Title: Plasma CHI3L1 in Amyotrophic Lateral Sclerosis: A Potential Differential Diagnostic Biomarker
Author: Alessandro Bombaci*, Umberto Manera, Giovanni De Marco, Federico Casale, Paolina Salamone, Giuseppe Fuda, Giulia Marchese, Barbara Iazzolino, Laura Peotta, Cristina Moglia, Andrea Calvo and Adriano Chiò
Affiliation: “Rita Levi Montalcini” Department of Neuroscience, University of Turin, 10126 Turin, Italy
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: J. Clin. Med. 2023, 12(6), 2367; https://doi.org/10.3390/jcm12062367
Publication Year and Month: 2023 03
Abstract: Background: Motor neuron diseases (MNDs) are fatal neurodegenerative diseases. Biomarkers could help with defining patients’ prognoses and stratifications. Besides neurofilaments, chitinases are a promising family of possible biomarkers which correlate with neuroinflammatory status. We evaluated the plasmatic levels of CHI3L1 in MNDs, MND mimics, and healthy controls (HCs).
Methods: We used a sandwich ELISA to quantify the CHI3L1 in plasma samples from 44 MND patients, 7 hereditary spastic paraplegia (HSP) patients, 9 MND mimics, and 19 HCs. We also collected a ALSFRSr scale, MRC scale, spirometry, mutational status, progression rate (PR), blood sampling, and neuropsychological evaluation.
Results: The plasma levels of the CHI3L1 were different among groups (p = 0.005). Particularly, the MND mimics showed higher CHI3L1 levels compared with the MND patients and HCs. The CHI3L1 levels did not differ among PMA, PLS, and ALS, and we did not find a correlation among the CHI3L1 levels and clinical scores, spirometry parameters, PR, and neuropsychological features. Of note, the red blood cell count and haemoglobin was correlated with the CHI3L1 levels (respectively, p < 0.001, r = 0.63; p = 0.022, and r = 0.52).
Conclusions: The CHI3L1 plasma levels were increased in the MND mimics cohort compared with MNDs group. The increase of CHI3L1 in neuroinflammatory processes could explain our findings. We confirmed that the CHI3L1 plasma levels did not allow for differentiation between ALS and HCs, nor were they correlated with neuropsychological impairment.
Keywords: biomarker; chitinases; cognitive impairment; differential diagnosis; early diagnosis; MND mimics; red blood cells
Conclusions: The measurement of the plasmatic levels of CHI3L1 could be useful in the differential diagnosis between MNDs and MND mimics. This is an important issue, since the early diagnosis of an MND is a determinant in the early starting of neuroprotective therapy and in clinical trial recruitment.
Further multicentre and longitudinal studies on a larger patient cohort, testing alongside other fluid biomarkers, are needed to better explain the role of CHI3L1 in the diagnosis and prognosis of MNDs and, also, of MND mimics.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Physical Medicine and Rehabilitation Research (PM&R)
Citation: 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
Comments (if any):
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Category: Late Effects of Polio, Restless Legs Syndrome
Title: Restless legs syndrome and post polio syndrome: a case-control study
Author: A Romigi, M Pierantozzi, F Placidi, E Evangelista, M Albanese, C Liguori, M Nazzaro, B U Risina, V Simonelli, F Izzi, N B Mercuri, M T Desiato
Affiliation: Neurophysiopathology Unit, Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; IRCCS Neuromed Via Atinense 18, Pozzilli (IS), Italy.
Journal: European Journal of Neurology
Citation: 22(3):472-8.
doi: 10.1111/ene.12593.
Publication Year and Month: 2015 03
Abstract: Background and purpose
The aim was to investigate the prevalence of restless legs syndrome (RLS), fatigue and daytime sleepiness in a large cohort of patients affected by post polio syndrome (PPS) and their impact on patient health-related quality of life (HRQoL) compared with healthy subjects.
Methods
PPS patients were evaluated by means of the Stanford Sleepiness Scale and the Fatigue Severity Scale (FSS). The Short Form Health Survey (SF-36) questionnaire was utilized to assess HRQoL in PPS. RLS was diagnosed when standard criteria were met. Age and sex matched healthy controls were recruited amongst spouses or friends of PPS subjects.
Results
A total of 66 PPS patients and 80 healthy controls were enrolled in the study. A significantly higher prevalence of RLS (P < 0.0005; odds ratio 21.5; 95% confidence interval 8.17–57) was found in PPS patients (PPS/RLS+ 63.6%) than in healthy controls (7.5%). The FSS score was higher in PPS/RLS+ than in PPS/RLS− patients (P = 0.03). A significant decrease of SF-36 scores, including the physical function (P = 0.001), physical role (P = 0.0001) and bodily pain (P = 0.03) domains, was found in PPS/RLS+ versus PPS/RLS− patients. Finally, it was found that PPS/RLS+ showed a significant correlation between International Restless Legs Scale score and FSS (P < 0.0001), as well as between International Restless Legs Scale score and most of the SF-36 items (physical role P = 0.0018, general health P = 0.0009, vitality P = 0.0022, social functioning P = 0.002, role emotional P = 0.0019, and mental health P = 0.0003).
Conclusions: Our findings demonstrate a high prevalence of RLS in PPS, and that RLS occurrence may significantly influence the HRQoL and fatigue of PPS patients. A hypothetical link between neuroanatomical and inflammatory mechanisms in RLS and PPS is suggested.
Outcome of Research: More research required
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Category: Late Effects of Polio, Post-Polio Motor Unit
Title: Early and late losses of motor units after poliomyelitis
Author: A. J. McComas (1), C. Quartly (1) and R. C. Griggs (2)
Affiliation: (1) Department of Medicine, McMaster University, Hamilton, Canada
(2) Department of Neurology, University of Medicine (Neurology), Health Sciences Centre (4U1),
Rochester, New York, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Brain (1997), 120, 1415–1421
Publication Year and Month: 1997 08
Abstract: Motor unit number estimation was employed to assess muscle innervation in 76 patients with prior poliomyelitis. Of the 68 patients who were < 70 years of age, new musculoskeletal symptoms had appeared in all but four; the mean latent interval was 38.0 +/- 10.1 years. As expected, there was a high incidence of muscles exhibiting denervation in previously affected limbs (87%). However, the incidence in supposedly unaffected limbs was also high (65%). Significant differences in the degree of denervation were found between muscles of the same hands and feet. Judged on the basis of their potential amplitudes, the surviving motor units in partially denervated muscles tended to be enlarged. The enlargement was proportional to the extent of the denervation and was comparable to that found in amyotrophic lateral sclerosis. In some muscles, possibly those innervated by failing motor neurons, motor-unit enlargement was not present. Needle examination confirmed the high incidences of denervation in affected and allegedly unaffected limbs. Of the 188 muscles with EMG features of chronic denervation, only nine exhibited fibrillations or positive sharp waves (4.8%). Ninety-five muscles of 18 patients were studied a second time after an interval of 2 years. Overall, there was a 13.4% reduction in motor-unit number and a 18.4% diminution in M-wave amplitude (P < 0.001). The rate of motor-unit loss was twice that occurring in healthy subjects aged > 60 years. Analysis of individual patients indicated that some were deteriorating more rapidly than others. These studies confirm that denervation progresses in patients with prior poliomyelitis in both clinically affected and unaffected muscles, and indicate that this progression is more rapid than that occurring in normal ageing.
Keywords: poliomyelitis; motor units; EMG
Conclusions: In conclusion, MUNE may be said to have fulfilled expectations in throwing new light on the extent of muscle denervation in poliomyelitis, and on the adaptive properties and subsequent loss of surviving motor units. Thus, motor unit loss following the initial infection was shown to be more severe and more widespread than previously supposed. Axonal sprouting is as vigorous as in amyotrophic lateral sclerosis, but is not seen in some motor units, possibly because of impending motor neuron death. Indeed, in some patients with post-polio syndrome, further losses of motor units can be demonstrated.
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: 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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Cardiorespiratory, Late Effects of Polio, Respiratory Complications and Management
Title: Living the Present with an Enemy from the Past: The Role of Noninvasive Ventilation in a Poliomyelitis Survivor
Author: Adelaide Alves, Sara Conde, and Carla Ribeiro
Affiliation: Pulmonology Department of Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Journal:
Citation: Clin Case Rep Open Access. 2021;4(2):185.
https://dx.doi.org/10.46527/2582-5038.185
Publication Year and Month: 2021 04
Abstract: Poliomyelitis epidemics of the twentieth century boosted the development of noninvasive positive-pressure ventilation which has changed the natural history and extended survival in a wide range of disorders with chest wall and muscular involvement. Poliomyelitis has almost been eradicated from developed countries since the introduction of vaccination. However, challenges keep coming since there are a substantial number of survivors of the disease who need particular clinical care, namely in the respiratory field. We present a case report of a polio survivor attempting to demonstrate that even after so many years the respiratory approach of these patients remains a current issue in clinical practice with noninvasive ventilation as a cornerstone element.
Keywords: Poliomyelitis; Respiratory failure; Noninvasive ventilation
Conclusions: Finally, we should be aware of a post-polio syndrome referring to a sub-category of the late effects of polio several years following the initial recovery, including muscle weakness and fatigability [11]. This late muscle involvement may also affect the respiratory muscles leading to chronic respiratory failure several years after primary infection [12,13].
For all these reasons, polio continues to represent a current clinical condition in the field of Pulmonology not only because there are many survivors with established thoracic deformities and neuromuscular involvement, but also because of the possibility of late respiratory effects.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Psychology
Title: Healthy together: A systematic review of theory and techniques used in health interventions for persons with chronic neurological conditions and their caregivers
Author: Afolasade Fakolade (1), Alexandra J. Walters (2), Julie Cameron (1), Amy E. Latimer-Cheung (2), Lara A. Pilutti (1)
Affiliation: (1) Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
(2) School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
Journal: Patient Education and Counseling
Citation: Volume 103, Issue 4, April 2020, Pages 788-803
https://doi.org/10.1016/j.pec.2019.10.022
Publication Year and Month: 2020 04
Abstract: Objective
To evaluate the level of theory application and use of behaviour change techniques (BCTs) in dyadic health interventions for persons with chronic neurological conditions (CNCs) and their caregivers.
Methods
A systematic review of five databases was conducted to locate articles published before January 2019. Methodological quality was assessed, study characteristics, theory application and BCTs were narratively summarized.
Results
More than half of the studies identified (59% [16/27]) did not mention theory, and only 22% (6/27) were explicitly theory-based. Across the 27 studies, two to 17 BCTs (mean = 6.8 ± 4.02) were used. Common BCTs were related to intervention implementation (e.g., credible source), knowledge (e.g., instruction on how to perform behaviour) and skill development (e.g., behavioural practice/rehearsal).
Conclusions: Conclusions
Researchers need to incorporate theory-based dyadic techniques that target both people with CNCs and their caregivers into the design and implementation of future health interventions.
Practice implications
Health professionals require explicitly theory-based interventions to provide dyads with CNCs techniques that they can apply in their daily life to the benefit of each individual and the partnership.
Outcome of Research: Not applicable
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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: 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: Activity Levels
Title: Neuromuscular function in polio survivors
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Orthopedics
Citation: Orthopedics. 1991 Dec; 14(12):1343-7
Publication Year and Month: 1991 12
Abstract: Although there is no documented, objective evidence that symptomatic post-polio subjects are rapidly losing strength, they have a number of neuromuscular deficits related to a more severe poliomyelitis illness that may explain why they complain of problems with strength, endurance, and local muscle fatigue. Symptomatic post-polio subjects were hospitalized longer during the acute poliomyelitis, recovered more slowly, and had electromyographic evidence of greater loss of anterior horn cells. Additionally, recent assessment demonstrated that they were weaker, had a reduced work capacity, and recovered strength less readily after activity in the quadriceps muscles as compared to asymptomatic subjects. Of great clinical importance, rating of perceived exertion in the muscle during exercise was the same in symptomatic and asymptomatic post-polio and control subjects, indicating that symptomatic subjects have a mechanism to monitor local muscle fatigue that could be used to avoid exhaustion. A study of pacing (interspersing activity with rest breaks) showed that symptomatic subjects had less local muscle fatigue and greater strength recovery when they paced their activity than when they worked at a constant rate to exhaustion. We recommend that post-polio individuals pace their daily activity to avoid excessive fatigue.
Conclusions:
Outcome of Research:
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Category: Muscle Strength
Title: Neuromuscular function: comparison of symptomatic and asymptomatic polio subjects to control subjects
Author: Agre JC, Rodriquez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin - Madison Medical School 53792
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1990 Jul; 71(8):545-51
Publication Year and Month: 1990 07
Abstract: The purpose of this study was to determine if there were any differences between symptomatic and asymptomatic polio survivors by history of acute poliomyelitis illness, electromyographic evidence of terminal motor unit reorganization, and neuromuscular function of the quadriceps femoris muscle. Thirty-four symptomatic postpolio subjects, 16 asymptomatic postpolio subjects, and 41 controls were studied. A questionnaire assessed polio history. Peak knee extension torque was measured isokinetically and isometrically. Endurance (time to exhaustion) was measured at 40% of maximal isometric torque. Work capacity was determined as the product of torque and duration. Recovery of isometric strength was measured at regular intervals for ten minutes after exhaustion. Quantitative electromyography was also performed on the quadriceps to determine motor unit action potential duration and amplitude. It was found that symptomatic subjects had evidence of more severe original polio involvement by history (documented electromyographically), were weaker and capable of performing less work than asymptomatic subjects, and recovered strength less readily than controls.
Conclusions:
Outcome of Research:
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Category: Muscle Strength, Exercise
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: Post-Polio Motor Unit
Title: Late effects of polio: critical review of the literature on neuromuscular function
Author: Agre JC, Rodríquez AA, Tafel JA
Affiliation: University of Wisconsin - Madison Medical School
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1991 Oct; 72(11):923-31
Publication Year and Month: 1991 10
Abstract: Many individuals who have had poliomyelitis are now complaining of several new problems attributed to their former illness including muscle atrophy; fatigue; progressive weakness; and muscle, back, and joint pain. This paper critically examines the literature regarding the neuromuscular effects of poliomyelitis. Weakness resulting from poliomyelitis was due to destruction of anterior horn cells. After the illness, muscle strength was partially recovered as a result of several physiologic adaptive mechanisms including terminal sprouting and reinnervation, myofiber hypertrophy, and, possibly, myofiber type transformation. Several pathophysiologic and functional etiologies have been proposed for late neuromuscular deterioration, but none has been proven. In fact, to date, there is no objective evidence documenting progressive loss of strength in polio survivors. Studies attempting to differentiate polio survivors with and without symptoms of deterioration have resulted in conflicting results; however, it appears reasonable to conclude that symptomatic postpolio subjects had a more severe illness with greater loss of neuromuscular function. Exercise may be helpful for many postpolio patients, but the prescription must be tailored to the individual to avoid problems of overuse or excessive fatigue.
Conclusions:
Outcome of Research:
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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: Scandanavian Journal of Rehabilitation Medicine (Currently known as Journal of Rehabilitation Medicine - JRM)
Citation: 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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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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Category: Quality of Life
Title: Disability and quality of life in individuals with postpolio syndrome.
Author: Ahlström G, Karlsson U.
Affiliation: Research and Development Unit, Psychiatry and Habilitation, Orebro Medical Centre Hospital, Sweden. [email protected]
Journal: Disability and Rehabilitation
Citation: 2000 Jun 15;22(9):416-22.
Publication Year and Month: 2000 06
Abstract: PURPOSE:
The purpose of the study is to investigate disability and quality of life in individuals with the characteristic symptoms of postpolio syndrome.
METHOD:
Disability is assessed by means of the self-report activities of daily living instrument, and quality of life by means of Kaasa's questionnaire and the quality of life profile.
RESULTS:
The 39 subjects have on average lived with polio sequelae for 52 years. Their main difficulties are with moving, lifting and carrying. This means restricted mobility, sedentary activities and a need to prioritize. Half of them feel that polio has lessened their possibilities in life, and a quarter have still not accepted the limitations polio has involved. Nevertheless the majority report a high level of psychosocial well-being, and almost a quarter say that living with polio has meant personal development and strength. We found a significant correlation between on the one hand disability with regard to ambulation, arm strength and finger strength on the self-report ADL, and on the other hand the number of negative problems on the quality of life profile (0.33-0.45).
Conclusions: The latter instrument needs further testing before its validity can be determined with certainty.
Outcome of Research: More research required
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Category: Cardiovascular, Exercise, Late Effects of Polio, Muscle Strength
Title: Effects of muscle strengthening and cardiovascular fitness activities for poliomyelitis survivors: A systematic review and meta-anaylsis.
Author: Akhilesh Kumar RAMACHANDRAN, MSc, BEng (1), Stephen P. J. GOODMAN, PhD, Hon BEXSc (2), Michael J. JACKSON, MPT, BEd, BACH (1) and Timothy J. H. LATHLEAN, PhD, MClinRehab, Hon BSc, BBehSc (2,3)
Affiliation: 1) Polio Australia Incorporated
2) Discipline of Exercise and Sports Science, School of Science and Technology, University of New England
3) Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide.
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: J Rehabil Med 2021; 53: jrm00184, doi: 10.2340/16501977-2832
Publication Year and Month: 2021 04
Abstract: Objective:
To evaluate and assess the effectiveness of muscle strengthening and cardiovascular interventions in improving outcomes in poliomyelitis (polio) survivors.
Data sources:
A systematic literature search was conducted in Medline, PubMed, CINAHL, PsychINFO, Web of Science, and Google Scholar for experimental and observational studies.
Study selection and extraction:
Screening, data-extraction, risk of bias and quality assessment were carried out independently by the authors. The quality appraisal and risk of bias were assessed using the Downs and Black Checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to increase clarity of reporting.
Data synthesis:
A total of 21 studies that met all the inclusion criteria were subjected to statistical analyses according to intervention (muscle strengthening or cardiovascular fitness). A random-effects metaanalysis showed a statistically significant effect for the exercise interventions favouring improvement in outcomes according to the International Classification of Functioning, Disability and Health (ICF).
Conclusion:
This review provides further insight into the effects associated with muscle strengthening and cardiovascular interventions among polio survivors, and helps to further identify the current state of research in this area. Future research is needed, focusing on individualized approaches to exercise with polio survivors and specific exercise prescription recommendations, based on established frameworks, such as the ICF.
Conclusions: The findings of this review and analysis provide “very low level evidence” (according to the Grading of Recommendations Assessment, Development and Evaluate; GRADE) to polio survivors, clinicians and researchers. The main findings of this review relate specifically to changes in body function, and activity and participation, and include evidence of effect on improved functioning without furthering debility in polio survivors. This systematic review and meta-analysis provides additional insights into effects associated with exercise, across various types of interventions, in polio survivors, and advances the level of methodological quality of research in this area. Although there was evidence demonstrating effect across domains, due to inherent biases within the literature to date, further and high-quality primary exercise-focused research is required in order to strengthen the certainty of evidence regarding important research questions about the ongoing health of polio survivors.
Outcome of Research: More research required
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Category: Anaesthesia, Surgery
Title: Percutaneous Tracheostomy
Author: Al-Shathri Z, Susanto I
Affiliation: Division of Pulmonary, Critical Care Medicine, Allergy and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Journal: Seminars in Respiratory and Critical Care Medicine
Citation: 2018 Dec;39(6):720-730
Publication Year and Month: 2018
Abstract: Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication.
Conclusions:
Outcome of Research: More research required
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Category: Late Effects of Polio, Psychology, Quality of Life
Title: The value of a post-polio syndrome self-management programme
Author: Alexandra Curtis,corresponding author1,# Jeong Su Lee,1,# Georgios Kaltsakas,1,2 Vivian Auyeung,2 Simon Shaw,1 Nicholas Hart,1,2 and Joerg Steier1,2
Affiliation: 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK;
2Faculty of Life Sciences and Medicine, King’s College, London, UK
corresponding authorCorresponding author.
Contributions: (I) Conception and design: A Curtis, JS Lee, N Hart, J Steier, V Auyeung; (II) Administrative support: A Curtis, JS Lee, N Hart, J Steier; (III) Provision of study materials or patients: A Curtis, JS Lee, J Steier, S Shaw, V Auyeung; (IV) Collection and assembly of data: A Curtis, JS Lee; (V) Data analysis and interpretation: A Curtis, JS Lee, J Steier, V Auyeung, G Kaltsakas; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Correspondence to: Ms. Alexandra Curtis, MRes, BSc. Guy’s and St Thomas’ NHS Foundation Trust, Lane Fox Unit, Westminster Bridge Road, London SE1 7EH, UK. Email: [email protected].
Journal: Journal of Thoracic Disease
Citation: 12(Suppl 2), S153–S162. https://doi.org/10.21037/jtd-cus-2020-009
Publication Year and Month: 2020 10
Abstract: Background
Post-polio syndrome is characterised by symptoms of fatigue, pain and new-onset neuromuscular weakness, and emerges decades after the initial poliovirus infection. We sought to evaluate the only post-polio syndrome specific self-management programme in the United Kingdom.
Methods
This was a retrospective study of patients who had completed a residential self-management programme led by a multi-disciplinary clinical team. Following a confirmed diagnosis of post-polio syndrome by rehabilitation and neurology specialists, patients were offered to participate in the programme. Although group-based, patients also received individually tailored support on physical exercise and fatigue management. Physical effects, physical function, psychosocial well-being measures were assessed at baseline and 6 months follow-up. Knowledge was tested at baseline and immediately following the programme. Statistical comparisons were made using paired t-test and Wilcoxon signed rank test according to the data distribution.
Results
Over a period of 17 years, 214 participants (median age 61.3 years old, 63% female) attended 31 programmes. At 6 months the following post-polio syndrome specific symptoms improved significantly: fatigue, as measured by the Multidimensional Assessment of Fatigue scale [37.6 (7.1) vs. 34.2 (9.3), P=0.005]; and pain [15.0 (6.1) vs. 13.1 (6.7), P=0.001], atrophy [10.0 (8.0–12.0) vs. 9.0 (7.0–11.0), P=0.002] and bulbar symptoms [3.0 (1.0–5.0) vs. 2.0 (0–4.0), P=0.003] as measured by the Index of Post-polio Sequelae scale. Knowledge related to post-polio syndrome also significantly increased [14.0 (11.0–16.0) vs. 17.0 (16.0–19.0), P=0.001]. Participants were able to walk at a faster speed over 10 meters [0.77 (0.59–1.00) vs. 0.83 (0.67–1.10) m/s, P=0.003] and walked longer distances during the 2-minute walk test [76.9 (31.7) vs. 82.0 (38.4) m, P=0.029]. Depression and anxiety scores did not change over time [PHQ-9, 2.0 (0.3–10.8) vs. 2.0 (0.3–6.8), P=0.450; GAD-7, 2.0 (0–7.0) vs. 1.0 (0–3.0), P=0.460] nor was there change in self-reported quality of life {60 [50–70] vs. 60 [55–70], P=0.200}.
Conclusions
This study suggests that a post-polio syndrome self-management programme led to improvement in symptoms, knowledge and walking speed, but not quality of life. Anxiety and depression scores remained low.
Keywords: Rehabilitation, post-polio syndrome (PPS), fatigue, quality of life (QoL)
Conclusions: A self-management programme for PPS can improve fatigue, the severity to which pain, atrophy and bulbar function issues are experienced and the overall knowledge of PPS, as well as physical function over a 6-month period. Despite some limitations the study results are important to a wider audience given the difficulties in collecting systematic data in this cohort and the relatively sparse evidence for the current approach to PPS management. Experiences from PPS management might prove valuable at a time when a new viral pandemic requires us to design future rehabilitation and self-management programmes for many more survivors of a devastating viral condition.
Outcome of Research: More research required
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Category: Orthoses
Title: The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study
Author: Ali Mojaver (1 2 3), Mokhtar Arazpour (1 2), Gholamreza Aminian (2), Monireh Ahmadi Bani (2), Mahmood Bahramizadeh (2), Guive Sharifi (4), Arash Sherafatvaziri (5)
Affiliation: 1 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 , Iran.
3 Student Research Commute , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
4 Department of Neurosurgery, Loghman Hakim Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran.
5 Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran.
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil Assist Technol. 2017 Oct;12(7):747-751. doi: 10.1080/17483107.2016.1260654. Epub 2016 Dec 16.
Publication Year and Month: 2017 10
Abstract: Background: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait.
Aim: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs.
Method: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters.
Results: Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence.
Keywords: Knee-ankle-foot orthosis; heel-to-toe rocker sole; poliomyelitis; walking.
Conclusions: Conclusions: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced. The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: 1246: Missed chronic respiratory failure in a post-polio syndrome patient
Author: Aljasmi M, Agarwal K, Uppalapati S, Bazan L
Affiliation: Not stated
Journal: Critical Care Medicine
Citation: Crit Care Med. 2015 Dec;43(12 Suppl 1):313
Publication Year and Month: 2015 12
Abstract: This is a brief Case Report which does not have an abstract. This is an extract:
INTRODUCTION: Prior to the introduction of the polio vaccine, paralytic poliomyelitis was a major cause of morbidity and death. Twenty-five to fifty percent of the survivors are known to develop post-polio syndrome. Symptoms include fatigue, insidious respiratory failure, obstructive sleep apnea, bulbar neuropathy, central ventilatory abnormalities, hemi-diaphragmatic paralysis and progressive functional decline with new onset weakness, among others. We present a case of post-polio syndrome presenting with hypercapnic respiratory failure.
Conclusions:
Outcome of Research: Not applicable
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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: Differential Diagnosis
Title: Diagnosing Post-Polio Syndrome in the Elderly, a Case Report
Author: Amole, M. & Khouzam-Skelton, N.
Affiliation: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
Journal: Geriatrics
Citation: 2(2), 14; doi:10.3390/geriatrics2020014
Publication Year and Month: 2017 02
Abstract: Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome. Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.
Conclusions: Post-polio syndrome is an interesting disorder characterized by new neuromuscular deficits that present years after the resolution of a polio infection. There are several diagnostic criteria, but one of the most important is the exclusion of other possible diagnoses. Post-polio syndrome diagnosis is even more difficult in the elderly population due to the presence of multiple comorbid conditions. Extensive testing may be necessary for an appropriate diagnosis in this population.
Outcome of Research: Not applicable
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Category: Ageing
Title: Symptom profiles in individuals aging with post-polio syndrome
Author: Amtmann D, Bamer AM, Verrall A, Salem R, Borson S
Affiliation: Rehabilitation Medicine, University of Washington, Seattle, Washington
Journal: Journal of the American Geriatrics Society
Citation: J Am Geriatr Soc. 2013 Oct;61(10):1813-5. doi: 10.1111/jgs.12465
Publication Year and Month: 2013 10
Abstract: This paper does not have an abstract.
Conclusions:
Outcome of Research: Not applicable
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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: SAGE Open Medicine
Citation: 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: 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: 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: Proceedings of the National Academy of Sciences
Citation: 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: 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: Post-Polio Motor Unit
Title: Electrodiagnostic Findings in 108 Consecutive Patients Referred to a Post-Polio Clinic – The Value of Routine Electrodiagnostic Studies
Author: Anne C. Gawne, Bao T. Pham, and Lauro S. Halstead
Affiliation:
Journal: Annals of the New York Academy of Sciences
Citation: The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment Volume 753 pp 383-385 of the Annals of the New York Academy of Sciences May 25, 1995.
Publication Year and Month: 1995 05
Abstract: Many patients with a history of polio develop new symptoms including weakness, pain, fatigue, and changes in function, or post-polio syndrome (PPS).[1] Before a diagnosis of PPS is made, other diagnoses must first be ruled out. Assessment must be done in a comprehensive and coordinated manner.[2] Therefore, as part of our routine evaluation, we do an electromyogram/nerve conduction study (EMG/NCS) on every patient. During examinations on our clinic patients we began to notice (1) electrodiagnostic evidence of polio in limbs not previously felt to be involved; (2) a normal EMG, or evidence of another disease; and (3) EMG evidence consistent with additional neurological lesions, including compression neuropathies, peripheral neuropathies, and radiculopathies. A prospective study using a routine, standardized four-extremity electrodiagnostic protocol was done to quantify the frequency of these occurrences.
Conclusions: Our findings strongly support the value of a standardized four-extremity EMG/NCS as an adjuvant to a comprehensive history and physical examination. It helps to differentiate between old polio and other neurological diagnoses. There is a high prevalence of subclinical polio, which is important to know about in order to give proper recommendations regarding rest and activity. Given the frequency of risk factors for development of potentially treatable neurological lesions like CTS, early detection is valuable. We believe routine electrodiagnostic testing is essential for proper evaluation and management of the post-polio patient.
Outcome of Research:
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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: EFORT Open Rev
Citation: 2018;3:358-362. DOI: 10.1302/2058-5241.3.170028
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.
We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of TKA in patients with poliomyelitis-affected knees. Six studies including 82 knees met the inclusion criteria and were reviewed. The mean patient age was 63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13).
All studies reported significant improvement in knee function following TKA. There were six failures requiring revision surgery in 82 cases (7%) occurring at a mean of 6.2 years (0.4 to 12). The reasons for revision surgery were aseptic loosening (17%, n=1), infection (33%, n=2), periprosthetic fracture (17%, n=1) and instability (33%, n=2). Thirty-six knees had a degree of recurvatum pre-operatively (44%), which was in the range of 5° to 30°. Ten of these knees (28%) developed recurrent recurvatum post-operatively.
The findings support the use of TKA in patients with poliomyelitis-affected knees. The post-operative functional outcome is similar to other patients; however, the revision rate is higher. Quadriceps muscle power appears to be an important prognostic factor for functional outcome and the use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength.
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: Vocational Implications
Title: Occupations that people with late effects of polio perceive difficult to perform
Author: Appelin K, Lexell J, Månsson Lexell E
Affiliation: Department of Rehabilitation Medicine, Skåne University Hospital, Sweden
Journal: Occupational Therapy International
Citation: Occupational Therapy International - Occup Ther Int. 2014 Sep;21(3):98-107. doi: 10.1002/oti.1368
Publication Year and Month: 2014 09
Abstract: The aims of this study were to describe which occupations that people with late effects of polio perceive difficult to perform, which occupational area the occupations were related to and their level of complexity. The aims were also to describe their own perception of the importance, performance and satisfaction with these occupations. Sixty-two participants (mean age 61 years) were assessed with the Canadian Occupational Performance Measure. A total of 431 occupations were reported (43% self-care, 32% productivity and 25% leisure). Two subcategories, household management (27 %) and functional mobility (23 %), represented half of all the reported occupations. Ratings for prioritized occupations (N = 300) were high for importance and generally low for performance and satisfaction. A wide variety of occupations were reported, related to both occupational areas and different levels of complexity within an occupational area. The results underscore the importance of using assessment tools that can capture both the variety and complexity of occupations. By obtaining more detailed information about occupations that people with late effects of polio perceive difficult to perform, this will enable occupational therapists to offer targeted interventions that can facilitate engagement in meaningful and purposeful occupations. A larger and more heterogeneous sample may enable the results to be generalized to more people with late effects of polio. Future studies should focus on methods that can facilitate engagement in meaningful and purposeful occupations for people with late effects of polio.
Conclusions:
Outcome of Research: Not applicable
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Category: Restless Legs Syndrome, Sleep Analysis
Title: Sleep disorders frequency in post-polio syndrome patients caused by periodic limb movements
Author: Araujo MA de P (1); Silva TMe (2); Moreira GA (3); Pradella-Hallinan M (3); Tufik S (4); Oliveira ASB (4)
Affiliation: (1) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Master in Health Sciences; (2) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Specialized in neuromuscular diseases; (3) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Doctor in Sciences; (4) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Post Doctor in Sciences
Journal: Arquivos de Neuro-Psiquiatria
Citation: vol.68 no.1 São Paulo Feb. 2010
http://dx.doi.org/10.1590/S0004-282X2010000100008
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: In conclusion, the polysomnography records are an apt way of establishing PLMS in PPS. Understanding the role this plays in the lives of PPS will allow health carers to work on enhancing the overall sleep quality of polio survivors.
Outcome of Research: More research required
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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: 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: Applied Health Economics and Health Policy
Citation: 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: Living with polio and postpolio syndrome in the United Kingdom
Author: Atwal A (1), Giles A, Spiliotopoulou G, Plastow N, Wilson L
Affiliation: (1) School of Health Science and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, London, UK - [email protected]
Journal: Scandinavian Journal of Caring Sciences
Citation: Scand J Caring Sci. 2013 Jun;27(2):238-45. doi: 10.1111/j.1471-6712.2012.01029.x
Publication Year and Month: 2013 06
Abstract: The term Postpolio Syndrome (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life in polio survivors. Polio had been eradicated in the United Kingdom (UK) and most of Europe, although this is not the case in all countries. Research in this area has tended to focus upon the impact of polio and PPS on health status and functional health rather than its overall effect on people's lives. This study's two main aims were to explore the ways in which polio and PPS in the UK has affected the respondents' lives and to ascertain their views about how the quality of life could be improved. The two questions were as follows: (1) How has the health of people with polio and PPS affected their quality of life? (2) What would people with polio and PPS change to improve their quality of life? Deductive content analysis using existing qualitative data from a cross-sectional survey of 336 returned questionnaires from persons with polio and PPS was carried out. The average age of the participants was 54 years. Our research found that polio survivors valued social occupations and participation in family life. Our research has also shown that healthcare professionals still do not understand polio and PPS and this lack of understanding influences their clients' quality of life. Finances and accessibility of environments also influence participation in chosen occupations. Rehabilitation programmes for people with polio and PPS need to be targeted towards maintaining and improving accessible environments and participation in chosen occupations, and healthcare professionals need to ensure that persons with polio and PPS are referred to persons with specific expertise in this area.
Conclusions:
Outcome of Research: Not applicable
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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: 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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Category: Quality of Life
Title: Survey of the Late Effects of Polio in Lothian
Author: B. Pentland, D. J. Hellawell, J. Benjamin, R. Prasad
Affiliation: Rehabilitation Studies Unit
Journal: Rehabilitation Literature
Citation: Rehabilitation Studies Unit; January 1999
Publication Year and Month: 1999 01
Abstract: The Edinburgh Branch of the British Polio Fellowship (BPF) expressed the concern of members that the medical and related professions often appeared unfamiliar with the late consequences of polio and that services were not meeting their needs. In an attempt to determine the number of people affected and the nature of their experience, this postal survey was done in 1998.
A set of questionnaires were sent to 221 people, in Edinburgh and the Lothians, who had been identified as suffering polio in the past from those known to the BPF and hospital records. There were 125 replies which constituted the study population: 60% were female; the median age was 59 years; and the median time since original diagnosis was 51 years.
Common symptoms were: cold intolerance (70%); fatigue (66%); increased weakness in previously affected muscles (67%); new weakness in unaffected muscles (60%); muscle pain (64%); joint pain (61%); and joint stiffness (64%). These symptoms were often of recent onset. Other complaints included sleep disturbance (63%); exertional breathlessness (56%); headaches (33%); and swallowing difficulty (18%).
In terms of disability: 78% had difficulty with stairs; 72% with walking and 70% with bending. This was reflected in over a third reporting difficulty getting outdoors without help. Motor problems affecting upper limbs were present in over half the subjects. Daily activities were restricted because of severe pain in 38%. Over half (55%) the study population described difficulty living alone. The major factors restricting the lives of the subjects were physical problems, lack of energy and pain.
During the preceding 5 years, contact with health services were: hospital clinic 62%; physiotherapy 46%; occupational therapy 29%; speech therapy 2%; orthotics 40%; and wheelchair service 42%. The majority described satisfaction with these services but further study is warranted.
A conservative estimate is that there are about 300 people in Edinburgh and the Lothians with the range of difficulties demonstrated in this study and we suggest that special provision is made for them.
Conclusions: Half of the study population were under 59 years of age so that it would be incorrect to consider the population of people with post-polio symptoms as in the geriatric age group.
The commonest symptoms were cold intolerance, increased muscle weakness, muscle pain, fatigue and joint pain. It is particularly notable that these symptoms, with the exception of the first, were often of recent onset (i.e. within the last five years).
Pain is worthy of emphasis as a symptom, being commonly reported in the back and neck as well as in muscles and joints. It was also identified as a major source of limitation in daily activities.
Lower limb motor disabilities were extremely common with about 3/4 unable to walk a quarter of a mile or go up and down steps. Over 1/3 need help to leave their home or garden.
Motor disabilities of the upper limb were also common, affecting 1/3 to 1/2 of the population.
Physical disabilities, fatigue and pain are the principal causes of handicap in this population rather than mental or social factors.
Although those accessing health and related services generally reported them as satisfactory, there are no grounds for complacency and this area warrants further study.
The findings are similar to reports from England, the U.S.A and Scandinavia.
This study, although population based, was not designed to provide an accurate figure for the size of the post-polio population in Lothian. However, based on studies from other Western countries and our findings, we suggest that there may be approximately 1,500 polio survivors, at least 300 of whom are likely to experience significant health problems.
Outcome of Research:
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Category: Respiratory Complications and Management
Title: A Short History of Medical Expert Guidelines and How They Pertain to Tracheostomy Tubes and Physical Medicine and Rehabilitation
Author: Bach JR
Affiliation: Professor of Physical Medicine and Rehabilitation Department of PM&R, Professor of Neurology, Department of Neurology, Medical Director of the Center for Ventilator Management Alternatives and Pulmonary Rehabilitation of the University Hospital, of the Rutgers New Jersey Medical School, Newark, New Jersey, USA. [email protected].
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2019 Feb 27. doi: 10.1097/PHM.0000000000001172.
Publication Year and Month: 2019 02
Abstract: Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation exsufflation (MIE) have been used since 1953 to spare patients with ventilatory pump failure from ever requiring tracheostomy tubes for ventilatory support or secretion management. Today there are patients with spinal muscular atrophy type 1 who are 25 years old and CNVS dependent since 4 months or age, post-polio survivors CNVS dependent for 64 years, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 years, high level spinal cord injured patients CNVS dependent for over 20 years, and even lung disease patients dependent on CNVS. All these patients, although unweanable from ventilatory support and with little or no measurable vital capacity, can also be extubated to CNVS and MIE without resort to tracheotomies when necessary to continue CNVS. However, for various reasons, this is not cited in academic society expert guidelines. This article considers the extent of the damage being caused by this.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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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: Late Effects of Polio
Title: Post-polio syndrome and risk factors in Korean polio survivors: a baseline survey by telephone interview
Author: Bang H (1), Suh JH (2), Lee SY (3), Kim K (1), Yang EJ (1), Jung SH (1), Jang SN (4), Han SJ (2), Kim WH (5), Oh MG (6), Kim JH (5), Lee SG (7), Lim JY (1)
Affiliation: (1) Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea; (2) Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Seoul, Korea; (3) Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Bucheon, Korea; (4) Red Cross College of Nursing, Chung-Ang University, Seoul, Korea; (5) Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea; (6) Department of Rehabilitation Medicine and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea; (7) Department of Physical Medicine and Rehabilitation, Research Institute of Medical Sciences, Chonnam National University College of Medical School, Gwangju, Korea
Journal: Annals of Rehabilitation Medicine
Citation: Ann Rehabil Med. 2014 Oct;38(5):637-47. doi: 10.5535/arm.2014.38.5.637
Publication Year and Month: 2014 10
Abstract: OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors.
METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR).
RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS.
Conclusions: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.
Outcome of Research: Not applicable
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Category: Orthoses
Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02
Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.
Design: Cross-sectional survey study.
Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.
Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.
Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).
Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.
Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation
Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.
Outcome of Research: Effective
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Category: Speech Pathology
Title: Otolaryngology manifestation of postpolio syndrome
Author: Baugh RF
Affiliation: Not Stated
Journal: Journal of the National Medical Association
Citation: J Natl Med Assoc. 1993 Sep;85(9):689-91
Publication Year and Month: 1993 09
Abstract: Twenty-one patients with postpolio syndrome were surveyed to determine otolaryngologic symptoms. An alteration in voice, dysphagia, and fatigue were the most common symptoms reported. Prevailing etiologic theories are presented, and treatment recommendations are offered.
Conclusions:
Outcome of Research: Not applicable.
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Category: Late Effects of Polio
Title: What Makes It So Hard? Barriers to Health Promotion Experienced by People With Multiple Sclerosis and Polio
Author: Becker, Heather PhD; Stuifbergen, Alexa RN, PhD, FAAN
Affiliation: University of Texas at Austin, School of Nursing, 1700 Red River, Austin, TX 78701.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Family & Community Health 27(1):p 75-85, January 2004.
Publication Year and Month: 2004 01
Abstract: Perceptions of barriers to health promotion were examined in three groups of individuals with disabilities: (1) those with multiple sclerosis, (2) those with postpolio syndrome, and (3) polio survivors without postpolio syndrome. While there were small statistically significant differences among the three groups, all rated fatigue and impairment as their most frequent problems. For all groups, financial and interpersonal resources contributed significantly to the prediction of barriers, after accounting for perceived impairment. The findings suggest that health professionals should explore thoroughly the nature of individuals' perceived barriers to staying healthy, so that they can target their health-promoting interventions most effectively.
Conclusions: Many barriers for persons with disabilities exist at the community level and must be addressed with policies that target the community as a whole. A goal of Healthy People 20103 is to reduce the proportion of people with disabilities reporting environmental barriers to participation in home, school, work, or community activities. Nosek 8 and Harrison 33 have pointed out that full implementation of the ADA would eliminate many environmental barriers that individuals with disabilities experience in accessing good health care. In addition, health care providers must be educated about the attitudinal barriers that prevent persons with disabilities from leading healthy lives. Also, providers can make a critical contribution by advocating for the full inclusion of people with disabilities in all health-promoting activities and health care services.
Outcome of Research: Not applicable
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Category: Diagnosis and Management, Orthoses, Surgery
Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India
(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics
9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09
Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.
Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.
Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.
Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.
Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity
Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Health psychology : official journal of the Division of Health Psychology, American Psychological Association
Citation: 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.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study.
Author: Bertelsen M, Broberg S, Madsen E.
Affiliation: Rehabilitation Centre of the Danish Society of Polio and Accident Victims (PTU), Rødovre, Denmark. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2009 Jan;41(1):85-7.
Publication Year and Month: 2009 01
Abstract: OBJECTIVE:
The aim of this study was to evaluate the outcome of physiotherapy as part of a multidisciplinary rehabilitation.
DESIGN:
Prospective uncontrolled intervention study.
SUBJECTS:
Fifty patients with late effects of polio, first time referred to physiotherapy at the Danish Society of Polio and Accident Victims (PTU) Rehabilitation Centre.
METHODS:
The intervention was physiotherapy as an essential part of an individually planned multidisciplinary rehabilitation. The outcome measures Six-Minute Walk Test and Timed-Stands Test were used to assess the functional capacity. Quality of life was evaluated by Medical Outcome Survey Short Form (SF-36) and fatigue by Multidimensional Fatigue Inventory (MFI-20). Patients were tested at baseline; 3 months after the start of rehabilitation and at one-year follow-up.
RESULTS:
The patients showed significantly better functional capacity on all measurements 3 months after start of intervention and at one-year follow-up. The patients showed significant improvement in 3 of the SF-36 dimensions regarding quality of life, but only the improvement in "general health" remained after one year.
Conclusions: This study shows that patients with late effects of polio, who experience new problems related to polio, can benefit from an individually planned multidisciplinary intervention with emphasis on physiotherapy, and the improvement in physical capacity and general health can remain at one-year follow-up.
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: Neurological sciences: official journal of the Italian neurological society
Citation: 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: 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: Activity Levels
Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
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: Not applicable
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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: 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: Inflammation
Title: Elevated plasma inflammatory mediators in post-polio syndrome: No association with long-term functional decline
Author: Bickerstaffe A, Beelen A, Lutter R, Nollet F
Affiliation: Department of Rehabilitation, AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
Journal: Journal of Neuroimmunology
Citation: J Neuroimmunol. 2015 Dec 15;289:162-7. doi: 10.1016/j.jneuroim.2015.10.019. Epub 2015 Nov 11
Publication Year and Month: 2015 12
Abstract: A key feature of post-polio syndrome (PPS) is progressive loss of muscle strength. In other chronic diseases systemic inflammation has been linked to muscle wasting. In this study plasma TNF-α, IL-6, IL-8, and leptin levels were significantly increased in PPS-patients compared to healthy controls. There was however no association between these raised systemic levels of inflammatory mediators and long-term decline in quadriceps strength or other clinical parameters. In conclusion, there is evidence for systemic inflammation in PPS, yet the relationship with clinical deterioration remains tenuous.
Conclusions:
Outcome of Research: Not applicable
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Category: Falls and Bone Density
Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11
Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.
METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.
RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.
Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.
Outcome of Research: Not applicable
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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: Mechatronics
Citation: 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
Comments (if any):
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Category: Orthoses
Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China
Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511
Publication Year and Month: 2019
Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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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: The American Journal of Medicine
Citation: 1949: 6(5):563–578
Publication Year and Month: 1949 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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Category: Muscle Strength
Title: Patient-report as an option for describing muscle weakness: An integrative review
Author: Bohannon, Richard W.
Affiliation: Department of Physical Therapy, College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA | Tel.: +1 910 814 4096; E-mail: [email protected]
Journal: Isokinetics and Exercise Science
Citation: vol. Pre-press, no. Pre-press, pp. 1-4, 2019
Publication Year and Month: 2019
Abstract: BACKGROUND: Muscle strength, although usually measured by performance, can be measured by patient-report. OBJECTIVE: Review the utility and clinimetric properties of muscle strength assessed by patient-report. METHODS: PubMed and hand searches were used to identify relevant literature. Findings were systematically summarized. RESULTS: Most patient-report measures identified individuals with muscle weakness, however, the clinimetric properties of measures were highly limited. Particularly missing was information on reliability and responsiveness. CONCLUSIONS: There is a place for the inclusion of patient-reported muscle strength, but clinimetric support for its use is still limited.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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Category: Exercise
Title: Endurance Training Effect on Individuals With Postpoliomyelitis
Author: Brian Ernstoff, MD, Hakon Wetterqvist, MD, PhD, Henry Kvist, MD, PhD, Gunnar Grimby, MD, PhD
Affiliation:
Journal:
Citation: Ernstoff B, Wetterqvist H, Kvist H, Grimby G. Endurance training effect on individuals with postpoliomyelitis. Arch Phys Med Rehabil 1996;77:843-8.
Publication Year and Month: 1996
Abstract: Objective: To determine the effects of an endurance training program on the exercise capacity and muscle structure and function in individuals with postpolio syndrome.
Design: Preexercise and postexercise testing was performed with muscle strength evaluations using isokinetic testing as well as hand-held Myometer. Muscle fatigue was determined by use of isokinetic testing, and endurance was determined by exercise testing. Enzymatic evaluation was performed with muscle biopsies taken at the same site; preexercise and postexercise muscle cross-sectional area was measured by computed tomography. Disability and psychosocial evaluation was performed by a Functional Status Questionnaire.
Setting: A university.
Subjects: Seventeen postpolio subjects ranging in age from 39 to 49 years volunteered for a 6-month combined endurance and strength training program. They had a history of acute poliomyelitis at least 25 years earlier and were able to walk with or without aid.
Intervention: Twelve of the subjects (mean age 42 years) completed the program, attending an average of 29 sessions, which were offered for 60 minutes twice a week.
Main Outcome Measures: Strength, endurance, enzymatic activity, and cross-sectional area were measured 3 months before the beginning of training, just before training, and at the completion of the exercise program.
Conclusions: Results: Knee extension was reduced to an average of 60% of control values and did not change with training. Strength measured with a hand-held Myometer increased significantly for elbow flexion, wrist extension, and hip abduction. Exercise test on a bicycle-ergometer showed significant reduction (6 beats/min) in heart rate at 70W and increase (12 beats/min) in maximal heart rate with training. The training program could be performed without major complications and resulted in an increase in muscle strength in some muscle groups and in work performance with respect to heart rate at submaximal work load.
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Orthoses
Title: The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons With Late Effects of Polio: A Mixed-Methods Study
Author: Brogårdh, Christina RPT, PhD (1,2); Espelund, Christina RPT, MSc (2); Lexell, Jan MD, PhD, DPhilhc (1,3)
Affiliation: 1 Department of Health Sciences, Lund University, Lund, Sweden.
2 Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
Journal: Journal of Orthotics and Prosthetics
Citation: Journal of Prosthetics and Orthotics 31(2):p 95-103, April 2019. | DOI: 10.1097/JPO.0000000000000249
Publication Year and Month: 2019 04
Abstract: Introduction
Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.
Materials and Methods
A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires.
Results
The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.
Conclusions: Conclusions
A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Diagnosis and Management
Title: Paralytic vs "nonparalytic" polio: distinction without a difference?
Author: Bruno RL
Affiliation: The Post-Polio Institute, Englewood Hospital and Medical Center, New Jersey, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):4-12
Publication Year and Month: 2000 01
Abstract: Nonparalytic polio (NPP) is commonly thought to be synonymous with "abortive polio," in which the poliovirus neither entered the central nervous system nor damaged neurons. Described are two epidemic illness-"The Summer Grippe" and Iceland disease-apparently caused by a low virulence but neuropathic type 2 poliovirus. Studies show that neuronal lesions in the brain and spinal cord and muscle weakness were common in NPP, and epidemiologic studies document late-onset weakness and fatigue in 14% to 42% of NPP survivors. These findings indicate that clinicians should not require a history of paralytic polio, electromyographic evidence of denervation, and new muscle weakness for the diagnosis of "Postpolio Syndrome" but should be aware that NPP, and possibly even poliovirus-induced "minor illnesses," can be associated with acute central nervous system damage and late-onset muscle weakness and fatigue.
Conclusions:
Outcome of Research: Not applicable
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Category: Psychology
Title: The psychology of polio as prelude to post-polio sequelae: behavior modification and psychotherapy
Author: Bruno RL, Frick NM
Affiliation: Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, East Orange, NJ
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1185-93
Publication Year and Month: 1991 11
Abstract: Even as the physical causes and treatments for post-polio sequelae (PPS) are being identified, psychological symptoms – chronic stress, anxiety, depression, and compulsive, Type A behavior – are becoming evident in polio survivors. Importantly, these symptoms are not only causing marked distress but are preventing patients from making the lifestyle changes necessary to treat their PPS. Neither clinicians nor polio survivors have paid sufficient attention to the acute polio experience, its conditioning of life-long patterns of behavior, its relationship to the development of PPS, and its effect on the ability of individuals to cope with and treat their new symptoms. We describe the acute polio and post-polio experiences on the basis of patient histories, relate the experience of polio to the development of compulsive, Type A behavior, link these behaviors to the physical and psychological symptoms reported in the National Post-Polio Surveys, and present a multimodal behavioral approach to treatment.
Conclusions:
Outcome of Research:
Comments (if any): The full text of this paper (as revised 7 February 2000) has been generously made available by Dr Bruno.
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Category: Diagnosis and Management
Title: Polioencephalitis, stress, and the etiology of post-polio sequelae
Author: Bruno RL, Frick NM, Cohen J
Affiliation: Post-Polio Rehabilitation and Research Service, Kessler Institute for Rehabilitation, East Orange, NJ 07018
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1269-76
Publication Year and Month: 1991 11
Abstract: Post-mortem neurohistopathologies that document polio virus-induced lesions in reticular formation and hypothalamic, thalamic, peptidergic, and monoaminergic neurons in the brain are reviewed from 158 individuals who contracted polio before 1950. This polioencephalitis was found to occur in every case of poliomyelitis, even those without evidence of damage to spinal motor neurons. These findings, in combination with data from the 1990 National Post-Polio Survey and new magnetic resonance imaging studies documenting post-encephalitis-like lesions in the brains of polio survivors, are used to present two hypotheses: 1) polioencephalitic damage to aging reticular activating system and monoaminergic neurons is responsible for post-polio fatigue, and 2) polioencephalitic damage to enkephalin-producing neurons is responsible for hypersensitivity to pain in polio survivors. In addition, the antimetabolic action of glucocorticoids on polio-damaged, metabolically vulnerable neurons may be responsible for the fatigue and muscle weakness reported by polio survivors during emotional stress.
Conclusions: The ability of the polio virus to produce symptoms by its destruction of neurons outside of the anterior horn has been accepted for more than 100 years. It is only our recent experience with PPS that has forced us to recognize that both the people who survived the original viral onslaught and their central nervous systems have been operating for decades under extreme stress. This stress now may be combining with the aging of an extensively damaged but here-to-fore remarkably functional central nervous system to reveal the previously hidden symptoms of polioencephalitis.
The above-presented hypotheses concerning the etiology of PPS fatigue suggest that reductions in both emotional and physical stress will reduce PPS. This is the experience of post-polio clinics throughout the world (36,54,55,56). As PPS fatigue continues to be treated with stress-management, work simplification and energy conservation (see 36,56), the hypotheses are being tested by studying the neuroanatomy, neuroendocrinology and neuropsychology of PPS fatigue. In addition, pharmacological means for stimulating the RAS that do not further metabolically stress its remaining aging, polio-damaged neurons are being tested.
Outcome of Research:
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Category: Post-Polio Motor Unit
Title: Vasomotor abnormalities as post-polio sequelae: functional and clinical implications
Author: Bruno RL, Johnson JC, Berman WS
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):865-9
Publication Year and Month: 1985 07
Abstract: Persons who had poliomyelitis report cold and discolored extremities and decreased muscle strength when exposed to mildly cool ambient temperatures. Bilateral digital cutaneous blood flow, skin temperature and median nerve latencies and amplitudes were measured at 30 degrees C, 25 degrees C and 20 degrees C in five post-polio subjects and age-matched controls. Cutaneous blood flow was lowest on the more affected side in the post-polio subjects but vasoconstriction with decreasing Ta was equal bilaterally in both groups. With decreasing Ta, median motor nerve latencies became clinically abnormal and “giant” sensory nerve potential amplitudes were seen in a majority of the post-polio subjects. It is concluded that an impairment of sympathetic vasoconstrictor outflow in post-polios allows passive dilatation and engorgement of the cutaneous venous capacitance beds. This promotes uncontrolled heat loss and causes cooling of nerve and muscle that is responsible for the impairment of muscle functioning and the abnormal electrophysiological findings.
Conclusions:
Outcome of Research:
Comments (if any):
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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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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: Quality of Life
Title: The influence of post-polio syndrome on independence and life satisfaction
Author: Burger H (1), Marincek C
Affiliation: (1) Institute for Rehabilitation, Ljubljana, Slovenia
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil. 2000 May 10;22(7):318-22
Publication Year and Month: 2000 10
Abstract: PURPOSE: The aim of the study was to find out the influence of the new symptoms on life satisfaction and independent living and the most frequent disabilities in patients with post-polio syndrome that are affecting the satisfaction and independence.
METHOD: A questionnaire was sent to all the post-polio survivors (207) who visited the Rehabilitation Institute in Ljubljana at least once in the last ten years. We got 100 answers, which were analysed by SPSS (statistical package for social sciences).
RESULTS: Sixty nine reported that they had new symptoms that may be classified as post-polio syndrome.
Conclusions: We have found that the new symptoms in post-polio survivors, which may be classified as post-polio syndrome, increased their walking and climbing stairs disability, increased their disability to perform daily activities and also decreased their satisfaction with life.
Outcome of Research: Not applicable
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Category: Late Effects of Polio, Surgery
Title: Total hip arthroplasty in patients affected by poliomyelitis
Author: C. M. DeDeugd, K. I. Perry, W. H. Trousdale, M. J. Taunton, D. G. Lewallen, M. P. Abdel
Affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The Bone & Joint Journal
Bone Joint J 2018;100-B:733–9
Doi: https://doi.org/10.1302/0301-620X.100B6.BJJ-2018-0127.R1
Publication Year and Month: 2018 06
Abstract: Aims
The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population.
Patients and Methods
A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded.
Results
In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs.
Conclusion
Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed.
Conclusions: Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed.
Outcome of Research: Not applicable
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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
Comments (if any):
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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: Journal of Visualized Experiments
Citation: (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
Comments (if any):
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Category: Post-Polio Motor Unit
Title: Late denervation in patients with antecedent paralytic poliomyelitis
Author: Cashman NR, Maselli R, Wollmann RL, Roos R, Simon R, Antel JP
Affiliation: Not stated
Journal: The New England Journal of Medicine
Citation: N Engl J Med. 1987 Jul 2; 317(1):7-12
Publication Year and Month: 1987 07
Abstract: The development of new weakness, fatigue, and pain decades after acute paralytic poliomyelitis is a recognized syndrome. We conducted a controlled study of this syndrome by analyzing clinical, electromyographic, and muscle-biopsy features in 18 patients with a history of poliomyelitis--13 reporting 1 to 20 years of new weakness and 5 without new symptoms. The patients with new weakness also reported new muscle atrophy (9 of 13) and fatigue (10 of 13), symptoms not reported by the controls. The age at the time of acute poliomyelitis, severity of poliomyelitis, residual disability, number of years since acute poliomyelitis, and age at the time of study were comparable in the weakening and control groups. Evidence of remote denervation consistent with antecedent poliomyelitis was demonstrated in all patients by electromyography or muscle biopsy or both. In addition, active denervation (as evidenced by spontaneous activity on conventional electromyography, increased jitter on single-fiber electromyography, or atrophic myofibers) was found in 12 patients in the weakening group and in all 5 controls. Immunohistochemical detection of myofibers expressing the neural-cell adhesion molecule corroborated ongoing denervation in both patient groups. When muscle data from both groups were pooled, correlations were observed between the extent of past reinnervation and the degree of ongoing motor-unit instability. We conclude that the extensive reinnervation of denervated muscle that occurs in paralytic poliomyelitis may be followed by late denervation of the previously reinnervated muscle fibers. Electromyographic and muscle-biopsy evidence of ongoing denervation does not distinguish between stable patients with prior paralytic poliomyelitis and those with new weakness.
Conclusions:
Outcome of Research:
Comments (if any):
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Category: Psychology
Title: Growing up with a disability following paralytic poliomyelitis: experiences from persons with late effects of polio
Author: Catharina Sjödahl Hammarlund, Jan Lexell & Christina Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden
Journal: Disability and Rehabilitation
Citation: DOI: 10.1080/09638288.2019.1647296
Publication Year and Month: 2019 08
Abstract: Purpose: To describe the experiences of growing up after acute paralytic poliomyelitis and strategies used to adapt to the new situation.
Methods: Seven women and seven men (mean age 70 years, min–max 61–78 years) with late effects of polio, who had contracted paralytic polio in their childhood. Data were collected using semi-structured interviews, transcribed verbatim, and analyzed by systematic text condensation.
Results: Memories of contracting acute paralytic poliomyelitis involved being immobilized and sent away from home for surgical and physiotherapeutic treatment. Growing up in a social context that was often tough and unfriendly resulted in the development of strategies, such as optimistic thinking, trying to blend in, trusting one’s ability to manage, and to handle the preconceptions and expectations of others. At the onset of late effects of polio, some of these strategies were still functioning, whereas overachieving, disregarding pain, and weariness were not.
Conclusion: The challenges of growing up with a disability following paralytic polio led to the development of various psychological strategies for managing daily life. By understanding these experiences and strategies, knowledge may be gained in assisting rehabilitation professionals to better support persons with late effects of polio in adapting to the new situation.
Conclusions: Growing up with a disability after paralytic poliomyelitis presented both physical and psychological challenges, necessitating new strategies for managing daily situations, such as optimistic thinking, trying to blend in and trust in one’s ability to manage. At the onset of late effects of polio, some of these strategies were still functioning. Strategies that were obsolete were those that made the participants work too hard, for example overachieving, disregarding pain, and weariness. By understanding the experiences and evolved strategies from the past, rehabilitation professionals may better support persons with late effects of polio in their process of adaptation to the new situation.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Quality of Life
Title: Perceived consequences of ageing with late effects of polio and strategies for managing daily life: a qualitative study
Author: Catharina Sjödahl Hammarlund, Jan Lexell and Christina Brogårdh
Affiliation: 1Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
2The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
3Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
4Department of Health Science, Luleå University of Technology, Luleå, Sweden
Catharina Sjödahl Hammarlund, Phone: +46462228961,
Email: es.ul.dem@dnulrammaH_lhadojS.anirahtaC.
Journal: BMC Geriatrics
Citation: 2017; 17: 179.
Publication Year and Month: 2017
Abstract: Background
New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life.
Methods
Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation.
Results
The latent analysis resulted in three categories ‘Various consequences of ageing with LEoP’, ‘Limitations in everyday activities and participation restrictions’, and ‘Strategies for managing daily life when ageing with LEoP’ and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance.
Conclusions: Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.
Outcome of Research: More research required
Comments (if any):
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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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Category: Immune Response
Title: Factors Associated with the Severity of COVID-19 Outcomes in People with Neuromuscular Diseases: Data from the International Neuromuscular COVID-19 Registry
Author: Chiara Pizzamiglio (1,2), Robert D. S. Pitceathly (1,2), Michael P. Lunn (1), Stefen Brady (3), Fabiola De Marchi (4), Lucia Galan (5), Jeannine M. Heckmann (6), Alejandro Horga (5), Maria J. Molnar (7), Acary S. B. Oliveira (8), Wladimir B. V. R. Pinto (8), Guido Primiano (9,10), Ernestina Santos (11), Benedikt Schoser (12), Serenella Servidei (9,10), Paulo V. Sgobbi Souza (8), Venugopalan Vishnu (13), Michael G. Hanna (1,2), Mazen M. Dimachkie (14), Pedro M. Machado (1), The Neuromuscular Diseases and COVID-19 Study Group
Affiliation: For The Neuromuscular Diseases and COVID-19 Study Group. Individual affiliations are not listed.
Journal: European Journal of Neurology
Citation: Pizzamiglio, C., Pitceathly, R.D.S., Lunn, M.P., Brady, S., De Marchi, F., Galan, L., Heckmann, J.M., Horga, A., Molnar, M.J., Oliveira, A.S.B., Pinto, W.B.V.R., Primiano, G., Santos, E., Schoser, B., Servidei, S., Sgobbi Souza, P.V., Vishnu, V., Hanna, M.G., Dimachkie, M.M., Machado, P.M. and (2022), Factors Associated with the Severity of COVID-19 Outcomes in People with Neuromuscular Diseases: Data from the International Neuromuscular COVID-19 Registry. Eur J Neurol. Accepted Author Manuscript. https://doi.org/10.1111/ene.15613
Publication Year and Month: 2022 10
Abstract: BACKGROUND
To determine factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases (NMDs).
METHODS
NMD cases of any age and confirmed/presumptive COVID-19, submitted to the International Neuromuscular COVID-19 Registry up to 31/December/2021, were included. A mutually exclusive ordinal COVID-19 severity scale was defined: (1) no hospitalisation; (2) hospitalisation without oxygenation; (3) hospitalisation with ventilation/oxygenation; (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios for severe outcome, adjusting for age, sex, race/ethnicity, NMD, comorbidities, baseline functional status (modified Rankin scale [mRS]), use of immunosuppressive/immunomodulatory medication, and pandemic calendar period.
RESULTS
Of 315 patients from 13 countries (mean age 50.3 [±17.7] years, 154 [48.9%] female), 175 (55.5%) were not hospitalised, 27 (8.6%) were hospitalised without supplemental oxygen, 91 (28.9%) were hospitalised with ventilation/supplemental oxygen, and 22 (7%) died. Higher odds of severe COVID-19 outcomes were observed for: age≥50 years (50-64 years: OR=2.4, 95%CI 1.33-4.31; >64 years: OR=4.16, 95%CI 2.12-8.15; both vs. <50 years), non-White race/ethnicity (OR=1.81, 95%CI 1.07-3.06; vs. White), mRS moderately severe/severe disability (OR=3.02, 95%CI 1.6-5.69; vs. no/slight/moderate disability), history of respiratory dysfunction (OR=3.16, 95%CI 1.79-5.58), obesity (OR=2.24, 95%CI 1.18-4.25), ≥3 comorbidities (OR=3.2, 95%CI 1.76-5.83; vs. ≤2; if comorbidity count used instead of specific comorbidities), glucocorticoid treatment (OR=2.33, 95%CI 1.14-4.78), and Guillain-Barré syndrome (OR=3.1, 95%CI 1.35-7.13; vs. mitochondrial disease).
Conclusions: CONCLUSIONS
Among people with NMDs, there is differential risk of COVID-19 outcomes according to demographic and clinical characteristics. These findings could be used to develop tailored management strategies and evidence-based recommendations for NMD patients.
Outcome of Research: More research required
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Category: Falls, Late Effects of Polio
Title: Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study
Author: Christina Brogårdh (1,2), Jan Lexell (1,2) and Catharina Sjödahl Hammarlund (1,3)
Affiliation: 1) Department of Health Sciences, Lund University, 221 00 Lund, Sweden
2) Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden
3) The PRO-CARE Group, School of Health and Society, Kristianstad University, 291 39 Kristianstad, Sweden
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Int. J. Environ. Res. Public Health 2021, 18(13), 7202; https://doi.org/10.3390/ijerph18137202
Publication Year and Month: 2021 07
Abstract: Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
Keywords: activities of daily living; fear of falling; postpoliomyelitis syndrome; qualitative research
Conclusions: Fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Diagnosis and Management, Late Effects of Polio
Title: Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study
Author: Claudio Andre Barbosa de Lira (I), Douglas Assis Teles Santos (II), Ricardo Borges Viana (III), Juliana Moreira Guimarães (IV), Jéssica Nathalia Soares Oliveira (V), Bolivar Saldanha Sousa (VI), Marcos Gonçalves de Santana (VII), Rodrigo Luiz Vancini (VIII),
Marília Santos Andrade (IX), Pantelis Nikolaidis (X), Thomas Rosemann (XI), Beat Knechtle (XII)
Affiliation: (I) BSc, PhD. Associate Professor, Faculdade de Educação Física e Dança (FEFD), Universidade Federal de Goiás (UFG), Goiânia (GO), Brazil. https://orcid.org/0000-0001-5749-6877
(II) BSc, MSc. Assistent Professor, Colegiado de Educação Física, Universidade do Estado da Bahia (UNEB), Teixeira de Freitas (BA), Brazil. https://orcid.org/0000-0002-7664-5468
(III) BSc, PhD. Professor, Escola Superior de Educação Física e Fisioterapia do Estado de Goiás (ESEFFEGO), Universidade Estadual de Goiás (UEG), Goiânia (GO), Brazil. https://orcid.org/0000-0001-9200-3185
(IV) BSc. Nurse, Unidade Acadêmica Especial de Ciências da Saúde, Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0002-6729-0335
(V) BSc. Biomedic, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU),
Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0002-9531-4277
(VI) MD, PhD. Physician, Hospital Israelita Albert Einstein, São Paulo-Brazil, São Paulo (SP), Brazil. https://orcid.org/0000-0001-9682-5987
(VII) BSc, PhD. Associate Professor, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0001-7674-3263
(VIII) BSc, PhD. Adjunct Professor, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil. https://orcid.org/0000-0003-1981-1092
(IX) PhD. Physical Therapist and Associate Professor, Department of Physiology, Universidade Federal de São Paulo (USP), São Paulo (SP), Brazil. https://orcid.org/0000-0002-7004-4565
(X) BSc, PhD. Professor, School of Health and Caring Sciences, University of West Attica, Athens, Greece. https://orcid.org/0000-0001-8030-7122
(XI) MD, PhD. Physician and Professor, Institute of Primary Care, University of Zurich, Zurich, Switzerland. https://orcid.org/0000-0002-6436-6306
(XII) MD, PhD. Physician and Scientific Assistant, Institute of Primary Care, University of Zurich, Zurich, Switzerland; and Researcher, Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland https://orcid.org/0000-0002-2412-9103
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Sao Paulo Med. J.
139 (5) • Aug-Sep 2021
https://doi.org/10.1590/1516-3180.2020.0617.16032021
Publication Year and Month: 2021 08
Abstract: BACKGROUND:
Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors.
OBJECTIVE:
Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals.
DESIGN AND SETTING:
Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás.
METHODS:
The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed).
RESULTS:
In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%.
CONCLUSIONS:
The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.
KEYWORDS (MeSH terms):
Poliomyelitis; Physicians; Nervous system; Postpoliomyelitis syndrome; Knowledge
AUTHORS’ KEY WORDS:
Medical education; Neuromuscular disease; Late effects of polio
Conclusions: Our study showed that, overall, there is a lack of knowledge about PPS and poliomyelitis, especially among psychologists and nutritionists. Therefore, the services provided by these professionals may become compromised. Furthermore, government initiatives should be implemented to increase knowledge among healthcare professionals.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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, MD; Robert Henderson, MD
Section Editor: Jeremy M Shefner, MD, PhD
Deputy 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
Comments (if any):
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Category: Post-Polio Motor Unit
Title: Motor unit number estimation: A technology and literature review
Author: Clifton L. Gooch MD (1); Timothy J. Doherty MD, PhD (2); K. Ming Chan MD (3); Mark B. Bromberg MD, PhD (4); Richard A. Lewis MD (5); Dan W. Stashuk PhD (6); Michael J. Berger MD, PhD (7); Michael T. Andary MD (8); Jasper R. Daube MD (9)
Affiliation: (1) Department of Neurology, University of South Florida, Tampa, Florida, USA
(2) Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
(3) Division of Physical Medicine and Rehabilitation/Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
(4) Department of Neurology, University of Utah, Salt Lake City, Utah, USA
(5) Department of Neurology, Cedars‐Sinai, Los Angeles, California, USA
(6) Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
(7) School of Kinesiology, University of Western Ontario, London, Ontario, Canada
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
(8) College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
(9) Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
Journal: Muscle & Nerve
Citation: 50: 884–893, 2014; https://doi.org/10.1002/mus.24442
Publication Year and Month: 2014 09
Abstract: Introduction: Numerous methods for motor unit number estimation (MUNE) have been developed. The objective of this article is to summarize and compare the major methods and the available data regarding their reproducibility, validity, application, refinement, and utility.
Methods: Using specified search criteria, a systematic review of the literature was performed. Reproducibility, normative data, application to specific diseases and conditions, technical refinements, and practicality were compiled into a comprehensive database and analyzed.
Results: The most commonly reported MUNE methods are the incremental, multiple‐point stimulation, spike‐triggered averaging, and statistical methods. All have established normative data sets and high reproducibility. MUNE provides quantitative assessments of motor neuron loss and has been applied successfully to the study of many clinical conditions, including amyotrophic lateral sclerosis and normal aging.
Conclusions: MUNE is an important research technique in human subjects, providing important data regarding motor unit populations and motor unit loss over time.
Conclusions: MUNE is an important research technique in human subjects, providing important data regarding motor unit populations and motor unit loss over time.
Outcome of Research: More research required
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Category: Speech Pathology
Title: Incidence and nature of dysphagia in polio survivors
Author: Coelho CA, Ferranti R
Affiliation: Department of Communication Disorders, Gaylord Hospital, Wallingford, CT 06492
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1991 Dec; 72(13):1071-5
Publication Year and Month: 1991 12
Abstract: Questionnaires pertaining to swallowing function were mailed to 220 members of postpolio support groups in Connecticut. Of the 109 responses, 80 individuals reported having no difficulty with swallowing, while 29 reported having either intermittent or consistent swallowing problems. Twenty-one of the 29 were seen for videofluoroscopic swallowing studies and pulmonary function testing. The swallowing studies showed that 43% of these individuals had difficulty with bolus control, 19% with delayed swallow response, and 81% with decreased pharyngeal transit. Although none of these individuals were observed to aspirate, two were judged to be at significant risk. Incidence of dysphagia within the group of polio survivors was estimated to be approximately 18%. Seventeen of the 20 postpolio subjects with dysphagia also demonstrated decreased breathing capacity. Although moderately to severely depressed values in the pulmonary function measures accompanied moderate dysphagia in certain postpolio individuals, reduced values in these same measures were also present in individuals with minimal swallowing dysfunction. Therefore, although impaired breathing may complicate swallowing dysfunction and vice versa, it does not appear that one can be predicated from the other. Management of dysphagia in postpolio individuals is discussed.
Conclusions:
Outcome of Research:
Comments (if any):
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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: Polio Immunisation
Title: Review of the health consequences of SV40 contamination of poliomyelitis vaccines, and in particular a possible association with cancers
Author: Cossart Y, A0
Affiliation: Bosch Professor of Infectious Diseases, University of Sydney, Australia
Journal: Therapeutic Goods Administration Alert/Advisory
Citation:
Publication Year and Month: 2004 12
Abstract: The published papers concerning the human health risk of vaccines contaminated with SV40 virus falls into three groups: those published in the 1960s when the virus was discovered, a second group dating from the period when the two related human viruses BK and JC were described and the third recent period when molecular techniques were applied to the problem.
GROUP 1: SV40 was discovered in 1960 and shown
~ To be a common infection in healthy rhesus monkeys
~ To belong to the polyoma virus family
~ To cause tumours (especially ependymomas, osteosarcomas, mesotheliomas and lymphomas) when injected into baby hamsters
~ To be incompletely killed by the heat and formalin treatment used to inactivate polioviruses during "Salk" vaccine manufacture
~ To be capable of infecting human recipients of contaminated vaccine
~ To be capable of transforming human cells into cancer cells in the laboratory
Immediate steps were taken to free the vaccine seed cultures of SV40 and to ensure that all future batches of vaccine (both the inactivated "Salk" and the then prototype attenuated "Sabin" types) were made in monkey kidney cultures free of SV40. This was accomplished in 1963.
Many millions of children and adults had already been inoculated with polio vaccine before these measures were fully effective. It is not known which of the early batches actually contained infectious doses of SV40, but tests of recipients showed that many produced SV40 antibodies. This could be the result of either SV40 infection or "immunisation" by the killed SV40 in the vaccine.
Concern focussed on the risk to very young children but no increased risk of cancer was found in follow up of over 1000 vaccinees. As the tumour types induced in hamsters are rare these studies were supplemented with much larger studies comparing cancer registry data for children born (and presumably mostly immunised) during the period between introduction of polio vaccine and eradication of SV40 from manufacture (ie 1957-63) and children born within the preceding or subsequent five year periods. These studies were reassuring, although it was recognised that the follow up was not sufficiently long term to detect a risk of the cancers such as mesothelioma which occur in middle age and beyond. There were also some discrepant reports but in retrospect these (including the single Australian study) have significant design limitations.
GROUP 2: The issue was revived in the 1970s when two new human polyomaviruses (BK and JC) were discovered. These cause tumours and degenerative neurological disease in humans. They also share antigens and DNA sequences with SV40 which may cause cross reactions leading to false positive results in diagnostic tests. Surveys showed that serological evidence of infection with the two new agents was common in healthy people and that disease emerged almost exclusively in immune deficient individuals. Attempts to isolate SV40 from human tumours, even by explanting the cells in culture, were generally unsuccessful, but one typical SV40 strain was obtained from a melanoma and two others from diseased brain tissue. Serological surveys showed that earlier findings that up to 5% of the population had low titre SV40 antibody were mostly, if not entirely, due to cross reactions with the much commoner human polyoma viruses.
It was thus concluded that while SV40 involvement in human tumours could not be absolutely denied it must be very rare indeed.
GROUP 3 : The most recent group of publications has reported the use of molecular techniques to detect SV40 DNA in tumours. The results have been conflicting, some studies showing no positives
others a high proportion. Most workers have focussed on detection of the viral oncogene (T antigen) and/or its expression. Persistence of these sequences integrated into the host cell genome would be expected from experimental studies of polyomavirus induced tumours of other species. Unfortunately the SV40 sequences of interest are widely used as tools in molecular laboratories creating a very substantial risk of cross contamination when testing tumour samples. This casts doubt on these studies which has not yet been resolved. Another new avenue of research has revealed that the SV40 oncogene (Tag) acts through complexing with p53 and affects the pRb pathway of cell cycle control. Genetic mutations of these control elements makes the cell exquisitely sensitive to SV40 transformation. These mutations occur naturally in the population, and confer cancer susceptibility on individuals who often develop tumours of similar type to those associated with SV40. This may need to be taken into account in future epidemiological studies.
Conclusions: The literature establishes a plausible mechanism for human carcinogenesis by SV40 virus. Studies of the prevalence of SV40 antibody in the community and the presence of SV40 in human tumours do not absolutely exclude the possibility of rare involvement of the virus in individual cases of cancer, but fail to provide evidence of statistically greater risk for people immunised during the period when SV40 was likely to have been present in polio vaccine. This conclusion has also been reached by several international review panels.
Outcome of Research: Not applicable
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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: Canadian Journal of Anesthesia
Citation: 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: Pain
Title: Fibromyalgia Is Common in a Postpoliomyelitis Clinic
Author: D A Trojan (1), N R Cashman
Affiliation: (1) Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Quebec.
Journal: Archives of Neurology
Citation: Trojan DA, Cashman NR. Fibromyalgia is common in a postpoliomyelitis clinic. Arch Neurol. 1995 Jun;52(6):620-4. doi: 10.1001/archneur.1995.00540300094019. PMID: 7763212.
Publication Year and Month: 1995 06
Abstract: Objective: To determine prospectively the occurrence and clinical characteristics of fibromyalgia in patients serially presenting to a postpolio clinic. Fibromyalgia may mimic some of the symptoms of postpoliomyelitis syndrome, a disorder characterized by new weakness, fatigue, and pain decades after paralytic poliomyelitis.
Design: Case series.
Setting: A university-affiliated hospital clinic.
Patients: One hundred five patients were evaluated with a standardized history and physical examination during an 18-month period. Ten patients were excluded because of the absence of past paralytic poliomyelitis.
Interventions: Patients with fibromyalgia were treated with low-dose, nighttime amitriptyline hydrochloride or other conservative measures.
Main Outcome Measures: Patients with fibromyalgia had diffuse pain and 11 or more of 18 specific tender points on examination (American College of Rheumatology criteria, 1990). Patients with borderline fibromyalgia had muscle pain and five to 10 tender points on physical examination.
Results: Ten (10.5%) of 95 postpolio patients met the criteria for fibromyalgia, and another 10 patients had borderline fibromyalgia. All patients with fibromyalgia complained of new weakness, fatigue, and pain. Patients with fibromyalgia were more likely than patients without fibromylagia to be female (80% vs 40%, P<.04) and to complain of generalized fatigue (100% vs 71%, P=.057), but were not distinguishable in terms of age at presentation to clinic, age at polio, length of time since polio, physical activity, weakness at polio, motor strength scores on examination, and the presence of new weakness, muscle fatigue, or joint pain. Approximately 50% of patients in both the fibromyalgia and borderline fibromyalgia groups responded to low-dose, nighttime amitriptyline therapy.
Conclusions: Conclusions: (1) Fibromyalgia occurs frequently in a postpolio clinic. (2) Fibromyalgia can mimic some symptoms of postpoliomyelitis syndrome. (3) Fibromyalgia in postpolio patients can respond to specific treatment.
Outcome of Research: Not applicable
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Category: Late Effects of Polio
Title: Late functional deterioration following paralytic poliomyelitis
Author: D. Kidd, R.S. Howard, A.J. Williams, F.W. Heatley, C.P. Panayiotopoulos and G.T. Spencer
Affiliation: Departments of Neurology, Respiratory Medicine and Orthopaedics, the Lane-Fox Unit, St Thomas' Hospital, London, UK
Journal: Post-Polio Network (NSW) Inc
Citation: QJ Med 1997; 90: 189 - 196
Publication Year and Month: 1997 01
Abstract: Many patients with previous poliomyelitis develop 'post-polio syndrome' (PPS) in which late functional deterioration follows a period of relative stability. The frequency with which PPS can be attributed to clearly defined causes remains uncertain. We reviewed 283 newly-referred patients with previous poliomyelitis seen consecutively over a 4-year period; 239 patients developed symptoms of functional deterioration at a mean of 35 (5-65) years after the paralytic illness. Functional deterioration was associated with orthopaedic disorders in 170 cases, neurological disorders in 35, respiratory disorders in 19 and other disorders in 15. Progressive post-polio muscular atrophy was not observed. Functional deterioration following paralytic poliomyelitis is common, and associated with orthopaedic, neurological, respiratory and general medical factors which are potentially treatable.
Conclusions:
Outcome of Research: Not applicable
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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: Physiotherapy Theory and Practice
Citation: (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: Falls
Title: Relationship of depression and medications on incidence of falls among people with late effects of polio
Author: Da Silva, C.P.; Zuckerman, B.; Olkin, R.
Affiliation: School of Physical Therapy, Texas Women's University, Houston Texas, USA
Journal: Physiotherapy Theory and Practice
Citation: Volume 33, 2017 - Issue 5
Publication Year and Month: 2017 04
Abstract: The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence.
Conclusions: Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: The post-polio syndrome as an evolved clinical entity. Definition and clinical description.
Author: Dalakas MC
Affiliation: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
Journal: Annals of the New York Academy of Sciences
Citation: Ann N Y Acad Sci. 1995 May 25;753:68-80
Publication Year and Month: 1995 05
Abstract: Post-polio syndrome (PPS) refers to the new neuromuscular symptoms that occur at least 15 years after stability in patients with prior acute paralytic polio-myelitis. They include: (1) new muscle weakness and atrophy in the limbs, the bulbar or the respiratory muscles [post-poliomyelitis muscular atrophy (PPMA)] and (2) excessive muscle fatigue and diminished physical endurance. PPS is a clinical diagnosis that requires exclusion of all other medical, neurological, orthopedic or psychiatric diseases that could explain the cause of the new symptoms. Routine electromyography is useful to confirm chronic and ongoing denervation and exclude neuropathies. Muscle biopsy, single fiber electromyography (EMG), macro-EMG, serum antibody titers to polio virus, and spinal fluid studies are very useful research tools but they are rarely needed to establish the clinical diagnosis. PPS is a slowly progressive phenomenon with periods of stability that vary from 3 to 10 years. Current evidence indicates that PPS is the evolution of a subclinically ongoing motor neuron dysfunction that begins after the time of the acute polio. It is clinically manifested as PPS when the well-compensated reinnervating process crosses a critical threshold beyond which the remaining motor neurons cannot maintain the innervation to all the muscle fibers within their motor unit territory.
Conclusions:
Outcome of Research: Not applicable
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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: Post-Polio Motor Unit
Title: A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms
Author: Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N, Albrecht P, Sever J
Affiliation: Not stated
Journal: The New England Journal of Medicine
Citation: N Engl J Med. 1986 Apr 10; 314(15):959-63
Publication Year and Month: 1986 04
Abstract: A “post-polio” syndrome characterized by new neuromuscular symptoms, including muscle weakness, may develop years after recovery from acute paralytic poliomyelitis. We studied 27 patients (mean age, 50.6 years) in whom new muscle weakness developed a mean of 28.8 years after recovery from acute polio. We reevaluated these patients during a mean follow-up period of 8.2 years (range, 4.5 to 20) after they were originally studied at the National Institutes of Health. The total mean follow-up period after the onset of new weakness was 12.2 years (range, 6 to 29). The patients were assessed with quantitative muscle testing, muscle biopsy, electromyography, and virologic and immunologic examination of the cerebrospinal fluid. Muscle strength had declined in all patients. The rate of decline averaged 1 percent per year. The decrease was irregular, with subjective plateau periods that ranged from 1 to 10 years. None of the patients had amyotrophic lateral sclerosis. Oligoclonal bands (IgG) were found in the cerebrospinal fluid of 7 of 13 patients studied, but no specific elevation of antibodies to poliovirus was observed in the cerebrospinal fluid. The newly affected muscles that were evaluated longitudinally with follow-up muscle biopsies and electromyography showed signs of chronic and new denervation. Groups of atrophic muscle fibers (group atrophy) and "neurogenic jitter" were not present. New post-polio muscle weakness is not a life-threatening form of motor-neuron deterioration. It appears that this weakness is not due to a loss of whole motor neurons, as in amyotrophic lateral sclerosis, but that it is due to a dysfunction of the surviving motor neurons that causes a slow disintegration of the terminals of individual nerve axons.
Conclusions:
Outcome of Research:
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Category: Muscular Atrophy
Title: Late postpoliomyelitis muscular atrophy: clinical, virologic, and immunologic studies
Author: Dalakas MC, Sever JL, Madden DL, Papadopoulos NM, Shekarchi IC, Albrecht P, Krezlewicz A
Affiliation: Not stated
Journal: Reviews of Infectious Diseases
Citation: Rev Infect Dis. 1984 May-Jun; 6 Suppl 2:S562-7
Publication Year and Month: 1984 05
Abstract: Seventeen relatively young patients, ages 31-65 years (average, 45) with prior poliomyelitis, who after a number of years of stability had experienced new neuromuscular symptoms, were studied. Seven patients had deterioration of functional capacity and then stabilization without new muscular weakness. The other 10 had late postpoliomyelitis muscular atrophy (late PPMA) characterized by focal progressive muscle weakness, wasting, fasciculations, and muscle pains affecting previously spared muscles or muscles previously affected but recovered. Four patients with late PPMA had lymphorrhages or lymphocytic infiltrates in their biopsied muscle; three of three patients had oligoclonal IgG bands in their spinal fluid, and five had variable peripheral T lymphocyte-subset ratios. In one patient with late PPMA, antibodies to poliovirus were specifically elevated in the cerebrospinal fluid. Our findings indicate that new motor-neuron disease can occur in patients with prior poliomyelitis and that immunopathologic mechanisms may play a role.
Conclusions:
Outcome of Research:
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Category: Psychology
Title: Psychological Trauma and Its Treatment in the Polio Epidemics
Author: Daniel J. Wilson
Affiliation: Department of History, Muhlenberg College
Journal: Bulletin of the History of Medicine
Citation: Vol. 82, No. 4 (Winter 2008), pp. 848-877
https://www.jstor.org/stable/44449627
Publication Year and Month: 2008
Abstract: In this paper, I explore the kinds of psychological trauma experienced by polio patients in the mid-twentieth century in the United States. I argue that the trauma was the result of the experience of sudden paralysis, the conditions under which patients were treated, and the expectations for rehabilitation derived from the psychosocial context of the period. Psychiatric and psychological counseling in hospitals was only beginning to be offered in this period, and most polio patients received little or no counseling or assistance in dealing with their psychological problems. Contemporary psychological studies suggest that many polio patients suffered from psychological problems but that they were relatively mild. However, compared with the many studies of the physical problems of polio patients, there were relatively few studies of the psychological issues associated with the disease. The narratives and memoirs of polio survivors vividly testify to the psychological burden they experienced as patients during both the acute phase of the illness and during rehabilitation.
Conclusions: The psychological consequences of polio could be significant. Sudden paralysis, isolation from family and friends, a long and often painful rehabilitation, permanent disability, feelings of guilt and shame, and a zeitgeist that exhorted the polio survivor to always try harder to achieve normalization all combined in various measures to create psychological distress in many polio patients and survivors. Not every polio patient or survivor experienced substantial psychological distress or damage, but the potential was always there, especially for those who brought to the polio experience already fragile personalities or who lacked supportive families. As the polio narratives make clear, for those survivors who experienced psychological problems, the psychic damage from polio could be severe and long-lasting.
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: Journal of the American Podiatric Medical Association
Citation: 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: Drugs
Title: An Open Trial of Pyridostigmine in Post-poliomyelitis Syndrome
Author: Daria A. Trojan and Neil R. Cashman
Affiliation: From the Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal.
Journal:
Citation: The Canadian Journal of Neurological Sciences Volume 22, No. 3 August 1995 223-227
Publication Year and Month: 1995 08
Abstract: Background: One of the major symptoms of postpoliomyelitis syndrome (PPS) is disabling generalized fatigue. Subjects with PPS also report muscle fatiguability and display electrophysiologic evidence of anticholinesterase-responsive neuromuscular junction transmission defects, suggesting that anticholinesterase therapy may be useful in the management of disabling fatigue. Methods: We initiated an open trial of the oral anticholinesterase pyridostigmine, up to 180 mg per day, in 27 PPS patients with generalized fatigue and muscle fatiguability. Response to Pyridostigmine was assessed with the Hare fatigue scale, the modified Barthel index for activities of daily living, and a modified Klingman mobility index. Results: Two patients could not tolerate the medication. After one month of therapy, 16 patients (64%) reported a reduction in fatigue on the Hare fatigue scale; three of 16 showed improvement on the modified Barthel index for activities of daily living, and two of 16 experienced improvement on a modified Klingman mobility index. Pyridostigmine responders were significantly more fatigued than non-responders on the pre-treatment Hare score, but were not significantly different with regard to age, sex, age at acute poliomyelitis, or severity of acute poliomyelitis. Conclusions: Pyridostigmine may be useful in the management of fatigue in selected patients with PPS. Response to pyridostigmine may be predicted by severity of pre-treatment fatigue.
Conclusions:
Outcome of Research: Not applicable
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Category: Drugs
Title: Anticholinesterases in Post-Poliomyelitis Syndrome
Author: Daria A. Trojan and Neil R. Cashman
Affiliation: Department of Neurology, Montreal Neurological Institute and Hospital, McGill University
Journal: Annals of the New York Academy of Sciences
Citation: Reprinted from The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment, Volume 753 of the Annals of the New York Academy of Sciences, May 25, 1995
Publication Year and Month: 1995 05
Abstract: New weakness, fatigue, and pain after decades of functional stability in those who have recovered from acute paralytic poliomyelitis constitutes post-poliomyelitis syndrome (PPS).[1-7] The cause of PPS is unknown, but it is thought to be due to a distal degeneration of enlarged post-polio motor units produced by terminal axonal sprouting during the recovery process after acute polio.[8,9] The symptoms of weakness and fatigue may be a direct result of this distal motor unit degeneration;[2,7-13] however, it is presently unclear how pain relates to disease of the motor unit. PPS is a slowly progressive motor neuron disease for which there is currently no specific treatment.[4]
Conclusions: Our studies indicate that a proportion of fatigued post-poliomyelitis patients can experience an amelioration of defects in neuromuscular junction transmission and of clinical fatigue with anticholinesterases. Because S-SFEMG response was significantly associated with clinical response to anticholinesterases, fatigue in PPS may be caused by defects in neuromuscular junction transmission in a proportion of patients. Preliminary studies in a small group of patients indicate that anticholinesterases may produce their clinical neuromuscular response by producing an increase in isokinetic strength in a proportion of patients. Our studies provide a physiological rationale for the use of anticholinesterases in PPS for the symptom of fatigue. However, further randomized, placebo-controlled, double-blinded trials are needed to establish definitively the benefits and risks of these agents.
Outcome of Research:
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Category: Drugs
Title: Anticholinesterase-responsive neuromuscular junction transmission defects in post-poliomyelitis fatigue
Author: Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Affiliation: Department of Neurology, McGill University, Montreal Neurological Institute and Hospital
Journal: Journal of the Neurological Sciences
Citation: 114 (1993) 170-177
Publication Year and Month: 1992 08
Abstract: Disabling generalized fatigue and muscle fatiguability are common features of post-poliomyelitis syndrome (PPS). In 17 fatigued PPS patients, we measured jitter on stimulation single-fiber electromyography (S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium. We observed reduction in jitter (defined as a significant difference in jitter means before and after edrophonium, unpaired t-test P < 0.05) in 7 patients, no change in 8, and a significant increase in 2 patients. Blinded to their edrophonium results, the 17 patients were treated with pyridostigmine 180 mg/day for 1 month, with a subjective improvement of fatigue in 9 patients, and with a significant reduction in mean Hare fatigue scores in the entire group of 17 patients (pre = 2.71, and post = 1.71; Wilcoxan signed rank sum test, P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was significantly associated with pyridostigmine-induced subjective improvement of fatigue (Fisher's exact test, P < 0.04). A significant reduction in fatigue with pyridostigmine was observed only in the 7 patients who experienced a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum test, P = 0.03). In addition, the 9 pyridostigmine responders experienced a significant reduction in jitter means pre- and post-edrophonium (100% vs. 88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular transmission as measured by jitter on S-SFEMG can improve with edrophonium in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability in some patients with PPS may be due to anticholinesterase-responsive NMJ transmission defects.
Conclusions:
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Stimulation frequency-dependent neuromuscular junction transmission defects in patients with prior poliomyelitis
Author: Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Affiliation: Department of Neurology, McGill University, Montreal Neurological Institute and Hospital
Journal:
Citation: Journal of the Neurological Sciences, 118 (1993) 150-157
Publication Year and Month: 1993 03
Abstract: Generalized fatigue and muscle fatiguability are major symptoms of post-poliomyelitis syndrome (PPS), and may be due to neuromuscular junction transmission defects, as suggested by increased jitter on single fiber electromyography (SFEMG). To determine the etiology of this defect, we studied jitter at low (1, 5 Hz) and high (10, 15, 20 Hz) frequency stimulation with stimulation SFEMG in 17 post-polio patients with muscle fatiguability, and in 9 normal controls. In 5 of 17 PPS patients and in 1 of 9 controls, jitter was significantly higher (unpaired t-test, P < 0.05) at high frequency stimulation (HFS). In the remaining PPS patients and controls there was no significant difference in jitter at high and low stimulation frequencies. PPS patients with increased jitter at HFS had a significantly longer time interval since acute polio (mean 48.5 years) than PPS patients without increased jitter at HFS (mean 40 years; P < 0.05), but were not distinguished by other historical or clinical criteria. We conclude that the neuromuscular junction defect in post-polio patients is similar to that observed in amyotrophic lateral sclerosis, and is probably due to ineffective conduction along immature nerve sprouts and exhaustion of acetylcholine stores. The appearance of an increase in jitter with HFS in post-polio patients may be dependent upon time after acute polio.
Conclusions:
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Electrophysiology and Electrodiagnosis of the Post-Polio Motor Unit
Author: Daria A. Trojan, MD, Daniel Gendron, MD, Neil R. Cashman, MD
Affiliation:
Journal: Orthopedics
Citation: Orthopedics December 1991 Vol 14 No 12 1353-1361
Publication Year and Month: 1991 12
Abstract: Post-poliomyelitis syndrome refers to new symptoms that may occur years after recovery from poliomyelitis. The most common of these symptoms are new weakness, fatigue, and pain. This article describes electrodiagnostic studies -- conventional electromyography (EMG), single fiber electromyography (SFEMG), and macroelectromyography (macro-EMG) -- that have provided information on the post-polio motor unit and on the possible etiology of some post-polio syndrome symptoms. Muscular fatigue, and indirectly, general fatigue, may be due to neuromuscular junction transmission defects in some post-polio individuals, as suggested by reduction of the compound motor action potentials on repetitive stimulation, and increased jitter and blocking on SFEMG. Progressive weakness and atrophy in post-polio syndrome is probably due to a distal degeneration of post-polio motor units with resultant irreversible muscle fiber denervation. Electrodiagnostic evidence of ongoing denervation includes fibrillation and fasciculation potentials on conventional EMG, increased jitter and blocking on SFEMG, and smaller macro-EMG amplitudes in newly weakened postpolio muscles. However, even though electrodiagnostic studies have provided insight into the possible causes of some postpolio syndrome symptoms, no specific electrodiagnostic test for the syndrome is currently available.
Conclusions:
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Predictive Factors for Post-Poliomyelitis Syndrome
Author: Daria A. Trojan, MD, MSc, Neil R. Cashman, MD, Stanley Shapiro, PhD, Catherine M. Tansey, MSc, John M. Esdaile, MD
Affiliation: From the Department of Neurology (Drs. Trojan, Cashman), Montreal Neurological Institute and Hospital, the Department of Medicine (Dr. Esdaile), Montreal General Hospital, and the Department of Epidemiology and Biostatistics (Dr. Shapiro, Ms. Tansey), McGill University, Montreal, Quebec, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil Vol 75, July 1994, 770-777
Publication Year and Month: 1994 07
Abstract: Post-poliomyelitis syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. The purpose of this study was to identify, through a case-control study design, factors that predict subsequent PPS in patients with prior paralytic poliomyelitis. Among patients attending a university-affiliate hospital post-polio clinic, "cases" were patients with new weakness and fatigue, and "controls" were patients without these complaints. A chart review of 353 patients identified 127 cases and 39 controls. Logistic regression modeling was used to calculate adjusted and unadjusted odds ratios. In univariate analyses, significant risk factors for PPS were a greater age at time of presentation to clinic (p = 0.01), a longer time since acute polio (p = 0.01), and more weakness at acute polio (p = 0.02). Other significant associated, but not necessarily causal factors were a recent weight gain (p = 0.005), muscle pain (p = 0.01) particularly that associated with exercise (p = 0.005), and joint pain (p = 0.04). Multivariate analyses revealed that a model containing age at presentation to clinic, severity of weakness at acute polio, muscle pain with exercise, recent weight gain, and joint pain best distinguished cases from controls. Age at acute polio, degree of recovery after polio, weakness at best point after polio, physical activity, and sex were not contributing factors. These findings suggest that the degree of initial motor unit involvement as measured by weakness at acute polio, and possibly the aging process and overuse are important in predicting PPS.
Conclusions: In conclusion, the results from this study provide insight on predictive factors for PPS, and can be applied in the clinical management of patients who have recovered from paralytic poliomyelitis. Our findings support the hypothesis that the severity of initial motor unit involvement as estimated by weakness at acute polio, and possibly the normal ageing process and overuse are important in predicting PPS. Even though patients have no control over the severity of weakness as a result of acute polio, they do have control over some predictive factors for PPS. Patients can be advised that they should avoid gaining weight and exercising to the point of muscle pain because these variables have been found to be strongly associated with PPS. The exact role of physical activity will still need further evaluation; however, the usual recommendations of low-level aerobic exercise with avoidance of muscle pain and fatigue appear valid. Thus, this study can provide the basis for physiologically reasonable and practical advice to post-polio patients to minimize or delay the risk of PPS.
Outcome of Research: Not applicable
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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: PLoS One
Citation: 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
Comments (if any):
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Category: Women's Health
Title: Pregnancy following Poliomyelitis
Author: Daw E, Chandler G.
Affiliation: University of Dundee, Scotland
Journal: Postgraduate Medical Journal
Citation: 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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Journal of Clinical Research in Anesthesiology
Citation: 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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Exercise
Title: Effect of modified aerobic training on movement energetics in polio survivors
Author: Dean E, Ross J
Affiliation: School of Rehabilitation Medicine, University of British Columbia, Vancouver, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1243-6
Publication Year and Month: 1991 11
Abstract: Given that individuals with disabilities may be unable to achieve maximal oxygen uptake in an exercise test and that maximal exercise testing may cause increased fatigue, pain, and muscle weakness, we examined the role of submaximal exercise testing and training based on objective as well as subjective parameters in polio survivors. Experimental (N = 7) and control subjects (N = 13) were tested before and after a 6-week period. The experimental subjects participated in a 6-week exercise training program for 30 to 40 minutes, three times a week. The program consisted of treadmill walking at 55% to 70% of age-predicted maximum heart rates; however, exercise intensity was modified to minimize discomfort/pain and fatigue. Neither objective nor subjective exercise responses were significantly different in the control group over the 6 weeks. No change was observed in cardiorespiratory conditioning in the experimental group. However, movement economy, which is related to the energy cost of walking, was significantly improved; and walking duration was significantly increased at the end of training. Modified aerobic training may have a role in enhancing endurance and reducing fatigue during activities of daily living in polio survivors.
Conclusions:
Outcome of Research:
Comments (if any):
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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: Ageing & Society
Citation: 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
Comments (if any):
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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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Fatigue
Title: Multidimensional fatigue inventory and post-polio syndrome - a Rasch analysis
Author: Dencker A (1,3), Sunnerhagen KS (1,2), Taft C (1,3), Lundgren-Nilsson Å (1,2)
Affiliation: (1) Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; (2) Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; (3) Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30, Sweden - [email protected].
Journal: Health and Quality of Life Outcomes
Citation: Health Qual Life Outcomes. 2015 Feb 12;13(1):20. doi: 10.1186/s12955-015-0213-9
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: 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: Not applicable.
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Category: Psychology
Title: Psychological Resilience and Depressive Symptoms in Older Adults Diagnosed with Post-polio Syndrome (2012)
Author: Diana Pierini, RN, BSN (1)
Alexa Stuifbergen, PhD, RN, FAAN (2)
Affiliation: (1) [Doctoral Student] and The University of Texas at Austin, School of Nursing, Austin, TX
(2) Professor and Associate Dean of Research at The University of Texas at Austin, School of
Nursing, Austin, TX
Journal: Rehabilitation Nursing
Citation: 35(4): 167–175. DOI: 10.1002/j.2048-7940.2010.tb00043.x
Publication Year and Month: 2012 09
Abstract: Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post-polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self-efficacy, personal resources, interpersonal relationships, self-rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored > or = 10 on the Center for Epidemiologic Studies Short Depression Scale (CES-D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self-rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (beta = -.26). The implications for rehabilitation nurses in developing a patient-strengths perspective in the assessment and counseling of older adults with PPS are discussed.
Conclusions: Preventing depressive symptoms from developing into depression is a worthwhile goal for health promotion in older adults diagnosed with PPS. While no causal relationships are posited as a result of the study, future studies should explore the potential for psychological resilience factors to ameliorate depressive symptoms. Rehabilitation nurses are in an ideal position to encourage resiliency while providing emotional support. Although the vicissitudes of life cannot be altered, patients diagnosed with PPS can be helped in positive ways by offering encouragement and hope.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Psychology
Title: Postpoliomyelitis Syndrome: Assessment of Behavioral Features
Author: Donald L. Freidenberg, David Freeman, Steven J. Huber, Jacquelin Perry, Armin Fischer, Wilfred G. Van Gorp and Jeffrey L. Cummings
Affiliation:
Journal: © Copyright 1989 Raven Press Ltd., New York
Lincolnshire Post-Polio Library copy by kind permission of Dr. Perry
Citation: Neuropsychiatry, Neuropsychology, and Behavioral Neurology Vol. 2, No. 4, pp 272-281. 1989
Publication Year and Month: 1989
Abstract: Postpoliomyelitis syndrome (PPS) is an increasingly recognized phenomenon characterized by late-onset weakness, pain, and fatigue. Psychiatric and cognitive disturbances have been noted in postpoliomyelitis patients, but the relationship of these symptoms to PPS is unknown. We examined postpoliomyelitis patients with and without PPS using objective neuropsychological and neuropsychiatric procedures. Our results suggest that disturbances of mood were common and that subtle cognitive deficits also occured in postpoliomyelitis patients. However, patients with PPS did not have greater depression or cognitive deficits compared to postpoliomyelitis patients without PPS. Key Words: Postpoliomyelitis syndrome, Mood disturbances, Cognitive deficits.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Diagnosis and Management
Title: Physical therapy management of the patient with post-polio syndrome. A case report.
Author: Donna J. Twist, Dong M. Ma
Affiliation:
Journal: Physical Therapy
Citation: Volume 66, Issue 9, 1 September 1986, Pages 1403–1406
Publication Year and Month: 1986 09
Abstract: This case report documents the treatment of a patient who experienced progressive muscle weakness and a decrease in function over time that did not appear to be related to any secondary neuromuscular disease. We discuss the relationship between age and maximal muscle function in addition to some general guidelines for rehabilitation. This type of patient can represent a challenge for the physical therapist. This case report, however, illustrates the degree of muscular and functional recovery that can result with a physical therapy program aimed at reducing levels and intensity of exercise, daily activity, and stress.
Conclusions: A combination of short-term goals appears to be essential to the successful management of a patient with post-polio syndrome.
Outcome of Research: Not applicable
Comments (if any):
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Category: Complementary Therapies
Title: Myofascial Release: Perspective of an informed consumer.
Author: DOROTHY WOODSMITH, RN, PHD,
Affiliation: UNIVERSITY OF SOUTHERN MAINE, PORTLAND, MAINE
Journal: Polio Network News
Citation: Polio Network News, Winter 1997 Vol. 13 No.1
Publication Year and Month: 1997
Abstract: As the recipient of over 50 myofascial release treatments for my polio-related symptoms administered by Steven Moreau, MS, Pz I want to discuss the
topic from the perspective of an informed consumer.
I have paraphrased and quoted from materials
prepared by Moreau.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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Category: Post-Polio Motor Unit
Title: Electromyographic and morphological functional compensation in late poliomyelitis
Author: Einarsson G, Grimby G, Stålberg E
Affiliation: Department of Rehabilitation Medicine, Gothenburg University, Sweden
Journal: Muscle & Nerve
Citation: Muscle Nerve. 1990 Feb; 13(2):165-71
Publication Year and Month: 1990 02
Abstract: Patients with prior poliomyelitis may experience muscle function deterioration decades after onset of disease. The present study is aimed at describing electromyographic and morphometric evidence of muscular compensation and of on-going muscular instability. Ten subjects 42-62 years of age with onset of polio 25-52 years earlier were studied with macro EMG, single-fiber EMG (SFEMG), muscle strength measurement, and morphometrical analysis of muscle biopsies from the vastus lateralis muscle. SFEMG revealed increased fiber density (FD) and large macro-MUP potentials indicating pronounced reinnervation as compensation to loss of motor neurons. From electrophysiological data of motor unit size, morphometric measures of fiber size, and muscle strength data, the minimal degree of motor neuron loss was estimated to be greater than 70%.
Conclusions:
Outcome of Research:
Comments (if any):
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Category: Late Effects of Polio, Quality of Life
Title: Life Satisfaction in Persons With Late Effects of Polio: A Test‐Retest Reliability Study
Author: Elisabeth Ekstrand RPT, PhD; Jan Lexell MD, PhD, DPhil h.c.; Christina Brogårdh RPT, PhD
Affiliation: E.E. - Department of Health Sciences, Lund University, Lund, Sweden; andDepartmentof Hand Surgery, Skåne University Hospital, Malmö, Sweden. Address correspondenceto: E.E., Department of Health Sciences,Physiotherapy Research Group, Lund Univer-sity, Box 157, SE-221 00 Lund, Sweden; e-mail: [email protected]
Disclosure: nothing to disclose.
J.L. and C.B. - Department of Health Sciences, Lund University, Lund, Sweden; andDepartment of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics,Skåne University Hospital, Lund, Sweden
Disclosure: nothing to disclose.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Volume 12, Issue 10 p.997-1002
https://doi.org/10.1002/pmrj.12325
Publication Year and Month: 2020 01
Abstract:
Background
The Life Satisfaction Questionnaire (LiSat‐11), including one global item and 10 domain‐specific items, is used to evaluate life satisfaction in persons with the late effects of polio (LEoPs). However, there is a lack of knowledge about its psychometric properties.
Objective
To evaluate the test‐retest reliability of the LiSat‐11 and the associations between the global and domain‐specific items in persons with LEoPs.
Design
A test‐retest design, where data were collected by a postal survey.
Setting
University Hospital, Outpatient Clinic.
Participants
A cross‐sectional sample of persons (20 women and 31 men; mean age 72 years) with LEoPs.
Main Outcome Measurements
LiSat‐11, assessing how satisfied a person is with different aspects of life, such as life as a whole, vocation, economy, leisure, contacts with friends and acquaintances, sexual life, activities of daily living (ADLs), family life, partner relationship, somatic health, and psychological health.
Methods
LiSat‐11 was administered on two occasions, 2 weeks apart. The test‐retest reliability was evaluated by Kappa statistics, the percent agreement (PA), and the Svensson rank‐invariant method. The association between the items was evaluated with the Spearman rank correlation coefficient (rho).
Results
The Kappa coefficients showed good to excellent agreement (0.64‐0.90) and the PA ≤1 point was high (>92%) for all items. No items showed any systematic or random disagreements according to the Svensson method. All domain‐specific items correlated significantly with the global item “Life as a whole” (P < .01; rhos 0.41 to 0.75).
Conclusions
LiSat‐11 is reliable for assessing life satisfaction in persons with LEoPs. The global item “Life as a whole” is useful as an overall measure but cannot fully replace the information obtained from the domain‐specific items of LiSat‐11.
Conclusions: LiSat‐11 is a reliable outcome measure to assess life satisfaction in persons with LEoPs. The association between the global item “Life as a whole” and the domain‐specific items indicates that LiSat‐11 measures various aspects that can affect a personʼs life satisfaction. The global question “Life as a whole” is useful as an overall measure but cannot fully replace the information obtained from the domain‐specific questions of LiSat‐11.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Clinical Infectious Diseases
Citation: 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
Comments (if any):
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Category: Vocational Implications
Title: Vocational implications of post-polio syndrome
Author: Elrod LM, Jabben M, Oswald G, Szirony GM
Affiliation: CARE Department, University of Arkansas at Little Rock, Little Rock, AR 72204, USA
Journal: Work
Citation: Work. 2005;25(2):155-61
Publication Year and Month: 2005
Abstract: Of more than 1,000,000 survivors of poliomyelitis living in the United States, about 80% experience symptoms associated with post-polio syndrome (PPS). New weakness, fatigue, and pain are the most common symptoms that may appear years after acute polio. PPS is reported to be the most prevalent progressive neuromuscular disease in North America. The physical symptoms of PPS can be severe enough to decrease an individual's quality of life, significantly alter work function, and impose lifestyle changes. The psychological implications of battling once again with a disease that had stabilized decades ago can be devastating. Rehabilitation physicians and counselors knowledgeable of post-polio syndrome and its possible impact on employment can have a positive influence on persons with PPS.
Conclusions:
Outcome of Research: Not applicable
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Category: Complementary Therapies
Title: Pitting oedema in a polio survivor with lumbar radiculopathy complicated disc herniation
Author: Eric Chun Pu Chu, Aaron Ka Chun Chan, Andy Fu Chieh Lin
Affiliation: New York Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, China
Journal: Journal of Family Medicine and Primary Care
Citation: Volume : 8 | Issue : 5 | Page : 1765-1768
Publication Year and Month: 2019 05
Abstract: We report a 58-year-old male with sequelae of polio who presented with low back and left buttock pain, and pitting oedema of both legs for four months. The patient had a history of poliomyelitis at the age of 1 year which resulted in bilateral lower leg weakness, particularly on the left side. Magnetic resonance imaging showed cervical spinal stenosis secondary to posterior osteophyte formation, left paracentral disc extrusion at L2/L3 and L3/L4 levels with compression of the traversing L4 nerve root. The findings confirmed a diagnosis of lumbar radiculopathy caused by a herniated disc. The patient subsequently underwent a chiropractic treatment. The painful symptoms and pitting oedema in this case resolved with spinal adjustment in addition to scraping therapy to strengthen bilateral low back and the gluteal muscles. This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation. The pathophysiological mechanism is elusive, but might involve a complexity of cytokine-mediated inflammation and interconnection between somatic and autonomic nervous systems.
Conclusions: This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation.
Outcome of Research: More research required
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Category: Diagnosis and Management, Late Effects of Polio
Title: Post-poliomyelitis syndrome (2019)
Author: Eric Chun Pu Chu1 and Kary Ka Wai Lam2
Affiliation: 1New York Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, People’s Republic of China
2Downtown Chiropractic Limited, Hong Kong, People’s Republic of China
Correspondence: Eric Chun Pu ChuNew York Chiropractic and Physiotherapy Centre, New York Medical Group, 41/F Langham Place Office Tower, 8 Argyle Street, Mongkok, Hong Kong, People’s Republic of China, Phone: Tel +852 3 594 7844, Fax: Fax +852 3 594 6193, Email [email protected]
Journal: International Medical Case Reports Journal
Citation: 12, 261–264. https://doi.org/10.2147/IMCRJ.S219481
Publication Year and Month: 2019 08
Abstract: Most developed countries eliminated paralytic poliomyelitis (polio) in the 1970s to 1980s. It was believed that after recovery from acute paralytic poliomyelitis, the physical condition of survivors would remain stable for the rest of their lives. However, the elimination of polio does not equate the end of medical management of polio. Hundreds of thousands of polio survivors worldwide are still at risk of developing the late effects of the disease. Here, we report a case of post-polio syndrome who attended our clinic for the presence of new weakness and neuromuscular problems six decades after recovery from paralytic polio. It is essential that health professionals be aware of these conditions and have an understanding of the underlying pathophysiology of the symptoms.
Conclusions: Post-polio syndrome is related to the exhaustion of the motor units that form decades after the polio attack. This case report describes the effectiveness of manual interventions in assisting our patient in restoring the level of function and alleviating pain. The limitation of the current report is that it is just a single case. Further comparison with more existing therapeutic regimens is warranted to clarify these issues.
Outcome of Research: Not applicable
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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: US Respiratory & Pulmonary Diseases
Citation: 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: Quality of Life
Title: Quality of life in Hungarian polio survivors
Author: Erika Viktória Miszory (1), Melinda Járomi (2) & Annamária Pakai (3)
Affiliation: 1. University of Pécs Faculty of Health Sciences Doctoral School of Health Sciences, Hungary, Hungarian Defence Forces Medical Centre, Institute of Rehabilitation Hévíz, Hévíz, Hungary
2. University of Pécs Faculty of Health Sciences, Institute of Physiotherapy and Sport Science, Pécs, Hungary
3. University of Pécs Faculty of Health Sciences, Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Pécs, Hungary
Journal: Journal of Public Health
Citation: (Berl.) (2021).
https://doi.org/10.1007/s10389-020-01459-w
Publication Year and Month: 2021 02
Abstract: AIM
The number of Hungarian polio patients can be estimated at approximately 3000. Polio infection is currently affecting people 56–65 years of age. The aim of the study was to reveal the quality of life of patients living with polio virus in Hungary.
SUBJECT AND METHODS
The quantitative cross-sectional study was conducted in January–April 2017 among polyomyelitis patients living in Hungary. In the non-random, targeted, expert sample selection, the target group was composed of patients infected with poliovirus (N = 268). We have excluded those who refused to sign the consent statement. Our data collection method was an SF-36 questionnaire. Using the IBM SPSS Statistics Version 22 program, descriptive and mathematical statistics (χ2-test) were calculated (p < 0.05).
RESULTS
The mean age of the members of the examined population is 63.5 years; 68.1% were women and 31.90% were men. The majority of the respondents were infected by the polyovirus in 1956 (11.9%), 1957 (24.3%), and 1959 (19.5%). Polio patients, with the exception of two dimensions (mental health, social operation), on the scale of 100 do not reach the “average” quality of life (physical functioning 23 points, functional role 36 points, emotional role 47 points, body pain 48 points, general health 42 points, vitality 50 points, health change 31 points).
CONCLUSION
The quality of life of polio patients is far below the dimensions of physical function, while the difference in mental health compared to healthy people is minimal. It would be important to educate health professionals about the existing disease, to develop an effective rehabilitation method.
Conclusions: The quality of life of polio patients is far below the dimensions of physical function, while the difference in mental health compared to healthy people is minimal. It would be important to educate health professionals about the existing disease, to develop an effective rehabilitation method.
Outcome of Research: More research required
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Category: Late Effects of Polio, Pain
Title: Pain in Post-Polio Syndrome: A separate pain entity?
Author: Evert Christiaan Boshuis, MD (1), Eva Melin, MD, PhD (2) and Kristian Borg, MD, PhD (2)
Affiliation: (1) Department of Psychiatry, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
(2) Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: Clinical Communications, 5, jrmcc00077.
DOI: https://doi.org/10.2340/20030711-1000077
Publication Year and Month: 2022 01
Abstract: Background: Most patients with polio recover from the initial infection, but develop muscle weakness, pain and fatigue after 15–40 years, a condition called post-polio syndrome. Although poliovirus has been almost eliminated, 12–20 million people worldwide still have polio sequelae. The pain is described mainly as nociceptive, but some patients experience neuropathic pain. The aim of this study was to further characterize post-polio pain.
Patients and methods: A total of 20 patients with post-polio syndrome participated in the study. Physical examination was performed, and questionnaires containing pain drawing and visual analogue scales (VAS) for pain intensity during rest and motion and VAS for fatigue were completed. A walk test was performed to evaluate physical performance.
Results: Pain intensity was high (42/100 on the VAS at rest and 62/100 while moving). The pain was localized in both joints and muscles. Pain in the muscles was of “deep aching” character, included “muscle cramps” and was located mainly in polio-weakened limbs.
Conclusion: Muscle pain in patients with post-polio syndrome does not fulfil the criteria for either nociceptive or neuropathic pain; thus, it is suggested that the pain is termed “post-polio muscular pain”. The intensity of post-polio muscular pain is higher while moving, but does not influence physical function, and is separate from fatigue.
LAY ABSTRACT
Most polio patients recover from the initial infection, but develop muscle weakness, pain and fatigue after 15–40 years, a condition called Post-Polio Syndrome. Though the poliovirus has almost been eliminated, 12-20 million people worldwide still have polio-equelae. The pain is mainly described as nociceptive, but some patients experience neuropathic pain. This study was undertaken to further characterize post-polio pain. We examined 20 Post-polio patients and found that the pain was localised in both joints and muscles. The pain in the muscles was of ‘deep aching’ character, included ‘muscle cramps’ and was mainly located in polio-weakened limbs. The intensity of the pain is higher while moving but does not influence the physical function. To know more about the characteristics of the pain perceived gives better possibilities for treatment and rehabilitation
Conclusions: In conclusion, pain in PPS is mostly of deep aching character and muscle cramps, localized in the polio-weakened limb. This type of pain seems to be specific to PPS. It is suggested that this pain is termed post-polio muscular pain (PPMP). Future studies should aim to characterize PPMP and to analyse the influence of motor and sensory dysfunction on the pain.
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: Diagnosis and Management
Title: EFNS guideline on diagnosis and management of post-polio syndrome - report of an EFNS task force
Author: Farbu E, Gilhus NE, Barnes MP, Borg K, de Visser M, Driessen A, Howard R, Nollet F, Opara J, Stalberg E
Affiliation: Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway – [email protected] – European Federation of Neurological Society
Journal: European Journal of Neurology
Citation: Eur J Neurol. 2006 Aug; 13(8):795-801
Publication Year and Month: 2006 08
Abstract: Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.
Conclusions:
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Category: Vocational Implications
Title: Education, occupation, and perception of health amongst previous polio patients compared to their siblings.
Author: Farbu E, Gilhus NE.
Affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway. [email protected]
Journal: European Journal of Neurology
Citation: 2002 May;9(3):233-41.
Publication Year and Month: 2002 05
Abstract: Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950-1954 epidemic cohort, or from a cohort of hospital-admitted rehabilitation patients. Ninety-four paralytic patients and 74 non-paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi-square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full-time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full-time employment rate amongst the paralytic patients, only 52% of this group being employed full-time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.
Conclusions: Previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.
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: Exercise
Title: The use of strengthening exercises in post-polio sequelae - methods and results
Author: Feldman RM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):889-90
Publication Year and Month: 1985 07
Abstract: Some individuals who had poliomyelitis 20 to 30 years ago are now reporting a recurrence of symptoms of weakness in the same muscle groups that were weakened during the initial onset of the disease. Electrophysiological findings on EMG and repetitive stimulation studies identify changes peculiar to this disease. Non-fatiguing progressive resistive exercises have been used to strengthen muscle groups demonstrating this secondary weakness after the muscles have been identified by electrophysiological studies. Favorable results are reported after non-fatiguing exercises which, combined with Occupational Therapy and appropriate orthotic management, have resulted in improvement in function of ambulation and activities of daily living. The causes of muscle atrophy and pain seen in these individuals are also discussed.
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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: Miller School of Medicine, University of Miami, USA
Journal: Research on Chronic Diseases
Citation: (2017) 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: 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: Exercise
Title: The effects of long-term non-fatiguing resistance exercise in subjects with post-polio syndrome
Author: Fillyaw MJ, Badger GJ, Goodwin GD, Bradley WG, Fries TJ, Shukla A
Affiliation: Department of Physical Therapy, University of Vermont, Burlington
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1253-6
Publication Year and Month: 1991 11
Abstract: Measures of torque were used to evaluate changes in muscle strength and endurance in 17 patients with post-polio syndrome who did prescribed resistance exercise for up to 2 years. Exercise compliance averaged 75%, with 16 subjects increasing the weight lifted in training. Maximum torque was significantly increased in the exercised muscle compared to the control muscle; no difference was seen in muscle endurance. Individuals with post-polio syndrome can increase muscle strength by doing non-fatiguing resistance exercise, but they should undergo quantitative testing of muscle strength a minimum of every 3 months to guard against overwork weakness.
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Category: Exercise
Title: Effort-limited treadmill walk test: reliability and validity in subjects with postpolio syndrome.
Author: Finch LE, Venturini A, Mayo NE, Trojan DA.
Affiliation: Department of Physiotherapy, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2004 Aug;83(8):613-23.
Publication Year and Month: 2004 08
Abstract: OBJECTIVE:
To determine the reliability and construct validity of an effort-limited treadmill walk test to measure functional ability in subjects with postpolio syndrome in an outpatient postpolio clinic.
DESIGN:
Functioning and distance walked on a treadmill to a Borg "hard" effort level were measured three times, a week apart, by two blinded raters in 15 subjects with postpolio syndrome, aged 37-67 yrs, with new weakness, fatigue, and pain but with no other cause of symptomatology or condition-limiting walking. One rater tested them twice. Fatigue activity level, mobility, and health-related quality of life (Medical Outcome Study Short Form Health Survey [SF-36]) defined functioning. Generalizability correlation coefficients determined intrarater, test-retest and interrater reliability. The correlations relating the distance walked and functioning determined construct validity.
RESULTS:
Reliability for generalizability correlation coefficients were: intrarater, 0.91; test-retest, 0.85; and interrater, 0.58. Interrater reliability improved to 0.91 with adherence to a standardized protocol. Validity was established with correlations between the distance walked and SF-36 physical component score (0.66), physical role (0.60), bodily pain (0.60), and vitality (0.55).
Conclusions: The treadmill walk test provides a reproducible and valid measure of ability in persons with postpolio syndrome with a single rater, but a standardized protocol is essential for reliability.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: Poliomyelitis: late respiratory complications and management
Author: Fischer DA
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):891-4
Publication Year and Month: 1985 07
Abstract: One hundred forty-six respiratory polios have been reviewed for complications and current respiratory aids. One hundred thirty-eight of these people required respirator assistance at the onset of their poliomyelitis infection. Fifteen patients have kyphoscoliosis. Seventy-five percent of the total patients require some assisted ventilation. Fifty-two percent have tracheostomies. Most of these people have been followed at Rancho Los Amigos Medical Center for many years. The literature regarding late respiratory complications of polio is reviewed.
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Category: Muscle Strength
Title: Men With Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-Year Longitudinal Study
Author: Flansbjer UB (1), Brogårdh C (2), Horstmann V (3), Lexell J (4)
Affiliation: (1) 1Department of Health Sciences, Lund University, Rehabilitation Medicine Research Group, Box 157, SE221 00 Lund, Sweden; (2) Department of Health Sciences, Lund University, Physiotherapy Research Group, Box 157, SE221 00 Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; (3) Department of Health Sciences, Lund University, Research Group Active and Healthy Ageing, Box 157, SE221 00 Lund, Sweden; (4) Department of Health Sciences, Lund University, Rehabilitation Medicine Research Group, Box 157, SE221 00 Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2015 May 12. pii: S1934-1482(15)00233-6. doi: 10.1016/j.pmrj.2015.05.005
Publication Year and Month: 2015 05
Abstract: BACKGROUND: In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons.
OBJECTIVE: To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength.
DESIGN: A prospective, longitudinal study.
SETTING: University hospital outpatient program.
PARTICIPANTS: Fifty-two ambulant persons (mean age ± standard deviation: 64 ± 6 years) with verified late effects of polio.
METHODS: Mixed linear models were used to analyze changes in muscle strength and to identify determinants among the following covariates: gender, age, age at acute polio infection, time with late effects of polio, body mass index, and estimated baseline muscle weakness.
MAIN OUTCOME MEASUREMENTS: Knee extensor and flexor and ankle dorsiflexor muscle strength were measured annually with a Biodex dynamometer.
RESULTS: The men (n = 28) had significant linear change over time for all knee muscle strength measurements, from -1.4% (P < .05) per year for isokinetic knee flexion in the less-affected lower limb to -4.2% (P < .001) for isokinetic knee extension in the more-affected lower limb, and for 2 ankle dorsiflexor muscle strength measurements (-3.3%-1.4% per year [P < .05]). The women (n = 24) had a significant linear change over time only for ankle dorsiflexor measurements (4.0%-5.5% per year [P < .01]). Gender was the strongest factor that predicted a change in muscle strength over time.
Conclusions: Over 4 years, men had a greater decline in muscle strength than did women, but the rate of decline did not accelerate. This finding indicates that gender could be a contributing factor to the progressive decline in muscle strength in persons with late effects of polio.
Outcome of Research: Not applicable
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Category: Muscle Strength
Title: Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio
Author: Flansbjer UB, Lexell J
Affiliation: Department of Rehabilitation, Skåne University Hospital, Orupssjukhuset, Lund, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Jun;42(6):588-92. doi: 10.2340/16501977-0561
Publication Year and Month: 2010 06
Abstract: OBJECTIVE: To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio.
DESIGN: A test-retest reliability study.
SUBJECTS: Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio.
METHODS: Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60°/s and isometric contractions with knee flexion angle 90º) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (đ) together with the 95% confidence intervals for đ, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs.
RESULTS: Test-retest agreements were high, (ICC1,1 0.93–0.99) and measurement errors generally small. The SEM% was 4–14% and the SRD% 11–39%, with the highest values for the isokinetic measurements.
Conclusions: Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.
Outcome of Research: Not applicable.
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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: 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: 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: PLoS Pathog
Citation: 13(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: Psychology
Title: Post-polio sequelae and the psychology of second disability
Author: Frick NM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):851-3
Publication Year and Month: 1985 07
Abstract: Thousands of persons who had poliomyelitis are reporting new physical symptoms that are eroding physical abilities, regained only after strenuous and lengthy rehabilitation, that were thought to have been permanently restored. These symptoms are causing persons to feel they are becoming disabled for a second time by the same disease. These new symptoms are psychologically traumatic also because they are unexpected, their cause is unknown and there is a lack of knowledge and understanding concerning them within the medical community. Society's negative and pejorative attitude toward the disabled is discussed to explain the psychological trauma associated with any first or second disability. Psychological processes that promote acceptance of disability are outlined with special emphasis on the post-polio experience. Post-polio support groups are described as one means to obtain the resources necessary to surmount the physical and psychological difficulties associated with post-polio sequelae.
Conclusions:
Outcome of Research:
Comments (if any):
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Category: Diagnosis and Management
Title: Post-polio sequelae: physiological and psychological overview
Author: Frick NM, Bruno RL
Affiliation: Not stated
Journal: Rehabilitation Literature
Citation: Rehabil Lit. 1986 May-Jun; 47(5-6):106-11
Publication Year and Month: 1986 05
Abstract: When the Salk and Sabin vaccines brought an end to the annual summer nightmare of polio epidemics, most Americans simply forgot about polio. Even many of those who had paralytic poliomyelitis put the disease out of their minds once they had achieved maximum recovery of function. Unfortunately, polio has again forced itself into the nation's consciousness. Over the past five years, many of those who had polio have been experiencing new and unexpected symptoms that range in severity from being merely unpleasant to severely debilitating.
Conclusions:
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by Dr Bruno.
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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: Cardiorespiratory
Title: Cardiopulmonary exercise testing in neuromuscular disease: a systematic review
Author: Gabriela Barroso de Queiroz Davoli (1), Bart Bartels (2), Ana Claudia Mattiello-Sverzut (3), Tim Takken (4*)
Affiliation: (1) University of São Paulo, Ribeirão Preto Medical School, Brazil, 0000-0002-4981-3868 – ORCID, [email protected].
(2) Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands, 0000-0002-5801-6692–ORCID, [email protected].
(3) University of São Paulo, Ribeirão Preto Medical School, Brazil, 0000-0002-4181-0718 –ORCID, [email protected].
(4) Child Development & Exercise Center Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands, 0000-0002-7737-118X –ORCID, [email protected].
* Corresponding author: Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands. Heidelberglaan 100 3584 CX Utrecht, The Netherlands. Tel +31887554030.
Email [email protected].
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Expert Review of Cardiovascular Therapy
Gabriela Barroso de Queiroz Davoli, Bart Bartels, Ana Claudia
Mattiello-Sverzut & Tim Takken (2021): Cardiopulmonary exercise testing in neuromuscular
disease: a systematic review, Expert Review of Cardiovascular Therapy, DOI:
10.1080/14779072.2021.2009802
Publication Year and Month: 2021 11
Abstract: INTRODUCTION:
Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs’ physical fitness, the applicability of CPET remains largely unknown.
AREAS COVERED:
This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient’s aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Except for reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations.
EXPERT OPINION:
CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are considered. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.
Keywords: exercise test, exercise modality, feasibility, muscle disease, rehabilitation, aerobic fitness.
ARTICLE HIGHLIGHTS:
● Standardizations in CPET protocols are needed because of low adherence to ATS/ACCP recommendations;
● High completion rates and few adverse events support the feasibility of CPET in pediatric and adult patients with NMD;
● Low cardiopulmonary stress (e.g. low peak heart rate), despite high metabolic demand (e.g. peak respiratory exchange ratio >1), might be a feature of NMDs, except for patients with glycogen storage disease or motor neuron disease;
● The upright cycle ergometer with ramp-wise increment is advisable to assess various ambulatory adults and some pediatric patients with NMD;
● On the treadmill, the Naughton and the Dubowy protocols are alternatives for some adults and the young patients with NMD when an upright cycle ergometer is not available.
Conclusions: The knowledge about exercise limiting factors and aerobic fitness in NMDs is increasing and brings the need to understand the applicability and safety of the goldstandard method, CPET, in assessing these variables for this specific group. Our results direct that CPET is feasible for adult and young patients with NMDs when the patient’s functional level and the exercise modality of CPET are considered. However, to safety favour the implementation of CPET in the routine assessment of patients with NMDs, clinicians are urged to follow the ATS/ACCP recommendations for performing and Information Classification: General reporting CPET. Furthermore, there is vast potential for standardization and design of disease-specific CPET protocols for patients with NMDs.
Outcome of Research: Not applicable
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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: Falls and Bone Density, Surgery
Title: Total Hip Arthroplasty in Patients With Postpolio Residual Paralysis: A Systematic Review
Author: Gaurav K. Upadhyaya, MS Orthopaedics (1)
Mohit K. Patralekh, MS Orthopaedics (2)
Vijay K. Jain, MS Orthopaedics (3)
Karthikeyan.P. Iyengar, FRCS (TR & Orth) (4)
Deepak Gautam, MS Orthopaedics (5)
Raju Vaishya, MS Orthopaedics (6)
Rajesh Malhotra, MS Orthopaedics (5)
Affiliation: 1. Department of Orthopaedics, All India Institute of Medical Sciences, Rae Bareli, Uttar Pradesh, India
2. Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
3. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
4. Orthopaedics and Trauma, Southport and Ormskirk NHS Trust, Southport, UK
5. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
6. Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
Journal: The Journal of Arthroplasty
Citation: Volume 36, Issue 6, June 2021, Pages 2239-2247
DOI:https://doi.org/10.1016/j.arth.2021.01.046
Publication Year and Month: 2021 01
Abstract: BACKGROUND
Patients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies.
METHODS
A systematic search of electronic databases of PubMed, Scopus, and Web of Science pertaining to English literature was undertaken from 1945 to August 2020 to assess the results of THA in patients with poliomyelitis. Information was gathered about demographics, indication, clinical course, complications, functional outcome, survival, and need for any revision surgery in these patients.
RESULTS
The literature search revealed 81 articles. Finally, after deduplication and manual selection, 16 relevant articles (128 hips) were included for evaluation. There is a paucity of literature evaluating THA in patients with poliomyelitis over the last 2 decades. The principal reason for arthroplasty was osteoarthritis of the hip in the ipsilateral (paralyzed) limb. A combination of cemented, uncemented, and hybrid implant fixation system was found to be used by surgeons. Addressing instability and perioperative management of limb length discrepancy were found to be challenging propositions.
CONCLUSION
THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.
Conclusions: THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.
Outcome of Research: Effective
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Category: Diagnosis and Management
Title: Cardiac risk factors in polio survivors
Author: Gawne AC, Wells KR, Wilson KS.
Affiliation: Roosevelt Warm Springs Institute for Rehabilitation, Warm Springs, GA 31830, USA - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2003 May;84(5):694-6
Publication Year and Month: 2003 05
Abstract: OBJECTIVE: To assess the prevalence of dyslipidemia and other risk factors for coronary heart disease in a sample of polio survivors with and without postpoliomyelitis syndrome.
DESIGN: Retrospective chart review.
SETTING: A multidisciplinary outpatient postpolio clinic.
PARTICIPANTS: Eighty-eight consecutive symptomatic postpolio patients, 50 women (mean age, 59.0y; range, 36-81y) and 38 men (mean age, 61.2y; range, 44-83y).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Presence of risk factors for coronary heart disease: clinical atherosclerotic disease, male age >or=45 years or female age >or=55 years, history of hypertension (blood pressure >or=140/90mmHg or on antihypertensive medication), diabetes mellitus, cigarette smoking, and high-density lipoprotein (HDL) less than 35mg/dL. Obesity (body mass index [BMI], >25kg/m(2)) was assessed as an intervention target. Laboratory values included fasting total cholesterol, HDL, low-density lipoprotein, triglycerides, and glucose.
RESULTS: Of the total sample, 61.3% had dyslipidemia. Average HDL cholesterol ratio was 4.01 (women, 3.68; men, 4.55). Forty-four patients (50%) had a history of hypertension or had elevated blood pressure. Seven patients (8%) had a history of diabetes or had elevated fasting blood glucose (>110). Eighteen patients (20.4%) were smokers or had a history of smoking; 9 continued to smoke and 9 had quit smoking. Twenty-five patients (28.4%) were overweight (BMI, >25kg/m(2)). Forty-one patients (46.5%) had more than 1 risk factor for coronary heart disease. Nine of the total sample (10.2%) had a history of heart disease ranging from atrial fibrillation to angina. Only 19 patients had a previous diagnosis of dyslipidemia and only 12 were on a lipid-lowering medication.
Conclusions: Polio patients have a high prevalence of dyslipidemia. The study sample supports the National Cholesterol Education Program's Adult Treatment Panel III statements that hypercholesterolemia is underdiagnosed and undertreated. The postpolio population carries a high prevalence of 2 or more coronary heart disease risk factors. Evaluation and rehabilitation of polio patients should include screening for dyslipidemia and education about elimination of controllable risk factors.
Outcome of Research: Not applicable.
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Category: Vocational Implications
Title: University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953–80
Author: Geraldine Huynh
Affiliation: University of Alberta
Journal: Canadian Bulletin of Medical History (CBMH)
Citation: https://doi.org/10.3138/cbmh.249-022018
Published Online: March 22, 2019
Publication Year and Month: 2019 03
Abstract: Following Canada’s largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta’s fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.
Conclusions:
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: Acta Anaesthesiologica Scandinavica
Citation: 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: Falls and Bone Density
Title: Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota
Author: Goerss JB, Atkinson EJ, Windebank AJ, O'Fallon WM, Melton LJ 3rd
Affiliation: Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905
Journal: Mayo Clinic Proceedings
Citation: Mayo Clin Proc. 1994 Apr; 69(4):333-9
Publication Year and Month: 1994 04
Abstract: OBJECTIVE: To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis (“polio”).
DESIGN: We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.
MATERIALS AND METHODS: A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.
RESULTS: Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.
Conclusions: These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.
Outcome of Research:
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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: Drugs
Title: Prior poliomyelitis – IVIg treatment reduces proinflammatory cytokine production
Author: Gonzalez H, Khademi M, Andersson M, Piehl F, Wallström E, Borg K, Olsson T
Affiliation: Department of Neuroimmunology Unit, Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden – [email protected]
Journal: Journal of Neuroimmunology
Citation: J Neuroimmunol. 2004 May; 150(1-2):139-44
Publication Year and Month: 2004 05
Abstract: The postpolio syndrome (PPS) is characterized by progressive disabilities decades after recovery from the acute paralytic disease. There are reports on intrathecal inflammatory reactions in PPS, including increased expression of cytokines by cerebrospinal fluid (CSF) mononuclear cells (CSF-MC). This is potentially of relevance for the clinical condition. We here explored if cytokine expression in the CSF of PPS patients could be modulated by high-dose intravenous immunoglobulins (IvIg). The expression of TNF-alpha, IFN-gamma, IL-10 and IL-4 mRNAs was measured by real-time RT-PCR in CSF and peripheral blood mononuclear cells (PBMC) of 16 PPS patients before, and 6-8 weeks after IvIg treatment, and in 26 patients with noninflammatory other neurological diseases (OND). TNF-alpha, IFN-gamma and IL-10 CSF mRNA levels were elevated in samples from untreated persons with PPS compared to OND. Upon IvIg treatment, IFN-gamma and TNF-alpha mRNA levels were dramatically reduced, while IL-10 remained unchanged. Placebo-controlled studies are now warranted to evaluate if IvIg treatment also has any effects on the clinical manifestations of PPS.
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Category: Inflammation
Title: Prior poliomyelitis - evidence of cytokine production in the central nervous system
Author: Gonzalez H, Khademi M, Andersson M, Wallström E, Borg K, Olsson T
Affiliation: Department of Clinical Neuroscience, Division of Neurology, Karolinska Hospital, S-171 76 Stockholm, Sweden – [email protected]
Journal: Journal of the Neurological Sciences
Citation: J Neurol Sci. 2002 Dec 15; 205(1):9-13 and Comment in: J Neurol Sci. 2002 Dec 15; 205(1):5-8
Publication Year and Month: 2002 12
Abstract: In order to study the role of a possible inflammatory reaction in the post-polio syndrome (PPS) four key cytokines were determined by means of mRNA expression in mononuclear cells from cerebrospinal fluid (CSF) and peripheral blood of 13 patients. Data were compared with those of samples from eight non-inflammatory control persons. The PPS-patients displayed increased numbers of CSF cells expressing mRNA for TNF-alpha (p<0.02), IFN-gamma (p<0.02), IL-4 (p<0.001) and IL-10 (p<0.05), in comparison to the non-inflammatory controls. As positive controls, samples from patients with Multiple Sclerosis (MS) were examined. We conclude that there is a chronic intra CNS expression of inflammatory cytokines in PPS, in the range of that in MS, a well known neuroinflammatory disease. However, the pathogenic significance of this is unclear.
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Category: Diagnosis and Management
Title: Management of postpolio syndrome (2010)
Author: Gonzalez H, Olsson T, Borg K
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden – [email protected]
Journal: The Lancet Neurology
Citation: Lancet Neurol. 2010 Jun; 9(6):634-42 and Comment in: Lancet Neurol. 2010 Jun; 9(6):561-3
Publication Year and Month: 2010 06
Abstract: Postpolio syndrome is characterised by the exacerbation of existing or new health problems, most often muscle weakness and fatigability, general fatigue, and pain, after a period of stability subsequent to acute polio infection. Diagnosis is based on the presence of a lower motor neuron disorder that is supported by neurophysiological findings, with exclusion of other disorders as causes of the new symptoms. The muscle-related effects of postpolio syndrome are possibly associated with an ongoing process of denervation and reinnervation, reaching a point at which denervation is no longer compensated for by reinnervation. The cause of this denervation is unknown, but an inflammatory process is possible. Rehabilitation in patients with postpolio syndrome should take a multiprofessional and multidisciplinary approach, with an emphasis on physiotherapy, including enhanced or individually modified physical activity, and muscle training. Patients with postpolio syndrome should be advised to avoid both inactivity and overuse of weak muscles. Evaluation of the need for orthoses and assistive devices is often required.
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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: Journal of Proteomics
Citation: 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: Polio Immunisation
Title: New vaccine strategies to finish polio eradication
Author: Grassly NC
Affiliation: Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London W2 1PG, UK; Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
Journal: The Lancet Infectious Diseases
Citation: Lancet Infect Dis, Volume 15, Issue 8, 864-865
Publication Year and Month: 2015 06
Abstract: The Global Polio Eradication Initiative (GPEI) currently faces two specific challenges. First, all the cases in the past 9 months caused by ongoing wild-virus transmission were in Afghanistan and Pakistan—Africa has had a remarkable 9 months without detection of the disease. Second, circulating vaccine-derived polioviruses are continuing to cause poliomyelitis in a few countries, a rare outcome associated with continued use of the live-attenuated oral poliovirus vaccine (OPV). In The Lancet Infectious Diseases, the results of two clinical trials of OPV that address these challenges are reported by Fatima Mir and colleagues and Concepción Estívariz and colleagues.
Conclusions:
Outcome of Research: Not applicable
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Category: Muscle Strength
Title: Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio
Author: Grimby G, Kvist H, Grangård U
Affiliation: Department of Rehabilitation Medicine, University of Göteborg, Sahlgrenska University Hospital, Sweden
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1996 Oct; 77(10):1044-8
Publication Year and Month: 1996 10
Abstract: OBJECTIVE: To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period.
DESIGN: Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness.
SETTING: University hospital.
SUBJECTS: Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization.
OUTCOME MEASUREMENTS: Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer.
RESULTS: Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05).
Conclusions: The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.
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Category: Muscle Strength
Title: An 8-year longitudinal study of muscle strength, muscle fiber size, and dynamic electromyogram in individuals with late polio
Author: Grimby G, Stålberg E, Sandberg A, Sunnerhagen KS
Affiliation: Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Göteborg University, Sweden
Journal: Muscle & Nerve
Citation: Muscle Nerve. 1998 Nov; 21(11):1428-37
Publication Year and Month: 1998 11
Abstract: Twenty-one subjects with polio 24 to 51 years prior to the first examination were studied on three occasions, each 4 years apart with measurements of muscle strength and endurance for knee extension, macro EMG, and muscle biopsy from vastus lateralis. On average the muscle strength decreased during the 8-year follow-up by 9-15%. Endurance decreased during the observation period. The muscle fiber area was markedly increased in most subjects. There was a decrease in the capillarization during the follow-up. Macro EMG was increased in all subjects (range 3-42 times control) and increased in 20 legs during the 8-year follow-up, but showed a decrease in 8 of 9 legs with an approximative breakpoint when macro MUPs were around 20 times the normal size. Thus, evidence of on-going denervation/reinnervation as well as of failing capacity to maintain large motor units was demonstrated. SFEMG showed a moderate degree of disturbed neuromuscular transmission.
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Category: Quality of Life
Title: Surviving polio in a post-polio world
Author: Groce NE (1), Banks LM (2), Stein MA (3)
Affiliation: (1) Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK; (2) London School of Hygiene and Tropical Medicine, London, UK; (3) Harvard Law School Project on Disability, Harvard Law School, Cambridge, USA
Journal: Social Science & Medicine
Citation: Social Science & Medicine. 2014 Apr;107;171-178
Publication Year and Month: 2014 04
Abstract: Excitement mounts as the global health and international development communities anticipate a polio-free world. Despite substantial political and logistical hurdles, only 223 cases of wild poliovirus in three countries were reported in 2012. Down 99% from the estimated 350,000 annual cases in 125 countries in 1988—this decline signals the imminent global eradication of polio.
However, elimination of new polio cases should not also signal an end to worldwide engagement with polio. As many as 20 million continue to live with the disabling consequences of the disease. In developed countries where polio immunization became universal after dissemination of the polio vaccine in the 1950s, almost all individuals who have had polio are now above age 50. But in many developing countries where polio vaccination campaigns reached large segments of the population only after 1988, millions disabled by polio are still children or young adults. Demographically, this group is also different. After three decades of immunization efforts, those children unvaccinated in the late 1980s were more likely to be from poorer rural and slum communities and to be girls—groups not only harder to reach than more affluent members of the population but also individuals who, if they contract polio, are less likely to have access to medical and rehabilitation programs or education, job training, employment and social support services.
The commitment to eradicate polio should not be considered complete while those living with the disabling sequelae of polio continue to live in poor health, poverty and social isolation. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming. Based on a literature review, discussion and field observations, we identify continuing challenges posed by polio and argue that the attention, funding and commitment now being directed towards eradication be shifted to provide for the rehabilitative, medical, educational and social needs of those for whom the disabling sequelae of polio will remain a daily challenge for decades to come.
Conclusions:
Outcome of Research: Not applicable
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Category: Late Effects of Polio, Muscular Atrophy, Sleep Analysis
Title: Neuronopathies and Sleep Disorders: Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis and Post-polio Syndrome
Author: Gülçin Benbir Şenel
Affiliation: İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Nöroloji Anabilim Dalı, Uyku Bozuklukları Bilim Dalı, İstanbul, Türkiye
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Turkish Sleep Medicine 2021;2:90-96
DOI: 10.4274/jtsm.galenos.2021.39306
Publication Year and Month: 2021
Abstract: Neuronopathies are defined as diseases affecting the bodies of neuron cells. These disorders may be inherited, sporadic or acquired and may be observed in children or adults. Spinal muscular atrophies, amyotrophic lateral sclerosis and Post-polio syndrome are prototype disorders in this group. The clinical course, time for diagnosis and therapeutic processes are very compelling for the patients, their relatives and physicians. Disturbances in sleep structure, an increase in cyclic alternating pattern and sleep-related disorders, especially of sleep-related breathing disorders, are commonly reported in these patients. More importantly, changes in sleep microstructure and associated sleep-related disorders have a negative effect on the course of the neuronopathies. By contrast, beneficial outcomes on the clinical course and prognosis of neuronopathies have been reported upon the diagnosis and treatment of sleep-related disorders early in the disease course.
Keywords:
Spinal muscular atrophies, amyotrophic lateral sclerosis, Post-polio syndrome, sleep-related disorders
Conclusions: Investigating and treating deteriorations in the microstructure of sleep and sleep-related disorders in patients with spinal muscular atrophies, amyotrophic lateral sclerosis or Post-polio syndrome are important.
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Muscle Function, Muscle Structure, and Electrophysiology in a Dynamic Perspective in Late Polio
Author: Gunnar Grimby, MD, PhD, Erik Stålberg, MD.
Affiliation:
Journal: Reprinted from POST-POLIO SYNDROME
edited by Halstead & Grimby, © 1995
Hanley & Belfus, Inc., Philadelphia, PA.
Lincolnshire Post-Polio Library
Citation: Gunnar Grimby, MD, PhD, Erik Stålberg, MD., Muscle Function, Muscle Structure, and Electrophysiology in a Dynamic Perspective in Late Polio, Chapter 2, pp 15-24.
Publication Year and Month: 1995
Abstract: The muscular impairment in patients with a history of polio varies from none to severe. The relationship between the degree of initial involvement and the effect of various compensatory mechanisms determines the clinical picture, which changes dynamically. Early and late recovery after poliomyelitis depend on a number of factors. Clinical improvement that appears within a few weeks after the acute phase is probably due to recovery in the excitability of functional, but not degenerated, motor neurons. Degeneration of neurons, causing peripheral denervation, is compensated by collateral sprouting, i.e., by nerve twigs branching off from surviving motor units overlapping with the denervated ones. This is most likely the main factor explaining recovery within the first 6-12 months. Another late compensatory process is the increase in size of the muscle fibers. As a result of these processes, normal muscle strength and presumably normal muscle volume can be seen despite a calculated loss exceeding 50% of the number of motor neurons.
Conclusions:
Outcome of Research:
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Category: Respiratory Complications and Management
Title: Physiologic events initiating REM sleep in patients with the postpolio syndrome
Author: H. Siegel, C. McCutchen, M.C. Dalakas, A. Freeman, B. Graham, D. Alling, S. Sato
Affiliation:
Journal: Neurology
Citation: February 1, 1999, DOI: https://doi.org/10.1212/WNL.52.3.516
Publication Year and Month: 1999 02
Abstract: Background: We previously studied the occurrence of muscle tone reduction (MTR), sawtooth waves (STW), and REM in sleep, and found a stereotypical sequence of these events in normal subjects. Patients with the postpolio syndrome may have involvement of the reticular formation in the brainstem, an area known to mediate initiation of REM sleep. We hypothesized that such brainstem pathology might affect the stereotyped sequence of events initiating REM sleep.
Methods: We measured the latencies to the onsets of the first MTR, the first STW, and the first REM in 13 patients with postpolio syndrome, 7 of whom had bulbar involvement. All latencies were calculated from the last body movement before the onset of REM sleep.
Results: Using analysis of variance, we found highly significant differences among the overall mean latencies of the three types of onset (MTR, STW, REM) and also between the mean latencies of the two subgroups of patients (bulbar, nonbulbar). Although the latencies for the entire group were longer than those of the normal volunteers, the differences were not significant. However, when the bulbar and nonbulbar groups were compared, analysis of variance showed significantly longer latencies for the bulbar group than for the nonbulbar group (p < 0.0001). The values for the nonbulbar patients closely resembled those for the normal controls. Although the latencies differed, the slopes of the regressions of REM on STW, STW on MTR, and REM on MTR resembled each other closely (p = 0.924).
Conclusions: Conclusion: Prolongation of these latencies may be due to prolonged recruitment time for neurons in the pontine tegmentum, following damage from polio. This may be a sensitive marker of a brainstem lesion, and may also represent a type of sleep pathology not previously explored.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: Repeater F-waves are signs of motor unit pathology in polio survivors
Author: Hachisuka A (1), Komori T, Abe T, Hachisuka K
Affiliation: (1) Department of Rehabilitation Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
Journal: Muscle & Nerve
Citation: Muscle Nerve. 2015 May;51(5):680-5. doi: 10.1002/mus.24428
Publication Year and Month: 2015 05
Abstract: INTRODUCTION: The purpose of this study was to determine whether F-waves reveal electrophysiological features of anterior horn cells in polio survivors.
METHODS: Forty-three polio survivors and 20 healthy controls underwent motor nerve conduction studies of the median and tibial nerves bilaterally, including sampling of F-waves elicited by 100 stimuli and the determination of motor unit number estimation (MUNE).
RESULTS: A significant increase in abnormally stereotyped ("repeater") F-waves and a reduction of F-wave persistence were observed in both nerves in the polio group as compared with the control group. Repeater F-waves had a negative correlation with MUNE.
Conclusions: These trends in F-wave persistence and repeater F-waves after motor unit loss are characteristic findings in polio survivors. Repeater F-waves are a sign of motor unit pathology.
Outcome of Research: Not applicable
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Category: Late Effects of Polio
Title: New problems in old polio patients: results of a survey of 539 polio survivors
Author: Halstead LS, Rossi CD
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):845-50
Publication Year and Month: 1985 07
Abstract: Presented are the results of a questionnaire survey on new health problems in 539 polio survivors. The most common new problems were fatigue, weakness in previously affected and unaffected muscles, muscle pain, and joint pain. The median time from polio to the onset of these problems ranged from 30 to 40 years. Factors at onset of polio most strongly associated with developing these new health problems were: being hospitalized, being over 10 years old, being on a ventilator, and having paralytic involvement of all four limbs. The differential diagnoses of these new problems, implications for treatment and areas for future research are discussed.
Conclusions:
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Category: Diagnosis and Management
Title: Nonparalytic polio and postpolio syndrome
Author: Halstead LS, Silver JK
Affiliation: National Rehabilitation Hospital, Washington, DC 20010, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):13-8
Publication Year and Month: 2000 01
Abstract: We describe four cases of postpolio syndrome with typical histories, physical examination results, and electrodiagnostic evidence of extensive anterior horn cell disease, as well as the putative pathophysiology of postpolio syndrome in persons with histories of nonparalytic polio and the diagnostic implications for individuals older than 40 yr of age who are experiencing unexplained new weakness, fatigue, and muscle or joint pain. Although the diagnosis of postpolio syndrome traditionally has required a remote history of paralytic polio, many persons such as the ones described here with typical symptoms of postpolio syndrome have no clear history of paralytic disease and are being misdiagnosed. With this in mind, we believe that the diagnostic criteria for postpolio syndrome should be modified to include the following: a history of remote paralytic polio or findings on history, physical examination results, and laboratory studies compatible with poliovirus damage of the central nervous system earlier in life.
Conclusions:
Outcome of Research: Not applicable
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Category: Quality of Life
Title: Life purpose: effect on functional decline and quality of life in polio survivors.
Author: Harrison TC, Stuifbergen AK.
Affiliation: School of Nursing, University of Texas-Austin, USA. [email protected]
Journal: Rehabilitation Nursing
Citation: 2006 Jul-Aug;31(4):149-54.
Publication Year and Month: 2006 07
Abstract: This article explores the protective effects that finding a purpose in life has on the level of physical and mental impairment and overall quality of life. Results were gathered from a national sample of 2,153 polio survivors. Although the combined social and physical experience of living with the disabling effects of polio has been associated with accelerated aging due to an increased allostatic load, finding a purpose in life may diminish these effects. The findings of this study indicate that purpose in life is associated with less perceived decline in health. Moreover, purpose in life is predictive of better quality of life despite levels of physical and mental impairment. Rehabilitation nurses should consider ways to help persons with polio maintain activities and interests that promote their sense of purpose in life.
Conclusions: Rehabilitation nurses should consider ways to help persons with polio maintain activities and interests that promote their sense of purpose in life.
Outcome of Research: More research required
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Category: Late Effects of Polio
Title: Barriers That Further Disablement: A Study of Survivors of Polio
Author: Harrison, Tracie & Stuifbergen, Alexa
Affiliation: University of Texas at Austin.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Neuroscience Nursing 33(3):p 160-166, June 2001.
Publication Year and Month: 2001 06
Abstract: This exploratory study of polio survivors was undertaken to clarify current level of function, comorbidity, and secondary conditions and to discover the relationships between perceived barriers to health, functional limitation, comorbidity, secondary conditions, and disability in a small convenience sample. Given the underrepresentation of research in the literature explaining the health status, perceived function, and barriers to health in this disabled population, a descriptive study with correlation was conducted. Thirty-one individuals living with the effects of polio were surveyed. Disability was correlated with perceived barriers to health but not with functional limitations, comorbidity, or secondary conditions. Secondary conditions were correlated with the number of years living with the illness. The findings support a model of disablement and allostatic load. Further research is needed to test these models and to provide direction for nurses caring for those aging with the effects of polio.
Conclusions: Further research is needed to test these models and to provide direction for nurses caring for those aging with the effects of polio.
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: Sleep and Breathing (Book)
Citation: 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: Falls and Bone Density
Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08
Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.
DESIGN: Cross-sectional study involving a chart review.
SETTING: A university-affiliated hospital postpolio clinic.
PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.
RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).
Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.
Outcome of Research: Not applicable
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Category: Cultural Context, Disability Rights, Late Effects of Polio, Quality of Life, Vocational Implications
Title: “The car is my extra legs” – Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio
Author: Helena Selander, Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing,1,2,* Iolanda Santos Tavares Silva, Formal analysis, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing,1,3 Felicia Kjellgren, Conceptualization, Investigation, Methodology, Writing – review & editing,1 and Katharina S. Sunnerhagen, Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing1
Wen-Jun Tu, Editor
Affiliation: 1 Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
2 The Swedish National Road and Transport Research Institute (VTI), Gothenburg, Sweden
3 Department of Occupational Therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden
Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: [email protected]
Journal: PLoS One
Citation: 14(10), e0224685. https://doi.org/10.1371/journal.pone.0224685
Publication Year and Month: 2019 10
Abstract: Background
The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture.
Method
A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis.
Results
The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem.
Conclusions
Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants’ mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.
Conclusions: More work is needed on young immigrants with late effects of polio to identify their mobility needs and find solutions that could minimize barriers and help them to be more independent outdoors. This group in Sweden has often been overlooked in clinical settings and in society generally. It is important to consider the need of care and support for persons with late effects polio as the need for care has been questioned and decision makers (such as health commissioners) believe persons with late effects of polio no longer exist in Sweden. Moreover, they are not prioritized despite needing rehabilitation interventions that could increase their outdoor mobility. Independent mobility is a major enabler for ongoing employment and the ability to access a car can increase their chances for social integration. According to participants in this study, public transport is not adequate or efficient enough for their needs. For young immigrants with late effects of polio, driving can prevent involuntary isolation and facilitate participation. A car may increase quality of life and reduce the demand for societal support.
Outcome of Research: More research required
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Category: Orthoses
Title: Management of postpolio syndrome
Author: Henrik Gonzalez (1), Tomas Olsson, Kristian Borg
Affiliation: 1 Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden. [email protected]
Journal: The Lancet Neurology
Citation: Lancet Neurol. 2010 Jun;9(6):634-42. doi: 10.1016/S1474-4422(10)70095-8.
Publication Year and Month: 2010 06
Abstract: Postpolio syndrome is characterised by the exacerbation of existing or new health problems, most often muscle weakness and fatigability, general fatigue, and pain, after a period of stability subsequent to acute polio infection. Diagnosis is based on the presence of a lower motor neuron disorder that is supported by neurophysiological findings, with exclusion of other disorders as causes of the new symptoms. The muscle-related effects of postpolio syndrome are possibly associated with an ongoing process of denervation and reinnervation, reaching a point at which denervation is no longer compensated for by reinnervation. The cause of this denervation is unknown, but an inflammatory process is possible. Rehabilitation in patients with postpolio syndrome should take a multiprofessional and multidisciplinary approach, with an emphasis on physiotherapy, including enhanced or individually modified physical activity, and muscle training. Patients with postpolio syndrome should be advised to avoid both inactivity and overuse of weak muscles. Evaluation of the need for orthoses and assistive devices is often required.
Conclusions: Postpolio syndrome is likely caused by ongoing neurodegeneration, perhaps driven by aberrant chronic inflammation. More effective methods to halt the progression of neurological deficits in postpolio syndrome will probably require a deeper understanding of the pathophysiology of these processes. We envisage efforts to characterise biomarkers for postpolio syndrome, such as certain cytokines or other biochemical markers associated with clinical progression. Such markers would be of importance for monitoring pharmacological and rehabilitation interventions. Immunological, virological, and genetic approaches will be needed to increase the knowledge of the pathophysiology of postpolio syndrome. With this information, hopefully tailor-made and more specific and effective interventions might be possible, particularly in the early stages of postpolio syndrome.
Outcome of Research: More research required
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Category: Orthoses
Title: Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness
Author: Hilde E Ploeger (1), Sicco A Bus (2), Merel-Anne Brehm (2), Frans Nollet (2)
Affiliation: 1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: [email protected].
2 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands.
Journal: Gait & Posture
Citation: Gait Posture. 2014 Jul;40(3):391-8. doi: 10.1016/j.gaitpost.2014.05.016. Epub 2014 Jun 4.
Publication Year and Month: 2014 07
Abstract: In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group.
Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with a DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6 min walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires.
Compared with shoes-only, walking with the DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p < 0.05). Furthermore, walking energy cost was lower (-7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were significantly more satisfied, felt safer, and less exhausted with the DR-AFO, compared to shoes-only (p < 0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO.
In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.
Keywords: Ankle-foot orthosis; Calf muscle weakness; Gait analysis; Poliomyelitis; Walking energy cost.
Conclusions: In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.
Outcome of Research: More research required
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Category: Muscle Strength
Title: Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post-polio symptoms
Author: Hildegunn L, Jones K, Grenstad T, Dreyer V, Farbu E, Rekand T
Affiliation: Department of Physical Therapy, Haukeland University Hospital, Bergen, Norway
Journal: Physiotherapy Research International
Citation: Physiother Res Int. 2007 Mar;12(1):39-49
Publication Year and Month: 2007 07
Abstract: BACKGROUND AND PURPOSE: Several years after the acute polio illness, patients may develop new post-polio symptoms. The purpose of the present study was to evaluate patients with post-polio symptoms with regard to perceived fatigue, functional ability, muscle strength, pain and with regard to measured physical fitness and isometric muscle strength. In addition, the relationship between the results of these subjective and objective measurements was investigated.
METHOD: This was a prospective cross-sectional study in which 32 patients with post-polio symptoms were included. Main outcome measures were the Fatigue Severity Scale (FSS), the Disability Rating Index (DRI), pain intensity, pain distribution, self-reported and measured muscle strength and oxygen uptake.
RESULTS: A marked reduction in isometric muscle strength compared to normal data, high scores in fatigue, widespread pain, low oxygen uptake and difficulties in performing some daily activities were found. Self-reported general muscle strength, pain intensity and pain distribution correlated significantly with patients' perceived fatigue and function at the activity level. There was no significant correlation between self-reported and measured results except for that found between isometric muscle strength in the legs and patients' perceived general muscle strength and oxygen uptake.
Conclusions: Evaluation of pain intensity, pain distribution, perceived muscle strength, fatigue and ability to perform daily tasks reveals important aspects of health status in patients with post-polio symptoms. Reduction in isometric muscle strength was not reflected in those tests or in reported symptoms, and should be monitored independently using a sensitive assessment tool. Accurate screening of isometric muscle strength in isolated muscle groups contributes to therapeutic management in making a functional diagnosis at the level of body function and structure when designing specific training programmes and in motivating patients. An evaluation combining self-reports with sensitive muscle strength measures provide supplementary information and is appropriate for evaluating these patients in physiotherapy practice.
Outcome of Research: Not applicable
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Category: Late Effects of Polio
Title: People living with post-polio syndrome must not be forgotten
Author: Hill T
Affiliation: British Polio Fellowship
Journal: Nursing Standard
Citation: Nurs Stand. 2015 Nov 4;30(10):30-1. doi: 10.7748/ns.30.10.30.s38
Publication Year and Month: 2015 11
Abstract: As research conducted by YouGov reveals, only 7% of people in Britain are aware of the neurological condition post-polio syndrome (PPS). The British Polio Fellowship is keen to highlight what is now an urgent need for more support for those living with PPS, from both the public and the nursing and medical community.
Conclusions:
Outcome of Research: Not applicable
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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: Acute Flaccid Paralysis
Title: Potential for the Australian and New Zealand paediatric intensive care registry to enhance acute flaccid paralysis surveillance in Australia: a data-linkage study
Author: Hobday LK (1), Thorley BR (1), Alexander J (2), Aitken T (1), Massey PD (3,4), Cretikos M (5,6), Slater A (2,7), Durrheim DN (3,8)
Affiliation: (1) National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia; (2) Australian and New Zealand Intensive Care Society, Herston, Queensland, Australia; (3) Hunter New England Population Health, Wallsend, NSW, Australia; (4) School of Health, University of New England, Armidale, NSW, Australia; (5) School of Public Health, University of Sydney, Darlington, NSW, Australia; (6) Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia; (7) Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston, Queensland, Australia; (8) Hunter Medical Research Institute, New Lambton, NSW, Australia
Journal: BioMed Central Infectious Diseases
Citation: BMC Infect Dis. 2013 Aug 21;13:384. doi: 10.1186/1471-2334-13-384.
Publication Year and Month: 2013 08
Abstract: BACKGROUND: Australia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one non-polio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance.
METHODS: A data-linkage study for the period from 1 January 2005 to 31 December 2008 compared 165 non-polio AFP cases classified by the Polio Expert Panel with 880 acute neurological presentations potentially compatible with AFP documented in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry.
RESULTS: Forty-two (25%) AFP cases classified by the Polio Expert Panel were matched to case records in the ANZPIC Registry. Of these, nineteen (45%) cases were classified as Guillain-Barré syndrome on both registries. Ten additional Guillain-Barré syndrome cases recorded in the ANZPIC Registry were not notified to the national AFP surveillance system.
Conclusions: The identification of a further ten AFP cases supports inclusion of intensive care units in national AFP surveillance, particularly specialist paediatric intensive care units, to identify AFP cases that may not otherwise be reported to the national surveillance system.
Outcome of Research: Not applicable
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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: Issues Ment Health Nurs.
Citation: 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: 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: 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: Activity Levels
Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05
Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.
SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.
METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.
RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.
Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.
Outcome of Research: Not applicable.
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Category: Fatigue
Title: A comparison of 4 questionnaires to measure fatigue in postpoliomyelitis syndrome
Author: Horemans HL, Nollet F, Beelen A, Lankhorst GJ
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Mar;85(3):392-8
Publication Year and Month: 2004 03
Abstract: OBJECTIVE: To assess the comparability and reproducibility of 4 questionnaires used to measure fatigue in postpoliomyelitis syndrome (PPS).
DESIGN: Repeated-measures at a 3-week interval.
SETTING: University hospital.
PARTICIPANTS: Convenience sample of 65 patients with PPS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: The Fatigue Severity Scale (FSS), the Nottingham Health Profile (NHP) energy category, the Polio Problem List (PPL) fatigue item, and the Dutch Short Fatigue Questionnaire (SFQ).
RESULTS: Correlations of scores between questionnaires were all significant (P<.01) and ranged from .43 (between the NHP energy category and the PPL fatigue item) to .68 (between the PPL fatigue item and the SFQ). Scores on the second visit, normalized to a 0 to 100 scale, were: FSS, 78+/-15; NHP energy category, 47+/-35; PPL fatigue item, 81+/-17; and SFQ, 65+/-22. Except for the difference between the FSS and the PPL fatigue item, the differences in scores between the questionnaires were significant (P<.01). Scale analysis indicated that all questionnaires measured the same unidimensional construct. The reproducibility of the FSS, the PPL fatigue item, and the SFQ was moderate. The smallest detectable change was 1.5 points for the FSS, 2.0 points for the PPL fatigue item, and 1.9 points for the SFQ.
Conclusions: Although the questionnaires measure the same fatigue construct in PPS, the results are not interchangeable because the ranges of measurement differ. The NHP energy category, in particular, appeared to have a high detection threshold. The moderate reproducibility of the questionnaires indicates a lack of precision, especially when applied at the individual patient level.
Outcome of Research: Not applicable
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Category: Acute Flaccid Paralysis
Title: Acute Flaccid Paralysis Associated with Novel Enterovirus C105
Author: Horner LM, Poulter MD, Brenton JN, Turner RB
Affiliation: University of Virginia School of Medicine, Charlottesville, Virginia, USA
Journal: Emerging Infectious Diseases
Citation: Emerg Infect Dis. 2015 Oct. Vol. 21:10. http://dx.doi.org/10.3201/eid2110.150759
Publication Year and Month: 2015 10
Abstract: An outbreak of acute flaccid paralysis among children in the United States during summer 2014 was tentatively associated with enterovirus D68 infection. This syndrome in a child in fall 2014 was associated with enterovirus C105 infection. The presence of this virus strain in North America may pose a diagnostic challenge.
Conclusions:
Outcome of Research: Not applicable
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Category: Muscular Atrophy
Title: A case of post-poliomyelitis muscular atrophy with cranial nerve signs and widespread muscular atrophy of extremities
Author: Hoshino S, Hayashi A, Ohkoshi N, Mizusawa H, Shoji S
Affiliation: Department of Neurology, University of Tsukuba
Journal: Rinsho Shinkeigaku (Clinical Neurology)
Citation: Rinsho Shinkeigaku. 1997 May; 37(5):407-9
Publication Year and Month: 1997 05
Abstract: Here we report a case of a 56-year-old male with post-poliomyelitis muscular atrophy (PPMA), who presented with cranial nerve signs and widespread atrophy of the extremities. He had suffered from poliomyelitis at the age of 2 years. After recovery from the acute stage, the paralysis remained in his left arm. He noticed muscle weakness of the right upper and lower extremities at the age of 45 years and the muscle atrophy progressed to his arms, hip and thigh at the age of 55 years. Neurological examination revealed muscle atrophy of the neck and disturbance of left V, VIII, IX, X and bilateral XI cranial nerves. We diagnosed this case as PPMA from his history and electromyographic and muscle biopsy findings which suggested chronic denervation. Among the 21 PPMA cases in the past in which the acute poliomyelitis had resulted in paralysis of the only one limb, ours was the only case that had muscle atrophy of all the limbs. Cranial nerve involvement is known to occur in acute poliomyelitis; therefore, there is a possibility that the involvement of the cranial nerves in our case might be a delayed progressive symptoms.
Conclusions:
Outcome of Research:
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Category: Diagnosis and Management
Title: Poliomyelitis and the postpolio syndrome
Author: Howard, R.S.
Affiliation: Lane-Fox Unit and Department of Neurology, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London
Journal: The British Medical Journal
(The BMJ)
Citation: 330(7503): 1314–1318.
doi: 10.1136/bmj.330.7503.1314
Publication Year and Month: 2005 06
Abstract: Acute poliomyelitis is now rarely encountered in the United Kingdom, but “imported” poliomyelitis still occurs and it is necessary to distinguish acute poliomyelitis from other causes of acute flaccid paralysis. Despite the obvious success of preventive policies, many patients who had poliomyelitis experience late functional deterioration after periods of prolonged stability—the so called postpolio syndrome. The patterns of disability and their management present unique challenges to the multidisciplinary rehabilitation team.
Conclusions: Although some patients who have had poliomyelitis may later develop wasting, pain, and fatigue in isolation, in most there is significant underlying weakness and skeletal deformity predisposing to functional deterioration. The severe physical stresses of postpolio disability contribute to the development of progressive orthopaedic, respiratory, neurological, and general medical abnormalities, often exacerbated by intercurrent events. These abnormalities may present with atypical clinical features because of the extent of underlying atrophy and weakness, but many are potentially treatable and most patients can be helped to understand and manage increasing disability. It is essential to emphasise that the symptoms, disabilities, and impairments of postpolio functional deterioration are often amenable to treatment. It is also important to urge caution before attributing functional deterioration to a primary “postpolio syndrome” or “progressive postpolio muscular atrophy.”
Outcome of Research: Not applicable
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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: Polio Immunisation
Title: Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12
Author: Iqbal S (1), Shi J (1), Seib K (2), Lewis P (1), Moro PL (1), Woo EJ (3), Shimabukuro T (1), Orenstein WA (2)
Affiliation: (1) Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; (2) Emory University, School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA; (3) Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
Journal: The Lancet Infectious Diseases
Citation: DOI: http://dx.doi.org/10.1016/S1473-3099(15)00059-6
Publication Year and Month: 2015 08
Abstract: BACKGROUND: Safety data from countries with experience in the use of inactivated poliovirus vaccine (IPV) are important for the global polio eradication strategy to introduce IPV into the immunisation schedules of all countries. In the USA, IPV has been included in the routine immunisation schedule since 1997. We aimed to analyse adverse events after IPV administration reported to the US Vaccine Adverse Event Reporting System (VAERS).
METHODS: We analysed all VAERS data associated with IPV submitted between Jan 1, 2000, and Dec 31, 2012, either as individual or as combination vaccines, for all age and sex groups. We analysed the number and event type (non-serious, non-fatal serious, and death reports) of individual reports, and explored the most commonly coded event terms to describe the adverse event. We classified death reports according to previously published body-system categories (respiratory, cardiovascular, neurological, gastrointestinal, other infectious, and other non-infectious) and reviewed death reports to identify the cause of death. We classified sudden infant death syndrome as a separate cause of death considering previous concerns about sudden infant syndrome after vaccines. We used empirical Bayesian data mining methods to identify disproportionate reporting of adverse events for IPV compared with other vaccines. Additional VAERS data from 1991 to 2000 were analysed to compare the safety profiles of IPV and oral poliovirus vaccine (OPV).
FINDINGS: Of the 41 792 adverse event reports submitted, 39 568 (95%) were for children younger than 7 years. 38 381 of the reports for children in this age group (97%) were for simultaneous vaccination with IPV and other vaccines (most commonly pneumococcal and acellular pertussis vaccines), whereas standalone IPV vaccines accounted for 0·5% of all reports. 34 880 reports were for non-serious events (88%), 3905 reports were for non-fatal serious events (10%), and 783 reports were death reports (2%). Injection-site erythema was the most commonly coded term for non-serious events (29%), and pyrexia for non-fatal serious events (38%). Most deaths (96%) were in children aged 12 months or younger; most (52%) had sudden infant death syndrome as the reported cause of death. The safely profiles of combined IPV and whole-cell pertussis vaccines, OPV and whole-cell pertussis vaccines, and OPV and acellular pertussis vaccines were similar. We noted no indication of disproportionate reporting of adverse events after immunisation with IPV-containing vaccines compared with other vaccines between 1990 and 2013.
INTERPRETATION: Fairly few adverse events were reported for the more than 250 million IPV doses distributed between 2000 and 2012. Sudden infant death syndrome reports after IPV were consistent with reporting patterns for other vaccines. No new or unexpected vaccine safety problems were identified for fatal, non-fatal serious, and non-serious reports in this assessment of adverse events after IPV.
Conclusions:
Outcome of Research: Not applicable
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Category: Respiratory Complications and Management
Title: Diaphragmatic dysfunction
Author: J.Ricoy, N.Rodríguez-Núñez, J.M.Álvarez-Dobaño, M.E.Toubes, V.Riveiro, L.Valdés
Affiliation: Pneumology Service, University Hospital Complex of Santiago, Santiago de Compostela, Spain
Interdisciplinary Research Group in Pulmonology, Institute of Sanitary Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
Journal: Journal of Pulmonology
Citation: PULMOE-1323;No. of Pages 13
Publication Year and Month: 2018
Abstract: The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival.
Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres.
This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.
Conclusions:
Outcome of Research: More research required
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Category: Quality of Life
Title: Quality of life and health conditions reported from two post-polio clinics in Israel.
Author: Jacob T, Shapira A.
Affiliation: Physical Therapy Department, Ariel University Center of Samaria, Ariel, Israel. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2010 Apr;42(4):377-9
Publication Year and Month: 2010 04
Abstract: OBJECTIVE:
To evaluate the perceptions of health and quality of life among a group of polio survivors in Israel and to identify potential activities for improving their quality of life.
DESIGN:
An observational study.
SUBJECTS:
The sample consisted of 101 polio survivors who sought treatment at 2 post-polio clinics in Israel. The majority of participants were between the ages of 45 and 65 years, and approximately 25% were wheelchair-bound.
METHODS:
Participants were invited to attend a seminar, where they were invited to complete a questionnaire on demographic variables, mobility, perceptions of and satisfaction with health status and quality of life, and the potential contribution of 16 activities to improve their quality of life.
RESULTS:
Participants had low physical scores and normative mental scores. Mean scores on the Short-Form-12 questionnaire for physical and mental components were 32.9 and 50.3, respectively. Approximately 70% expressed the belief that exposure to up-to-date information about post-polio, as well as participation in social activities, might improve their quality of life.
Conclusions: Information about the physical and mental components of polio survivors, as well as the desire to partake in specific activities for polio survivors, may serve as a basis for the operations and prioritization of service providers.
Outcome of Research: More research required
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Category: Diagnosis and Management, Late Effects of Polio
Title: Post-polio syndrome and the phantom of acute previous poliomyelitis: a systemic entity
Author: Jacqueline Stephanie Fernandes do Nascimento (1), Nicolle dos Santos Moraes Nunes (1), Thais de R. Bessa-Guerra (1*), Marco Antonio Alves Azizi (2), Adalgiza Mafra Moreno (2), Antônio Marcos da Silva Catharino (2), Paulo Henrique de Moura (2), Thiago Rodrigues Gonçalves (2), Renata R. T. Castro (2), Acary Souza Bulle Oliveira (3), Marcos RG de Freitas (4) and Marco Orsini (2)
Affiliation: (1) Graduanda de Medicina na Universidade lguaçu (UNIG) - Nova lguaçu, RJ -Brasil
(2) Professor titular na Universidade lguaçu (UNIG). Nova lguaçu, RJ -Brasil
(3) Neurologista, Doutor em Neurologia pela Escola Paulista de Medicina (UNIFESP) - São Paulo (SP) - Brasil
(4) Neurologista, Doutor, Professor Titular e Chefe do Serviço de Neurologia da UFF, Niterói-RJ - Brasil
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: International Journal of Current Research
Vol. 13, Issue, 04
Publication Year and Month: 2021 04
Abstract: Introduction:
Poliomyelitis, often referred to as infantile paralysis or polio, was first described in 1840 by Jakob Von Heine, a German orthopedic physician. It is an acute and infectious disease caused by an enterovirus of worldwide distribution. With the implementation of immunization, the incidence of cases has reduced exponentially worldwide. However, a portion of individuals who have already developed polio, are now manifesting the late effects of polio, called post polio syndrome (PPS).
Case Report:
PRF, male, system analyst. Diagnosis of acute previous polio at the 18th month of age in a hospital in Fortaleza in 1965. At the age of 18 he started to present a new clinic of muscle fatigue, weakness and inability to perform his daily activities.
Discussion:
The Post-polio syndrome (PPS) was first reported in 1875, by Raymond, when reporting the case of a 19-year-old man, previously infected with acute previous polio and at that time had presented a new clinic of muscle weakness and atrophy. Post-poliomyelitis syndrome is defined as a presentation of the delayed effects of polio with the appearance of new neuromuscular symptoms that occur at least 15 years after clinical and functional stability in the natural history of patients with a previous history of acute previous polio. It can be characterized by: new muscle weakness, atrophy and pain, fatigue, sleep disorders, joint pain, cold intolerance, recent weight gain, respiratory distress and dysphagia. Criteria that support the diagnosis are used, such as: (1) Having been affected with acute previous polio; (2) at least 15 years of clinical stability; (3) new clinic of muscle weakness and fatigue; (4) complete or partial recovery of the functions lost in the poliomyelitis period, with a subsequent decline; (5) no other clinical conditions that explain the case. However, effective monitoring by a multidisciplinary team is necessary to assess the degree of functional and motor deterioration, respiratory capacity, as well as the psychological assessment of the patient.
Conclusion:
Although acute previous poliomyelitis has been eradicated in Brazil, as well as in several countries in the world, it is estimated that today there are still about 12 million individuals with poliomyelitis after-effects.
Conclusions: Although acute previous polio has been eradicated in Brazil, as well as in several countries in the world, it is estimated that today there are still about 12 million individuals with poliomyelitis after-effects. These patients overload the health system, especially those diagnosed with post-polio syndrome. Therefore, studies in different areas of health sciences are extremely important for understanding the pathophysiological mechanisms and with the aim of improving the quality of life of these patients.
Studies that address the biochemical and physiological issue can be useful for understanding the neurodegeneration that occurs in PPS, in addition to composing material for the study of the repercussion of a physical / motor after-effect on one or more organic systems and on functional capacity.
Outcome of Research: More research required
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Category: Falls, Late Effects of Polio
Title: Polio survivors have poorer walking adaptability than healthy individuals
Author: Jana Tuijtelaars (1), Melvyn Roerdink (2), Bart Gerardus Hendricus Raijmakers (1), Frans Nollet (1), Merel-Anne Brehm (1)
Affiliation: (1) Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
(2) Department of Human Movement Sciences, Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, Amsterdam, the Netherlands
Journal: Gait & Posture
Citation: https://doi.org/10.1016/j.gaitpost.2021.04.031
Publication Year and Month: 2021 04
Abstract: Background:
Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.
Research question:
Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?
Methods:
In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0%, 20% and 30% variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.
Results:
46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2mm), polio survivors stepped less accurately onto targets (36.4±0.9mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3%, ObR: 59±4%) than healthy individuals (100±0.3%, p < 0.001 and 94±3%, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).
Significance:
Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.
Abbreviations:
CoP: Center of Pressure
CWS: Comfortable Walking Speed
ObA: Obstacle Avoidance Anticipatory
ObR: Obstacle Avoidance Reactive
ST0: Stepping Targets, 0% variation in step length and width relative to normal walking
ST20: Stepping Targets, 20% variation in step length and width relative to normal walking
ST30: Stepping Targets, 30% variation in step length and width relative to normal walking
VE: Variable stepping Error
%GDS: Percentage successful goal-directed steps
Keywords:
Poliomyelitis, walking adaptability, falling, fall, risk, C-Mill, muscle, weakness
Conclusions: Polio survivors had a demonstrable limited ability to adapt walking to environmental circumstances compared to community-dwelling healthy individuals of similar age. They had fewer successful goal-directed steps, stepped less consistently on stepping targets and, despite walking slower, had lower obstacle-avoidance success rates, especially under high time-pressure demands. This diminished walking adaptability could place them at higher risk of falling, especially in everyday life, where walking often needs to be adapted to expected and unexpected circumstances. Future research should study the validity and reproducibility of walking-adaptability assessment in polio survivors to determine its added value to the currently used methods of fall-risk assessment in clinical practice.
Outcome of Research: More research required
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Category: Falls and Bone Density
Title: Validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors
Author: Jana Tuijtelaars (a,c), Merel-Anne Brehm (a,c), Frans Nollet (a,c), Melvyn Roerdink (b)
Affiliation: (a) Amsterdam UMC location University of Amsterdam, Rehabilitation medicine, Meibergdreef 9, Amsterdam, The Netherlands
(b) Department of Human Movement Sciences, Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, Amsterdam, the Netherlands
(c) Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
Journal: Gait & Posture
Citation: Jana Tuijtelaars, Merel-Anne Brehm, Frans Nollet, Melvyn Roerdink, Validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors, Gait & Posture, Volume 96, 2022, Pages 314-321, ISSN 0966-6362, https://doi.org/10.1016/j.gaitpost.2022.06.008.
Publication Year and Month:
Abstract: Background
The C-Mill interactive treadmill allows for a safe walking-adaptability assessment, unveiling reduced walking adaptability in polio survivors compared to healthy individuals, possibly related to their high fall rate. However, evidence on its validity and reproducibility is scarce.
Research question
What is the validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors?
Methods
Polio survivors with a history and/or fear of falling (n = 46) performed two walking-adaptability assessments, 1–2 weeks apart, including target-stepping tests (with 0%, 20% and 30% inter-target variance) and obstacle-avoidance tests (anticipatory and reactive). We examined (1) face validity by determining Group effects (for subgroups stratified for fall frequency, fear of falling and leg muscle weakness) and Condition effects (for difficulty level) on walking-adaptability outcomes, (2) construct validity by correlating walking-adaptability and balance outcomes, and (3) content validity by establishing possible ceiling effects. We determined whether face-validity findings were reproducible over test occasions and calculated Intraclass Correlation Coefficients (ICC) and the 95% Limits of Agreement (LoA) for walking-adaptability outcomes.
Results
Walking-adaptability outcomes differed in to-be-expected directions for subgroups stratified for fall frequency and leg muscle weakness and for difficulty levels, all reproducible over test occasions. Correlations between walking-adaptability and balance outcomes were mainly low (r < 0.587). Ceiling effects were present for anticipatory obstacle-avoidance and balance outcomes, but not for reactive obstacle avoidance. ICCs [95% confidence intervals] were good for the challenging 20% (0.80[0.67–0.88]) and 30% target-stepping conditions (0.74[0.57–0.85]) and for the reactive obstacle-avoidance (0.76[0.59–0.86]) condition, but not for 0% target-stepping and anticipatory obstacle–avoidance (ICC<0.62) conditions. Likewise, the narrowest LoA were observed for the 20% and 30% target-stepping conditions.
Significance
We proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors with a history of falls and/or fear of falling. Adding walking-adaptability assessment, particularly the more challenging tests given their superior reproducibility, to currently used clinical tests could improve fall-risk evaluation in this population.
Keywords: Polio survivors, Walking adaptability, Fall-risk assessment, Validity, Reproducibility
Conclusions: Results from this study proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors experiencing falls and/or FoF. Compared to balance tests, walking-adaptability tests address other mobility aspects and are more sensitive for identifying differences in subgroups stratified for established fall-risk factors, and therefore, might add value to the current fall-risk assessment in this population. Based on content validity and reproducibility outcomes, we propose that the more challenging variable target-stepping and reactive obstacle-avoidance tests are best suitable for assessing walking adaptability in polio survivors.
Outcome of Research: Effective
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Category: Falls
Title: Construct Validity And Reproducibility of C-Mill Walking-Adaptability Assessment in Polio Survivors
Author: Jana Tuijtelaars, Merel-Anne Brehm, Frans Nollet, Melvyn Roerdink
Affiliation: Amsterdam UMC, Department of Rehabilitation Medicine
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 102, Issue 10, Pages e47-e48.
https://doi.org/10.1016/j.apmr.2021.07.604
Publication Year and Month: 2021 10
Abstract: Research Objectives
To the assess construct validity and reproducibility of walking-adaptability assessment on an instrumented treadmill (the C-Mill) in polio survivors.
Design
Observational study with two repeated walking-adaptability measurements (target stepping, with 0%, 20% and 30% target position variance, and anticipatory and reactive obstacle avoidance), separated by 2-3 weeks.
Setting
Outpatient clinic of a university hospital.
Participants
Polio survivors (n=46) who fell in the previous year and/or reported fear of falling.
Interventions
Not applicable.
Main Outcome Measures
We examined 1) face validity by determining Group (for subgroups stratified for fall frequency, fear of falling and leg-muscle weakness) and Condition effects (for difficulty level) on walking-adaptability outcomes, 2) construct validity by correlating walking-adaptability and balance outcomes, and 3) content validity by establishing possible ceiling effects. We determined whether face-validity findings were reproducible over test occasions and calculated Intraclass Correlation Coefficients (ICC) and the 95% Limits of Agreement (LoA) for walking-adaptability outcomes.
Results
Walking-adaptability outcomes differed in to-be-expected directions for subgroups stratified for fall frequency and leg-muscle weakness and for difficulty levels, all reproducible over test occasions. Correlations between walking-adaptability and balance outcomes were mainly low (r < 0.587). Ceiling effects were present for anticipatory obstacle-avoidance and balance outcomes, but not for reactive obstacle avoidance. ICCs [95% confidence intervals] were good for the challenging 20% (0.80[0.67-0.88]) and 30% target-stepping (0.74[0.57-0.85]) and reactive obstacle-avoidance (0.76[0.59-0.86]) conditions, but not for 0% target-stepping and anticipatory obstacle-voidance (ICC < 0.62) conditions. Likewise, the narrowest LoA were observed for the 20% and 30% target-stepping conditions.
Conclusions: We proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors with a history and/or fear of falling. Adding walking-adaptability assessment, particularly the more challenging tests given their superior reproducibility, to currently used clinical tests could improve fall-risk evaluation in this population.
Outcome of Research: Effective
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Category: Diagnosis and Management
Title: Identification of targets for improving access to care in persons with long term physical disabilities
Author: Jennifer L.Wong, Kevin N.Alschuler, Tracy M.Mroz, Kimberly P.Hreha, Ivan R.Molton
Affiliation: University of Washington, Rehabilitation Medicine, United States
Journal: Disability and Health Journal
Citation: Available online 20 January 2019
Publication Year and Month: 2019 01
Abstract: Background
People with long-term physical disability (LTPD) continue to experience difficulties in accessing health care despite the focus of highlighting disparities in the last two decades.
Objectives
To describe health care utilization, accommodations and barriers experienced while accessing health care, and reasons why individuals delay or skip health care among people with LTPD.
Methods
The current study was a part of a larger longitudinal survey administered to individuals with physical disability associated with one of four long-term conditions (MS; SCI; PPS; MD). Measures included demographics, health care utilization, barriers to health care, and reasons for delaying or skipping medical care from the sixth wave of data from 2015 to 2016.
Results
Roughly 90% of all participants (N = 1159) saw at least one medical provider within 12 months. The most encountered barrier participants reported experiencing within that time was an office that did not have a safe transfer device to move them to an exam table (69%). Participants’ physical function, quality of life, status of living with a spouse, diagnostic condition, and sex (male) were significantly associated with endorsing a barrier in accessing health care. The inability to afford out of pocket expenses was the highest reported reason for delaying health care.
Conclusions: People with LTPD access a variety of health care, including rehabilitation services, and continue to experience barriers when doing so. While understanding barriers individuals experience when accessing health care is important, it is equally important to document the type of care they delay or skip due to barriers.
Outcome of Research: More research required
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Category: Anaesthesia, Surgery
Title: Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations
Author: Jie Li, Zongshan Hu, Changchun Tseng, Zhihui Zhao, Yiwen Yuan,Zezhang Zhu, Yong Qiu, Zhen Liu
Affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
Journal: World Neurosurgery
Citation: Volume 122, February 2019, Pages e1111-e1119
Publication Year and Month: 2019 02
Abstract: Background
We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity (PSD) using 3 types of pelvic fixation and investigated the incidence and risk factors for complications.
Methods
We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016. Of the 42 patients, 15 had been treated with the Galveston technique, 13 with iliac screw fixation, and 14 with S2-alar-iliac (S2AI) screw fixation. Demographic data, radiographic parameters, and complications were analyzed. Health-related quality of life was determined using Scoliosis Research Society (SRS) 22-item questionnaires and the Oswestry Disability Index scores.
Results
After surgery, the correction rate of the main curve was 51.7%, 57.8%, and 52.1% in the 3 groups, with significant improvement in regional kyphosis, coronal balance, and pelvic obliquity (PO) (P < 0.05). The correction of PO was similar among the 3 types of pelvic fixation; however, the patients treated with S2AI fixation required significantly less operative time (P < 0.05) and blood loss (P < 0.006). The overall complication rate was 40.5%, with a major complication rate of 23.8%. Age at surgery (P = 0.006) and grade >2 SRS-Schwab osteotomy (P = 0.036) were significant risk factors for complications. Significant improvement was found in the SRS-22 and Oswestry Disability Index scores at the final follow-up examination in the 3 groups.
Conclusions: Conclusions
The present study showed satisfactory correction of spinopelvic deformity for 42 patients with PSD. Compared with the Galveston technique and iliac screw fixation, the use of S2AI significantly decrease the operative time and estimated blood loss and obtained similar correction of PO. Patient age at surgery and grade >2 SRS-Schwab osteotomy were significant risk factors for complications.
Outcome of Research: More research required
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Category: Drugs
Title: Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee
Author: Jinny Tavee MD (1), Thomas H. Brannagan III MD (2), Michael W. Lenihan MD (3), Sri Muppidi MD (4), Liz Kellermeyer BA, MLS (1), Peter D Donofrio MD, AANEM (5)
Affiliation: (1) National Jewish Health, Division of Neurology, Denver, Colorado, USA
(2) Vagelos College of Physicians and Surgeons, Neurological Institute, Columbia University, New York, New York, USA
(3) Adirondack Neurology Associates, PC, Glens Falls, New York, USA
(4) Stanford Neuroscience Health Center, Palo Alto, California, USA
(5) Neurology Clinic, Vanderbilt University, Nashville, Tennessee, USA
Journal: Muscle & Nerve
Citation: Tavee, J, Brannagan, TH, Lenihan, MW, et al. Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee. Muscle & Nerve. 2023; 1-19. doi:10.1002/mus.27922
Publication Year and Month: 2023 07
Abstract: Intravenous immune globulin (IVIG) is an immune-modulating biologic therapy that is increasingly being used in neuromuscular disorders despite the paucity of high-quality evidence for various specific diseases. To address this, the AANEM created the 2009 consensus statement to provide guidance on the use of IVIG in neuromuscular disorders. Since then, there have been several randomized controlled trials for IVIG, a new FDA-approved indication for dermatomyositis and a revised classification system for myositis, prompting the AANEM to convene an ad hoc panel to update the existing guidelines.New recommendations based on an updated systemic review of the literature were categorized as Class I-IV. Based on Class I evidence, IVIG is recommended in the treatment of chronic inflammatory demyelinating polyneuropathy, Guillain-Barré Syndrome (GBS) in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome and myasthenia gravis exacerbations but not stable disease. Based on Class II evidence, IVIG is also recommended for Lambert-Eaton myasthenic syndrome and pediatric GBS. In contrast, based on Class I evidence, IVIG is not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy and small fiber neuropathy that is idiopathic or associated with tri-sulfated heparin disaccharide or fibroblast growth factor receptor-3 autoantibodies. Although only Class IV evidence exists for IVIG use in necrotizing autoimmune myopathy, it should be considered for anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase myositis given the risk of long-term disability. Insufficient evidence exists for the use of IVIG in Miller-Fisher syndrome, IgG and IgA paraproteinemic neuropathy, autonomic neuropathy, chronic autoimmune neuropathy, polymyositis, idiopathic brachial plexopathy and diabetic lumbosacral radiculoplexopathy.
Conclusions: IVIG is not recommended for Post-Polio Syndrome (PPS) as there is no long-term benefit.
Outcome of Research: More research required
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Category: Orthoses
Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry
Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12
Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.
Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.
Outcome of Research: Not applicable
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Category: Polio Immunisation
Title: Rotary’s PolioPlus Program: Lessons Learned, Transition Planning, and Legacy
Author: John L. Sever Michael McGovern Robert Scott Carol Pandak Amy Edwards David Goodstone
Affiliation:
Journal: The Journal of Infectious Diseases
Citation: Volume 216, Issue suppl_1 S355–S361, https://doi.org/10.1093/infdis/jiw556
Publication Year and Month: 2017 06
Abstract: Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary PolioPlus program, participating in national immunization days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication, assisting at immunization posts and clinics, and mobilizing their communities for immunization activities (including poliovirus and other vaccines) and other health benefits. Rotary has contributed more than $1.61 billion for the global eradication of polio and has committed to provide an additional $35 million each year until 2018 (all dollar amounts represent US dollars). Its unwavering commitment to eradicate polio has been vital to the success of the program. Rotary is providing additional support for routine immunization and healthcare. When polio is finally gone, we will have the knowledge from the lessons learned with PolioPlus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health. Rotary has already transitioned its grants program to include 6 areas of focus: disease prevention and treatment, water and sanitation, maternal and child health, basic education and literacy, economic and community development, and peace and conflict prevention/resolution. Funding for these grants in 2015–2016 was $71 million. The legacy of the polio program will be the complete eradication of poliovirus and the elimination of polio for all time.
Conclusions: Through Rotary’s polio eradication efforts, the organization has learned how to raise funds with coordinated campaigns, and raise awareness with innovative communications methods and celebrity engagement. In addition, Rotary members learned how to work with other organizations to implement large-scale projects that required advocacy, security planning, and coordination in the field. Finally, the launch of PolioPlus as Rotary’s flagship project has a legacy of uniting Rotary members around the world behind a common goal. Ending polio will be a major stepping stone for the United Nations’ sustainable development goals, particularly goal 3, to “ensure healthy lives and promote well-being for all at all ages” [33]. When polio is finally gone, we will have the blueprint for tackling other global issues, even those beyond public health.
Outcome of Research: Not applicable
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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: ude.iiawaH@eliraB.
Journal: Preventing Chronic Disease
Citation: 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: Respiratory Complications and Management
Title: Pulmonary dysfunction and its management in post-polio patients
Author: John R. Bach, Margaret Tiltona.
Affiliation: Department of Physical Medicine and Rehabilitation; UMDNJ-New Jersey Medical School, Director of the Center for Ventilator Management Alternatives, University Hospital, Newark.
Journal: NeuroRehabilitation
Citation: NeuroRehabilitation 8 (1997) 139-153
Publication Year and Month: 1997
Abstract: Respiratory dysfunction is extremely common and entails considerable risk of morbidity and mortality for individuals with past poliomyelitis. Although it is usually primarily due to respiratory muscle weakness, post-poliomyelitis individuals also have a high incidence of scoliosis, obesity, sleep disordered breathing, and bulbar muscle dysfunction. Although these factors can result in chronic alveolar hypoventilation (CAH) and frequent pulmonary complications and hospitalizations, CAH is usually not recognized until acute respiratory failure complicates an otherwise benign upper respiratory tract infection. The use of non-invasive inspiratory and expiratory muscle aids, however, can decrease the risk of acute respiratory failure, hospitalizations for respiratory complications, and need to resort to tracheal intubation. Timely introduction of non-invasive intermittent positive pressure ventilation (IPPV), manually assisted coughing, and mechanical insufflation-exsufflation (MI-E) and non-invasive blood gas monitoring which can most often be performed in the home setting, are the principle interventions for avoiding complications and maintaining optimal quality of life.
Conclusions: The failure to make timely appropriate management decisions often leads to episodes of acute respiratory failure and unnecessary hospitalizations, endotracheal intubations, bronchoscopies, and tracheostomies. The use of these invasive approaches adversely affects quality of life and can increase the risk of pulmonary complications and mortality for post-poliomyelitis patients [47]. Episodes of acute respiratory failure which most often result from otherwise benign upper respiratory tract infections can be reversed by the timely use of non-invasive respiratory muscle aids.
Outcome of Research: Not applicable
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Category: Respiratory Complications and Management
Title: Pulmonary Dysfunction and Sleep Disordered Breathing as Post-Polio Sequelae: Evaluation and Management
Author: John R. Bach, MD and Augusta S. Alba, MD
Affiliation: New Jersey Medical School of the University of Medicine and Dentistry of New Jersey, and the Department of Physical Medicine and Rehabilitation, University Hospital; Department of Physical Rehabilitation Medicine, New York University and Godwater Memorial Hospital, New York, NY.
Journal: Orthopedics
Citation: Orthopedics December 1991 Vol 14 No 12 1329-1337.
Publication Year and Month: 1991
Abstract: Post-polio sequelae can include sleep disordered breathing and chronic alveolar hypoventilation (CAH). Both conditions develop insidiously and can render the post-polio survivor susceptible to cardiopulmonary morbidity and mortality when not treated in a timely and appropriate manner. These conditions can be diagnosed by a combination of spirometry, noninvasive blood gas monitoring, and ambulatory polysomnography. Sleep disordered breathing is most frequently managed by nasal continuous positive airway pressure, while tracheostomy ventilation is the most common treatment for ventilatory failure. We report the more effective and comfortable techniques recently made available for managing sleep disordered breathing and the use of noninvasive treatment options for CAH, respiratory failure, and impaired airway clearance mechanisms. One hundred forty-three cases are reviewed.
Conclusions:
Outcome of Research: Not applicable
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Category: Respiratory Complications and Management
Title: Airway Secretion Clearance by Mechanical Exsufflation for Post-Poliomyelitis Ventilator-Assisted Individuals
Author: John R. Bach, William H. Smith, Jennifier Michaels, Lou Saporito, Augusta S. Alba, Rajeev Dayal, Jeffrey Pan.
Affiliation:
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil Vol 74:170-177, February 1993.
Publication Year and Month: 1992 03
Abstract: Pulmonary complications from impaired airway secretion clearance mechanisms are major causes of morbidity and mortality for post-poliomyelitis individuals. The purpose of this study was to review the long-term use of manually assisted coughing and mechanical insufflation-exsufflation (MI-E) by post-poliomyelitis ventilator-assisted individuals (PVAIs) and to compare the peak cough expiratory flows (PCEF) created during unassisted and assisted coughing. Twenty-four PVAIs who have used noninvasive methods of ventilatory support for an average of 27 years, relied on methods of manually assisted coughing and/or MI-E without complications during intercurrent respiratory tract infections (RTIs). Nine of the 24 individuals were studied for PCEF. They had a mean forced vital capacity (FVC) of 0.54 ± 0.47L and a mean maximum insufflation capacity achieved by air stacking of ventilator insufflations and glossopharyngeal breathing of 1.7L. The PCEF were as follows: unassisted, 1.78 ± 1.16L/sec; following a maximum assisted insufflation, 3.75 ± 0.73L/sec; with manual assistance by abdominal compression following a maximum assisted insufflation, 4.64 ± 1.42L/sec; and with MI-E, 6.97 ± 0.89L/sec. We conclude that manually assisted coughing and MI-E are effective and safe methods of airway secretion clearance for PVAIs with impaired expiratory muscle function who would otherwise be managed by endotracheal suctioning. Severely decreased maximum insufflation capacity but not vital capacity indicate need for a tracheostomy.
Conclusions: Post-poliomyelitis individuals using noninvasive methods of ventilatory support have greater PCEF produced by manually assisted coughing and by MI-E than can be produced by unassisted coughing. Thus, if intubation and tracheostomy are to be avoided, it becomes crucial for these individuals and their caregivers to learn and have access to these methods, particularly during RTIs when expiratory muscle weakness is exacerbated.[55] These principles may also apply to individuals with severe expiratory muscle weakness due to other neuromuscular conditions. We believe that it is largely because of the lack of general knowledge of and access to MI-E that other centers are more likely to resort to intubation and tracheostomy for patients with advanced neuromuscular disease and RTIs. We conclude that loss of FVC in itself does not mandate the need for intubation or tracheostomy for ventilatory support. A maximum insufflation capacity below 500mL may be a better indicator. MI-E should be further explored as a convenient and probably more effective alternative to endotracheal suctioning for ventilator-supported neuromuscular individuals.
Outcome of Research:
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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: Exercise
Title: Cardiorespiratory responses to aerobic training by patients with postpoliomyelitis sequelae
Author: Jones DR, Speier J, Canine K, Owen R, Stull GA
Affiliation: Sister Kenny Institute, Minneapolis, Minn (Mr Jones and Drs Speier, Canine, and Owen)
School of Health Related Professions, State University of New York at Buffalo (Dr Stull)
Journal: The Journal of the American Medical Association
Citation: JAMA. 1989 Jun 9;261(22):3255-58
Publication Year and Month: 1989 06
Abstract: We examined the cardiorespiratory responses of 16 patients with postpoliomyelitis sequelae to a 16-week aerobic exercise program. The patients exercised at 70% of maximal heart rate. Dependent variables were resting and maximal heart rates, systolic and diastolic blood pressures, maximum oxygen consumption, maximum carbon dioxide consumption, respiratory quotient, and maximum expired volume per unit time. The exercise group was superior to the control group in watts, exercise time, maximum expired volume per unit time, and maximum oxygen consumption. No untoward events or loss of leg strength occurred as a result of the exercise regimen. We conclude that the aerobic training program employed in this study is a safe, short-term procedure and that patients with postpolio sequelae respond to training in a manner similar to healthy adults.
Conclusions:
Outcome of Research:
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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: Diagnostics
Citation: 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: Diagnosis and Management
Title: Characteristics and management of postpolio syndrome
Author: Jubelt B, Agre JC
Affiliation: State University of New York, Upstate Medical University, 750 E Adams St, Syracuse, NY 13210, USA – [email protected]
Journal: The Journal of the American Medical Association
Citation: JAMA. 2000 Jul 26;284(4):412-4
Publication Year and Month: 2000 07
Abstract: Postpolio syndrome (PPS) refers to new, late manifestations occurring many years after acute poliomyelitis infection. Over the last 25 years, PPS has become a relatively common problem encountered by primary care physicians. A 1987 National Health Interview Survey estimated that about half of the 640,000 survivors of paralytic poliomyelitis in the United States had new late manifestations of PPS. Subsequent studies in the 1990s have found the occurrence of PPS among patients with previous poliomyelitis to range from 28.5% to 64%. The average time in various reports from the acute poliomyelitis until the onset of PPS is about 35 years, with a range from 8 to 71 years. However, it is unclear if the occurrence of PPS increases with aging, which may be the case based on the most accepted etiologic hypothesis.
Conclusions:
Outcome of Research:
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Category: Post-Polio Motor Unit
Title: Neurological manifestations of the post-polio syndrome
Author: Jubelt B, Cashman NR
Affiliation: Les Turner Amyotrophic Lateral Sclerosis Research Laboratory, Northwestern University Medical School, Chicago, Illinois
Journal: Critical Reviews in Neurobiology
Citation: Crit Rev Neurobiol. 1987;3(3):199-220
Publication Year and Month: 1987 03
Abstract: Patients with late effects of poliomyelitis, ie PPS, are being seen at an ever increasing frequency by general physicians, neurologists, and orthopedists. An appropriate time interval for the onset of late manifestations has elapsed since the major epidemics of poliomyelitis in the 1940s and 1950s. Post-polio neurological manifestations primarily include new weakness, atrophy, muscle pain, and fasciculations. Fortunately, the weakness is of a very slow, progressive nature. Abnormal laboratory studies include routine EMG, demonstrating chronic denervation; SFEMG, demonstrating increased fiber density, increased jitter, and blocking; and muscle biopsy most often revealing fiber-type grouping of chronic denervation and small isolated angular (or angulated) fibers and group atrophy in some series, both suggestive of active denervation. Unfortunately, both EMG and muscle biopsy studies suffer from a lack of specificity as they do not appear to distinguish asymptomatic from symptomatic (new weakness, PPMA) patients with prior poliomyelitis. Although the cause of PPMA is unknown, electrophysiological (SFEMG) and muscle biopsy studies suggest that the process involves a loss or dropout of axon terminals of reinnervated motor units. The axons terminal dropout could be due to dysfunction in the cell soma, the axon, or the terminals themselves. Whether motor neuron exhaustion, a persistent viral infection, or immune-mediated mechanisms play a role in the pathogenesis of the late weakness is unclear at present and will require further investigation. Treatment at this time is of a supportive nature. A major controversy involves the role of strengthening exercises in these patients since experimental animal studies suggest that excessive exercise of denervated muscles leads to increased weakness. Clearly, a better understanding of PPS and PPMA will allow more effective management of these patients’ problems and might also provide insight into other motor neuron and neuromuscular junction diseases.
Conclusions:
Outcome of Research:
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Category: Orthoses
Title: Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis
Author: Julian K. Lo MD, Lawrence R. Robinson MD
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
Correspondence to: J. K. Lo; e-mail: [email protected]
Journal: Muscle & Nerve
Citation: Muscle Nerve. 58:760–769, May 2018. https://doi.org/10.1002/mus.26167
Publication Year and Month: 2018 05
Abstract: Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment.
Conclusions:
Outcome of Research: More research required
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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: 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: 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: Maturitas
Citation: 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: 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: Climacteric
Citation: 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: 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: 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
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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: Vocational Implications
Title: Developing vocational rehabilitation services for people with long-term neurological conditions: Identifying facilitators and barriers to service provision
Author: Kate Hayward, Bilal A Mateen, E Diane Playford, Gail Eva
Affiliation: Therapy and Rehabilitation Services, National Hospital for Neurology and Neurosurgery, London, UK
Journal: British Journal of Occupational Therapy (BJOT)
Citation:
Publication Year and Month: 2019 03
Abstract: Introduction
This study aimed to understand existing vocational rehabilitation service provision in one locality in London (population 3.74 million), identify any gaps and explore reasons for this, to support service development.
Method
Using soft systems methodology to guide the research process, semi-structured interviews were completed with nine participants, who were clinicians and managers providing vocational rehabilitation within a National Health Service context. Data were analysed thematically to build a ‘rich picture’ and develop a conceptual model of vocational rehabilitation service delivery. Findings were then ratified with participants at an engagement event.
Results
The findings indicate a spectrum of vocational rehabilitation service provision for long-term neurological conditions with differing levels of funding in place. Vocational rehabilitation often takes place ‘under the radar’ and therefore the true vocational rehabilitation needs of this population, and the extent of service provision, is not known. There is inconsistency of understanding across the services as to what constitutes vocational rehabilitation and outcomes are not routinely measured.
Conclusions: For vocational rehabilitation services to develop they require appropriate funding, driven by government policy to commissioners. Clear definitions of vocational rehabilitation, collecting and sharing outcome data and effective communication across services are needed at a local level. This is expressed in a conceptual model of vocational rehabilitation service delivery.
Outcome of Research: More research required
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Category: Acute Flaccid Paralysis
Title: Acute Flaccid paralysis in adults: Our experience
Author: Kaushik R (1), Kharbanda PS (2), Bhalla A (1), Rajan R (2), Prabhakar S (2)
Affiliation: (1) Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India; (2) Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
Journal: Journal of Emergencies, Trauma, and Shock
Citation: J Emerg Trauma Shock. 2014 Jul-Sep; 7(3): 149–154. doi: 10.4103/0974-2700.136847
Publication Year and Month: 2014 07
Abstract: Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis.
MATERIALS AND METHODS: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried out. The patients were followed through their hospital stay till discharge or death.
RESULTS: The mean age was 33.27 (range 13-89) years with male preponderance (67.7%). The most common etiology was neuroparalytic snake envenomation (51.9%), followed by Guillain Barre syndrome (33.1%), constituting 85% of all patients. Hypokalemic paralysis (7.5%) and acute intermittent porphyria (4.5%) were the other important conditions. We did not encounter any case of acute poliomylitis in adults. In-hospital mortality due to respiratory paralysis was 9%.
Conclusions: Neuroparalytic snakebite and Guillain Barre syndrome were the most common causes of acute flaccid paralysis in adults in our study.
Outcome of Research: Not applicable
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Category: Continence
Title: Bladder symptoms among polio survivors
Author: Kay L, Bertelsen M
Affiliation: Danish Society of Polio and Accident Victims, Rødovre, Denmark
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med 2013; 45: 560–564
Publication Year and Month: 2013 05
Abstract: OBJECTIVE: To describe bladder symptoms among polio survivors and the inconvenience they cause.
DESIGN: A survey using the validated Danish Prostatic Symptom Score questionnaire concerning bladder symptoms.
SUBJECTS: A random age- and gender-stratified sample of polio survivors drawn from members of the Danish Society of Polio and Accident Victims.
METHODS: Eligible subjects were sent the questionnaire by post.
RESULTS: Of 453 eligible subjects 272 responded. Within 2 weeks 87.5% of respondents had experienced at least one bladder symptom, and 76.5% reported that they had been bothered by a bladder symptom. Out of the 12 symptoms in the questionnaire we found a significant gender difference, with straining and weak stream reported more often among men, and urge incontinence reported more often among women. Incontinence occurred significantly more often among women (73.3%) than among men (40.9%). Compared with a similar study of the background population, bladder symptoms overall occurred approximately twice as often among polio survivors.
Conclusions: The majority of polio survivors experience bladder symptoms, prevalences being approximately twice as high as in the background population. Furthermore, polio survivors to a much larger extent find their bladder symptoms bothersome. A successful rehabilitation programme should therefore also focus on these symptoms.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Neurological Symptoms in Danes with a History of Poliomyelitis: Lifelong Follow-Up of Late Symptoms, their Association with Initial Symptoms of Polio, and Presence of Postpolio Syndrome
Author: Kay L. Nielsen N.M. Wanscher B. Jennum P.
Affiliation: Specialized Hospitalet for Polio and Accident Patients, Rødovre, Denmark
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Medical Department 3, Næstved, Slagelse and Ringsted Hospital, Slagelse, Denmark
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
Journal: European Neurology
Citation: 2018, Vol.80, No. 5-6
Publication Year and Month: 2018
Abstract: Background: Previous studies suggest that patients with a history of poliomyelitis (PM) later in life experience a variety of symptoms. These studies were carried out in patients who later in life were admitted to hospital or became members of polio societies and may therefore not be representative of all polio patients. Little data have been published concerning patients actually discharged from hospital with a diagnosis of acute paralytic PM. Objectives: The aim of this study was to compare the prevalence of late symptoms in individuals with a history of paralytic PM with that of controls, and to study whether late symptoms in individuals with a history of PM were associated with symptoms at the acute stage of polio, and finally to compare the prevalence of symptoms in polio patients with postpolio syndrome (PPS) with the prevalence of symptoms in polio patients without PPS. Methods: A questionnaire concerning various symptoms was sent to a previously established cohort of patients, who during the polio epidemics were discharged from the Department of Infectious Disease at Blegdamshospitalet, Copenhagen, with a diagnosis of paralytic PM, and to age- and gender-matched controls without PM. Information about symptoms at the acute stage of disease was obtained from hospital records. Logistic regression analysis with adjustment for age and gender was applied to compare the occurrence of late symptoms in cases and controls and within the above-mentioned groups of individuals with a history of PM. Results: (i) Compared with controls, individuals with a history of polio significantly more often reported muscle symptoms, pain, neuropathic sensory symptoms, and bulbar symptoms; (ii) the occurrence of symptoms did not seem to be related to symptoms of the initial PM; and (iii) symptom prevalence was significantly higher in individuals with a history of polio who reported PPS as compared with those who did not.
Conclusions: Conclusion: Our data indicate that individuals with a history of PM late in life experience a variety of symptoms that cannot be attributed to lesions of the anterior horn. Furthermore, late symptoms do not seem to be related to initial symptoms of the acute stage of PM but to reported PPS. The last finding supports the perception that the cause of PPS is not just normal ageing.
Outcome of Research: More research required
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Category: Epidemiology
Title: A systematic review of the world wide prevalence of survivors of poliomyelitis reported in 31 studies
Author: Kelly M Jones (1), Shivanthi Balalla (1), Alice Theadom (1), Gordon Jackman (2),
Valery L Feigin (1)
Affiliation: 1) 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 2006, Auckland, New Zealand
2) Polio New Zealand Inc., New Plymouth, New Zealand
Journal: BMJ Open
Citation: 2017;7:e015470.
http://dx.doi.org/10.1136/bmjopen-2016-015470
Publication Year and Month: 2017 04
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.
Conclusions: In conclusion, this review reported prevalence of poliomyelitis survivors worldwide from all identified studies. The majority of research to date has been limited to the examination of children and adolescents in low-income to lower middle-income countries (predominantly India) who reside in geographical regions that are not representative of the national population (eg, in terms of age, sex, ethnic distributions) and face high rates of non-polio AFP. Further research of the prevalence of survivors of poliomyelitis is required using a population-based approach, examining nationally representative samples of all ages, particularly in high-income countries including those declared to be polio free. Such efforts will reduce risks for sampling and measurement bias and improve capacity to provide reliable and more robust worldwide prevalence estimates.
Outcome of Research: More research required
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Category: Quality of Life
Title: Depression and life satisfaction among people ageing with post-polio and spinal cord injury.
Author: Kemp BJ, Krause JS.
Affiliation: Rehabilitaion Research and Training Center On Aging With Spinal Cord Injury, Rancho Los Amigos Medical Center, Downey, CA 90242, USA.
Journal: Disability and Rehabilitation
Citation: 1999 May-Jun;21(5-6):241-9.
Publication Year and Month: 1999 05
Abstract: PURPOSE AND BACKGROUND:
Attention has recently begun to focus on the ageing of individuals with disability, not only as a long-term follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a psychological perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression.
METHODS:
This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 non-disabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomatology and a 10-item life satisfaction scale with four-point ratings on each item used.
RESULTS:
Life satisfaction varied by the group, with the non-disabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomatology.
Conclusions: The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: A cross-sectional survey of healthcare workers on the knowledge and attitudes towards polio vaccination in Pakistan
Author: Khan MU (1), Ahmad A (1), Aqeel T (2), Akbar N (2), Salman S (3), Idress J (4)
Affiliation: (1) Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; (2) Department of Pharmacy Practice, Faculty of Pharmacy, University of Baluchistan, Quetta, Pakistan; (3) Department of Pharmacy, University of Peshawar, Peshawar, Pakistan; (4) Department of Integrated Sciences, Post Graduate Nursing College, Peshawar, Pakistan.
Journal: Public Library of Science
Citation: PLoS One. 2015 Nov 11;10(11):e0142485. doi: 10.1371/journal.pone.0142485. eCollection 2015.
Publication Year and Month: 2015 11
Abstract: INTRODUCTION: Pakistan accounts for 85.2% of the total polio cases reported worldwide. Healthcare workers (HCWs) are an integral part of immunization campaigns and source of education for the general public. This study aimed to assess the knowledge and attitudes towards polio vaccination among HCWs providing immunisation and education to general public in Quetta and Peshawar divisions of Pakistan.
METHODS: A cross-sectional survey of 490 HCWs was conducted in two major referral public teaching hospitals of Quetta and Peshawar divisions. During February to April, 2015, a random sample of 490 HCWs was invited to participate in this study. Knowledge and attitudes were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and logistic regression analyses were used to express the results.
RESULTS: A total of 468 participants responded to the questionnaire, giving a response rate of 95.5%. Overall, participants demonstrated good knowledge and positive attitudes towards polio vaccination. The mean knowledge score of HCWs about polio was 13.42±2.39 (based on 18 knowledge questions) while the mean attitude score was 28.75±5.5 (based on 9 attitudes statements). Knowledge gaps were identified about the incubation period of poliovirus (19.5%), management issues (31.9%), use of polio vaccine in mild illnesses (34.7%) and the consequences of the polio virus (36.9%). The majority of participants agreed that all children should be vaccinated for polio (95.1%), while reservations were noted about the need of a booster (38.9%), and sterility issues associated with polio vaccines (43.6%). Internet (n = 167, 37%) and Posters (n = 158, 35%) were the main sources used by HCWs to educate themselves about polio.
Conclusions: Participants in this study had good knowledge and positive attitudes towards polio vaccination. Although the data are indicative of gaps in the knowledge of HCWs, the findings may not be generalized to other hospitals in Pakistan.
Outcome of Research: Not applicable
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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: Part of the Biosystems & Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
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: Activity Levels
Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02
Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.
DESIGN: Longitudinal study.
SETTING: A research clinic and the community.
PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.
RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.
Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.
Outcome of Research:
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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: Foot and Ankle Surgery.
Citation: 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: 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: Post-Polio Motor Unit
Title: Functional recovery – a major risk factor for the development of postpoliomyelitis muscular atrophy
Author: Klingman J, Chui H, Corgiat M, Perry J
Affiliation: Department of Neurology, University of Southern California School of Medicine, Los Angeles
Journal: Archives of Neurology
Citation: Arch Neurol. 1988 Jun;45(6):645-7
Publication Year and Month: 1988 06
Abstract: A retrospective study was undertaken to identify potential risk factors for the development of progressive postpoliomyelitis muscular atrophy (PPMA). Patients with PPMA (n = 57) were compared with patients with a history of poliomyelitis but without a history of progressive weakness (n = 49). Patients who later developed PPMA had histories of more widespread acute paralysis, but relatively greater functional recovery. They were less disabled, and reported higher recent activity levels. Seventy-nine percent of the total variance between the PPMA and control groups could be accounted for by recovery alone (ie, severity minus disability). Functional recovery is generally attributed to reinnervation of sarcomeres by collateral sprouting from surviving lower motor neurons. Since degree of recovery predicts the risk of developing PPMA, our findings suggest that enlarged motor units may carry an increased susceptibility for dysfunction and/or degeneration.
Conclusions:
Outcome of Research:
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Category: Activity Levels, Psychology
Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01
Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.
METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.
DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.
TRIAL REGISTRATION: Dutch Trial Register NTR1371.
Conclusions:
Outcome of Research: Not applicable.
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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: 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: Fatigue
Title: Measuring fatigue in polio survivors: content comparison and reliability of the Fatigue Severity Scale and the Checklist Individual Strength
Author: Koopman FS, Brehm MA, Heerkens YF, Nollet F, Beelen A
Affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2014 Sep;46(8):761-7. doi: 10.2340/16501977-1838
Publication Year and Month: 2014 09
Abstract: OBJECTIVES: To compare the content of the Fatigue Severity Scale and the subscale "subjective experience of fatigue" of the Checklist Individual Strength, and to assess the reliability of both questionnaires in polio survivors.
DESIGN: Repeated-measures at a 3-week interval.
SUBJECTS: Consecutive series of 61 polio survivors.
METHODS: Concepts contained in the questionnaire items were linked to the International Classification of Functioning, Disability and Health (ICF), using standardized linking rules. Reliability analyses included tests of internal consistency, test-retest reliability and measurement error.
RESULTS: Questionnaires differed in the extent to which they measured other than fatigue-related aspects of functioning (represented ICF components: "Body functions": 50% and 80%, "Activities and Participation": 30% and 0%, for the Fatigue Severity Scale and Checklist Individual Strength, respectively). Internal consistency and test-retest reliability were considered acceptable, while measurement error was large (Cronbach's α: 0.90 and 0.93, intraclass correlation coefficient: 0.80 and 0.85, smallest detectable change: 28.7% and 29.4% for the Fatigue Severity Scale and Checklist Individual Strength, respectively).
Conclusions: Considering the acceptable clinimetric properties, we conclude that both the Fatigue Severity Scale and the Checklist Individual Strength can be applied in research on post-poliomyelitis syndrome when measuring fatigue. However, because the 2 questionnaires differ in content they cannot be used interchangeably.
Outcome of Research: Not applicable.
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Category: Diagnosis and Management
Title: Cognitive behavioural therapy for reducing fatigue in post-polio syndrome and in facioscapulohumeral dystrophy: A comparison
Author: Koopman, Fieke S., Merel A. Brehm, Anita Beelen, Nicole Voet, Gijs Bleijenberg, Alexander Geurts, Frans Nollet
Affiliation: Department of Rehabilitation , Academic Medical Center, University of Amsterdam, PO 22660, 1100 DD Amsterdam, The Netherlands. E-mail: [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2017; 49: 585–590
Publication Year and Month: 2017
Abstract: Post-polio syndrome (PPS) and facioscapulohumeral dystrophy (FSHD) are two different neuromuscular disorders. Fatigue is a frequent complaint in both disorders. A recent study showed that cognitive behavioral therapy (CBT), which is a type of psychotherapy that helps patients to identify and reshape thoughts and behavior patterns that contribute to the fatigue was effective in alleviating fatigue in FSHD but not in PPS. In this study we investigated whether this difference in effectiveness might be explained by dissimilar fatigue-related thoughts (for example focusing on fatigue) in both conditions. We used questionnaires to measure the fatigue-related thoughts in 21 patients with PPS and 24 patients with FSHD . It appeared that fatigue-related thoughts in PPS were similar to those in FSHD and thus do not explain the difference in effectiveness of CBT.
Conclusions: Fatigue-related thoughts in PPS were similar to those in FSHD and thus do not explain the difference in effectiveness of CBT.
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: 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: Ageing
Title: Aging and sequelae of poliomyelitis
Author: Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J
Affiliation: centre hospitalier régional universitaire de Montpellier, hôpital Lapeyronie, France –
[email protected]
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Ann Phys Rehabil Med. 2010 Feb;53(1):24-33 – Epub 2009 Nov 10
Publication Year and Month: 2010 02
Abstract: OBJECTIVE: We estimate that there are about 50,000 persons who survived poliomyelitis in their childhood in France (mean age estimated between 50 and 65 years). After a few decades of stability, 30 to 65% of individuals who had been infected and recovered from polio begin to experience new signs and symptoms.
METHOD: Review of the literature on Pubmed with the following keywords "Poliomyelitis" and "Post-Polio Syndrome (PPS)".
RESULTS: These new signs and symptoms are characterized by muscular atrophy (decreased muscle mass), muscle weakness and fatigue, muscle and/or joint pain. All these symptoms lead to significant changes in mobility with falls and inability to carry on with daily life activities. There are several intricate causes. The normal aging process and weight gain are regularly blamed. Respiratory disorders and sleep disorders must be looked for: respiratory insufficiency, sleep-related breathing disorders such as sleep apnea, restless legs syndrome. Orthopedics complications are quite common: soft-tissue pathologies of the upper limbs, degenerative pathologies of the large joints or spinal cord, fall-related fractures. Finally, the onset of an authentic PPS is possible.
Conclusions: The therapeutic care of this late functional deterioration requires regular monitoring check-ups in order to implement preventive measures and appropriate treatment. This therapeutic care must be multidisciplinary as physical rehabilitation, orthotics and technical aids are all essential.
Outcome of Research:
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Category: Surgery
Title: Postpolio syndrome and anesthesia
Author: Lambert DA, Giannouli E, Schmidt BJ
Affiliation: Department of Anesthesia, University of Manitoba, Canada
Journal: Anesthesiology
Citation: Anesthesiology. 2005 Sep;103(3):638-44
Publication Year and Month: 2005 09
Abstract: The development of polio vaccines 50 years ago essentially halted childhood polio epidemics in the industrialized world. During the past quarter century, a constellation of delayed neuromuscular symptoms, called postpolio syndrome, became recognized among the aging polio survivors. The prevalence of postpolio syndrome in the US population is estimated to be in the hundreds of thousands. The most common symptoms are fatigue, pain, and new onset weakness thought to be related to delayed deterioration of motor neuron function. When a patient with postpolio syndrome presents for surgery, special precautions are warranted, because these patients may have respiratory impairment, sleep apnea, swallowing difficulties, and cold intolerance. This article first reviews clinical features and some pathoetiologic theories of postpolio syndrome and then focuses on anesthetic considerations including the use of common anesthetics, neuromuscular blockade, regional anesthesia, and general anesthetic management strategies.
Conclusions:
Outcome of Research:
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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: Diagnosis and Management
Title: National Rehabilitation Hospital Limb Classification for Exercise, Research, and Clinical Trials in Post-Polio Patients
Author: Lauro S. Halstead, Anne Carrington Gawne, and Bao T. Pham
Affiliation: The Post-Polio Program; National Rehabilitation Hospital, Washington, DC
Journal: Annals of the New York Academy of Sciences
Citation: The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment Volume 753 pp 343-353 of the Annals of the New York Academy of Sciences May 25, 1995.
Publication Year and Month: 1995 05
Abstract:
Conclusions: A need exists for an objective classification of polio patients for clinical and research purposes that takes into account the focal, asymmetric, and frequent subclinical nature of polio lesions. In order to prescribe a safe, effective exercise program, we developed a five-level (Classes I-V) limb-specific classification system based on remote and recent history, physical examination, and a four-extremity electrodiagnostic study (EMG/NCS). Class I limbs have no history of remote or recent weakness, normal strength, and a normal EMG. Class II limbs have no history of remote or recent weakness (or if remote history of weakness, full recovery occurred), normal strength and EMG evidence of prior anterior horn cell disease (AHCD). Class III limbs have a history of remote weakness with variable recovery, no new weakness, decreased strength, and EMG evidence of prior AHCD. Class IV limbs have a history of remote weakness with variable recovery, new clinical weakness, decreased strength, and EMG evidence of AHCD. Class V limbs have a history of severe weakness with little-to-no recovery, severely decreased strength and atrophy, and few-to-no motor units on EMG. In a prospective study of 400 limbs in 100 consecutive post-polio patients attending our clinic, 94 (23%) limbs were Class I, 88 (22%) were Class II, 95 (24%) were Class III, 75 (19%) were Class IV, and 48 (12%) were Class V. Guidelines for the use of this classification in a clinical/research setting are presented along with sample case histories and class-specific exercise recommendations.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: The treatment of fatigue by non-invasive brain stimulation.
Author: Lefaucheur JP, Chalah MA, Mhalla A, Palm U, Ayache SS, Mylius V.
Affiliation: Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Service de physiologie-Explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France. Electronic address: [email protected].
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Service de physiologie-Explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Department of Neurology, Philipps University, Marburg, Germany; Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.
Journal: Clinical Neurophysiology
Citation: 2017 Apr;47(2):173-184.
Publication Year and Month: 2017 04
Abstract: The use of non-invasive brain neurostimulation (NIBS) techniques to treat neurological or psychiatric diseases is currently under development. Fatigue is a commonly observed symptom in the field of potentially treatable pathologies by NIBS, yet very little data has been published regarding its treatment. We conducted a review of the literature until the end of February 2017 to analyze all the studies that reported a clinical assessment of the effects of NIBS techniques on fatigue. We have limited our analysis to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). We found only 15 studies on this subject, including 8 tDCS studies and 7 rTMS studies. Of the tDCS studies, 6 concerned patients with multiple sclerosis while 6 rTMS studies concerned fibromyalgia or chronic fatigue syndrome. The remaining 3 studies included patients with post-polio syndrome, Parkinson's disease and amyotrophic lateral sclerosis. Three cortical regions were targeted: the primary sensorimotor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex. In all cases, tDCS protocols were performed according to a bipolar montage with the anode over the cortical target. On the other hand, rTMS protocols consisted of either high-frequency phasic stimulation or low-frequency tonic stimulation. The results available to date are still too few, partial and heterogeneous as to the methods applied, the clinical profile of the patients and the variables studied (different fatigue scores) in order to draw any conclusion. However, the effects obtained, especially in multiple sclerosis and fibromyalgia, are really carriers of therapeutic hope.
Conclusions:
Outcome of Research: More research required
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Category: Falls
Title: Fear of falling, balance confidence and health-related quality of life in individuals with postpolio syndrome.
Author: Legters K, Verbus NB, Kitchen S, Tomecsko J, Urban N.
Affiliation: Gannon University, Erie, PA 16541, USA. [email protected]
Journal: Physiotherapy Theory and Practice
Citation: 2006 Jun;22(3):127-35.
Publication Year and Month: 2006 06
Abstract: The purposes of this study were to examine prevalence of fear of falling (FOF) and decreased balance confidence in individuals with postpolio syndrome (PPS) and to determine whether balance confidence was correlated with health-related quality of life (HRQOL) in this population. A survey, which included demographic questions, the Activities-specific Balance Confidence (ABC) Scale, and the MOS SF-36v2, was made available by mail and electronically to individuals with PPS. Descriptive and correlation statistics were used to analyze the responses. Fear of falling was reported in 95% of respondents, with 80% indicating that FOF affected their quality of life. Median ABC score (42 of 100), physical component score (27 of 100), and mental component score (47 of 100) were below average compared with the general population. A moderate correlation (r = 0.4; p < 0.001) was found between balance confidence and the physical component score of HRQOL in PPS.
Conclusions: There was an overwhelming presence of FOF and severely impaired balance confidence in the majority of those with PPS. A fair correlation between the physical functioning component of HRQOL and balance confidence was noted in this population.
Outcome of Research: More research required
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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: 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: Journal of Health Psychology
Citation: 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: Quality of Life
Title: Life satisfaction and self-reported impairments in persons with late effects of polio.
Author: Lexell J, Brogårdh C.
Affiliation: Department of Health Sciences, Lund University, 22100 Lund, Sweden. [email protected]
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 55, Issues 9–10, December 2012, Pages 577-589
Publication Year and Month: 2012 12
Abstract: Objective
Decades after an acute poliomyelitis infection many persons experience new symptoms or impairments which may affect their life satisfaction. The objective of this study was to investigate the association between life satisfaction and self-reported impairments in persons with late effects of polio.
Material and methods
One hundred and sixty-nine persons (104 women and 65 men) with prior polio responded on admission to rehabilitation to the Life Satisfaction Questionnaire (LiSat-11) assessing satisfaction with life as a whole and 10 domains of life satisfaction and to a 13-item questionnaire assessing self-reported impairments related to late effects of polio.
Results
A majority was to some degree satisfied with life as a whole and with all 10 domains of life satisfaction in LiSat-11, but less than 20% was very satisfied or satisfied with their somatic health. Muscle fatigue, muscle weakness, general fatigue, muscle and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments. Overall, those who rated themselves as not satisfied (according to LiSat-11) reported significantly higher degrees of impairment than those who were satisfied. The relationships between the items of life satisfaction in LiSat-11 and the items in the self-report questionnaire varied from −0.01 to −0.64.
Conclusions: Satisfaction with life as a whole, and different domains of life satisfaction are low to moderately associated with self-reported impairments. This implies that rehabilitation interventions must address not only self-reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio.
Outcome of Research: More research required
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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: Orthoses
Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12
Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.
Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.
Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.
Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: Lung function in post-poliomyelitis syndrome: a cross-sectional study
Author: Lira CABD, Minozzo FC, Sousa BS, Vancini RL, Andrade MDS, Quadros AAJ, Oliveira ASB, Silva ACD.
Affiliation: Federal University of Goiás at Jataí, Jataí, Brazil - [email protected]
Journal: Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology)
Citation: J Bras Pneumol. 2013 Jun-Aug; 39(4): 455–460. doi: 10.1590/S1806-37132013000400009
Publication Year and Month: 2013 08
Abstract: OBJECTIVE: To compare lung function between patients with post-poliomyelitis syndrome and those with sequelae of paralytic poliomyelitis (without any signs or symptoms of post-poliomyelitis syndrome), as well as between patients with post-poliomyelitis syndrome and healthy controls.
METHODS: Twenty-nine male participants were assigned to one of three groups: control; poliomyelitis (comprising patients who had had paralytic poliomyelitis but had not developed post-poliomyelitis syndrome); and post-poliomyelitis syndrome. Volunteers underwent lung function measurements (spirometry and respiratory muscle strength assessment).
RESULTS: The results of the spirometric assessment revealed no significant differences among the groups except for an approximately 27% lower mean maximal voluntary ventilation in the post-poliomyelitis syndrome group when compared with the control group (p = 0.0127). Nevertheless, the maximal voluntary ventilation values for the post-poliomyelitis group were compared with those for the Brazilian population and were found to be normal. No significant differences were observed in respiratory muscle strength among the groups.
Conclusions: With the exception of lower maximal voluntary ventilation, there was no significant lung function impairment in outpatients diagnosed with post-poliomyelitis syndrome when compared with healthy subjects and with patients with sequelae of poliomyelitis without post-poliomyelitis syndrome. This is an important clinical finding because it shows that patients with post-poliomyelitis syndrome can have preserved lung function.
Outcome of Research: Not applicable.
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Category: Diagnosis and Management
Title: Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations.
Author: Lo JK, Robinson LR.
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
Journal: Muscle & Nerve
Citation: https://doi.org/10.1002/mus.26168
Publication Year and Month: 2018 05
Abstract: Postpolio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. Many theories exist regarding the pathogenesis of PPS, which remains incompletely understood. In contrast, the late effects of poliomyelitis are often a consequence of biomechanical alterations that occur as a result of polio‐related surgeries, musculoskeletal deformities, or weakness. Osteoporosis and fractures of the polio‐involved limbs are common. A comprehensive clinical evaluation with appropriate investigations is essential to fulfilling the established PPS diagnostic criteria. PPS is a diagnosis of exclusion in which a key clinical feature required for the diagnosis is new muscle weakness and/or muscle fatigability that is persistent for at least 1 year. Electromyographic and muscle biopsy findings including evidence of ongoing denervation cannot reliably distinguish between patients with or without PPS.
Conclusions: Electromyographic and muscle biopsy findings including evidence of ongoing denervation cannot reliably distinguish between patients with or without PPS.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Post‐polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis.
Author: Lo JK, Robinson LR.
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
Journal: Muscle & Nerve
Citation: https://doi.org/10.1002/mus.26167
Publication Year and Month: 2018 05
Abstract: Post‐polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760–769, 2018
Conclusions: The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis.
Outcome of Research: More research required
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Category: Quality of Life
Title: Life satisfaction in persons with late effects of polio. Applied Research in Quality of Life
Author: Lund ML, Lexell J.
Affiliation: Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden. [email protected]
Journal: Disability and Rehabilitation
Citation: 2009;31(19):1592-7.
Publication Year and Month: 2009 09
Abstract: PURPOSE:
To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio.
METHODS:
One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11).
RESULTS:
The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11.
Conclusions: Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.
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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Category: Respiratory Complications and Management
Title: Central Sleep Apnea: a Brief Review
Author: M. Safwan Badr and Shahrokh Javaheri
Affiliation: 1.Department of Internal Medicine, Division of Pulmonary, Critical; Care and Sleep MedicineWayne State University School of MedicineDetroitUSA
2.John D. Dingell VA Medical CenterWayne State University School of MedicineDetroitUSA
3.Sleep LaboratoryBethesda North HospitalCincinnatiUSA
4.Division of Pulmonary Sleep and Critical Medicine, College of MedicineUniversity of CincinnatiCincinnatiUSA
5.Division of CardiologyThe Ohio State UniversityColumbusUSA
Journal: Current Pulmonology Reports
Citation: pp 1–8
Publication Year and Month: 2019 03
Abstract: Purpose of Review
The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis, and treatment, including areas of controversy and uncertainty.
Recent Findings
Central apnea may be due to hypoventilation or to hypocapnia following hyperventilation. The occurrence of central apnea initiates a cascade of events that perpetuates breathing instability, recurrent central apnea, and upper airway narrowing. In fact, breathing instability and upper airway narrowing are key elements of central and obstructive apnea. Clinically, central apnea is noted in association with obstructive sleep apnea, heart failure, atrial fibrillation, cerebrovascular accident tetraplegia, and chronic opioid use. Management strategies for central apnea aim to eliminate abnormal respiratory events, stabilize sleep, and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive servo-ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population.
Conclusions: There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.
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: Post-Polio Motor Unit
Title: Motor Unit Number Index (MUNIX) as a biomarker of motor unit loss in post-polio syndrome versus needle EMG
Author: Malgorzata Gawel, Ewa Zalewska, Elżbieta Szmidt-Salkowska, Marta Lipowska, Anna Lusakowska, Anna M.Kaminska, Anna Kostera-Pruszczyk
Affiliation: Department of Neurology, Medical University of Warsaw, 02-097 Warsaw, Banacha 1A str., Poland
Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Ks. Trojdena 4 str., Poland
Journal: Journal of Electromyography and Kinesiology
Citation: Volume 46, June 2019, Pages 35-40
Publication Year and Month: 2019 06
Abstract: MUNIX method (Motor Unit Number Index) had been not used to assess number of motor neurons in post-polio syndrome in contrary to needle electromyography.
Objectives
To confirm if MUNIX reflects motor unit loss and clinical stage and to assess difference in MUNIX and EMG results between muscles in different stage.
Methods
132 Muscles (MUNIX) and 96 (EMG) in 12 patients were studied and divided into groups: with normal strength(N), stable weakness and atrophy(S), new weakness and atrophy(W).
Results
In PPS group MUNIX global was 561.36 ± 282.6 (right 6 muscles) and 561.27 ± 281.1 (left) significantly lower than in control group (six muscles 1139.6 ± 164.5) (p < 0.05). MUNIX global correlated with MRC global. MUNIX was greater in muscles with normal strength (95–100% of normal values) than in those with stable weakness (48%-0% of normal values) and new weakness (65%-0% of normal values). Respectively to clinical stage of muscle MUP (motor unit potential) amplitude increased to 350% of normal value, from 250% to 110%, and from 300% to 700%. No correlation was found between MUP parameters and MRC values.
Conclusions: MUNIX reflects motor dysfunction and could be a good biomarker for loss of motor neurons in PPS.
Outcome of Research: More research required
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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: 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: Respiratory Complications and Management
Title: Respiratory Muscle In Post-Polio Syndrome: Highlights
Author: Marco Orsini, Mauricio De Sant Anna, Carlos Henrique Melo Reis, Ricardo Martello, Eduardo Trajano,
Carlos Eduardo Cardoso, Marcos RG de Feritas and Acary SB Oliveira
Affiliation: Masters Program in Science Applied Health - Vassouras University and Masters Program in Local Devolopment - Unisuam. CASF Ramon Freitas - Neurology
Service- Nova Iguaçu- RJ- Brazil
IFRJ. Federal Institute of Rio de Janeiro - Brazil. Physical Therapy Service
Rio de Janeiro Federal University - UFRJ, Brazil
Masters Program in Science Applied Health - Vassouras University- Brazil
Masters Program in Science Applied Health - Vassouras University
Masters Program in Science Applied Health - Vassouras University
Federal University of Rio de Janeiro - Neurology Service - UFRJ
São Paulo Federal University - Unifesp - Neurology Service - Brazil
Journal: Biomedical Journal of Scientific & Technical Research (BJSTR)
Citation:
Publication Year and Month: 2018 11
Abstract: The main function of the respiratory muscles is the movement
of the thoracic wall, thus exerting ventilation, and the increase in
the work of this muscle is directly proportional to the intensity
of the activity performed De Troyer et al. [1-3]. During basal
respiration, the slow-twitch fibers are used, while the fast-twitch
fibers are recruited because of increased heart rate Sinderby et
al. [4]. The diaphragm moves caudal approximately 1 to 3cm.
Under conditions of ventilatory effort this incursion can reach
up to 10cm. For an adequate work performed by the ventilatory
muscles, approximately 1 to 3% of the oxygen consumption
(VO2) Kress et al. [5,6]. Several clinical conditions can modify
this process, leading to a greater demand for breathing muscles,
such as obesity Sant Anna Junior M et al. [7], chronic obstructive
pulmonary disease, heart failure, amyotrophic lateral sclerosis
among others.
Conclusions:
Outcome of Research: More research required
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Category: Epidemiology, Late Effects of Polio
Title: Epidemic poliomyelitis, post-poliomyelitis sequelae and the eradication program
Author: Margaret Peel
Affiliation: University of Melbourne - Department of Microbiology and Immunology Melbourne, Australia
Position: Principal Microbiologist
Description: Retired
Journal: Microbiology Australia
Citation: 41(4):196 DOI: 10.1071/MA20053
Publication Year and Month: 2020 11
Abstract: Epidemics of paralytic poliomyelitis (polio) first emerged in the late 19th and early 20th centuries in the United States and the Scandinavian countries. They continued through the first half of the 20th century becoming global. A major epidemic occurred in Australia in 1951 but significant outbreaks were reported from the late 1930s to 1954. The poliovirus is an enterovirus that is usually transmitted by the faecal–oral route but only one in about 150 infections results in paralysis when the central nervous system is invaded. The Salk inactivated polio vaccine (IPV) became available in Australia in 1956 and the Sabin live attenuated oral polio vaccine (OPV) was introduced in 1966. After decades of stability, many survivors of the earlier epidemics experience late-onset sequelae including post-polio syndrome. The World Health Organization launched the global polio eradication initiative (GPEI) in 1988 based on the easily administered OPV. The GPEI has resulted in a dramatic decrease in cases of wild polio so that only Pakistan and Afghanistan report such cases in 2020. However, a major challenge to eradication is the reversion of OPV to neurovirulent mutants resulting in circulating vaccine-derived poliovirus (cVDPV). A novel, genetically stabilised OPV has been developed recently to stop the emergence and spread of cVDPV and OPV is being replaced by IPV in immunisation programs worldwide. Eradication of poliomyelitis is near to achievement and the expectation is that poliomyelitis will join smallpox as dreaded epidemic diseases of the past that will be consigned to history.
Conclusions: Eradication of poliomyelitis is near to achievement and the expectation is that poliomyelitis will join smallpox as dreaded epidemic diseases of the past that will be consigned to history.
Outcome of Research: Effective
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Category: Brain, Diagnosis and Management, Late Effects of Polio, Post-Polio Motor Unit
Title: Spinal cord gray matter atrophy is associated with functional decline in post-polio syndrome
Author: Maria Janina Wendebourg (1,2), Matthias Weigel (1,2,3,4,5), Laura Richter (1), Vanya Gocheva (6), Patricia Hafner (6), Anna-Lena Orsini (6), Valentina Crepulja (1,2), Simone Schmidt (6), Antal Huck (4), Johanna Oechtering (1), Maria Blatow (7), Tanja Haas (3,4), Cristina Granziera (1,2,5), Ludwig Kappos (1,2,5), Philippe Cattin (4), Oliver Bieri (3,4) Dirk Fischer (6), Regina Schlaeger (1,2,5)
Affiliation: 1. Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
2. Translational Imaging in Neurology (ThINk), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
3. Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
4. Department of Biomedical Engineering, University of Basel, Basel, Switzerland
5. MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
6. Division of Pediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
7. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich,
Journal: European Journal of Neurology
Citation: Eur J Neurol. 2022;00:1–11.
DOI: 10.1111/ene.15261
Publication Year and Month: 2022 01
Abstract: Objective: To determine if patients with post- polio syndrome (PPS) show spinal cord gray matter (SCGM) atrophy and to assess associations between SCGM atrophy, muscle strength and patient- reported functional decline.
Methods: Twenty patients diagnosed with PPS (March of Dimes criteria) and 20 age- and sex- matched healthy controls (HC) underwent 3T axial 2D- rAMIRA magnetic resonance imaging at the intervertebral disc levels C2/C3–C6/C7, T9/T10 and the lumbar enlarge-ment level (Tmax) (0.5 × 0.5 mm2 in- plane resolution). SCGM areas were segmented manu-ally by two independent raters. Muscle strength, self-reported fatigue, depression and pain measures were assessed.
Results: Post- polio syndrome patients showed significantly and preferentially re-duced SCGM areas at C2/C3 (p= 0.048), C3/C4 (p= 0.001), C4/C5 (p< 0.001), C5/C6 (p= 0.004) and Tmax (p= 0.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM areaTmax together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS- related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity.
Conclusions: Patients with PPS show significant SCGM atrophy that correlates with mus-cle strength and is associated with PPS- related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not ex-plained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.
Conclusions: The rAMIRA approach is a novel, promising, clinically feasible and sensitive method for segment-wise quantitation of GM atrophy in the cervical and thoracic SC in patients with lower motor neuron disorders. This study demonstrated its clinical applicability and vali-dated it in patients with PPS, a presumed pure, lower motor neuron disorder, which can serve as a model for other neurodegenerative, genetic or autoimmune diseases of the SCGM.
Patients with PPS show significant SCGM atrophy, particularly at levels close to the cervical and lumbar enlargements. Even after adjustment for the level of depression, fatigue and pain, potential confounding symptoms frequently observed in PPS, SCGM atrophy is significantly and segment-wise associated with muscle strength in corresponding myotomes. Moreover, SCGM atrophy is associated with patient-reported PPS-related functional decline. Secondary analyses suggest that SCGM atrophy is rather due to a second dis-ease phase than being a sole residuum of the initial infection or a pure aging effect. These observations support the hypothesis of a focally accentuated neurodegenerative process in the SC underlying PPS. Larger, ideally multicentric, longitudinal studies conducted over a sufficiently long timespan are an important next step to confirm our results and gain more insights into the development of SCGM atrophy over time and its correlation to clinical symptom evolution in patients with PPS.
Outcome of Research: More research required
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Category: Late Effects of Polio, Quality of Life
Title: Relationship between participation in life situations and life satisfaction in persons with late effects of polio
Author: Maria Larsson Lund & Jan Lexell
Affiliation: Maria Larsson Lund - Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden Correspondence: [email protected]
Jan Lexell - Department of Rehabilitation Medicine, Lund University Hospital, Lund, Sweden; Division of Rehabilitation Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
Journal: Disability and Rehabilitation
Citation: 31(19), 1592–1597. https://doi.org/10.1080/09638280802638881
Publication Year and Month: 2009 09
Abstract:
Purpose. To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio.
Methods. One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11).
Results. The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11.
Keywords: Activities of daily living, disability evaluation, disabled persons, personal autonomy, postpoliomyelitis syndrome, rehabilitation, quality of life
Conclusions: Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.
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: Orthoses
Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02
Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.
Conclusions:
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: Dtsch Med Wochenschr.
Citation: 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:
Title: Patient and Clinician Reported Outcomes and Experiences Following Advanced Tele-Rehabilitation Assessments Conducted in Rural Alberta
Author: Martin Ferguson-Pell & Emily Armstrong
Affiliation: University of Alberta Faculty of Rehabilitation Medicine
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 102, Issue 10, Page e10
https://doi.org/10.1016/j.apmr.2021.07.419
Publication Year and Month: 2021 10
Abstract: Research Objectives
To determine the feasibility of a clinic-to-clinic tele-rehabilitation model in rural Alberta.
Design
This pilot study employed a Plan-Do-Study-Act (PDSA) methodology. We focused on 4 clinical areas: Hip & Knee post-arthroplasty follow-up, Vestibular & Balance issues, Severe Shoulder Pain & Instability, and Wheelchair Seating. We co-developed assessment processes with non-physician experts that connected to a general physiotherapist using new technologies. After a series of in-house trials, these assessments were then deployed to 5 rural communities in Alberta. Technologies included Kinetisense Markerless Motion Capture and a telepresence robot. Patients were provided with a minimum of two clinical visits, with follow-up approximately 4 weeks after initial assessment. Experience and outcome measures centered on ICF principles were collected from both patients and clinicians.
Setting
The study took place in public and private rehabilitation settings and a primary care facility.
Participants
Participants were selected from a convenience sample by local practitioners. Initial and follow-up assessments for 16 patients in this pilot study were completed.
Interventions
A novel suite of technologies and processes were developed through close consultation with expert clinicians to enable complex rehabilitation assessments to be conducted remotely.
Main Outcome Measures
A mix of outcome and experience measures determined the effectiveness of this model. The COPM, and a study-specific Patient Reported Experience Measure, measured patient outcomes. Two study-specific Clinician Reported Experience Measures provided clinician data.
Results
Across our 4 modules, 14 out of 16 participants either agreed (3) or strongly agreed (11) that they enjoyed their Tele-Rehab session overall. No participants disagreed, and 2 were neutral. Based on COPM scores, overall patients saw improvements in both performance and satisfaction for their identified goals.The remote clinicians were all confident in the treatment plans prescribed by the hub clinician (n=13, 4 Agree, 9 Strongly Agree). Both hub and remote clinicians had confidence in each other, and all agreed (5) or strongly agreed (18) that the assessments were a success.
Keywords: Telemedicine; Rehabilitation; Technology
Conclusions: Conclusions
Preliminary results indicate that this is an effective way of delivering care, but additional study is required.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Unraveling the transmission ecology of polio
Author: Martinez-Bakker M (1), King AA (1,2), Rohani P (1,2)
Affiliation: (1) Department of Ecology & Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America; (2) Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan, United States of America; Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
Journal: Public Library of Science
Citation: PLoS Biol. 2015 Jun;13(6): e1002172. doi:10.1371/journal.pbio.1002172
Publication Year and Month: 2015 06
Abstract: Sustained and coordinated vaccination efforts have brought polio eradication within reach. Anticipating the eradication of wild poliovirus (WPV) and the subsequent challenges in preventing its re-emergence, we look to the past to identify why polio rose to epidemic levels in the mid-20th century, and how WPV persisted over large geographic scales. We analyzed an extensive epidemiological dataset, spanning the 1930s to the 1950s and spatially replicated across each state in the United States, to glean insight into the drivers of polio’s historical expansion and the ecological mode of its persistence prior to vaccine introduction. We document a latitudinal gradient in polio’s seasonality. Additionally, we fitted and validated mechanistic transmission models to data from each US state independently. The fitted models revealed that: (1) polio persistence was the product of a dynamic mosaic of source and sink populations; (2) geographic heterogeneity of seasonal transmission conditions account for the latitudinal structure of polio epidemics; (3) contrary to the prevailing “disease of development” hypothesis, our analyses demonstrate that polio’s historical expansion was straightforwardly explained by demographic trends rather than improvements in sanitation and hygiene; and (4) the absence of clinical disease is not a reliable indicator of polio transmission, because widespread polio transmission was likely in the multiyear absence of clinical disease. As the world edges closer to global polio eradication and continues the strategic withdrawal of the Oral Polio Vaccine (OPV), the regular identification of, and rapid response to, these silent chains of transmission is of the utmost importance.
Conclusions:
Outcome of Research: Not applicable
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