2014 07

Abstract: This paper does not have an abstract.

Conclusions:

Outcome of Research: More research required.

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Category: Complementary Therapies

Title: Clinical neurological and tongue inspection according to Traditional Chinese Medicine (TCM) – evaluation of post polio syndrome patients
Author: Abe, G.C., Ramos, P.E., da Silva, B.L., Quadros, A.J., Oliveira, A.S.B.
Affiliation: Universidade Federal de São Paulo, Neurologia e Neurocirurgia, São Paulo - SP, Brazil
Journal: Journal of the Neurological Sciences
Citation: Volume 381, Supplement, 15 October 2017, Pages 199-200

Publication Year and Month: 2017 10

Abstract: Objective: To describe tongue characteristics of PPS patients relating to neurology.

RESULTS
89 individuals were evaluated within a 12 month period, 61 (68,5%) females, 28(31,5%)males, aged from 32–57 years old (mean = 46). The most frequent characteristics were: decreased moisture (52.5%); thick whitish coating (60.7%); red color (46,1%), and normal movement (49.4%). The enlarged size (40.4%) prevailed over the small/thin size (15.7%). The presence of “other findings” (OF) was over 70%.

Conclusions: Conclusion: The frequency of enlarged size associated to minor normal characteristics in OF and in tongue coating suggests that the group has a less marked impairment within the natural history of PPS.

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: CMAP scan and scanning EMG in the same muscle: Two cases with post-polio muscular atrophy
Author: Mehmet Baris Baslo, Nermin G.Sirin, EmelOguz-Akarsu, ElifKocasoy-Orhan, BaharErbas, ImranGoker, TugrulArtugAli EmreOge
Affiliation:
Journal: Clinical Neurophysiology
Citation: Volume 129, Supplement 1, May 2018, Page e32

Publication Year and Month: 2018 05

Abstract: Post-polio muscular atrophy (PPMA) is characterized by new onset or increased weakness in patients with prior poliomyelitis after a stable period of time. Loss of highly reinnervated motor units during ageing has been accused for the development of this syndrome which is also known as “unstable-polio”. These patients have less number of motor units that can be estimated by conventional electrophysiological methods. By showing the large steps, CMAP scan provides information about the amount of collateral reinnervation in the construction of total muscle response (CMAP). As well as the number of motor units, their territory is also an object of curiosity. It is possible to record bioelectrical activity of motor unit lengthwise by scanning EMG and depict the temporal and spatial features of motor unit action potential (MUAP). This presentation aims to combine the findings in CMAP scan with scanning EMG and draw attention to reinnervation status of 2 PPMA patients whose tibialis anterior (TA) muscles were affected in different degrees.

Methods
Two patients aged 39and 41 years were included. Patient 1 had PPMA for 8 years and his TA muscle strength was 3-/5, whereas Patient 2 showed PPMA findings for 1 year and his TA strength was 4/5. CMAP scan of TA muscle on recently affected side was performed with a commercially available software. In scanning EMG, MU territories were scanned with a concentric needle electrode (CNE) which is attached to a stepper motor. Another CNE is used for sweep triggering with the rate of selected motor units’ firing frequency. Acquired signals were processed by the dedicated software designed by the authors.

Results
CMAP scan of Patient 1 revealed a 1.65 mV CMAP constituting of 4 very large steps and Patient 2 revealed a 5.5 mV CMAP containing a few smaller steps. In scanning EMG, both patients’ motor units showed increased voltage in different parts corresponding to dense areas arisen from collateral reinnervation. Interestingly, the patient with more pronounced weakness for a longer period revealed both huge steps in his CMAP scan and also showed electrically silent areas in his scanned motor units. On the other hand, the patient with stronger TA muscle did not show very large steps or silent areas in his CMAP scan and MU scan, respectively.

Conclusions: Loss of dense motor units leads to PPMA. However, in PPMA patients with severe weakness which is depicted by less number of motor units and presence of huge steps in CMAP scan, loss of fractions in motor unit territory might be a principal contributing factor which can only be demonstrated by scanning EMG.

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Category: Ageing

Title: Cognitive Behavior Therapy combined with Exercise for Adults with Chronic Diseases: Systematic
Review and Meta-Analysis
Author: Bernard P, Romain AJ, Caudroit J, Chevance G, Carayol M, Gourlan M, Dancause KN, Moullec G
Affiliation: Université du Québec à Montréal, Montréal, Quebec , Canada.
Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
Laboratory Epsylon, Dynamics of Human Abilities and Health Behavior, University of Montpellier,
Montpellier, France.

Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Health psychology : official journal of the Division of Health Psychology, American Psychological Association, May 2018, Vol.37(5), pp.433-450
Publication Year and Month: 2018 05

Abstract: Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise).
Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials.
Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes.

Conclusions: Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing
depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.

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Category: Respiratory Complications and Management

Title: Comparison of activity and fatigue of the respiratory muscles and pulmonary characteristics between post-polio patients and controls: A pilot study
Author: David Shoseyov, Tali Cohen-Kaufman, Isabella Schwartz, Sigal Portnoy,
Affiliation: Pediatric department, Hadassah Mount Scopus, Jerusalem, Israel
Physical Medicine and Rehabilitation department, Hadassah Mount Scopus, Jerusalem, Israel
Department of Physiotherapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
National Yang-Ming University, TAIWAN
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: PLoS One. 2017; 12(7): e0182036.
Publication Year and Month: 2017 07

Abstract: Objectives
To compare pulmonary function measures, maximal respiratory pressure and fatigue of respiratory muscles between patients with Post-Polio Syndrome (PPS) and controls.

Design
Cross-sectional study.

Patients
Patients with PPS (N = 12; age 62.1±11.6 years) able to walk for 6 minutes without human assistance; age-matched controls with no history of polio or pulmonary dysfunction (N = 12; age 62.2±6.5 years).

Measurements
A body plethysmograph was used to quantify Residual Volume (RV), Total Lung Capacity (TLC), and Thoracic Gas Volume (TGV) etc. A manometer was used to measure Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure. A spirometer was used to measure Maximal Voluntary Ventilation (MVV). Surface electromyography (sEMG) recorded diaphragmatic muscle activity while performing MVV.

Results
The control group had significantly higher TGV and showed improvement in MIP following the effort (difference of 5.5±4.0cmH2O) while the PPS group showed deterioration in MIP (difference of -2.5±5.0cmH2O). Subjects with scoliosis had significantly higher RV/TLC values compared with subjects without scoliosis. The 25th frequency percentile of the sEMG signal acquired during MVV was reduced in the PPS group.

Conclusions: Maximal respiratory pressure test and sEMG measurements may identify fatigue of respiratory muscles in patients with PPS. Early diagnosis of respiratory impairment may delay respiratory decline and future need of invasive respiratory aids.

Outcome of Research: More research required

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Category: Orthoses

Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Gait & Posture, Volume 66, October 2018, Pages 38-44

Publication Year and Month: 2018 10

Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.

Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?

Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.

Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).

Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.

Outcome of Research: More research required

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Category: Assistive Technology, Late Effects of Polio

Title: Coping with a Second Disability: Implications of the Late Effects of Poliomyelitis for Occupational Therapists
Author: Mary Westbrook, Lynette McDowell
Affiliation: Macquarie University, Sydney. Australia
Journal: Australian Occupational Therapy Journal
Citation: 38(2):83 - 91
Publication Year and Month: 2010 08

Abstract: The long term effects of many physical disabilities have only recently begun to be appreciated. For people who have lived for years with what they thought to be stable conditions, the onset of secondary disabilities may be associated with considerable problems and distress. A questionnaire survey of 324 people with poliomyelitis revealed the occurrence of late effects in 94% of respondents. The majority reported increased weakness, pain and fatigue, problems in carrying out daily living activities and difficulties in obtaining appropriate health care. Although occupational therapists were less likely to be consulted than other professionals, they received one of the highest satisfaction ratings from clients.

Conclusions: Discussion of case studies indicates ways in which occupational therapists can provide symptom relief and enable clients to maintain valued roles. As the survival rates of people with disabilities increase there is a need for greater awareness of, and research into, the late effects of disability.

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: Correlation of motor units with strength and spectral characteristics in polio survivors and controls
Author: Rodriguez AA, Agre JC
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School
Journal: Muscle & Nerve
Citation: 1991 May;14(5):429-34.
Publication Year and Month: 1991 05

Abstract: The purpose of this study was to determine whether quantitative motor unit analysis in postpolio individuals correlates with muscle strength, endurance, work capacity, or power spectral characteristics of surface EMG and to determine whether power spectrum differentiates postpolio from control subjects. This study was designed to compare these variables in 34 symptomatic postpolio, 16 asymptomatic postpolio, and 41 control subjects. Quantitative motor unit analysis of the quadriceps femoris muscle was performed using a concentric needle electrode. Isometric knee extension peak torque, endurance (time to exhaustion) at 40% of maximal torque, work capacity (tension time index), and recovery of force through 10 minutes post-exhaustion were determined. Median frequency of the surface power spectrum was determined during the above testing. Power spectrum histograms were compared at the onset and termination of endurance exercise. Motor unit action potential variables did not correlate with isometric peak torque, tension time index, endurance time, recovery of strength, or with median frequency. Surface power spectrum did not differentiate postpolio from control subjects.

Conclusions:

Outcome of Research: More research required

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Category: Ageing

Title: Currents issues in cardiorespiratory care of patients with post-polio syndrome
Author: Marco Orsini, Agnaldo J. Lopes, Fernando S. Guimarães, Marcos R. G. Freitas, Osvaldo J. M.
Nascimento, Mauricio de Sant’ Anna Junior, Pedro Moreira Filho, Stenio Fiorelli, Ana Carolina A. F.
Ferreira, Camila Pupe, Victor H. V. Bastos, Bruno Pessoa, Carlos B. Nogueira, Beny Schmidt,
Olivia G. Souza, Eduardo R Davidovich, Acary S. B. Oliveira, Pedro Ribeiro
Affiliation: Centro Universitário Augusto Motta, Programa de Pós-Graduação em Ciências da Reabilitação, Rio de Janeiro RJ, Brasil
Journal: Arquivos de Neuro-Psiquiatria
Citation: Arq. Neuro-Psiquiatr. vol.74 no.7 São Paulo July 2016
Publication Year and Month: 2016 07

Abstract: Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk.

Method

A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered.

Results and Discussion

Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia.

Conclusions: Conclusion

Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

Outcome of Research: More research required

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Category: Restless Legs Syndrome

Title: Do you have restless leg syndrome? I understood from your eyes
Author: Hatice Kose Ozlece, Volkan Solmaz, Sadık Altan Özal, Yahya Çelik
Affiliation: Department of Neurology Acıbadem Private Hospital Kayseri Turkey
Department of Neurology Private Konak Hospital Sakarya Turkey
Department of Eye Disease Trakya University Medical Faculty Edirne Turkey
Department of Neurology Adatıp Private Hospital Sakarya Turkey
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Sleep and Breathing, pp 1–7
Publication Year and Month: 2018 10

Abstract: Purpose
According to many studies in the literature, there is a strong association between restless leg syndrome and dopaminergic dysfunction. Dopamine is also the major catecholamine in the retina and is also a possible transmitter of the amacrine and interplexiform cells. The aim of this study is to investigate the possible association between RLS and retinal thickness.

Methods
In this study, we included 33 patients who were diagnosed with idiopathic RLS according to the “International RLS Study Group” criteria and 31 healthy subjects. All the patients and controls underwent routine ophthalmologic examination and had spectral-domain optical coherence tomography (OCT) performed. We compared the retinal thickness of the patients and control subjects.

Results
In the RLS group, foveal thickness was thinner then controls. Also, only inferior, superior, and temporal quadrant retina nerve fiber layer (RNFL) thickness were significantly thinner in the RLS group. The parafoveal ganglion cell complex (GCC) in the superior temporal, inferior temporal, inferior nasal quadrant, and perifoveal superior nasal thickness was also significantly thinner in the patient group. Pearson correlation analyses showed that there were statistically significant negative correlations between disease duration and macular GCC and RNFL thickness. Negative correlations were also detected between parafoveal superior, temporal, inferior and nasal macular thickness, parafoveal superior nasal, inferior temporal GCC thickness, and perifoveal superior nasal GCC thickness and disease duration.

Conclusions: According to our results; most retinal layers are thinner in RLS patients, so it can be considered that OCT has a predictive value for progression of RLS.

Outcome of Research: More research required

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Category: Speech Pathology

Title: Dysphonia as the initial presenting symptom in postpolio syndrome: a case report
Author: Ference, T. & Cutler, J.
Affiliation: University of Miami
Journal:
Citation: Research on Chronic Diseases.
Ference, T. & Cutler, J. (2017) Dysphonia as the initial presenting symptom in postpolio syndrome: a case report. Research on Chronic Diseases. 1(1):4-5
Publication Year and Month: 2017 01

Abstract: Post-polio syndrome is a slowly progressive condition that affects polio survivor’s years after their initial infection with polio virus. Individuals with post-polio syndrome suffer from a variety of symptoms that negatively impact their independence and overall happiness, including daily general fatigue (48- 93%), pain (72-91%), respiratory issues (11- 41%), depression (13.45%), and sleep disorders (13-48%). Here, we present a patient with post-polio syndrome who presents with an unusual symptom manifestation of hoarseness.

Conclusions: In treating post-polio syndrome patients with hoarse voice a multidisciplinary team can help maximize and preserve function. Weakness of the abdominal muscles, diaphragm, and laryngeal muscles should be considered in persons with history of polio.

Outcome of Research: More research required

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Category: Exercise

Title: Effect of aquatic exercise training in persons with poliomyelitis disability
Author: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A.
Affiliation:
Journal:
Citation: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A. (1994) Effect of aquatic exercise training in persons with poliomyelitis disability. Sports Medicine, Training and Rehabilitation. 5(1):29-39
Publication Year and Month: 1994 01

Abstract: Aquatic exercise, including swimming, reduces the effect of body weight on limbs and joints. A combination of swimming and specific activities involving resistive devices was used in an attempt to improve strength in persons who had symptomatic weakness related to poliomyelitis. Dynamic muscular force application in selected limb movements and range of motion were measured before and after an 8‐week aquatic exercise intervention. Peak (PF) and average force (AF) were determined in the water using a differential pressure transducer attached to either the hand, foot, or a resistive device. Arm flexion, extension, adduction, abduction, and horizontal adduction and abduction along with combined hip flexion and knee extension were tested for both PF and AF Subjects were randomly assigned to experimental and control groups; complete data were available on nine experimental and four control subjects. PF and AF changes were greater (p ≤ 0.05) for experimental compared with control for right arm flexion (PF, 96 versus 6%) and extension (PR 105 versus ‐15%; AF, 76 versus ‐30%), respectively. Changes were greater (p ≤0.05) in experimental than control for left arm extension (PF, 88% versus 19%) and horizontal abduction (PF, 127% versus ‐21%; AF, 122% versus ‐17%). Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.

Conclusions: Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.

Outcome of Research: More research required

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Comments (if any): Baseline strength measurements and functional outcomes (land-based) would have assisted greatly to determine the benefits of the increased forces produced from this aquatic training.

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Category: Drugs

Title: Effect of intravenous immunoglobulin in patients with post-polio syndrome - an uncontrolled pilot study
Author: Kaponides G, Gonzalez H, Olsson T, Borg K
Affiliation: Department of Public Health Sciences, Division of Rehabilitation Medicine, Stockholm, Sweden - [email protected]

Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2006 Mar;38(2):138-40
Publication Year and Month: 2006 03

Abstract: OBJECTIVE: To analyse changes in muscle strength, physical performance and quality of life during intravenous immunoglobulin (IVIg) treatment in patients with post-polio syndrome.

DESIGN: Open clinical trial.

PATIENTS: A total of 14 patients (6 women, 8 men; mean age 57 years, range 43-67 years) were included in the study.

INTERVENTION: Treatment with 90 g IVIg (30 g daily for 3 days).

MAIN OUTCOME: Muscle strength, measured with dynamic dynamometry, muscle function, by means of performing the 6-minute walk test, and quality of life, analysed by means of the SF-36 questionnaire, were performed before and after treatment.

RESULTS: For quality of life there was a statistically significant improvement for all but one of the 8 multi-item scales of SF-36 when comparing data before and after treatment with IVIg. The multi-item scale most improved was Vitality. There was no significant increase in muscle strength and physical performance.

Conclusions: Data indicate that IVIg may have a clinically relevant effect, with an improvement in quality of life. The effect may be due to a decrease in an inflammatory process in the central nervous system, which earlier has been reported in patients with past-polio syndrome after IVIg treatment. Since a possible placebo effect cannot be ruled out, a randomized controlled study is needed.

Outcome of Research: More research required.

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Category: Drugs

Title: Efficacy of Modafinil on fatigue and excessive daytime sleepiness associated with neurological disorders: a systematic review and meta-analysis
Author: Sheng P, Hou L, Wang X, Wang X, Huang C, Yu M, Han X, Dong Y.
Affiliation: Department of Neurosurgery, Shanghai Institute of Neurosurgery, Military Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
Journal: Public Library of Science
Citation: PLoS One. 2013 Dec 3;8(12):e81802. doi: 10.1371/journal.pone.0081802
Publication Year and Month: 2013 03

Abstract: BACKGROUND: Modafinil is a novel wake-promoting agent approved by the FDA ameliorating excessive daytime sleepiness (EDS) in three disorders: narcolepsy, shift work sleep disorder and obstructive sleep apnea. Existing trials of modafinil for fatigue and EDS associated with neurological disorders provided inconsistent results. This meta-analysis was aimed to assess drug safety and effects of modafinil on fatigue and EDS associated with neurological disorders.

METHODS: A comprehensive literature review was conducted in order to identify published studies assessing the effects of modafinil on fatigue and EDS associated with neurological disorders. Primary outcomes included fatigue and EDS. Secondary outcomes included depression and adverse effects.

FINDINGS: Ten randomized controlled trials were identified including 4 studies of Parkinson's disease (PD), 3 of multiple sclerosis (MS), 2 of traumatic brain injury (TBI) and 1 of post-polio syndrome (PPS). A total of 535 patients were enrolled. Our results suggested a therapeutic effect of modafinil on fatigue in TBI (MD -0.82 95% CI -1.54 - -0.11 p=0.02, I(2)=0%), while a beneficial effect of modafinil on fatigue was not confirmed in the pooled studies of PD or MS. Treatment results demonstrated a clear beneficial effect of modafinil on EDS in patients with PD (MD -2.45 95% CI -4.00 - -0.91 p=0.002 I(2)=14%), but not with MS and TBI. No difference was seen between modafinil and placebo treatments in patients with PPS. Modafinil seemed to have no therapeutic effect on depression. Adverse events were similar between modafinil and placebo groups except that more patients were found with insomnia and nausea in modafinil group.

Conclusions: Existing trials of modafinil for fatigue and EDS associated with PD, MS, TBI and PPS provided inconsistent results. The majority of the studies had small sample sizes. Modafinil is not yet sufficient to be recommended for these medical conditions until solid data are available.

Outcome of Research: More research required.

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Category: Diagnosis and Management

Title: Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study
Author: Atta Abbas Naqvi, Syed Baqir Shyum Naqvi, Fatima Zehra, Ashutosh Kumar Verma, Saman Usmani, Sehrish Badar, Rizwan Ahmad, Niyaz Ahmad
Affiliation: 1.Department of Pharmacy Practice, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
2.Faculty of PharmacyHamdard UniversityKarachiPakistan
3.Applied Economics Research CentreUniversity of KarachiKarachiPakistan
4.Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaMindenMalaysia
5.Institute of Pharmaceutical Sciences, Jinnah Sindh Medical UniversityKarachiPakistan
6.Natural Products and Alternative Medicines, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
7.Department of Pharmaceutics, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Applied Health Economics and Health Policy, December 2018, Volume 16, Issue 6, pp 871–888
Publication Year and Month: 2018 12

Abstract: 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.

Conclusions: 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.

Outcome of Research: More research required

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Category: Late Effects of Polio

Title: Experiences and perspectives of patients with post-polio syndrome and therapists with exercise and cognitive behavioural therapy
Author: Minne Bakker, Karen Schipper, Fieke S. Koopman, Frans Nollet and Tineke A. Abma
Affiliation: Department of Medical Humanities, EMGO+ Institute, VU Medical Center
(VUmc), Amsterdam, The Netherlands
Journal: BioMed Central Neurology
Citation: BMC Neurology (2016) 16:23
Publication Year and Month: 2016

Abstract: Background: Many persons affected with poliomyelitis develop post-polio syndrome (PPS) later in their life.
Recently, the effectiveness of Exercise Therapy (ET) and Cognitive Behavioural Therapy (CBT) for PPS has been evaluated in a randomized controlled trial, but did not show a decrease in fatigue or improvement in secondary endpoints like Quality of Life and self-perceived activity limitations. The aim of this explorative study was to gain insight in the perceived effects and experiences of the interventions from the perspectives of the patients and
therapists.
Methods: Qualitative data were collected through semi-structured interviews with 17 patients and 7 therapists. All participants were involved in the trial. A thematic analysis of the data was performed.
Results: Some patients experienced a short term enhanced endurance and a better use of energy during the day. However, in general patients did not experience a long lasting reduction of fatigue from the CBT or ET. Mainly patients of the CBT, but also some patients of the ET described an increase of self-esteem and self-acceptance. As a result, patients were sometimes better able to perform physical activities during the day. In contrast to the CBT, the
ET was in general perceived by the patients as an intensive therapy, which was difficult to fit into their daily routine. Therapists of both the CBT and the ET struggled with a low intrinsic motivation of the patients in the study.
This made it sometimes difficult for the therapists to follow the protocol.

Conclusions: Conclusion: Confirming the negative quantitative study outcome, the qualitative results did not demonstrate lasting effects on fatigue. Patients did, however, experience some benefits on self-esteem and acceptance of the disease. This study showed that it is of great importance to work with feasible interventions; they should fit the patients’ needs on a practical (fit into their daily routine) and mental (fit their need for support) level.

Outcome of Research: More research required

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Category: Polio Immunisation

Title: Expert Review on Poliovirus Immunity and Transmission
Author: Radboud J. Duintjer Tebbens Mark A. Pallansch Konstantin M. Chumakov Neal A. Halsey Tapani Hovi Philip D. Minor John F. Modlin Peter A. Patriarca Roland W. Sutter Peter F. Wright Steven G. F. Wassilak Stephen L. Cochi Jong‐Hoon Kim Kimberly M. Thompson
Affiliation: Kid Risk, Inc., P.O. Box 590129 Newton, MA, USA
Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD, USA
Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
National Institute for Health and Welfare (THL), Helsinki, Finland
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Risk Analysis, Volume33, Issue4 April 2013 Pages 544-605
Publication Year and Month: 2013 04

Abstract: Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.

Conclusions:

Outcome of Research: More research required

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Category: Respiratory Complications and Management

Title: Feasibility of lung volume recruitment in early neuromuscular weakness: a comparison between amyotrophic lateral sclerosis, myotonic dystrophy, and postpolio syndrome
Author: Kaminska M (1,2), Browman F (3), Trojan DA (4), Genge A (4), Benedetti A (2,5), Petrof BJ (6,7)
Affiliation: (1) Respiratory Division, McGill University Health Centre, 1001 Decarie Blvd, D05.2504 Montreal, Quebec, Canada H4A 3J1; (2) Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Quebec, Canada; (3) Department of Respiratory Therapy, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada; (4) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada; (5) Departments of Medicine and Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada; (6) Meakins-Christie Laboratories, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; (7) Respiratory Division, McGill University Health Centre, 1001 Decarie Blvd, D05.2506 Montreal, Quebec, Canada H4A 3J1
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2015 Apr;1-8
Publication Year and Month: 2015 04

Abstract: BACKGROUND: Lung volume recruitment (LVR) is a cough assistance technique used in persons with neuromuscular disorders (NMDs), most typically in those requiring noninvasive ventilation (NIV). Whether it may be useful in persons with NMDs who have milder respiratory impairment is unknown.

OBJECTIVE: To assess the feasibility, impact on quality of life (QOL), and preliminary physiological effects of daily LVR in different categories of persons with NMDs who have an early stage of respiratory impairment.

DESIGN: Feasibility study.

SETTING: Academic tertiary care center.

PARTICIPANTS: Outpatients diagnosed with amyotrophic lateral sclerosis (n = 8), postpolio syndrome (n = 10), and myotonic dystrophy (n = 6) who had restrictive respiratory defects but were not yet using NIV.

METHODS: Participants were asked to perform LVR up to 4 times daily and log their LVR use in a diary. Physiological measurements and questionnaires were completed at baseline and after 3 months.

MAIN OUTCOME MEASUREMENTS: Compliance with LVR use was assessed, along with QOL and willingness to continue the treatment. Physiological measurements included forced vital capacity (FVC), lung insufflation capacity (LIC), and the LIC minus FVC difference.

RESULTS: Of the 24 recruited subjects, 7 with amyotrophic lateral sclerosis, 7 with postpolio syndrome, and 5 with myotonic dystrophy completed the study (n = 19). At baseline, mean values for FVC and spontaneous peak cough flow were 59.9% predicted and 373.1 L/min, respectively. For subjects completing the study, 74% were willing to continue long-term LVR use, and QOL scores were not adversely affected by LVR in any NMD subgroup. The LIC-FVC difference increased from baseline to follow-up by a mean of 0.243 L (P = .006) in all subjects (n = 19), suggesting a possible improvement in respiratory system mechanics.

Conclusions: In patients with NMDs who have early restrictive respiratory defects but do not yet require NIV, regular use of LVR is feasible with no negative impact on QOL over a 3-month period and may have physiological benefits. Further work is needed to determine whether early institution of LVR can improve respiratory system mechanics and help delay ventilatory failure in persons with NMDs.

Outcome of Research: More research required

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Category: Orthoses

Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Physical Medicine and Rehabilitation Research, DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018

Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.

Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.

Outcome of Research: More research required

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Category: Polio Immunisation

Title: Genetically Thermo-Stabilised, Immunogenic Poliovirus Empty Capsids; a Strategy for Non-replicating Vaccines
Author: Fox, H., Knowlson, S., Minor, P.D., Macadam, A.J.
Affiliation: This work was supported by the WHO Polio Research Committee (http://www.polioeradication.org/Research/Grantsandcollaboration.aspx) through I8-TSA-043 & I8-TSA-083 as well as by NIBSC (National Institute for Biological Standards and Control) through core funding received from the UK Department of Health to fund biological standards and control. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Fox H, Knowlson S, Minor PD, Macadam AJ (2017) Genetically Thermo-Stabilised, Immunogenic Poliovirus Empty Capsids; a Strategy for Non-replicating Vaccines. PLoS Pathog13(1): e1006117. https://doi.org/10.1371/journal.ppat.1006117
Publication Year and Month: 2017 01

Abstract: While wild type polio has been nearly eradicated there will be a need to continue immunisation programmes for some time because of the possibility of re-emergence and the existence of long term excreters of poliovirus. All vaccines in current use depend on growth of virus and most of the non-replicating (inactivated) vaccines involve wild type viruses known to cause poliomyelitis. The attenuated vaccine strains involved in the eradication programme have been used to develop new inactivated vaccines as production is thought safer. However it is known that the Sabin vaccine strains are genetically unstable and can revert to a virulent transmissible form. A possible solution to the need for virus growth would be to generate empty viral capsids by recombinant technology, but hitherto such particles are so unstable as to be unusable. We report here the genetic manipulation of the virus to generate stable empty capsids for all three serotypes. The particles are shown to be extremely stable and to generate high levels of protective antibodies in animal models.

Conclusions: The final preparations studied were extremely stable compared to IPV and could conceivably give rise to a vaccine that would not require a cold chain; moreover they were more immunogenic than IPV made from the equivalent strains in the animal model used for testing IPV potency and in challenge studies in transgenic mice. It is possible that this is partly because the particles, unlike IPV, were not treated with formalin. The viruses from which they were derived had lost infectivity presumably because they were unable to uncoat by virtue of their hyperstable capsids. A suitable expression platform would be required to make this a viable vaccine production system and is the focus of one strand of current work of the Consortium, but the properties of the particles are very promising.

Outcome of Research: More research required

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Category: Quality of Life

Title: Growing older with post-polio syndrome:
Social and quality-of-life implications
Author: Andrea Duncan and Zinnia Batliwalla
Affiliation: 1Department of Occupational Science & Occupational Therapy, University
of Toronto, Toronto, ON, Canada
2March of Dimes Canada, Toronto, ON, Canada
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: SAGE Open Medicine
Volume 6: 1–7
Publication Year and Month: 2018 07

Abstract: Objectives: To understand the quality-of-life implications for post-polio syndrome survivors.
Methods: For this qualitative study, a focus group methodology, with a case study design, was used. The data were analyzed
for themes using a social ecological conceptual framework.
Results: Three focus groups were conducted with a total of 24 participants (N=24). Participants defined quality of life as
being able to engage in meaningful activities of daily living. Participants shared experiences of adapting to declining physical
health and embracing new activities of daily living. They expressed hope and shared stories that demonstrated resiliency.

Conclusions: The literature states that individuals aging with post-polio syndrome express concern that health providers
often know little about their disability condition. The participants in this study reflected this experience by sharing feelings of
misunderstanding from the medical community and expressing a desire to have more dynamic education for health providers.

Outcome of Research: More research required

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Category: Complementary Therapies

Title: Hatha yoga and meditation in patients with post-polio syndrome
Author: DeMayo W, Singh B, Duryea B, Riley D
Affiliation: Southern California University of the Health Sciences, USA
Journal: Alternative Therapies in Health and Medicine
Citation: Altern Ther Health Med. 2004 Mar-Apr;10(2):24-5
Publication Year and Month: 2004 03

Abstract: This paper does not have an abstract. The following is an extract:
Conemaugh Health System has completed a preliminary outcome study evaluating the benefits of Hatha yoga and meditation in patients with post-polio syndrome (PPS). This research integrates clinical trials investigating the application of Hatha yoga with ongoing patient care and education. The results of this clinical trial will be used to develop a longitudinal data collection effort integrating research and clinical trials investigating the applications of Hatha yoga in ongoing patient care and education.

Conclusions:

Outcome of Research: More research required

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Category: Differential Diagnosis

Title: Health and Social Considerations in Norwegian Polio Survivors: A 20-Year Follow-up Study
Author: Festvag L, Schanke A-K, Gilhus NE, et al.
Affiliation: Sunnaas Rehabilitation Hospital
University of Oslo
University of Bergen; Haukelund University Hospital, Bergen
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2016;48(8):688-695
Publication Year and Month: 2016 10

Abstract: Objective: To explore the physical and social situation of the Norwegian polio population in 2014, and to compare the status of this population in 2014 with the results of a similar survey carried out 20 years previously, in 1994.

Design: The study was based on a questionnaire covering demographics, polio history, and current medical, psychological and social conditions.

Subjects: The questionnaire was prepared in cooperation with the National Society of Polio Survivors and others with known polio (n = 1,968). A total of 1,408 persons responded (72%), mean age 70 years (range 28–98 years).

Results: The most frequent health problems reported were muscle and joint pain, cold intolerance and insomnia. New muscle weakness and loss of muscle volume were reported more frequently in 2014 than in the 1994 study. The use of orthopaedic aids, assistive devices, ventilators and other respiratory aids had increased significantly, but 83% reported that they still had no home care or nursing services support. The 2014 polio population reported only minor subjective worsening of health and well-being compared with the 1994 cohort.

Conclusion: The present study indicates that the elderly polio population are experiencing new muscle weakness and increasing health problems, but that the deterioration occurs slowly and with fewer consequences for the subjective experience of general health and well-being, indicating that the patients are adapting to their life situation. However, subgroups of the elderly polio population are in need of special care.

Conclusions: The present study indicates that the elderly polio population are experiencing new muscle weakness and increasing health problems, but that the deterioration occurs slowly and with fewer consequences for the subjective experience of general health and well-being, indicating that the patients are adapting to their life situation. However, subgroups of the elderly polio population are in need of special care.

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Histopathologic Basis of Clinical Findings in Poliomyelitis
Author: Bodian, D.
Affiliation: Poliomyelitis Research Center, Department of Epidemiology, Johns Hopkins University, Baltimore
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: American Journal of Medicine. 1949: 6(5):563–578
Publication Year and Month: 05

Abstract: 1. Experimental evidence indicates that the onset of CNS pathologic changes occurs in the preparalytic period and is closely associated with the earliest evidence of virus activity in any particular region involved.
2. The earliest cytopathologic changes are diffuse chromatolysis of Nissl substance in the cytoplasm of nerve cells and mild cellular exudate consisting of polymorphonuclear and mononuclear leukocytes.
3. Nerve cell changes may be present in the earliest stages without inflammatory reaction in the vicinity and therefore are not necessarily the result of the latter, but rather the result of direct virus action.
4. Nerve cell changes either lead to rapid destruction of the cell or to arrest in the stage of cytoplasmic chromatolysis, following which complete morphologic recovery of the cell generally occurs over a period of about a month or less, depending upon the severity of injury.
5. Virus activity, nerve cell changes and inflammatory reaction are localized only in certain susceptible regions of the CNS, largely due to specific differences of susceptibility of nerve cells. The intensity of the inflammatory reaction, however, may be quite variable in different susceptible centers and in different individuals. Severe inflammatory reaction is usually but not always associated with extensive nerve cell destruction. Severe nerve cell damage may occur without extensive cellular infiltration in the cord.
6. Lesions in the cerebral cortex are usually confined to the motor area of the precentral gyrus and even here the lesions are rarely severe enough to suggest that they may produce clinical symptoms.
7. “Encephalitic” symptoms such as restlessness, stupor, disorientation and coma are associated with severe inflammatory reaction in the brainstem and often with small softenings in this region. They are not associated with unusual involvement of the cerebral cortex.
8. Brainstem centers principally involved in most instances are the reticular formation of the hind-brain, the vestibular nuclei and the roof nuclei of the cerebellum. Resulting functional disturbances are discussed.
9. Widespread dissemination of virus among most motor nerve cells in spinal cord enlargements occurs in experimental poliomyelitis as early as the first day of paralysis. Motor nerve cells which are affected either are destroyed very quickly during the first few days of the disease or undergo slower recovery changes leading to complete morphologic recovery within about a month. After this time it can be shown that the degree of paralysis and atrophy are closely correlated with the number of motor nerve cells destroyed. In the acute stage, however, this correlation is not as high and other factors must also play a role in producing paralysis. An important factor is the reversible injury of motor nerve cells. Less complete evidence from human material suggests that a similar situation obtains in human poliomyelitis.
10. Experimental work suggests three possible factors which may determine the variation in severity of infection. These are, first, variations due to difference in strains of the virus, second, reduction of severity due to previous paralytic or non-paralytic infection, and third, host variation unrelated to previous immunizing experience with the virus.

Conclusions: Poliomyelitis virus has strains that can vary depending on the host, and response to the virus. The virus causes most damage to the anterior horn cells of the cervical and lumbar segments, however there is damage to the brainstem and premotor areas in the brain.

Outcome of Research: More research required

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Comments (if any): David Bodian produced papers that helped enable (effective) availability for vaccinations. His work is still cited and referred to in understanding the effects of the polio virus, especially in relation to the central nervous system pathology.

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Category: Post-Polio Motor Unit

Title: How long does denervation take in poliomyelitis? Or is it a lifetime?
Author: Senol, M.G., Kaplan, C., Ozdağ, F., Saraçoğlu, M.
Affiliation: GATA Haydarpasa Training Hospital, Istanbul
Journal:
Citation: Journal of Neurosciences in rural practice
Senol, M.G., Kaplan, C., Ozdağ, F., Saraçoğlu, M. (2017) How long does denervation take in poliomyelitis? Or is it a lifetime? J Neurosci Rural Pract. 8:511-5
Publication Year and Month: 2017 11

Abstract: Background and Objective: This study aims to determine the period of reinnervation in patients with poliomyelitis. This research was conducted to identify the appearance of denervation potentials in patients with poliomyelitis as indicators for reinnervation.

Materials and Methods: A total of 246 male patients with poliomyelitis were assessed electrophysiologically between 1988 and 2007. The mean age was 22.8 (18–42). It has been an average of 19.9 ± 4.9 years since the beginning of complaints from the patients.

Results: The patients had no complaints of newly developing muscle weakness, fatigue, muscle and joint pain, and difficulties in breathing and swallowing. Neurological examinations revealed the absence of myotomal pain and sensory loss. Upon assessment of the patients' limbs, the following findings were revealed: two patients had left upper and lower limb involvement, two patients had left upper and right lower limb involvement, 6 patients had left upper limb involvement, 12 patients had both lower limb involvement, 105 patients had left lower limb involvement, 1 patient had both upper limb involvement, 2 patients had right lower and upper limb involvement, 12 patients had right upper limb involvement, 6 patients had both lower limb involvement, 95 patients had right lower limb involvement, and 3 had all the three extremities affected. The needle electromyography revealed the presence of denervation potentials in 25.2% (62) of the patients.

Conclusion: When poliovirus attacks the motor neuron, this neuron may be completely destroyed, damaged, or unaffected. Reinnervation occurs when nearby functioning motor units send out terminal axon sprouts to reinnervate the damaged muscle fibers. As a consequence of poliomyelitis, several muscle fibers become atrophic and fibrotic, but others continue to survive. This study showed that patients with a history of poliomyelitis experienced denervation with subsequent reinnervation for many years.

Conclusions: The electrophysiological evidences indicating denervation continuing in 25% of the patients are shown in this study.

Outcome of Research: More research required

Availability of Paper: The full text of this paper has been generously made available by the publisher.

Comments (if any): This study has great potential if there is regular monitoring of participants to see the effects of ageing and denervation.

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Category: Inflammation

Title: Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation.
Author: Gonzalez H, Ottervald J, Nilsson KC, et al
Affiliation: Karolinska Institute, Sweden
AstraZeneca, Sweden
Lund Technical University, Sweden
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Proteomics
J Proteomics. 2009 Jan 30;71(6):670-81
Publication Year and Month: 2009 01

Abstract: Survivors of poliomyelitis often develop increased or new symptoms decades after the acute infection, a condition known as post-polio syndrome (PPS). The condition affects 20-60% of previous polio patients, making it one of the most common causes of neurological deficits worldwide. The underlying pathogenesis is not fully understood and accurate diagnosis is not feasible. Herein we investigated whether it was possible to identify proteomic profile aberrations in the cerebrospinal fluid (CSF) of PPS patients. CSF from 15 patients with well-defined PPS were analyzed for protein expression profiles. The results were compared to data obtained from nine healthy controls and 34 patients with other non-inflammatory diseases which served as negative controls. In addition, 17 samples from persons with secondary progressive multiple sclerosis (SPMS) were added as relevant age-matched references for the PPS samples. The CSF of persons with PPS displayed a disease-specific and highly predictive (p=0.0017) differential expression of five distinct proteins: gelsolin, hemopexin, peptidylglycine alpha-amidating monooxygenase, glutathione synthetase and kallikrein 6, respectively, in comparison with the control groups. An independent ELISA confirmed the increase of kallikrein 6. We suggest that these five proteins should be further evaluated as candidate biomarkers for the diagnosis and development of new therapies for PPS patients.

Conclusions: Protein analysis employing classical proteomics combined with multivariate modeling and identification using mass spectrometry resulted in the discovery of three differentially
expressed proteins or their fragments in PPS samples as compared to in controls. This firstly suggests that these proteins may exert key roles in PPS patophysiology. Secondly, these proteins and their fragments represent potential candidates as biomarkers for the disease. To merit as true biomarkers studies will be required in larger materials of PPS and a variety of other CNS diseases.
Notably, however, in comparison with samples from SPMS (being an age-matched control group with ongoing inflammation and neuronal destruction), the most predictive proteins were specific for PPS.
In conclusion, we herein demonstrate a protein profile, based on its high predictive value, has the potential to serve as a diagnostic biomarker for PPS. The proteins identified in this study are known to be involved in different pathways associated with tissue damage and apoptosis. These data and previous observations of inflammation and cytokine production provide strong support for the hypothesis that PPS is caused by an active inflammatory and neurodegenerative process. There is consequently potential for various modes of anti-inflammatory and/or neuroprotective therapy.

Outcome of Research: More research required

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Category: Drugs

Title: Immunoglobulin g for the treatment of chronic pain: report of an expert workshop
Author: Tamburin S (1), Borg K, Caro XJ, Jann S, Clark AJ, Magrinelli F, Sobue G, Werhagen L, Zanette G, Koike H, Späth PJ, Vincent A, Goebel A
Affiliation: (1) Department of Neurological and Movement Sciences, University of Verona, Verona, Verona, Italy
Journal: Pain Medicine
Citation: Pain Med. 2014 Jul;15(7):1072-82. doi: 10.1111/pme.12319
Publication Year and Month: 2014 07

Abstract: BACKGROUND: The treatment of chronic pain is still unsatisfactory. Despite the availability of different drugs, most patients with chronic pain do not receive satisfactory pain relief or report side effects. Converging evidence implicates involvement of the immune system in the pathogenesis of different types of nociceptive and neuropathic chronic pain.

DESIGN: At a workshop in Liverpool, UK (October 2012), experts presented evidence suggesting immunological involvement in chronic pain and recent data supporting the concept that the established immune-modulating drug, polyvalent immunoglobulin G (IgG), either given intravenously (IVIg) or subcutaneously (SCIg), may reduce pain in some peripheral neuropathies and a range of other pain disorders. Workshop's attendees discussed the practicalities of using IVIg and SCIg in these disorders, including indications, cost-effectiveness, and side effects.

RESULTS: IgG may reduce pain in a range of nociceptive and neuropathic chronic pain conditions, including diabetes mellitus, Sjögren's syndrome, fibromyalgia, complex regional pain syndrome, post-polio syndrome, and pain secondary to pathological autoantibodies.

Conclusions: IgG is a promising treatment in several chronic pain conditions. IgG is a relatively safe therapeutic strategy, with uncommon and mild side effects but high costs. Randomized, controlled trials and predictive tests are needed to better support the use of IgG for refractory chronic pain.

Outcome of Research: More research required

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Category: Polio Immunisation

Title: Intestinal Immunity to Poliovirus Following Sequential Trivalent Inactivated Polio Vaccine/Bivalent Oral Polio Vaccine and Trivalent Inactivated Polio Vaccine–only Immunization Schedules: Analysis of an Open-label, Randomized, Controlled Trial in Chilean Infants
Author: Elizabeth B Brickley Wendy Wieland-Alter Ruth I Connor Margaret E Ackerman Austin W Boesch Minetaro Arita William C Weldon Miguel G O’Ryan Ananda S Bandyopadhyay Peter F Wright
Affiliation: 1Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; 2Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical
Medicine, United Kingdom; 3
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, 4Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth
College, and 5Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; 6
Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan; 7
Division of Viral
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 8
Microbiology and Mycology Program and Millennium Institute of Immunology and Immunotherapy, Faculty of Medicine,
University of Chile, Santiago; and 9
Bill & Melinda Gates Foundation, Seattle, Washington
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Clinical Infectious Diseases, Volume 67, Issue suppl_1, 15 November 2018, Pages S42–S50, https://doi.org/10.1093/cid/ciy603
Publication Year and Month: 2018 10

Abstract: Background
Identifying polio vaccine regimens that can elicit robust intestinal mucosal immunity and interrupt viral transmission is a key priority of the polio endgame.

Methods
In a 2013 Chilean clinical trial (NCT01841671) of trivalent inactivated polio vaccine (IPV) and bivalent oral polio vaccine (bOPV; targeting types 1 and 3), infants were randomized to receive IPV-bOPV-bOPV, IPV-IPV-bOPV, or IPV-IPV-IPV at 8, 16, and 24 weeks of age and challenged with monovalent oral polio vaccine type 2 (mOPV2) at 28 weeks. Using fecal samples collected from 152 participants, we investigated the extent to which IPV-bOPV and IPV-only immunization schedules induced intestinal neutralizing activity and immunoglobulin A against polio types 1 and 2.

Results
Overall, 37% of infants in the IPV-bOPV groups and 26% in the IPV-only arm had detectable type 2–specific stool neutralization after the primary vaccine series. In contrast, 1 challenge dose of mOPV2 induced brisk intestinal immune responses in all vaccine groups, and significant rises in type 2–specific stool neutralization titers (P < .0001) and immunoglobulin A concentrations (P < 0.0001) were measured 2 weeks after the challenge. In subsidiary analyses, duration of breastfeeding also appeared to be associated with the magnitude of polio-specific mucosal immune parameters measured in infant fecal samples.

Conclusions: Taken together, these results underscore the concept that mucosal and systemic immune responses to polio are separate in their induction, functionality, and potential impacts on transmission and, specifically, provide evidence that primary vaccine regimens lacking homologous live vaccine components are likely to induce only modest, type-specific intestinal immunity.

Outcome of Research: More research required

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Category: Drugs

Title: Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
Author: Huang Y-H (1), Chen H-C (2,3), Huang K-W (4,5,6), Chen P-C (1,7), Hu C-J (1,8), Tsai C-P (5,9), Tam K-W (2,10,11,12,13,14), Kuan Y-C (1,5,8,14)
Affiliation: (1) Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (2) Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (3) Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (4) Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan; (5) Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; (6) Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (7) College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; (8) Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan; (9) Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; (10) Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (11) Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (12) Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; (13) Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (14) Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan
Journal: BioMed Central Neurology
Citation: BMC Neurology 2015, 15:39 doi:10.1186/s12883-015-0301-9
Publication Year and Month: 2015 03

Abstract: BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial.

METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels.

RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity.

Conclusions: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.

Outcome of Research: More research required

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Category: Drugs

Title: Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up
Author: Gonzalez H (1), Khademi M (2), Borg K (1), Olsson T (2)
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, blg 39, fl 3, S-192 88, Stockholm, Sweden; (2) Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Journal: Journal of Neuroinflammation
Citation: Journal of Neuroinflammation. 2012; 9: 167. doi: 10.1186/1742-2094-9-167
Publication Year and Month: 2012 07

Abstract: BACKGROUND: Expression of inflammatory cytokines in cerebrospinal fluid (CSF) has led to the hypothesis of intrathecal chronic inflammation to explain the denervation observed in post-polio syndrome (PPS). It has been shown that therapy with intravenous immunoglobulin (IVIG) improves physical performance and dampens down the inflammatory process at 6 months in PPS patients. We here examined the effects of IVIG on cytokine expression and clinical outcome one year after IVIG treatment.

METHODS: From a previous study with 135 PPS patients included, 41 patients were further evaluated before un-blinding for one year (21 placebo and 20 treated with IVIG, Xepol® 50 mg/ml), and were assessed for clinical variables by performing the Short Form-36 survey (SF-36) questionnaire assessment, the 6 minute walk distance test (6MWT) and registering pain level by Visual Analogue Scale (VAS) after IVIG treatment. A separate cohort of 37 PPS patients went through lumbar puncture (LP) at baseline and 20 patients, treated with IVIG, repeated the LP one year later. Thirty patients affected with other neurological diseases (OND) were used as control group. Inflammatory cytokines TNF, TGFβ, IFNγ, IL-23, IL-13 and IL-10 were measured in blood cells and CSF cells with RT-PCR.

RESULTS: Scores of the physical components of SF-36 were significantly higher at the one year follow up time-point in the IVIG-treated patients when compared to baseline as well as to the control subjects. Pain VAS score and 6MWT improved significantly in the IVIG-treated patients when compared with baseline Relative expression of TNF and IFN-γ in both PBMCs and CSF from PPS patients were increased compared to OND subjects at baseline (p < 0.05). One year after IVIG-treatment a decreased expression of IFN-γ and IL23 was found in CSF of PPS patients, while anti-inflammatory IL-13 was increased (p < 0.05).

Conclusions: IVIG has effects on relevant QoL variables and inflammatory cytokines up to one year in patients with PPS. This gives a basis for scheduling IVIG in upcoming trials with this therapy.

Outcome of Research: More research required.

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Category: Orthoses

Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Biosystems & Biorobotics, vol 19. Advanced Technologies for the Rehabilitation of Gait and Balance Disorders pp 399-414
Publication Year and Month: 2018 01

Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).

Conclusions:

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Inverse Relationship Between Polio Incidence in the US and Colorectal Cancer.
Author: STEVEN LEHRER and PETER H RHEINSTEIN
Affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, U.S.A. [email protected]
Severn Health Solutions, Severna Park, MD, U.S.A.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: In vivo (Athens, Greece) vol. 32,6 (2018): 1485-1489.
Publication Year and Month: 2018

Abstract: BACKGROUND/AIM:
Polio is predominantly an enteric viral infection that was progressively eradicated in the United States after the introduction of polio vaccine in the early 1950s. U.S. colorectal cancer rates have dropped steadily for individuals born between 1890 and 1950, but have been increasing for every generation born since 1950. Moreover, the lowest worldwide age adjusted rates of colorectal cancer in 2012 were in sub-Saharan Africa, Gambia and Mozambique, where polio has not been eradicated. In the current study, poliomyelitis incidence in US states before the introduction of polio vaccine was analyzed.

MATERIALS AND METHODS:
Reported cases of poliomyelitis per 100,000 population by state 1932-1951 were from Centers for Disease Control. Colorectal cancer deaths per 100,000 in men (2005-2009) by US State are from the American Cancer Society. US state overweight and obesity data are from the Centers for Disease Control and Prevention (CDC). Smoking data are from the CDC.

RESULTS:
By US state, colorectal cancer incidence per 100,000 in men for 2005-2009 was inversely correlated with reported cases of poliomyelitis per 100,000 for 1932-1951 (r=-0.311, p=0.032). Colorectal cancer deaths per 100,000 in men in 2005-2009 were also inversely correlated with reported cases of poliomyelitis per 100,000 by state for 1932-1951 (r=-0.493, p<0.001). The relationship between colorectal cancer deaths and polio incidence was significant (β=-0.196, p=0.028) and independent of the effects of smoking (β=0.289, p=0.012) and overweight (β=0.547, p<0.001). The relationship in females with colorectal cancer was identical.

Conclusions: Polio virus infection of cells of the colon may induce some degree of resistance to the development of colon cancer decades later. The effect of polio virus infection seems to be especially potent in reducing the rate of death from colon cancer.

Outcome of Research: More research required

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Category: Surgery

Title: Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome
Author: Klerken, T., Kosse, N.M., Aarts, C.A.M., Louwerens, J.W.K.
Affiliation: Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Foot and Ankle Surgery. https://doi.org/10.1016/j.fas.2017.11.003

Publication Year and Month: 2017 11

Abstract: Background
Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up.


Conclusions
Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.

Conclusions: A triple arthrodesis was effective 15 years after surgery. Aggravation of ankle joint osteoarthritis does not relate to patient satisfaction. Slow radiographic aggravation of osteoarthritis of the ankle joint was seen in 42% of the patients.

Outcome of Research: More research required

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Category: Exercise

Title: Low-intensity, alternate-day exercise improves muscle performance without apparent adverse affect in postpolio patients.
Author: Agre, J., Rodriguez, A., Franke, T., Swiggum, E., Harmon, R., Curt, J.
Affiliation: Agre- Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, 53791, USA.
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 1996;75(1):50-8.
Publication Year and Month: 1996 01

Abstract: The purpose of this study was to examine the effect of a low-intensity, alternate-day, 12 wk quadriceps muscle-strengthening exercise program on muscle strength and muscle and motor unit integrity in 12 postpolio patients. Patients performed six to ten repetitions of a 5-s duration knee extension exercise with ankle weights. After completing six repetitions, patients rated the perceived exertion (RPE) in the exercised muscle. The patient continued repetitions until RPE was >/= 17 or ten repetitions were performed. The weight was increased the next exercise day whenever the RPE was < 17 after ten repetitions. Before and after the training program, median macroamplitude as well as jitter and blocking were determined electromyographically (EMG), serum creatine kinase (CK) was measured, and quadriceps muscle strength was assessed. The ankle weight lifted after 2 wk of training and at the end of the program were also recorded. Although the ankle weight lifted at the end of the program significantly (P < 0.05) increased from a mean +/- SD of 7.1 +/- 2.7 to 11.2 +/- 4.7 kg, the dynametrically determined muscle strength measures did not significantly (P > 0.05) increase. The EMG and the serum CK variables also did not significantly (P >0.05) change as a result of the exercise program. We conclude that performance was improved, as demonstrated by an increase in the amount of weight the patients lifted in the exercise program. No evidence was found to show that this program adversely affected the motor units or the muscle as the EMG and CK did not change.

Conclusions: Patients increased leg strength without changes in motor unit innervation or fatigue levels.

Outcome of Research: More research required

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Comments (if any): This is a good result on the efficacy of exercise. Caution should be applied to using these results across all people with a history of polio. Reasonable leg strength existed for all people involved in this study. Further investigations are required on they type, frequency and intensity of exercise as well as confirming results over a longer period of time.

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Category: Falls and Bone Density

Title: Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects
Author: Thaiana Santos Galvão PT, Egídio Sabino Magalhães Júnior PT, MSc, Marco Antonio Orsini Neves PhD, MD & Arthur de Sá Ferreira PhD, PT
Affiliation: This study was supported by the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) [Grant numbers E-26/200.564/2015 and E-26/202.769/2015].
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Physiotherapy Theory and Practice, DOI: 10.1080/09593985.2018.1512178
Publication Year and Month: 2018

Abstract: Introduction: This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman’s ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = –13, CI 95% −16 to −9 points), lower dynamic postural stability (MD = –14, CI 95% −19 to −8 points), and increased fear of falling (MD = 14, CI 95% 10–18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738–0.351), risk of falling (ρ = −0.746), and fear of falling (ρ = −0.432). Dynamic postural stability was correlated with risk of falling (ρ = −0.841), fear of falling (ρ = −0.277), and static postural stability (ρ = −0.869 to −0.435; ρ = −0.361 to −0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.

Conclusions:

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: Macro electromyography and motor unit number index in the tibialis anterior muscle: differences and similarities in characterizing motor unit properties in prior polio
Author: Sandberg A, Nandedkar SD, Stalberg E
Affiliation: Department of Neuroscience, Clinical Neurophysiology, Uppsala University, Uppsala SE-751 85, Sweden
Journal: Muscle & Nerve
Citation: 2011 Mar;43(3):335-41
Publication Year and Month: 2011 03

Abstract: Our objective was to establish the usefulness of the noninvasive method of the motor unit number index (MUNIX) in a large muscle and to study how macro electromyography (EMG) and MUNIX complement each other in describing the motor units (MUs) in prior polio. MUNIX and macro EMG were performed in 48 tibialis anterior muscles in 33 prior polio patients. In addition, the reproducibility of MUNIX was investigated. It is shown that MUNIX can be used to characterize MUs with high reproducibility, even in a large muscle. As judged by MUNIX values, the patients had a 25% reduction of motor neurons, whereas the macro EMG indicated a loss of 60% of the neurons. Macro EMG showed more pronounced changes compared with control material than the MUNIX. One of the reasons for this finding may be the difference in MU populations studied with the two methods.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Measuring Physical and Cognitive Fatigue in People With Post-Polio Syndrome: Development of the Neurological Fatigue Index for Post-Polio Syndrome (NFI-PP).
Author: Young CA, Wong SM, Quincey AC, Tennant A
Affiliation: Walton Centre NHS Trust, Lower Lane, Liverpool, L9 7LJ, United Kingdom.
Walton Centre NHS Trust, Liverpool, United Kingdom.
Swiss Paraplegic Research, Nottwil, Switzerland.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: 2018 Feb;10(2):129-136.
Publication Year and Month: 2018 02

Abstract: BACKGROUND:
Fatigue in post-polio syndrome (PPS) has been shown to affect quality of life adversely. There is currently no disease-specific measure of fatigue for PPS.

OBJECTIVE:
To develop a scale to measure fatigue in PPS that meets rigorous psychometric standards.

DESIGN:
Qualitative followed by validation and test-retest studies.

SETTING:
Polio clinic followed by national questionnaire studies.

PARTICIPANTS:
A total of 45 participants from polio clinic for qualitative; 319 participants from clinic or self-referral for validation study, of whom 87 completed the retest questionnaire.

METHODS:
Draft questionnaire items on PPS fatigue were derived from transcripts of qualitative interviews. After cognitive debriefing, the draft measure was administered by mail along with comparator questionnaires to a new sample.

MAIN OUTCOME MEASUREMENTS:
Draft PPS fatigue measure, Fatigue Severity Scale, and visual analog scale for fatigue.

RESULTS:
Analysis of 271 of 319 (85%) questionnaires identified a 2-factor solution (RMSEA 0.058). For the physical subscale, a 20-item scale showed good fit (χ2P = .189), strict unidimensionality (t-test 5.17%), and reliability 0.91. For the cognitive subscale, a 7-item scale showed excellent fit (χ2P = .917), strict unidimensionality (t-test 5.2%), and reliability 0.89. Evidence of a "difficulty factor" emerged also supporting a total score that showed good fit (χ2P = .151), strict unidimensionality (t-test 0.4%), and reliability consistent with group use at 0.73. Test-retest correlations for all scales were greater than 0.85. Standard error of measurement on metric ranges was 5.4 for total, 2.9 for physical, and 1.69 for cognitive domains. With the latent estimate of the total score transformed to a 0-100 scale, the mean score was 49.5 (SD 6.9). Spearman correlations with the Fatigue Severity Scale and visual analog scale were 0.60 and 0.55, respectively.

Conclusions: CONCLUSIONS:
A patient-derived Neurological Fatigue Index for PPS, with physical and cognitive subscales and a total score, has demonstrated good reliability, appropriate concurrent validity, and satisfies the Rasch measurement model. A raw-score to interval scale transformation is available for parametric applications and the calculation of change scores.

Outcome of Research: More research required

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Category: Orthoses

Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The Journal of Physiology
Publication Year and Month: 2018 06

Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.

Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘pre‐molecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.

Outcome of Research: More research required

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Category: Women's Health

Title: Menopause and post-polio symptoms as predictors of subjective sleep disturbance in poliomyelitis survivors.
Author: Kalpakjian CZ, Quint EH, Toussaint LL.
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Climacteric. 2007 Feb;10(1):51-62.
Publication Year and Month: 2007 02

Abstract: OBJECTIVES:
Sleep disturbance in polio survivors is a common complaint, yet little is known about the effects of the interaction of physical disability and menopause on sleep. The purpose of this study was to understand the relative contribution of menopause factors and disability to subjective sleep disturbance.

METHODS:
Participants were 465 women aged 50-65 years who had physical disabilities due to poliomyelitis. Hierarchical regression modeling was used to examine menopause (symptoms, status, hormone replacement use, ovarectomy status) and disability factors (post-polio symptoms) in sleep disturbance.

RESULTS:
In the final model, 19% (frequency) and 17% (severity) of sleep disturbance variance was explained. Psychological symptoms exerted the most influence (for both outcomes) followed by post-polio symptoms, vasomotor symptoms, an interaction of vasomotor and post-polio symptoms and estrogen use. For women with fewer post-polio symptoms, vasomotor symptoms exerted greater influence on sleep disturbance than for women with greater post-polio symptoms.

CONCLUSIONS:
Psychological symptoms had the strongest association with sleep disturbance in these women. Controlling for the influence of various menopause factors, our findings show that vasomotor symptoms were only one of several influences on sleep disturbance.

Conclusions:

Outcome of Research: More research required

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Category: Women's Health

Title: Menopause characteristics of women with physical disabilities from poliomyelitis.
Author: Kalpakjian CZ, Quint EH, Tate DG, Roller S, Toussaint LL.
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Maturitas. 2007 Feb 20;56(2):161-72.
Publication Year and Month: 2007 02

Abstract: OBJECTIVE:
To describe menopause characteristics of women with physical disabilities from poliomyelitis.

METHODS:
Nine hundred and nine women with a history of poliomyelitis completed a survey on health, physical functioning, emotional well being and menopause.

RESULTS:
The majority of the sample was postmenopausal having had a natural menopause around the average age of 50.3 years; 34.7% of the sample had had hysterectomies. Thirty-nine percent were using some form of hormone replacement therapy (HRT). Menopause symptoms were clustered into psychological, somatic-sensory, somatic-sleep and vasomotor factors. Among never and past HRT users, there were significant differences in menopause factor severity by menopause status. Somatic/sleep symptoms were lowest in never users; past users had significantly higher vasomotor symptoms; desire for sexual activity and painful intercourse did not vary by HRT use. Compared to population estimates, post-polio women had similar rates of hysterectomies overall, but among some age cohorts they had significantly lower rates, contrary to expectations. However, they used HRT at significantly higher rates than expected.

CONCLUSIONS:
This study suggests that basic menopause characteristics of women with polio are generally similar to those of their non-disabled peers. There were few substantial differences in severity of menopause symptoms by HRT use, which is critical in light of the dearth of studies examining its risk-benefit ratio among women with physical disabilities. Until such studies provide some evidence of the specific risks or benefits to women with physical disability, each woman should carefully weigh the known risks and benefits with her physician.

Conclusions:

Outcome of Research: More research required

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Category: Assistive Technology

Title: Mobility and participation among ageing powered wheelchair users: using a lifecourse approach
Author: Delphine Labbé, W. Ben Mortenson, Paula W. Rushton, Louise Demers, and William C. Miller
Affiliation: Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
Rehabilitation Research Lab, Vancouver, Canada
Department of Gerontology, Simon Fraser University, Vancouver, Canada
School of Rehabilitation, Université de Montréal, Montreal, Canada
CHU Sainte Justine Research Center, Montréal, Canada
Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montreal, Canada
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Ageing and Society, 1-17.
Publication Year and Month: 2018 09

Abstract: About 65 million people use wheelchairs worldwide. Powered wheelchairs offer independent mobility for those who find it difficult to propel a manual wheelchair. Previous studies have described powered wheelchairs as a mixed blessing for the users in terms of usability, accessibility, safety, cost and stigma; however, few studies have explored their impact on mobility and participation over time. Therefore, as part of a larger longitudinal study, we used a combined retrospective and prospective lifecourse perspective to explore the experiences of older adult powered wheelchair users. Based on the interpretive description approach, 19 participants took part in a series of semi-structured interviews over a two-year period about their mobility, social participation and ageing process. The participants were powered wheelchair users, at least 50 years of age, recruited in Vancouver, Montreal and Quebec City (Canada). We identified three themes that highlighted how the powered wheelchair experience was integrated into the life continuum of the users. ‘It's my legs’ emphasised how powered wheelchairs are a form of mobility that not only enables users to take part in activities, but also impacts their identities, past and present. ‘Wheels of change’ explored the dynamic nature of powered wheelchair use and changes related to ageing. ‘Getting around’ illustrated how users’ mobility was affected by the interaction with their physical and social environments.

Conclusions: Developing public policies to advance social and environmental changes could help countries to ensure equity of access and social inclusion of those ageing with disabilities.

Outcome of Research: More research required

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Category: Pain

Title: Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing.
Author: Furrer, A., Michel, G., Terrill, A.L., Jensen, M.P., Müller, R.
Affiliation: Nil
Journal: Disability and Rehabilitation
Citation: Furrer, A., Michel, G., Terrill, A.L., Jensen, M.P., Müller, R. (2017) Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing. Disability and Rehabilitation 23:1-10 doi: 10.1080/09638288.2017.1390614. [Epub ahead of print]
Publication Year and Month: 2017 10

Abstract: PURPOSE:
To investigate the associations between subjective well-being and pain intensity, pain interference, and depression in individuals with physical disabilities. We hypothesized that (1) pain control and (2) pain catastrophizing mediate the effects of subjective well-being on pain intensity, pain interference, and depression.

METHODS:
Analyses of cross-sectional data from 96 individuals diagnosed with spinal cord injury, multiple sclerosis, neuromuscular disease, or post-polio syndrome, with average pain intensity of ≥4 (0-10) on at least half the days in the past month. Two models tested study hypotheses using structural equation.

RESULTS:
Both models showed acceptable model fit. Pain catastrophizing significantly mediated the effect of subjective well-being on pain intensity and pain interference, but not on depression. Pain control did not significantly mediate the effect of subjective well-being on pain intensity, pain interference, or depression. Path coefficients showed significant direct effects of subjective well-being on pain control (β = 0.39), pain catastrophizing (β = -0.61), pain interference (β = -0.48; -0.42), and depression (β = -0.75; -0.78).

CONCLUSIONS:
This study supports the potential of enhancing subjective well-being and lowering pain catastrophizing for reducing pain intensity, pain interference, and depressive symptoms in individuals with chronic pain and a physical disability. The findings indicate that true experiments to test for causal associations are warranted. Implications for rehabilitation The majority of individuals with physical disabilities report having persistent moderate-to-severe pain that may negatively limit daily activities and quality of life. The present cross-sectional study indicates that individuals who reported greater subjective well-being showed significantly lower pain intensity via the mediating effect of lower pain catastrophizing. Since sample size and respective power are low, these findings should be taken as first indications of potential underlying mechanisms between subjective well-being and pain outcomes that need further confirmation in longitudinal research. However, the findings suggest that treatments which enhance subjective well-being (increasing positive affect and life satisfaction, and decreasing negative affect, e.g., via positive psychology exercises) and reducing pain catastrophizing (via e.g., cognitive-behavioral therapy) may have the highest potential for benefiting individuals with disability-associated chronic pain.

Conclusions: Treatments which enhance subjective well-being (increasing positive affect and life satisfaction, and decreasing negative affect, e.g., via positive psychology exercises) and reducing pain catastrophizing (via e.g., cognitive-behavioral therapy) may have the highest potential for benefiting individuals with disability-associated chronic pain.

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Motoneuron Disease and Past Poliomyelitis in England and Wales
Author: Martyn CN, Barker DJP, Osmond C.
Affiliation: MRC Environmental Epidemiology Unit, Southampton Hospital, United Kingdom
Journal: The Lancet Neurology
Citation: The Lancet, 331(8598):1319-1322

Publication Year and Month: 1988 06

Abstract: Past notification rates for poliomyelitis show a close geographical relation with current mortality from motoneuron disease in England and Wales. The increasing rate of poliomyelitis during the first half of this century and its predilection for affluent places and families were unique amongst infectious diseases. The unusual epidemiology of poliomyelitis is now being paralleled by motoneuron disease. These observations provide new evidence for a causal connection between the two conditions.

Conclusions:

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: Motor unit number estimation (MUNE)
Author: Clifton L Gooch, MD. Robert Henderson, MD.
Affiliation: Department of Neurology
University of South Florida, Royal Brisbane & Women's Hospital
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Clifton L Gooch, MDRobert Henderson, MDSection Editor:Jeremy M Shefner, MD, PhDDeputy Editor:April F Eichler, MD, MPH
Publication Year and Month: 2018

Abstract: Electrophysiologic testing of nerve and muscle function has played a critical role in the diagnosis of neuromuscular disease for over half a century. Advances in computer technology and technical refinements have enabled the development of more sophisticated electrodiagnostic methods, which are providing information on the motor nerve and its function in health and disease. Motor unit number estimation (MUNE) is a technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. In addition, MUNE methods provide a means of measuring motor unit size, enabling tracking of both loss of motor units and the compensatory phenomenon of collateral reinnervation. MUNE is used most often in neuromuscular disorders such as amyotrophic lateral sclerosis and spinal muscular atrophy.
This topic will review the methodology and utility of MUNE.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Multidimensional fatigue inventory and post-polio syndrome – a Rasch analysis
Author: Anna Dencker, Katharina S Sunnerhagen, Charles Taft and Åsa Lundgren-Nilsson
Affiliation: Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. [email protected]
Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, 405 30, Gothenburg, Sweden. [email protected]
Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. [email protected]
Journal: Health and Quality of Life Outcomes
Citation: 2015 Feb 12;13:20
Publication Year and Month: 2015 02

Abstract: BACKGROUND:
Fatigue is a common symptom in post-polio syndrome (PPS) and can have a substantial impact on patients. There is a need for validated questionnaires to assess fatigue in PPS for use in clinical practice and research. The aim with this study was to assess the validity and reliability of the Swedish version of Multidimensional Fatigue Inventory (MFI-20) in patients with PPS using the Rasch model.

METHODS:
A total of 231 patients diagnosed with PPS completed the Swedish MFI-20 questionnaire at post-polio out-patient clinics in Sweden. The mean age of participants was 62 years and 61% were females. Data were tested against assumptions of the Rasch measurement model (i.e. unidimensionality of the scale, good item fit, independency of items and absence of differential item functioning). Reliability was tested with the person separation index (PSI). A transformation of the ordinal total scale scores into an interval scale for use in parametric analysis was performed. Dummy cases with minimum and maximum scoring were used for the transformation table to achieve interval scores between 20 and 100, which are comprehensive limits for the MFI-20 scale.

RESULTS:
An initial Rasch analysis of the full scale with 20 items showed misfit to the Rasch model (p < 0.001). Seven items showed slightly disordered thresholds and person estimates were not significantly improved by rescoring items. Analysis of MFI-20 scale with the 5 MFI-20 subscales as testlets showed good fit with a non-significant x (2) value (p = 0.089). PSI for the testlet solution was 0.86. Local dependency was present in all subscales and fit to the Rasch model was solved with testlets within each subscale. PSI ranged from 0.52 to 0.82 in the subscales.

Conclusions: CONCLUSIONS:
This study shows that the Swedish MFI-20 total scale and subscale scores yield valid and reliable measures of fatigue in persons with post-polio syndrome. The Rasch transformed total scores can be used for parametric statistical analyses in future clinical studies.

Outcome of Research: More research required

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Category: Quality of Life

Title: Multiple Chronic Medical Conditions and Health-Related Quality of Life in Older Adults, 2004–2006
Author: John P. Barile, PhD,corresponding author William W. Thompson, PhD, Matthew M. Zack, MD, Gloria L. Krahn, PhD, MPH, Willi Horner-Johnson, PhD, and Sonya E. Bowen, MSW
Affiliation: William W. Thompson, Matthew M. Zack, Gloria L. Krahn, Centers for Disease Control and Prevention, Atlanta, Georgia; Willi Horner-Johnson, Oregon Health and Science University, Portland, Oregon; Sonya E. Bowen, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Corresponding Author: John P. Barile, PhD, University of Hawai‘i at Mānoa, 2530 Dole St, Sakamaki Hall, C404, Honolulu, HI 96822. Telephone: 808-956-6271. E-mail: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Preventing Chronic Disease, Published online 2013 Sep 26. doi: 10.5888/pcd10.120282
Publication Year and Month: 2013 09

Abstract: Introduction
Understanding longitudinal relationships among multiple chronic conditions, limitations in activities of daily living, and health-related quality of life is important for identifying potential opportunities for health promotion and disease prevention among older adults.

Methods
This study assessed longitudinal associations between multiple chronic conditions and limitations in activities of daily living on health-related quality of life among older adults (≥65 years) from 2004 through 2006, using data from the Medicare Health Outcomes Survey (N = 27,334).

Results
Using a longitudinal path model, we found the numbers of chronic conditions at baseline and 2-year follow-up were independently associated with more limitations in activities of daily living at 2-year follow-up. In addition, more limitations in activities of daily living at 2-year follow-up were associated with worse health-related quality of life during the follow-up time period. The association between multiple chronic conditions and indices of health-related quality of life was mediated by changes in limitations in activities of daily living.

Conclusions: Both baseline and new multiple chronic conditions led to worse health in terms of activities of daily living and health-related quality of life and should be considered important outcomes to intervene on for improved long-term health. In addition, public health practitioners should consider addressing classes of multiple chronic conditions by using interventions designed to reduce the emergence of multiple chronic conditions, such as physical activity, reductions in smoking rates, and improved and coordinated access to health care services.

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Multiple sclerosis and poliomyelitis. A Danish historical cohort study.
Author: Nielsen NM, Wohlfahrt J, Melbye M, Rasmussen S, Mølbak K, Askgaard DS, Aaby P.
Affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Journal: Acta Neurologica Scandinavica
Citation: Acta Neurol Scand 2000 Jun;101(6):384-7.
Publication Year and Month: 2000 06

Abstract: OBJECTIVE:
To evaluate whether persons with a history of poliomyelitis are at an increased risk of developing multiple sclerosis (MS).

MATERIAL AND METHODS:
All patients diagnosed with acute poliomyelitis in the greater capital area of Copenhagen, Denmark, between 1919 and 1954 were identified and followed with respect to MS. Information on vital status and diagnosis of sclerosis was obtained through linkage with the Danish Civil Registration System and The Danish Multiple Sclerosis Registry, respectively. Follow-up started on the date of the establishment of the Danish Civil Registration System (April 1, 1968) until death, emigration or December 31, 1996, whichever came first. The observed incidence of MS among polio patients was compared with the expected incidence calculated according to national gender, age and period specific rates of MS.

RESULTS:
During 149,364 years of follow-up, 19 cases of multiple sclerosis were observed among 5652 polio patients compared with 11.0 expected (SIR = 1.73 (1.04-2.74)). The increased risk of MS was most pronounced in polio patients hospitalized during adolescence. Neither gender nor the acute severity of poliomyelitis modified the risk of MS.

CONCLUSION:
Our results are based on small numbers of events, however the findings suggest that the polio patients might be at an increased risk of MS.

Conclusions:

Outcome of Research: More research required

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Comments (if any): There appears a higher incidence of Multiple Sclerosis in this study of Danish patients previously diagnosed with Poliomyelitis. This should not be interpreted that previously contracting Poliomyelitis will lead to Multiple Sclerosis.

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Category: Muscle Strength

Title: Muscle strength is only a weak to moderate predictor of gait performance in persons with late effects of polio.
Author: Flansbjer, UB, Brogardh, C, Lexell, J
Affiliation: Department of Rehabilitation Medicine, Lund University Hospital, Lund, Sweden Department of Health Sciences, Lund University, Lund, Swede
Journal: NeuroRehabilitation
Citation: 2013;33(3):457-64. doi: 10.3233/NRE-130978
Publication Year and Month: 2013 03

Abstract: OBJECTIVE:
To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance.

METHODS:
Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed "Up & Go", the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk test.

RESULTS:
There were significant correlations between knee extensor and flexor muscle strength and gait performance (p < 0.01), and between ankle dorsiflexor muscle strength and gait performance (p < 0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle dorsiflexors explained 4% to 24%, whereas gender, age and BMI contributed at most an additional 9%.

CONCLUSION:
Knee muscle strength, and to some extent ankle dorsiflexor muscle strength, are predictors of gait performance in persons with late effects of polio, but the strength of the relationships indicates that other factors are also important.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Muscular effects in late polio.
Author: Sunnerhagen, K.S., Grimby, G.
Affiliation: Department of Rehabilitation Medicine, Goteborg University, Sweden
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Acta Physiologica Scandinavica.
Sunnerhagen, K.S. & Grimby, G. (2001) Muscular Effects of Polio. Acta Physiologica Scandinavica, 171: 335–340. doi:10.1046/j.1365-201x.2001.00836.x
Publication Year and Month: 2001 03

Abstract: New or increased muscular weakness, fatigue and muscle and joint pain with neuropathic electromyography (EMG) changes in a person with a confirmed history of polio constitute the cardinal symptoms of the post-polio syndrome. Unusual tiredness or fatigue is a common complaint in late polio subjects as is intolerance to cold. Fatigue in polio subjects can have several explanations: emotional fatigue, central nervous system fatigue, ‘general’ fatigue and/or neuromuscular fatigue. Some studies indicate central fatigue, but it is unclear how often and to which degree there will be a central muscular fatigue. Polio patients are known to be deconditioned (reduced function because of low activity level), and aerobic power is reduced. Defects in the neuromuscular transmission may be present but are not seen in all post-polio subjects with reduction in force and increased fatigability. The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible explanations may be an imperfection in the sarcoplasmatic reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.

Conclusions: The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible explanations may be an imperfection in the sarcoplasmatic reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.

Outcome of Research: More research required

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Category: Post-Polio Motor Unit

Title: Neuromuscular function in polio survivors at one-year follow-up.
Author: Agre JC, Rodriguez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 1991 Jan;72(1):7-10.
Publication Year and Month: 1991 01

Abstract: Many polio survivors complain of progressive loss of strength, work capacity, endurance, and ability to recover from fatiguing activity. These variables were measured initially and one year later in the quadriceps muscles of 28 symptomatic and 16 asymptomatic persons who had polio and 38 control individuals. Peak knee extension torque was measured isokinetically and isometrically. Endurance, or the amount of time the subject could maintain isometric torque at 40% of maximal torque, was measured. Work capacity was determined as the product of isometric torque and endurance time. Recovery of strength was measured at regular intervals for ten minutes after the endurance test. Statistical analysis was done by repeated measures ANOVA. Although the initial measures showed significant deficits in mean peak torque, work capacity, and recovery of strength in symptomatic postpolio subjects, no significant changes were found one year later in any of the variables.

Conclusions: Symptomatic postpolio subjects do not lose significant neuromuscular function in one year.

Outcome of Research: More research required

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Category: Complementary Therapies

Title: No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study
Author: Brogardh C, Flansbjer U-B, Lexell J.
Affiliation: Skane University Hospital
Lund University
Lulea University of Technology
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 91, Issue 9, September 2010, Pages 1474-1477
Publication Year and Month: 2010 09

Abstract: Objective
To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.

Design
A case-controlled pilot study with assessments before and after training.

Setting
A university hospital rehabilitation department.

Participants
People (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55−71y) with clinically and electrophysiologically verified late effects of polio.

Interventions
All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°−55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).

Main Outcome Measures
Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).

Results
All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.

Conclusions: This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.

Outcome of Research: More research required

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Category: Activity Levels, Psychology,

Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08

Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).

OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.

METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.

RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.

Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.

Outcome of Research: More research required

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Category: Immune Response

Title: Normal serum levels of immune complexes in postpolio patients
Author: Melin E (1), Sohrabian A (2), Rönnelid J (2), Borg K (1)
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; (2) Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
Journal: Results in Immunology
Citation: Results in Immunology. 2014; 4: 54–57. doi: 10.1016/j.rinim.2014.06.001
Publication Year and Month: 2014 06

Abstract: OBJECTIVE: The pathophysiology of the postpolio syndrome is not fully understood. Increased cytokine levels in cerebrospinal fluid and peripheral blood indicate a systemic inflammatory process. Decreased cytokine levels and the clinical effect of intravenous immunoglobulin treatment further indicate an inflammatory/immunological pathogenesis. The aim of the present study was to evaluate whether an autoimmune process follows the initial infection, by means of analyzing immune complexes.

PATIENTS AND METHODS: Circulating immune complexes were analyzed from blood samples of 20 postpolio patients and 95 healthy controls. To compensate for differences in age between patients and controls, a sub-analysis was performed using only the 30 oldest controls. Tumor necrosis factor-inducing properties of polyethylene glycol-precipitated immune complexes were compared between the postpolio patients and 10 healthy controls.

RESULTS: When comparing levels in postpolio patients to the whole control group, including the 30 oldest investigated, there were no statistically significant differences. No difference was found in tumor necrosis factor levels induced by immune complexes when comparing patients and controls.

Conclusions: There was no increase in circulating immune complex or in tumor necrosis factor-inducing effects of circulating immune complex between postpolio patients and healthy controls, indicating that the postpolio syndrome is not due to an autoimmune reaction.

Outcome of Research: More research required.

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Category: Surgery

Title: Outcome of total knee arthroplasty in patients with poliomyelitis
Author: Anoop Prasad, Richard Donovan, Manoj Ramachandran, Sebastian Dawson-Bowling, Steven Millington, Rej Bhumbra, Pramod Achan, Sammy A. Hanna
Affiliation:
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The British Editorial Society of Bone & Joint Surgery, 6 Jun 2018
Publication Year and Month: 2018 06

Abstract: Total knee arthroplasty (TKA) in patients affected by poliomyelitis is technically challenging owing to abnormal anatomical features including articular and metaphyseal angular deformities, external rotation of the tibia, excessive valgus alignment, bone loss, narrowness of the femoral and tibial canals, impaired quadriceps strength, flexion contractures, genu recurvatum and ligamentous laxity. Little information is available regarding the results and complications of TKA in this challenging group of patients.

Conclusions: The findings of this review support the use of TKA to alleviate pain and functional limitation in poliomyelitis patients with knee arthropathy. Post-operative patient satisfaction and functional improvement is similar to other patients; however, the revision rate is higher. Quadriceps muscle power is an important prognostic factor for functional outcome and patients should be counselled about this pre-operatively. The use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength. Irrespective of the type of implant used, meticulous intra-operative balancing of soft tissues and restoration of alignment are crucial factors for achieving a good outcome.

Outcome of Research: More research required

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Category: Brain

Title: Parallels between Post Polio fatigue and chronic fatigue syndrome: a common pathophysiology?
Author: Bruno, R.L., Creange, S.J., and Frick, N.M
Affiliation: Kids' Fatigue Management Program and The Post-Polio Institute, Englewood Hospital and Medical Center, New Jersey
Journal:
Citation: Am J Med.

Publication Year and Month: 1998 09

Abstract: Fatigue is the most commonly reported and most debilitating of post-polio sequelae affecting the >1.8 million North American polio survivors. Post-polio fatigue is characterized by subjective reports of difficulty with attention, cognition, and maintaining wakefulness. These symptoms resemble those reported in nearly 2 dozen outbreaks of post-viral fatigue syndromes (PVFS) that have recurred during this century and that are related clinically, historically, anatomically, or physiologically to poliovirus infections. This article reviews recent studies that relate the symptoms of post-polio fatigue and chronic fatigue syndrome (CFS) to clinically significant deficits on neuropsychologic tests of attention, histopathologic and neuroradiologic evidence of brain lesions, impaired activation of the hypothalamic-pituitary-adrenal axis, increased prolactin secretion, and electroencephalogram (EEG) slow-wave activity. A possible common pathophysiology for post-polio fatigue and CFS, based on the Brain Fatigue Generator Model of PVFS, and a possible pharmacotherapy for PVFS based on replacement of depleted brain dopamine, will be described

Conclusions: There is evidence of severe brain lesions at the brain stem and less severe lesions in the cerebellum and cerebral cortex which could play a role in general and cognitive fatigue.

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Pathogenetic mechanisms of post-polio syndrome: morphological, electrophysiological, virological, and immunological correlations.
Author: Dalakas MC
Affiliation: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1382, USA.
Journal: Annals of the New York Academy of Sciences
Citation: 1995 May 25;753:167-85.
Publication Year and Month: 1995 05

Abstract: To understand the mechanism of post-poliomyelitis muscular atrophy (PPMA) and the post-polio syndrome (PPS) in general, we performed the following studies: (1) histopathology in spinal cord sections from patients who died 9 days to 44 years after acute paralytic poliomyelitis; (2) enzyme histochemistry, immunocytochemistry (for lymphocyte subsets, MHC antigens and N-CAM) and polymerase chain reaction (PCR) for poliovirus RNA in the muscle biopsies from symptomatic or asymptomatic muscles of post-polio patients; (3) determination of lymphocyte subsets and circulating IgG or IgM antibodies against GM1 and poliovirus; (4) virological studies in the spinal fluid for oligoclonal bands and search for poliovirus genome with PCR; (5) electrophysiological studies including single fiber EMG, fiber density and macro-EMG; and (6) [31P] exercise MRS spectroscopy on previously affected muscles to search for a metabolic correlate of fatigue. These studies concluded that in PPS a continuing dysfunction is present in the spinal cord motor neurons, resulting in ongoing muscle denervation and reinnervation first evident at the axonal branch points. Symptoms are related to attrition of the oversprouting motor neurons which after a period of time cannot support all their axonal sprouts, resulting in failure of re-reinnervation. In some patients with PPS there is also an ongoing immune activation and presence of defective viral particles in the spinal fluid. However, their role in the pathogenesis of PPS is presently unknown.

Conclusions: These studies concluded that in PPS a continuing dysfunction is present in the spinal cord motor neurons, resulting in ongoing muscle denervation and reinnervation first evident at the axonal branch points.

Outcome of Research: More research required

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Category: Polio Immunisation

Title: Patients with Primary Immunodeficiencies Are a Reservoir of Poliovirus and a Risk to Polio Eradication
Author: Aghamohammadi A (1), Abolhassani H (1), Kutukculer N (2), Wassilak SG (3), Pallansch MA (4), Kluglein S (5), Quinn J (6), Sutter RW (7), Wang X (8), Sanal O (9), Latysheva T (10), Ikinciogullari A (11), Bernatowska E (12), Tuzankina IA (13), Costa-Carvalho BT (14), Franco JL (15), Somech R (16), Karakoc-Aydiner E (17), Singh S (18), Bezrodnik L (19), Espinosa-Rosales FJ (20), Shcherbina A (21), Lau Y (22,23), Nonoyama S (24), Modell F (6), Modell V (6), The JMF Centers Network Investigators and Study Collaborators, Barbouche M (25), and McKinlay MA (5)
Affiliation: (1) Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Science, Tehran, Iran; (2) Faculty of Medicine, Department of Pediatric Immunology, Ege University, Izmir, Turkey; (3) Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; (4) Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; (5) Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States; (6) Jeffrey Modell Foundation, New York, NY, United States; (7) Research and Product Development, World Health Organization, Geneva, Switzerland' (8) Department of Clinical Immunology, Children’s Hospital of Fudan University, Shanghai, China; (9) Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey; (10) Department of Allergology and Immunotherapy, Institute of Immunology, Moscow, Russia; (11) Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey; (12) Department of Clinical Immunology, The Children’s Memorial Health Institute, Warsaw, Poland; (13) Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia; (14) Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil; (15) Grupo de Inmunodeficiencias Primarias, Facultad de Medicina, Departamento de Microbiología y Parasitología, Universidad de Antioquia, Medellín, Colombia; (16) Pediatric Department A and the Immunology Service, Sheba Medical Center, Tel Hashomer, Jeffrey Modell Foundation Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (17) Division of Pediatric Allergy and Immunology, Marmara Medical Faculty, Istanbul, Turkey; (18) Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India; (19) Dr. Ricardo Gutierrez Hospital de Niños, Buenos Aires, Argentina; (20) Clinical Immunology and Allergy Unit, Instituto Nacional de Pediatría, Ciudad de México, Mexico; (21) Department of Clinical Immunology, Dmitry Rogachev Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia; (22) Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong; (23) Shenzhen Primary Immunodeficiency Diagnostic and Therapeutic Laboratory, Hong Kong University-Shenzhen Hospital, Shenzhen, China; (24) Department of Pediatrics, National Defense Medical College, Saitama, Japan; (25) Department of Immunology, Institut Pasteur de Tunis, University Tunis El-Manar, Tunis, Tunisia.
Journal: Frontiers in Immunology
Citation: Front. Immunol. 8:685. doi: 10.3389/fimmu.2017.00685
Publication Year and Month: 2017 06

Abstract: Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) have been isolated from primary immunodeficiency (PID) patients exposed to oral poliovirus vaccine (OPV). Patients may excrete poliovirus strains for months or years; the excreted viruses are frequently highly divergent from the parental OPV and have been shown to be as neurovirulent as wild virus. Thus, these patients represent a potential reservoir for transmission of neurovirulent polioviruses in the post-eradication era. In support of WHO recommendations to better estimate the prevalence of poliovirus excreters among PIDs and characterize genetic evolution of these strains, 635 patients including 570 with primary antibody deficiencies and 65 combined immunodeficiencies were studied from 13 OPV-using countries. Two stool samples were collected over 4 days, tested for enterovirus, and the poliovirus positive samples were sequenced. Thirteen patients (2%) excreted polioviruses, most for less than 2 months following identification of infection. Five (0.8%) were classified as iVDPVs (only in combined immunodeficiencies and mostly poliovirus serotype 2). Non-polio enteroviruses were detected in 30 patients (4.7%). Patients with combined immunodeficiencies had increased risk of delayed poliovirus clearance compared to primary antibody deficiencies. Usually, iVDPV was detected in subjects with combined immunodeficiencies in a short period of time after OPV exposure, most for less than 6 months. Surveillance for poliovirus excretion among PID patients should be reinforced until polio eradication is certified and the use of OPV is stopped. Survival rates among PID patients are improving in lower and middle income countries, and iVDPV excreters are identified more frequently. Antivirals or enhanced immunotherapies presently in development represent the only potential means to manage the treatment of prolonged excreters and the risk they present to the polio endgame.

Conclusions: This study provides an estimate of the global iVDPV prevalence among PID patients without paralytic disease and supports expanded screening for iVDPV excretion in these patients. Although most previous studies focused on the risk of long-term iVDPV infection in antibody deficient patients, the predominance of risk in patients with combined immunodeficiencies included in the current study highlights the importance of considering this group of PID patients in any surveillance program. Reinfection with poliovirus and NPEV excretion in PID patients described elsewhere demonstrates the need for prolonged follow-up (17).

The Global Polio Eradication Initiative plans to cease use of OPV worldwide once WPV has been certified as eradicated, which will end the generation of new iVDPVs. However, there is currently no means for addressing the threat posed by existing immunodeficient persons infected with iVDPVs, either to the infected individual’s risk of paralytic disease, or to the community of a continuing source of poliovirus transmission. Antivirals represent a potential means to manage the treatment of iVDPV excreters and the risk they present to the eradication effort (32, 34). Two safe virus-specific antivirals acting by differing mechanisms are now being developed and may be used as a combination (e.g., pocapavir and V-7404). This strategy may resolve the individual’s infection, stop iVDPV excretion, and serve to eliminate the risk of poliovirus transmission in the community. Currently, pocapavir is being considered for use in poliovirus excreting PID patients on a compassionate use basis.

The potential risk posed by iVDPV excreters to the polio eradication effort indicates the immediate need to develop and implement a global iVDPV surveillance strategy. Utilizing this approach, individuals at risk of prolonged poliovirus excretion can be identified and antiviral treatment can be initiated.

Outcome of Research: More research required

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Category: Continence

Title: Pelvic floor and poliomyelitis. Case report
Author: Gabriella Fizzotti, Michelangelo Buonocore, Eliana Giambelluca, Antonio Nardone
Affiliation: Spinal Unit, ICS Maugeri, Pavia, Italy
Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, ICS Maugeri, Pavia, Italy,
School of Specialization in Physical Medicine and Rehabilitation, University of Pavia, Pavia, Italy;
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences University of Pavia, Pavia
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Open Access 2:1-3 (2018)
Publication Year and Month: 2018

Abstract: Introduction: Living with polio increases the risk of having bladder dysfunction. Normal pelvic visceral function depends on the complex interactions
of intact somatic and autonomic nervous systems. Tests that are used to investigate the integrity of the somatic innervation of the pelvic floor muscles and urinary and anal sphincters include electromyography (EMG), nerve conduction studies and the evaluation of the sacral reflexes.
Clinical Picture and Investigation: A 53-year-old South-American man who had a history of poliomyelitis which affected his lower right limb
when he was 2 years old. Patient was unable to empty his bladder completely. The aim of this paper is to describe the correlation between pelvic
floor dysfunction, bladder symptoms and neurophysiological tests in poliomyelitis.

Conclusions: Conclusion: Neurophysiological diagnostic procedures adopted in our study can discern the degree of central and peripheral nervous system damage and confirmed that pelvic floor and detrusor muscles have been paralyzed by the poliovirus.

Outcome of Research: More research required

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Category: Brain

Title: Physiology of the motor cortex in polio survivors.
Author: Lupu, V.D. et al.
Affiliation: EMG Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Building 10, CRC, 7-5680, 10 Center Drive, MSC-1404 Bethesda, Maryland 20892, USA.

Journal: Muscle & Nerve
Citation: Muscle Nerve. 2008;37(2):177-82.
DOI: 10.1002/mus.20913

Publication Year and Month: 2008 02

Abstract: We hypothesized that the corticospinal system undergoes functional changes in long-term polio survivors. Central motor conduction times (CMCTs) to the four limbs were measured in 24 polio survivors using transcranial magnetic stimulation (TMS). Resting motor thresholds and CMCTs were normal. In 17 subjects whose legs were affected by polio and 13 healthy controls, single- and paired-pulse TMS was used to assess motor cortex excitability while recording from tibialis anterior (TA) muscles at rest and following maximal contraction until fatigue. In polio survivors the slope of the recruitment curve was normal, but maximal motor evoked potentials (MEPs) were larger than in controls. MEPs were depressed after fatiguing exercise. Three patients with central fatigue by twitch interpolation had a trend toward slower recovery. There was no association with symptoms of post-polio syndrome. These changes occurring after polio may allow the motor cortex to activate a greater proportion of the motor neurons innervating affected muscles.

Conclusions:

Outcome of Research: More research required

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Comments (if any): There appear to be compensatory effects by the motor cortex to increase the strength of action potentials to innervate muscles that have fewer motor units (due to the polio virus). Surprisingly, this investigation did not find association between PPS or central fatigue with increased central recruitment patterns to innervate remaining muscle tissue.

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Category: Diagnosis and Management

Title: Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo
Author: Mancini S, Coldiron ME, Nicholas S, Llosa AE, Mouniaman-Nara I, Ngala J, Grais RF, Porten K
Affiliation: Epicentre, Paris, France - [email protected]
Journal: BioMedCentral Research Notes
Citation: BMC Res Notes. 2014 Oct 23;7:755. doi: 10.1186/1756-0500-7-755
Publication Year and Month: 2014 10

Abstract: BACKGROUND: A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.

FINDINGS: Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength.

Conclusions: Most acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.

Outcome of Research: More research required.

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Category: Diagnosis and Management

Title: Polio survivors perceptions of a multi-disciplinary rehabilitation programme
Author: Atwal, A., Duncan, H., Queally, C., Cedar, S.H.
Affiliation: Nil
Journal: Disability and Rehabilitation
Citation: Atwal, A., Duncan, H., Queally, C., Cedar, S.H. (2017) Polio survivors perceptions of a multi-disciplinary rehabilitation programme. Disability and Rehabilitation. DOI: 10.1080/09638288.2017.1381184
Publication Year and Month: 2017 10

Abstract: Purpose: Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor’s perceptions of an in-patient multi-disciplinary rehabilitation programme.

Methods: Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data.

Results: Participants’ experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme.

Conclusions: The research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production.

Implications for Rehabilitation
The patients’ expertise and lived experience must be at the centre of a rehabilitation programme.

Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions.

Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided.

When measuring outcomes patient preferences and views must be evaluated.

Outcome of Research: More research required

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Comments (if any): This investigation supports feedback from polio survivors in Australia on the benefits of group-based rehabilitation, especially where there is an opportunity to learn and discuss their rehabilitation with fellow participants.

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Category: Quality of Life

Title: Polio survivors' perceptions of the meaning of quality of life and strategies used to promote participation in everyday activities
Author: Atwal A, Spiliotopoulou G, Coleman C, Harding K, Quirke C, Smith N, Osseiran Z, Plastow N, Wilson L
Affiliation: Division of Occupational Therapy, School of Health Sciences and Social Care, Brunel University, Uxbridge, UK
Journal: Health Expectations
Citation: Health Expect. 2014 Jan;doi:10.1111/hex.12152
Publication Year and Month: 2014 01

Abstract: INTRODUCTION: The term ‘post-polio syndrome’ (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life. Research in this area has focused upon health status rather than its effect on quality of life.

AIM: To gain an in-depth understanding of the meaning of quality of life for polio survivors and to determine the type of strategies that are used by people with PPS and the support that they consider as important to facilitate participation in everyday life activities that have an impact on their quality of life.

METHOD: Six focus groups were conducted with 51 participants from two regions in England. Data were audio-taped and analysed using thematic analysis.

RESULTS: Our research found that polio survivors used terms used to describe quality of life which could be associated with that of happiness. Our research has identified resolvable factors that influence quality of life namely inaccessible environments, attitudes of health-care professionals and societal attitudes. Polio survivors have tried alternative therapies, chiefly acupuncture and massage, and found them to be effective in enhancing their quality of life.

Conclusions: It is suggested that health-care professionals should consider factors which influence happiness and implement a person-centred approach with the views of the polio survivor being listened to. The three factors that influenced quality of life could be resolved by health-care professionals and by society. With regard to strategies used, we suggest that polio survivors should have access to the treatments that they perceive as important, although further research is required to design optimal interventions for this client group.

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Poliomyelitis and Parkinson Disease.
Author: Nielsen NM, Rostgaard K, Hjalgrim H, Aaby P, Askgaard D.
Affiliation: Department of Epidemiology Research, National University Hospital, Copenhagen, Denmark
Journal: The Journal of the American Medical Association
Citation: JAMA. 2002;287(13):1650–1651.
doi:10.1001/jama.287.13.1645
Publication Year and Month: 2002 04

Abstract: Parkinson disease (PD), which is due to loss of dopaminergic neurons in the zona compacta of the substantia nigra,1 may involve both genetic and environmental risk factors.2 Poliovirus is believed to cause neuronal damage in the substantia nigra,3 and thus a history of poliovirus infection may be associated with an increased risk of PD

Conclusions:

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Post-polio syndrome and total health status in a prospective hospital study.
Author: Farbu E, Rekand T, Gilhus NE
Affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway
Journal: European Journal of Neurology
Citation: 2003 Jul;10(4):407-13.
Publication Year and Month: 2003 07

Abstract: New loss of function among patients with previous polio is frequently reported and has several causes. All patients referred to the Department of Neurology, Haukeland University Hospital, Bergen, for 13 months during 2000-2001 with diagnosis late effects of polio were examined prospectively to identify their symptoms and loss of function. Eighty-five patients aged 47-91 years with mean of 61 years were included. The most common complaints were pain (44%), muscular weakness (27%), and fatigue (16%). Muscular weakness occurred in lower limbs in 75%, in respiratory muscles in only 5%. Walking in stairs was impaired in 72% and outdoor walking in 65%. Seventeen patients (19%) reported no loss of function. Post-polio syndrome was diagnosed in 26% of the patients. Polio-related loss of function including cervical and lumbosacral radiculopathies, mononeuropathies and degenerative joint disease were found in an additional 53%. Eleven patients (13%) had distinct non-polio-related disorders that caused new loss of function. The remaining 8% had a stable condition.

Conclusions: In conclusion, the majority of polio patients who seek hospital, experience a new loss of function because of polio-related disorders. A careful neurological examination is necessary to identify the correct diagnosis and treatment.

Outcome of Research: More research required

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Category: Coping Styles and Strategies

Title: Post-polio syndrome: psychological adjustment to disability.

Author: Hollingsworth L, Didelot MJ, Levington C.
Affiliation: Purdue University-Calumet, School of Education G-5, 2200 169th Street, Hammond, IN 46323-2094, USA.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Issues Ment Health Nurs. 2002;23(2):135-56.
Publication Year and Month: 2002 03

Abstract: Although the Pan American Health Organization declared in 1995 that polio had been eliminated in the Western Hemisphere, life-altering effects of the disease continue for many survivors. It is known as Post-Polio Syndrome (PPS). The sheer number of individuals experiencing the symptoms has attracted the attention of the medical community. These physical symptoms are severe enough to change the quality of life and require lifestyle changes for people with PPS to cope with the disease. The psychological implications for individuals who must face the reemergence of a disease they thought they had defeated 30 to 40 years ago are staggering. Thus, there is a crucial need for health care professionals, especially mental health nurses and psychotherapists, to address mental health issues that individuals with PPS experience.

Conclusions: There is a crucial need for health care professionals, especially mental health nurses and psychotherapists, to address mental health issues that individuals with PPS experience.

Outcome of Research: More research required

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Category: Pain

Title: Predictive factors and correlates for pain in postpoliomyelitis syndrome patients
Author: Vasiliadis HM, Collet JP, Shapiro S, Venturini A, Trojan DA
Affiliation: Department of Epidemiology and Biostatistics, Jewish General Hospital, McGill University, Montreal, Que, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2002 Aug;83(8):1109-15
Publication Year and Month: 2002 08

Abstract: OBJECTIVE: To identify predictive and associated factors for muscle and joint pain in postpoliomyelitis syndrome (PPS).

DESIGN: Cross-sectional study design.

SETTING: Postpolio clinics.

PARTICIPANTS: Baseline data on 126 PPS patients entered into a multicentered clinical trial.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Adjusted odds ratios were computed by using logistic regression modeling. Patients with or without muscle or joint pain were compared with regard to predictors and associated factors.

RESULTS: In multivariate analyses for muscle pain, significant predictive and associated factors were female gender (P=.0006), longer duration of general fatigue (P=.019), and a lower score on the general health scale (P=.009) of the Medical Outcomes Study 36-Item Short-From Health Survey (SF-36). In multivariate analyses for joint pain, significant predictive and associated factors were female gender (P<.003), longer latency (duration of stability after polio; P=.008), younger age at interview (P<.002), greater weakness at acute polio (P<.07), weaker lower-extremity muscle strength (P<.04), and a lower SF-36 general health scale score (P<.02).

Conclusions: Women are more likely to report muscle and joint pain in PPS. Greater initial motor unit involvement and lower-extremity weakness may be additional important factors for determining joint pain. Both muscle and joint pain are associated with reductions in quality of life.

Outcome of Research: More research required

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Category: Orthoses

Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.

Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.

Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017

Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.

OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.

METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.

RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001).

Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.

Outcome of Research: More research required

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Category: Late Effects of Polio

Title: Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.
Author: Paolo Ragonese, Brigida Fierro, Giuseppe Salemi, Giovanna Randisi, Daniela Buffa, Marco D'Amelio, Antonella Aloisio, Giovanni Savettieri
Affiliation: Dipartimento di Neurologia, Oftalmologia, Otorinolaringoiatria e Psichiatria, Università di Palermo, Italy.
Journal: Journal of the Neurological Sciences
Citation: 2005 Sep 15;236(1-2):31-5.
Publication Year and Month: 2005 09

Abstract: OBJECTIVE:
To investigate frequency and associated factors of post polio syndrome (PPS) in an Italian cohort of people with prior poliomyelitis.

METHODS:
We screened subjects admitted for poliomyelitis at the paediatric hospital of the University of Palermo during the time frame 1945-1960. Patients who developed PPS were identified through a structured questionnaire and a neurologic examination. PPS diagnosis was made according to specified diagnostic criteria. Frequency of PPS was calculated in the selected cohort of polio survivors. The association with the investigated risk factors (sex, age at onset of polio, extension and severity of polio, education, associated diseases, cigarette smoking, trauma, polio vaccination) was analysed by the calculation of the odds ratio.

RESULTS:
Forty-eight participants met the adopted diagnostic criteria for PPS, giving a prevalence of 31.0%. The prevalence rate was significantly higher in women than in men (p=0.02). Logistic regression analyses revealed a significant inverse association with onset of poliomyelitis at over 12 months of age (OR 0.33; CI 0.14-0.79) a higher degree of education (OR 0.20; CI 0.07-0.79), and a significant association with the presence of other diseases (OR 9.86; CI 3.69-26.34).

Conclusions: CONCLUSIONS:
In our survey one-third of patients with prior poliomyelitis had PPS. Higher age at onset of poliomyelitis is inversely associated with PPS. The association with other diseases may indicate that a chronic physical stress, particularly in already weak motor units, can contribute to the development of signs and symptoms of PPS. Our results also suggest the impact of socio-economic conditions on the risk of PPS.

Outcome of Research: More research required

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Category: Respiratory Complications and Management

Title: Protocol for diaphragm pacing in patients with respiratory muscle weakness due to motor neurone disease (DiPALS): a randomised controlled trial.
Author: McDermott C, Maguire C, Cooper CL, Ackroyd R, Baird WO, Baudouin S, Bentley A, Bianchi S, Bourke S, Bradburn MJ, Dixon S, Ealing J, Galloway S, Karat D, Maynard N, Morrison K, Mustfa N, Stradling J, Talbot K, Williams T, Shaw PJ.
Affiliation: Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK.
Journal: BioMed Central Neurology
Citation: 2012 Aug 16;12:74.
Publication Year and Month: 2012 08

Abstract: BACKGROUND:
Motor neurone disease (MND) is a devastating illness which leads to muscle weakness and death, usually within 2-3 years of symptom onset. Respiratory insufficiency is a common cause of morbidity, particularly in later stages of MND and respiratory complications are the leading cause of mortality in MND patients. Non Invasive Ventilation (NIV) is the current standard therapy to manage respiratory insufficiency. Some MND patients however do not tolerate NIV due to a number of issues including mask interface problems and claustrophobia. In those that do tolerate NIV, eventually respiratory muscle weakness will progress to a point at which intermittent/overnight NIV is ineffective. The NeuRx RA/4 Diaphragm Pacing System was originally developed for patients with respiratory insufficiency and diaphragm paralysis secondary to stable high spinal cord injuries. The DiPALS study will assess the effect of diaphragm pacing (DP) when used to treat patients with MND and respiratory insufficiency.

METHOD/DESIGN:
108 patients will be recruited to the study at 5 sites in the UK. Patients will be randomised to either receive NIV (current standard care) or receive DP in addition to NIV. Study participants will be required to complete outcome measures at 5 follow up time points (2, 3, 6, 9 and 12 months) plus an additional surgery and 1 week post operative visit for those in the DP group. 12 patients (and their carers) from the DP group will also be asked to complete 2 qualitative interviews.

DISCUSSION:
The primary objective of this trial will be to evaluate the effect of Diaphragm Pacing (DP) on survival over the study duration in patients with MND with respiratory muscle weakness. The project is funded by the National Institute for Health Research, Health Technology Assessment (HTA) Programme (project number 09/55/33) and the Motor Neurone Disease Association and the Henry Smith Charity.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Psychometric properties of fatigue severity and fatigue impact scales in postpolio patients
Author: Oncu J (1), Atamaz F, Durmaz B, On A
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Şişli Etfal Teaching Hospital, Istanbul; Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-Izmir, Turkey.
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2013 Dec;36(4):339-45. doi: 10.1097/MRR.0b013e3283646b56
Publication Year and Month: 2013 12

Abstract: We evaluate the reliability, validity, and responsiveness of the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS) and to determine whether these scales are potentially applicable for measuring fatigue in postpolio patients (PPS). After the Turkish adaptation of FSS and FIS using a forward-backward procedure, the scales were administered to 48 PPS patients without additional health problems that may induce fatigue. Reliability studies were carried out by determination of intraclass correlation coefficient and internal consistency by the Cronbach-α coefficient. Validity was tested by within-scale analyses and analyses against the external criteria including convergent validity and discriminant validity. Correlations with the Notthingham Health Profile (NHP), fatigue, pain and cramp severity (visual analog scale), and manual muscle testing were performed. Sensitivity to changes was determined by standardized response mean values. All patients completed scales, suggesting their satisfactory acceptance. Reliability studies were satisfactory, with higher Cronbach-α values and intraclass correlation coefficients than 0.80. The FSS score was correlated moderately with visual analog scale-fatigue (r=0.41) and the NHP-energy dimension (r=0.29). All FIS scores except cognitive scores were moderately related to the NHP-social isolation score (r=0.40, 0.37, and 0.43 for FIS-physical, social, and total scores, respectively). There was also a significant correlation between the FIS-physical score and the NHP-energy score (r=0.31). On the basis of the standardized response mean values, response to treatment for these two questionnaires was satisfactory (P=0.00). The Turkish versions of FSS and FIS were reliable, sensitive to clinical changes, and also well accepted by patients with PPS. Although they had somewhat satisfactory convergent validity, the absence of strong correlations did not support the validity entirely.

Conclusions:

Outcome of Research: More research required

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Category: Pain

Title: Psychosocial factors and adjustment to pain in individuals with postpolio syndrome
Author: Hirsh AT, Kupper AE, Carter GT, Jensen MP
Affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98104, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2010 Mar;89(3):213-24. doi: 10.1097/PHM.0b013e3181c9f9a1
Publication Year and Month: 2010 03

Abstract: OBJECTIVE: The purpose of the current study was to examine the associations among measures of psychosocial factors, pain, and adjustment in persons with postpoliomyelitis syndrome.

DESIGN: A cross-sectional survey design was used. Sixty-three community-dwelling individuals with postpoliomyelitis syndrome returned completed questionnaires (71% response rate) that included measures of pain intensity and interference, psychological functioning, pain catastrophizing, social support, and pain-related beliefs and coping.

RESULTS: After controlling for demographic variables, the group of psychosocial variables accounted for an additional 23% of the variance in pain intensity. These variables explained an additional 35% and 50% of the variance in pain interference and psychological functioning, respectively, after accounting for demographic variables and pain intensity. Social support was associated with both psychological functioning and pain interference, whereas catastrophizing was most closely related to psychological functioning. Individual pain beliefs and coping strategies were variably related to the three criterion measures.

Conclusions: The overall results of the current study are consistent with a biopsychosocial framework for understanding pain and functioning in individuals with postpoliomyelitis syndrome. Although additional research is needed to clarify the nature of the relationships between individual psychosocial variables and functional indices, the findings suggest the need for a multidisciplinary approach to pain management in individuals with postpoliomyelitis syndrome.

Outcome of Research: More research required.

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Category: Drugs

Title: Pyridostigmine in postpolio syndrome: no decline in fatigue and limited functional improvement
Author: Horemans H (1), Nollet F (1), Beelen A (1), Drost G (2), Stegeman D (2), Zwarts M (2), Bussmann J (3), de Visser M (4), Lankhorst G (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, Netherlands; (2) Department of Clinical Neurophysiology, University Medical Centre Nijmegen, Netherlands; (3) Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Netherlands; (4) Department of Neurology, Academic Medical Centre, University of Amsterdam, Netherlands
Journal: Journal of Neurology, Neurosurgery and Psychiatry
Citation: J Neurol Neurosurg Psychiatry 2003;74:1655-1661 doi:10.1136/jnnp.74.12.1655
Publication Year and Month: 2003 12

Abstract: OBJECTIVES: To investigate the effect of pyridostigmine on fatigue, physical performance, and muscle function in subjects with postpoliomyelitis syndrome.

METHODS: 67 subjects with increased fatigue and new weakness in one quadriceps muscle showing neuromuscular transmission defects, were included in a randomised, double blind, placebo controlled trial of 60 mg pyridostigmine four times a day for 14 weeks. Primary outcome was fatigue (on the "energy" category of the Nottingham health profile). Secondary outcomes included two minute walking distance and quadriceps strength and jitter. Motor unit size of the quadriceps was studied as a potential effect modifier. The primary data analysis compared the changes from baseline in the outcomes in the last week of treatment between groups.

RESULTS: 31 subjects treated with pyridostigmine and 31 subjects treated with placebo completed the trial. No significant effect of pyridostigmine was found on fatigue. The walking distance improved more in the pyridostigmine group than in the placebo group (by 7.2 m (6.0%); p<0.01). Subgroup analysis showed that a significant improvement in walking performance was only found in subjects with normal sized motor units. Quadriceps strength improved more in the pyridostigmine group than in the placebo group (by 6.7 Nm (7.2%); p = 0.15). No effect of pyridostigmine was found on jitter.

Conclusions: Pyridostigmine in the prescribed dose did not reduce fatigue in subjects with postpoliomyelitis syndrome. However, it may have a limited beneficial effect on physical performance, especially in subjects with neuromuscular transmission defects in normal sized motor units.

Outcome of Research: More research required.

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Category: Quality of Life

Title: Quality of life for post-polio syndrome: a patient derived, Rasch standard scale.
Author: Young CA, Quincey AC, Wong SM, Tennant A
Affiliation: Department of Neurology , Walton Centre NHS Trust , Lower Lane , Liverpool , UK.
ICF Unit , Swiss Paraplegic Research , Nottwil , Switzerland
Journal: Disability and Rehabilitation
Citation: 2018 Mar;40(5):597-602
Publication Year and Month: 2018 03

Abstract: OBJECTIVE:
To design a disease-specific quality of life (QoL) questionnaire for people with post-polio syndrome (PPS).

METHODS:
Qualitative interviews were conducted with 45 people with PPS to identify themes and derive potential items reflecting impact upon QoL. After cognitive debriefing, these were made into a questionnaire pack along with comparative questionnaires and posted to 319 patients. The 271 (85%) returned questionnaires were subjected to exploratory factor analysis (EFA) and Rasch analysis.

RESULTS:
A 25 item scale, the post-polio quality of life scale (PP-QoL), showed good fit to the Rasch model (conditional chi-square p = 0.156), unidimensionality (% t-tests 2.0: CI 0.7-3.8), and Cronbach's alpha of 0.87. With the latent estimate transformed to a 0-100 scale, the mean score was 56.9 (SD 18.5) with only 3.3% of respondents at the floor or ceiling of the scale. Test-retest reliability showed an intraclass correlation coefficient (ICC) (2.1) of 0.916, and correlation of 0.85.

Conclusions: CONCLUSION:
The disease-specific PP-QoL demonstrated excellent reliability, appropriate concurrent validity, and satisfied the standards of the Rasch model. It enables examination of the impact of health status upon perceived QoL, and the impact of rehabilitation interventions. The scale is freely available for academic or not-for-profit users to improve research in this neglected, disabling condition. Implications for Rehabilitation In post-polio syndrome (PPS), existing work examines aspects of health-related quality of life (HRQoL), such as activity limitations. A disease-specific QoL measure would enable researchers to model the impact of health status, such as fatigue or mobility restrictions, upon QoL in PPS. The post-polio quality of life scale (PP-QoL) is based on the patients' lived experience, meets Rasch standards and is free for use for academic and not-for-profit researchers. The raw score is reliable for individual use in clinical settings, and interval scale transformation is available for parametric applications and the calculation of change scores.

Outcome of Research: More research required

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Category: Muscle Strength

Title: Randomized controlled trial of strength training in post-polio patients
Author: Chan, K. M., Amirjani, N., Sumrain, M., Clarke, A. and Strohschein, F. J.
Affiliation: Funded by Alberta Heritage Foundation and Canada Foundation
Journal: Muscle & Nerve
Citation: Chan, K. M., Amirjani, N., Sumrain, M., Clarke, A. and Strohschein, F. J. (2003), Randomized controlled trial of strength training in post-polio patients. Muscle Nerve, 27: 332–338. doi:10.1002/mus.10327
Publication Year and Month: 2003 02

Abstract: Many post-polio patients develop new muscle weakness decades after the initial illness. However, its mechanism and treatment are controversial. The purpose of this study was to test the hypotheses that: (1) after strength training, post-polio patients show strength improvement comparable to that seen in the healthy elderly; (2) such training does not have a deleterious effect on motor unit (MU) survival; and (3) part of the strength improvement is due to an increase in voluntary motor drive. After baseline measures including maximum voluntary contraction force, voluntary activation index, motor unit number estimate, and the tetanic tension of the thumb muscles had been determined, 10 post-polio patients with hand involvement were randomized to either the training or control group. The progressive resistance training program consisted of three sets of eight isometric contractions, three times weekly for 12 weeks. Seven healthy elderly were also randomized and trained in a similar manner. Changes in the baseline parameters were monitored once every 4 weeks throughout the training period. The trained post-polio patients showed a significant improvement in their strength (P < 0.05). The magnitude of gain was greater than that seen in the healthy elderly (mean ± SE, 41 ± 16% vs. 29 ± 8%). The training did not adversely affect MU survival and the improvement was largely attributable to an increase in voluntary motor drive. We therefore conclude that moderate intensity strength training is safe and effective in post-polio patients.

Conclusions: This study demonstrated moderate intensity strength training of affected hand muscles is safe and effective in post-polio patients.

Outcome of Research: More research required

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Comments (if any): Strength training of more functional muscles (e.g. legs) that consider baseline strength levels, appropriate loading and rest, with regular monitoring is important to evaluate in a randomised control trial to assist with exercise recommendations.

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Category: Diagnosis and Management

Title: Repetitive transcranial magnetic stimulation in treatment of post polio syndrome
Author: Pastuszak, Z., Piusaska-Macoch, R., Stepieri, A., Czernicki, Z.,
Affiliation: Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, A. Pawińskiego 5, 02-106 Warsaw, Poland

Department of Neurology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland

Department of Neurosurgery, Warsaw University of Medicine, Cegłowska 80, 01-809 Warsaw, Poland
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Neurologia i Neurochirurgia Polska
2018; Volume 52 (2): 2018, Pages 281-284

Publication Year and Month: 2018 03

Abstract: Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome.

Conclusions: rTMS can be an effective method in treatment of post polio syndrome but further studies with larger group need to be done to confirm that data.

Outcome of Research: More research required

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Category: Activity Levels

Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12

Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).

DESIGN: Repeated measurement at a 3-week interval.

SETTING: University hospital.

PARTICIPANTS: Convenience sample of 65 patients with PPS.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.

RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).

Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.

Outcome of Research: More research required

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Category: Restless Legs Syndrome

Title: Restless legs syndrome in post-polio syndrome: a series of 10 patients with demographic, clinical and laboratorial findings
Author: Marin LF (1), Carvalho LB, Prado LB, Quadros AA, Oliveira AS, Prado GF
Affiliation: (1) Neuro-Sono Sleep Center, Universidade Federal de São Paulo, Rua Claudio Rossi 394, Sao Paulo, SP, Brazil. [email protected]
Journal: Parkinsonism & Related Disorders
Citation: Parkinsonism Relat Disord. 2011 Aug;17(7):563-4. doi: 10.1016/j.parkreldis.2011.02.011
Publication Year and Month: 2011 08

Abstract: BACKGROUND: Few studies have described the occurrence of restless legs syndrome in post-polio syndrome.

METHODS: We studied 10 consecutive patients with post-polio syndrome and symptoms of restless legs syndrome. We look at demographic, clinical and laboratorial data.

RESULTS: A remarkable finding was the concomitant onset of symptoms of both diseases, suggesting a possible underlying mechanism. Severity of restless legs symptoms was moderate to very severe.

Conclusions: Epidemiological studies with larger samples are needed to better establish the relationship and the incidence of restless legs syndrome in post-polio syndrome.

Outcome of Research: More research required

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Category: Ageing

Title: Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging.
Author: McNalley TE, Yorkston KM, Jensen MP, Truitt AR, Schomer KG, Baylor C, Molton IR.
Affiliation: From the Department of Rehabilitation Medicine, University of Washington, Seattle
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2015 Feb;94(2):139-45.
Publication Year and Month: 2015 02

Abstract: OBJECTIVE:
This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging.

DESIGN:
A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables.

RESULTS:
The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS.

Conclusions: CONCLUSIONS:
Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.

Outcome of Research: More research required

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Category: Complementary Therapies

Title: Risk assessment and prognostic in patients with post polio syndrome according to systematic tongue analysis adapted from traditional Chinese medicine
Author: Abe, G.C., Ramos, P.E. da Silva, B.L., Mello, C.A.D.S., Quadros, A.A.J., Oliveira, A.S.B.
Affiliation: Federal University of São Paulo, Neurology and Neurosurgery, São Paulo, Brazil
Journal: Journal of the Neurological Sciences
Citation: Volume 381, Supplement, 15 October 2017, Pages 1138-1139

Publication Year and Month: 2017 10

Abstract: Background: The tongue is used in traditional Chinese medicine for prognostic assessment. Muscle weakness, fatigue, pain and other symptoms occur with great variability in post polio syndrome (PPS).

Objective: Identify risk patients in a group with PPS through observation of tongue coating with systematic tongue analysis (STA).

Conclusions: Conclusion: STA identified, through the coating, a patient with worsening risk confirmed; and a patient with association of severe chronic diseases (her follow-up will be analyzed in a later work).

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Risk factors for post-polio syndrome among an Italian population: a case-control study.
Author: Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P, Turri M, Ferlisi M, Fiorini M, Pimazzoni F, Squintani G, Martini M, Danzi B, Monaco S.
Affiliation: Section of Neurology, Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy. [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Neurological sciences: official journal of the Italian neurological society, 2012 Dec;33(6):1271-5. doi: 10.1007/s10072-012-0931-2. Epub 2012 Jan 14.
Publication Year and Month: 2012 01

Abstract: Post-polio syndrome (PPS) is a clinical syndrome of new weakness, fatigue and musculoskeletal pain occurring in a variable proportion of polio survivors decades after acute disease. To date, several risk factors for PPS development have been reported, although the etiology of this disorder remains elusive. Using a case-control design, we aimed to assess risk indicators for PPS in a group of Italian polio survivors. Subjects with prior poliomyelitis attending the rehabilitation hospital of Malcesine, Italy, were the target population. Patients with PPS, diagnosed according to the European Federation of Neurological Societies criteria, served as cases, while patients not meeting diagnostic criteria for PPS were used as controls. All subjects were assessed through a structured questionnaire made of 82 questions and neurological examination. The association with investigated risk factors (sex, age at polio onset, age at onset of symptoms, extension and severity of polio, employment) was analyzed by the calculation of the odds ratio. A total of 161 out of 391 eligible patients met the adopted diagnostic criteria for PPS, giving a frequency of 41.2%. Symptoms most frequently complained by PPS patients were loss of muscle strength, loss of resistance, loss of muscle volume and generalized fatigue. Female gender, the presence of respiratory disturbance during the acute phase of polio and the use of orthoses and aids during the recovery and stabilization represented independent risk factors for PPS in the studied population.

Conclusions:

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Sense of Coherence in persons with late effects of polio
Author: Nolvi M, Brogardh C, Jacobsson L, Lexell J
Affiliation: Maria Nolvi, MD, Department of Health Sciences, PO Box 157, Lund University, SE-221 00 Lund, Sweden
Journal: NeuroRehabilitation
Citation: Vol. 42, no. 1, pp. 103-111, 2018
Publication Year and Month: 2018 01

Abstract: BACKGROUND:Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population. OBJECTIVE:To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability). METHOD:Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC. RESULTS:SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants’ marital status and level of education explained 37% (p < 0.001) of the variance in SOC.

Conclusions: CONCLUSION:Persons with LEoP have a level of sense of coherence (SOC) indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.

Outcome of Research: More research required

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Category: Respiratory Complications and Management

Title: Sleep disordered breathing in adult with polio sequelae: A case control study of predictive factors
Author: A.Leotard, A.Pages, M.Salga, G.Genet, J.Levy, M.A.Quera-Salva, F.Genet
Affiliation: Hopital R.-Poincaré, Sleep unit, Garches, France

Hopital R.-Poincaré, Department of Physical Medicine and Rehabilitation, Garches, France
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 61, Supplement, July 2018, Page e72

Publication Year and Month: 2018 07

Abstract: Introduction/Background
Estimates of sleep disorder breathing (SDB) prevalence are higher in patients with polio sequelae than in general population, ranging from 50% to 65%. No specific predictive factors have been described in our knowledge. The aim of this study was to identify SDB predictive factors among polio survivors.

Material and method
A case control study including patients with polio sequelae with confirmed SDB (apnea hypopnea index (AHI) ≥ 5; n = 38) compared to polio patients with AHI ≤ 5 or negative Berlin questionnaire (n = 114). Matching criteria were: sex, age at evaluation, and body mass index (BMI). For each patient, age at acute polio, bulbar, trunk, and lower limbs involvement, scoliosis, current walking abilities and history of arthrodesis, brace or iron lung were assessed using preexisting database and medical charts. SDB symptoms, Berlin questionnaire and AHI using polysomnographic reports were also assessed retrospectively.

Results
Among the 362 polio patients from our systematic database 152 (38 cases and 114 controls) were matched for comparison. SDB ratio was significantly higher in patients with bulbar involvement at acute polio (100% vs. 22.5%), trunk involvement at acute polio (41.9% vs. 18.4%), bulbar involvement at evaluation (100% vs. 23%), scoliosis (38.6% vs. 13.8%) and non-walking patients (50% vs. 22.5%) compared with polio controls. Multivariate analysis only shown scoliosis to be associated with SDB in those patients (OR = 2.72 (95% CI: 1.10–6.95); P = 0.03).

Conclusions: Despite there was an increased ratio of SDB in patients with bulbar and trunk involvement, only scoliosis seems to specifically increase the risk of SDB occurrence among polio survivors. In those patients, symptoms suggestive of SDB should be searched for systematically, especially in case of trunk deformities.

Outcome of Research: More research required

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Category: Restless Legs Syndrome

Title: Sleep disorders frequency in post-polio syndrome patients caused by periodic limb movements
Author: Araujo MA (1), Silva TM, Moreira GA, Pradella-Hallinan M, Tufik S, Oliveira AS
Affiliation: (1) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil
Journal: Arquivos de Neuro-Psiquiatria
Citation: Arq Neuropsiquiatr. 2010 Feb;68(1):35-8.
Publication Year and Month: 2010 02

Abstract: Post-polio syndrome (PPS) in individuals with polio longer than 15 years is characterized by weakness and/or muscle fatigue, deficit of deglutition and breath and periodic limb movements (PLM) during sleep. We undertook a review of 99 patients with PPS, and assessed the frequency of PLM through polysomnographic recordings at our sleep disorders unit. The total number of PLM, total time of sleep (TTS), efficiency of sleep (EfS), awaking index (AI) and apnea-hypopnea index (AHI) were analyzed. Sixteen patients presented PLM in excess of 5 for the entire night. When comparing these with the group without PLM, a correlation was found (p=0.001). Significant difference was found for the correlation of the parameters: IAH, ID, TTS and EfS when compared the two groups. There is a close relationship between PPS and PLM.

Conclusions:

Outcome of Research: More research required

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Category: Quality of Life

Title: Sleep Disorders in Neuromuscular Diseases
Author: Eric J Gartman
Affiliation: The Warren Alpert School of Medicine of Brown University Division of Pulmonary, Critical Care, and Sleep Medicine, Providence VA Medical Center,
Providence, RI, US
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: US Respiratory & Pulmonary Diseases. 2018;3(1):27–32
Publication Year and Month: 2018

Abstract: Disturbances in sleep are common in patients with neuromuscular diseases (NMDs) and are the source of a significant amount of morbidity.Underlying these disorders of sleep are the physiologic alterations that result from progressive changes in muscle strength, effective ventilation, and control of respiration. This review will discuss the normal changes that occur during sleep, how the physiologic alterations present in neuromuscular and chest wall disorders affect these normal processes, how to assess patients for the presence of sleep disorders, and how to approach treatment.

Conclusions:

Outcome of Research: More research required

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Category: Muscle Strength

Title: Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy.
Author: Spector, S. A., Gordon, P. L., Feuerstein, I. M., Sivakumar, K., Hurley, B. F. and Dalakas, M. C.
Affiliation: Funded by Henry M. Jackson Foundation for the Advancement of Military Science
Journal: Muscle & Nerve
Citation: Spector, S. A., Gordon, P. L., Feuerstein, I. M., Sivakumar, K., Hurley, B. F. and Dalakas, M. C. (1996), Strength gains without muscle injury after strength training in patients with postpolio muscular atrophy. Muscle Nerve, 19: 1282–1290.
Publication Year and Month: 1996 10

Abstract: We evaluated changes in the dynamic and isometric strength in the newly weakened quadriceps muscles and asymptomatic triceps muscles of 6 patients with postpolio muscular atrophy (PPMA) after 10 weeks of progressive resistance strength training. Alterations in muscle size were determined with magnetic resonance imaging. Serum creatine kinase levels were measured throughout training, and histological signs of muscle injury and changes in muscle fiber size and types were assessed with muscle biopsies before and after training. Exercise training led to an increase in dynamic strength of 41% and 61% for the two knee extensor tests, and 54% and 71% for the two elbow extensor tests. Up to 20% of the improvement was maintained 5 months after cessation of training. Isometric strength, whole muscle cross-sectional areas of quadriceps and triceps muscles, and serum muscle enzymes did not change. No destructive histopathological changes were noted in the repeat muscle biopsies, and no consistent changes in muscle fiber size or fiber type percentages were observed. These results demonstrate that a supervised resistance training program can lead to significant gains in dynamic strength of both symptomatic and asymptomatic muscles of PPMA patients without serological or histological evidence of muscular damage.

Conclusions: This study of 6 patient who had postpolio muscluar atrophy (PPMA) demonstrated a supervised resistance training program can lead to significant gains in dynamic strength of both symptomatic and asymptomatic muscles of PPMA patients without serological or histological evidence of muscular damage.

Outcome of Research: More research required

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Comments (if any): A small sample size and further information regarding the baseline strength values of affected muscles makes it difficult to conclude on the significance of these results.

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Category: Exercise

Title: Strength, endurance and work capacity after muscle strengthening exercise in postpolio subjects.
Author: Agre, J., Rodriguez, A., Franke, T.
Affiliation: Agre - Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison, USA.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1997;78(7):681-6.
Publication Year and Month: 1997 07

Abstract: OBJECTIVE:
To determine whether a 12-week home quadriceps muscle strengthening exercise program would increase muscle strength, isometric endurance, and tension time index (TTI) in postpolio syndrome subjects without adversely affecting the surviving motor units or the muscle.

DESIGN:
A longitudinal study to investigate the effect of a 12-week exercise program on neuromuscular function and electromyographic variables.

SETTING:
Neuromuscular laboratory of a university hospital.

SUBJECTS:
Seven subjects were recruited from a cohort of 12 subjects who had participated in a previous exercise study. All subjects had greater than antigravity strength of the quadriceps. Upon completion of a postpolio questionnaire, all acknowledged common postpolio syndrome symptoms such as new fatigue, pain, and weakness; 6 of the 7 acknowledged new strength decline.

INTERVENTION:
On Mondays and Thursdays subjects performed three sets of four maximal isometric contractions of the quadriceps held for 5 seconds each. On Tuesdays and Fridays subjects performed three sets of 12 dynamic knee extension exercises with ankle weights.

MAIN OUTCOME MEASURES:
Neuromuscular variables of the quadriceps muscles were measured at the beginning and completion of the exercise program and included: isokinetic peak torque (ISOKPT, at 60 degrees/sec angular velocity) and total work performed of four contractions (ISOKTW), isometric peak torque (MVC), endurance (EDUR, time subject could hold isometric contraction at 40% of the initial MVC), isometric tension time index (TTI, product of endurance time and torque at 40% of MVC), and initial and final ankle weight (WGT, kg) lifted. Electromyographic variables included: fiber density (FD), jitter (MCD), and blocking (BLK) from single fiber assessment and median macro amplitude (MACRO). Serum creatine kinase (CK) was also measured initially and at 4-week intervals throughout the study.

RESULTS:
The following variables significantly (p < .05) increased: WGT by 47%, ISOKPT, 15%, ISOKTW, 15%; MVC, 36%; EDUR, 21%; TTI, 18%. The following variables did not significantly (p > .05) change: FD, MCD, BLK, MACRO, and CK.

CONCLUSIONS:
This home exercise program significantly increased strength, endurance, and TTI without apparently adversely affecting the motor units or the muscle, as the EMG and CK variables did not change.

Conclusions: A home exercise at low-moderate exercise with rest periods can improve or maintain leg strength and endurance in some post-polio subjects.

Outcome of Research: More research required

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Comments (if any): These results are positive for exercise and have been included in more recent literature reviews. More research is required on the appropriate recommendation for strength programs for people who are experiencing lower limb weakness. Further guidance on exercise prescription is required.

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Category: Quality of Life

Title: The association between post-polio symptoms as measured by the Index of Post-Polio Sequelae and self-reported functional status
Author: Schwartz I, Gartsman I, Adler B, Friedlander Y, Manor O, Levine H, Meiner Z
Affiliation: Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Israel; The Hebrew University-Hadassah, Braun School of Public Health, Israel; Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Israel. Electronic address: [email protected]
Journal: Journal of the Neurological Sciences
Citation: J Neurol Sci. 2014 Oct 15;345(1-2):87-91. doi: 10.1016/j.jns.2014.07.012
Publication Year and Month: 2014 10

Abstract: OBJECTIVE: To evaluate the association between self-reported severity of polio sequelae and current functional status among polio survivors.

METHODS: This was a cross sectional study of 195 polio survivors attending a polio outpatient clinic at a university hospital. The main outcome measures of demographic, medical, social, and functional data were gleaned from a questionnaire adapted for the polio population. The severity of polio sequelae was evaluated with the self-reported Index of Post-Polio Sequelae (IPPS).

RESULTS: The mean age of our sample was 57.6 ± 10.5 years, 53% were men, 38% had acquired higher education and 37% were employed. We found significant correlations between the total IPPS score and independence in activity of daily living (P<0.05), the use of walking aids (P<0.005) and mobility in and out-of-doors (P<0.0001). A positive correlation was also found between the total IPPS score and subjective assessment of physical and mental health (P<0.0001).

Conclusions: Higher disability in ADL and mobility and lower perception of physical and mental health in polio survivors were associated with a higher score on the IPPS, reflecting greater severity of polio sequelae. These findings demonstrate the IPPS as a useful tool in the clinical evaluation of the polio population, however further data is needed in order to determine if this index can assess clinically significant changes over time.

Outcome of Research: More research required.

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Category: Exercise

Title: The development of an instrument to assess post-exertional malaise in patients with myalgic encephalomyelitis and chronic fatigue syndrome
Author: Leonard A Jason, Carly S Holtzman, Madison Sunnquist, Joseph Cotler
Affiliation: Department of Psychology, DePaul University, Chicago, IL 60614, USA. Email: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Health Psychology, Article first published online: October 24, 2018
Publication Year and Month: 2018 10

Abstract: Post-exertional malaise, or a variation of this term, is a key symptom of myalgic encephalomyelitis and chronic fatigue syndrome, as this symptom is mentioned in almost all myalgic encephalomyelitis and chronic fatigue syndrome case definitions. Until now there has not been a comprehensive questionnaire to assess post-exertional malaise. To rectify this situation, in this article we describe the development of a new questionnaire, called the DePaul Post-Exertional Malaise Questionnaire, which was based on input from hundreds of patients. Preliminary validation was provided by the findings of significant and predictable relationships between different domains of this post-exertional malaise questionnaire and physical functioning.

Conclusions:

Outcome of Research: More research required

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Category: Assistive Technology

Title: The extent of using mobility assistive devices can partly explain fatigue among persons with late effects of polio – a retrospective registry study in Sweden
Author: Santos Tavares SilvaEmail author, K. S. Sunnerhagen, C. Willén and I. Ottenvall Hammar
Affiliation:
Journal: BioMed Central Neurology
Citation:
Publication Year and Month: 2016 06

Abstract: Background
Fatigue is reported as one of the most disabling symptoms and is common among persons living with late effects of polio. Although fatigue has been studied in the context of people living with late effects of polio, there is a lack of knowledge concerning the association of fatigue and variables of importance for participation in daily life. Therefore, the aim of this study was to explore possible factors associated with fatigue among persons with late effects of polio in Sweden.

Methods
This retrospective registry study consisted of 89 persons with late effects of polio living in Sweden. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) scale, Swedish version. Pearson’s correlation coefficient was used to analyse the correlation between the factors and fatigue, and a multiple linear regression was carried out to explore factors for fatigue.

Results
Fatigue statistically significantly correlated with age (r = 0.234, p < 0.05) and the use of mobility assistive devices (r = 0.255, p < 0.05). The multiple linear regression model showed that the factors age (β = 0.304, p < 0.019) and mobility assistive devices (β = 0.262, p < 0.017) were associated with fatigue among persons living with late effects of polio, and the model partly explained 14% of the variation of fatigue.

Conclusions: Conclusions
Fatigue could partly be explained by the extent of using mobility assistive devices and age. Healthcare professionals should provide and demonstrate the importance of assistive devices to ensure management of fatigue in persons living with late effects of polio.

Outcome of Research: More research required

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Category: Quality of Life

Title: The health-related quality of life of patients suffering from the late effects of polio (post-polio).
Author: Kling C, Persson A, Gardulf A.
Affiliation: Department of Occupational Therapy, Department of Rehabilitation Medicine and The Nursing Care Research and Development Unit, Huddinge University Hospital, Stockholm, Sweden
Journal: Journal of Advanced Nursing
Citation: 2000;32(1):164-73.
Publication Year and Month: 2000 07

Abstract: In Sweden alone, there are today approximately 10 000-16 500 polio survivors. Between 60% and 80% experience new symptoms several years after the initial attack of poliomyelitis. The aims of this study were to investigate and describe the self-rated health-related quality of life and functional status of a group of Swedish patients with post-polio, to investigate whether any differences within the group could be related to demographic or disease-specific data and to compare the post-polio patients with individuals sampled from the general population. Data were obtained by using two questionnaires, the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL) and the Sickness Impact Profile (SIP). A total of 150 patients, 86 women and 64 men with median age 61 (20-82) years, were consecutively included. The study showed that the patients mainly reported that their physical, functional status was affected by their post-polio condition. Factors found to be associated with the physical, functional status were age and the number of parts of the body affected by the polio. On comparing the post-polio patients with two samples from the Swedish general population, it was found that the patients reported a poorer functional status and health-related quality of life. The women with post-polio reported more pain, as compared with both the men with post-polio and the women in the general population sample. The family life of the patients - in contrast to their physical abilities - did not seem to be affected by the new deteriorating condition. It is concluded that, owing to the wide range of symptoms, the patients with post-polio need care and support from multidisciplinary teams, including nurses and occupational therapists.

Conclusions:

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: The split hand syndrome in ALS and post-polio-syndrome
Author: M.Hoheisel, L.Burmeister, M.Tesch
Affiliation: Schlosspark-Klinik Berlin, Neurology, Berlin, Germany
Journal: Clinical Neurophysiology
Citation: Volume 129, Issue 8, August 2018, Pages e82-e83

Publication Year and Month: 2018 08

Abstract: Introduction
Electrodiagnostic evaluation for amyotrophic lateral sclerosis (ALS) relies on extensive measurements. As one diagnostic clue, the split-hand-index (SHI) was proposed. It compares the compound muscle action potential (CMAP) of the abductor pollicis brevis (APB) muscle with the CMAP of the abductor digiti minimi (ADM) muscle.

In ALS, asymmetric atrophy of APB and ADM results in the index being reduced compared to the healthy population. This holds true despite the fact, that there is the same segmental innervation C8 for both examined muscles, as was previously discussed. Several studies have shown a diagnostic value in differentiating ALS from other motorneuron-diseases by means of the SHI, claiming a specific form of neurodegeneration in ALS, which is less marked for example in lower motor neuron disease (LMND), spinal muscle atrophy (SMA) or Hirayama disease.

In our study, we aimed to compare the SHI of ALS-patients with our cohort of patients with post-polio-syndrome (PPS) to find out, whether it has a discriminative value in these patients too and to add knowledge to the proposed neuroscientific explanations of asymmetric thenar/hypothenar-atrophy.

Methods
We conducted a retrospective analysis of our post-polio cohort since 1997. All patients were screened whether CMAPs of APB and ADM were collected. For comparison, we screened electrodiagnostic reports of all patients with a diagnosis of ALS for collected CMAPs of APB and ADM. We excluded patients with neuropathy of the median nerve (NMN) by means of a prolonged distal motoric latency (>4,4 ms). Finally we randomly chose the same number of patients from our reports in that time period with normal results (NR), by excluding diagnosis of NMN, acute polyneuropathies and radiculo- and plexopathies of the arm. We calculated the SHI by dividing the CMAP of APB by the CMAP of ADM.

Results
We found a significant difference (p = 0,01) of the SHI between ALS patients (0,97 ± 0,84) and the NR-group (1,26 ± 0,72). The SHI of the PPS-group (0,91 ± 0,55) was not significantly different compared to the NR group (p = 0,08), but showed a trend. Comparing the ALS-group with the PPS-patients, we found no statistically relevant difference (p = 0,83).

Conclusions: As expected, we could reproduce a significant decrease of the SHI in ALS patients. However our results showed no statistically relevant difference between ALS-patients and PPS-patients when comparing the SHI. There is a broader distribution of values in the PPS-group, including cases of very high grade asymmetric atrophy of APB and ADM. A low SHI therefore is of no help in differentiating PPS from ALS-patients.

As a limitation of our study it is important to acknowledge the retrospective study type and a possible selection bias of patients who suffer from an already clinically visible asymmetry, possible increasing electrodiagnostic evaluation numbers of the hand.

Outcome of Research: More research required

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Category: Late Effects of Polio

Title: Three case studies of late diagnoses of polio in Australian adults
Author: C.Formby, D.Currie
Affiliation: St Vincent's Hospital Melbourne, Polio Services Victoria, Fitzroy, Australia
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 61, Supplement, July 2018, Page e272
Publication Year and Month: 2018 07

Abstract: Introduction/Background
Polio Services Victoria (PSV) is a publicly funded organization; anyone with a history of polio residing in Australia may be seen by the service. The majority of patients referred to the service were diagnosed with polio shortly after they were infected with the virus, for most this was in early childhood and ranges from two to eight decades ago. In the past 18 months three patients were referred to PSV with untypically late diagnoses of polio, two of which were sisters. All were born in Australia between 1930 and 1950 and are considered to have acquired their infection in Australia during their early childhood. The three were able to live relatively uneventful lives however their verbal histories indicate suspicion of polio during their childhood medical examinations in school, but ultimately no formal diagnosis was made at that time. In later life, symptoms characteristic of the late effects of polio emerged. In combination with imaging and nerve conduction studies these symptoms were diagnosed as being the result of a likely childhood infection of polio. Their current and future management plans are typical of that seen regularly within the service with the patients reporting their main problems as being:

–pain;

–fatigue;

–increasing muscle atrophy and associated weakness.

These three cases highlight that although Australia, like most of the world, holds polio free status there may still be further undiagnosed cases. Polio should be considered as a differential diagnosis for patients presenting with any of the cardinal signs and symptoms of late effects of polio who have resided in a country during a time prior to polio eradication. Special consideration should be given where a sibling or close relative was diagnosed with polio.

Conclusions:

Outcome of Research: More research required

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Category: Diagnosis and Management

Title: Treatment for postpolio syndrome
Author: Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F
Affiliation: Department of Rehabilitation, University of Amsterdam Academic Medical Center, PO Box 22660, Amsterdam, North Holland, Netherlands, 1100 DD
Journal: Cochrane Database of Systematic Reviews
Citation: Cochrane Database Syst Rev. 2015 May 18;5:CD007818
Publication Year and Month: 2015 05

Abstract: BACKGROUND: Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. This is an update of a review first published in 2011.

OBJECTIVES: To systematically review the evidence from randomised and quasi-randomised controlled trials for the effect of any pharmacological or non-pharmacological treatment for PPS compared to placebo, usual care or no treatment.

SEARCH METHODS: We searched the following databases on 21 July 2014: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL Plus. We also checked reference lists of all relevant articles, searched the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) Database and trial registers and contacted investigators known to be involved in research in this area.

SELECTION CRITERIA: Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.

DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS: We included 10 pharmacological (modafinil, intravenous immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (that is temperature ± 25°C, dry and sunny) and a cold climate (that is temperature ± 0°C, rainy or snowy), static magnetic fields) studies with a total of 675 participants with PPS in this review. None of the included studies were completely free from any risk of bias, the most prevalent risk of bias being lack of blinding.There was moderate- and low-quality evidence that IVIg has no beneficial effect on activity limitations in the short term and long term, respectively, and inconsistency in the evidence for effectiveness on muscle strength. IVIg caused minor adverse events in a substantial proportion of the participants. Results of one trial provided very low-quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations without generating adverse events. Data from two single trials suggested that muscle strengthening of thumb muscles (very low-quality evidence) and static magnetic fields (moderate-quality evidence) are safe and beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there was evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.

Conclusions: Due to insufficient good-quality data and lack of randomised studies, it was impossible to draw definite conclusions about the effectiveness of interventions for PPS. Results indicated that IVIg, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation to clarify whether any real and meaningful effect exists.

Outcome of Research: More research required.

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Category: Diagnosis and Management

Title: Update on current and emerging treatment options for post-polio syndrome
Author: Farbu E
Affiliation: Neurocenter and National Competence Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
Journal: Therapeutics and Clinical Risk Management
Citation: Ther Clin Risk Manag. 2010 Jul 21;6:307-13
Publication Year and Month: 2010 07

Abstract: Post-polio syndrome (PPS) refers to the clinical deterioration experienced by many polio survivors several decades after their acute illness. The symptoms are new muscle weakness, decreased muscle endurance, fatigue, muscle pain, joint pain, cold intolerance, and this typical clinical entity is reported from different parts of the world. The pathophysiology behind PPS is not fully understood, but a combination of distal degeneration of enlarged motor units caused by increased metabolic demands and the normal aging process, in addition to inflammatory mechanisms, are thought to be involved. There is no diagnostic test for PPS, and the diagnosis is based on a proper clinical workup where all other possible explanations for the new symptoms are ruled out. The basic principle of management of PPS lies in physical activity, individually tailored training programs, and lifestyle modification. Muscle weakness and muscle pain may be helped with specific training programs, in which training in warm water seems to be particularly helpful. Properly fitted orthoses can improve the biomechanical movement pattern and be energy-saving. Fatigue can be relieved with lifestyle changes, assistive devices, and training programs. Respiratory insufficiency can be controlled with noninvasive respiratory aids including biphasic positive pressure ventilators. Pharmacologic agents like prednisone, amantadine, pyridostigmine, and coenzyme Q10 are of no benefit in PPS. Intravenous immunoglobulin (IVIG) has been tried in three studies, all having positive results. IVIG could probably be a therapeutic alternative, but the potential benefit is modest, and some important questions are still unanswered, in particular to which patients this treatment is useful, the dose, and the therapeutic interval.

Conclusions:

Outcome of Research: More research required.

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Category: Continence

Title: Urologic manifestations of postpolio syndrome
Author: Johnson VY, Hubbard D, Vordermark JS
Affiliation: Not stated
Journal: Journal of Wound, Ostomy, and Continence Nursing
Citation: J Wound Ostomy Continence Nurs. 1996 Jul;23(4):218-23
Publication Year and Month: 1996 07

Abstract: To determine the character and prevalence of bladder dysfunction among persons with a history of polio, we conducted a survey of randomly selected polio survivors. The survey solicited information on the acute episode of polio and the nature of late-onset neurologic symptoms that could be attributed to postpolio syndrome. There were 242 female and 88 male respondents to the study. Symptoms attributable to postpolio syndrome were present in 87.2% of female subjects and 73.9% of male subjects. Respondents with postpolio syndrome had a significantly greater prevalence of urologic symptoms than seen among respondents without postpolio syndrome, although no dominant pattern of voiding dysfunction was noted. The early onset of erectile dysfunction was more common among male subjects with postpolio syndrome than among male subjects without postpolio syndrome. Genuine stress incontinence was seen in 36.3% of the survey population. Sixteen women with postpolio syndrome underwent surgical repair for urinary incontinence, with a success rate of 60.5%. Bladder disorders are common among persons with PPS, but further clinical and urodynamic data are necessary to define the nature and magnitude of this dysfunction.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Vitality among Swedish patients with post-polio: a physiological phenomenon
Author: Ostlund G (1), Wahlin A (2), Sunnerhagen KS (3,4), Borg K (1)
Affiliation: (1) Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Sweden; (2) Department of Psychology, Stockholm University, Stockholm, Sweden; (3) Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; (4) Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2008 Oct;40(9):709-14. doi: 10.2340/16501977-0253
Publication Year and Month: 2008 10

Abstract: OBJECTIVE: To evaluate vitality and fatigue in post-polio patients, and the relative contributions of physiological and psychological parameters to the level of vitality.

DESIGN: Multi-centre study.

SUBJECTS: One hundred and forty-three patients with post-polio syndrome.

METHODS: Inventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regression models were constructed to examine predictors of variations in vitality, pain, reduced activity and physical fatigue.

RESULTS: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiological indicators. After controlling for age, physiological para notmeters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.

Conclusions: Vitality in post-polio patients depends on physio-logical parameters. Mental fatigue is not a prominent predictor. Subgroups with or without fatigue, independent of age, need further study.

Outcome of Research: More research required.

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Category: Assistive Technology, Orthoses

Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01

Abstract: The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT) through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG); impedance-cardiograph (ICG); and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS) were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.

Conclusions:

Outcome of Research: More research required

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Category: Exercise

Title: Whole Body Vibration Methods with Survivors of Polio
Author: Carolyn P. Da Silva
Affiliation: School of Physical Therapy, Texas Woman's University
Outpatient Medical Clinic, TIRR Memorial Hermann Rehabilitation and Research
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Visualized Experiments, (140), e58449, doi:10.3791/58449 (2018)
Publication Year and Month: 2018

Abstract: The purpose of the original study was to examine the use of whole body vibration (WBV) on polio survivors with and without post-polio syndrome as a form of weight bearing exercise. The goal of this article is to highlight the strengths, limitations, and applications of the method used.
Fifteen participants completed two intervention blocks with a wash-out period in between the blocks. Each block consisted of twice a week (four weeks) WBV interventions, progressing from 10 to 20 min per session. Low intensity (peak to peak displacement 4.53 mm, frequency 24 Hz,
g force 2.21) and higher intensity (peak to peak displacement 8.82 mm, frequency 35 Hz, g force 2.76) WBV blocks were used. Pain severity significantly improved in both groups following higher intensity vibration. Walking speed significantly improved in the group who participated
in higher intensity intervention first. No study-related adverse events occurred. Even though this population can be at risk of developing overuse-related muscle weakness, fatigue, or pain from excessive physical activity or exercise, the vibration intensity levels utilized did not
cause significant muscle weakness, pain, fatigue, or sleep disturbances. Therefore, WBV appears to provide a safe method of weight bearing exercise for this population. Limitations included the lack of measurement of reflexes, muscular activity, or circulation, the difficulty in participant
recruitment, and insufficient strength of some participants to stand in recommended position. Strengths included a standard, safe protocol with intentional monitoring of symptoms and the heterogeneity of the participants in their physical abilities. An application of the methods is the home use of WBV to reduce the barriers associated with going to a facility for weight bearing exercise for longer term interventions, and benefits for conditions such as osteoporosis, particularly for aging adults with mobility difficulties due to paralysis or weakness. Presented method may serve as a starting point in future studies.

Conclusions:

Outcome of Research: More research required

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Category: Complementary Therapies

Title: Whole body vibration on people with sequelae of polio
Author: Da Silva CP, Szot CL, de Sa N.
Affiliation: School of Physical Therapy, Texas Woman's University, Houston, USA
Supported by the Post-polio Health International 2013–2014
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Physiotherapy Theory and Practice
Whole body vibration on people with sequelae of polio, Physiotherapy Theory and Practice, (2018). DOI: 10.1080/09593985.2018.1454559
Publication Year and Month: 2018 10

Abstract: Purpose: The purpose was to explore the feasibility of whole body vibration (WBV) on polio survivors with/without post-polio syndrome (PPS) by studying its effects on walking speed (10-m walk test), endurance (2-min walk test), pain severity/interference (Brief Pain Inventory [BPI]), sleep quality (Pittsburg Sleep Quality Index), fatigue (Fatigue Severity Scale), leg strength (manual muscle testing and hand-held dynamometry), and muscle cramping (written logs). Methods: Fifteen individuals completed the study, participating in eight sessions in two 4-week blocks. Participants started with ten 1-min vibration bouts/session, increasing to 20 min. Low (amplitude 4.53 mm, g force 2.21) and higher (amplitude 8.82 mm, g force 2.76) intensity blocked intervention occurred in random order crossover design. Blinded testing ensued before/after intervention blocks and at follow-up. Results: No study-related adverse events occurred. Participants starting first with higher intensity intervention improved in walking speed (p = 0.017). BPI pain severity significantly improved (p = 0.049) after higher intensity intervention. No significant changes were found after low intensity vibration or in other outcome measures. Conclusions: WBV appears to be a safe exercise for this population. Long-term use in polio survivors needs to be researched, particularly in reducing barriers to participation to promote the physical aspects of health.

Conclusions:

Outcome of Research: More research required

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Category: Fatigue

Title: Word Finding Difficulty As A Post-Polio Sequelae
Author: Bruno, R.L. & Zimmerman, J.R.
Affiliation: The Post-Polio Institute
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: American Journal of Physical Medicine & Rehabilitation; 2000; 79:343-348
Publication Year and Month: 2000 05

Abstract: Seventy-nine percent of respondents to the 1990 National Post-Polio Survey reported difficulty
"thinking of words I want to say," with 37% reporting frequent, moderate-to severe word finding
difficulty. In this study, 33 polio survivors were administered the Post-Polio Fatigue Questionnaire,
Animal Naming and FAS Tests, and tests of attention and information processing speed. Plasma
prolactin was also measured as a marker for brain dopamine secretion. Subjects reporting high
fatigue severity and word finding difficulty had clinically abnormal or significantly lower Animal Naming
Test scores as compared to subjects with low symptom severity. Impaired performance on the most
difficult tests of attention and information processing speed were also associated with lower scores on
the word finding tests. A significant negative correlation between Animal Naming Test scores and
plasma prolactin suggests that a decrement in brain dopamine secretion is related to reduced animal
naming ability. These data support the hypothesis that decreased dopamine secretion, possibly
secondary to poliovirus damage to the basal ganglia, may underlie not only fatigue and impaired
attention but also word finding difficulty in polio survivors.

Conclusions: Our clinical experience, that word finding difficulty decreases when polio survivors reduce fatigue by
decreasing physical overexertion and emotional stress, is supported by the correlation of subjective
fatigue with word finding difficulty (2,5). Polio survivors with "brain fatigue" and associated cognitive
symptoms must be encouraged to employ all conservative techniques that have been found to be
effective in treating fatigue to also treat their word finding difficulty, including energy conservation,
work simplification, pacing activities, frequent rests and the use of assistive devices. Only when these
techniques have been consistently applied and found to be insufficient to reduce fatigue and improve
word finding should a trial of bromocriptine be attempted (35,36,37).

Outcome of Research: More research required

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Comments (if any): The link to the revised version from Dr R.L. Bruno has been used.

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There are currently 117 research papers whose outcomes are rated as “more research required”.

Category: Fatigue

Title: Brain volume and fatigue in patients with postpoliomyelitis syndrome
Author: Trojan DA (1), Narayanan S (2), Francis SJ (3), Caramanos Z (4), Robinson A (5), Cardoso M (6), Arnold DL (7)
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, 3801 University Street, Montreal, Quebec, Canada H3A 2B4; (2) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (3) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (4) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (5) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada; (6) Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (7) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2014 Mar;6(3):215-20. doi: 10.1016/j.pmrj.2013.09.009
Publication Year and Month: 2014 03

Abstract: BACKGROUND: Acute paralytic poliomyelitis is associated with encephalitis. Early brain inflammation may produce permanent neuronal injury with brain atrophy, which may result in symptoms such as fatigue. Brain volume has not been assessed in postpoliomyelitis syndrome (PPS).

OBJECTIVE: To determine whether brain volume is decreased compared with that in normal controls, and whether brain volume is associated with fatigue in patients with PPS.

DESIGN: A cross-sectional study.

SETTING: Tertiary university-affiliated hospital postpolio and multiple sclerosis (MS) clinics.

PARTICIPANTS: Forty-nine ambulatory patients with PPS, 28 normal controls, and 53 ambulatory patients with MS.

METHODS: We studied the brains of all study subjects with magnetic resonance imaging by using a 1.5 T Siemens Sonata machine. The subjects completed the Fatigue Severity Scale. Multivariable linear regression models were computed to evaluate the contribution of PPS and MS compared with controls to explain brain volume.

MAIN OUTCOME MEASUREMENTS: Normalized brain volume (NBV) was assessed with the automated program Structured Image Evaluation, using Normalization, of Atrophy method from the acquired magnetic resonance images. This method may miss brainstem atrophy.

RESULTS: Technically adequate NBV measurements were available for 42 patients with PPS, 27 controls, and 49 patients with MS. The mean (standard deviation) age was 60.9 ± 7.6 years for patients with PPS, 47.0 ± 14.6 years for controls, and 46.2 ± 9.4 years for patients with MS. In a multivariable model adjusted for age and gender, NBV was not significantly different in patients with PPS compared with that in controls (P = .28). As expected, when using a similar model for patients with MS, NBV was significantly decreased compared with that in controls (P = .006). There was no significant association between NBV and fatigue in subjects with PPS (Spearman ρ = 0.23; P = .19).

Conclusions: No significant whole-brain atrophy was found, and no association of brain volume with fatigue in PPS. Brain atrophy was confirmed in MS. It is possible that brainstem atrophy was not recognized by this study.

Outcome of Research: Not effective

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Category: Fatigue

Title: Cognitive functioning in post‐polio patients with and without general fatigue
Author: Ostlund G, Borg K, Wahlin A.
Affiliation: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):147-51
Publication Year and Month: 2005 03

Abstract: OBJECTIVE AND DESIGN: This study examined 2 main hypotheses. First, whether patients with post-polio suffering from general fatigue (n=10) demonstrate cognitive deficits compared with patients with post-polio without general fatigue (n=10). Secondly, by systematically varied test order administration we examined whether such differences varied as a function of increasing cognitive load during cognitive testing.

SUBJECTS: Twenty patients diagnosed with post-polio syndrome, 10 with general fatigue and 10 without fatigue.

RESULTS: Neither of the 2 hypotheses were confirmed. The group with general fatigue reported elevated levels of depression. However, no systematic association between level of depression and cognitive performance could be detected.

Conclusions: The results of this study provide no evidence that general fatigue or cognitive load affects cognitive functioning in post-polio.

Outcome of Research: Not effective.

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There are currently 2 research papers whose outcomes are rated as “not effective”.

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