Title: Cancer risk in a cohort of polio survivors
Author: Neilsen NM, Wohlfahrt J, Aaby P, et al.
Affiliation: Department of Epidemiology, National University, Copenhagen, Denmark
Department of Infectious Diseases, National University, Copenhagen, Denmark
Journal: International Journal of Cancer
Citation: (2001). 92, pp.605–608
Publication Year and Month: 2000 11
Abstract: Poliomyelitis has hypothetically been associated with an increased risk of central nervous system (CNS) tumors. The present study was performed to examine not only the risk of CNS tumors but also the overall risk of cancer among a cohort of 5,883 polio patients. Patients diagnosed with acute poliomyelitis in the Danish capital, Copenhagen, between 1919 and 1954 were identified and followed with respect to cancer.
Information on vital status and cancer diagnoses was obtained through linkage with the Danish Civil Registration System and the Danish Cancer Registry, respectively. The ratio of observed number of cancers to the number expected from population-based incidence rates, i.e., the standardized incidence ratio (SIR), served as measure of the relative cancer risk.
Overall, 717 cases of cancer were observed among 5,883 polio patients during 249,084 person-years of follow-up vs. an expected number of 645 (SIR 5 1.11 [95% confidence
interval 1.03 to 1.20])). The increased risk was restricted to female polio patients (SIR 5 1.18 [1.07 to 1.30]), among whom the risk was particularly high for breast cancer (SIR 5 1.35 [1.12 to 1.61]) and for skin cancer (SIR 5 1.66 [1.32 to 2.07]). The risk of breast cancer was highest among women with a history of paralytic polio (SIR 5 1.62 [1.24 to 2.10]). The observed number of CNS tumors did not exceed the expected (SIR 5 1.09 [0.72 to 1.60]).
Women diagnosed with poliomyelitis, in particular paralytic polio, may be at increased risk of breast cancer. There was no association between malignancies of the CNS and poliomyelitis.
Conclusions:
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category:
Title: Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration
Author: Stacey Li Hi Shing, Jasmin Lope, Mary Clare McKenna, Rangariroyashe H. Chipika, Orla Hardiman, Peter Bede
Affiliation: Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of the Neurological Sciences
Stacey Li Hi Shing, Jasmin Lope, Mary Clare McKenna, Rangariroyashe H. Chipika, Orla Hardiman, Peter Bede, Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration, Journal of the Neurological Sciences, Volume 424, 2021, 117361, ISSN 0022-510X, https://doi.org/10.1016/j.jns.2021.117361.
Publication Year and Month: 2021 02
Abstract: Background
Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting.
Objective
The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics.
Methods
Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton.
Results
In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.
Conclusions
Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
Keywords
Post-polio syndrome, Motor neuron disease, Neuroimaging, Pathology, Poliomyelitis
Conclusions: Contrary to previous reports, we found no evidence of cerebral grey or white matter degeneration in a cohort of polio survivors using a validated quantitative neuroimaging protocol. The brainstem, corticospinal tracts and the cerebellum exhibit superior integrity in poliomyelitis survivors compared to healthy controls.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category:
Title: Late effects of polio: Interviewing general practitioners and health professionals about the need for and the means of promoting continuing professional development.
Author: Petra Quinlan-Turner (1), Phyllis Lau (2), Keith R McVilly (3)
Affiliation: (1) MBBS, PMETB GP (UK), MPH(Hons), Policy Officer, Surgery Recovery and Reform Branch, Commissioning and System Improvement Division, Victorian Department of Health, Melbourne, Vic. (1 author)
(2) BPharmSci (Hons), GradDip Drug Eval Pharm Sci, PhD, Senior Research Fellow, Department Of General Practice, Faculty of Medicine, Dentistry and Health Science, The University Of Melbourne, Carlton, Vic. (1 author)
(3) PhD, MAPS, FCClP, FIASSIDD, Professor of Disability and Inclusion, School of Social and Political Sciences, The University of Melbourne, Melbourne, Vic. (1 author)
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Australian Journal of General Practice, 01 May 2023, 52(5):317-323
DOI: 10.31128/ajgp-07-22-6504 PMID: 37149772
Publication Year and Month: 2023 03
Abstract: Background and objectives
Polio Australia estimates tens of thousands of polio survivors are experiencing late effects of polio (LEoP), including increased cases among young women of childbearing age in some migrant communities. Because polio has been declared eradicated in Australia, the provision and uptake of education by general practitioners (GPs) and healthcare professionals (HCPs) is minimal. We explored the awareness of LEoP among HCPs and ways to enhance knowledge dissemination to improve clinical practice.
Method
A qualitative study was undertaken, informed by a descriptive (transcendental) phenomenological approach. Semistructured interviews were audio recorded, transcribed and analysed inductively, with a conciliation among the research team used to finalise the themes.
Results
HCPs expressed the importance of learning about LEoP and how this may help build supportive patient-practitioner relationships and contribute to patient outcomes. Factors influencing the uptake of professional development included motivation, possibly stemming from a lack of awareness of LEoP, together with the time and logistical limitations of practice generally.
Discussion
Online learning activities followed by an assessment may be attractive for some HCPs, but peer-based and multidisciplinary continuing professional development activities remain preferred.
Conclusions: Thousands of Australian and New Zealand polio survivors are experiencing sequelae from past polio infections, many in migrant communities and including women of childbearing age. HCPs need to be aware of LEoP and PPS and incorporate this knowledge into their assessment and management of patients. A lack of awareness of LEoP and PPS, combined with time constraints for CPD, serves to perpetuate a serious gap in clinical knowledge, with potential adverse consequences for patients at risk of not being diagnosed or poorly managed.
Professional organisations could combine to develop multidisciplinary peer learning modules on LEoP. Existing online resources, such as the LEoP module on HealthPathways, could be more widely promoted. Organising dedicated symposia, such as that co-hosted by the University of Otago and Polio New Zealand , could also help with the dissemination of knowledge. Importantly, exploring the views of polio survivors and involving them in the co-development and delivery of educational materials could improve the relevance to all stakeholders involved.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Activity Levels
Title: Energy conservation, occupational therapy, and the treatment of post-polio sequelae
Author: Young GR
Affiliation: Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, California 90242
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1233-9
Publication Year and Month: 1991 11
Abstract: Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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:
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
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:
Comments (if any):
Link to Full Paper (if available):
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Activity Levels
Title: Physical activity in persons with late effects of polio: a descriptive study.
Author: Winberg C, Flansbjer UB, Carlsson G, Rimmer J, Lexell J.
Affiliation: 1 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden. Electronic address: [email protected].
2 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Box 157, SE221 00 Lund, Sweden.
4 University of Alabama, Birmingham, USA.
Journal: Disability and Health Journal
Citation: 2014 Jul;7(3):302-8. doi: 10.
Publication Year and Month: 2014 07
Abstract: BACKGROUND:
To promote a healthy and active lifestyle there is a need to increase our knowledge of the level of physical activity (PA) among people with late effects of polio.
OBJECTIVES:
To examine PA in people with late effects of polio and to assess the relationship between PA, life satisfaction and various sociodemographic factors.
METHODS:
PA was assessed in 81 persons with late effects of polio using the Physical Activity and Disability Survey (PADS) and by a pedometer. Life satisfaction was assessed with the Life Satisfaction Questionnaire (LiSat-11).
RESULTS:
The amount of PA varied considerably but on average the participants were physically active almost 3 h per day, mostly in household activities. The mean value of the pedometer counts was 6212 steps per day (SD = 3208). Sixty-nine percent of the participants rated themselves as satisfied with life as a whole. The sum of PADS was positively and significantly related to the number of steps (r = 0.39, p < 0.001), increasing age (r = 0.26, p < 0.05) and to the level of global satisfaction with life (rho = 0.23, p < 0.05). The number of steps was also positively and significantly associated with level of global satisfaction with life (rho = 0.37, p < 0.001).
Conclusions: Despite a progressive physical disability, people with late effects of polio are physically active, but much of the activities are performed as part of their household activities and not as traditional exercise. The relationship between PA, life satisfaction and age further supports the general contention that an active lifestyle is an important factor for perceived well-being among older people.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
Category: Activity Levels, Late Effects of Polio, Muscle Strength, Psychology, Quality of Life
Title: Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome
Author: Vanya Gocheva,corresponding author1 Patricia Hafner,1 Anna-Lena Orsini,1,2 Simone Schmidt,1,3 Sabine Schaedelin,4 Nicole Rueedi,1 Daniela Rubino-Nacht,1 Peter Weber,1 and Dirk Fischer1
Affiliation: 1Division of Neuropediatrics and Developmental Medicine, University Children’s Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056 Basel, Switzerland
2Division of Neurology, University Hospital Basel, Basel, Switzerland
3Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
4Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
Vanya Gocheva, Email: [email protected].
corresponding author.
Journal: Journal of Patient-Reported Outcomes
Citation: 4(1), 59. https://doi.org/10.1186/s41687-020-00226-5
Publication Year and Month: 2020 12
Abstract: Background
The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS.
Aim
To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS.
Methods
Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM).
Results
There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes.
Conclusions
Study findings indicate that objectively measured walking and motor abilities do not reflect patient’s perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.
Conclusions: Self-reported impairments, HRQOL domains, activities of daily living and muscle function outcomes remained stable during 6 months in patients with PPS, except for the HRQOL psychological health domain which declined during this period. Clinical muscle outcomes had no statistically significant relationship with HRQOL and self-reported impairments of PPS patients while a significant relationship was observed with the activities of daily living. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient’s perspective of disability measured by PROMs is related to objectively measured walking and motor abilities.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Acute Flaccid Paralysis
Title: Human Enteroviruses isolated during acute flaccid paralysis surveillance in Ghana: implications for the post eradication era
Author: Odoom JK, Obodai E, Barnor JS, Ashun M, Arthur-Quarm J, Osei-Kwasi M
Affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
Journal: Pan African Medical Journal
Citation: Pan Afr Med J. 2012; 12: 74
Publication Year and Month: 2012 07
Abstract: INTRODUCTION: Surveillance of acute flaccid surveillance (AFP) has been used world-wide to monitor the control and eradication of circulating wild polioviruses. The Polio Laboratory since its accreditation in 1996 has supported the Disease Surveillance Department for AFP surveillance. This study aims to isolate and characterize human enteroviruses from patients with AFP in Ghana.
METHOD: Stool suspension was prepared from 308 samples received in 2009 from the surveillance activities throughout the country and inoculated on both RD and L20B cell lines. Isolates that showed growth on L20B were selected for real-time RT-PCR using degenerate and non-degenerate primers and probes. RD isolates were however characterized by microneutralisation technique with antisera pools from RIVM, The Netherlands and viruses that were untypable subjected to neutralization assay using antibodies specific for E71.
RESULTS: Of the 308 samples processed, 17 (5.5%) grew on both L20B and RD cells while 32 (10.4%) grew on RD only. All 28 isolates from L20B were characterized by rRT-PCR as Sabin-like polioviruses. No wild poliovirus or VDPV was found. However from the microneutralisation assay, six different enteroviruses were characterized. Among these, Coxsackie B viruses were most predominant followed by Echovirus. Three children from whom non-polio enteroviruses were isolated had residual paralysis while one child with VAPP found. The non-polio enteroviruses circulated throughout the country with the majority (20.7%) from Ashanti region.
Conclusions: This study showed the absence of wild or vaccine-derived poliovirus circulation in the country. However, the detection of three non-polio enteroviruses and one Sabin-like poliovirus with residual paralysis call for continuous surveillance even in the post polio eradication era.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Acute Flaccid Paralysis
Title: Recent advances on the role of host factors during non-poliovirus enteroviral infections
Author: Owino C.O., Jang Hahn Cu J.
Affiliation:
Journal: Journal of Biomedical Science
Citation: 26:47 doi: https://doi.org/10.1186/s12929-019-0540-y
Publication Year and Month: 2019 06
Abstract: Non-polio enteroviruses are emerging viruses known to cause outbreaks of polio-like infections in different parts of the world with several cases already reported in Asia Pacific, Europe and in United States of America. These outbreaks normally result in overstretching of health facilities as well as death in children under the age of five. Most of these infections are usually self-limiting except for the neurological complications associated with human enterovirus A 71 (EV-A71). The infection dynamics of these viruses have not been fully understood, with most inferences made from previous studies conducted with poliovirus.
Non-poliovirus enteroviral infections are responsible for major outbreaks of hand, foot and mouth disease (HFMD) often associated with neurological complications and severe respiratory diseases. The myriad of disease presentations observed so far in children calls for an urgent need to fully elucidate the replication processes of these viruses. There are concerted efforts from different research groups to fully map out the role of human host factors in the replication cycle of these viral infections. Understanding the interaction between viral proteins and human host factors will unravel important insights on the lifecycle of this groups of viruses.
This review provides the latest update on the interplay between human host factors/processes and non-polio enteroviruses (NPEV). We focus on the interactions involved in viral attachment, entry, internalization, uncoating, replication, virion assembly and eventual egress of the NPEV from the infected cells. We emphasize on the virus- human host interplay and highlight existing knowledge gaps that needs further studies. Understanding the NPEV-human host factors interactions will be key in the design and development of vaccines as well as antivirals against enteroviral infections. Dissecting the role of human host factors during NPEV infection cycle will provide a clear picture of how NPEVs usurp the human cellular processes to establish an efficient infection. This will be a boost to the drug and vaccine development against enteroviruses which will be key in control and eventual elimination of the viral infections.
Conclusions: The emergence of outbreaks of enteroviral infections in different parts of the world point to the need of mapping all the host factors involved in the infection paradigm. Given that viruses need host factors in every step of their infection from attachment, entry, replication, virion assembly and eventual entry, there is need to elucidate all the host factors involved for an improved understanding of the molecular dynamics of enteroviral infections. This will be a big boost towards the long overdue antiviral and vaccine development against these epidemiologically important viruses. There is much to be elucidated on the formation of NPEV replication complex formation as the existing mechanisms do not wholly explain the processes and steps involved in this important process during viral replication. The nuclear host factors involved in the enteroviral replication also needs to be fully described as this is a vital step in maintaining viral replication and eventual life cycle. Viral entry studies need to be carried out as the known receptors and viral entry requirements do not fully explain the myriad of disease features observed during viral infections. The role of cellular processes such as autophagy, apoptosis, necroptosis, pyroptosis as well as post-translational modifications in enteroviral infections also needs to be fully elucidated. This will be specifically important in explaining the little-known stages of viral infections such as non-lytic egress for continuous viral cycle within the host.
The paucity of information on the infection dynamics of these viruses calls for concerted efforts to elucidate the viral-human cell interactions. There is still a lot to be investigated to fill the gaps that exist on the life cycle of non-polio enteroviruses. With new cases emerging in different parts of the world, it is just a matter of time before we have a global outbreak of non-poliovirus enteroviral infections in different parts of the world. There is also an urgent need for further studies especially in the field of vaccine developments as well as antiviral therapy against enteroviruses.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here for preview
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:
Comments (if any):
Link to Full Paper (if available):
Category: Ageing
Title: Changes in Post-Polio Survivors Over Five Years: Symptoms and Reactions to Treatments.
Author: Mary T. Westbrook, PhD.
Affiliation: Faculty of Health Sciences, The University of Sydney.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Proceedings of the 12th World Congress, International Federation of Physical Medicine and Rehabilitation, Sydney, March 1995.
Publication Year and Month: 1995 03
Abstract: A group of 176 people with post-polio syndrome, identified using Ramlow et al's (1992) criteria, took part in a 5 year follow-up survey. Most reported increased muscle weakness (91%), fatigue (91%), muscle pain (80%), joint pain (64%) and changes in walking (60%). Increases in other symptoms occurred in less than half the group. Cramps, sensitivity to cold, muscle atrophy and muscle twitching were the symptoms most likely to have stabilised. The average respondent reported greater difficulty in carrying out 4 of the 8 activities of daily living investigated. Respondents were significantly less anxious and depressed about their condition at follow-up. Degree of post-polio changes reported at the time of the first survey was a better predictor of decline during the five years than were initial polio histories or psycho-social variables. Health practitioners most likely to have been consulted were general practitioners and physiotherapists. Specialists in rehabilitation medicine were rated as providing more beneficial treatment than other medical practitioners. Treatments reported to provide good symptom relief included massage and water activities but not exercise. Life style modifications associated with pacing, reduced activity and rest were particularly effective. Overall 68% of respondents considered there was much they could do to control post-polio symptoms.
Conclusions: The results confirm and elaborate the findings of previous lengthier longitudinal studies of post-polio syndrome (Dalakas et al., 1986; Grimby et al., 1994; Mulder et al., 1972) The syndrome typically appears to he progressive with the symptoms increasingly interfering with activities of living. However over time most people in the sample studied coped by trying a range of remedies, particularly treatments prescribed by health practitioners and life style modifications. Many of these helped to alleviate symptoms and although respondents were physically less well at the time of follow-up, the group was significantly less anxious and depressed. However, respondents who had declined most over the five year period described their present lives less positively than did survivors whose symptoms had progressed more slowly.
Polio survivors who exhibited most symptoms of post-polio in the initial survey were those reporting greater progression over the next five years. The reason why may become more apparent when the etiology of post-polio syndrome, which is still not fully understood (Jubelt & Druker, 1993), is elucidated.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Ageing
Title: Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging
Author: McNalley TE, Yorkston KM, Jensen MP, Truitt AR, Schomer KG, Baylor C, Molton IR.
Affiliation: From the Department of Rehabilitation Medicine, University of Washington, Seattle
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2015 Feb;94(2):139-45.
Publication Year and Month: 2015 02
Abstract: OBJECTIVE:
This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging.
DESIGN:
A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables.
RESULTS:
The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS.
Conclusions: CONCLUSIONS:
Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Ageing
Title: Secondary conditions and life satisfaction among polio survivors.
Author: Stuifbergen AK
Affiliation: University of Texas, Austin School of Nursing, Austin, TX 78701-1499, USA. [email protected]
Journal: Rehabilitation Nursing
Citation: 2005 Sep-Oct;30(5):173-9
Publication Year and Month: 2005 09
Abstract: Persons living with the effects of polio are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. The purpose of this study was to explore the frequency of selected secondary conditions, factors associated with these conditions, and the relationship between secondary conditions and quality of life among polio survivors. Data from a large convenience sample (N = 2,153) indicate that secondary conditions are prevalent and associated with decreased life satisfaction. Prompt identification and treatment of secondary conditions before they progress to greater impairment and/or disability and attention to an overall healthful lifestyle is important to preserve function and maintain quality of life of polio survivors.
Conclusions: Prompt identification and treatment of secondary conditions before they progress to greater impairment and/or disability and attention to an overall healthful lifestyle is important to preserve function and maintain quality of life of polio survivors.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
Category: Ageing, Exercise, Falls
Title: Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability
Author: Patricia N. Matsuda PT, PhD, DPT (1) Thomas Eagen PhD, MPH (1) Kimberly P. Hreha EdD, OTR/L (2) Marcia L. Finlayson PhD, OT Reg (Ont), OTR (3) Ivan R. Molton PhD (1)
Affiliation: 1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA
2. Division of Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX
3. School of Rehabilitation Therapy, Queen's University, Kingston, Canada
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Volume 12, Issue 5 p. 454-461
https://doi.org/10.1002/pmrj.12289
Publication Year and Month: 2019 11
Abstract: BACKGROUND
An estimated one billion people worldwide live with some form of disability and may face many challenges as they age, including increased fall risk. Understanding the risk factors linking falls, fear of falling, and activity restriction is critical for developing effective programs to increase activity levels among persons with disabilities.
OBJECTIVES
To determine if differences exist in the level of physical activity in people with different types of conditions associated with disability and to investigate if fear of falling is associated with physical activity in individuals who are aging with a long‐term disability.
DESIGN
Cross‐sectional retrospective design.
SETTING
Community.
PARTICIPANTS
A convenience sample of 1812 community‐dwelling individuals who had one of four diagnoses: multiple sclerosis (MS), muscular dystrophy (MD), spinal cord injury (SCI), or post‐polio syndrome (PPS).
METHODS
Descriptive statistics, chi‐square, and analysis of variance, followed by multivariate linear regression analysis were used to examine the association between physical activity status and fear of falling.
MAIN OUTCOME MEASUREMENTS
Physical activity volume and fear of falling.
RESULTS
After controlling for age, sex, duration of disability, and mobility level, there was variation across diagnostic groups (P < .001). People with SCI reported greater physical activity (M = 25.19) compared to other groups (MS: M = 18.70; MD: M = 21.83; PPS: M = 15.47). Patients with PPS had the greatest concerns about falling (M = 16.08), and patients with MS had the lowest (M = 13.12). Fear of falling was associated with physical activity (P < .001), which remained significant after controlling for diagnosis type, falls history, and level of mobility.
CONCLUSION
Level of physical activity appears to vary among disability diagnoses. These results highlight the importance of addressing fear of falling in people with long‐term disability because fear of falling is associated with physical activity.
Conclusions: Level of physical activity appears to vary among disability diagnoses. These results highlight the importance of addressing fear of falling in people with long‐term disability because fear of falling is associated with physical activity.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Ageing, Late Effects of Polio
Title: A Review of Secondary Health Conditions in Post-Polio Syndrome: Prevalence and Effects of Aging
Author: Thomas E. McNalley, MD, MA, Kathryn M. Yorkston, PhD1, Mark P. Jensen, PhD1, Anjali R. Truitt, MPH1, Katherine G. Schomer, MA1, Carolyn Baylor, PhD1, and Ivan R. Molton, PhD1
Affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 94(2): 139–145. doi:10.1097/PHM.0000000000000166
Publication Year and Month: 2015 02
Abstract: Objective—This study seeks to better understand the prevalence and severity of secondary health conditions in individuals with post-polio syndrome (PPS), and the association between these conditions and aging.
Design—A scoping literature review was conducted searching electronic databases for studies published from 1986 – 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables.
Results—The findings indicate that: (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk of falls; (3) reports of the associations between the frequency or severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS.
Conclusions—Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these health secondary conditions or reduce their negative impact.
Keywords
Post-Polio Syndrome; Secondary Conditions; Aging; Scoping Review
Conclusions: The key findings from this scoping review include the following: (1) people with PPS experience a large number of serious secondary health conditions, including fatigue, pain, depression, muscle weakness, pulmonary and sleep disorders, and falls; (2) although comparisons with normative samples are rare, one study suggests that depression has a greater impact on the lives of people with PPS than on the general population; and (3) a number of methodological issues limit our ability to interpret the findings related to the associations between secondary conditions and aging.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Anaesthesia
Title: Anesthetic considerations for patients with postpolio syndrome: a case report.
Author: Wheeler D
Affiliation: Little Rock Anesthesia Services, Little Rock, Arkansas, USA
Journal: AANA
Citation: 2011 Oct;79(5):408-10.
Publication Year and Month: 2011 10
Abstract: Postpolio syndrome is a disorder related to the recurrence of neuromuscular symptoms in survivors of paralytic poliomyelitis. A comprehensive understanding of the pathophysiology is necessary for the anesthesia provider to develop a safe anesthetic plan. This case report discusses the anesthetic challenges and considerations in patients with postpolio syndrome, focusing on the importance of careful pharmacologic dosing of opioids, and neuromuscular agents as well as perioperative and postoperative issues related to aspiration risks, cold intolerance, and positioning.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
Category: Assistive Technology
Title: The extent of using mobility assistive devices can partly explain fatigue among persons with late effects of polio – a retrospective registry study in Sweden
Author: Santos Tavares SilvaEmail author, K. S. Sunnerhagen, C. Willén and I. Ottenvall Hammar
Affiliation:
Journal: BioMed Central Neurology
Citation:
Publication Year and Month: 2016 06
Abstract: Background
Fatigue is reported as one of the most disabling symptoms and is common among persons living with late effects of polio. Although fatigue has been studied in the context of people living with late effects of polio, there is a lack of knowledge concerning the association of fatigue and variables of importance for participation in daily life. Therefore, the aim of this study was to explore possible factors associated with fatigue among persons with late effects of polio in Sweden.
Methods
This retrospective registry study consisted of 89 persons with late effects of polio living in Sweden. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) scale, Swedish version. Pearson’s correlation coefficient was used to analyse the correlation between the factors and fatigue, and a multiple linear regression was carried out to explore factors for fatigue.
Results
Fatigue statistically significantly correlated with age (r = 0.234, p < 0.05) and the use of mobility assistive devices (r = 0.255, p < 0.05). The multiple linear regression model showed that the factors age (β = 0.304, p < 0.019) and mobility assistive devices (β = 0.262, p < 0.017) were associated with fatigue among persons living with late effects of polio, and the model partly explained 14% of the variation of fatigue.
Conclusions: Conclusions
Fatigue could partly be explained by the extent of using mobility assistive devices and age. Healthcare professionals should provide and demonstrate the importance of assistive devices to ensure management of fatigue in persons living with late effects of polio.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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):
Link to Full Paper (if available): Click here for preview
Category: Assistive Technology
Title: Evaluation of Motor-Assisted Gloves (SEM Glove) for Patients with Functional Finger Disorders: a clinical pilot study
Author: RYUKI HASHIDA, HIROO MATSUSE, MASAFUMI BEKKI, MASAYUKI OMOTO, SHIMPEI MORIMOTO, TOMOKO HINO, YUUJI HARANO, CHIKAHIRO IWASA, KAZUKI MIYAMOTO, MASAKUNI HARAGUCHI, TAKESHI NAGO, NAOTO SHIBA
Affiliation: Division of Rehabilitation, Kurume University Hospital, Kurume 830-0011, Japan,
Department of Orthopedics, Kurume University School of Medicine, Kurume 830-0011, Japan,
Innovation Platform & Office for Precision Medicine, Graduate School of Biomedical Sciences,
Nagasaki University, Nagasaki 852-8501 Japan
Journal: Kurume Medical Journal
Citation: 65, 00-00, 2018
Publication Year and Month: 2018
Abstract: Summary: The SEM Glove developed by Bioservo Technologies AB is a new device that increases grip and
pinch force. The purpose of this study was to evaluate the effectiveness of the device on the grip and pinch
strength of patients with functional disorders of the fingers.
Materials and Method: 30 hospitalized patients with upper limb functional disorder were enrolled. The assistance
of the device for the grip and pinch strength of each subject were assessed by the difference between the measured values with and without the SEM Glove. The 95% confidence interval of the difference was calculated
across the subjects, and statistical significance was defined as when the lower limit was a positive value (corresponding with a paired t-test at a significance level of 0.05). The odds ratio was calculated in the study of subject
adaptation, with statistical significance set using Fisher’s exact test at a significance level of 0.05.
Results: Grip strength significantly decreased (worn-not worn difference (kg): mean = –3.7, CI95 (–5.4, –2.1)).
Pinch strength (thumb - middle finger) significantly increased (worn-not worn difference (N): mean = -4.1, CI95
(1.6, 6.6)). Analysis of factors related to improvement in hand function when wearing the SEM Glove extracted
manual muscle tests (MMTs) of the upper extremity 4 or higher. The odds ratio was 6.11.
Conclusions: Conclusions: Use of the SEM Glove improved the pinch strength of patients with functional disorders of the hands.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Assistive Technology, Late Effects of Polio
Title: Coping with a Second Disability: Implications of the Late Effects of Poliomyelitis for Occupational Therapists
Author: Mary Westbrook, Lynette McDowell
Affiliation: Macquarie University, Sydney. Australia
Journal: Australian Occupational Therapy Journal
Citation: 38(2):83 - 91
Publication Year and Month: 2010 08
Abstract: The long term effects of many physical disabilities have only recently begun to be appreciated. For people who have lived for years with what they thought to be stable conditions, the onset of secondary disabilities may be associated with considerable problems and distress. A questionnaire survey of 324 people with poliomyelitis revealed the occurrence of late effects in 94% of respondents. The majority reported increased weakness, pain and fatigue, problems in carrying out daily living activities and difficulties in obtaining appropriate health care. Although occupational therapists were less likely to be consulted than other professionals, they received one of the highest satisfaction ratings from clients.
Conclusions: Discussion of case studies indicates ways in which occupational therapists can provide symptom relief and enable clients to maintain valued roles. As the survival rates of people with disabilities increase there is a need for greater awareness of, and research into, the late effects of disability.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Assistive Technology, Orthoses
Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08
Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.
(2) Methods: narrative review.
(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.
(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.
Keywords: ankle-foot orthosis; orthosis; review
Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.
The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.
We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Assistive Technology, Quality of Life
Title: Assistive technology and prediction of happiness in people with post-polio syndrome
Author: Spiliotopoulou G, Fowkes C, Atwal A
Affiliation: Brunel University, School of Health Sciences and Social Care , Uxbridge, UB8 3PH , UK
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil Assist Technol. 2012 May;7(3):199-204. doi: 10.3109/17483107.2011.616921. Epub 2011 Oct 6
Publication Year and Month: 2012 05
Abstract: PURPOSE: To explore the relationship between level of happiness in people with post-polio syndrome (PPS) and assistive technology (AT) by taking into account confounding factors such as age, gender and house composition.
METHOD: Existing data from 218 adults with PPS, who had completed a cross-sectional survey conducted by the British Polio Fellowship in 2007, were used for a secondary quantitative analysis. Ordinal logistic regression was applied to determine whether ownership of or the need for AT predicted happiness in people with PPS.
RESULTS: Ownership of AT did not predict happiness, whereas the perceived need for AT was a significant predictor of feeling less happy (p = 0.028). Among the different types of AT needed, only need of home adaptations combined with major equipment was close to being significantly associated with less happiness (p = 0.078). Being older (p < 0.001) and living with a partner (p < 0.001) significantly increased the likelihood of feeling happier.
Conclusions: The findings indicate the importance of the contribution of need for AT in explaining happiness in people with PPS. The fact that users reported unmet equipment needs urge for increased user decision making and better understanding of why perceived needs are not resolved.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Brain
Title: Cerebral changes in post-polio syndrome: A quantitative MRI study
Author: Stacey Li Hi Shing, Jasmin Lope, Mary Clare McKenna, Rangariroyashe H. Chipika, Orla Hardiman, & Peter Bede
Affiliation: Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
Journal: Journal of the Neurological Sciences
Citation: S.L.H. Shing, J. Lope, M.C. McKenna, et al., Cerebral changes in post-polio syndrome: A quantitative MRI study, Journal of the Neurological Sciences (2021), https://doi.org/10.1016/j.jns.2021.117361
Publication Year and Month: 2021 02
Abstract: BACKGROUND
Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects polio survivors decades after their initial infection. Cerebral changes in PPS are poorly characterised and the few existing studies are strikingly conflicting.
OBJECTIVE
The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in post-polio syndrome with reference to healthy- and disease-controls using quantitative imaging metrics.
METHODS
Thirty-six patients with PPS, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted imaging and diffusion tensor imaging. Whole-brain imaging and region-of-interest analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were utilised to assess changes in diffusivity metrics in a study-specific whiter matter skeleton.
RESULTS
In contrast to healthy controls, PPS patients exhibited increased grey matter density in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. PPS patients exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.
CONCLUSIONS
Our findings suggests that PPS is associated with considerable cortical and white matter reorganisation which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
Conclusions: Contrary to previous reports, we found no evidence of cerebral grey or white matter degeneration in a cohort of polio survivors using a validated quantitative neuroimaging protocol. Anatomical regions which are preferentially affected in ALS, such as the corticospinal tracts and the cerebellum exhibit superior integrity in PPS than in healthy controls.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Brain, Late Effects of Polio, Post-Polio Motor Unit
Title: Imaging data indicate cerebral reorganisation in poliomyelitis survivors: Possible compensation for longstanding lower motor neuron pathology
Author: Stacey Li Hi Shing (a), Jasmin Lope (a), Rangariroyashe H. Chipika (a), Orla Hardiman (a), Peter Bede (a, b, ∗)
Affiliation: (a) Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
(b) Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
∗ Corresponding author: Peter Bede, Room 5.43, Computational Neuroimaging Group, Trinity Biomedical Sciences In- stitute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland.
E-mail address: [email protected] (P.Bede).
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Neurological Sciences
424 (2021) 117361
DOI: https://doi.org/10.1016/j.jns.2021.117361
Publication Year and Month: 2021 05
Abstract: BACKGROUND
Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting.
OBJECTIVE
The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics.
METHODS
Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton.
RESULTS
In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.
CONCLUSIONS
Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
Keywords
Post-polio syndrome, Motor neuron disease, Neuroimaging, Pathology, Poliomyelitis
Conclusions: Contrary to previous reports, we found no evidence of cerebral grey or white matter degeneration in a cohort of polio survivors using a validated quantitative neuroimaging protocol. The brainstem, corticospinal tracts and the cerebellum exhibit superior integrity in poliomyelitis survivors compared to healthy controls.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Cardiorespiratory
Title: Optimizing Protocol Selection for Cardiopulmonary Exercise Testing in Slowly Progressive Neuromuscular Diseases
Author: Sander Oorschot, Merel-Anne Brehm, Annerieke van Groenestijn, Frans Nollet, Eric Voorn
Affiliation: Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Oral Research Presentation 1743052| Volume 102, Issue 10, E9, October 01, 2021
DOI:https://doi.org/10.1016/j.apmr.2021.07.415
Publication Year and Month: 2021 10
Abstract: RESEARCH OBJECTIVES:
To develop a predictive model for cardiopulmonary exercise test (CPET) workload increments in individuals with slowly progressive neuromuscular diseases (NMD).
DESIGN:
Observational study.
SETTING:
Data were collected from multiple research projects at the Department of Rehabilitation Medicine at the Amsterdam UMC, location AMC.
PARTICIPANTS:
Individuals (29 men, age: 59.8 ± 12.5) with post-polio syndrome (N = 25), Charcot-Marie-Tooth disease (N = 34) and other slowly progressive NMD (N = 10).
INTERVENTIONS:
Participants underwent a CPET on a cycle ergometer to determine the maximal peak power output in Watts (Wpeak-measured).
MAIN OUTCOME MEASURES:
Forward linear regression analysis was performed with Wpeak-measured as dependent variable and age, gender, body mass index, Medical Research Council sum score (MRCsum) of muscle strength, 6-minute walking (6MWT) distance and energy consumption as independent variables. Determinants significantly associated with Wpeak-measured (p < 0.05) were included in a multivariate regression model to predict peak power output: Wpeak-predicted. The mean difference between Wpeak-measured and Wpeak-predicted was assessed with a paired t-test, and the Limits of Agreement (LoA) to determine the individual bias.
RESULTS:
The regression analysis resulted in the following model: Wpeak-predicted = - 64.308 + 45.743 x gender (0 = female; 1 = male) + 1.060 x MRCsum + 0.287 × 6MWT distance (R2 = 0.58). No significant difference was found between Wpeak-measured (mean = 127.7 ± 56.5 Watts) and Wpeak-predicted (mean = 122.1 ± 43.2 Watts). The LoA were -64.5, +75.7 Watts.
Conclusions: Our model predicted Wpeak accurately in patients with slowly progressive NMD. However, based on a lack of accuracy the model is not yet recommended in clinical practice and further research with higher sample size is required.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Cardiorespiratory, Late Effects of Polio, Respiratory Complications and Management
Title: Obesity and Pulmonary Function in Polio Survivors
Author: Soo Jeong Han, MD, PhD (1), Jae-Young Lim, MD, PhD(2), Jee Hyun Suh, MD(1)
Affiliation: 1. Department of Rehabilitation Medicine, Ewha Womans University School of Medicine, Seoul;
2. Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
Journal: Annals of Rehabilitation Medicine
Citation: 2015;39(6):888-896
pISSN: 2234-0645 • eISSN: 2234-0653
http://dx.doi.org/10.5535/arm.2015.39.6.888
Publication Year and Month: 2015 06
Abstract: OBJECTIVE
To examine the correlation between obesity and pulmonary function in polio survivors.
METHODS
This study was conducted based on a questionnaire survey and physical examination. The questionnaire included gender, age, paralyzed regions, physical activity levels, and accompanying diseases. The physical examination included measuring body mass index, waist circumference, muscle power, total fat amount, body fat percentage, and lean body mass. In addition, pulmonary function was tested based on forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), ratio of FEV1 to FVC, and chest circumference. Five university hospitals and a local health clinic participated in this study.
RESULTS
Pearson and partial correlation coefficients that used data collected from 73 polio survivors showed that obesity had a negative correlation with pulmonary function.
CONCLUSION
This study found that pulmonary function has a negative correlation with obesity for polio survivors. Therefore, it is necessary to develop specialized exercise programs to help polio survivors reduce their weight and strengthen their respiratory muscles.
Conclusions: This study found that pulmonary function has a negative correlation with obesity for polio survivors. Therefore, it is necessary to develop specialized exercise programs to help polio survivors reduce their weight and strengthen their respiratory muscles.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Clinical Evaluation, Diagnosis and Management, Late Effects of Polio
Title: Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease
Author: Stacey Li Hi Shing, Rangariroyashe H. Chipika, Eoin Finegan, Deirdre Murray, Orla Hardiman, and Peter Bede
Affiliation: Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
Edited by: Francesca Trojsi, University of Campania, Luigi Vanvitelli Caserta, Italy
Reviewed by: Andrea Romigi, Mediterranean Neurological Institute (IRCCS), Italy; Louisa Ng, The University of Melbourne, Australia
*Correspondence: Peter Bede ei.dct@pedeb
Journal: Frontiers in Neurology
Citation: 10, 773. https://doi.org/10.3389/fneur.2019.00773
Publication Year and Month: 2019 07
Abstract: Post-polio syndrome (PPS) is a neurological condition that affects polio survivors decades after their initial infection. Despite its high prevalence, the etiology of PPS remains elusive, mechanisms of progression are poorly understood, and the condition is notoriously under-researched. While motor dysfunction is a hallmark feature of the condition, generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS. The non-motor aspects of PPS are particularly challenging to evaluate, quantify, and treat. Generalized fatigue is one of the most distressing symptoms of PPS and is likely to be multifactorial due to weight-gain, respiratory compromise, poor sleep, and polypharmacy. No validated diagnostic, monitoring, or prognostic markers have been developed in PPS to date and the mainstay of therapy centers on symptomatic relief and individualized rehabilitation strategies such as energy conservation and muscle strengthening exercise regimes. Despite a number of large clinical trials in PPS, no effective disease-modifying pharmacological treatments are currently available.
Conclusions: Despite being one of the most devastating neurodegenerative conditions in the world, surprisingly limited research is undertaken in post-polio syndrome. Its pathogenesis remains elusive, no sensitive diagnostic tools have been developed, and validated prognostic and monitoring markers are lacking. Non-motor symptoms of PPS have considerable quality of life implications and are notoriously challenging to manage. The etiology of fatigue in PPS is yet to be elucidated and successful individualized management strategies are needed to maintain mobility, independence, and patient autonomy. There is striking a paucity of neuroimaging studies in PPS that could provide anatomical insights into the substrate of extra-motor symptoms. Ultimately, the characterization of PPS-associated pathology may help research efforts in other motor neuron diseases.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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):
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
Category: Complementary Therapies
Title: A randomized controlled trial of coenzyme Q10 for fatigue in the late-onset sequelae of poliomyelitis
Author: Peel MM (1), Cooke M (1), Lewis-Peel HJ (1), Lea RA (2), Moyle W (1)
Affiliation: (1) NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia; (2) Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Journal: Complementary Therapies in Medicine
Citation: Complementary Therapies in Medicine 23 (2015), pp. 789-793; DOI information: 10.1016/j.ctim.2015.09.002
Publication Year and Month: 2015 12
Abstract: OBJECTIVE: To determine if coenzyme Q10 alleviates fatigue in the late-onset sequelae of poliomyelitis.
DESIGN: Parallel-group, randomized, placebo-controlled trial.
BACKGROUND SETTING: Coenzyme Q10 has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue.
PARTICIPANTS: Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded.
METHOD: Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q10 or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome.
RESULTS: Of 103 participants, 54 were assigned to receive coenzyme Q10 and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q10 was safe and well-tolerated.
The registration number for the clinical trial is ACTRN 12612000552886.
Conclusions: A daily dose of 100 mg coenzyme Q10 for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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.
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
Category: Complementary Therapies
Title: Immediate and Long-Term Effects of Qigong on Cold Intolerance in Patients with Post-Poliomyelitis Syndrome
Author: Ramos, PS, Abe, GC, Pradella-Hallinan, M, Quadros, AAJ, Tao, T, Oliveira, ASB.
Affiliation: Federal University of Sao Paulo, Brazil
Tianjin University of Traditional Chinese Medicine (TUTCM), Tianjin, China.
Department of Tuina and Orthopedics, Tuina and Orthopedics Clinic, The First Teaching Hospital, Tianjin, China.
Journal: Scientific Research
Citation: Vol1(1). DOI:10.4236/health.2017.101004
Publication Year and Month: 2018 01
Abstract: Post-poliomyelitis syndrome (PPS) is a disorder in individuals who have had poliomyelitis, characterized by new muscle weakness and often associated with other symptoms, including cold intolerance (CI). Qigong is a Traditional Chinese Medicine technique to adjust energy and blood circulation. Objective: To verify the effects and late repercussions of Qigong on CI complaints in PPS patients. Methods: PPS patients (n = 22, 14 females, 8 males; ages 35 - 60) performed Qigong exercises in 40-minute sessions, three times per week, for three consecutive months. They were evaluated at baseline, the end of treatment and every three months for a year using a visual analogue scale adapted for CI (VAS-cold). Results: The systemic VAS-cold scores exhibited significant differences between the baseline, the end of treatment and throughout 12 months of follow-up. Conclusion: The CI scores were low and bearable at the end of intervention and for the following 12 months without activity.
Conclusions: We found that following DQ training, the complaints of CI exhibited statistically significant improvement in all the participants, and the sensitivity to cold exhibited low scores and bearable levels at the end of intervention and in the evaluations performed during the following 12 months.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Complementary Therapies
Title: Efficacy of Oral Care Provided by Interprofessional Collaboration for a Patient with Esophageal Cancer Associated with Post-polio Syndrome during Neoadjuvant Chemotherapy.
Author: Takahashi-Arimasa K, Kohno-Yamanaka R, Soga Y, Miura R, Morita M.
Affiliation: Dental Hygienist Team, Division of Medical Technology, Okayama University Hospital, Okayama 700-8558, Japan.
Journal: Acta Medica Okayama
Citation: Volume73 Issue1, 2019-02
Publication Year and Month: 2019 02
Abstract: Preoperative oral care is helpful to prevent postoperative complications in patients who are undergoing esophagectomy. Here, we report the case of an 81-year-old Japanese man with an upper limb disability caused by post-polio syndrome who was receiving neoadjuvant chemotherapy for esophageal cancer. He had poor oral health status and developed oral complications as a side effect of chemotherapy. He could not brush his teeth by himself. However, infection control by oral care provided by an interprofessional collaboration successfully improved his oral hygiene, and his follow-up involved no severe complications. Interprofessional collaboration is useful especially for patients with upper limb disability.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Coping Styles and Strategies
Title: Aging With Long-Term Mobility Impairment: Maintaining Activities of Daily Living via Selection, Optimization, and Compensation
Author: Remillard, E.T., Bailey Fausset, C., Fain, W.B.
Affiliation: Georgia Institute of Technology, Atlanta, Georgia 30318
Journal: The Gerontologist
Citation: gnx186, https://doi.org/10.1093/geront/gnx186
Publication Year and Month: 2017 11
Abstract: There is a growing number of adults with long-term mobility impairment aging into the older adult population. Little is known about the experiences of these individuals in maintaining activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as they face age-related changes in addition to a pre-existing mobility impairment.
Research Design and Methods
Through in-home interviews with 21 participants (ages 52–86) with long-term mobility impairment, the present study employed a qualitative description design to explore perceptions of how and why select ADL/IADL routines (e.g., bed transfer, toileting) have changed over time. The selection, optimization, and compensation (SOC) model was used as a framework to organize participants’ adaptations.
Results
Among the ADL/IADL routine changes mentioned, elective selection strategies, in which a person continues to work at maintaining a task, were more frequently endorsed than loss-based selection strategies, in which a person does a task less or gets help from someone. Findings suggest that this population is actively adapting their routines to preserve their involvement in, and frequency of doing, these ADLs/IADLs. Counter to expectation, perceived age-related changes underlying activity routine changes were subtle and generally did not include sensory and cognitive declines.
Discussion and Implications
Findings provide insights into the difficulties adults with long-term mobility impairment experience as they age, as well as the adaptations they employ to overcome those challenges. Results highlight the need for customizable, mobility supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span.
Conclusions: Despite challenges, this population is actively adapting their routines to maintain ADLs/IADLs and preserve their involvement in, and frequency of doing, these activities. For older adults with long-term mobility impairment, age-related changes underlying ADL/IADL routine changes are often subtle and can be difficult for individuals to identify and articulate about themselves. More research is necessary to understand the aging trajectories among this understudied population. Results highlight the need for customizable, supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span to promote independence at home.
Innovations in design and technology hold great potential to empower individuals aging with mobility impairment to maintain everyday activities and thrive. However, access to supportive devices, equipment, and housing remains a barrier for many individuals in this population. Income and insurance coverage are just a few of the factors that could limit one’s options for overcoming ADL/IADL challenges in the home. There is a need for convergence among aging and disability services, which tend to operate in silos, serving older adults, or people with disabilities; this divide is echoed in how supportive devices and equipment are accessed, delivered, and paid for in terms of eligibility and insurance. By moving from a model that emphasizes aging or disability, to one that addresses impairment as a spectrum, practitioners, and policy makers can better meet the needs of a diverse older adult population (Putnam, 2014).
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: The cultural context of polio biographies
Author: Scheer J, Luborsky ML
Affiliation: National Rehabilitation Hospital Research Center, Washington, DC 20010
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1173-81
Publication Year and Month: 1991 11
Abstract: Cultural contexts influence the ways individuals interpret and experience functional losses associated with post-polio sequelae. Using in-depth multiple interview case studies from two National Institute on Aging projects, the concept of “biographies” is presented to place the individuals’ polio-related experiences within the context of their lives. Two major cultural contexts shape the construction of polio biographies: normative life course expectations and developmental tasks; and traditions associated with polio recovery and rehabilitation. The authors identify key dimensions of personal concern among polio survivors that can be used as entrance points for effective clinical intervention and to promote treatment compliance.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Management of post-polio syndrome (1997)
Author: Trojan DA, Finch L
Affiliation: Not stated
Journal: NeuroRehabilitation
Citation: NeuroRehabil. 1997;8:93-105
Publication Year and Month: 1997 08
Abstract: The management of patients presenting with post-poliomyelitis syndrome is discussed. It is essential to identify and treat other medical and neurological conditions which could produce these symptoms. New weakness can be managed with exercise, avoidance of muscular overuse, weight loss, orthoses and assistive devices. Fatigue can be managed with energy conservation techniques. The management of pain is dependent upon its causes. Treatments are reviewed.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Post-polio sequelae - differential diagnosis and management
Author: Maynard FM
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):857-61
Publication Year and Month: 1985 07
Abstract: Forty-two patients with a past history of poliomyelitis were evaluated at a post-polio clinic for new problems or impairments. Evaluation included a complete history, neurological and biomechanical examination and electrodiagnostic studies. Based on this evaluation patients were placed into three groups: 23 patients were considered to have or likely to have Progressive Post-Polio Muscular Atrophy (PPPMA); 17 patients were considered to have other post-polio sequelae; and two patients had problems unrelated to a past history of polio but mistaken for post-polio sequelae. Musculoskeletal pain was a common complaint among all groups of patients. Twenty-two of the 40 patients with post-polio sequelae were advised to alter their method of ambulation and/or decrease their activity pattern in order to decrease strain and/or excessive exertion of involved muscles. The role of chronic overuse and exercise in producing PPPMA or musculoskeletal pain problems is discussed. Characteristic clinical problems and useful management plans are described.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Effect of treatment and noncompliance on post-polio sequelae
Author: Peach PE, Olejnik S
Affiliation: Roosevelt Warm Springs Institute for Rehabilitation, Georgia 31830
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1199-1203
Publication Year and Month: 1991 11
Abstract: In this study of 77 patients with post-polio sequelae (PPS), symptoms and manual test scores on initial evaluation were compared with those at subsequent follow-up evaluations. Patients were divided into three groups based on the degree to which they had complied with clinically recommended interventions: compliers, partial compliers, and noncompliers. At the end of the follow-up period (2.2 +/- 1.2 years), the mean muscle function scores of the entire study group had declined -1.5%, which represented a decline of -0.7% annually. On follow-up evaluations, the complier group had realized an improvement or resolution of post-polio symptoms, and also an improvement in muscle function of +0.6% annually. The partial complier group had realized either no improvement, or improvement in post-polio symptoms, but showed a further decline in muscle function of -3.0%, or an annual decline of -1.3%. The noncomplier group showed either no change, or a worsening of post-polio symptoms, and also showed a further decline in muscle function of -4.1%, which represented an annual decline of -2.0%.
Conclusions: The disparate outcomes among our post-polio patients underscore the need to develop more effective intervention strategies to achieve improved patient compliance, given the favorable outcomes experienced by patients who complied with clinical recommendations.
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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:
Comments (if any): The full text of this paper has been generously made available by Dr Bruno.
Link to Full Paper (if available): Click here to download
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:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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.
Link to Full Paper (if available): Click here to download
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Postpolio syndrome: unanswered questions regarding cause, course, risk factors, and therapies
Author: Nollet F
Affiliation: Not stated
Journal: The Lancet Neurology
Citation: Lancet Neurol. 2010 Jun;9(6):561-3 - Comment on: Lancet Neurol. 2010 Jun;9(6):634-42
Publication Year and Month: 2010 06
Abstract: Living with the consequences of poliomyelitis is not recognised as an important health issue at present. However, millions of people worldwide have lasting impairments caused by polio infection, many of whom also had a decline in muscle function and decline in activities of daily living after years of stable functioning.
Conclusions:
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher (requires free registration).
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: Postpolio syndrome
Author: Nollet F, de Visser M
Affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, the Netherlands – [email protected]
Journal: Archives of Neurology
Citation: Arch Neurol. 2004 Jul;61(7):1142-4
Publication Year and Month: 2004 07
Abstract: This paper has no abstract - this is an extract:
Postpolio syndrome (PPS) refers to a decline of muscle function usually occurring 30 to 40 years after the acute polio episode. This syndrome has been widely recognized only during the last decades, when many people affected by the large epidemics of the previous century experienced new muscle weakness as they grew older. However, cases of late-onset weakening following poliomyelitis were already reported at the end of the 19th century.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Epidemiology of the post-polio syndrome
Author: Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L
Affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, PA
Journal: American Journal of Epidemiology
Citation: Am J Epidemiol. 1992 Oct 1;136(7):769-86
Publication Year and Month: 1992 10
Abstract: A late-onset syndrome, consisting of muscle weakness, muscle pain, and unaccustomed fatigue, has been reported with increasing frequency among former poliomyelitis patients. A population-based cohort of poliomyelitis patients from Allegheny County, Pennsylvania, was traced and surveyed to estimate the prevalence and incidence and to identify determinants of the post-polio syndrome. A questionnaire validated in clinical examinations of 40 cohort members was used in the survey. The prevalence of the post-polio syndrome was 28.5% of all paralytic cases (95% confidence interval 24.4-32.6). The risk of post-polio syndrome was significantly higher among patients who sustained substantial permanent impairment after polio and among females. The incidence did not vary with age at acute onset, acute severity, or level of physical activity after recovery. The strongest determinant of post-polio syndrome onset was the length of the interval following the acute illness, with incidence peaking at 30-34 years. Of all cases of post-polio syndrome, 79% reported no major change in impairment status since onset. This study demonstrates that poliomyelitis patients are not equally susceptible to post-polio syndrome within the interval of 30-40 years after the original illness. For syndrome cases, the onset was associated with new neuromuscular symptoms and functional changes but not with major new impairment.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Diagnosis and Management
Title: Post-poliomyelitis syndrome (2005)
Author: Trojan DA, Cashman NR
Affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 rue Université, Montréal, Québec H3A 2B4, Canada – [email protected]
Journal: Muscle & Nerve
Citation: Muscle Nerve. 2005 Jan;31(1):6-19
Publication Year and Month: 2005 01
Abstract: Post-poliomyelitis syndrome (PPS) is a common neurological disorder that occurs in a large proportion of individuals who have recovered from paralytic poliomyelitis. The main clinical features are new weakness, muscular fatigability, general fatigue, and pain. The primary criteria necessary for the diagnosis of PPS are a history of paralytic poliomyelitis, partial or complete recovery of neurological function followed by a period of stability (usually several decades), persistent new muscle weakness or abnormal muscle fatigability, and the exclusion of other causes of new symptoms. The cause of PPS remains unclear, but is likely due to a distal degeneration of enlarged post-poliomyelitis motor units. Contributing factors to PPS may be aging (with motor neuron loss), overuse, and disuse. PPS is usually a slowly progressive neuromuscular disease. Although there is no specific treatment for PPS, an interdisciplinary management program can be useful in controlling symptoms.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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.
Comments (if any): Subscription required to view full text.
Link to Full Paper (if available): Click here for preview
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center
Author: Quadros AA (1), Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, Pereira RD, Ramos PE, Abe G, Oliveira AS
Affiliation: (1) Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo (Unifesp), São Paulo SP, Brazil - [email protected]
Journal: Arquivos de Neuro-psiquiatria
Citation: Arq Neuropsiquiatr. 2012 Aug;70(8):571-3
Publication Year and Month: 2012 08
Abstract: OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders.
METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms.
RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%).
Conclusions: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Characteristics of Patients at First Visit to a Polio Clinic in Sweden
Author: Skough Vreede, K. and Sunnerhagen, K.S.
Affiliation: Goteborg University
Journal: PLoS One
Citation: https://doi.org/10.1371/journal.pone.0150286
Publication Year and Month: 2016 03
Abstract: Aim
Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957.
Design
A consecutive cohort study.
Patients
Prior polio patients.
Methods
All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study.
Results
More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61–71% slower, and were 53–77% weaker in muscle strength of the knee and foot as well as grip strength.
Conclusion
The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years.
Conclusions: Polio in lower extremities was more common than polio in upper extremities, verified both
by EMG and clinical classification. This is in accordance with earlier studies. Polio in lower
extremities was also classified as clinically unstable or severely atrophic to a higher extent than
polio in upper extremities (as shown in Fig 1). This is in accordance with an earlier study by
Sandberg et al [20] indicating a more pronounced ongoing denervation-reinnervation process
over time in a lower extremity muscle compared to upper extremity muscle (tibialis anterior
and biceps brachii respectively). The same pattern was also seen in patients studied in Minnesota where patients with leg weakness were twice as likely to complain of new problems compared to those with arm weakness [10].
The ongoing denervation-reinnervation process in patients with PPS results in larger motor
units.When motor-unit size has reached an upper limit, further losses of neurons can no longer
be compensated for and this results in increased muscle weakness [21]. The patients
showed to be stronger in isometric endurance compared to normal population. This may be
explained by the fact that the patients were weaker than the normal population in isometric
peak torque, which the measure of isometric endurance was based on. An increase in type I
(slow) muscle fibres has also been described in prior polio patients [22–23] and may be due to
a transition of type II (fast) to type I (slow).
An important study limitation were seen in the classification of polio as polio were classified
for left and right arm and leg, respectively, and not per muscle group. This can explain why a
polio affected leg in some cases was stronger compared to normal values as the muscles
involved in the strength measured i.e. knee flexion and knee extension muscles may not be
affected of polio. And the same is applicable regarding muscle strength of the foot as well as
grip strength. Data of muscle strength from some of the subjects were missing for different reasons i.e. they may have just not had time to participate, or refused to participate and some were too weak to perform the strength test. Some of the patients with muscle strength data missing, tried to perform the test, but were too weak to get a result. In the future, the use of ultrasound may be used to assess muscle function [24]. This would give the possibility to have more information of muscle function since this does not require that the patient has muscle strength to overcome gravity, which is a requirement for isokinetic testing.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Repetitive transcranial magnetic stimulation in treatment of post polio syndrome
Author: Pastuszak, Z., Piusaska-Macoch, R., Stepieri, A., Czernicki, Z.,
Affiliation: Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, A. Pawińskiego 5, 02-106 Warsaw, Poland
Department of Neurology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland
Department of Neurosurgery, Warsaw University of Medicine, Cegłowska 80, 01-809 Warsaw, Poland
Journal: Neurologia i Neurochirurgia Polska
Citation: Volume 52 (2): 2018, Pages 281-284
Publication Year and Month: 2018 03
Abstract: Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome.
Conclusions: rTMS can be an effective method in treatment of post polio syndrome but further studies with larger group need to be done to confirm that data.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: Life-Long Morbidity Among Danes With Poliomyelitis
Author: Nielsen NM, Rostgaard K, Askgaard D, Skinhøj, & P Aaby P.
Affiliation: Department of Epidemiology Research, Danish Epidemiology Science
Centre, Statens Serum Institut (Nielsen, Rostgaard, Aaby) and Department of Infectious Diseases M, National University Hospital, (Askgaard, Skinhøj), Copenhagen,
Denmark.
Supported by the Danish Medical Research Council, the AP Møller and Chastine
McKinney Møller Foundation, the Danish National Research Foundation, the WedellWedellsborg Foundation, and The National Polio Society
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil 2004; 85:385-91 - doi:10.1016/S0003-9993(03)00474-X
Publication Year and Month: 2004 03
Abstract: Abstract
OBJECTIVE:
To estimate long-term morbidity in a cohort of Danish poliomyelitis patients.
DESIGN:
A historical prospective cohort study of 27,047 persons.
SETTING:
Denmark.
PARTICIPANTS:
A total of 5421 persons hospitalized for poliomyelitis between 1919 to 1954 in Copenhagen, Denmark, and 21,626 age- and gender-matched Danes. Participants were followed up on average for 20.6 years, yielding a total of 555,884 person-years of follow-up.
INTERVENTIONS:
Not applicable.
MAIN OUTCOME MEASURES:
The exposed (poliomyelitis) cohort and the unexposed (control) cohort were followed up for somatic hospitalization from 1977 to 1999 in the Danish Hospital Discharge Register. The incidence rate ratio (IRR) was calculated as the ratio between the incidence rate of disease in the exposed and unexposed cohorts.
RESULTS:
Overall, polio patients had a 1.2- to 1.3-fold increased risk of being hospitalized with pulmonary diseases, heart diseases, gastrointestinal disorders, or diseases of the locomotive apparatus. Among paralytic polio patients, long-term morbidity seems to be associated with the acute severity of poliomyelitis, as well as young age at infection. Paralytic patients, who contracted respiratory polio under the age of 5, had the highest risk of being hospitalized with lung diseases (IRR=7.26; 95% confidence interval [CI], 3.06-18.33), diseases of the locomotive apparatus (IRR=4.05; 95% CI, 1.66-9.86), heart diseases (IRR=1.70; 95% CI, 0.65-3.98), and diseases of the digestive system (IRR= 2.23; 95% CI, 1.03-4.62). Surprisingly, patients without paralyses, especially women, also had an increased morbidity.
CONCLUSIONS:
Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.
Conclusions: Overall, a history of poliomyelitis was associated with a slightly increased morbidity measured by hospitalizations. Long-term morbidity was highest among respiratory polio patients; however, patients presumably left without any residual symptoms also had an increased morbidity.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: Multiple sclerosis and poliomyelitis. A Danish historical cohort study.
Author: Nielsen NM, Wohlfahrt J, Melbye M, Rasmussen S, Mølbak K, Askgaard DS, Aaby P.
Affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Journal: Acta Neurologica Scandinavica
Citation: Acta Neurol Scand 2000 Jun;101(6):384-7.
Publication Year and Month: 2000 06
Abstract: OBJECTIVE:
To evaluate whether persons with a history of poliomyelitis are at an increased risk of developing multiple sclerosis (MS).
MATERIAL AND METHODS:
All patients diagnosed with acute poliomyelitis in the greater capital area of Copenhagen, Denmark, between 1919 and 1954 were identified and followed with respect to MS. Information on vital status and diagnosis of sclerosis was obtained through linkage with the Danish Civil Registration System and The Danish Multiple Sclerosis Registry, respectively. Follow-up started on the date of the establishment of the Danish Civil Registration System (April 1, 1968) until death, emigration or December 31, 1996, whichever came first. The observed incidence of MS among polio patients was compared with the expected incidence calculated according to national gender, age and period specific rates of MS.
RESULTS:
During 149,364 years of follow-up, 19 cases of multiple sclerosis were observed among 5652 polio patients compared with 11.0 expected (SIR = 1.73 (1.04-2.74)). The increased risk of MS was most pronounced in polio patients hospitalized during adolescence. Neither gender nor the acute severity of poliomyelitis modified the risk of MS.
CONCLUSION:
Our results are based on small numbers of events, however the findings suggest that the polio patients might be at an increased risk of MS.
Conclusions:
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Motoneuron Disease and Past Poliomyelitis in England and Wales
Author: Martyn CN, Barker DJP, Osmond C.
Affiliation: MRC Environmental Epidemiology Unit, Southampton Hospital, United Kingdom
Journal: The Lancet Neurology
Citation: The Lancet, 331(8598):1319-1322
Publication Year and Month: 1988 06
Abstract: Past notification rates for poliomyelitis show a close geographical relation with current mortality from motoneuron disease in England and Wales. The increasing rate of poliomyelitis during the first half of this century and its predilection for affluent places and families were unique amongst infectious diseases. The unusual epidemiology of poliomyelitis is now being paralleled by motoneuron disease. These observations provide new evidence for a causal connection between the two conditions.
Conclusions:
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Poliomyelitis and Parkinson Disease.
Author: Nielsen NM, Rostgaard K, Hjalgrim H, Aaby P, Askgaard D.
Affiliation: Department of Epidemiology Research, National University Hospital, Copenhagen, Denmark
Journal: The Journal of the American Medical Association
Citation: JAMA. 2002;287(13):1650–1651.
doi:10.1001/jama.287.13.1645
Publication Year and Month: 2002 04
Abstract: Parkinson disease (PD), which is due to loss of dopaminergic neurons in the zona compacta of the substantia nigra,1 may involve both genetic and environmental risk factors.2 Poliovirus is believed to cause neuronal damage in the substantia nigra,3 and thus a history of poliovirus infection may be associated with an increased risk of PD
Conclusions:
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Diagnosis and Management
Title: Stroke Risk in Poliomyelitis Survivors: A Nationwide Population-Based Study
Author: Wu C-H, Liou T-H, Chen H-H, Sun T-Y, Chen K-H, Chang K-H
Affiliation: Wu, Sun, KH Chang: Chung-Yuan Christian University
Liou: Shuang Ho Hospital and Taipei Medical University, Taipei
HH Chen; Chang: Wan Fang Hospital
Chang: Taipei Medical University, Taipei
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 93, Issue 12, Pages 2184–2188
Publication Year and Month: 2012 12
Abstract: Objectives
To assess the prevalence and risk of stroke among adults with polio and controls.
Design
A prospective, probability-sampling, 6-year population-based cohort study.
Setting
A National Health Insurance Research Database consisting of 316,355 randomly selected enrollees. The database is related to a National Health Insurance program with more than 22 million participants.
Participants
After excluding patients under 40 years of age, polio patients (N=212) (mean age ± SD, 54.0±10.2y; 57.1% men) were identified from the database from January 1, 2003 to December 31, 2008. For each polio patient, 2 age- and sex-matched patients were recruited as controls. Control patients did not have any neuromuscular diseases commonly found in childhood. The frequencies of patients with potential risk factors for stroke were assessed.
Intervention
None.
Main Outcome Measure
The prevalence and the adjusted odds ratio of ischemic stroke among polio patients and the controls were estimated.
Results
Polio patients had a higher prevalence of stroke (10.8% vs 2.4%, P<.001) than the controls. Polio patients with hypertension had a much higher prevalence of stroke (23.0%). The risk of stroke was higher for polio patients compared with the controls, yielding an adjusted odds ratio of 4.17 (95% confidence interval, 1.84–9.45, P<.001). Polio was a significant risk factor for stroke independent from hypertension, diabetes mellitus, hyperlipidemia, and cardiac diseases.
Conclusions
Adults with polio had a high prevalence of ischemic stroke. Polio was an additional risk factor for stroke. Polio patients with hypertension might potentiate the risk of stroke. Developing a health promotion program, suitable for polio patients, to increase participation in activities and exercises may be essential, especially for polio patients with hypertension.
Conclusions:
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: Sense of Coherence in persons with late effects of polio
Author: Nolvi M, Brogardh C, Jacobsson L, Lexell J
Affiliation: Maria Nolvi, MD, Department of Health Sciences, PO Box 157, Lund University, SE-221 00 Lund, Sweden
Journal: NeuroRehabilitation
Citation: Vol. 42, no. 1, pp. 103-111, 2018
Publication Year and Month: 2018 01
Abstract: BACKGROUND:Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population. OBJECTIVE:To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability). METHOD:Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC. RESULTS:SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants’ marital status and level of education explained 37% (p < 0.001) of the variance in SOC.
Conclusions: CONCLUSION:Persons with LEoP have a level of sense of coherence (SOC) indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
Category: Diagnosis and Management
Title: Inverse Relationship Between Polio Incidence in the US and Colorectal Cancer.
Author: STEVEN LEHRER and PETER H RHEINSTEIN
Affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, U.S.A. [email protected].
Severn Health Solutions, Severna Park, MD, U.S.A.
Journal: IN VIVO
Citation: (Athens, Greece) vol. 32,6 (2018): 1485-1489.
Publication Year and Month: 2018
Abstract: BACKGROUND/AIM:
Polio is predominantly an enteric viral infection that was progressively eradicated in the United States after the introduction of polio vaccine in the early 1950s. U.S. colorectal cancer rates have dropped steadily for individuals born between 1890 and 1950, but have been increasing for every generation born since 1950. Moreover, the lowest worldwide age adjusted rates of colorectal cancer in 2012 were in sub-Saharan Africa, Gambia and Mozambique, where polio has not been eradicated. In the current study, poliomyelitis incidence in US states before the introduction of polio vaccine was analyzed.
MATERIALS AND METHODS:
Reported cases of poliomyelitis per 100,000 population by state 1932-1951 were from Centers for Disease Control. Colorectal cancer deaths per 100,000 in men (2005-2009) by US State are from the American Cancer Society. US state overweight and obesity data are from the Centers for Disease Control and Prevention (CDC). Smoking data are from the CDC.
RESULTS:
By US state, colorectal cancer incidence per 100,000 in men for 2005-2009 was inversely correlated with reported cases of poliomyelitis per 100,000 for 1932-1951 (r=-0.311, p=0.032). Colorectal cancer deaths per 100,000 in men in 2005-2009 were also inversely correlated with reported cases of poliomyelitis per 100,000 by state for 1932-1951 (r=-0.493, p<0.001). The relationship between colorectal cancer deaths and polio incidence was significant (β=-0.196, p=0.028) and independent of the effects of smoking (β=0.289, p=0.012) and overweight (β=0.547, p<0.001). The relationship in females with colorectal cancer was identical.
Conclusions: Polio virus infection of cells of the colon may induce some degree of resistance to the development of colon cancer decades later. The effect of polio virus infection seems to be especially potent in reducing the rate of death from colon cancer.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
Category: Diagnosis and Management
Title: Safety and feasibility of transcranial direct current stimulation for patients with post-polio syndrome
Author: Y. Matsushima, A. Hachisuka, H. Itoh, K. Sugimoto, S. Saeki
Affiliation: Department of rehabilitation medicine, University of occupational and environmental health, Japan
Journal: Brain Stimulation
Citation: (2019) 385-592
Publication Year and Month: 2019
Abstract: Post-polio syndrome (PPS) is generally defined as a clinical syndrome consisting of new muscle weakness, fatigue, and pain in poliomyelitis survivors. In PPS, there is no definitively validated treatment option, although Acler M et al. reported that anodal transcranial direct current stimulation (tDCS) over pre-motor cortex for 15 days improved sleep and fatigue symptoms in patients with PPS. tDCS may be a valuable, non-invasive new tool for managing patients with PPS.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management
Title: Lipid metabolic pathways converge in motor neuron degenerative diseases
Author: Olivia J Rickman, Emma L Baple, and Andrew H Crosby
Affiliation: Medical Research (Level 4), RILD Wellcome Wolfson Centre, University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
Correspondence to: Professor Andrew Crosby Professor of Human Genetics University of Exeter Medical School Medical Research (Level 4) RILD Wellcome Wolfson Centre Royal Devon and Exeter NHS Foundation Trust Barrack Road, Exeter, EX2 5DW, UK E-mail: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Brain. 2020 Apr; 143(4): 1073–1087.
Published online 2019 Dec 18. doi: 10.1093/brain/awz382
Publication Year and Month: 2019 12
Abstract: Motor neuron diseases (MNDs) encompass an extensive and heterogeneous group of upper and/or lower motor neuron degenerative disorders, in which the particular clinical outcomes stem from the specific neuronal component involved in each condition. While mutations in a large number of molecules associated with lipid metabolism are known to be implicated in MNDs, there remains a lack of clarity regarding the key functional pathways involved, and their inter-relationships. This review highlights evidence that defines defects within two specific lipid (cholesterol/oxysterol and phosphatidylethanolamine) biosynthetic cascades as being centrally involved in MND, particularly hereditary spastic paraplegia. We also identify how other MND-associated molecules may impact these cascades, in particular through impaired organellar interfacing, to propose ‘subcellular lipidome imbalance’ as a likely common pathomolecular theme in MND. Further exploration of this mechanism has the potential to identify new therapeutic targets and management strategies for modulation of disease progression in hereditary spastic paraplegias and other MNDs.
Keywords: HSP, MND, cholesterol, mitochondria, lipidome imbalance
Conclusions: The development of new methodologies and approaches are important to delineate the specific subcellular biomarker deficits, such as oxysterol and PE imbalance, in HSP and MND. As well as providing potentially powerful biomarkers of disease, such tools may enable monitoring of treatment efficacy of therapeutics to re-address disease-associated lipidome imbalances. Specific genetic subtypes may be more amenable to treatment at targeting (for example) feedback systems, such as CDCA in CTX, or addressing oxysterol imbalance in SPG5. Genetic subtypes of disease leading to more complex subcellular outcomes may require multiple treatment approaches to address the specific mechanistic basis of each condition, and it may be unlikely that one approach will entail a ‘fix all’ treatment. Ultimately, clearer definition of the subcellular lipidome (and other) biological pathways underlying MND and HSP will pave the way for a more elegant approaches for predicting onset and severity of disease, and for designing and monitoring new therapeutic approaches.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management, Differential Diagnosis
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.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management, Differential Diagnosis, Gender Differences, Late Effects of Polio
Title: Postpolio Syndrome: A Review of Lived Experiences of Patients
Author: Oluwaseyi Jacob Oluwasanmi, Devaunna Andrene Mckenzie, Idowu Oluwasegun Adewole, Christian O Aluka, James Iyasse, Esther Olunu, and Adegbenro Omotuyi Fakoya1
Affiliation: Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
1Department of Anatomical Sciences, University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis
Address for correspondence: Dr. Adegbenro Omotuyi Fakoya, University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis. E-mail: [email protected]
Journal: International Journal of Applied & Basic Medical Research
Citation: 9(3), 129–134. https://doi.org/10.4103/ijabmr.IJABMR_333_18
Publication Year and Month: 2019 07
Abstract: Postpolio syndrome (PPS) refers to a group of conditions that are present in patients, years after recovery from initial acute paralytic poliomyelitis. About 15%–80% of 20 million polio survivors worldwide will experience exacerbation of symptoms which typically appear 15–30 years after the resolution of initial poliomyelitis. Symptoms include new muscle weakness, fatigue, myalgia, joint pain, dysphagia, and difficulty breathing. Other reported symptoms include cold intolerance, sleep disorder, dysphonia, loss of stamina, musculoskeletal deformities, cardiovascular disorders, psychosocial problems, and restless legs syndrome. These symptoms are attributed to the superimposed neuronal loss of aging with inflammatory mechanisms, but without any convincing evidence of viral reactivation. Risk factors include female gender, respiratory symptoms, normal aging, permanent disability caused by motor neuron damage, muscle overuse and disuse, aging, and immunologic mechanisms. Hypothyroidism-induced myopathy and fibromyalgia are a differential diagnosis for PPS, and exclusion diagnosis is required as confirmatory criteria for PPS. The symptoms of PPS presented determine the course of management.
Keywords: Fatigue, muscle weakness, myalgia, poliomyelitis, postpolio syndrome
Conclusions: PPS is a sequela of acute poliomyelitis which occurs decades after resolution of the initial paralytic or nonparalytic polio. Fatigue, muscle weakness, myalgia, and joint pain are the major symptoms of PPS. Diagnosis of PPS is made based on the exclusion of other conditions that can cause similar symptoms. The quality of life of patients with PPS is significantly affected by the reoccurrence of the constellations of symptoms they experience. Proper assessment and treatment should be performed to prevent severe impairment of function in patients.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Drugs
Title: Effect of intravenous immunoglobulin on pain in patients with post-polio syndrome
Author: Werhagen L, Borg K
Affiliation: Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2011 Nov;43(11):1038-40. doi: 10.2340/16501977-0884.
Publication Year and Month: 2011 11
Abstract: OBJECTIVE: Pain is a common symptom that affects quality of life in patients with post-polio syndrome. An increase in cytokine in the cerebrospinal fluid suggests that inflammation is pathophysiologically important in post-polio syndrome. Intravenous immunoglobulin might therefore be a therapeutic option. The aim of this study was to analyse the effect of intravenous immunoglobulin treatment on pain in post-polio syndrome.
METHODS: An uncontrolled clinical study. Patients with post-polio syndrome and pain (n = 45) underwent a neurological examination and were interviewed about pain before and 6 months after treatment with intravenous immunoglobulin. Pain intensity was measured on a visual analogue scale. The pain was classified according to the International Association for the Study of Pain criteria as neuropathic when it occurred in an area with decreased sensibility, or nociceptive when signs of inflammation and/or painful joints movements were present.
RESULTS: After treatment 31/45 (69%) patients were improved, with a mean visual analogue scale decrease from 53 to 42 (p = 0.001). Eighteen patients (40%) had a decrease of 20 or more points on the visual analogue scale. The effect of treatment did not differ regarding age, gender and severity of disability.
Conclusions: Two-thirds of 45 patients with post-polio syndrome and pain reported a decrease on the visual analogue scale for pain after treatment with intravenous immunoglobulin, and 40% reported a decrease of 20 or more points on the visual analogue scale.
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Drugs
Title: Efficacy of Modafinil on fatigue and excessive daytime sleepiness associated with neurological disorders: a systematic review and meta-analysis
Author: Sheng P, Hou L, Wang X, Wang X, Huang C, Yu M, Han X, Dong Y.
Affiliation: Department of Neurosurgery, Shanghai Institute of Neurosurgery, Military Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
Journal: Public Library of Science
Citation: PLoS One. 2013 Dec 3;8(12):e81802. doi: 10.1371/journal.pone.0081802
Publication Year and Month: 2013 03
Abstract: BACKGROUND: Modafinil is a novel wake-promoting agent approved by the FDA ameliorating excessive daytime sleepiness (EDS) in three disorders: narcolepsy, shift work sleep disorder and obstructive sleep apnea. Existing trials of modafinil for fatigue and EDS associated with neurological disorders provided inconsistent results. This meta-analysis was aimed to assess drug safety and effects of modafinil on fatigue and EDS associated with neurological disorders.
METHODS: A comprehensive literature review was conducted in order to identify published studies assessing the effects of modafinil on fatigue and EDS associated with neurological disorders. Primary outcomes included fatigue and EDS. Secondary outcomes included depression and adverse effects.
FINDINGS: Ten randomized controlled trials were identified including 4 studies of Parkinson's disease (PD), 3 of multiple sclerosis (MS), 2 of traumatic brain injury (TBI) and 1 of post-polio syndrome (PPS). A total of 535 patients were enrolled. Our results suggested a therapeutic effect of modafinil on fatigue in TBI (MD -0.82 95% CI -1.54 - -0.11 p=0.02, I(2)=0%), while a beneficial effect of modafinil on fatigue was not confirmed in the pooled studies of PD or MS. Treatment results demonstrated a clear beneficial effect of modafinil on EDS in patients with PD (MD -2.45 95% CI -4.00 - -0.91 p=0.002 I(2)=14%), but not with MS and TBI. No difference was seen between modafinil and placebo treatments in patients with PPS. Modafinil seemed to have no therapeutic effect on depression. Adverse events were similar between modafinil and placebo groups except that more patients were found with insomnia and nausea in modafinil group.
Conclusions: Existing trials of modafinil for fatigue and EDS associated with PD, MS, TBI and PPS provided inconsistent results. The majority of the studies had small sample sizes. Modafinil is not yet sufficient to be recommended for these medical conditions until solid data are available.
Outcome of Research: More research required.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Drugs
Title: Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders
Author: Östlund G (1), Broman L, Werhagen L, Borg K
Affiliation: (1) Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, 3rd floor, SE-182 88 Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2015 Aug 18. doi: 10.2340/16501977-1985
Publication Year and Month: 2015 08
Abstract: OBJECTIVE: To define and characterize responders and non-responders in a group of 124 patients with post-polio syndrome who received a single treatment with intravenous immunoglobulin.
DESIGN: Open trial, prospective follow-up study.
METHODS: Clinical examination and data from medical records. Short Form 36 (SF-36), Physical Activity Scale for the Elderly (PASE) and visual analogue scale (VAS) measured quality of life, physical activity and intensity of pain, respectively. Data were obtained before treatment and at 6-month follow-up.
RESULTS: Two responder groups were identified with the outcome SF-36 Vitality and 3 with Bodily pain, respectively. Forty-five percent were positive-responders, identified before treatment by reduced physical function, muscle atrophy in the lower extremities, higher levels of fatigue and pain, and a VAS pain score above 20. Negative-responders were identified by good physical function and mental health, lesser muscle atrophy in the lower extremities, and low levels of fatigue and pain.
Conclusions: Intravenous immunoglobulin is a biological intervention, and therefore it is important to be able to identify responders and non-responders. In order to maximize a positive outcome it is suggested that patients with a high level of fatigue and/or pain and reduced physical function are selected.
Outcome of Research: Effective
Comments (if any): Other - see Comments.
Link to Full Paper (if available): Click here to view Abstract
Category: Drugs
Title: IVIG treatment in post-polio patients: evaluation of responders
Author: Ostlund G (1), Broman L, Werhagen L, Borg K
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Building 39, 3rd floor, 182 88 Stockholm, Sweden
Journal: Journal of Neurology
Citation: J Neurol. 2012 Dec;259(12):2571-8. doi: 10.1007/s00415-012-6538-y. Epub 2012 May 17
Publication Year and Month: 2012 05
Abstract: The aim of this work is to evaluate the outcome of IVIG treatment in patients with post-polio syndrome (PPS) and to identify responders. The study included 113 PPS patients who had received one IVIG treatment in an open trial, prospective follow-up study. Clinical examination was performed and clinical data were retrieved from medical records. The short form 36 (SF-36), physical activity scale for the elderly (PASE), and the visual analogue scale (VAS) were used as measurements of quality of life, physical activity, and the intensity of pain. Data before treatment and at 6-month follow-up were collected. Analysis was performed in subgroups based on demographic and medical parameters. A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. A trend was found in patients with PPS as the only diagnosis. IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. Age below 65 years, paresis in the lower extremities, and lack of concomitant disorders may be the main indicators for a future identification of responders.
Conclusions:
Outcome of Research: Effective
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Drugs
Title: Immunoglobulin g for the treatment of chronic pain: report of an expert workshop
Author: Tamburin S (1), Borg K, Caro XJ, Jann S, Clark AJ, Magrinelli F, Sobue G, Werhagen L, Zanette G, Koike H, Späth PJ, Vincent A, Goebel A
Affiliation: (1) Department of Neurological and Movement Sciences, University of Verona, Verona, Verona, Italy
Journal: Pain Medicine
Citation: Pain Med. 2014 Jul;15(7):1072-82. doi: 10.1111/pme.12319
Publication Year and Month: 2014 07
Abstract: BACKGROUND: The treatment of chronic pain is still unsatisfactory. Despite the availability of different drugs, most patients with chronic pain do not receive satisfactory pain relief or report side effects. Converging evidence implicates involvement of the immune system in the pathogenesis of different types of nociceptive and neuropathic chronic pain.
DESIGN: At a workshop in Liverpool, UK (October 2012), experts presented evidence suggesting immunological involvement in chronic pain and recent data supporting the concept that the established immune-modulating drug, polyvalent immunoglobulin G (IgG), either given intravenously (IVIg) or subcutaneously (SCIg), may reduce pain in some peripheral neuropathies and a range of other pain disorders. Workshop's attendees discussed the practicalities of using IVIg and SCIg in these disorders, including indications, cost-effectiveness, and side effects.
RESULTS: IgG may reduce pain in a range of nociceptive and neuropathic chronic pain conditions, including diabetes mellitus, Sjögren's syndrome, fibromyalgia, complex regional pain syndrome, post-polio syndrome, and pain secondary to pathological autoantibodies.
Conclusions: IgG is a promising treatment in several chronic pain conditions. IgG is a relatively safe therapeutic strategy, with uncommon and mild side effects but high costs. Randomized, controlled trials and predictive tests are needed to better support the use of IgG for refractory chronic pain.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Drugs
Title: Bromocriptine In The Treatment Of Post-Polio Fatigue: A pilot study with implications for the pathophysiology of fatigue
Author: Richard L. Bruno, Ph.D., Jerald R. Zimmerman, M.D., Susan Creange, M.A., Todd Lewis, Ph.D., Terry Molzen, M.A., and Nancy M. Frick, M.Div, Lh.D.
Affiliation: Post-Polio Rehabilitation and Research Service; Kessler Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation; UMDNJ/New Jersey Medical School, Harvest Center; Hackensack, New Jersey
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: American Journal of Physical Medicine and Rehabilitation, 1997 (in press)
Publication Year and Month: 1997
Abstract: Objective: Determine the effectiveness of bromocriptine in the treatment of severe and disabling post-polio fatigue.
Design: Placebo-controlled drug trial in a pilot series of patients.
Setting: Outpatient rehabilitation hospital.
Patients: Of 83 patients without comorbidities who completed treatment with the Post-Polio Service, 5 of 8 patients who had paralytic polio and continued to report moderate to severe daily fatigue after complying with conservative treatments for post-polio fatigue agreed to be studied.
Intervention: Placebo was given for four weeks followed by increasing doses of bromocriptine mesylate (Parlodel®) administered at noon for 28 days reaching a total dose of 12.5 mg/day.
Main Outcome Measures: Daily logs of subjective fatigue and cognitive difficulties.
Results: Three of the subjects reported symptom improvement on bromocriptine but not on placebo. However, all subjects experienced nausea on bromocriptine, likely eliminating blinding. Drug responders had clinically impaired performance on neuropsychological tests of attention and information processing speed. Logged daily difficulty with attention, cognition, word finding memory, staying awake and fatigue on awakening were significantly negatively correlated with days on bromocriptine, but not with days on placebo, in drug responders.
Conclusions: A double-blind, placebo-controlled multicenter study will be needed to confirm bromocriptine's effectiveness in treating attentionally-impaired polio survivors whose severe and disabling fatigue does not responded to conservative treatment.
Conclusions: This pilot study of severely fatigued polio survivors suggests that bromocriptine may be of use in the treatment of post-polio fatigue that has not responded to conservative therapies. However, the small sample size and methodological limitations make this suggestion merely tentative. Since nausea was universally experienced, all subjects may have realized that they were receiving active drug and were thereby biased toward reporting reductions in symptoms. The percentage of days on which side effects were experienced on bromocriptine was higher in the responders (48%) than non-responders (34%). Although the placebo phase was not compromised, the bromocriptine phase of the study may have been as unblinded as an open-label drug trial. Reductions in morning fatigue and fatigue-related cognitive symptoms as the dose of bromocriptine increased were not paralleled by drug-related improvements in neuropsychologic test scores, most likely since the same form of the tests was administered on placebo and on bromocriptine. Subjects repeatedly taking the same test would be expected to demonstrate a learning effect and have their test scores improve. This has been seen even in polio survivors with severe fatigue who were repeatedly administered the same neuropsychologic tests over the course of several hours [4] It was also surprising that drug responders noticed no reduction in fatigue during the afternoon, since bromocriptine was administered at noon so that a peak blood level would be reached at 3:00 PM when many polio survivors report hitting an afternoon "wall" of fatigue. Since the pharmacokinetics of bromocriptine could differ from the time course of its pharmacological effect, as is seen with D2 receptor antagonists, moving the dose of drug to before sleep or upon awakening may prolong any beneficial effect of the drug into the afternoon. [18]
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Drugs
Title: Use of Medication in People with Post-Polio Syndrome
Author: Susan Perlman, MD
Affiliation: University of California Los Angeles (UCLA)
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Polio Network News (Now called Polio-Polio Health)
WINTER 1999, VOL. 15, No. 1
Publication Year and Month: 1999 12
Abstract: Until we better understand the causes of post -polio syndrome, we will have no curative medication. At best, we can use medication to treat the symptoms and to improve the quality of life, and we can avoid using medication that could make the symptoms worse. Certain other diseases (elevated blood cholesterol levels, high blood pressure, heart disease, and cancers) require use of medications with side effects that can exacerbate symptoms of post-polio syndrome. These should be used, but with careful monitoring of the polio survivor's functioning.
Conclusions: Polio survivors and their physicians should scrutinize all medications - current and newly added - used to treat various medical problems to be assured that related conditions, such as fibromyalgia, elevated cholesterol, high blood pressure, etc., are appropriately treated, but with minimal effect on polio-related symptoms.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Dysphagia, Dysphonia, Late Effects of Polio
Title: Pharyngolaryngeal manifestations of post-polio syndrome (Manifestações faringo-laríngeas da síndrome pós-poliomielite)
Author: Noemi Grigoletto De Biase (1), Bruno Teixeira de Moraes (2), Mariana Dantas Aumond Leb (3), Gustavo Polacow Korn (4), Marina Padovani (5), Miriam Moraes (6), Glaucya Madazio (7).
Affiliation: Departament of Laryngology and Voice of the Discipline of Otorhinolaryngology of Federal University of São Paulo - Medical School Paulista (UNIFESP-EPM). São Paulo / SP - Brazil
1) Prof. Doc. Associate of Departament of Fundamentals of Phonoaudiology of Pontifical Catholic University of São Paulo. Advisor of Masters Degree of UNIFESP-EPM.
2) Fellow in Larynx and Voice by the Departament of Otorhinolaryngology and Surgery of Head and Kneck by Federal University of São Paulo - Medical School Paulista (UNIFESP-EPM). Doctor Otorhinolaryngologist.
3) Master in Medicine by UNIFESP-EPM. Doctor Otorhinolaryngologist.
4) PhD in Science by the Departament of Otorhinolaryngology and Surgery of Head and Kneck by Federal University of São Paulo - Medical School Paulista (UNIFESPEPM). Doctor Otorhinolaryngologist.
5) PhD in Science of Human Communication by UNIFESP. Clinical Audiologist.
6) Master in Science of Human Communication by UNIFESP - Clinical Audiologist.
7) PhD in Science of Human Communication by UNIFESP. Clinical Audiologist.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Intl. Arch. Otorhinolaryngol., São Paulo - Brasil, v.15, n.4, p. 529-533, Oct/Nov/December - 2011.
Publication Year and Month: 2010 04
Abstract: INTRODUCTION: The post-polio syndrome (PPS) is characterized by a new episod of atrophy or muscle weakness in individuals previously affected by poliomyelitis. The symptoms start from an extended period of clinical stability ranging from 20 to 40 years, after the initial chart of polio. Among the pathophysiological mechanisms, the most likely is that the syndrome represents a process of attrition and neuronal metabolic exhaustion due to a continuous process of denervation reinnervation which begins after the initial acute.
OBJECTIVE: Review the clinical characteristics and pathophysiological of PPS,as well as present the approach in cases with pharyngolaryngeal manifestations.
CASE REPORT: We present the clinical case of a male patient with 48 years old, with main complaints of dysphonia, dysphagia and previous history of polio. The patient underwent a diagnostic investigation, in which the voice psychoacoustic findings are described. Laringoscopic, electromyographic and the videoendoscopy of swallowing compatible with PPS. The treatment consisted in phonotherapy in a total of 11 weekly sessions and guidelines for swallowing, with satisfactory improvement of the symptoms.
FINAL COMMENTS: The pharyngolaryngeal manifestations of PPS are susceptible to treatment, obtaining satisfactory results, with improvement of life quality of the patients.
KEYWORDS: poliomyelitis, post-polio syndrome, neuromuscular diseases, larynx diseases, voice disorders.
Conclusions: The diagnosis of PPS depends of the high rate of suspicion and a good anamnesis, in which the patient reports previous history of poliomyelitis. As in the most of the cases these patients present other commemorative resulting of the syndrome, voice alterations become less evident before the whole picture. Active searches in services of references in treatment of PPS can show that the frequency of dysphonia and dysphagia maybe is bigger than the ones described in the literature. Considering that the laryngeal-pharyngeal manifestations of PPS are suitable for treatment with improvement of life quality of the patients, is evident the importance of the diagnosis.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Polio residuals clinic: conditioning exercise program
Author: Owen RR, Jones D
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):882-3
Publication Year and Month: 1985 07
Abstract: The additional disability experienced by individuals who had poliomyelitis many years earlier has a variety of expressions and a variety of interacting origins. Undertraining and deconditioning are addressed in this article. Weakened musculature often fatigues before a conditioning level of activity is reached. An adapted exercise program for cardiac endurance will reduce symptoms of fatigue and pain. An intentional training program for muscles weakened further by disuse or underutilization will supplement the conditioning program. The clinical assessment and exercise prescription is described.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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):
Link to Full Paper (if available):
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Exercise
Title: Post-polio fatigue: a 31P magnetic resonance spectroscopy investigation
Author: Thompson RT, Barton PM, Marsh GD, Cameron MG, Gravelle DG, Hsieh JT, Hayes KC, Driedger AA
Affiliation: Department of Nuclear Medicine, St. Joseph's Health Center, London, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1263-7
Publication Year and Month: 1991 11
Abstract: Changes in high energy phosphates (HEP) and intramuscular pH during exercise were measured in 17 patients with post-polio fatigue and in 28 healthy controls using 31P magnetic resonance spectroscopy (MRS). Subjects performed a dynamic hand grip exercise at low and high intensity. Mean changes in the HEP and pH showed no significant differences between the groups, although the post-polio group's response was highly variable. Six patients showed evidence of a lower lactate accumulation during the high intensity exercise when compared with controls. These data suggest that the whole body fatigue experienced by polio survivors is not related to any systemic metabolic abnormality.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome
Author: Vreede KS, Henriksson J, Borg K, Henriksson M
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88 Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013 Sep;45(9):924-8. doi: 10.2340/16501977-1209.
Publication Year and Month: 2013 09
Abstract: OBJECTIVE: To evaluate gait in patients with post-polio syndrome, using the 6-minute walk test (6MWT) combined with three-dimensional kinematic analysis.
DESIGN: Descriptive study.
SUBJECTS: Eighteen patients and 11 healthy controls.
METHODS: Kinematic data were obtained during a 6MWT by a Vicon motion capture system. Distance, heart rate, leg tiredness, dyspnoea and exertion were also recorded.
RESULTS: Patients with post-polio syndrome showed larger increases in leg tiredness (p < 0.001) and dyspnoea (p < 0.05) as a result of the 6MWT than did controls. Walking speed decreased by 14.1% in patients vs 4.7% in controls (p < 0.05). Fourteen out of 18 patients displayed plantar-flexed ankle at initial contact (1/11 controls). At foot-off, the patients had a flexed hip (extended in controls) and a more flexed knee. Walking speed in patients correlated with hip angle at footoff, at the start (r = –0.60, p < 0.001) and the end of the 6MWT (r = –0.74, p < 0.001), being higher the more the hip was extended.
CONCLUSION: The 6MWT is fatiguing for patients with post polio syndrome, and this was reflected in the kinematic data. Walking speed was negatively correlated with the increased hip flexion, but not with the ankle plantar-flexion at foot-off in the patients with post-polio syndrome. The three-dimensional results underscore the importance of hip function in this patient group.
Conclusions:
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Postpolio syndrome and cardiopulmonary conditioning
Author: Owen RR
Affiliation: Sister Kenny Institute, Minneapolis, Minnesota 55407
Journal: The Western Journal of Medicine
Citation: West J Med. 1991 May;154(5):557-8 (Rehabilitation Medicine - Adding Life to Years [Special Issue])
Publication Year and Month: 1991 05
Abstract: Postpolio syndrome is a group of related signs and symptoms occurring in people who had paralytic poliomyelitis years earlier. New weakness, fatigue, poor endurance, pain, reduced mobility, increased breathing difficulty, intolerance to cold, and sleep disturbance in various degrees and expressions make up the syndrome. The reported incidence is between 25% and 80%. The origins are multifactorial and can be associated with underexertion, overexertion, inactivity due to intercurrent illness or injury, hypo-oxygenation, sleep apnea, deconditioning, and the failure of sprouted, compensatory large motor units. The exercise question in postpolio syndrome is related to the experience of new weakness or loss of muscle function due to overuse, which is often associated with injudicious repeated challenges to weakened musculature. Carefully prescribed exercise can be used for increasing strength and endurance and improving cardiopulmonary conditioning.
Conclusions: Stretching and flexibility exercises are critical physical hygiene measures for the management of pain, instability, and deformity. These exercises should also precede cardiopulmonary conditioning and other vigorous physical pursuits. Muscle training and strengthening when carefully defined and judiciously implemented can safely build force and power. Resistive exercises should be prescribed for specific goals rather than for purposes of general muscle training. An adapted cardiopulmonary conditioning program has been created to provide improved cardiac status without the risk of overuse damage to nerve and muscle.
The management of postpolio syndrome requires applying traditional physical treatment principles with specific attention to the factors of the vulnerability of compensatory mechanisms to injury by overuse, underuse, underoxygenation, and an inefficient use of weakened musculature. Clinicians must provide information and a balanced prescription of exercise, rest, activity, support, and intelligent accommodation to additional disability.
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher
Link to Full Paper (if available): Click here to download
Category: Exercise
Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01
Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.
DESIGN: Before-after tests.
SETTING: A university hospital department.
PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).
INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).
MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.
RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.
Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.
Outcome of Research: Effective.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Determining the anaerobic threshold in postpolio syndrome: comparison with current guidelines for training intensity prescription
Author: Voorn EL (1), Gerrits KH (2), Koopman FS (3), Nollet F (3), Beelen A (3)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands. Electronic address: [email protected]; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2014 May;95(5):935-40. doi: 10.1016/j.apmr.2014.01.015
Publication Year and Month: 2014 05
Abstract: OBJECTIVES: To determine whether the anaerobic threshold (AT) can be identified in individuals with postpolio syndrome (PPS) using submaximal incremental exercise testing, and to compare current guidelines for intensity prescription in PPS with the AT.
DESIGN: Cohort study.
SETTING: Research laboratory.
PARTICIPANTS: Individuals with PPS (N=82).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Power output, gas exchange variables, heart rate, and rating of perceived exertion (RPE) were measured in an incremental submaximal cycle ergometry test. Two independent observers identified the AT. Comparison of current guidelines for training intensity prescription in PPS (40%-60% heart rate reserve [HRR] or RPE of 12) with the AT was based on correlations between recommended heart rate and the heart rate at the AT. In addition, we determined the proportion of individuals that would have been recommended to train at an intensity corresponding to their AT.
RESULTS: The AT was identified in 63 (77%) of the participants. Pearson correlation coefficients between the recommended heart rate and the heart rate at the AT were lower in cases of 40% HRR (r=.56) and 60% HRR (r=.50) than in cases of prescription based on the RPE (r=.86). Based on the RPE, 55% of the individuals would have been recommended to train at an intensity corresponding to their AT. This proportion was higher compared with 40% HRR (41%) or 60% HRR (18%) as criterion.
Conclusions: The AT can be identified in most individuals with PPS offering an individualized target for aerobic training. If the AT cannot be identified (eg, because gas analysis equipment is not available), intensity prescription can best be based on the RPE.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to download
Category: Exercise
Title: Submaximal exercise capacity and maximal power output in polio subjects
Author: Nollet F, Beelen A, Sargeant AJ, de Visser M, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Dec;82(12):1678-85
Publication Year and Month: 2001 12
Abstract: OBJECTIVES: To compare the submaximal exercise capacity of polio subjects with postpoliomyelitis syndrome (PPS) and without (non-PPS) with that of healthy control subjects, to investigate the relationship of this capacity with maximal short-term power and quadriceps strength, and to evaluate movement economy.
DESIGN: Cross-sectional survey.
SETTING: University hospital.
PARTICIPANTS: Forty-three polio subjects (25 PPS, 18 non-PPS) and 12 control subjects.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Power output, oxygen uptake, and heart rate were measured in an incremental submaximal cycle ergometry test. Maximal short-term power was measured in 5-second all-out efforts. Knee extensor strength was measured on a chair dynamometer.
RESULTS: The mean submaximal power +/- standard deviation at 80% of heart rate reserve of 83.8 +/- 29.9 watts in the polio subjects was significantly less than the mean submaximal power of 142.1 +/- 30.4 watts in the control group. However, expressed as a percentage of the maximal short-term power, submaximal power did not differ between the groups. Strength and maximal short-term power correlated significantly (p < .005) with submaximal power (r = .64 and .76, respectively). The oxygen uptake was higher than theoretically expected for the given submaximal power output in polio subjects, and appeared to increase with increasing asymmetry in strength and power between legs. No differences were found between PPS and non-PPS subjects.
Conclusions: The submaximal work capacity of polio subjects was severely reduced, mainly in association with the reduced muscle capacity. And, because of a reduced movement economy, their energy cost was elevated. Although muscle loads in activities such as walking and climbing stairs differ from cycling, they also may require elevated relative levels of effort, predisposing subjects to premature fatigue in sustained activity.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise
Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03
Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.
The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to download
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.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09
Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.
Design: Observational study.
Participants: Thirty-three polio survivors, able to walk ≥ 150 m.
Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.
Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.
Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.
Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise
Title: Effect of aquatic exercise training in persons with poliomyelitis disability
Author: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A.
Affiliation:
Journal:
Citation: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A. (1994) Effect of aquatic exercise training in persons with poliomyelitis disability. Sports Medicine, Training and Rehabilitation. 5(1):29-39
Publication Year and Month: 1994 01
Abstract: Aquatic exercise, including swimming, reduces the effect of body weight on limbs and joints. A combination of swimming and specific activities involving resistive devices was used in an attempt to improve strength in persons who had symptomatic weakness related to poliomyelitis. Dynamic muscular force application in selected limb movements and range of motion were measured before and after an 8‐week aquatic exercise intervention. Peak (PF) and average force (AF) were determined in the water using a differential pressure transducer attached to either the hand, foot, or a resistive device. Arm flexion, extension, adduction, abduction, and horizontal adduction and abduction along with combined hip flexion and knee extension were tested for both PF and AF Subjects were randomly assigned to experimental and control groups; complete data were available on nine experimental and four control subjects. PF and AF changes were greater (p ≤ 0.05) for experimental compared with control for right arm flexion (PF, 96 versus 6%) and extension (PR 105 versus ‐15%; AF, 76 versus ‐30%), respectively. Changes were greater (p ≤0.05) in experimental than control for left arm extension (PF, 88% versus 19%) and horizontal abduction (PF, 127% versus ‐21%; AF, 122% versus ‐17%). Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.
Conclusions: Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise
Title: Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter?
Author: Whitehead BR, Blaxton JM
Affiliation: 1 Behavioral Sciences Department, University of Michigan-Dearborn.
2 Department of Psychology, University of Notre Dame, Indiana.
Journal: The Gerontologist
Citation: 2017 Nov 10;57(6):1062-1071
Publication Year and Month: 2017 11
Abstract: PURPOSE OF THE STUDY:
There is little debate that maintaining some level of physical activity in later life conveys positive benefits both physically and psychologically. What is less understood is the extent to which the type of activity or the length of time spent doing it matters when it comes to these benefits on the daily level. Here, we investigated (a) whether the presence of daily purposeful exercise (Exercise) or non-exercise physical activity (Activity) is sufficient for experiencing day-level benefits, or if time spent matters, and (b) whether there are differential well-being benefits of Exercise and Activity on the daily level.
DESIGN AND METHODS:
Older adults (N = 127; aged 60-95, Mage = 79.4) filled out surveys for 14 days, reporting daily Exercise and Activity behaviors as well as Positive and Negative Affect (PA/NA), Perceived Stress (PS), Perceived Health (PH), and Sleep Quality (SQ).
RESULTS:
Multilevel regression models showed that for purposeful exercise, more time spent was beneficial for PA, NA, and PH, but for PS, only the presence of exercise was important (time did not matter). For non-exercise activity, time did not have as great an influence as presence-doing any form of activity was beneficial for both PA and SQ. Exercise and Activity had largely independent (additive) effects.
Conclusions: Results reveal that both purposeful exercise and non-exercise activity convey independent daily well-being benefits, and that for some aspects of daily well-being, duration does matter. Findings can be applied in the development of physical activity education or engagement programs for older adults.
Outcome of Research: Effective
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Short-term effects of aerobic exercise on functional capacity, fatigue, and quality of life in patients with post-polio syndrome.
Author: Oncu J, Durmaz B, Karapolat H.
Affiliation: Ege University Medical Faculty Physical Medicine and Rehabilitation Department, Izmir, Turkey.
Journal: Clin Rehabil.
Citation: 2009 Feb;23(2):155-63
Publication Year and Month: 2009 02
Abstract: OBJECTIVE:
To investigate and compare the impact of hospital and home exercise programmes on aerobic capacity, fatigue, and quality of life in patients with post-polio syndrome.
DESIGN:
A prospective, randomized controlled trial.
SETTING:
Department of Physical Medicine and Rehabilitation, University Hospital.
SUBJECTS:
Thirty-two patients were divided into two groups for either hospital- or home-based aerobic exercise programme.
MAIN OUTCOME MEASURES:
Patients were assessed before and after the rehabilitation programme, with respect to functional capacity (pVo2), fatigue (Fatigue Severity Scale, Fatigue Impact Scale) and quality of life (Nottingham Heath Profile).
RESULTS:
After the exercise programme, improvement was observed in the hospital exercise group compared to a pre-exercise period in all Nottingham Heath Profile scores (except sleep scores), pVo2, Fatigue Severity Scale and Fatigue Impact Scale (cognitive, physical, psychosocial, total) (P<0.05). In contrast, in the home exercise group a decrease was observed in pVo2 scores after the rehabilitation programme, compared to a pre-rehabilitation period (P<0.05). In addition, a significant improvement was observed in the home exercise group after the rehabilitation programme in all parameters excluding Fatigue Impact Scale-physical, Fatigue Impact Scale-psychosocial, and Nottingham Heath Profile-sleep (P<0.05). When the two exercise groups were compared, improvement was observed in the hospital exercise group compared to the home exercise group in pVo2 and Fatigue Severity Scale-total, Fatigue Impact Scale-physical, Fatigue Impact Scale-psychosocial, Fatigue Impact Scale-total, and Nottingham Heath Profile-energy scores (P<0.05).
Conclusions: CONCLUSION:
Fatigue and quality of life were both improved in the home and hospital exercise groups. An increase was also found in the functional capacity in the hospital exercise group. A regular exercise programme is beneficial to patients with post-polio syndrome.
Outcome of Research: Effective
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
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):
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: Effects of resistance training in combination with coenzyme Q10 supplementation in patients with post-polio: a pilot study.
Author: Skough K, Krossén C, Heiwe S, Theorell H, Borg K.
Affiliation: Department of Clinical Sciences, Karolinska Institutet, Division of Rehabilitation Medicine, Danderyds Hospital, Stockolm, Sweden.
Journal: Journal of Rehabilitation Medicine
Citation: 2008 Oct;40(9):773-5.
Publication Year and Month: 2008 10
Abstract: OBJECTIVE:
Coenzyme Q10 supplementation leads to increased muscle metabolism in patients with post-polio syndrome. The aim of this study was to investigate the effect of resistance training in combination with oral supplementation with coenzyme Q10 in patients with post-polio syndrome regarding muscle strength and endurance as well as functional capacity and health-related quality of life.
DESIGN:
Parallel randomized, controlled, double-blind pilot study.
PATIENTS AND METHODS:
A total of 14 patients (8 women and 6 men) with post-polio syndrome participated in a 12-week muscular resistance training, 3 days/week. The patients were randomized for oral supplementation with coenzyme Q10, 200 mg/day, or placebo. Measurements used were: sit-stand-sit test, timed up & go test, 6-minute walk test, muscle strength measurement by means of dynamic dynamometer and short-form (SF)-36 questionnaire.
RESULTS:
Muscle strength, muscle endurance and quality of life regarding mental health increased statistically significantly in all 14 patients. There was no significant difference between the coenzyme Q10 and placebo groups regarding muscle strength, muscle endurance and quality of life.
Conclusions: There was no effect of coenzyme Q10 supplementation during resistance training on post-polio syndrome symptoms. Thus, supplementation with coenzyme Q10 has no beneficial effect on muscle function in patients with post-polio syndrome.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise
Title: Assessment of subjective and motor fatigue in Polio survivors, attending a Postpolio clinic, comparison with healthy controls and an exploration of clinical correlates.
Author: Murray D, Hardiman O, Meldrum D.
Affiliation: Department of Physiotherapy, Beaumont Hospital , Beaumont, Dublin , Ireland .
Journal: Physiotherapy Theory and Practice
Citation: 2014 May;30(4):229-35.
Publication Year and Month: 2014 05
Abstract: PURPOSE:
Polio survivors experience declining mobility, pain and fatigue. The extent of motor fatigue and its impact on mobility and quality of life, in addition to other commonly reported impairments requires evaluation.
METHODS:
An observational, case-control, cross-sectional design was used to assess 30 Polio survivors and 30 age- and sex-matched controls. Muscle strength and motor fatigue were assessed using fixed dynamometry. Fatigue, pain and quality of life were assessed using the Piper Fatigue Scale, the Fatigue Severity Scale, visual analogue scales and the RAND Short Form-36, respectively. An 8-min walking test, including physiological cost index (PCI), evaluated mobility.
RESULTS:
A significant difference in motor fatigue was identified only in hand grip (p = 0.03). Polio survivors were significantly weaker (p < 0.001) and more fatigued (p < 0.001) than controls. Motor fatigue was not related to subjective fatigue, mobility or quality of life. Muscle strength predicted mobility. Pain and fatigue were associated with lower mental quality of life, while PCI was associated with physical quality of life.
Conclusions: Motor fatigue has been identified in Polio survivors but was only significantly different in hand grip, using this approach. Pain, fatigue and elevated energy cost of walking negatively influenced quality of life. Motor fatigue was unrelated to subjective fatigue, mobility or quality of life.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise
Title: Aerobic exercise in adult neuromuscular rehabilitation: A survey of healthcare professionals
Author: Voorn EL, Koopman F, Nollet F, Brehm MA.
Affiliation: Academic Medical Centre, Amsterdam
Journal: Journal of Rehabilitation Medicine
Citation: 51: 518–524
Publication Year and Month: 2019 07
Abstract: Objective: To evaluate the current application of
aerobic exercise in adult neuromuscular rehabilitation.
Design: Cross-sectional survey.
Participants: Dutch rehabilitation specialists and physical therapists in specialized centres for slowly progressive neuromuscular diseases and in primary care.
Methods: Participants received a self-designed, web-based, questionnaire, including 27 close-ended questions covering 4 categories: respondent profile, application of aerobic exercise, barriers to prescribing aerobic exercise, and need for support to improve the application of aerobic exercise.
Results: All respondents (n = 52) prescribed aerobic exercise and in a wide variety of neuromuscular diseases, mostly applying sessions of more than 20 min, 2 days per week, over a period of 9–16 weeks, using different exercise modes and methods to target intensity. The majority (81%) agreed that aerobic exercise should be incorporated into neuromuscular
rehabilitation. However, all respondents perceived barriers to the application of aerobic exercise
in one or more domains, and 77% of the respondents indicated needing support to improve application of this type of training, mostly with respect to screening procedures (54%) and dosing of exercise programmes (48%).
Conclusion: Aerobic exercise is widely applied, yet our results raise awareness of the necessity of more evidence based knowledge, in order to develop and implement guidelines in adult neuromuscular rehabilitation.
Conclusions: More evidence-based knowledge is needed, in order to develop guidelines to support healthcare professionals in prescribing aerobic exercise in neuromuscular rehabilitation.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Exercise
Title: The Relationship Between The Physical Strain Of Walking And Daily Activity Time In Individuals With Slowly Progressive Neuromuscular Diseases
Author: Sander Oorschot, Eric Voorn, Annerieke van Groenestijn, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam UMC, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
Journal:
Citation: DOI:https://doi.org/10.1016/j.apmr.2021.07.416
Publication Year and Month: 2021 10
Abstract: Research Objectives
To investigate the physical strain of walking and its relationship with daily activity time in individuals with neuromuscular diseases (NMD).
Design
Observational study.
Setting
Data were collected from multiple research projects at the Department of Rehabilitation Medicine at the Amsterdam UMC, location AMC.
Participants
Thirty-one adults with post-polio syndrome (N = 11), Charcot-Marie-Tooth disease (N = 12) and other slowly progressive NMD (N = 8) participated (age: 59.9 ± 14.3).
Interventions
Steady state oxygen consumption during comfortable 6-minute walking (VO2walk), peak oxygen uptake (VO2peak) during maximal cycle ergometry, and heart rate and step count during 7 consecutive days were assessed.
Main Outcome Measures
Physical strain was defined as the ratio of VO2walk and VO2peak (in %). Daily activity time was expressed as average daily step count and time spent in moderate (40-60% heart rate reserve) to vigorous (>60% heart rate reserve) physical activity (MVPA). Regression analyses assessed the relationships between physical strain, VO2walk, and VO2peak with daily activity time.
Results
Participants walked 8262 ± 3403 steps and physical strain during walking was 64% ± 15%. Physical strain was inversely related to step count (r2=.26, p=0.004), while VO2peak was positively related to step count (r2=.20, p=0.013) and inversely related to MVPA (r2=.14, p= 0.040). The other relations were not significantly correlated.
Conclusions: Conclusions
Physical strain of walking is high in patients with slowly progressive NMD compared to able-bodied individuals (27% ± 6%) [1], approximating vigorous exercise intensities. People with a higher physical strain take less steps daily. People with lower VO2peak take less steps daily, while spending more time in MVPA. The small proportions of explained variance indicate that more factors play a role in daily activity.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Exercise, Activity Levels
Title: The Postpolio Syndrome: An Overuse Phenomenon
Author: Perry, J., Barnes, G., & Gronley, J. K.
Affiliation:
Journal: Clinical Orthopedics and Related Research
Citation: Clinical Orthopaedics and Related Research Volume 233:145-162; August 1988
Publication Year and Month: 1988 08
Abstract: Persons with good recovery of function following their initial poliomyelitis are now, more than 30 years later, experiencing new weakness, fatigue, and muscle pain. The likelihood of muscle overuse being the cause of this late functional loss was investigated by dynamic electromyography (EMG) and foot-switch stride analysis in 34 symptomatic patients. Manual testing grouped the muscles, with strong (S) encompassing Grades Good (G) and Normal (N) while weak (W) included Fair plus (F+) to zero (0). After testing quadriceps and calf strength, the patients fell into one of four classes: strong quadriceps and calf (SQ/SC) strong quadriceps and weak calf (SQ/WC) weak quadriceps and strong calf (WQ/SC) or combined weak quadriceps and calf (WQ/WC). Quantified EMG; (normalized by the manual muscle test EMG) defined the mean duration and intensity of the quadriceps soleus, lower gluteus maximus, and long head of the biceps femoris during walking. Overuse was defined as values greater than the laboratory normal (mean·+ 1 SD). Each muscle exhibited instances of overuse, normalcy, and sparing. The biceps femoris was the only muscle with dominant overuse (82%). Quadriceps overuse was next in frequency (53%). Soleus activity infrequently exceeded normal function (34%), but this still represented more than twice the intensity and duration of the other muscles. Gluteus maximus action was also seldom excessive (34%). The patients averaged two muscles with excessive use during walking. Gait velocity of the SQ/SC strong group was highest (71% of normal) while the three categories that included weak muscles had walking speeds in the range of 50% of normal. The finding of muscle overuse during a single free-speed walking test that does not attain normal velocity supports the concept of muscle overuse being the cause of the patient's dysfunction.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any):
Link to Full Paper (if available): Click here to view Abstract
Category: Falls
Title: Falls in Post-Polio Patients: Prevalence and Risk Factors
Author: Yonah Ofran (1,2), Isabella Schwartz (1,2), Sheer Shabat (1,2), Martin Seyres (1,2), Naama Karniel (2,3) and Sigal Portnoy (3,*).
Affiliation: (1) Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, Israel
(2) Department of Physical Medicine & Rehabilitation, Hadassah University Hospital, Jerusalem 9765418, Israel
(3) Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
* Author to whom correspondence should be addressed.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Biology
Biology 2021, 10(11), 1110; https://doi.org/10.3390/biology10111110
Publication Year and Month: 2021 10
Abstract: Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. Methods: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. Results: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). Conclusion: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.
Keywords: gait analysis; coefficient of variability; gait symmetry; timed up and go
Conclusions: We conclude that the gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for PPS patients.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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:
Comments (if any):
Link to Full Paper (if available):
Category: Falls and Bone Density
Title: High incidence of osteoporosis and fractures in an aging post-polio population
Author: Mohammad AF (1), Khan KA (1), Galvin L (2), Hardiman O (2), O’Connell PG (1)
Affiliation: Departments of (1) Rheumatology, and (2) Neurology, Beaumont Hospital, Dublin, Ireland
Journal: European Neurology
Citation: Eur Neurol. 2009 Nov; 62(6):369–374. doi:10.1159/000242444
Publication Year and Month: 2009 11
Abstract: BACKGROUND/AIMS: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.
METHODS: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg.
Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Falls and Bone Density
Title: Polio survivors: falls and subsequent injuries
Author: Silver JK, Aiello DD
Affiliation: Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2002 Aug;81(8):567-70
Publication Year and Month: 2002 08
Abstract: OBJECTIVE: This study examines the frequency of falls in polio survivors and their resulting morbidity.
DESIGN: Two groups, fallers vs. nonfallers, were investigated in this descriptive study. A total of 233 polio survivors volunteered to complete a structured questionnaire on fall history and sequelae.
RESULTS: Of the study participants, 64% had fallen within the previous year, and 61% had falls for which they received medical attention, including 35% who had at least one fracture. There was not a correlation between age and falling, but there was a strong correlation between tripping and falling.
Conclusions: Falls with resultant injuries are a significant issue for polio survivors that warrants further study. Because tripping was predictive of falling in this sample, bracing should be considered as a treatment or preventative measure.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Falls and Bone Density
Title: Falls among adults aging with disability
Author: Matsuda PN (1), Verrall AM (2), Finlayson ML (3), Molton IR (2), Jensen MP (2)
Affiliation: (1) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. Electronic address: [email protected]; (2) Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; (3) School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2015 Mar;96(3):464-71. doi: 10.1016/j.apmr.2014.09.034
Publication Year and Month: 2015 03
Abstract: OBJECTIVE: To investigate the prevalence of and risk factors for falling among individuals aging with multiple sclerosis (MS), muscular dystrophy (MD), postpolio syndrome (PPS), and spinal cord injury (SCI).
DESIGN: Cross-sectional survey data from 2009 to 2010 were analyzed. We used forward logistic regression models to examine whether risk factors such as age, sex, mobility level, years since diagnosis, vision, balance, weakness, number of comorbid conditions, and physical activity could distinguish participants who reported falling from those who did not.
SETTING: Surveys were mailed to community-dwelling individuals who had 1 of 4 diagnoses (MS, MD, PPS, or SCI). The survey response rate was 91%.
PARTICIPANTS: A convenience sample of community-dwelling individuals (N=1862; age, 18-94y) with MS, MD, PPS, or SCI in the United States.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURE: Self-reported fall within the last 6 months.
RESULTS: Fall prevalence for people with MS (54%), MD (70%), PPS (55%), and SCI (40%). Across all 4 groups, fall rates peaked in middle age (45-64y) and among people with moderate mobility limitations. Seven risk factors differentiated participants who fell from those who did not: mobility level, imbalance, age, curvilinear age (age(2)), number of comorbid conditions, duration of diagnosis, and sex. The models differed across diagnostic groups.
Conclusions: People aging with long-term physical disabilities experience unique challenges that affect their risk of falls. A better understanding of the frequency, severity, and risk factors of falls across diagnostic groups is needed to design and implement customized, effective fall prevention and management programs for these individuals.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any):
Link to Full Paper (if available): Click here for preview
Category: Falls and Bone Density
Title: Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects
Author: Thaiana Santos Galvão PT, Egídio Sabino Magalhães Júnior PT, MSc, Marco Antonio Orsini Neves PhD, MD & Arthur de Sá Ferreira PhD, PT
Affiliation: This study was supported by the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) [Grant numbers E-26/200.564/2015 and E-26/202.769/2015].
Journal: Physiotherapy Theory and Practice
Citation: DOI: 10.1080/09593985.2018.1512178
Publication Year and Month: 2018
Abstract: Introduction: This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman’s ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = –13, CI 95% −16 to −9 points), lower dynamic postural stability (MD = –14, CI 95% −19 to −8 points), and increased fear of falling (MD = 14, CI 95% 10–18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738–0.351), risk of falling (ρ = −0.746), and fear of falling (ρ = −0.432). Dynamic postural stability was correlated with risk of falling (ρ = −0.841), fear of falling (ρ = −0.277), and static postural stability (ρ = −0.869 to −0.435; ρ = −0.361 to −0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Falls and Bone Density
Title: Participation in Two Evidence-Based Falls Prevention Programs by Adults Aging With a Long-Term Disability: Case-Control Study of Reach and Effectiveness
Author: Thomas John Eagen, S. M. Teshale, A. P. Herrera-Venson, A. Ordway, J. Caldwell
Affiliation: University of Washington Seattle
Journal: Journal of Aging and Health
Citation: November 2018
Publication Year and Month: 2018 11
Abstract: Objective: Adults aging with a long-term disability (LTD) are at an increased risk for falls. The Older Americans Act Title III-D and Prevention and Public Health Fund (PPHF) support several organizations to deliver falls prevention evidence-based programs designed to reduce risk factors; however, little is understood about the reach and effectiveness of these fall prevention programs for those with LTD compared to those without LTD. This study compared the reach and effectiveness of two evidence-based falls prevention programs between older adults with and without LTD. Method: Using a matched case-control design, 105 LTD older adults enrolled in A Matter of Balance (AMOB) or Stepping On were matched to 315 non-LTD older adults on age, sex, race, and education. Results: On average, LTD older adults attended a higher number of class sessions and were significantly more likely to complete the program compared with the matched-sample of non-LTD older adults. LTD older adults were equally likely as non-LTD older adults to report significant reductions in self-reported fear of falling, falls-related activity restriction, and improvement in falls self-efficacy following completion of the programs.
Conclusions: Discussion: These findings provide preliminary evidence for the effectiveness of these evidence-based falls prevention programs for LTD older adults; however, more research is needed to extend these findings.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here for preview
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Falls, Fractures and Osteoporosis, 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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Activity and post-polio fatigue
Author: Packer TL, Martins I, Krefting L, Brouwer B
Affiliation: Division of Occupational Therapy, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
Journal: Orthopedics
Citation: Orthopedics. 1991 Nov; 14(11):1223-6
Publication Year and Month: 1991 11
Abstract: Fatigue was studied in 12 subjects with post-polio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 +/- 1.6 (non-disabled scores = 2.3 +/- 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Fatigue
Title: Cognitive functioning in post‐polio patients with and without general fatigue
Author: Ostlund G, Borg K, Wahlin A.
Affiliation: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):147-51
Publication Year and Month: 2005 03
Abstract: OBJECTIVE AND DESIGN: This study examined 2 main hypotheses. First, whether patients with post-polio suffering from general fatigue (n=10) demonstrate cognitive deficits compared with patients with post-polio without general fatigue (n=10). Secondly, by systematically varied test order administration we examined whether such differences varied as a function of increasing cognitive load during cognitive testing.
SUBJECTS: Twenty patients diagnosed with post-polio syndrome, 10 with general fatigue and 10 without fatigue.
RESULTS: Neither of the 2 hypotheses were confirmed. The group with general fatigue reported elevated levels of depression. However, no systematic association between level of depression and cognitive performance could be detected.
Conclusions: The results of this study provide no evidence that general fatigue or cognitive load affects cognitive functioning in post-polio.
Outcome of Research: Not effective.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Circadian fatigue or unrecognized restless legs syndrome? The post-polio syndrome model
Author: Romigi A, Maestri M
Affiliation: Neurophysiopathology Unit, Department of Systems Medicine, Sleep Medicine Centre, Tor Vergata University and Hospital , Rome , Italy ; IRCCS Neuromed , Pozzilli , Italy; Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy.
Journal: Frontiers in Neurology
Citation: Front Neurol. 2014 Jul 7;5:115. doi: 10.3389/fneur.2014.00115
Publication Year and Month: 2014 07
Abstract: This paper does not have an abstract.
Conclusions:
Outcome of Research: More research required.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Vitality among Swedish patients with post-polio: a physiological phenomenon
Author: Ostlund G (1), Wahlin A (2), Sunnerhagen KS (3,4), Borg K (1)
Affiliation: (1) Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Sweden; (2) Department of Psychology, Stockholm University, Stockholm, Sweden; (3) Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; (4) Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2008 Oct;40(9):709-14. doi: 10.2340/16501977-0253
Publication Year and Month: 2008 10
Abstract: OBJECTIVE: To evaluate vitality and fatigue in post-polio patients, and the relative contributions of physiological and psychological parameters to the level of vitality.
DESIGN: Multi-centre study.
SUBJECTS: One hundred and forty-three patients with post-polio syndrome.
METHODS: Inventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regression models were constructed to examine predictors of variations in vitality, pain, reduced activity and physical fatigue.
RESULTS: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiological indicators. After controlling for age, physiological para notmeters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.
Conclusions: Vitality in post-polio patients depends on physio-logical parameters. Mental fatigue is not a prominent predictor. Subgroups with or without fatigue, independent of age, need further study.
Outcome of Research: More research required.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Brain volume and fatigue in patients with postpoliomyelitis syndrome
Author: Trojan DA (1), Narayanan S (2), Francis SJ (3), Caramanos Z (4), Robinson A (5), Cardoso M (6), Arnold DL (7)
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, 3801 University Street, Montreal, Quebec, Canada H3A 2B4; (2) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (3) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (4) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (5) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada; (6) Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (7) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2014 Mar;6(3):215-20. doi: 10.1016/j.pmrj.2013.09.009
Publication Year and Month: 2014 03
Abstract: BACKGROUND: Acute paralytic poliomyelitis is associated with encephalitis. Early brain inflammation may produce permanent neuronal injury with brain atrophy, which may result in symptoms such as fatigue. Brain volume has not been assessed in postpoliomyelitis syndrome (PPS).
OBJECTIVE: To determine whether brain volume is decreased compared with that in normal controls, and whether brain volume is associated with fatigue in patients with PPS.
DESIGN: A cross-sectional study.
SETTING: Tertiary university-affiliated hospital postpolio and multiple sclerosis (MS) clinics.
PARTICIPANTS: Forty-nine ambulatory patients with PPS, 28 normal controls, and 53 ambulatory patients with MS.
METHODS: We studied the brains of all study subjects with magnetic resonance imaging by using a 1.5 T Siemens Sonata machine. The subjects completed the Fatigue Severity Scale. Multivariable linear regression models were computed to evaluate the contribution of PPS and MS compared with controls to explain brain volume.
MAIN OUTCOME MEASUREMENTS: Normalized brain volume (NBV) was assessed with the automated program Structured Image Evaluation, using Normalization, of Atrophy method from the acquired magnetic resonance images. This method may miss brainstem atrophy.
RESULTS: Technically adequate NBV measurements were available for 42 patients with PPS, 27 controls, and 49 patients with MS. The mean (standard deviation) age was 60.9 ± 7.6 years for patients with PPS, 47.0 ± 14.6 years for controls, and 46.2 ± 9.4 years for patients with MS. In a multivariable model adjusted for age and gender, NBV was not significantly different in patients with PPS compared with that in controls (P = .28). As expected, when using a similar model for patients with MS, NBV was significantly decreased compared with that in controls (P = .006). There was no significant association between NBV and fatigue in subjects with PPS (Spearman ρ = 0.23; P = .19).
Conclusions: No significant whole-brain atrophy was found, and no association of brain volume with fatigue in PPS. Brain atrophy was confirmed in MS. It is possible that brainstem atrophy was not recognized by this study.
Outcome of Research: Not effective
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Fatigue
Title: Psychometric properties of fatigue severity and fatigue impact scales in postpolio patients
Author: Oncu J (1), Atamaz F, Durmaz B, On A
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Şişli Etfal Teaching Hospital, Istanbul; Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-Izmir, Turkey.
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2013 Dec;36(4):339-45. doi: 10.1097/MRR.0b013e3283646b56
Publication Year and Month: 2013 12
Abstract: We evaluate the reliability, validity, and responsiveness of the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS) and to determine whether these scales are potentially applicable for measuring fatigue in postpolio patients (PPS). After the Turkish adaptation of FSS and FIS using a forward-backward procedure, the scales were administered to 48 PPS patients without additional health problems that may induce fatigue. Reliability studies were carried out by determination of intraclass correlation coefficient and internal consistency by the Cronbach-α coefficient. Validity was tested by within-scale analyses and analyses against the external criteria including convergent validity and discriminant validity. Correlations with the Notthingham Health Profile (NHP), fatigue, pain and cramp severity (visual analog scale), and manual muscle testing were performed. Sensitivity to changes was determined by standardized response mean values. All patients completed scales, suggesting their satisfactory acceptance. Reliability studies were satisfactory, with higher Cronbach-α values and intraclass correlation coefficients than 0.80. The FSS score was correlated moderately with visual analog scale-fatigue (r=0.41) and the NHP-energy dimension (r=0.29). All FIS scores except cognitive scores were moderately related to the NHP-social isolation score (r=0.40, 0.37, and 0.43 for FIS-physical, social, and total scores, respectively). There was also a significant correlation between the FIS-physical score and the NHP-energy score (r=0.31). On the basis of the standardized response mean values, response to treatment for these two questionnaires was satisfactory (P=0.00). The Turkish versions of FSS and FIS were reliable, sensitive to clinical changes, and also well accepted by patients with PPS. Although they had somewhat satisfactory convergent validity, the absence of strong correlations did not support the validity entirely.
Conclusions:
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Fatigue
Title: Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors
Author: Trojan DA, Arnold DL, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, Narayanan S, Tartaglia MC, Caramanos Z, Da Costa D
Affiliation: Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, 3801 University St., Montreal, Quebec, H3A 2B4, Canada
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2009 May;1(5):442-9. doi: 10.1016/j.pmrj.2009.03.003
Publication Year and Month: 2009 05
Abstract: OBJECTIVE: To determine the biopsychosocial correlates of general, physical, and mental fatigue in patients with postpoliomyelitis syndrome (PPS) by assessing the additional contribution of potentially modifiable factors after accounting for important nonmodifiable disease-related factors. It was hypothesized that disease-related, behavioral, and psychosocial factors would contribute in different ways to general, physical, and mental fatigue in PPS and that a portion of fatigue would be determined by potentially modifiable factors.
DESIGN: Cross-sectional study.
SETTING: A tertiary university-affiliated hospital post-polio clinic.
PATIENTS: Fifty-two ambulatory patients with PPS who were not severely depressed were included.
ASSESSMENT OF RISK FACTORS: Potential correlates for fatigue included disease-related factors (acute polio weakness, time since acute polio, PPS duration, muscle strength, pain, forced vital capacity, maximum inspiratory pressure, maximum expiratory pressure, body mass index, disability, fibromyalgia), behavioral factors (physical activity, sleep quality), and psychosocial factors (depression, stress, self-efficacy).
MAIN OUTCOME MEASUREMENTS: Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI; assesses fatigue on 5 subscales) and the Fatigue Severity Scale (FSS).
RESULTS: Multivariate models were computed for MFI General, Physical, and Mental Fatigue. Age-adjusted multivariate models with nonmodifiable factors included the following predictors of (1) MFI General Fatigue: maximum inspiratory pressure, fibromyalgia, muscle strength; (2) MFI Physical Fatigue: maximum expiratory pressure, muscle strength, age, time since acute polio; and (3) MFI Mental Fatigue: none. The following potentially modifiable predictors made an additional contribution to the models: (1) MFI General Fatigue: stress, depression; (2) MFI Physical Fatigue: physical activity, pain; and (3) MFI Mental Fatigue: stress.
Conclusions: PPS fatigue is multidimensional. Different types of fatigue are determined by different variables. Potentially modifiable factors account for a portion of fatigue in PPS.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Fatigue
Title: Disability and functional assessment in former polio patients with and without postpolio syndrome
Author: Nollet F, Beelen A, Prins MH, de Visser M, Sargeant AJ, Lankhorst GJ, de Jong BA
Affiliation: Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1999 Feb;80(2):136-43
Publication Year and Month: 1999 02
Abstract: OBJECTIVES: To compare perceived health problems and disability in former polio subjects with postpolio syndrome (PPS) and those without postpolio syndrome (non-PPS), and to evaluate perceived health problems, disability, physical performance, and muscle strength.
DESIGN: Cross-sectional survey; partially blinded data collection.
SUBJECTS: One hundred three former polio subjects, aged 32 to 60yrs. This volunteer sample came from referrals and patient contacts. Criterion for PPS: new muscle weakness among symptoms.
MAIN OUTCOME MEASURES: Nottingham Health Profile (NHP), adapted D-code of the International Classification of Impairments, Disabilities and Handicaps, performance test, and muscle strength assessment.
RESULTS: PPS subjects (n = 76) showed higher scores (p < .001) than non-PPS subjects (n = 27) within the NHP categories of physical mobility, energy, and pain. On a 16-item Polio Problems List, 78% of PPS subjects selected fatigue as their major problem, followed by walking outdoors (46%) and climbing stairs (41%). The disabilities of PPS subjects were mainly seen in physical and social functioning. No differences in manually tested strength were found between patient groups. PPS subjects needed significantly more time for the performance test than non-PPS subjects and their perceived exertion was higher. Perceived health problems (NHP-PhysMobility) correlated significantly with physical disability (r = .66), performance-time (r = .54), and muscle strength (r = .38). With linear regression analysis, 54% of the NHP-PhysMobility score could be explained by the performance test (time and exertion), presence of PPS, and muscle strength, whereas strength itself explained only 14% of the NHP-PhysMobility score.
Conclusions: PPS subjects are more prone to fatigue and have more physical mobility problems than non-PPS subjects. In former polio patients, measurements of perceived health problems and performance tests are the most appropriate instruments for functional evaluation.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Fatigue
Title: A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis
Author: Tersteeg IM (1), Koopman FS, Stolwijk-Swüste JM, Beelen A, Nollet F; CARPA Study Group
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2011 Jun;92(6):899-904. doi: 10.1016/j.apmr.2011.01.005
Publication Year and Month: 2011 06
Abstract: OBJECTIVES: To study the severity and 5-year course of fatigue in patients with late-onset sequelae of poliomyelitis (LOSP) and to identify physical and psychosocial determinants of fatigue.
DESIGN: Prospective cohort study with 5 measurements over 5 years.
SETTING: University hospital.
PARTICIPANTS: Patients with LOSP (N=168); 89% of the subjects completed the study.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Fatigue assessed with the Fatigue Severity Scale (FSS). Potential determinants were perceived physical functioning, bodily pain and mental health, extent of paresis, walking capacity, comorbidity, sleeping disorders, coping, and social support. Associations were investigated by multivariable longitudinal analysis using generalized estimating equations.
RESULTS: The mean FSS score ± SD at baseline was 5.1±1.4, which did not change significantly during the 5-year follow-up. Reduced physical functioning, increased bodily pain, reduced sleep quality, more psychologic distress, and higher task-oriented coping were independently associated with fatigue. The extent of paresis and walking capacity were strongly associated with physical functioning.
Conclusions: Fatigue is severe and persistent in patients with LOSP due to physical and psychologic factors, which has implications for counseling and treatment. In addition to the commonly applied interventions targeting physical aspects, psychologic interventions are a potential area for reducing fatigue.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to download
Category: Fatigue
Title: Post polio syndrome: fatigued patients a specific subgroup?
Author: Östlund G (1), Wahlin Å, Sunnerhagen KS, Borg K
Affiliation: (1) Divison of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2011 Jan;43(1):39-45. doi: 10.2340/16501977-0634
Publication Year and Month: 2011 01
Abstract: OBJECTIVES: To examine the characteristics of fatigued and non-fatigued post-polio patients and to define potential subgroups across the fatigue continuum.
DESIGN: Multi-centre study.
SUBJECTS: A total of 143 post-polio patients were subdivided on the basis of percentile distribution into a fatigue group, a intermediate group, and a non-fatigue group, using the Multi Fatigue Inventory 20 general fatigue ratings.
METHODS: Data on background, quality of life, fatigue and pain were collected. Descriptive statistics and correlations in each group and analysis of variance and χ2 for group comparisons were performed. Non-linear regressions were employed to evaluate differences in the strength of associations between physical and mental fatigue, on the one hand, and vitality on the other.
RESULTS: The fatigued group was younger, had shorter polio duration, more pain, higher body mass index, lower quality of life and was more physically and mentally fatigued. A higher proportion of this group had contracted polio after 1956 and was under 65 years of age. Mental fatigue had a relatively higher explanatory value than physical fatigue for differences in vitality in the fatigued group, whereas reversed patterns were seen in the other groups.
Conclusions: Fatigued post-polio patients can be considered as a subgroup.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: The Neuropsychology of Post-Polio Fatigue
Author: Richard L. Bruno, Ph.D., Thomas Galski, Ph.D., John DeLuca, Ph.D.
Affiliation:
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Bruno RL, Galski T, DeLuca J. The neuropsychology of post-polio fatigue. Archives of Physical Medicine and Rehabilitation, 1993; 74: 1061-1065.
Publication Year and Month: 1993
Abstract: To test the hypothesis that post-polio fatigue and its concomitant cognitive deficits are associated with an impairment of attention and not of higher-level cognitive processes, six carefully screened polio survivors were administered a battery of neuropsychological tests. Only subjects reporting severe fatigue, and not those with mild fatigue, demonstrated clinically significant deficits on all tests of attention, concentration and information processing speed while showing no impairments of cognitive ability or verbal memory. These findings suggest that an impaired ability to maintain attention and rapidly process complex information appears to be a characteristic in polio survivors reporting severe fatigue, since these deficits were documented even when their subjective rating of fatigue was low. This finding supports the hypothesis that a polio-related impairment of selective attention underlies polio survivors' subjective experience of fatigue and cognitive problems.
Conclusions: These findings provide preliminary support for the hypothesis that post-polio fatigue is associated with impaired functioning on neuropsychological tests that assess attention and not on those assessing higher-level cognitive processes. An impaired ability to maintain attention and rapidly process complex information appears to be a characteristic of these polio survivors reporting severe fatigue, since the deficits were documented during the first testing period when the subjective rating of fatigue was still low.
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: The Pathophysiology Of Post-Polio Fatigue: A Role for the Basal Ganglia in the Generation of Fatigue
Author: Richard L. Bruno, Ph.D., Robert Sapolsky, Ph.D., Jerald R. Zimmerman, M.D., and Nancy M. Frick, Lh.D.
Affiliation: Post-Polio Rehabilitation and Research Service; Kessler Institute for Rehabilitation, Department of Physical Medicine and Rehabilitation; UMDNJ/New Jersey Medical School, Department of Biological Sciences; Stanford University, Harvest Center; Hackensack, New Jersey
Journal: Annals of the New York Academy of Sciences
Citation: Bruno RL, Sapolsky R, Zimmerman JR, Frick NM. The pathophysiology of a central cause of post-polio fatigue. Annals of the New York Academy of Sciences, 1995; 753: 257-275.
Publication Year and Month: 1995
Abstract: Fatigue is the most commonly reported, most debilitating and least studied Post-Polio Sequelae (PPS) affecting the more than 1.63 million American polio survivors. Post-polio fatigue is characterized by subjective reports of problems with attention, cognition and maintaining wakefulness, symptoms reminiscent of nearly two dozen outbreaks during this century of post-viral fatigue syndromes that are related clinically, historically or anatomically to poliovirus infections. These relationships, and recent studies that associate post-polio fatigue with clinically significant deficits on neuropsychologic tests of attention, histopathologic and neuroradiologic evidence of brain lesions and impaired activation of the hypothalamic-pituitary-adrenal axis, will be reviewed to described a role for the reticular activating system and basal ganglia in the pathophysiology of post-polio fatigue. The possibility of pharmacologic therapy for PPS is also discussed.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Fainting and Fatigue: Causation or Coincidence?
Author: Richard L. Bruno, Ph.D.
Affiliation: Post-Polio Rehabilitation and Research Service; Kessler Institute for Rehabilitation.
Journal: Lincolnshire Post-Polio Library copy by arrangement with the Harvest Center Library
Citation: Bruno RL. Fainting and Fatigue: Causation or Coincidence? CFIDS Chronicle, 1996; 9(2): 37-39.
Publication Year and Month: 1996
Abstract: As the former autonomic nervous system fellow at New York's Columbia-Presbyterian Medical Center, and in my current incarnation studying chronic fatigue in polio survivors, I have read with special interest the reports from Johns Hopkins University describing neurally mediated hypotension (NMH) in adults and adolescents with CFIDS.[1] In June 1995, we presented a paper to the American Congress of Rehabilitation Medicine describing several of our post-polio patients who have had episodes of vasovagal syncope.[2] One patient with a 10-year history of severe, chronic and disabling post-polio fatigue had a history of frequent fainting 35 years before she ever experienced fatigue.
Conclusions: Taken together, these findings suggest that polio survivors may be predisposed to fainting because of poliovirus damage to their brainstem cardiodepressor and blood pressure regulation centers and PVN. However, it is important to note that many viruses besides polioviruses (e.g., the Coxsackie viruses) are also known to frequently and preferentially damage the brainstem, especially the reticular formation.[7,11] People with post-viral fatigue may have similar brainstem and hypothalamic damage as is seen following poliovirus infection, as Costa's finding of decreased brainstem perfusion in CFIDS suggests. Thus, damage to cardioregulatory centers could be responsible for NMH in people with CFIDS. But what of the coincidence of fainting and fatigue?
Outcome of Research:
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Muscular effects in late polio.
Author: Sunnerhagen, K.S., Grimby, G.
Affiliation: Department of Rehabilitation Medicine, Goteborg University, Sweden
Journal: Acta Physiologica Scandinavica
Citation: (2001) 171: 335–340. doi:10.1046/j.1365-201x.2001.00836.x
Publication Year and Month: 2001 03
Abstract: New or increased muscular weakness, fatigue and muscle and joint pain with neuropathic electromyography (EMG) changes in a person with a confirmed history of polio constitute the cardinal symptoms of the post-polio syndrome. Unusual tiredness or fatigue is a common complaint in late polio subjects as is intolerance to cold. Fatigue in polio subjects can have several explanations: emotional fatigue, central nervous system fatigue, ‘general’ fatigue and/or neuromuscular fatigue. Some studies indicate central fatigue, but it is unclear how often and to which degree there will be a central muscular fatigue. Polio patients are known to be deconditioned (reduced function because of low activity level), and aerobic power is reduced. Defects in the neuromuscular transmission may be present but are not seen in all post-polio subjects with reduction in force and increased fatigability. The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible explanations may be an imperfection in the sarcoplasmatic reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.
Conclusions: The fatigue experienced by late polio patients is most likely an augmented peripheral muscle fatigue. Possible explanations may be an imperfection in the sarcoplasmatic reticulum with altered calcium release mechanisms (activation) or in sliding filament function (contractile properties). This may be a secondary effect to the enlarged muscle fibres. However, the prolonged subjective feeling of fatigue reported despite unchanged maximal voluntary contraction (MVC) remains unexplained.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Measuring Physical and Cognitive Fatigue in People With Post-Polio Syndrome: Development of the Neurological Fatigue Index for Post-Polio Syndrome (NFI-PP).
Author: Young CA, Wong SM, Quincey AC, Tennant A
Affiliation: Walton Centre NHS Trust, Lower Lane, Liverpool, L9 7LJ, United Kingdom.
Walton Centre NHS Trust, Liverpool, United Kingdom.
Swiss Paraplegic Research, Nottwil, Switzerland.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: 2018 Feb;10(2):129-136.
Publication Year and Month: 2018 02
Abstract: BACKGROUND:
Fatigue in post-polio syndrome (PPS) has been shown to affect quality of life adversely. There is currently no disease-specific measure of fatigue for PPS.
OBJECTIVE:
To develop a scale to measure fatigue in PPS that meets rigorous psychometric standards.
DESIGN:
Qualitative followed by validation and test-retest studies.
SETTING:
Polio clinic followed by national questionnaire studies.
PARTICIPANTS:
A total of 45 participants from polio clinic for qualitative; 319 participants from clinic or self-referral for validation study, of whom 87 completed the retest questionnaire.
METHODS:
Draft questionnaire items on PPS fatigue were derived from transcripts of qualitative interviews. After cognitive debriefing, the draft measure was administered by mail along with comparator questionnaires to a new sample.
MAIN OUTCOME MEASUREMENTS:
Draft PPS fatigue measure, Fatigue Severity Scale, and visual analog scale for fatigue.
RESULTS:
Analysis of 271 of 319 (85%) questionnaires identified a 2-factor solution (RMSEA 0.058). For the physical subscale, a 20-item scale showed good fit (χ2P = .189), strict unidimensionality (t-test 5.17%), and reliability 0.91. For the cognitive subscale, a 7-item scale showed excellent fit (χ2P = .917), strict unidimensionality (t-test 5.2%), and reliability 0.89. Evidence of a "difficulty factor" emerged also supporting a total score that showed good fit (χ2P = .151), strict unidimensionality (t-test 0.4%), and reliability consistent with group use at 0.73. Test-retest correlations for all scales were greater than 0.85. Standard error of measurement on metric ranges was 5.4 for total, 2.9 for physical, and 1.69 for cognitive domains. With the latent estimate of the total score transformed to a 0-100 scale, the mean score was 49.5 (SD 6.9). Spearman correlations with the Fatigue Severity Scale and visual analog scale were 0.60 and 0.55, respectively.
Conclusions: CONCLUSIONS:
A patient-derived Neurological Fatigue Index for PPS, with physical and cognitive subscales and a total score, has demonstrated good reliability, appropriate concurrent validity, and satisfies the Rasch measurement model. A raw-score to interval scale transformation is available for parametric applications and the calculation of change scores.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue
Title: Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis
Author: Sungha Kim (1), Ying Xu (1), Kelly Dore (2), Rebecca Gewurtz (1), Nadine Larivière (2) and Lori Letts (1)
Affiliation: (1) School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
(2) Department of Medicine, McMaster Education Research, Innovation & Theory (MERIT), David Braley Health Science Centre, Hamilton, ON, Canada
Corresponding author:
Sungha Kim, School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada L8S
1C7. Email: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Chronic Illness
https://doi.org/10.1177/17423953211039783
Publication Year and Month: 2021 07
Abstract: Objective
The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions.
Methods
Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management.
Results
Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:−0.62 to − 0.21); standardised mean difference of the seven exercise studies was −0.55 (95% confidence interval: −0.78 to −0.31).
Discussion
Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
Keywords
Fatigue, self-management, occupational therapy, physiotherapy, chronic conditions
Conclusions: Fatigue is a complicated symptom with different aspects, including fatigue severity, impact, and multidimensional aspects.91 We did not differentiate these aspects because of a lack of information about the exact differences among them.92 Researchers will need to work to understand and explicitly explain the differences among fatigue’s different dimensions. Only then can future reviews focus on a specific aspect of fatigue and determine the effectiveness of a fatigue self-management programme in addressing it.
In summary, although the evidence for the effectiveness of some fatigue self-management programmes is not convincing, physical exercises inspired by self-management principles may reduce fatigue symptoms, improve quality of life, and enhance other functional abilities. Further research is needed to determine the optimal type, duration, and intensity of a fatigue self-management exercise.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue, Late Effects of Polio, Pain
Title: The Association of Pain, Fatigue and Functional Capacity with Function in Subjects with Post-Polio Syndrome in Gujarat, India
Author: Sheth Megha S Sheth, MPT (1); Srishti S Sharma, PhD Scholar (2)
Affiliation: (1) SBB College of Physiotherapy
(2) CM Patel College of Physiotherapy
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Society of Indian Physiotherapists
Volume 1, Issue 2. p. 42-46. Doi No:-10.18231
Publication Year and Month: 2017 08
Abstract: Background:
Almost 80 lakh people are affected by polio in India. Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors’ years after the initial polio attack. These patients report new, late onset, neuromuscular symptoms like fatigue, pain, new and unusual muscular deficits, and decreased functional abilities. Although these are common problems in individuals with PPS, less research especially in India, has examined the role that these symptoms might exert on physical or psychological function.
Aims:
To find co-relation of pain, fatigue, functional capacity with function in subjects with Post-Polio Syndrome.
Design:
Co-relational study.
Methods:
A convenience sample of 20 subjects with PPS according to Halstead criteria 1985 was selected. Pain was examined using Brief Pain Inventory (BPI), Fatigue by fatigue severity scale (FSS) and functional capacity by 2 minute walk distance. Physical and psychological functions were examined using PROMIS (Patient Reported Outcomes Measurement Information System) and PHQ-9 (Patient Health Questionnaire-9) questionnaires.
Statistical Analysis:
Spearman’s test for co-relation was applied.
Results:
A positive linear co-relation was found between functional capacity and physiological function (r = 0.873); negative linear co-relation between functional capacity and psychological function (r = -0.743). Fatigue showed a positive linear correlation with psychological function (r = 0.486). A negative correlation was calculated between pain and fatigue with physical function (r = -0.258; r = -0.396 respectively). Correlation of pain and psychological function (r = 0.130) was weak.
Conclusion:
Reduced functional capacity co-relates with the physical and psychological function of subjects with PPS, and fatigue co-relates with psychological function. Physiotherapy for decreasing pain, fatigue and improving functional capacity may improve physical and psychological function.
Keywords: Physical function, Psychological function, Pain, Fatigue, Functional capacity.
Conclusions: Conclusion
There is a strong correlation between functional capacity and physical and psychological function of subjects with PPS, and moderate correlation of fatigue with psychological function. Correlation of pain and fatigue with physical function and of pain and psychological function was weak.
Implications
There is a need for effective and accessible management options in polio survivors. Physiotherapy for decreasing pain, fatigue and improving functional capacity may improve physical and psychological function. The study highlights the need to screen subjects with PPS and suggest interventional strategies to reduce their problems.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Fatigue, Late Effects of Polio, Sleep Analysis
Title: Transcranial direct current stimulation (tDCS) for sleep disturbances and fatigue in patients with post-polio syndrome
Author: Michele Acler, Tommaso Bocci, Diana Valenti, Mara Turri, Alberto Priori, Laura Bertolasi
Affiliation: Sezione di Neurologia, Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy.
Journal: Restorative Neurology and Neuroscience
Citation: Restor Neurol Neurosci. 2013;31(5):661-8. doi: 10.3233/RNN-130321.
Publication Year and Month: 2013
Abstract: PURPOSE:
Post-polio syndrome develops about 20-40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Here, we assessed whether transcranial direct current stimulation (tDCS) improves sleep and fatigue symptoms in patients with post-polio syndrome.
METHODS:
We enrolled 32 patients with a diagnosis of post-polio syndrome. tDCS (1.5 mA, 15 min) was delivered by a direct current stimulator connected to three electrodes: two anodal electrodes on the scalp over the right and left pre-motor cortex and the other above the left shoulder (cathode). 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (daily for five days a week, for three weeks) on clinical scales (Short Form Health Survey [SF-36], Piper Fatigue Scale [PFS], Fatigue Severity Scale [FSS], 101-Point Numerical Rating [PNR-101], Hamilton Rating Scale for Depression [HRSD], Pittsburgh Sleep Quality Index [PSQI]) at baseline (T0) and three weeks later (T1).
RESULTS:
At T1 SF-36 sub-items physical functioning, role physical, vitality, social functioning and role emotional improved significantly more in patients who received tDCS (p < 0.01) than in sham-treated patients. Also, PSQI scores improved more in treated patients (p < 0.05, two-way ANOVA with "stimulation" and "time" as factors: p < 0.01). tDCS-induced benefits were more pronounced in patients who were younger at primary infection (p < 0.05).
CONCLUSION:
Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.
KEYWORDS: Poliomyelitis, post-polio syndrome, fatigue, rehabilitation, transcranial direct current stimulation, tDCS, sleep
Conclusions: Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Fractures and Osteoporosis
Title: Outcome of femoral fractures in poliomyelitis patients
Author: Yechiel N. Gellman, Amal Khoury, Meir Liebergall, Rami Mosheiff & Yoram A. Weil
Affiliation: Orthopedic Trauma Service, Hadassah Hebrew University Hospital, Jerusalem, Israel
Department of Orthopedics, Hadassah Medical Center, POB 12000, 91120, Jerusalem, Israel
Journal: International Orthopaedics
Citation: 43, 2607–2612 (2019). https://doi.org/10.1007/s00264-019-04285-2
Publication Year and Month: 2019
Abstract: Background and purpose
As patients who were afflicted with poliomyelitis during the outbreaks in the past are aging, lower extremity osteoporotic fractures are becoming more frequent. Fixation in deformed, porotic bone, coupled with muscle weakness and imbalance creates a unique challenge when treating these fractures as does their reduced rehabilitation potential. The aim of this study was to investigate the outcome of femoral fractures in surviving poliomyelitis patients.
Patients and methods
Sixty-five patients with 74 femoral fractures were treated between 1990 and 2014. Clinical outcome was assessed using the Parkland and Palmer mobility score, and quality-of-life was assessed using the SF-12® score.
Results
Some 84% of the fractures were a result of low-energy mechanisms and occurred in the polio-affected limbs, but nonaffected limbs were also injured owing to low-energy mechanisms in all cases. Fifty-seven fractures were treated operatively. There were nine re-operations (16%), including implant removals, nonunion, peri-implant fractures, and malunion. Some 60% of the patients did not regain their previous ambulatory capacity. Post-operative weight-bearing status did not correlate with the final functional outcome.
Conclusions: Polio patients with femoral fractures have a guarded prognosis for regaining their pre-injury ambulatory capacity. A higher re-operation rate than that with “normal” osteoporotic fractures is expected.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Immune Response
Title: Intrathecal immune response in patients with the post-polio syndrome
Author: Sharief MK, Hentges R, Ciardi M
Affiliation: Department of Clinical Neurochemistry, National Hospital for Neurology and Neurosurgery, London, United Kingdom
Journal: The New England Journal of Medicine
Citation: N Engl J Med. 1991 Sep 12;325(11):749-55
Publication Year and Month: 1991 09
Abstract: BACKGROUND: The syndrome of progressive muscular atrophy decades after acute paralytic poliomyelitis (post-polio syndrome) is not well understood. The theory that physiologic changes and aging cause the new weakness does not explain the immunologic abnormalities reported in some patients. An alternative explanation is persistent or recurrent poliovirus infection.
METHODS: We assessed the intrathecal antibody response to poliovirus and intrathecal production of interleukin-2 and soluble interleukin-2 receptors in 36 patients with the post-polio syndrome and 67 controls (including 13 who had had poliomyelitis but had no new symptoms and 18 with amyotrophic lateral sclerosis). Intrathecal antibody responses to measles, mumps, herpes simplex, and varicella zoster viruses were also determined.
RESULTS: Oligoclonal IgM bands specific to poliovirus were detected in the cerebrospinal fluid of 21 of the 36 patients with the post-polio syndrome (58 percent) but in none of the control group (P less than 0.0001). In quantitative studies there was evidence of increased intrathecal synthesis of IgM antibodies to poliovirus only among the patients with the post-polio syndrome; there was no increased synthesis of IgM to measles, mumps, herpes simplex, or varicella zoster viruses. The patients with post-polio syndrome had significantly higher mean (+/- SD) (cerebrospinal fluid levels of interleukin-2 and soluble interleukin-2 receptors than the controls (8.1 +/- 5.3 vs. 1.4 +/- 0.8 U per milliliter and 159.6 +/- 102.9 vs. 10.7 +/- 6.2 U per milliliter, respectively). The intrathecal synthesis of IgM antibodies to poliovirus correlated with the cerebrospinal fluid concentrations of interleukin-2 (P less than 0.0005) and soluble interleukin-2 receptors (P less than 0.001).
Conclusions: An intrathecal immune response against poliovirus is present in many patients with the post-polio syndrome. In some of these patients the recrudescence of muscle weakness may be caused by persistent or recurrent infection of neural cells with the poliovirus.
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Immune Response
Title: Normal serum levels of immune complexes in postpolio patients
Author: Melin E (1), Sohrabian A (2), Rönnelid J (2), Borg K (1)
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; (2) Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
Journal: Results in Immunology
Citation: Results in Immunology. 2014; 4: 54–57. doi: 10.1016/j.rinim.2014.06.001
Publication Year and Month: 2014 06
Abstract: OBJECTIVE: The pathophysiology of the postpolio syndrome is not fully understood. Increased cytokine levels in cerebrospinal fluid and peripheral blood indicate a systemic inflammatory process. Decreased cytokine levels and the clinical effect of intravenous immunoglobulin treatment further indicate an inflammatory/immunological pathogenesis. The aim of the present study was to evaluate whether an autoimmune process follows the initial infection, by means of analyzing immune complexes.
PATIENTS AND METHODS: Circulating immune complexes were analyzed from blood samples of 20 postpolio patients and 95 healthy controls. To compensate for differences in age between patients and controls, a sub-analysis was performed using only the 30 oldest controls. Tumor necrosis factor-inducing properties of polyethylene glycol-precipitated immune complexes were compared between the postpolio patients and 10 healthy controls.
RESULTS: When comparing levels in postpolio patients to the whole control group, including the 30 oldest investigated, there were no statistically significant differences. No difference was found in tumor necrosis factor levels induced by immune complexes when comparing patients and controls.
Conclusions: There was no increase in circulating immune complex or in tumor necrosis factor-inducing effects of circulating immune complex between postpolio patients and healthy controls, indicating that the postpolio syndrome is not due to an autoimmune reaction.
Outcome of Research: More research required.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Immune Response
Title: Leukocyte myeloperoxidase and pathogenesis of the post-polio syndrome
Author: Movitz C, Bergström T, Borg K, Hellstrand K, Lycke E, Lycke J
Affiliation: Department of Infectious Diseases, University of Gothenburg, Gothenburg; Department of Public Health Services, Division of Rehabilitation Medicine, Danderyds University Hospital, Karolinska Institute, Stockholm; Department of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden - [email protected]
Journal: Scandinavian Journal of Infectious Disease
Citation: Scand J Infect Dis. 2010 Dec;42(11-12):958-60. doi: 10.3109/00365548.2010.524663
Publication Year and Month: 2010 12
Abstract: Letter to the Editor - does not have an abstract.
Conclusions:
Outcome of Research: Not applicable.
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): View first of three pages here
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Inflammation
Title: Elevated blood lipids are uncommon in patients with post-polio syndrome - a cross sectional study.
Author: Melin E, Kahan T, Borg K
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden - [email protected]; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden - [email protected]; Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden - [email protected].
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2015 Apr 29;15:67. doi: 10.1186/s12883-015-0319-z
Publication Year and Month: 2015 04
Abstract: BACKGROUND: The post-polio syndrome occurs in people who previously have had poliomyelitis. After the initial recovery, new or increasing neurologic symptoms occur. Inflammation and dyslipidaemia may play an important role in the development of atherosclerotic complications, for example myocardial infarction and angina pectoris. Previous studies on cardiovascular risk factors in the post-polio syndrome have found a higher prevalence of hypertension, ischemic heart disease, hyperlipidaemia, and stroke in these patients. The present study was undertaken in order to evaluate whether post-polio patients have elevated lipid values, and if blood lipid abnormalities could be correlated to signs of inflammation.
METHODS: Cross-sectional study of 89 consecutive post-polio patients, (53 women, mean age 65 years) from the Post-Polio Outpatient Clinic, Danderyd University Hospital, Stockholm, Sweden. The lipid profiles of post-polio patients were compared to age and sex matched reference values from two earlier studies. Statistical analyses were performed by the Student's t-test, and linear regression analyses were assessed by Pearson's correlation coefficient.
RESULTS: Mean total cholesterol levels (5.7 mmol/L) were low or normal in post-polio patients, whereas low density lipoprotein levels (3.6 mmol/L) were normal, and high density lipoprotein (1.5 mmol/L) and triglycerides (1.4 mmol/L) lower than reference values. The prevalence of diabetes (7%), hypertension (38%), concomitant cardiovascular disease, (including angina pectoris, myocardial infarction, heart failure, atrial fibrillation and stroke) (7%), and calculated 10 year risk of coronary heart disease according to Framingham risk score algorithm (8%) was not increased in post-polio patients.
Conclusions: Compared to reference populations, post-polio patients in Sweden appear to have low or normal total cholesterol and low density lipoprotein levels, whereas high density lipoprotein and triglyceride levels are low. Hence, a possible persisting inflammatory process in post-polio syndrome does not seem to be associated with increased lipids and an increased risk for coronary heart disease events.
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Inflammation
Title: Elevated expression of prostaglandin E2 synthetic pathway in skeletal muscle of prior polio patients
Author: Melin E (1), Lindroos E, Lundberg IE, Borg K, Korotkova M
Affiliation: (1) Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, 18288 Stockholm, Sweden. [email protected].
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2014 Jan;46(1):67-72. doi: 10.2340/16501977-1230
Publication Year and Month: 2014 01
Abstract: OBJECTIVE: The aim of this study was to investigate signs of inflammation in muscle of patients with prior polio, since the main symptoms in these patients are muscle pain, weakness and fatigue. In the context of pain and inflammation, the prostaglandin E2 pathway is of interest. Prostaglandin E2 has many biological actions and is a mediator of inflammation and pain.
PATIENTS AND METHODS: Skeletal muscle biopsies from 8 patients with prior polio and post-polio symptoms, presenting with pain and muscular weakness, and from 6 healthy controls were studied. Immunohistochemistry, conventional microscopy, and computerized image analysis were performed.
RESULTS: There was statistically significant higher expression of enzymes of the prostaglandin E2 synthetic pathway, in muscle from patients, compared with controls. Expression of prostaglandin enzymes was mainly in scattered cells and blood vessels, and may indicate an inflammatory process of the muscle, which could be secondary to systemic inflammation.
Conclusions: This data may indicate an inflammatory process in muscle of prior polio patients. Up-regulation of the prostaglandin E2 pathway reveals a potential background to the pain experienced by these patients, and may provide opportunities for directed pharmacological and physical therapies, which could lead to better outcomes of rehabilitation interventions.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Late Effects of Polio
Title: Polio: long-term problems
Author: Perry J, Fleming C
Affiliation: Not stated
Journal: Orthopedics
Citation: Orthopedics. 1985 Jul; 8(7):877-81
Publication Year and Month: 1985 07
Abstract: The most common long-term problems seen in polio are brace problems, knee recurvatum, increasing weakness due to overuse and ankle equinus. A definite increased incidence of problems is seen after the patient is more than 30 years post-polio. The basis for most of these problems is chronic mechanical strain of weak musculature and substituting ligaments. Overuse can cause increasing weakness resulting in pain and decreasing function. It is therefore important to follow polio patients closely, especially those that are more than 30 years post-polio. If signs of overuse or chronic mechanical strain are noted, treatment should not be delayed.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Late Effects of Polio
Title: Psoriasis sparing the lower limb with postpoliomyelitis residual paralysis
Author: Wang TS (1), Tsai TF
Affiliation: (1) Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
Journal: British Journal of Dermatology
Citation: Br J Dermatol. 2014 Aug;171(2):429-31. doi: 10.1111/bjd.12854
Publication Year and Month: 2014 08
Abstract: This paper does not have an abstract.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here for preview
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Late Effects of Polio
Title: Risk of symptoms related to late effects of poliomyelitis
Author: Rekand T, Albrektsen G, Langeland N, Aarli JA
Affiliation: Department of Neurology, Haukeland Hospital, Bergen, Norway
Journal: Acta Neurologica Scandinavica
Citation: Acta Neurol Scand. 2000 Mar;101(3):153-8
Publication Year and Month: 2000 03
Abstract: OBJECTIVE: To compare the risk of developing symptoms related to late effects of poliomyelitis between polio patients and persons of similar age and sex without history of poliomyelitis.
MATERIAL AND METHODS: The study comprised information on 148 patients with prior poliomyelitis and 115 persons with no history of poliomyelitis. Information was obtained by questionnaire and analyzed by multiple logistic regression method.
RESULTS: The risk of experiencing two or more symptoms was significantly higher among the polio patients than among the persons without history of poliomyelitis. The elevation in risk was less pronounced in the nonparalytic group (OR = 2.35; 95% CI = 0.92-5.97) than the group with permanent muscular weakness (OR = 8.84; 95% CI =4.32-18.09).
Conclusions: Although symptoms defined in the PPS are unspecific and may occur in the general population, the risk for developing such symptoms are higher among the polio victims. The difference in risk among nonparalytic and paralytic patients may depend on the extent of motor neuron damage in the acute stage.
Outcome of Research: Not applicable
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio
Title: Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.
Author: Paolo Ragonese, Brigida Fierro, Giuseppe Salemi, Giovanna Randisi, Daniela Buffa, Marco D'Amelio, Antonella Aloisio, Giovanni Savettieri
Affiliation: Dipartimento di Neurologia, Oftalmologia, Otorinolaringoiatria e Psichiatria, Università di Palermo, Italy.
Journal: Journal of the Neurological Sciences
Citation: 2005 Sep 15;236(1-2):31-5.
Publication Year and Month: 2005 09
Abstract: OBJECTIVE:
To investigate frequency and associated factors of post polio syndrome (PPS) in an Italian cohort of people with prior poliomyelitis.
METHODS:
We screened subjects admitted for poliomyelitis at the paediatric hospital of the University of Palermo during the time frame 1945-1960. Patients who developed PPS were identified through a structured questionnaire and a neurologic examination. PPS diagnosis was made according to specified diagnostic criteria. Frequency of PPS was calculated in the selected cohort of polio survivors. The association with the investigated risk factors (sex, age at onset of polio, extension and severity of polio, education, associated diseases, cigarette smoking, trauma, polio vaccination) was analysed by the calculation of the odds ratio.
RESULTS:
Forty-eight participants met the adopted diagnostic criteria for PPS, giving a prevalence of 31.0%. The prevalence rate was significantly higher in women than in men (p=0.02). Logistic regression analyses revealed a significant inverse association with onset of poliomyelitis at over 12 months of age (OR 0.33; CI 0.14-0.79) a higher degree of education (OR 0.20; CI 0.07-0.79), and a significant association with the presence of other diseases (OR 9.86; CI 3.69-26.34).
Conclusions: CONCLUSIONS:
In our survey one-third of patients with prior poliomyelitis had PPS. Higher age at onset of poliomyelitis is inversely associated with PPS. The association with other diseases may indicate that a chronic physical stress, particularly in already weak motor units, can contribute to the development of signs and symptoms of PPS. Our results also suggest the impact of socio-economic conditions on the risk of PPS.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio
Title: Experiences and perspectives of patients with post-polio syndrome and therapists with exercise and cognitive behavioural therapy
Author: Minne Bakker, Karen Schipper, Fieke S. Koopman, Frans Nollet and Tineke A. Abma
Affiliation: Department of Medical Humanities, EMGO+ Institute, VU Medical Center
(VUmc), Amsterdam, The Netherlands
Journal: BioMed Central Neurology
Citation: BMC Neurology (2016) 16:23
Publication Year and Month: 2016
Abstract: Background: Many persons affected with poliomyelitis develop post-polio syndrome (PPS) later in their life.
Recently, the effectiveness of Exercise Therapy (ET) and Cognitive Behavioural Therapy (CBT) for PPS has been evaluated in a randomized controlled trial, but did not show a decrease in fatigue or improvement in secondary endpoints like Quality of Life and self-perceived activity limitations. The aim of this explorative study was to gain insight in the perceived effects and experiences of the interventions from the perspectives of the patients and
therapists.
Methods: Qualitative data were collected through semi-structured interviews with 17 patients and 7 therapists. All participants were involved in the trial. A thematic analysis of the data was performed.
Results: Some patients experienced a short term enhanced endurance and a better use of energy during the day. However, in general patients did not experience a long lasting reduction of fatigue from the CBT or ET. Mainly patients of the CBT, but also some patients of the ET described an increase of self-esteem and self-acceptance. As a result, patients were sometimes better able to perform physical activities during the day. In contrast to the CBT, the
ET was in general perceived by the patients as an intensive therapy, which was difficult to fit into their daily routine. Therapists of both the CBT and the ET struggled with a low intrinsic motivation of the patients in the study.
This made it sometimes difficult for the therapists to follow the protocol.
Conclusions: Conclusion: Confirming the negative quantitative study outcome, the qualitative results did not demonstrate lasting effects on fatigue. Patients did, however, experience some benefits on self-esteem and acceptance of the disease. This study showed that it is of great importance to work with feasible interventions; they should fit the patients’ needs on a practical (fit into their daily routine) and mental (fit their need for support) level.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
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):
Link to Full Paper (if available): Click here for preview
Category: Late Effects of Polio
Title: Long-term follow-up of patients with prior polio over a 17-year period.
Author: Vreede KS, Broman L, Borg K.
Affiliation: Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, Floor 3, SE-182 88 Stockholm, Sweden, [email protected].
Journal: Journal of Rehabilitation Medicine
Citation: 2016 Apr;48(4):359-64
Publication Year and Month: 2016 04
Abstract: OBJECTIVE:
Follow-up of the health of patients with prior polio over a 17-year period.
DESIGN:
Follow-up study.
PATIENTS:
Patients with prior polio.
METHODS:
The study questionnaire was answered in 1995 by 270 patients. In 2012 the questionnaire was sent again to the surviving patients.
RESULTS:
Of the patients who answered the questionnaire in 1995, 116 (40%) were still alive in 2012. The group of patients who had died was older, and had a mean age of 70 years in 1995. A total of 60 patients participated in the study by answering the questionnaire in both 1995 and 2012. Most of these patients (84%) reported that they felt progressively worse, with poor mobility and increased muscle weakness in 2012 compared with 1995, and more than half reported a lower quality of life in 2012. The number of wheelchair users had increased significantly. Furthermore, the patients experienced increasing problems with activities of daily living (ADL) function.
Conclusions: More than half of the patients with prior polio had died between 1995 and 2012. These patients were, on average, older than patients surviving in 2012. When interviewed in 2012 most of the patients felt progressively worse, with poor mobility and increased muscle weakness.
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio
Title: Risk factors for functional deterioration in a
cohort with late effects of poliomyelitis:
A ten-year follow-up study
Author: Zeev Meiner (1*), Anat Marmor (1), Murad Jalagel (1), Hagai Levine (2), Shimon Shiri (1) and Isabella Schwartz (1)
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
(2) Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
Journal: NeuroRehabilitation
Citation: vol. 49, no. 3, pp. 491-499.
DOI:10.3233/NRE-210216
Publication Year and Month: 2021 11
Abstract: Background:
More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome.
Objective:
To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years.
Methods:
A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires.
Results:
Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions.
Conclusions:
Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.
Keywords: ADL; Poliomyelitis; functional outcomes; wheelchair use.
Conclusions: The results of the present study indicate that aging has a significant effect on the independence and quality of life of people with LEoP. Other risk factors for deterioration in functional independence were ethnicity, use of a wheelchair, and use of an orthotic device in childhood. These findings emphasize the need for specific rehabilitation programs for to prevent further deterioration in this population.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio
Title: The risk of post-polio syndrome among immigrant groups in Sweden
Author: Per Wändell (1,2), Kristian Borg (3), Xinjun Li (2), Axel C. Carlsson (1,4), Jan Sundquist (2,5,6) & Kristina Sundquist (2,5,6)
Affiliation: (1) Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
(2) Center for Primary Health Care Research, Lund University, Malmö, Sweden
(3) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
(4) Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
(5) Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
(6) Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Scientific Reports volume 13, Article number: 6044 (2023)
https://doi.org/10.1038/s41598-023-33240-w
Publication Year and Month: 2023 04
Abstract: To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52–2.07) and 1.39 (1.19–1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17–10.59) and 8.39 (5.44–12.95), respectively, and Asia, HRs 6.32 (5.11–7.81) and 4.36 (3.38–5.62) respectively, and in men from Latin America, HR 3.66 (2.17–6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.
Conclusions: In conclusion, we found a higher risk of PPSs in individuals from non-Western regions, especially from Africa and Asia. It is of importance to be aware of PPS in the whole healthcare system in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. PPS patients need treatment and follow-up for their lifetime. PPS will only disappear decades after the worldwide eradication of polio.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio, Muscle Strength, Post-Polio Motor Unit
Title: Treatment with L‐Citrulline in patients with post‐polio syndrome: A single center, randomized, double blind, placebo‐controlled trial
Author: Niveditha Putananickal (1), Anna-Lena Orsini (1), Simone Schmidt (1), Vanya Gocheva (1), Daniela Rubino (1), Tanja Haas (2), Sabine Schädelin (3), Xeni Deligianni (2), Oliver Bieri (2), Dirk Fischer (1), Patricia Hafner (1)
Affiliation: (1) Division of Pediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, Switzerland
(2) Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
(3) Department of Clinical Research, Clinical Trial Unit, University of Basel Hospital, Basel, Switzerland
Journal: Neuromuscular Disorders
Citation: Volume 31, Issue 11, p. 1136-1143
DOI: https://doi.org/10.1016/j.nmd.2021.08.011
Publication Year and Month: 2021 11
Abstract: This single-centered, randomized, double-blind, placebo-controlled study reports the results of L-Citrulline treatment for 24 weeks in patients with post-polio syndrome (PPS). Twenty-nine patients were randomized and assigned into receiving a treatment of 15 g L-Citrulline or placebo. The primary endpoint was the change of the 6 min walking distance test. Secondary endpoints included motor function measure, quantitative muscle strength, quantitative MRI and self-reported impairment questionnaires. Patients receiving L-Citrulline walked 17.5 longer in the 6 min walking distance test when compared to placebo group, however not statistically significant (95% CI = -14.69; 49.68, p = 0.298). None of the secondary endpoints showed a statistically significant change in the L-Citrulline group when compared to placebo group. The motor function measure showed a change of -0.78 (95% CI= [-3.39; 1.83] p = 0.563). Muscle degeneration of leg muscles assessed with quantitative MRI indicated no significant change (estimate= -0.01, 95% CI =-0.13; 0.11, p = 0.869). L-Citrulline was safe and well tolerated. In conclusion, administration of 15 g L-Citrulline daily for 24 weeks to patients with PPS showed no beneficial treatment effect in timed muscle function.
Keywords:
Post-polio syndrome, Late effects of poliomyelitis, L-Citrulline, 6MWT, Quantitative MRI
Conclusions: Our results demonstrate that 15 g of daily CIT treatment for 24 weeks did not show a beneficial treatment effect on timed muscle function assessment in patients with PPS. None of the secondary outcomes indicated a beneficial effect due to the CIT treatment.
The chosen qMRI method for detecting muscle degeneration of lower calf muscles seems not appropriate for future studies in a population with PPS. Furthermore, an appropriate endpoint integrating the asymmetric and slow decline has to be still determined in patients with PPS. To further evaluate the therapeutic effect of CIT in individuals with PPS trials, potentially a combination with Metformin is proposed.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio, Post-Polio Motor Unit
Title: A Longitudinal Motor Unit Number Index (MUNIX) Estimation Study in Poliomyelitis (2815)
Author: Taha Omer (1), Bahman Nasseroleslami (1), Fiona Molloy (2), Gerard Mullins (2), Orla Hardiman (3)
Affiliation: (1) Trinity College Dublin
(2) Beaumont Hospital
(3) Trinity Biomedical Sciences Institute
Journal: Neurology
Citation: 96.15 Supplement (2021): 2815. Web. 08 Feb. 2022.
Publication Year and Month: 2021 04
Abstract: Objective:
We aimed at establishing MUNIX repository of Poliomyelitis survivors, determining the rate of MUNIX decline longitudinally and comparing patient characteristics and disease parameters among polio subgroups.
Background:
Motor Unit Number index (MUNIX) is a non-invasive method that that involves utilizing the surface-recorded compound muscle action potential (CMAP) and electromyographic (EMG) interference pattern to compute the motor unit number index (MUNIX). This is the first study of this scale that applied MUNIX in Poliomyelitis (Polio).
Design/Methods:
We performed longitudinal MUNIX measurements in 6 muscles in 41 Polio patients, 3-monthly, over 21 months period on the least affected side or the side with clinically not affected fourth limb. Detailed clinical data was also collected.
Results:
Of 41 (34 spinal and 7 spinobulbar) enrolled patients (M: F= 19:21), subgroup results varied.
Mean age (±SD) of patients was 62.1(±6.8) years. Mean disease duration at visit1 was 59.8(±6.6) years.
Slight longitudinal decline in MUNIX values were recorded in 7 participants (17%). There were no differences between the later cohort and the rest of participants as regards to: demographics, polio onset age, gender, subtype, duration or post-polio syndrome (PPS) metrics (symptoms, onset age, duration and recovery type).
MUSIX values temporarily increased in 8 participants (19.5%) at time of muscle pain, returning to about 80–90% of baseline. Disease metrics were similar in this subgroup compared to other participants.
Conclusions:
This is the largest scale MUNIX study in Poliomyelitis. Our observation of the effect of pain on MUSIX needs further research perhaps using a combination of Neurophysiological techniques.
Conclusions: This is the largest scale MUNIX study in Poliomyelitis. Our observation of the effect of pain on MUSIX needs further research perhaps using a combination of Neurophysiological techniques.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view full text or to download
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.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio, Quality of Life
Title: Quality of life assessment scales in polio survivors: a scoping review
Author: Surajo Kamilu Sulaiman (1), Heather Michelle Aldersey (1), Nora Fayed (1), Bashir Kaka (2) & Christiana Okyere (1)
Affiliation: (1) School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
(2) Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, PMB 3011, Kano, Nigeria
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Quality of Life Research volume 28, pages 2341–2357 (2019)
https://doi.org/10.1007/s11136-019-02185-x
Publication Year and Month: 2019 04
Abstract: Background
Quality of life evaluation is essential to explore the effect of paralytic polio on the daily life experience of the polio survivor. Researchers have employed a range of assessment instruments to evaluate quality of life among polio survivors. Hence, to select the appropriate scale, it is crucial to compare the contents and psychometric properties of these instruments.
Purpose
This scoping review explores quality of life instruments that are used in polio literature and analyzes their contents and psychometric properties using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.
Method
Using the Arksey and O’Malley framework, we conducted a literature search in the following electronic databases Medline, CINAHL, Web of Science, Embase, and Google Scholar to identify relevant studies that focused on quality of life of polio survivors. Of the 88 articles that qualify for full-text screening, 34 studies met our inclusion criteria. Two independent reviewers extracted data from the selected studies via Covidence, a reference manager that allows for blinding of reviews.
Results
Most of the instruments included in this review are generic, self-reported, and multidimensional. Despite having mostly adequate psychometric properties, these properties were not evaluated in polio survivors.
Conclusion
The information provided in this review could be used to guide instrument selection and identify the need to develop a new tool or to adapt a pre-existing scale for measuring quality of life among polio survivors.
Conclusions: The information provided in this review could be used to guide instrument selection and identify the need to develop a new tool or to adapt a pre-existing scale for measuring quality of life among polio survivors.
Outcome of Research: More research required
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Late Effects of Polio, Respiratory Complications and Management
Title: Post-Polio Syndrome Causing Late Onset Respiratory Failure
Author: Sharon Enghelberg MD, Itamar Y. Love MD and Micha Rapoport MD
Affiliation: Department of Internal Medicine C, Shamir Medical Center, Zerifin, Israel
Journal: Israel Medical Association Journal (IMAJ)
Citation: 2020; 22: 395–396
Publication Year and Month: 2020
Abstract: CASE STUDY:
We present a patient with thoracic cage deformity and chronic progressive hypoventilation due to late onset PPS.
Conclusions: PPS can be a significant cause for respiratory deterioration in patients with
previous history of poliomyelitis. Physicians should be aware of this potential
diagnosis, as early diagnosis can facilitate individualized treatment plan and
prevent unnecessary examinations and mistreatment.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
Category: Late Effects of Polio, Surgery
Title: Physical Therapist Management Following Rotator Cuff Repair for a Patient With Postpolio Syndrome
Author: Mary Carlson, Tana Hadlock
Affiliation: M Carlson, PT, PhD, is Associate Professor, Physical Therapy Program,
University of Texas at El Paso, 1101 N Campbell, El Paso, TX 79902 (USA).
T Hadlock, MA, OTR, is Instructor, Occupational Therapy Program, Yamaguchi Health and Welfare College, Ube City, Yamaguchi Prefecture, Japan.
Journal: PTJ: Physical Therapy & Rehabilitation Journal (Prior to 2021, was titled Physical Therapy)
Citation: Phys Ther. 2007;87:179–192.
https://doi.org/10.2522/ptj.20050200
Publication Year and Month: 2007 02
Abstract: Background and Purpose
Postpoliomyelitis sequelae, such as gait instability and progressive weakness, predispose people with postpolio syndrome to secondary disabilities. With aging, people who depend on their upper extremities to accommodate lower-extremity deficits may anticipate overuse injuries. The purpose of this case report is to describe the use of mobilization and exercise in postoperative rehabilitation of rotator cuff surgery on a patient with postpolio syndrome.
Case Description
A 48-year-old woman with postpolio syndrome had rotator cuff surgical repair followed by physical therapy intervention. Maitland mobilization and mild functional exercises were chosen to avoid triggering fatigue.
Outcomes
Measurements taken preoperatively, before and after physical therapy intervention, and 2 years after intervention showed return to independent status with excellent retention.
Discussion
No fatigue or overuse weakness was encountered. This is the first case report to document physical therapy following rotator cuff repair in a patient with postpolio syndrome.
Conclusions: In summary, this is the first case report to document the effects of physical therapy in a patient with PPS who had a rotator cuff tear resulting from extended use due to postpolio sequelae. The physical therapist used a Maitland technique with functional active exercises for the patient. The physical therapist additionally emphasized communication and used the patient responses to adjust treatment. The patient was knowledgeable about her condition and was able to be an active partner of the rehabilitation team, monitor fatigue, and modify her exercises and activities as needed. Additionally, the change between her status immediately following rehabilitation and 2 years later showed continued progress in strength and ROM. We believe that the combination of good practitioner/patient communication, use of the Maitland technique to increase joint ROM without patient effort, and careful selection of a few functionally important active and resistive exercises contributed to the success of this patient’s rehabilitation.
Future research might use a single-subject research design for multiple individuals with PPS who have rehabilitation following orthopedic surgery. A standardized functional survey would strengthen the design, and a handheld dynamometer could be used to quantify muscle strength in lieu of the BTE device. The single-subject design is stronger than the case report and can infer an effect of the intervention on the outcome.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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:
Comments (if any):
Link to Full Paper (if available):
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.
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
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.
Conclusions:
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Muscle Strength
Title: The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review
Author: Stolwijk-Swüste JM, Beelen A, Lankhorst GJ, Nollet F; CARPA Study Group
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2005 Aug;86(8):1693-701
Publication Year and Month: 2005 08
Abstract: OBJECTIVES: To review systematically studies of late-onset polio sequelae on the course of functional status and muscle strength over time and to identify prognostic factors of change.
DATA SOURCES: We conducted a computerized literature search up to July 2004 in MEDLINE, EMBASE, CINAHL, Web of Science, PsychInfo, and the Cochrane controlled trial register using the key words: postpolio, postpoliomyelitis, postpoliomyelitis syndrome, post poliomyelitis muscular atrophy, and poliomyelitis.
STUDY SELECTION: Reports were selected by 1 reviewer if the study involved subjects with a history of poliomyelitis, the outcome measures described functional status or muscle strength, and follow-up was for at least 6 months.
DATA EXTRACTION: Studies were summarized with regard to population, design, sample size, outcome measures, results, and methodologic scores. Overlap in populations between studies was checked.
DATA SYNTHESIS: Of 71 potentially relevant studies, 19 were included (2 on functional status, 15 on muscle strength, 2 on both muscle strength and functional status). Two studies on the course of functional status had sufficient quality and reported inconsistent results. Four studies on the course of muscle strength had sufficient quality. Two studies reported a decline in strength and 2 reported no change. Decline in strength was only reported in studies with a follow-up period longer than 2 years. One study reported extent of paresis as a prognostic factor for change in perceived physical mobility.
Conclusions: Conclusions cannot be drawn from the literature with regard to the functional course or prognostic factors in late-onset polio sequelae. The rate of decline in muscle strength is slow, and prognostic factors have not yet been identified. Long-term follow-up studies with unselected study populations and age-matched controls are needed, with specific focus on prognostic factors.
Outcome of Research:
Comments (if any):
Link to Full Paper (if available):
Category: Muscle Strength
Title: Disability in a 4-year follow-up study of people with post-polio syndrome
Author: Willén C, Thoren-Jönsson AL, Grimby G, Sunnerhagen KS
Affiliation: Institute of Neurosciences and Physiology-Rehabilitation Medicine, Sahlgrenska Academy, Göteborg, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2007 Mar;39(2):175-80.
Publication Year and Month: 2007 03
Abstract: OBJECTIVE: To evaluate changes over time in a clinically based cohort of individuals with post-polio syndrome.
DESIGN: A prospective longitudinal study.
SUBJECTS: A total of 106 individuals with poliomyelitis sequelae were included in the study. They were self-referred or had been referred to the post-polio clinic. After 4 years subjects were called for a follow-up and underwent the same measurements as at the initial assessment.
METHODS: The following measurements were conducted at both the initial assessment, and the follow-up: questionnaires including Nottingham Health Profile, muscle strength and walking speed.
RESULTS: Minor changes in disability during a 4-year period were shown. A significant reduction in muscle strength was only seen for 60° flexion in the left leg and for right and left dorsal flexion. No change could be seen in the total Nottingham Health Profile score.
Conclusions: The minor changes in disability found in this study are an indication that we still do not know which subjects are at risk for deterioration. It is difficult to say whether the small changes over time shown in this study are associated with support from the polio clinic or are an expression of the natural history of the syndrome. However, it is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity.
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
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.
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Muscle Strength
Title: Reliability of contractile properties of the knee extensor muscles in individuals with post-polio syndrome.
Author: Voorn EL (1,2), Brehm MA (1), Beelen A (1), de Haan A (2), Nollet F (1), Gerrits KH (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
Journal: Public Library of Science (PLoS One)
Citation: PLoS One. 2014 Jul 14;9(7):e101660. doi: 10.1371/journal.pone.0101660.
Publication Year and Month: 2014 07
Abstract: OBJECTIVE: To assess the reliability of contractile properties of the knee extensor muscles in 23 individuals with post-polio syndrome (PPS) and 18 age-matched healthy individuals.
METHODS: Contractile properties of the knee extensors were assessed from repeated electrically evoked contractions on 2 separate days, with the use of a fixed dynamometer. Reliability was determined for fatigue resistance, rate of torque development (MRTD), and early and late relaxation time (RT50 and RT25), using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM, expressed as % of the mean).
RESULTS: In both groups, reliability for fatigue resistance was good, with high ICCs (>0.90) and small SEM values (PPS: 7.1%, healthy individuals: 7.0%). Reliability for contractile speed indices varied, with the best values found for RT50 (ICCs>0.82, SEM values <2.8%). We found no systematic differences between test and retest occasions, except for RT50 in healthy subjects (p = 0.016).
SIGNIFICANCE: This was the first study to examine the reliability of electrically evoked contractile properties in individuals with PPS. Our results demonstrate its potential to study mechanisms underlying muscle fatigue in PPS and to evaluate changes in contractile properties over time in response to interventions or from natural course.
Conclusions: Both in individuals with PPS and in healthy individuals, the reliability of fatigue resistance, as obtained from electrically evoked contractions of the knee extensor muscles is high. The reliability of contractile speed indices is only moderate, except for RT50 in PPS, demonstrating high reliability. Considering these results, the assessment of contractile properties in PPS is sufficiently reliable to identify those patients with impaired contractile functioning of their knee extensor muscles, and, accordingly, to evaluate changes over time or following interventions in this patient group. Based on its potential in PPS, future research may also focus on the feasibility of this method in other slowly progressive neuromuscular diseases where muscle fatigue is a major problem.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to download
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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
Comments (if any): Paid subscription required to view or download full text.
Link to Full Paper (if available): Click here to view Abstract
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 a