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Title: Stimulation frequency-dependent neuromuscular junction transmission defects in patients with prior poliomyelitis
Author: Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Affiliation: Department of Neurology, McGill University, Montreal Neurological Institute and Hospital
Journal:
Citation: Journal of the Neurological Sciences, 118 (1993) 150-157
Publication Year and Month: 1993 03
Abstract: Generalized fatigue and muscle fatiguability are major symptoms of post-poliomyelitis syndrome (PPS), and may be due to neuromuscular junction transmission defects, as suggested by increased jitter on single fiber electromyography (SFEMG). To determine the etiology of this defect, we studied jitter at low (1, 5 Hz) and high (10, 15, 20 Hz) frequency stimulation with stimulation SFEMG in 17 post-polio patients with muscle fatiguability, and in 9 normal controls. In 5 of 17 PPS patients and in 1 of 9 controls, jitter was significantly higher (unpaired t-test, P < 0.05) at high frequency stimulation (HFS). In the remaining PPS patients and controls there was no significant difference in jitter at high and low stimulation frequencies. PPS patients with increased jitter at HFS had a significantly longer time interval since acute polio (mean 48.5 years) than PPS patients without increased jitter at HFS (mean 40 years; P < 0.05), but were not distinguished by other historical or clinical criteria. We conclude that the neuromuscular junction defect in post-polio patients is similar to that observed in amyotrophic lateral sclerosis, and is probably due to ineffective conduction along immature nerve sprouts and exhaustion of acetylcholine stores. The appearance of an increase in jitter with HFS in post-polio patients may be dependent upon time after acute polio.
Conclusions:
Outcome of Research: Not applicable
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Category: Drugs
Title: An Open Trial of Pyridostigmine in Post-poliomyelitis Syndrome
Author: Daria A. Trojan and Neil R. Cashman
Affiliation: From the Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal.
Journal:
Citation: The Canadian Journal of Neurological Sciences Volume 22, No. 3 August 1995 223-227
Publication Year and Month: 1995 08
Abstract: Background: One of the major symptoms of postpoliomyelitis syndrome (PPS) is disabling generalized fatigue. Subjects with PPS also report muscle fatiguability and display electrophysiologic evidence of anticholinesterase-responsive neuromuscular junction transmission defects, suggesting that anticholinesterase therapy may be useful in the management of disabling fatigue. Methods: We initiated an open trial of the oral anticholinesterase pyridostigmine, up to 180 mg per day, in 27 PPS patients with generalized fatigue and muscle fatiguability. Response to Pyridostigmine was assessed with the Hare fatigue scale, the modified Barthel index for activities of daily living, and a modified Klingman mobility index. Results: Two patients could not tolerate the medication. After one month of therapy, 16 patients (64%) reported a reduction in fatigue on the Hare fatigue scale; three of 16 showed improvement on the modified Barthel index for activities of daily living, and two of 16 experienced improvement on a modified Klingman mobility index. Pyridostigmine responders were significantly more fatigued than non-responders on the pre-treatment Hare score, but were not significantly different with regard to age, sex, age at acute poliomyelitis, or severity of acute poliomyelitis. Conclusions: Pyridostigmine may be useful in the management of fatigue in selected patients with PPS. Response to pyridostigmine may be predicted by severity of pre-treatment fatigue.
Conclusions:
Outcome of Research: Not applicable
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Category: Psychology
Title: Stress and "Type A" Behavior as Precipitants of Post-Polio Sequelae: The Felician/Columbia Survey
Author: Richard L. Bruno, PhD, and Nancy M. Frick, MDiv, LhD
Affiliation:
Journal:
Citation: In LS Halstead and DO Wiechers (Eds.): Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains: March of Dimes Research Foundation, 1987.
Publication Year and Month: 1987
Abstract: A behavioral profile has begun to emerge from studies of persons who survived acute poliomyelitis and are now experiencing post-polio sequelae. Persons who had polio have been shown to be employed full time at four times the rate of the general disabled population (1,2). Persons who had polio have more years of formal education on average than the general population (3), and marry at approximately the same rate as those who are not disabled (4). These data, combined with our own experience with thousands of persons who had polio, indicated that "polio survivors" are competent, hard-driving and time-conscious overachievers who demand perfection in all aspects of their personal, professional, and social lives. It appeared that those who survived polio exhibit "Type A" behavior and would therefore experience chronic emotional stress.
The notion that individuals who had polio exhibit "Type A" behavior and experience chronic stress was thought to be extremely important for an understanding of the pathophysiology and treatment of post-polio sequelae (PPS). Animal studies have demonstrated that stress accelerates the onset of muscle fatigue (5), augments age-related decreases in the terminal axon branch number (6), and accelerates age-related losses of neurons (7). Therefore, this study was designed to test 2 hypotheses: 1) persons who had poliomyelitis exhibit "Type A" behavior and symptoms pathognomonic of chronic stress, and 2) "Type A" behavior and stress precipitate or exacerbate PPS.
Conclusions:
Outcome of Research: Not applicable
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Category: Orthoses
Title: Gait Analysis Techniques
Author: JoAnne K. Gronley and Jacquelin Perry
Affiliation: Physical Therapist, Pathokinesiology Service, Rancho Los Amigos Hospital; Director, Pathokinesiology Service, Rancho Los Amigos Hospital, and Professor of Orthopaedic Surgery, University of Southern California
Journal:
Citation: The Journal of American Physical Therapy Assn. Vol. 63, No. 12, December 1984 1831-1838
Publication Year and Month: 1984 12
Abstract: In the gait laboratory at Rancho Los Amigos Hospital, the emphasis is on patient testing to identify functional problems and determine the effectiveness of treatment programs. Footswitch stride analysis, dynamic EMG, energy-cost measurements, force plate, and instrumented motion analysis are the techniques most often used. Stride data define the temporal and distance factors of gait. We use this information to classify the patient's ability to walk and measure response to treatment programs. Inappropriate muscle action in the patient disabled by an upper motor neuron lesion is identified with dynamic EMG. Intramuscular wire electrodes are used to differentiate the action of adjacent muscles. We use the information to localize the source of abnormal function so that selection of treatment procedures is more precise. Force and motion data aid in determining the functional requirement and the muscular response necessary to meet the demand. Determining the optimum mode of locomotion and developing criteria for program planning have become more realistic with the aid of energy-cost measurements. Microprocessors and personal computer systems have made compact and reliable single-concept instrumentation available for basic gait analysis in the standard clinical environment at a modest cost. The more elaborate composite systems, however, still require custom instrumentation and engineering support.
Conclusions: This review of the RLAH gait laboratory has emphasized our clinical focus on patient care. Research projects have followed two directions. Technical developments have related to developing the footswitch, energy cost, and dynamic EMG systems. Functional research has assessed normal performance to provide baselines for interpreting pathological activities.
Outcome of Research: Not applicable
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Category: 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:
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Category: Orthoses
Title: Findings in Post-Poliomyelitis Syndrome
Author: Perry, J.P., Fontaine, J.D., Mulroy, S., Downey, P.T.
Affiliation: Pathokinesiology Service, Rancho Los Amigos Medical Center, Downey
Journal:
Citation: The Journal of Bone and Joint Surgery Vol. 77-A, No. 8, August 1995, 1148-1153
Publication Year and Month: 1995 08
Abstract: The purpose of this study was to identify overuse of muscles and other alterations in the mechanics of gait in twenty-one patients who had muscular dysfunction as a late consequence of poliomyelitis. All of the patients had good or normal strength (grade 4 or 5) of the vastus lateralis and zero to fair strength (grade 0 to 3) of the calf, as determined by manual testing.
Dynamic electromyography was used, while the patients were walking, to quantify the intensity and duration of contraction of the inferior part of the gluteus maximus, the long head of the biceps femoris. the vastus lateralis, and the soleus muscles. Patterns of contact of the foot with the floor, temporal-spatial parameters, and motion of the knee and ankle were recorded.
The principal mechanisms of substitution for a weak calf muscle fell into three groups: overuse of the quadriceps (twelve patients) or a hip extensor (the inferior part of the gluteus maximus in eight patients and the long head of the biceps femoris in four), or both; equinus contracture (twelve patients); and avoidance of loading-response flexion of the knee (five patients). Most patients used more than one method of substitution.
These obervations support the theory that postpoliomyelitis syndrome results from long-term substitutions for muscular weakness that place increased demands on joints, ligaments, and muscles and that treatment -- based on the early identification of overuse of muscles and ligamentous strain -- should aim at modification of lifestyle and include use of a brace.
Conclusions:
Outcome of Research:
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Category: Orthoses
Title: Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Author: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A.
Affiliation: Nil identified
Journal:
Citation: Ploeger, H.E., Bus, S.A., Nollet, F., Brehm, M-A. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait & Posture. 2017 58:146-153. doi: 10.1016/j.gaitpost.2017.07.107.
Publication Year and Month: 2017 07
Abstract: The objective was to identify gait patterns in polio survivors with calf muscle weakness and associate them to underlying lower extremity impairments, which are expected to help in the search for an optimal orthosis.
Unilaterally affected patients underwent barefoot 3D-gait analyses. Gait pattern clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.
Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20 and 32% of the variance in individual gait parameters.
Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.
Conclusions:
Outcome of Research: Effective
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Category: Exercise
Title: Effect of aquatic exercise training in persons with poliomyelitis disability
Author: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A.
Affiliation:
Journal:
Citation: Prins, J.H., Hartung, H.G., Merritt, D.J., Blancq, R.J., Goebert, D.A. (1994) Effect of aquatic exercise training in persons with poliomyelitis disability. Sports Medicine, Training and Rehabilitation. 5(1):29-39
Publication Year and Month: 1994 01
Abstract: Aquatic exercise, including swimming, reduces the effect of body weight on limbs and joints. A combination of swimming and specific activities involving resistive devices was used in an attempt to improve strength in persons who had symptomatic weakness related to poliomyelitis. Dynamic muscular force application in selected limb movements and range of motion were measured before and after an 8‐week aquatic exercise intervention. Peak (PF) and average force (AF) were determined in the water using a differential pressure transducer attached to either the hand, foot, or a resistive device. Arm flexion, extension, adduction, abduction, and horizontal adduction and abduction along with combined hip flexion and knee extension were tested for both PF and AF Subjects were randomly assigned to experimental and control groups; complete data were available on nine experimental and four control subjects. PF and AF changes were greater (p ≤ 0.05) for experimental compared with control for right arm flexion (PF, 96 versus 6%) and extension (PR 105 versus ‐15%; AF, 76 versus ‐30%), respectively. Changes were greater (p ≤0.05) in experimental than control for left arm extension (PF, 88% versus 19%) and horizontal abduction (PF, 127% versus ‐21%; AF, 122% versus ‐17%). Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.
Conclusions: Aquatic exercise training in subjects with poliomyelitis disability resulted in significant dynamic strength changes of the upper body while appearing not to exacerbate symptomatic fatigue or pain.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: How long does denervation take in poliomyelitis? Or is it a lifetime?
Author: Senol, M.G., Kaplan, C., Ozdağ, F., Saraçoğlu, M.
Affiliation: GATA Haydarpasa Training Hospital, Istanbul
Journal:
Citation: Journal of Neurosciences in rural practice
Senol, M.G., Kaplan, C., Ozdağ, F., Saraçoğlu, M. (2017) How long does denervation take in poliomyelitis? Or is it a lifetime? J Neurosci Rural Pract. 8:511-5
Publication Year and Month: 2017 11
Abstract: Background and Objective: This study aims to determine the period of reinnervation in patients with poliomyelitis. This research was conducted to identify the appearance of denervation potentials in patients with poliomyelitis as indicators for reinnervation.
Materials and Methods: A total of 246 male patients with poliomyelitis were assessed electrophysiologically between 1988 and 2007. The mean age was 22.8 (18–42). It has been an average of 19.9 ± 4.9 years since the beginning of complaints from the patients.
Results: The patients had no complaints of newly developing muscle weakness, fatigue, muscle and joint pain, and difficulties in breathing and swallowing. Neurological examinations revealed the absence of myotomal pain and sensory loss. Upon assessment of the patients' limbs, the following findings were revealed: two patients had left upper and lower limb involvement, two patients had left upper and right lower limb involvement, 6 patients had left upper limb involvement, 12 patients had both lower limb involvement, 105 patients had left lower limb involvement, 1 patient had both upper limb involvement, 2 patients had right lower and upper limb involvement, 12 patients had right upper limb involvement, 6 patients had both lower limb involvement, 95 patients had right lower limb involvement, and 3 had all the three extremities affected. The needle electromyography revealed the presence of denervation potentials in 25.2% (62) of the patients.
Conclusion: When poliovirus attacks the motor neuron, this neuron may be completely destroyed, damaged, or unaffected. Reinnervation occurs when nearby functioning motor units send out terminal axon sprouts to reinnervate the damaged muscle fibers. As a consequence of poliomyelitis, several muscle fibers become atrophic and fibrotic, but others continue to survive. This study showed that patients with a history of poliomyelitis experienced denervation with subsequent reinnervation for many years.
Conclusions: The electrophysiological evidences indicating denervation continuing in 25% of the patients are shown in this study.
Outcome of Research: More research required
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Category: Brain
Title: Parallels between Post Polio fatigue and chronic fatigue syndrome: a common pathophysiology?
Author: Bruno, R.L., Creange, S.J., and Frick, N.M
Affiliation: Kids' Fatigue Management Program and The Post-Polio Institute, Englewood Hospital and Medical Center, New Jersey
Journal:
Citation: Am J Med.
Publication Year and Month: 1998 09
Abstract: Fatigue is the most commonly reported and most debilitating of post-polio sequelae affecting the >1.8 million North American polio survivors. Post-polio fatigue is characterized by subjective reports of difficulty with attention, cognition, and maintaining wakefulness. These symptoms resemble those reported in nearly 2 dozen outbreaks of post-viral fatigue syndromes (PVFS) that have recurred during this century and that are related clinically, historically, anatomically, or physiologically to poliovirus infections. This article reviews recent studies that relate the symptoms of post-polio fatigue and chronic fatigue syndrome (CFS) to clinically significant deficits on neuropsychologic tests of attention, histopathologic and neuroradiologic evidence of brain lesions, impaired activation of the hypothalamic-pituitary-adrenal axis, increased prolactin secretion, and electroencephalogram (EEG) slow-wave activity. A possible common pathophysiology for post-polio fatigue and CFS, based on the Brain Fatigue Generator Model of PVFS, and a possible pharmacotherapy for PVFS based on replacement of depleted brain dopamine, will be described
Conclusions: There is evidence of severe brain lesions at the brain stem and less severe lesions in the cerebellum and cerebral cortex which could play a role in general and cognitive fatigue.
Outcome of Research: More research required
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Category: 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
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Category: Cardiorespiratory, Late Effects of Polio, Respiratory Complications and Management
Title: Living the Present with an Enemy from the Past: The Role of Noninvasive Ventilation in a Poliomyelitis Survivor
Author: Adelaide Alves, Sara Conde, and Carla Ribeiro
Affiliation: Pulmonology Department of Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Journal:
Citation: Clin Case Rep Open Access. 2021;4(2):185.
https://dx.doi.org/10.46527/2582-5038.185
Publication Year and Month: 2021 04
Abstract: Poliomyelitis epidemics of the twentieth century boosted the development of noninvasive positive-pressure ventilation which has changed the natural history and extended survival in a wide range of disorders with chest wall and muscular involvement. Poliomyelitis has almost been eradicated from developed countries since the introduction of vaccination. However, challenges keep coming since there are a substantial number of survivors of the disease who need particular clinical care, namely in the respiratory field. We present a case report of a polio survivor attempting to demonstrate that even after so many years the respiratory approach of these patients remains a current issue in clinical practice with noninvasive ventilation as a cornerstone element.
Keywords: Poliomyelitis; Respiratory failure; Noninvasive ventilation
Conclusions: Finally, we should be aware of a post-polio syndrome referring to a sub-category of the late effects of polio several years following the initial recovery, including muscle weakness and fatigability [11]. This late muscle involvement may also affect the respiratory muscles leading to chronic respiratory failure several years after primary infection [12,13].
For all these reasons, polio continues to represent a current clinical condition in the field of Pulmonology not only because there are many survivors with established thoracic deformities and neuromuscular involvement, but also because of the possibility of late respiratory effects.
Outcome of Research: Not applicable
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Category: Orthoses
Title: Manufacture of Passive Dynamic Ankle–Foot Orthoses Using Selective Laser Sintering
Author: Mario C. Faustini ; Richard R. Neptune ; Richard H. Crawford ; Steven J. Stanhope
Affiliation: Department of Mechanical Engineering, the University of Texas at Austin.
Journal: IEEE Transactions on Biomedical Engineering
Citation: Volume: 55 , Issue: 2 , Feb. 2008
Publication Year and Month: 2008 02
Abstract: Ankle-foot orthosis (AFO) designs vary in size, shape, and functional characteristics depending on the desired clinical application. Passive Dynamic (PD) Response ankle-foot orthoses (PD-AFOs) constitute a design that seeks to improve walking ability for persons with various neuromuscular disorders by passively (like a spring) providing variable levels of support during the stance phase of gait. Current PD-AFO manufacturing technology is either labor intensive or not well suited for the detailed refinement of PD-AFO bending stiffness characteristics. The primary objective of this study was to explore the feasibility of using a rapid freeform prototyping technique, selective laser sintering (SLS), as a PD-AFO manufacturing process. Feasibility was determined by replicating the shape and functional characteristics of a carbon fiber AFO (CF-AFO). The study showed that a SLS-based framework is ideally suited for this application. A second objective was to determine the optimal SLS material for PD-AFOs to store and release elastic energy; considering minimizing energy dissipation through internal friction is a desired material characteristic. This study compared the mechanical damping of the CF-AFO to PD-AFOs manufactured by SLS using three different materials. Mechanical damping evaluation ranked the materials as Rilsantrade D80 (best), followed by DuraFormtrade PA and DuraFormtrade GF. In addition, Rilsantrade D80 was the only SLS material able to withstand large deformations.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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Category: Anaesthesia
Title: Anesthetic considerations for patients with postpolio syndrome: a case report.
Author: Wheeler D
Affiliation: Little Rock Anesthesia Services, Little Rock, Arkansas, USA
Journal: 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
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Category: Respiratory Complications and Management
Title: Bi-level positive airway pressure ventilation maintains adequate ventilation in post-polio patients with respiratory failure.
Author: Gillis-Haegerstrand C, Markström A, Barle H.
Affiliation: Department of Anaesthesiology and Intensive Care, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden. [email protected]
Journal: Acta Anaesthesiologica Scandinavica
Citation: 2006 May;50(5):580-5
Publication Year and Month: 2006 05
Abstract: BACKGROUND:
Patients suffering from post-polio syndrome still contribute significantly to the number of patients with chronic respiratory failure requiring home mechanical ventilation (HMV). Many of these patients are treated either with invasive (tracheostomy) or non-invasive (nasal mask) controlled mechanical ventilation i.e. volume-controlled ventilation (VCV). In this group of patients, we have previously shown that bi-level pressure support ventilation (bi-level PSV) decreases the oxygen cost of breathing. The aim of this study was to compare the effect of bi-level PSV, with special regard to the adequacy of ventilation and the oxygen cost of breathing, during the patients' ordinary VCV and spontaneous breathing.
METHODS:
Eight post-polio patients on nocturnal VCV were investigated. Five of them were tracheostomized and three of them used a nasal mask. Work of breathing was analysed by assessing differences in oxygen consumption (VO2) using indirect calorimetry. Blood gases were obtained regularly to assess adequacy of ventilation.
RESULTS:
Bi-level PSV decreases the oxygen cost of breathing in post-polio patients with respiratory failure without decreasing ventilation efficiency. Furthermore, PaCO2 decreased significantly using this mode of ventilation (P < 0.05).
Conclusions: In this study, it was shown that bi-level PSV reduces the oxygen cost of breathing and gave a significant decrease in PaCO2 in PPS patients. These data suggest that bi-level PSV ventilation maintains adequate ventilation in patients who suffer from post-polio syndrome with respiratory failure.
Outcome of Research: More research required
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Category: 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
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Category: Speech Pathology
Title: Dysphagia and dysphonia among persons with post-polio syndrome – a challenge in neurorehabilitation
Author: Söderholm S, Lehtinen A, Valtonen K, Ylinen A
Affiliation: Käpylä Rehabilitation Centre, Finnish Association of People with Mobility Disabilities, Helsinki, Finland
Journal: Acta Neurologica Scandinavica
Citation: Acta Neurol Scand. 2010 Nov; 122(5):343–349. doi: 10.1111/j.1600-0404.2009.01315.x
Publication Year and Month: 2010 11
Abstract: OBJECTIVE: To study the occurrence of dysphagia and dysphonia in persons with post-polio syndrome admitted into the centre for neurological rehabilitation in Finland.
MATERIALS AND METHODS: Fifty-one persons with post-polio syndrome who were rehabilitated at Käpylä Rehabilitation Centre, Helsinki, Finland, in 2003–2004 were interviewed on problems with swallowing and voice production. Pulmonary function testing and grip strength measurement were performed. A clinical assessment of oral motor and laryngeal functions was carried out for those who reported daily problems with voice production or swallowing.
RESULTS: Fifteen persons (29.4%) reported daily problems with swallowing or voice production. In the clinical assessment, the most commonly observed deficits in swallowing included decreased pharyngeal transit (n = 13) and the food catching in the throat (n = 4). The disturbance of co-ordination of breathing and voice production was seen in 12 persons. There were no significant differences in any of the potential predictors between the groups.
Conclusions: Professionals need to be aware of the routine evaluation of dysphagia and dysphonia in patients with post-polio syndrome.
Outcome of Research: Not applicable
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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
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Category: Diagnosis and Management
Title: Multiple sclerosis and poliomyelitis. A Danish historical cohort study.
Author: Nielsen NM, Wohlfahrt J, Melbye M, Rasmussen S, Mølbak K, Askgaard DS, Aaby P.
Affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Journal: Acta Neurologica Scandinavica
Citation: Acta Neurol Scand 2000 Jun;101(6):384-7.
Publication Year and Month: 2000 06
Abstract: OBJECTIVE:
To evaluate whether persons with a history of poliomyelitis are at an increased risk of developing multiple sclerosis (MS).
MATERIAL AND METHODS:
All patients diagnosed with acute poliomyelitis in the greater capital area of Copenhagen, Denmark, between 1919 and 1954 were identified and followed with respect to MS. Information on vital status and diagnosis of sclerosis was obtained through linkage with the Danish Civil Registration System and The Danish Multiple Sclerosis Registry, respectively. Follow-up started on the date of the establishment of the Danish Civil Registration System (April 1, 1968) until death, emigration or December 31, 1996, whichever came first. The observed incidence of MS among polio patients was compared with the expected incidence calculated according to national gender, age and period specific rates of MS.
RESULTS:
During 149,364 years of follow-up, 19 cases of multiple sclerosis were observed among 5652 polio patients compared with 11.0 expected (SIR = 1.73 (1.04-2.74)). The increased risk of MS was most pronounced in polio patients hospitalized during adolescence. Neither gender nor the acute severity of poliomyelitis modified the risk of MS.
CONCLUSION:
Our results are based on small numbers of events, however the findings suggest that the polio patients might be at an increased risk of MS.
Conclusions:
Outcome of Research: More research required
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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
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Category: Assistive Technology
Title: Mobility and participation among ageing powered wheelchair users: using a lifecourse approach
Author: Delphine Labbé, W. Ben Mortenson, Paula W. Rushton, Louise Demers, and William C. Miller
Affiliation: Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
Rehabilitation Research Lab, Vancouver, Canada
Department of Gerontology, Simon Fraser University, Vancouver, Canada
School of Rehabilitation, Université de Montréal, Montreal, Canada
CHU Sainte Justine Research Center, Montréal, Canada
Centre de recherche de l'institut universitaire de gériatrie de Montréal, Montreal, Canada
Journal: Ageing & Society
Citation: 1-17.
Publication Year and Month: 2018 09
Abstract: About 65 million people use wheelchairs worldwide. Powered wheelchairs offer independent mobility for those who find it difficult to propel a manual wheelchair. Previous studies have described powered wheelchairs as a mixed blessing for the users in terms of usability, accessibility, safety, cost and stigma; however, few studies have explored their impact on mobility and participation over time. Therefore, as part of a larger longitudinal study, we used a combined retrospective and prospective lifecourse perspective to explore the experiences of older adult powered wheelchair users. Based on the interpretive description approach, 19 participants took part in a series of semi-structured interviews over a two-year period about their mobility, social participation and ageing process. The participants were powered wheelchair users, at least 50 years of age, recruited in Vancouver, Montreal and Quebec City (Canada). We identified three themes that highlighted how the powered wheelchair experience was integrated into the life continuum of the users. ‘It's my legs’ emphasised how powered wheelchairs are a form of mobility that not only enables users to take part in activities, but also impacts their identities, past and present. ‘Wheels of change’ explored the dynamic nature of powered wheelchair use and changes related to ageing. ‘Getting around’ illustrated how users’ mobility was affected by the interaction with their physical and social environments.
Conclusions: Developing public policies to advance social and environmental changes could help countries to ensure equity of access and social inclusion of those ageing with disabilities.
Outcome of Research: More research required
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Category: Complementary Therapies
Title: Hatha yoga and meditation in patients with post-polio syndrome
Author: DeMayo W, Singh B, Duryea B, Riley D
Affiliation: Southern California University of the Health Sciences, USA
Journal: Alternative Therapies in Health and Medicine
Citation: Altern Ther Health Med. 2004 Mar-Apr;10(2):24-5
Publication Year and Month: 2004 03
Abstract: This paper does not have an abstract. The following is an extract:
Conemaugh Health System has completed a preliminary outcome study evaluating the benefits of Hatha yoga and meditation in patients with post-polio syndrome (PPS). This research integrates clinical trials investigating the application of Hatha yoga with ongoing patient care and education. The results of this clinical trial will be used to develop a longitudinal data collection effort integrating research and clinical trials investigating the applications of Hatha yoga in ongoing patient care and education.
Conclusions:
Outcome of Research: More research required
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Category: Surgery
Title: Anesthetic implications of postpolio syndrome: new concerns for an old disease
Author: Schwartz A (1), Bosch LM
Affiliation: (1) Saint Louis University Hospital, St Louis, Missouri, USA
Journal: American Association of Nurse Anesthetists
Citation: AANA J. 2012 Oct;80(5):356-61
Publication Year and Month: 2012 10
Abstract: Poliomyelitis was pandemic in the United States and much of the world in the first half of the 20th century. The uses of polio vaccines have essentially eradicated the disease in the United States today. But poliovirus infection survivors who had experienced a paralytic attack can see a return of some symptoms, which is a syndrome called postpolio syndrome (PPS). The anesthetist must preoperatively assess reported amounts of patient physical activity and patient age, which can indicate the amount of muscle degeneration that may have already occurred. Patients with PPS demonstrate altered respiratory function, cold intolerance, a risk for aspiration, and experience chronic pain in muscles and joints. Patients with PPS display an increased sensitivity to some anesthetic agents such as long-acting narcotics and potent inhaled anesthetic gases with a high blood-gas partition coefficient, along with report of increased fatigue, weakness, and somnolence after anesthesia. Anesthesia care must center on the preservation of muscle function postoperatively. The anesthetist should consider the use of short-acting anesthetic agents, increased doses of analgesics, the use of warming devices, and careful attention to patient positioning. Prolonged postoperative care and hospital admission after surgery are possible.
Conclusions:
Outcome of Research: Not applicable
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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):
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Category: Psychology
Title: Recognizing typical coping styles of polio survivors can improve re-rehabilitation – a commentary
Author: Maynard FM, Roller S
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor 48109-0491
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 1991 Apr;70(2):70-2
Publication Year and Month: 1991 04
Abstract: This paper does not have an abstract
Conclusions:
Outcome of Research:
Comments (if any): The full paper is available from Polio Australia for private study purposes.
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Category: Psychology
Title: Coping with the late effects: differences between depressed and nondepressed polio survivors
Author: Tate D, Kirsch N, Maynard F, Peterson C, Forchheimer M, Roller A, Hansen N
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 1994 Feb;73(1):27-35
Publication Year and Month: 1994 02
Abstract: This study examined differences between depressed and nondepressed individuals with a history of paralytic poliomyelitis in terms of demographics, health status and coping strategies. The prevalence of distress and depression in this group of 116 polio survivors was determined. Subjects completed the Brief Symptom Inventory, the Coping with Disability Inventory and a questionnaire concerning their polio histories and self-perceptions of health. Medical assessments were performed by physicians. Only 15.8% of the sample had scores indicating depression and elevated distress. Depressed/distressed polio survivors were more likely to: be living alone, be experiencing further health status deterioration, seek professional help, view their health as poor, report greater pain, be less satisfied with their occupational status and their lives in general and exhibit poorer coping outcome behaviors in relation to their disability. Three factors in coping with the late effects of polio were identified through a factor analysis of the Coping with Disability Inventory: positive self-acceptance, information seeking/sharing about the disability and social activism. Differences between depressed/distressed and other polio survivors were found across these three factors, with depressed/distressed subjects having significantly lower coping scores. These and other results are discussed.
Conclusions:
Outcome of Research:
Comments (if any): The full paper is available from Polio Australia for private study purposes.
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Category: Pain
Title: Psychosocial factors and adjustment to pain in individuals with postpolio syndrome
Author: Hirsh AT, Kupper AE, Carter GT, Jensen MP
Affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98104, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2010 Mar;89(3):213-24. doi: 10.1097/PHM.0b013e3181c9f9a1
Publication Year and Month: 2010 03
Abstract: OBJECTIVE: The purpose of the current study was to examine the associations among measures of psychosocial factors, pain, and adjustment in persons with postpoliomyelitis syndrome.
DESIGN: A cross-sectional survey design was used. Sixty-three community-dwelling individuals with postpoliomyelitis syndrome returned completed questionnaires (71% response rate) that included measures of pain intensity and interference, psychological functioning, pain catastrophizing, social support, and pain-related beliefs and coping.
RESULTS: After controlling for demographic variables, the group of psychosocial variables accounted for an additional 23% of the variance in pain intensity. These variables explained an additional 35% and 50% of the variance in pain interference and psychological functioning, respectively, after accounting for demographic variables and pain intensity. Social support was associated with both psychological functioning and pain interference, whereas catastrophizing was most closely related to psychological functioning. Individual pain beliefs and coping strategies were variably related to the three criterion measures.
Conclusions: The overall results of the current study are consistent with a biopsychosocial framework for understanding pain and functioning in individuals with postpoliomyelitis syndrome. Although additional research is needed to clarify the nature of the relationships between individual psychosocial variables and functional indices, the findings suggest the need for a multidisciplinary approach to pain management in individuals with postpoliomyelitis syndrome.
Outcome of Research: More research required.
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Category: 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
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Category: Diagnosis and Management
Title: Nonparalytic polio and postpolio syndrome
Author: Halstead LS, Silver JK
Affiliation: National Rehabilitation Hospital, Washington, DC 20010, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):13-8
Publication Year and Month: 2000 01
Abstract: We describe four cases of postpolio syndrome with typical histories, physical examination results, and electrodiagnostic evidence of extensive anterior horn cell disease, as well as the putative pathophysiology of postpolio syndrome in persons with histories of nonparalytic polio and the diagnostic implications for individuals older than 40 yr of age who are experiencing unexplained new weakness, fatigue, and muscle or joint pain. Although the diagnosis of postpolio syndrome traditionally has required a remote history of paralytic polio, many persons such as the ones described here with typical symptoms of postpolio syndrome have no clear history of paralytic disease and are being misdiagnosed. With this in mind, we believe that the diagnostic criteria for postpolio syndrome should be modified to include the following: a history of remote paralytic polio or findings on history, physical examination results, and laboratory studies compatible with poliovirus damage of the central nervous system earlier in life.
Conclusions:
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Paralytic vs "nonparalytic" polio: distinction without a difference?
Author: Bruno RL
Affiliation: The Post-Polio Institute, Englewood Hospital and Medical Center, New Jersey, USA
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 2000 Jan-Feb;79(1):4-12
Publication Year and Month: 2000 01
Abstract: Nonparalytic polio (NPP) is commonly thought to be synonymous with "abortive polio," in which the poliovirus neither entered the central nervous system nor damaged neurons. Described are two epidemic illness-"The Summer Grippe" and Iceland disease-apparently caused by a low virulence but neuropathic type 2 poliovirus. Studies show that neuronal lesions in the brain and spinal cord and muscle weakness were common in NPP, and epidemiologic studies document late-onset weakness and fatigue in 14% to 42% of NPP survivors. These findings indicate that clinicians should not require a history of paralytic polio, electromyographic evidence of denervation, and new muscle weakness for the diagnosis of "Postpolio Syndrome" but should be aware that NPP, and possibly even poliovirus-induced "minor illnesses," can be associated with acute central nervous system damage and late-onset muscle weakness and fatigue.
Conclusions:
Outcome of Research: Not applicable
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Category: 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:
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Category: Exercise
Title: Low-intensity, alternate-day exercise improves muscle performance without apparent adverse affect in postpolio patients.
Author: Agre, J., Rodriguez, A., Franke, T., Swiggum, E., Harmon, R., Curt, J.
Affiliation: Agre- Department of Rehabilitation Medicine, University of Wisconsin-Madison Medical School, 53791, USA.
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: Am J Phys Med Rehabil. 1996;75(1):50-8.
Publication Year and Month: 1996 01
Abstract: The purpose of this study was to examine the effect of a low-intensity, alternate-day, 12 wk quadriceps muscle-strengthening exercise program on muscle strength and muscle and motor unit integrity in 12 postpolio patients. Patients performed six to ten repetitions of a 5-s duration knee extension exercise with ankle weights. After completing six repetitions, patients rated the perceived exertion (RPE) in the exercised muscle. The patient continued repetitions until RPE was >/= 17 or ten repetitions were performed. The weight was increased the next exercise day whenever the RPE was < 17 after ten repetitions. Before and after the training program, median macroamplitude as well as jitter and blocking were determined electromyographically (EMG), serum creatine kinase (CK) was measured, and quadriceps muscle strength was assessed. The ankle weight lifted after 2 wk of training and at the end of the program were also recorded. Although the ankle weight lifted at the end of the program significantly (P < 0.05) increased from a mean +/- SD of 7.1 +/- 2.7 to 11.2 +/- 4.7 kg, the dynametrically determined muscle strength measures did not significantly (P > 0.05) increase. The EMG and the serum CK variables also did not significantly (P >0.05) change as a result of the exercise program. We conclude that performance was improved, as demonstrated by an increase in the amount of weight the patients lifted in the exercise program. No evidence was found to show that this program adversely affected the motor units or the muscle as the EMG and CK did not change.
Conclusions: Patients increased leg strength without changes in motor unit innervation or fatigue levels.
Outcome of Research: More research required
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Category: Fatigue
Title: Word Finding Difficulty As A Post-Polio Sequelae
Author: Bruno, R.L. & Zimmerman, J.R.
Affiliation: The Post-Polio Institute
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: American Journal of Physical Medicine & Rehabilitation; 2000; 79:343-348
Publication Year and Month: 2000 05
Abstract: Seventy-nine percent of respondents to the 1990 National Post-Polio Survey reported difficulty
"thinking of words I want to say," with 37% reporting frequent, moderate-to severe word finding
difficulty. In this study, 33 polio survivors were administered the Post-Polio Fatigue Questionnaire,
Animal Naming and FAS Tests, and tests of attention and information processing speed. Plasma
prolactin was also measured as a marker for brain dopamine secretion. Subjects reporting high
fatigue severity and word finding difficulty had clinically abnormal or significantly lower Animal Naming
Test scores as compared to subjects with low symptom severity. Impaired performance on the most
difficult tests of attention and information processing speed were also associated with lower scores on
the word finding tests. A significant negative correlation between Animal Naming Test scores and
plasma prolactin suggests that a decrement in brain dopamine secretion is related to reduced animal
naming ability. These data support the hypothesis that decreased dopamine secretion, possibly
secondary to poliovirus damage to the basal ganglia, may underlie not only fatigue and impaired
attention but also word finding difficulty in polio survivors.
Conclusions: Our clinical experience, that word finding difficulty decreases when polio survivors reduce fatigue by
decreasing physical overexertion and emotional stress, is supported by the correlation of subjective
fatigue with word finding difficulty (2,5). Polio survivors with "brain fatigue" and associated cognitive
symptoms must be encouraged to employ all conservative techniques that have been found to be
effective in treating fatigue to also treat their word finding difficulty, including energy conservation,
work simplification, pacing activities, frequent rests and the use of assistive devices. Only when these
techniques have been consistently applied and found to be insufficient to reduce fatigue and improve
word finding should a trial of bromocriptine be attempted (35,36,37).
Outcome of Research: More research required
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Category: Ageing
Title: Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging
Author: McNalley TE, Yorkston KM, Jensen MP, Truitt AR, Schomer KG, Baylor C, Molton IR.
Affiliation: From the Department of Rehabilitation Medicine, University of Washington, Seattle
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2015 Feb;94(2):139-45.
Publication Year and Month: 2015 02
Abstract: OBJECTIVE:
This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging.
DESIGN:
A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables.
RESULTS:
The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS.
Conclusions: CONCLUSIONS:
Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: A Short History of Medical Expert Guidelines and How They Pertain to Tracheostomy Tubes and Physical Medicine and Rehabilitation
Author: Bach JR
Affiliation: Professor of Physical Medicine and Rehabilitation Department of PM&R, Professor of Neurology, Department of Neurology, Medical Director of the Center for Ventilator Management Alternatives and Pulmonary Rehabilitation of the University Hospital, of the Rutgers New Jersey Medical School, Newark, New Jersey, USA. [email protected].
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2019 Feb 27. doi: 10.1097/PHM.0000000000001172.
Publication Year and Month: 2019 02
Abstract: Continuous noninvasive ventilatory support (CNVS) and mechanical insufflation exsufflation (MIE) have been used since 1953 to spare patients with ventilatory pump failure from ever requiring tracheostomy tubes for ventilatory support or secretion management. Today there are patients with spinal muscular atrophy type 1 who are 25 years old and CNVS dependent since 4 months or age, post-polio survivors CNVS dependent for 64 years, Duchenne muscular dystrophy patients over age 45 CNVS dependent for over 25 years, high level spinal cord injured patients CNVS dependent for over 20 years, and even lung disease patients dependent on CNVS. All these patients, although unweanable from ventilatory support and with little or no measurable vital capacity, can also be extubated to CNVS and MIE without resort to tracheotomies when necessary to continue CNVS. However, for various reasons, this is not cited in academic society expert guidelines. This article considers the extent of the damage being caused by this.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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Category: Exercise
Title: Effort-limited treadmill walk test: reliability and validity in subjects with postpolio syndrome.
Author: Finch LE, Venturini A, Mayo NE, Trojan DA.
Affiliation: Department of Physiotherapy, McGill University Health Center, McGill University, Montreal, Quebec, Canada.
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2004 Aug;83(8):613-23.
Publication Year and Month: 2004 08
Abstract: OBJECTIVE:
To determine the reliability and construct validity of an effort-limited treadmill walk test to measure functional ability in subjects with postpolio syndrome in an outpatient postpolio clinic.
DESIGN:
Functioning and distance walked on a treadmill to a Borg "hard" effort level were measured three times, a week apart, by two blinded raters in 15 subjects with postpolio syndrome, aged 37-67 yrs, with new weakness, fatigue, and pain but with no other cause of symptomatology or condition-limiting walking. One rater tested them twice. Fatigue activity level, mobility, and health-related quality of life (Medical Outcome Study Short Form Health Survey [SF-36]) defined functioning. Generalizability correlation coefficients determined intrarater, test-retest and interrater reliability. The correlations relating the distance walked and functioning determined construct validity.
RESULTS:
Reliability for generalizability correlation coefficients were: intrarater, 0.91; test-retest, 0.85; and interrater, 0.58. Interrater reliability improved to 0.91 with adherence to a standardized protocol. Validity was established with correlations between the distance walked and SF-36 physical component score (0.66), physical role (0.60), bodily pain (0.60), and vitality (0.55).
Conclusions: The treadmill walk test provides a reproducible and valid measure of ability in persons with postpolio syndrome with a single rater, but a standardized protocol is essential for reliability.
Outcome of Research: More research required
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Category: 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
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Category: Respiratory Complications and Management
Title: Sleep-disordered breathing in neuromuscular disease
Author: Aboussouan LS
Affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
Journal: American Journal of Respiratory and Critical Care Medicine
Citation: Am J Respir Crit Care Med. 2015 May 1;191(9):979-89. doi: 10.1164/rccm.201412-2224CI
Publication Year and Month: 2015 05
Abstract: Sleep-disordered breathing in neuromuscular diseases is due to an exaggerated reduction in lung volumes during supine sleep, a compromised physiologic adaptation to sleep, and specific features of the diseases that may promote upper airway collapse or heart failure. The normal decrease in the rib cage contribution to the tidal volume during phasic REM sleep becomes a critical vulnerability, resulting in saw-tooth oxygen desaturation possibly representing the earliest manifestation of respiratory muscle weakness. Hypoventilation can occur in REM sleep and progress into non-REM sleep, with continuous desaturation and hypercarbia. Specific characteristics of neuromuscular disorders, such as pharyngeal neuropathy or weakness, macroglossia, bulbar manifestations, or low lung volumes, predispose patients to the development of obstructive events. Central sleep-disordered breathing can occur with associated cardiomyopathy (e.g., dystrophies) or from instability in the control of breathing due to diaphragm weakness. Mitigating factors such as recruitment of accessory respiratory muscles, reduction in REM sleep, and loss of normal REM atonia in some individuals may partially protect against sleep-disordered breathing. Noninvasive ventilation, a standard-of-care management option for sleep-disordered breathing, can itself trigger specific sleep-disordered breathing events including air leaks, patient-ventilator asynchrony, central sleep apnea, and glottic closure. These events increase arousals, reduce adherence, and impair sleep architecture. Polysomnography plays an important role in addressing pitfalls in the diagnosis of sleep-disordered breathing in neuromuscular diseases, identifying sleep-disordered breathing triggered by noninvasive ventilation, and optimizing noninvasive ventilation settings.
Conclusions:
Outcome of Research: Effective.
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Category: Surgery
Title: Postpolio syndrome and anesthesia
Author: Lambert DA, Giannouli E, Schmidt BJ
Affiliation: Department of Anesthesia, University of Manitoba, Canada
Journal: Anesthesiology
Citation: Anesthesiology. 2005 Sep;103(3):638-44
Publication Year and Month: 2005 09
Abstract: The development of polio vaccines 50 years ago essentially halted childhood polio epidemics in the industrialized world. During the past quarter century, a constellation of delayed neuromuscular symptoms, called postpolio syndrome, became recognized among the aging polio survivors. The prevalence of postpolio syndrome in the US population is estimated to be in the hundreds of thousands. The most common symptoms are fatigue, pain, and new onset weakness thought to be related to delayed deterioration of motor neuron function. When a patient with postpolio syndrome presents for surgery, special precautions are warranted, because these patients may have respiratory impairment, sleep apnea, swallowing difficulties, and cold intolerance. This article first reviews clinical features and some pathoetiologic theories of postpolio syndrome and then focuses on anesthetic considerations including the use of common anesthetics, neuromuscular blockade, regional anesthesia, and general anesthetic management strategies.
Conclusions:
Outcome of Research:
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Category: Women's Health
Title: Successful Use of Succinylcholine for Cesarean Delivery in a Patient with Postpolio Syndrome [letter to the Editor]
Author: Connelly NR, Abbott TC.
Affiliation: Tufts University School of Medicine, Baystate Medical Center, Springfield, Massachusetts.
Journal: Anesthesiology
Citation: Anesthesiology 6 2008, Vol.108, 1151-1152. doi:10.1097/ALN.0b013e318173eb78
Publication Year and Month: 2008 06
Abstract: There have been a few reports over the years using succinylcholine in patients with pathology similar to that seen in PPS. For example, succinylcholine-induced hyperkalemia and circulatory collapse were reported in a patient with acute idiopathic anterior horn cell disease4; the serum potassium during this cardiac arrest was 7.9 mEq/l. Another study of denervated baboons found an increase in intravascular potassium up to 5.5 mEq/l.5 PPS is similar in pathophysiology to the baboon denervation study, and one could assume that hyperkalemia could also be seen in PPS patients. There have been numerous reports of hyperkalemia in patients with neuromuscular disease.4–8 It would have been informative to have had the prepotassium and postpotassium measurements from the patient in the report of Wernet et al. 1 to determine the magnitude and time frame of the increase of serum potassium.
The avoidance of neuraxial anesthesia was also discussed by Wernet et al. Successful neuraxial anesthesia in patients with PPS has been reported without adverse complications.9,10 Many clinicians provide regional anesthesia for labor and delivery in patients with a history of PPS.11
If general anesthesia needs to be induced, the potential hazard of using succinylcholine in patients with PPS has been acknowledged.12 If the need for rapid sequence induction exists in a PPS patient, we believe one should choose a short-acting nondepolarizing muscle relaxant in lieu of succinylcholine; the only caveat would be to consider using a decreased dose because of the increase risk of muscular weakness.13
The mere fact that succinylcholine was used in the current case does not preclude the possible occurrence of severe, acute hyperkalemia in subsequent cases in patients with PPS.
Conclusions: We do not believe that one can conclude from this single case that succinylcholine should be used in patients with PPS.
Outcome of Research: Effective
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Category: Ageing
Title: Aging and sequelae of poliomyelitis
Author: Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J
Affiliation: centre hospitalier régional universitaire de Montpellier, hôpital Lapeyronie, France –
[email protected]
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Ann Phys Rehabil Med. 2010 Feb;53(1):24-33 – Epub 2009 Nov 10
Publication Year and Month: 2010 02
Abstract: OBJECTIVE: We estimate that there are about 50,000 persons who survived poliomyelitis in their childhood in France (mean age estimated between 50 and 65 years). After a few decades of stability, 30 to 65% of individuals who had been infected and recovered from polio begin to experience new signs and symptoms.
METHOD: Review of the literature on Pubmed with the following keywords "Poliomyelitis" and "Post-Polio Syndrome (PPS)".
RESULTS: These new signs and symptoms are characterized by muscular atrophy (decreased muscle mass), muscle weakness and fatigue, muscle and/or joint pain. All these symptoms lead to significant changes in mobility with falls and inability to carry on with daily life activities. There are several intricate causes. The normal aging process and weight gain are regularly blamed. Respiratory disorders and sleep disorders must be looked for: respiratory insufficiency, sleep-related breathing disorders such as sleep apnea, restless legs syndrome. Orthopedics complications are quite common: soft-tissue pathologies of the upper limbs, degenerative pathologies of the large joints or spinal cord, fall-related fractures. Finally, the onset of an authentic PPS is possible.
Conclusions: The therapeutic care of this late functional deterioration requires regular monitoring check-ups in order to implement preventive measures and appropriate treatment. This therapeutic care must be multidisciplinary as physical rehabilitation, orthotics and technical aids are all essential.
Outcome of Research:
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Category: Late Effects of Polio
Title: Three case studies of late diagnoses of polio in Australian adults
Author: C.Formby, D.Currie
Affiliation: St Vincent's Hospital Melbourne, Polio Services Victoria, Fitzroy, Australia
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 61, Supplement, July 2018, Page e272
Publication Year and Month: 2018 07
Abstract: Introduction/Background
Polio Services Victoria (PSV) is a publicly funded organization; anyone with a history of polio residing in Australia may be seen by the service. The majority of patients referred to the service were diagnosed with polio shortly after they were infected with the virus, for most this was in early childhood and ranges from two to eight decades ago. In the past 18 months three patients were referred to PSV with untypically late diagnoses of polio, two of which were sisters. All were born in Australia between 1930 and 1950 and are considered to have acquired their infection in Australia during their early childhood. The three were able to live relatively uneventful lives however their verbal histories indicate suspicion of polio during their childhood medical examinations in school, but ultimately no formal diagnosis was made at that time. In later life, symptoms characteristic of the late effects of polio emerged. In combination with imaging and nerve conduction studies these symptoms were diagnosed as being the result of a likely childhood infection of polio. Their current and future management plans are typical of that seen regularly within the service with the patients reporting their main problems as being:
–pain;
–fatigue;
–increasing muscle atrophy and associated weakness.
These three cases highlight that although Australia, like most of the world, holds polio free status there may still be further undiagnosed cases. Polio should be considered as a differential diagnosis for patients presenting with any of the cardinal signs and symptoms of late effects of polio who have resided in a country during a time prior to polio eradication. Special consideration should be given where a sibling or close relative was diagnosed with polio.
Conclusions:
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: Sleep disordered breathing in adult with polio sequelae: A case control study of predictive factors
Author: A.Leotard, A.Pages, M.Salga, G.Genet, J.Levy, M.A.Quera-Salva, F.Genet
Affiliation: Hopital R.-Poincaré, Sleep unit, Garches, France
Hopital R.-Poincaré, Department of Physical Medicine and Rehabilitation, Garches, France
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 61, Supplement, July 2018, Page e72
Publication Year and Month: 2018 07
Abstract: Introduction/Background
Estimates of sleep disorder breathing (SDB) prevalence are higher in patients with polio sequelae than in general population, ranging from 50% to 65%. No specific predictive factors have been described in our knowledge. The aim of this study was to identify SDB predictive factors among polio survivors.
Material and method
A case control study including patients with polio sequelae with confirmed SDB (apnea hypopnea index (AHI) ≥ 5; n = 38) compared to polio patients with AHI ≤ 5 or negative Berlin questionnaire (n = 114). Matching criteria were: sex, age at evaluation, and body mass index (BMI). For each patient, age at acute polio, bulbar, trunk, and lower limbs involvement, scoliosis, current walking abilities and history of arthrodesis, brace or iron lung were assessed using preexisting database and medical charts. SDB symptoms, Berlin questionnaire and AHI using polysomnographic reports were also assessed retrospectively.
Results
Among the 362 polio patients from our systematic database 152 (38 cases and 114 controls) were matched for comparison. SDB ratio was significantly higher in patients with bulbar involvement at acute polio (100% vs. 22.5%), trunk involvement at acute polio (41.9% vs. 18.4%), bulbar involvement at evaluation (100% vs. 23%), scoliosis (38.6% vs. 13.8%) and non-walking patients (50% vs. 22.5%) compared with polio controls. Multivariate analysis only shown scoliosis to be associated with SDB in those patients (OR = 2.72 (95% CI: 1.10–6.95); P = 0.03).
Conclusions: Despite there was an increased ratio of SDB in patients with bulbar and trunk involvement, only scoliosis seems to specifically increase the risk of SDB occurrence among polio survivors. In those patients, symptoms suggestive of SDB should be searched for systematically, especially in case of trunk deformities.
Outcome of Research: More research required
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Category: Quality of Life
Title: Life satisfaction and self-reported impairments in persons with late effects of polio.
Author: Lexell J, Brogårdh C.
Affiliation: Department of Health Sciences, Lund University, 22100 Lund, Sweden. [email protected]
Journal: Annals of Physical and Rehabilitation Medicine
Citation: Volume 55, Issues 9–10, December 2012, Pages 577-589
Publication Year and Month: 2012 12
Abstract: Objective
Decades after an acute poliomyelitis infection many persons experience new symptoms or impairments which may affect their life satisfaction. The objective of this study was to investigate the association between life satisfaction and self-reported impairments in persons with late effects of polio.
Material and methods
One hundred and sixty-nine persons (104 women and 65 men) with prior polio responded on admission to rehabilitation to the Life Satisfaction Questionnaire (LiSat-11) assessing satisfaction with life as a whole and 10 domains of life satisfaction and to a 13-item questionnaire assessing self-reported impairments related to late effects of polio.
Results
A majority was to some degree satisfied with life as a whole and with all 10 domains of life satisfaction in LiSat-11, but less than 20% was very satisfied or satisfied with their somatic health. Muscle fatigue, muscle weakness, general fatigue, muscle and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments. Overall, those who rated themselves as not satisfied (according to LiSat-11) reported significantly higher degrees of impairment than those who were satisfied. The relationships between the items of life satisfaction in LiSat-11 and the items in the self-report questionnaire varied from −0.01 to −0.64.
Conclusions: Satisfaction with life as a whole, and different domains of life satisfaction are low to moderately associated with self-reported impairments. This implies that rehabilitation interventions must address not only self-reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio.
Outcome of Research: More research required
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Category: Late Effects of Polio
Title: Post-polio syndrome and risk factors in Korean polio survivors: a baseline survey by telephone interview
Author: Bang H (1), Suh JH (2), Lee SY (3), Kim K (1), Yang EJ (1), Jung SH (1), Jang SN (4), Han SJ (2), Kim WH (5), Oh MG (6), Kim JH (5), Lee SG (7), Lim JY (1)
Affiliation: (1) Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea; (2) Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Seoul, Korea; (3) Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Bucheon, Korea; (4) Red Cross College of Nursing, Chung-Ang University, Seoul, Korea; (5) Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea; (6) Department of Rehabilitation Medicine and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea; (7) Department of Physical Medicine and Rehabilitation, Research Institute of Medical Sciences, Chonnam National University College of Medical School, Gwangju, Korea
Journal: Annals of Rehabilitation Medicine
Citation: Ann Rehabil Med. 2014 Oct;38(5):637-47. doi: 10.5535/arm.2014.38.5.637
Publication Year and Month: 2014 10
Abstract: OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors.
METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR).
RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS.
Conclusions: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.
Outcome of Research: Not applicable
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Category: 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
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Category: Diagnosis and Management
Title: The post-polio syndrome as an evolved clinical entity. Definition and clinical description.
Author: Dalakas MC
Affiliation: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
Journal: Annals of the New York Academy of Sciences
Citation: Ann N Y Acad Sci. 1995 May 25;753:68-80
Publication Year and Month: 1995 05
Abstract: Post-polio syndrome (PPS) refers to the new neuromuscular symptoms that occur at least 15 years after stability in patients with prior acute paralytic polio-myelitis. They include: (1) new muscle weakness and atrophy in the limbs, the bulbar or the respiratory muscles [post-poliomyelitis muscular atrophy (PPMA)] and (2) excessive muscle fatigue and diminished physical endurance. PPS is a clinical diagnosis that requires exclusion of all other medical, neurological, orthopedic or psychiatric diseases that could explain the cause of the new symptoms. Routine electromyography is useful to confirm chronic and ongoing denervation and exclude neuropathies. Muscle biopsy, single fiber electromyography (EMG), macro-EMG, serum antibody titers to polio virus, and spinal fluid studies are very useful research tools but they are rarely needed to establish the clinical diagnosis. PPS is a slowly progressive phenomenon with periods of stability that vary from 3 to 10 years. Current evidence indicates that PPS is the evolution of a subclinically ongoing motor neuron dysfunction that begins after the time of the acute polio. It is clinically manifested as PPS when the well-compensated reinnervating process crosses a critical threshold beyond which the remaining motor neurons cannot maintain the innervation to all the muscle fibers within their motor unit territory.
Conclusions:
Outcome of Research: Not applicable
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Category: 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
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Category: Drugs
Title: Anticholinesterases in Post-Poliomyelitis Syndrome
Author: Daria A. Trojan and Neil R. Cashman
Affiliation: Department of Neurology, Montreal Neurological Institute and Hospital, McGill University
Journal: Annals of the New York Academy of Sciences
Citation: Reprinted from The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment, Volume 753 of the Annals of the New York Academy of Sciences, May 25, 1995
Publication Year and Month: 1995 05
Abstract: New weakness, fatigue, and pain after decades of functional stability in those who have recovered from acute paralytic poliomyelitis constitutes post-poliomyelitis syndrome (PPS).[1-7] The cause of PPS is unknown, but it is thought to be due to a distal degeneration of enlarged post-polio motor units produced by terminal axonal sprouting during the recovery process after acute polio.[8,9] The symptoms of weakness and fatigue may be a direct result of this distal motor unit degeneration;[2,7-13] however, it is presently unclear how pain relates to disease of the motor unit. PPS is a slowly progressive motor neuron disease for which there is currently no specific treatment.[4]
Conclusions: Our studies indicate that a proportion of fatigued post-poliomyelitis patients can experience an amelioration of defects in neuromuscular junction transmission and of clinical fatigue with anticholinesterases. Because S-SFEMG response was significantly associated with clinical response to anticholinesterases, fatigue in PPS may be caused by defects in neuromuscular junction transmission in a proportion of patients. Preliminary studies in a small group of patients indicate that anticholinesterases may produce their clinical neuromuscular response by producing an increase in isokinetic strength in a proportion of patients. Our studies provide a physiological rationale for the use of anticholinesterases in PPS for the symptom of fatigue. However, further randomized, placebo-controlled, double-blinded trials are needed to establish definitively the benefits and risks of these agents.
Outcome of Research:
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Category: Post-Polio Motor Unit
Title: Correlation of Electrophysiology with Pathology, Pathogenesis, and Anticholinesterase Therapy in Post-Polio Syndrome
Author: Neil R. Cashman and Daria A. Trojan
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 [pp 138-150] of the Annals of the New York Academy of Sciences
May 25, 1995
Publication Year and Month: 1995 05
Abstract:
Conclusions: A great deal of data has been generated on PPS, and a great deal more will be generated before we understand the pathophysiology of this common and disabling disorder. Perhaps now, to guide future work and direct therapeutic approaches, it is best to think of the symptoms of PPS as due to two lesions of the motor unit: a "progressive lesion" and a "fluctuating lesion." The progressive lesion gives rise to the symptom of slowly progressive weakness, and is due to the degeneration of terminal axons (and perhaps motor neurons) over the course of years. This lesion, best articulated by Wiechers and Hubble,[18] has been difficult to objectify because of its indolent nature. However, significant clinical weakening has indeed been quantified by several groups, including Munsat and colleagues,[7] and Sonies and Dalakas.[53] The best objective "proof" of the progressive lesion at present is the appearance of muscle fiber atrophy in biopsies, isolated and in groups, suggesting ongoing "permanent" denervation.[22] Diminution of motor unit size over time, as suggested by the macro-EMG studies of Lange et al.,[32] are also consistent with this hypothesis, albeit more controversial.
The other lesion of the PPS motor unit, hypothesized as a "fluctuating lesion," may be due to dysfunction of terminal axons, which gives rise to symptoms (muscle fatigability, generalized fatigue, and a component of weakness) that can change over the course of minutes to days. The underlying pathophysiology of these symptoms may be due to critical enlargement of motor units with limitations of distal components subserving axonal conduction and NMJ transmission, and/or the constant remodeling of the motor unit which appears to occur in virtually every individual after recovery from paralytic poliomyelitis. The best objective evidence for this ongoing lesion is provided by innumerable electrophysiologic studies demonstrating unstable motor unit action potentials and decrement on repetitive stimulation with conventional EMG, increased SFEMG jitter, and a host ofother studies.[54] In addition, the widespread expression of N-CAM in muscle biopsies of post-polio subjects (sometimes exceeding 10% of fibers)[22] strongly suggests that axono-myofiber interactions are distinctly unstable and/or immature. Clearly, agents that support the integrity or function of motor axonal sprouts may improve or delay patient symptoms in PPS.
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Electrodiagnostic Findings in 108 Consecutive Patients Referred to a Post-Polio Clinic – The Value of Routine Electrodiagnostic Studies
Author: Anne C. Gawne, Bao T. Pham, and Lauro S. Halstead
Affiliation:
Journal: Annals of the New York Academy of Sciences
Citation: The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment Volume 753 pp 383-385 of the Annals of the New York Academy of Sciences May 25, 1995.
Publication Year and Month: 1995 05
Abstract: Many patients with a history of polio develop new symptoms including weakness, pain, fatigue, and changes in function, or post-polio syndrome (PPS).[1] Before a diagnosis of PPS is made, other diagnoses must first be ruled out. Assessment must be done in a comprehensive and coordinated manner.[2] Therefore, as part of our routine evaluation, we do an electromyogram/nerve conduction study (EMG/NCS) on every patient. During examinations on our clinic patients we began to notice (1) electrodiagnostic evidence of polio in limbs not previously felt to be involved; (2) a normal EMG, or evidence of another disease; and (3) EMG evidence consistent with additional neurological lesions, including compression neuropathies, peripheral neuropathies, and radiculopathies. A prospective study using a routine, standardized four-extremity electrodiagnostic protocol was done to quantify the frequency of these occurrences.
Conclusions: Our findings strongly support the value of a standardized four-extremity EMG/NCS as an adjuvant to a comprehensive history and physical examination. It helps to differentiate between old polio and other neurological diagnoses. There is a high prevalence of subclinical polio, which is important to know about in order to give proper recommendations regarding rest and activity. Given the frequency of risk factors for development of potentially treatable neurological lesions like CTS, early detection is valuable. We believe routine electrodiagnostic testing is essential for proper evaluation and management of the post-polio patient.
Outcome of Research:
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Category: Diagnosis and Management
Title: National Rehabilitation Hospital Limb Classification for Exercise, Research, and Clinical Trials in Post-Polio Patients
Author: Lauro S. Halstead, Anne Carrington Gawne, and Bao T. Pham
Affiliation: The Post-Polio Program; National Rehabilitation Hospital, Washington, DC
Journal: Annals of the New York Academy of Sciences
Citation: The Post-Polio Syndrome: Advances in the Pathogenesis and Treatment Volume 753 pp 343-353 of the Annals of the New York Academy of Sciences May 25, 1995.
Publication Year and Month: 1995 05
Abstract:
Conclusions: A need exists for an objective classification of polio patients for clinical and research purposes that takes into account the focal, asymmetric, and frequent subclinical nature of polio lesions. In order to prescribe a safe, effective exercise program, we developed a five-level (Classes I-V) limb-specific classification system based on remote and recent history, physical examination, and a four-extremity electrodiagnostic study (EMG/NCS). Class I limbs have no history of remote or recent weakness, normal strength, and a normal EMG. Class II limbs have no history of remote or recent weakness (or if remote history of weakness, full recovery occurred), normal strength and EMG evidence of prior anterior horn cell disease (AHCD). Class III limbs have a history of remote weakness with variable recovery, no new weakness, decreased strength, and EMG evidence of prior AHCD. Class IV limbs have a history of remote weakness with variable recovery, new clinical weakness, decreased strength, and EMG evidence of AHCD. Class V limbs have a history of severe weakness with little-to-no recovery, severely decreased strength and atrophy, and few-to-no motor units on EMG. In a prospective study of 400 limbs in 100 consecutive post-polio patients attending our clinic, 94 (23%) limbs were Class I, 88 (22%) were Class II, 95 (24%) were Class III, 75 (19%) were Class IV, and 48 (12%) were Class V. Guidelines for the use of this classification in a clinical/research setting are presented along with sample case histories and class-specific exercise recommendations.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Pathogenetic mechanisms of post-polio syndrome: morphological, electrophysiological, virological, and immunological correlations.
Author: Dalakas MC
Affiliation: Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1382, USA.
Journal: Annals of the New York Academy of Sciences
Citation: 1995 May 25;753:167-85.
Publication Year and Month: 1995 05
Abstract: To understand the mechanism of post-poliomyelitis muscular atrophy (PPMA) and the post-polio syndrome (PPS) in general, we performed the following studies: (1) histopathology in spinal cord sections from patients who died 9 days to 44 years after acute paralytic poliomyelitis; (2) enzyme histochemistry, immunocytochemistry (for lymphocyte subsets, MHC antigens and N-CAM) and polymerase chain reaction (PCR) for poliovirus RNA in the muscle biopsies from symptomatic or asymptomatic muscles of post-polio patients; (3) determination of lymphocyte subsets and circulating IgG or IgM antibodies against GM1 and poliovirus; (4) virological studies in the spinal fluid for oligoclonal bands and search for poliovirus genome with PCR; (5) electrophysiological studies including single fiber EMG, fiber density and macro-EMG; and (6) [31P] exercise MRS spectroscopy on previously affected muscles to search for a metabolic correlate of fatigue. These studies concluded that in PPS a continuing dysfunction is present in the spinal cord motor neurons, resulting in ongoing muscle denervation and reinnervation first evident at the axonal branch points. Symptoms are related to attrition of the oversprouting motor neurons which after a period of time cannot support all their axonal sprouts, resulting in failure of re-reinnervation. In some patients with PPS there is also an ongoing immune activation and presence of defective viral particles in the spinal fluid. However, their role in the pathogenesis of PPS is presently unknown.
Conclusions: These studies concluded that in PPS a continuing dysfunction is present in the spinal cord motor neurons, resulting in ongoing muscle denervation and reinnervation first evident at the axonal branch points.
Outcome of Research: More research required
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Category: Surgery
Title: Anaesthetists need to be wary of postpolio syndrome
Author: Tobin A
Affiliation: Deputy Director, Intensive Care Unit, St Vincent’s Hospital, Victoria, Australia
Journal: ANZCA Bulletin
Citation: ANZCA Bulletin September 2015, pp 42-43
Publication Year and Month: 2015 09
Abstract: This is a brief Safety and Quality news item which does not have an abstract. This is an extract:
Postpolio syndrome (PPS) occurs in a significant proportion of polio survivors years after recovering from the original illness. Anaesthetists need to be aware of the syndrome as polio survivors are relatively numerous (40,000 cases of paralytic polio in Australia from the 1930s to the 1960s), they are of an age where they will be increasingly presenting for elective and emergency procedures and the syndrome has important. Postpolio syndrome patients present a number of potential problems for the anaesthetist. However for those who are aware depressant effects of analgesics of the syndrome, careful assessment and planning should minimise the risk of perioperative complications and provide optimal patient outcomes.
Conclusions:
Outcome of Research: Not applicable
Comments (if any): Other - see Comments.
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Category: Diagnosis and Management
Title: Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study
Author: Atta Abbas Naqvi, Syed Baqir Shyum Naqvi, Fatima Zehra, Ashutosh Kumar Verma, Saman Usmani, Sehrish Badar, Rizwan Ahmad, Niyaz Ahmad
Affiliation: 1.Department of Pharmacy Practice, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
2.Faculty of PharmacyHamdard UniversityKarachiPakistan
3.Applied Economics Research CentreUniversity of KarachiKarachiPakistan
4.Discipline of Social and Administrative Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaMindenMalaysia
5.Institute of Pharmaceutical Sciences, Jinnah Sindh Medical UniversityKarachiPakistan
6.Natural Products and Alternative Medicines, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
7.Department of Pharmaceutics, College of Clinical PharmacyImam Abdulrahman Bin Faisal UniversityDammamSaudi Arabia
Journal: Applied Health Economics and Health Policy
Citation: December 2018, Volume 16, Issue 6, pp 871–888
Publication Year and Month: 2018 12
Abstract: Background
Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country.
Objective
This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors.
Conclusions: Conclusion
The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: Functional recovery – a major risk factor for the development of postpoliomyelitis muscular atrophy
Author: Klingman J, Chui H, Corgiat M, Perry J
Affiliation: Department of Neurology, University of Southern California School of Medicine, Los Angeles
Journal: Archives of Neurology
Citation: Arch Neurol. 1988 Jun;45(6):645-7
Publication Year and Month: 1988 06
Abstract: A retrospective study was undertaken to identify potential risk factors for the development of progressive postpoliomyelitis muscular atrophy (PPMA). Patients with PPMA (n = 57) were compared with patients with a history of poliomyelitis but without a history of progressive weakness (n = 49). Patients who later developed PPMA had histories of more widespread acute paralysis, but relatively greater functional recovery. They were less disabled, and reported higher recent activity levels. Seventy-nine percent of the total variance between the PPMA and control groups could be accounted for by recovery alone (ie, severity minus disability). Functional recovery is generally attributed to reinnervation of sarcomeres by collateral sprouting from surviving lower motor neurons. Since degree of recovery predicts the risk of developing PPMA, our findings suggest that enlarged motor units may carry an increased susceptibility for dysfunction and/or degeneration.
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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.
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Category: Pain
Title: Fibromyalgia Is Common in a Postpoliomyelitis Clinic
Author: D A Trojan (1), N R Cashman
Affiliation: (1) Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Quebec.
Journal: Archives of Neurology
Citation: Trojan DA, Cashman NR. Fibromyalgia is common in a postpoliomyelitis clinic. Arch Neurol. 1995 Jun;52(6):620-4. doi: 10.1001/archneur.1995.00540300094019. PMID: 7763212.
Publication Year and Month: 1995 06
Abstract: Objective: To determine prospectively the occurrence and clinical characteristics of fibromyalgia in patients serially presenting to a postpolio clinic. Fibromyalgia may mimic some of the symptoms of postpoliomyelitis syndrome, a disorder characterized by new weakness, fatigue, and pain decades after paralytic poliomyelitis.
Design: Case series.
Setting: A university-affiliated hospital clinic.
Patients: One hundred five patients were evaluated with a standardized history and physical examination during an 18-month period. Ten patients were excluded because of the absence of past paralytic poliomyelitis.
Interventions: Patients with fibromyalgia were treated with low-dose, nighttime amitriptyline hydrochloride or other conservative measures.
Main Outcome Measures: Patients with fibromyalgia had diffuse pain and 11 or more of 18 specific tender points on examination (American College of Rheumatology criteria, 1990). Patients with borderline fibromyalgia had muscle pain and five to 10 tender points on physical examination.
Results: Ten (10.5%) of 95 postpolio patients met the criteria for fibromyalgia, and another 10 patients had borderline fibromyalgia. All patients with fibromyalgia complained of new weakness, fatigue, and pain. Patients with fibromyalgia were more likely than patients without fibromylagia to be female (80% vs 40%, P<.04) and to complain of generalized fatigue (100% vs 71%, P=.057), but were not distinguishable in terms of age at presentation to clinic, age at polio, length of time since polio, physical activity, weakness at polio, motor strength scores on examination, and the presence of new weakness, muscle fatigue, or joint pain. Approximately 50% of patients in both the fibromyalgia and borderline fibromyalgia groups responded to low-dose, nighttime amitriptyline therapy.
Conclusions: Conclusions: (1) Fibromyalgia occurs frequently in a postpolio clinic. (2) Fibromyalgia can mimic some symptoms of postpoliomyelitis syndrome. (3) Fibromyalgia in postpolio patients can respond to specific treatment.
Outcome of Research: Not applicable
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Category: 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.
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Category: Post-Polio Motor Unit
Title: Late effects of polio: critical review of the literature on neuromuscular function
Author: Agre JC, Rodríquez AA, Tafel JA
Affiliation: University of Wisconsin - Madison Medical School
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1991 Oct; 72(11):923-31
Publication Year and Month: 1991 10
Abstract: Many individuals who have had poliomyelitis are now complaining of several new problems attributed to their former illness including muscle atrophy; fatigue; progressive weakness; and muscle, back, and joint pain. This paper critically examines the literature regarding the neuromuscular effects of poliomyelitis. Weakness resulting from poliomyelitis was due to destruction of anterior horn cells. After the illness, muscle strength was partially recovered as a result of several physiologic adaptive mechanisms including terminal sprouting and reinnervation, myofiber hypertrophy, and, possibly, myofiber type transformation. Several pathophysiologic and functional etiologies have been proposed for late neuromuscular deterioration, but none has been proven. In fact, to date, there is no objective evidence documenting progressive loss of strength in polio survivors. Studies attempting to differentiate polio survivors with and without symptoms of deterioration have resulted in conflicting results; however, it appears reasonable to conclude that symptomatic postpolio subjects had a more severe illness with greater loss of neuromuscular function. Exercise may be helpful for many postpolio patients, but the prescription must be tailored to the individual to avoid problems of overuse or excessive fatigue.
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Category: Muscle Strength, Exercise
Title: Strength, endurance, and work capacity after muscle strengthening exercise in postpolio subjects
Author: Agre JC, Rodriquez AA, Franke TM
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison, USA
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1997 Jul; 78(7):681-6
Publication Year and Month: 1997 07
Abstract: OBJECTIVE: To determine whether a 12-week home quadriceps muscle strengthening exercise program would increase muscle strength, isometric endurance, and tension time index (TTI) in postpolio syndrome subjects without adversely affecting the surviving motor units or the muscle.
DESIGN: A longitudinal study to investigate the effect of a 12-week exercise program on neuromuscular function and electromyographic variables.
SETTING: Neuromuscular laboratory of a university hospital.
SUBJECTS: Seven subjects were recruited from a cohort of 12 subjects who had participated in a previous exercise study. All subjects had greater than antigravity strength of the quadriceps. Upon completion of a postpolio questionnaire, all acknowledged common postpolio syndrome symptoms such as new fatigue, pain, and weakness; 6 of the 7 acknowledged new strength decline.
INTERVENTION: On Mondays and Thursdays subjects performed three sets of four maximal isometric contractions of the quadriceps held for 5 seconds each. On Tuesdays and Fridays subjects performed three sets of 12 dynamic knee extension exercises with ankle weights.
MAIN OUTCOME MEASURES: Neuromuscular variables of the quadriceps muscles were measured at the beginning and completion of the exercise program and included: isokinetic peak torque (ISOKPT, at 60 degrees/sec angular velocity) and total work performed of four contractions (ISOKTW), isometric peak torque (MVC), endurance (EDUR, time subject could hold isometric contraction at 40% of the initial MVC), isometric tension time index (TTI, product of endurance time and torque at 40% of MVC), and initial and final ankle weight (WGT, kg) lifted. Electromyographic variables included: fiber density (FD), jitter (MCD), and blocking (BLK) from single fiber assessment and median macro amplitude (MACRO). Serum creatine kinase (CK) was also measured initially and at 4-week intervals throughout the study.
RESULTS: The following variables significantly (p < .05) increased: WGT by 47%, ISOKPT, 15%, ISOKTW, 15%; MVC, 36%; EDUR, 21%; TTI, 18%. The following variables did not significantly (p > .05) change: FD, MCD, BLK, MACRO, and CK.
Conclusions: This home exercise program significantly increased strength, endurance, and TTI without apparently adversely affecting the motor units or the muscle, as the EMG and CK variables did not change.
Outcome of Research: Effective
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Category: Speech Pathology
Title: Incidence and nature of dysphagia in polio survivors
Author: Coelho CA, Ferranti R
Affiliation: Department of Communication Disorders, Gaylord Hospital, Wallingford, CT 06492
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1991 Dec; 72(13):1071-5
Publication Year and Month: 1991 12
Abstract: Questionnaires pertaining to swallowing function were mailed to 220 members of postpolio support groups in Connecticut. Of the 109 responses, 80 individuals reported having no difficulty with swallowing, while 29 reported having either intermittent or consistent swallowing problems. Twenty-one of the 29 were seen for videofluoroscopic swallowing studies and pulmonary function testing. The swallowing studies showed that 43% of these individuals had difficulty with bolus control, 19% with delayed swallow response, and 81% with decreased pharyngeal transit. Although none of these individuals were observed to aspirate, two were judged to be at significant risk. Incidence of dysphagia within the group of polio survivors was estimated to be approximately 18%. Seventeen of the 20 postpolio subjects with dysphagia also demonstrated decreased breathing capacity. Although moderately to severely depressed values in the pulmonary function measures accompanied moderate dysphagia in certain postpolio individuals, reduced values in these same measures were also present in individuals with minimal swallowing dysfunction. Therefore, although impaired breathing may complicate swallowing dysfunction and vice versa, it does not appear that one can be predicated from the other. Management of dysphagia in postpolio individuals is discussed.
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Category: Muscle Strength
Title: Reduction in thigh muscle cross-sectional area and strength in a 4-year follow-up in late polio
Author: Grimby G, Kvist H, Grangård U
Affiliation: Department of Rehabilitation Medicine, University of Göteborg, Sahlgrenska University Hospital, Sweden
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1996 Oct; 77(10):1044-8
Publication Year and Month: 1996 10
Abstract: OBJECTIVE: To study changes in cross-sectional thigh muscle area and muscle strength in late polio subjects over a 4-year period.
DESIGN: Longitudinal study of a cohort of polio survivors, comparing subjects who acknowledge (unstable) with those who do not acknowledge (stable) new muscle weakness.
SETTING: University hospital.
SUBJECTS: Eighteen subjects (6 men, 12 women) with polio-myelitis sequelae (39 to 46 years of age) were studied on two occasions 4 years apart; the first examination was 37 to 44 years after onset of polio. Subjects were recruited through hospital registers, newspaper advertisement, and a patient organization.
OUTCOME MEASUREMENTS: Thigh muscle and intermuscular and intramuscular adipose tissue (AT) cross-sectional areas were measured by computed tomography. Isometric muscle strength for knee extension and flexion was measured using a Kin-Com dynamometer.
RESULTS: Cross-sectional muscle area decreased on average 1.3 +/- 3.6 cm2 (1.4%, p < .05); the intermuscular and intramuscular AT area increased 1.8 +/- 3.4 cm2 (12.1%, p < .05). When divided by legs in which subjects reported (unstable) or did not report (unstable) or did not report (stable) increased muscle weakness, unstable legs showed significant reduction (p < .05) in muscle area, whereas stable legs did not. Estimated total thigh muscle strength decreased 7.8% +/- 2.9% (p < .01), with a significant (p < .001) reduction in unstable legs (13.4% +/- 4.3%) but not in stable legs. The reduction in strength appears to be greater than the reduction in cross-sectional muscle area, but there is still a significant correlation (r = .44, p < .05).
Conclusions: The present results demonstrate not only progress of muscle weakness, but also of muscle atrophy in postpolio subjects.
Outcome of Research:
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Category: Activity Levels
Title: Actual and perceived activity levels in polio survivors and older controls: a longitudinal study
Author: Klein MG, Braitman LE, Costello R, Keenan MA, Esquenazi A
Affiliation: Moss Rehabilitation Research Institute, Philadelphia, PA; Thomas Jefferson University, Philadelphia 19141, USA – [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Feb; 89(2):297-303
Publication Year and Month: 2008 02
Abstract: OBJECTIVE: To examine factors associated with daily step activity, perceived activity, maximum walking speed, and walking speed reserve over time in polio survivors and older adults with no history of polio.
DESIGN: Longitudinal study.
SETTING: A research clinic and the community.
PARTICIPANTS: Polio survivors (n=96; 65 in postpolio syndrome [PPS] group, 31 in non-PPS group) and older adults (n=112) with no history of polio.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Daily step activity, perceived activity, maximum walking speed, and walking speed reserve.
RESULTS: Results showed decreases in perceived activity over time in the PPS group. However, there was no change in average daily walking activity. Overall, polio survivors walk less and have a smaller walking speed reserve than controls. Knee strength was positively associated with maximum walking speed and walking speed reserve in all groups. Weight and age were associated with daily step activity in controls but not polio survivors.
Conclusions: Daily walking activity did not change statistically over the 3-year study period, although perceived activity and the walking speed reserve decreased among polio survivors with PPS. On average, polio survivors appear to function with minimal functional reserve, as their preferred walking speed was close to their maximum speed.
Outcome of Research:
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Category: 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:
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Category: Psychology
Title: Prevalence and associated features of depression and psychological distress in polio survivors
Author: Tate DG, Forchheimer M, Kirsch N, Maynard F, Roller A
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 1993 Oct;74(10):1056-60
Publication Year and Month: 1993 10
Abstract: This cross-sectional study examines the prevalence of psychological distress and depression among 116 polio survivors. It investigates demographic, medical, and coping differences between subjects with (n = 17) and without (n = 99) these symptoms. Subjects were administered the Brief Symptom Inventory (BSI), the Coping with Disability Inventory (CDI), and a questionnaire about their polio histories. The BSI provided measures of psychological distress and depression that defined the subgroups. The CDI assessed coping behaviors. BSI scores for the overall sample were within the normal range indicating no major distress, depression, nor elevated somatic complaints. Several significant differences were found between the two subgroups. On average, depressed/distressed subjects reported an increase in pain (p < .01) and further deterioration of their medical status since the time of their physical best subsequent to the onset of polio (p < .01). They consistently rated their health as poorer than did nondepressed/nondistressed subjects (p < .001). They also reported less satisfaction with life and their occupational status (p < .001) and displayed poorer coping behaviors combined (p < .001). Selected variables such as life satisfaction, pain, decrease in activity, and current living situation accounted for 51% of the variance when predicting distress and depression among this group of polio survivors.
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Category: Pain
Title: Pain in persons with post-polio syndrome: frequency, intensity, and impact
Author: Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP
Affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA (Stoelb, Carter, Purekal, Jensen); Department of Physical Medicine and Rehabilitation, University of California/Davis, Sacramento, CA
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2008 Oct; 89(10): 1933–1940. doi: 10.1016/j.apmr.2008.03.018
Publication Year and Month: 2008 10
Abstract: OBJECTIVE: To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS).
DESIGN: Retrospective, cross-sectional survey.
SETTING: Community-based survey.
PARTICIPANTS: Convenience sample of people with PPS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments.
RESULTS: A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey.
Conclusions: The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.
Outcome of Research: Not applicable.
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Category: Diagnosis and Management
Title: Cardiac risk factors in polio survivors
Author: Gawne AC, Wells KR, Wilson KS.
Affiliation: Roosevelt Warm Springs Institute for Rehabilitation, Warm Springs, GA 31830, USA - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2003 May;84(5):694-6
Publication Year and Month: 2003 05
Abstract: OBJECTIVE: To assess the prevalence of dyslipidemia and other risk factors for coronary heart disease in a sample of polio survivors with and without postpoliomyelitis syndrome.
DESIGN: Retrospective chart review.
SETTING: A multidisciplinary outpatient postpolio clinic.
PARTICIPANTS: Eighty-eight consecutive symptomatic postpolio patients, 50 women (mean age, 59.0y; range, 36-81y) and 38 men (mean age, 61.2y; range, 44-83y).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Presence of risk factors for coronary heart disease: clinical atherosclerotic disease, male age >or=45 years or female age >or=55 years, history of hypertension (blood pressure >or=140/90mmHg or on antihypertensive medication), diabetes mellitus, cigarette smoking, and high-density lipoprotein (HDL) less than 35mg/dL. Obesity (body mass index [BMI], >25kg/m(2)) was assessed as an intervention target. Laboratory values included fasting total cholesterol, HDL, low-density lipoprotein, triglycerides, and glucose.
RESULTS: Of the total sample, 61.3% had dyslipidemia. Average HDL cholesterol ratio was 4.01 (women, 3.68; men, 4.55). Forty-four patients (50%) had a history of hypertension or had elevated blood pressure. Seven patients (8%) had a history of diabetes or had elevated fasting blood glucose (>110). Eighteen patients (20.4%) were smokers or had a history of smoking; 9 continued to smoke and 9 had quit smoking. Twenty-five patients (28.4%) were overweight (BMI, >25kg/m(2)). Forty-one patients (46.5%) had more than 1 risk factor for coronary heart disease. Nine of the total sample (10.2%) had a history of heart disease ranging from atrial fibrillation to angina. Only 19 patients had a previous diagnosis of dyslipidemia and only 12 were on a lipid-lowering medication.
Conclusions: Polio patients have a high prevalence of dyslipidemia. The study sample supports the National Cholesterol Education Program's Adult Treatment Panel III statements that hypercholesterolemia is underdiagnosed and undertreated. The postpolio population carries a high prevalence of 2 or more coronary heart disease risk factors. Evaluation and rehabilitation of polio patients should include screening for dyslipidemia and education about elimination of controllable risk factors.
Outcome of Research: Not applicable.
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Category: Exercise
Title: Dynamic water exercise in individuals with late poliomyelitis
Author: Willén C, Sunnerhagen KS, Grimby G
Affiliation: Department of Rehabilitation Medicine, Göteborg University, Göteborg, Sweden - [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2001 Jan;82(1):66-72
Publication Year and Month: 2001 01
Abstract: OBJECTIVE: To evaluate the specific effects of general dynamic water exercise in individuals with late effects of poliomyelitis.
DESIGN: Before-after tests.
SETTING: A university hospital department.
PARTICIPANTS: Twenty-eight individuals with late effects of polio, 15 assigned to the training group (TG) and 13 to the control group (CG).
INTERVENTION: The TG completed a 40-minute general fitness training session in warm water twice weekly. Assessment instruments included the bicycle ergometer test, isokinetic muscle strength, a 30-meter walk indoors, Berg balance scale, a pain drawing, a visual analog scale, the Physical Activity Scale for the Elderly, and the Nottingham Health Profile (NHP).
MAIN OUTCOME MEASURES: Peak load, peak work load, peak oxygen uptake, peak heart rate (HR), muscle function in knee extensors and flexors, and pain dimension of the NHP.
RESULTS: The average training period was 5 months; compliance was 75% (range, 55-98). No negative effects were seen. The exercise did not influence the peak work load, peak oxygen uptake, or muscle function in knee extensors compared with the controls. However, a decreased HR at the same individual work load was seen, as well as a significantly lower distress in the dimension pain of the NHP. Qualitative aspects such as increased well-being, pain relief, and increased physical fitness were reported.
Conclusions: A program of nonswimming dynamic exercises in heated water has a positive impact on individuals with late effects of polio, with a decreased HR at exercise, less pain, and a subjective positive experience. The program was well tolerated (no adverse effects were reported) and can be recommended for this group of individuals.
Outcome of Research: Effective.
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Category: 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
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Category: Pain
Title: Predictive factors and correlates for pain in postpoliomyelitis syndrome patients
Author: Vasiliadis HM, Collet JP, Shapiro S, Venturini A, Trojan DA
Affiliation: Department of Epidemiology and Biostatistics, Jewish General Hospital, McGill University, Montreal, Que, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2002 Aug;83(8):1109-15
Publication Year and Month: 2002 08
Abstract: OBJECTIVE: To identify predictive and associated factors for muscle and joint pain in postpoliomyelitis syndrome (PPS).
DESIGN: Cross-sectional study design.
SETTING: Postpolio clinics.
PARTICIPANTS: Baseline data on 126 PPS patients entered into a multicentered clinical trial.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Adjusted odds ratios were computed by using logistic regression modeling. Patients with or without muscle or joint pain were compared with regard to predictors and associated factors.
RESULTS: In multivariate analyses for muscle pain, significant predictive and associated factors were female gender (P=.0006), longer duration of general fatigue (P=.019), and a lower score on the general health scale (P=.009) of the Medical Outcomes Study 36-Item Short-From Health Survey (SF-36). In multivariate analyses for joint pain, significant predictive and associated factors were female gender (P<.003), longer latency (duration of stability after polio; P=.008), younger age at interview (P<.002), greater weakness at acute polio (P<.07), weaker lower-extremity muscle strength (P<.04), and a lower SF-36 general health scale score (P<.02).
Conclusions: Women are more likely to report muscle and joint pain in PPS. Greater initial motor unit involvement and lower-extremity weakness may be additional important factors for determining joint pain. Both muscle and joint pain are associated with reductions in quality of life.
Outcome of Research: More research required
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Category: 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
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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
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Category: Fatigue
Title: A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis
Author: Tersteeg IM (1), Koopman FS, Stolwijk-Swüste JM, Beelen A, Nollet F; CARPA Study Group
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2011 Jun;92(6):899-904. doi: 10.1016/j.apmr.2011.01.005
Publication Year and Month: 2011 06
Abstract: OBJECTIVES: To study the severity and 5-year course of fatigue in patients with late-onset sequelae of poliomyelitis (LOSP) and to identify physical and psychosocial determinants of fatigue.
DESIGN: Prospective cohort study with 5 measurements over 5 years.
SETTING: University hospital.
PARTICIPANTS: Patients with LOSP (N=168); 89% of the subjects completed the study.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Fatigue assessed with the Fatigue Severity Scale (FSS). Potential determinants were perceived physical functioning, bodily pain and mental health, extent of paresis, walking capacity, comorbidity, sleeping disorders, coping, and social support. Associations were investigated by multivariable longitudinal analysis using generalized estimating equations.
RESULTS: The mean FSS score ± SD at baseline was 5.1±1.4, which did not change significantly during the 5-year follow-up. Reduced physical functioning, increased bodily pain, reduced sleep quality, more psychologic distress, and higher task-oriented coping were independently associated with fatigue. The extent of paresis and walking capacity were strongly associated with physical functioning.
Conclusions: Fatigue is severe and persistent in patients with LOSP due to physical and psychologic factors, which has implications for counseling and treatment. In addition to the commonly applied interventions targeting physical aspects, psychologic interventions are a potential area for reducing fatigue.
Outcome of Research: Effective
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Category: 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
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Category: Fatigue
Title: A comparison of 4 questionnaires to measure fatigue in postpoliomyelitis syndrome
Author: Horemans HL, Nollet F, Beelen A, Lankhorst GJ
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, the Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Mar;85(3):392-8
Publication Year and Month: 2004 03
Abstract: OBJECTIVE: To assess the comparability and reproducibility of 4 questionnaires used to measure fatigue in postpoliomyelitis syndrome (PPS).
DESIGN: Repeated-measures at a 3-week interval.
SETTING: University hospital.
PARTICIPANTS: Convenience sample of 65 patients with PPS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: The Fatigue Severity Scale (FSS), the Nottingham Health Profile (NHP) energy category, the Polio Problem List (PPL) fatigue item, and the Dutch Short Fatigue Questionnaire (SFQ).
RESULTS: Correlations of scores between questionnaires were all significant (P<.01) and ranged from .43 (between the NHP energy category and the PPL fatigue item) to .68 (between the PPL fatigue item and the SFQ). Scores on the second visit, normalized to a 0 to 100 scale, were: FSS, 78+/-15; NHP energy category, 47+/-35; PPL fatigue item, 81+/-17; and SFQ, 65+/-22. Except for the difference between the FSS and the PPL fatigue item, the differences in scores between the questionnaires were significant (P<.01). Scale analysis indicated that all questionnaires measured the same unidimensional construct. The reproducibility of the FSS, the PPL fatigue item, and the SFQ was moderate. The smallest detectable change was 1.5 points for the FSS, 2.0 points for the PPL fatigue item, and 1.9 points for the SFQ.
Conclusions: Although the questionnaires measure the same fatigue construct in PPS, the results are not interchangeable because the ranges of measurement differ. The NHP energy category, in particular, appeared to have a high detection threshold. The moderate reproducibility of the questionnaires indicates a lack of precision, especially when applied at the individual patient level.
Outcome of Research: Not applicable
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Category: Activity Levels
Title: Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome
Author: Horemans HL (1), Beelen A (2), Nollet F (2), Lankhorst GJ (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; (2) Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2004 Dec;85(12):1929-32
Publication Year and Month: 2004 12
Abstract: OBJECTIVE:
To assess the reproducibility of walking performance, heart rate, and perceived exertion at self-preferred speed and maximal walking speed in patients with the postpoliomyelitis syndrome (PPS).
DESIGN: Repeated measurement at a 3-week interval.
SETTING: University hospital.
PARTICIPANTS: Convenience sample of 65 patients with PPS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Walking performance: the distance walked in 2 minutes at a self-preferred speed and the time needed to walk 75 m at maximal speed, heart rate, and rating of perceived exertion (RPE) on an 11-point scale.
RESULTS: Test-retest reliability of walking performance was excellent for both tests (intraclass correlation coefficient [ICC] range, .94-.97). No systematic differences existed between test and retest. The smallest detectable change for an individual was 15% for both tests. Test-retest reliability for heart rate was good (ICC=.86) but moderate for RPE (Spearman rho range, .67-.70). The smallest detectable change for RPE was between 4 and 6 scale points. The variability in walking performance was significantly correlated with the variability in heart rate at self-preferred speed (r =.36, P <.01) but not with the variability in RPE (r =.20, P =.11).
Conclusions: Both walking tests showed good reproducibility and may be appropriate to monitor (individual) changes in walking capacity in patients with PPS. Because of its moderate reproducibility, RPE does not seem to be suitable to monitor physical exertion. The usefulness of an objective measure such as heart rate for this purpose needs further investigation.
Outcome of Research: More research required
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Category: Falls and Bone Density
Title: Osteoporosis in a postpolio clinic population
Author: Haziza M (1), Kremer R, Benedetti A, Trojan DA
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, McGill University, Montreal, QC, Canada
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil. 2007 Aug;88(8):1030-5
Publication Year and Month: 2007 08
Abstract: OBJECTIVES: To determine (1) the frequency of osteoporosis at the hip and lumbar spine in a postpolio clinic population and (2) the association of lower-extremity muscle strength and other potential contributing factors to osteoporosis with bone density measured at the hip.
DESIGN: Cross-sectional study involving a chart review.
SETTING: A university-affiliated hospital postpolio clinic.
PARTICIPANTS: Patient charts (N=379) were reviewed; 164 (26%) were included, and 215 (74%) were not included primarily (74%) because of the unavailability of bone density results.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Bone density (in g/cm(2)) and T score were assessed at the femoral neck and lumbar spine. Muscle strength was evaluated by manual muscle testing in 7 bilateral lower-extremity muscles.
RESULTS: The occurrence of osteoporosis at the hip and lumbar spine was 20 (32%) of 62 and 6 (10%) of 61 in men, 3 (9%) of 33 and 2 (6%) of 32 in premenopausal women, and 18 (27%) of 67 and 7 (11%) of 65 in postmenopausal women, respectively. In a logistic regression model, the presence of osteoporosis at the hip was significantly associated with strength sum score in the same extremity in which the bone density was performed after adjusting for other important risk factors (age, body mass index, time since polio).
Conclusions: Osteoporosis occurred commonly at the hip in a postpolio clinic population. Hip bone density was associated with muscle strength in the same lower extremity.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Predictive Factors for Post-Poliomyelitis Syndrome
Author: Daria A. Trojan, MD, MSc, Neil R. Cashman, MD, Stanley Shapiro, PhD, Catherine M. Tansey, MSc, John M. Esdaile, MD
Affiliation: From the Department of Neurology (Drs. Trojan, Cashman), Montreal Neurological Institute and Hospital, the Department of Medicine (Dr. Esdaile), Montreal General Hospital, and the Department of Epidemiology and Biostatistics (Dr. Shapiro, Ms. Tansey), McGill University, Montreal, Quebec, Canada.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil Vol 75, July 1994, 770-777
Publication Year and Month: 1994 07
Abstract: Post-poliomyelitis syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. The purpose of this study was to identify, through a case-control study design, factors that predict subsequent PPS in patients with prior paralytic poliomyelitis. Among patients attending a university-affiliate hospital post-polio clinic, "cases" were patients with new weakness and fatigue, and "controls" were patients without these complaints. A chart review of 353 patients identified 127 cases and 39 controls. Logistic regression modeling was used to calculate adjusted and unadjusted odds ratios. In univariate analyses, significant risk factors for PPS were a greater age at time of presentation to clinic (p = 0.01), a longer time since acute polio (p = 0.01), and more weakness at acute polio (p = 0.02). Other significant associated, but not necessarily causal factors were a recent weight gain (p = 0.005), muscle pain (p = 0.01) particularly that associated with exercise (p = 0.005), and joint pain (p = 0.04). Multivariate analyses revealed that a model containing age at presentation to clinic, severity of weakness at acute polio, muscle pain with exercise, recent weight gain, and joint pain best distinguished cases from controls. Age at acute polio, degree of recovery after polio, weakness at best point after polio, physical activity, and sex were not contributing factors. These findings suggest that the degree of initial motor unit involvement as measured by weakness at acute polio, and possibly the aging process and overuse are important in predicting PPS.
Conclusions: In conclusion, the results from this study provide insight on predictive factors for PPS, and can be applied in the clinical management of patients who have recovered from paralytic poliomyelitis. Our findings support the hypothesis that the severity of initial motor unit involvement as estimated by weakness at acute polio, and possibly the normal ageing process and overuse are important in predicting PPS. Even though patients have no control over the severity of weakness as a result of acute polio, they do have control over some predictive factors for PPS. Patients can be advised that they should avoid gaining weight and exercising to the point of muscle pain because these variables have been found to be strongly associated with PPS. The exact role of physical activity will still need further evaluation; however, the usual recommendations of low-level aerobic exercise with avoidance of muscle pain and fatigue appear valid. Thus, this study can provide the basis for physiologically reasonable and practical advice to post-polio patients to minimize or delay the risk of PPS.
Outcome of Research: Not applicable
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Category: 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:
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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
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Category: Respiratory Complications and Management
Title: Airway Secretion Clearance by Mechanical Exsufflation for Post-Poliomyelitis Ventilator-Assisted Individuals
Author: John R. Bach, William H. Smith, Jennifier Michaels, Lou Saporito, Augusta S. Alba, Rajeev Dayal, Jeffrey Pan.
Affiliation:
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Arch Phys Med Rehabil Vol 74:170-177, February 1993.
Publication Year and Month: 1992 03
Abstract: Pulmonary complications from impaired airway secretion clearance mechanisms are major causes of morbidity and mortality for post-poliomyelitis individuals. The purpose of this study was to review the long-term use of manually assisted coughing and mechanical insufflation-exsufflation (MI-E) by post-poliomyelitis ventilator-assisted individuals (PVAIs) and to compare the peak cough expiratory flows (PCEF) created during unassisted and assisted coughing. Twenty-four PVAIs who have used noninvasive methods of ventilatory support for an average of 27 years, relied on methods of manually assisted coughing and/or MI-E without complications during intercurrent respiratory tract infections (RTIs). Nine of the 24 individuals were studied for PCEF. They had a mean forced vital capacity (FVC) of 0.54 ± 0.47L and a mean maximum insufflation capacity achieved by air stacking of ventilator insufflations and glossopharyngeal breathing of 1.7L. The PCEF were as follows: unassisted, 1.78 ± 1.16L/sec; following a maximum assisted insufflation, 3.75 ± 0.73L/sec; with manual assistance by abdominal compression following a maximum assisted insufflation, 4.64 ± 1.42L/sec; and with MI-E, 6.97 ± 0.89L/sec. We conclude that manually assisted coughing and MI-E are effective and safe methods of airway secretion clearance for PVAIs with impaired expiratory muscle function who would otherwise be managed by endotracheal suctioning. Severely decreased maximum insufflation capacity but not vital capacity indicate need for a tracheostomy.
Conclusions: Post-poliomyelitis individuals using noninvasive methods of ventilatory support have greater PCEF produced by manually assisted coughing and by MI-E than can be produced by unassisted coughing. Thus, if intubation and tracheostomy are to be avoided, it becomes crucial for these individuals and their caregivers to learn and have access to these methods, particularly during RTIs when expiratory muscle weakness is exacerbated.[55] These principles may also apply to individuals with severe expiratory muscle weakness due to other neuromuscular conditions. We believe that it is largely because of the lack of general knowledge of and access to MI-E that other centers are more likely to resort to intubation and tracheostomy for patients with advanced neuromuscular disease and RTIs. We conclude that loss of FVC in itself does not mandate the need for intubation or tracheostomy for ventilatory support. A maximum insufflation capacity below 500mL may be a better indicator. MI-E should be further explored as a convenient and probably more effective alternative to endotracheal suctioning for ventilator-supported neuromuscular individuals.
Outcome of Research:
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Category: Exercise
Title: Cardiorespiratory responses to upper extremity aerobic training by postpolio subjects
Author: Kriz, J.L., Jones, D.R., Speier, J.L., Canine, J.K., Owen, R.R., Serfass, R.C.
Affiliation: Sister Kenny Institute
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Kriz, J.L., Jones, D.R., Speier, J.L., Canine, J.K., Owen, R.R., Serfass, R.C. (1992) Cardiorespiratory responses to upper extremity aerobic training by postpolio subjects. Arch Phys Med Rehabil. 73(1): 49-54
Publication Year and Month: 1992 01
Abstract: The cardiorespiratory responses of ten postpolio subjects participating in a 16-week upper extremity aerobic exercise program were compared to ten non-exercised controls. The subjects trained three times a week for 20 minutes per session. Exercise intensity was prescribed at 70% to 75% of heart rate reserve plus resting heart rate. Dependent variables were resting heart rate, maximal heart rate, resting and immediate-post-exercise systolic and diastolic blood pressures, maximal oxygen consumption, maximal carbon dioxide production, minute ventilation, respiratory exchange ratio, power, and exercise time. After training, the exercise group was superior to the control group in oxygen consumption, carbon dioxide production, minute ventilation, power, and exercise time. There was no reported loss of muscle strength. It was concluded that postpolio subjects can safely achieve an increase in aerobic capacity with a properly modified upper extremity exercise program. This improvement is comparable to that demonstrated by able-bodied adults.
Conclusions: Postpolio subjects can safely achieve an increase in aerobic capacity with a properly modified upper extremity exercise program. This improvement is comparable to that demonstrated by able-bodied adults.
Outcome of Research: More research required
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Category: Complementary Therapies
Title: No Effects of Whole-Body Vibration Training on Muscle Strength and Gait Performance in Persons With Late Effects of Polio: A Pilot Study
Author: Brogardh C, Flansbjer U-B, Lexell J.
Affiliation: Skane University Hospital
Lund University
Lulea University of Technology
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 91, Issue 9, September 2010, Pages 1474-1477
Publication Year and Month: 2010 09
Abstract: Objective
To evaluate the feasibility and possible effects of whole-body vibration (WBV) training on muscle strength and gait performance in people with late effects of polio.
Design
A case-controlled pilot study with assessments before and after training.
Setting
A university hospital rehabilitation department.
Participants
People (N=5; 3 men, 2 women; mean age, 64±6.7y; range, 55−71y) with clinically and electrophysiologically verified late effects of polio.
Interventions
All participants underwent 10 sessions of supervised WBV training (standing with knees flexed 40°−55° up to 60 seconds per repetition and 10 repetitions per session twice weekly for 5 weeks).
Main Outcome Measures
Isokinetic and isometric knee muscle strength (dynamometer), and gait performance (Timed Up & Go, Comfortable Gait Speed, Fast Gait Speed, and six-minute walk tests).
Results
All participants completed the 5 weeks of WBV training, with no discernible discomfort. No significant changes in knee muscle strength or gait performance were found after the WBV training period.
Conclusions: This pilot study did not show any significant improvements in knee muscle strength and gait performance following a standard protocol of WBV training. Thus, the results do not lend support to WBV training for people with late effects of polio.
Outcome of Research: More research required
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Category: 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
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Category: Diagnosis and Management
Title: Stroke Risk in Poliomyelitis Survivors: A Nationwide Population-Based Study
Author: Wu C-H, Liou T-H, Chen H-H, Sun T-Y, Chen K-H, Chang K-H
Affiliation: Wu, Sun, KH Chang: Chung-Yuan Christian University
Liou: Shuang Ho Hospital and Taipei Medical University, Taipei
HH Chen; Chang: Wan Fang Hospital
Chang: Taipei Medical University, Taipei
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 93, Issue 12, Pages 2184–2188
Publication Year and Month: 2012 12
Abstract: Objectives
To assess the prevalence and risk of stroke among adults with polio and controls.
Design
A prospective, probability-sampling, 6-year population-based cohort study.
Setting
A National Health Insurance Research Database consisting of 316,355 randomly selected enrollees. The database is related to a National Health Insurance program with more than 22 million participants.
Participants
After excluding patients under 40 years of age, polio patients (N=212) (mean age ± SD, 54.0±10.2y; 57.1% men) were identified from the database from January 1, 2003 to December 31, 2008. For each polio patient, 2 age- and sex-matched patients were recruited as controls. Control patients did not have any neuromuscular diseases commonly found in childhood. The frequencies of patients with potential risk factors for stroke were assessed.
Intervention
None.
Main Outcome Measure
The prevalence and the adjusted odds ratio of ischemic stroke among polio patients and the controls were estimated.
Results
Polio patients had a higher prevalence of stroke (10.8% vs 2.4%, P<.001) than the controls. Polio patients with hypertension had a much higher prevalence of stroke (23.0%). The risk of stroke was higher for polio patients compared with the controls, yielding an adjusted odds ratio of 4.17 (95% confidence interval, 1.84–9.45, P<.001). Polio was a significant risk factor for stroke independent from hypertension, diabetes mellitus, hyperlipidemia, and cardiac diseases.
Conclusions
Adults with polio had a high prevalence of ischemic stroke. Polio was an additional risk factor for stroke. Polio patients with hypertension might potentiate the risk of stroke. Developing a health promotion program, suitable for polio patients, to increase participation in activities and exercises may be essential, especially for polio patients with hypertension.
Conclusions:
Outcome of Research: Effective
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Category: Post-Polio Motor Unit
Title: Neuromuscular function in polio survivors at one-year follow-up.
Author: Agre JC, Rodriguez AA
Affiliation: Department of Rehabilitation Medicine, University of Wisconsin Medical School, Madison
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 1991 Jan;72(1):7-10.
Publication Year and Month: 1991 01
Abstract: Many polio survivors complain of progressive loss of strength, work capacity, endurance, and ability to recover from fatiguing activity. These variables were measured initially and one year later in the quadriceps muscles of 28 symptomatic and 16 asymptomatic persons who had polio and 38 control individuals. Peak knee extension torque was measured isokinetically and isometrically. Endurance, or the amount of time the subject could maintain isometric torque at 40% of maximal torque, was measured. Work capacity was determined as the product of isometric torque and endurance time. Recovery of strength was measured at regular intervals for ten minutes after the endurance test. Statistical analysis was done by repeated measures ANOVA. Although the initial measures showed significant deficits in mean peak torque, work capacity, and recovery of strength in symptomatic postpolio subjects, no significant changes were found one year later in any of the variables.
Conclusions: Symptomatic postpolio subjects do not lose significant neuromuscular function in one year.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: Changes in macro electromyography over time in patients with a history of polio: a comparison of 2 muscles.
Author: Sandberg A, Stalberg E
Affiliation: Department of Clinical Neurophysiology, Uppsala University Hospital, ing 85, 3 tr., S-751 85 Uppsala, Sweden.
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 2004 Jul;85(7):1174-82.
Publication Year and Month: 2004 07
Abstract: OBJECTIVE:
To investigate whether changes over time are different in a weight-bearing leg muscle than in a less heavily used arm muscle.
DESIGN:
Prospective study.
SETTING:
University hospital laboratory.
PARTICIPANTS:
Twenty-three patients with a history of poliomyelitis.
INTERVENTION:
Two investigations were performed 5 years apart, using macro electromyography and the patients' own assessments of symptoms in the tibial anterior and the biceps brachii muscles. Test-retest of macro electromyography was performed in controls and in patients with old polio.
MAIN OUTCOME MEASURES:
Macro motor unit potential (MUP) and symptoms in the tibial anterior and biceps brachii over time.
RESULTS:
The macro MUP amplitude increased by 24% (P<.05) in the tibial anterior but was unchanged in the biceps brachii muscle.
Conclusions: CONCLUSIONS:
An increase in the macro MUP amplitude of the tibial anterior muscle, but not of the biceps brachii, most likely indicates a more pronounced ongoing denervation-reinnervation process over time in the tibial anterior. This difference could be activity dependent, but other factors cannot be excluded.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: Are the nonparalytic muscles of polio survivors free from the risk of post-polio syndrome?
Author: K.Sawada, M.Horii, D.Imoto, Y.Mikami, T.Kubo
Affiliation: Kyoto Prefectural University of Medicine, Department of Rehabilitation Medicine, Kyoto, Japan
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 61, Supplement, July 2018, Page e263
Publication Year and Month: 2018 07
Abstract: Introduction/Background
The aim of this study was to reveal the relation between the neurogenetic change in the nonparalytic muscles in upper and lower limbs of Polio survivors and the later muscle strength decline.
Material and method
Retrospective study. We looked back the data of electromyography (EMG) of Polio survivors in our Polio clinic (average age: 58.9). Muscles whose strength at EMG had been normal were extracted. We looked up the muscle strength at EMG time and two years later from medical record.
Results
The subjects were 23 deltoid (middle strand), 40 biceps branchii, 36 triceps branchii, 24 vastus lateralis, 19 tibialis anterior, and gastrocnemius (medial head). The ratio of neurogenic change subject (giant spike or interference pattern reduction) was, 30.4%, 25.0%, 36.1%, 62.5%, 47.4%, and 73.7%, respectively. In neurogenic change group of Biceps, 50.0% showed decline in their muscle strength. In non-neurogenic change group of Deltoid, 25.0% showed decline in their muscle strength.
Conclusions: Conclusion
Present study suggested that some muscle strength decline may be caused by Post-polio syndrome (PPS), and that EMG might be the most useful tool for the risk detection of PPS, especially for Biceps branchii. On the other hand, the fact that 25% of Deltoid non-neurogenic change group showed muscle strength decline was not understood in this study. Pain or disuse from disorder in shoulder joint might possibly be as a cause.
Outcome of Research: More research required
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Category: Continence
Title: Pelvic floor and poliomyelitis. Case report
Author: Gabriella Fizzotti, Michelangelo Buonocore, Eliana Giambelluca, Antonio Nardone
Affiliation: Spinal Unit, ICS Maugeri, Pavia, Italy
Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, ICS Maugeri, Pavia, Italy,
School of Specialization in Physical Medicine and Rehabilitation, University of Pavia, Pavia, Italy;
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences University of Pavia, Pavia
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Open Access 2:1-3 (2018)
Publication Year and Month: 2018
Abstract: Introduction: Living with polio increases the risk of having bladder dysfunction. Normal pelvic visceral function depends on the complex interactions
of intact somatic and autonomic nervous systems. Tests that are used to investigate the integrity of the somatic innervation of the pelvic floor muscles and urinary and anal sphincters include electromyography (EMG), nerve conduction studies and the evaluation of the sacral reflexes.
Clinical Picture and Investigation: A 53-year-old South-American man who had a history of poliomyelitis which affected his lower right limb
when he was 2 years old. Patient was unable to empty his bladder completely. The aim of this paper is to describe the correlation between pelvic
floor dysfunction, bladder symptoms and neurophysiological tests in poliomyelitis.
Conclusions: Conclusion: Neurophysiological diagnostic procedures adopted in our study can discern the degree of central and peripheral nervous system damage and confirmed that pelvic floor and detrusor muscles have been paralyzed by the poliovirus.
Outcome of Research: More research required
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Category: Pain
Title: Activity pacing, avoidance, endurance, and associations with patient functioning in chronic pain: a systematic review and meta-analysis.
Author: Andrews NE, Strong J, Meredith PJ.
Affiliation: Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia. [email protected]
Journal: Archives of Physical Medicine and Rehabilitation
Citation: 2012 Nov;93(11):2109-2121.e7. doi: 10.1016/j.apmr.2012.05.029
Publication Year and Month: 2012 11
Abstract: OBJECTIVE:
To systematically review the associations between different approaches to activity (ie, activity pacing, avoidance, or endurance) and indicators of patient functioning in chronic pain samples.
DATA SOURCES:
A key word search was conducted in PsycINFO, MEDLINE via Ovid, EMBASE, and PubMed up to March 2011.
STUDY SELECTION:
To be included, studies had to (1) be written in English, (2) report on an adult chronic pain sample, and (3) report a correlation coefficient between at least 1 measure of 1 of the 3 "approach to activity" variables and an indicator of patient functioning.
DATA EXTRACTION:
Two reviewers independently screened abstracts and full-text articles for eligibility and extracted the data. Results of correlation analyses were grouped on the basis of measure of approach to activity (pacing/avoidance/endurance) and the criterion variable measured (pain/physical functioning/psychological functioning), resulting in 9 categories. Random-effects modeling was then used to pool data across studies in each category.
DATA SYNTHESIS:
Forty-one studies were eligible for inclusion. Results demonstrated that avoidance of activity was consistently associated with more pain, poorer psychological functioning, and more physical disability. While enduring with activity was associated with enhanced physical and psychological functioning, these relationships appeared to be dependent on the measure used, with measures more reflective of persisting with activities to the point of severe pain aggravation (overactivity) linked to poorer outcomes. Pacing was generally linked to better psychological functioning but more pain and disability.
Conclusions: Although causation cannot be determined, results of this study suggest that both avoidance of activity and overactivity are associated with poorer patient outcomes. Unexpected results relating to pacing may reflect either the ineffectiveness of pacing if not used to gradually increase an individual's activity level or the notion that individuals with better psychological functioning but more pain and disability are more inclined to pace activity.
Outcome of Research: More research required
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Category: 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
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Category: Falls
Title: Construct Validity And Reproducibility of C-Mill Walking-Adaptability Assessment in Polio Survivors
Author: Jana Tuijtelaars, Merel-Anne Brehm, Frans Nollet, Melvyn Roerdink
Affiliation: Amsterdam UMC, Department of Rehabilitation Medicine
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 102, Issue 10, Pages e47-e48.
https://doi.org/10.1016/j.apmr.2021.07.604
Publication Year and Month: 2021 10
Abstract: Research Objectives
To the assess construct validity and reproducibility of walking-adaptability assessment on an instrumented treadmill (the C-Mill) in polio survivors.
Design
Observational study with two repeated walking-adaptability measurements (target stepping, with 0%, 20% and 30% target position variance, and anticipatory and reactive obstacle avoidance), separated by 2-3 weeks.
Setting
Outpatient clinic of a university hospital.
Participants
Polio survivors (n=46) who fell in the previous year and/or reported fear of falling.
Interventions
Not applicable.
Main Outcome Measures
We examined 1) face validity by determining Group (for subgroups stratified for fall frequency, fear of falling and leg-muscle weakness) and Condition effects (for difficulty level) on walking-adaptability outcomes, 2) construct validity by correlating walking-adaptability and balance outcomes, and 3) content validity by establishing possible ceiling effects. We determined whether face-validity findings were reproducible over test occasions and calculated Intraclass Correlation Coefficients (ICC) and the 95% Limits of Agreement (LoA) for walking-adaptability outcomes.
Results
Walking-adaptability outcomes differed in to-be-expected directions for subgroups stratified for fall frequency and leg-muscle weakness and for difficulty levels, all reproducible over test occasions. Correlations between walking-adaptability and balance outcomes were mainly low (r < 0.587). Ceiling effects were present for anticipatory obstacle-avoidance and balance outcomes, but not for reactive obstacle avoidance. ICCs [95% confidence intervals] were good for the challenging 20% (0.80[0.67-0.88]) and 30% target-stepping (0.74[0.57-0.85]) and reactive obstacle-avoidance (0.76[0.59-0.86]) conditions, but not for 0% target-stepping and anticipatory obstacle-voidance (ICC < 0.62) conditions. Likewise, the narrowest LoA were observed for the 20% and 30% target-stepping conditions.
Conclusions: We proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors with a history and/or fear of falling. Adding walking-adaptability assessment, particularly the more challenging tests given their superior reproducibility, to currently used clinical tests could improve fall-risk evaluation in this population.
Outcome of Research: Effective
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Category:
Title: Patient and Clinician Reported Outcomes and Experiences Following Advanced Tele-Rehabilitation Assessments Conducted in Rural Alberta
Author: Martin Ferguson-Pell & Emily Armstrong
Affiliation: University of Alberta Faculty of Rehabilitation Medicine
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Volume 102, Issue 10, Page e10
https://doi.org/10.1016/j.apmr.2021.07.419
Publication Year and Month: 2021 10
Abstract: Research Objectives
To determine the feasibility of a clinic-to-clinic tele-rehabilitation model in rural Alberta.
Design
This pilot study employed a Plan-Do-Study-Act (PDSA) methodology. We focused on 4 clinical areas: Hip & Knee post-arthroplasty follow-up, Vestibular & Balance issues, Severe Shoulder Pain & Instability, and Wheelchair Seating. We co-developed assessment processes with non-physician experts that connected to a general physiotherapist using new technologies. After a series of in-house trials, these assessments were then deployed to 5 rural communities in Alberta. Technologies included Kinetisense Markerless Motion Capture and a telepresence robot. Patients were provided with a minimum of two clinical visits, with follow-up approximately 4 weeks after initial assessment. Experience and outcome measures centered on ICF principles were collected from both patients and clinicians.
Setting
The study took place in public and private rehabilitation settings and a primary care facility.
Participants
Participants were selected from a convenience sample by local practitioners. Initial and follow-up assessments for 16 patients in this pilot study were completed.
Interventions
A novel suite of technologies and processes were developed through close consultation with expert clinicians to enable complex rehabilitation assessments to be conducted remotely.
Main Outcome Measures
A mix of outcome and experience measures determined the effectiveness of this model. The COPM, and a study-specific Patient Reported Experience Measure, measured patient outcomes. Two study-specific Clinician Reported Experience Measures provided clinician data.
Results
Across our 4 modules, 14 out of 16 participants either agreed (3) or strongly agreed (11) that they enjoyed their Tele-Rehab session overall. No participants disagreed, and 2 were neutral. Based on COPM scores, overall patients saw improvements in both performance and satisfaction for their identified goals.The remote clinicians were all confident in the treatment plans prescribed by the hub clinician (n=13, 4 Agree, 9 Strongly Agree). Both hub and remote clinicians had confidence in each other, and all agreed (5) or strongly agreed (18) that the assessments were a success.
Keywords: Telemedicine; Rehabilitation; Technology
Conclusions: Conclusions
Preliminary results indicate that this is an effective way of delivering care, but additional study is required.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center
Author: Quadros AA (1), Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, Pereira RD, Ramos PE, Abe G, Oliveira AS
Affiliation: (1) Department of Neurology and Neurosurgery, Division of Neuromuscular Disorders, Federal University of São Paulo (Unifesp), São Paulo SP, Brazil - [email protected]
Journal: Arquivos de Neuro-psiquiatria
Citation: Arq Neuropsiquiatr. 2012 Aug;70(8):571-3
Publication Year and Month: 2012 08
Abstract: OBJECTIVE: To determine the frequency and clinical manifestations of patients with post-poliomyelitis syndrome (PPS) in a Brazilian division of neuromuscular disorders.
METHODS: A total of 167 patients with prior history of paralytic poliomyelitis was investigated for PPS, based on international diagnostic criteria. Other variables analyzed were: gender, race, age at poliomyelitis infection, age at PPS onset, and PPS symptoms.
RESULTS: One hundred and twenty-nine patients presented PPS, corresponding to 77.2% of the studied population. 62.8% were women and 37.2% were men. Mean age of patients with PPS at onset of PPS symptoms was 39.9±9.69 years. Their main clinical manifestations were: new weakness in the previously affected limbs (69%) and in the apparently not affected limbs (31%); joint pain (79.8%); fatigue (77.5%); muscle pain (76%); and cold intolerance (69.8%).
Conclusions: Most patients of our sample presented PPS. In Brazil, PPS frequency and clinical features are quite similar to those of other countries.
Outcome of Research: Effective
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Category: Restless Legs Syndrome, Sleep Analysis
Title: Sleep disorders frequency in post-polio syndrome patients caused by periodic limb movements
Author: Araujo MA de P (1); Silva TMe (2); Moreira GA (3); Pradella-Hallinan M (3); Tufik S (4); Oliveira ASB (4)
Affiliation: (1) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Master in Health Sciences; (2) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Specialized in neuromuscular diseases; (3) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Doctor in Sciences; (4) Universidade Federal de São Paulo (UNIFESP/EPM), Instituto do Sono, São Paulo SP, Brazil: Post Doctor in Sciences
Journal: Arquivos de Neuro-Psiquiatria
Citation: vol.68 no.1 São Paulo Feb. 2010
http://dx.doi.org/10.1590/S0004-282X2010000100008
Publication Year and Month: 2010 02
Abstract: Post-polio syndrome (PPS) in individuals with polio longer than 15 years is characterized by weakness and/or muscle fatigue, deficit of deglutition and breath and periodic limb movements (PLM) during sleep. We undertook a review of 99 patients with PPS, and assessed the frequency of PLM through polysomnographic recordings at our sleep disorders unit. The total number of PLM, total time of sleep (TTS), efficiency of sleep (EfS), awaking index (AI) and apnea-hypopnea index (AHI) were analyzed. Sixteen patients presented PLM in excess of 5 for the entire night. When comparing these with the group without PLM, a correlation was found (p=0.001). Significant difference was found for the correlation of the parameters: IAH, ID, TTS and EfS when compared the two groups. There is a close relationship between PPS and PLM.
Conclusions: In conclusion, the polysomnography records are an apt way of establishing PLMS in PPS. Understanding the role this plays in the lives of PPS will allow health carers to work on enhancing the overall sleep quality of polio survivors.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Ageing
Title: Currents issues in cardiorespiratory care of patients with post-polio syndrome
Author: Marco Orsini, Agnaldo J. Lopes, Fernando S. Guimarães, Marcos R. G. Freitas, Osvaldo J. M.
Nascimento, Mauricio de Sant’ Anna Junior, Pedro Moreira Filho, Stenio Fiorelli, Ana Carolina A. F.
Ferreira, Camila Pupe, Victor H. V. Bastos, Bruno Pessoa, Carlos B. Nogueira, Beny Schmidt,
Olivia G. Souza, Eduardo R Davidovich, Acary S. B. Oliveira, Pedro Ribeiro
Affiliation: Centro Universitário Augusto Motta, Programa de Pós-Graduação em Ciências da Reabilitação, Rio de Janeiro RJ, Brasil
Journal: Arquivos de Neuro-Psiquiatria
Citation: Arq. Neuro-Psiquiatr. vol.74 no.7 São Paulo July 2016
Publication Year and Month: 2016 07
Abstract: Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk.
Method
A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered.
Results and Discussion
Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia.
Conclusions: Conclusion
Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.
Outcome of Research: More research required
Comments (if any):
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Category: Sleep Analysis
Title: Analysis of sleep characteristics in post-polio syndrome patients
Author: Silva TM (1), Moreira GA, Quadros AA, Pradella-Hallinan M, Tufik S, Oliveira AS
Affiliation: (1) Department of Neurology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil. [email protected]
Journal: Arquivos de Neuropsiquiatria
Citation: Arq Neuropsiquiatr. 2010 Aug;68(4):535-40
Publication Year and Month: 2010 08
Abstract: The main post-polio syndrome (PPS) symptoms are new weakness, new atrophy, fatigue, pain and sleep disturbances. Polysomnography is the gold standard for sleep analysis.
OBJECTIVE: To analyze sleep patterns in PPS patients.
METHOD: Sixty patients (mean age 46.8+/-11.3 years) at the Federal University of São Paulo (UNIFESP/EPM) complaining of sleep disturbances were evaluated by means of polysomnography, performed at the Sleep Institute.
RESULTS: Sleep efficiency was lower due to high sleep latency and arousal index. The apnea and hypopnea index (AHI) and the periodic limb movements (PLM) index were higher. Sleep architecture was also impaired. There were no abnormalities of oxygen saturation, carbon dioxide levels, respiratory rate or heart rate.
Conclusions: New post-polio sleep disturbances were isolated symptoms. It appears that these symptoms were not due to post-polio features, but rather, that they were due to dysfunction of the surviving motor neurons in the brainstem. Abnormal dopamine production, which is responsible for many sleep-related breathing disorders and abnormal movements, may also have been implicated in the present findings.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Psychology
Title: Living with the late effects of disability: a five-year follow-up survey of coping among post-polio survivors
Author: Westbrook M, McIlwain D
Affiliation: Faculty of Health Sciences, The University of Sydney
Journal: Australian Occupational Therapy Journal
Citation: Aust Occup Ther J. 1996 June;43(2):60-71
Publication Year and Month: 1996 06
Abstract: A follow-up survey of 176 people aged 33–77 yrs with postpolio syndrome found that while they were experiencing significantly less anxiety, uncertainty, depression, and helplessness concerning their increasing disability than 5 yrs ago, their feelings of anger persisted. Relationships were found between coping styles, breadth of coping attempted, and emotions experienced. Specifically, a coping style of focusing on symptoms while attempting to maintain previous activity levels characterized people who felt more helpless, depressed, and angry. Those who coped by accommodating to their symptoms had adopted more strategies. Coping strategies involving lifestyle and personal changes were rated as more effective than many treatments and interpersonal strategies. Findings highlight the need for health practitioners to tap into clients' knowledge when designing and evaluating appropriate rehabilitation programs.
Conclusions:
Outcome of Research:
Comments (if any): The full paper is available from Polio Australia for private study purposes.
Link to Full Paper (if available):
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: 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.
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Category: Activity Levels, Psychology
Title: Exercise therapy and cognitive behavioural therapy to improve fatigue, daily activity performance and quality of life in postpoliomyelitis syndrome: the protocol of the FACTS-2-PPS trial
Author: Koopman FS (1), Beelen A (1), Gerrits KH (2), Bleijenberg G (3), Abma TA (4), de Visser M (5), Nollet F (1)
Affiliation: (1) Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; (2) Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands; (3) Expert Centre Chronic Fatigue Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands;(4) Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands; (5) Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands - [email protected]
Journal: BioMed Central Neurology
Citation: BMC Neurol. 2010 Jan 18;10:8. doi: 10.1186/1471-2377-10-8
Publication Year and Month: 2010 01
Abstract: BACKGROUND: Postpoliomyelitis Syndrome (PPS) is a complex of late onset neuromuscular symptoms with new or increased muscle weakness and muscle fatigability as key symptoms. Main clinical complaints are severe fatigue, deterioration in functional abilities and health related quality of life. Rehabilitation management is the mainstay of treatment. Two different therapeutic interventions may be prescribed (1) exercise therapy or (2) cognitive behavioural therapy (CBT). However, the evidence on the effectiveness of both interventions is limited. The primary aim of the FACTS-2-PPS trial is to study the efficacy of exercise therapy and CBT for reducing fatigue and improving activities and quality of life in patients with PPS. Additionally, the working mechanisms, patients' and therapists' expectations of and experiences with both interventions and cost-effectiveness will be evaluated.
METHODS/DESIGN: A multi-centre, single-blinded, randomized controlled trial will be conducted. A sample of 81 severely fatigued patients with PPS will be recruited from 3 different university hospitals and their affiliate rehabilitation centres. Patients will be randomized to one of three groups i.e. (1) exercise therapy + usual care, (2) CBT + usual care, (3) usual care. At baseline, immediately post-intervention and at 3- and 6-months follow-up, fatigue, activities, quality of life and secondary outcomes will be assessed. Costs will be based on a cost questionnaire, and statistical analyses on GEE (generalized estimated equations). Analysis will also consider mechanisms of change during therapy. A responsive evaluation will be conducted to monitor the implementation process and to investigate the perspectives of patients and therapists on both interventions.
DISCUSSION: A major strength of the FACTS-2-PPS study is the use of a mixed methods design in which a responsive and economic evaluation runs parallel to the trial. The results of this study will generate new evidence for the rehabilitation treatment of persons with PPS.
TRIAL REGISTRATION: Dutch Trial Register NTR1371.
Conclusions:
Outcome of Research: Not applicable.
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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.
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Category: Drugs
Title: Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
Author: Huang Y-H (1), Chen H-C (2,3), Huang K-W (4,5,6), Chen P-C (1,7), Hu C-J (1,8), Tsai C-P (5,9), Tam K-W (2,10,11,12,13,14), Kuan Y-C (1,5,8,14)
Affiliation: (1) Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (2) Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (3) Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (4) Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan; (5) Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; (6) Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (7) College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; (8) Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan; (9) Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; (10) Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (11) Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (12) Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; (13) Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (14) Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan
Journal: BioMed Central Neurology
Citation: BMC Neurology 2015, 15:39 doi:10.1186/s12883-015-0301-9
Publication Year and Month: 2015 03
Abstract: BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial.
METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels.
RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity.
Conclusions: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Late Effects of Polio
Title: Experiences and perspectives of patients with post-polio syndrome and therapists with exercise and cognitive behavioural therapy
Author: Minne Bakker, Karen Schipper, Fieke S. Koopman, Frans Nollet and Tineke A. Abma
Affiliation: Department of Medical Humanities, EMGO+ Institute, VU Medical Center
(VUmc), Amsterdam, The Netherlands
Journal: BioMed Central Neurology
Citation: BMC Neurology (2016) 16:23
Publication Year and Month: 2016
Abstract: Background: Many persons affected with poliomyelitis develop post-polio syndrome (PPS) later in their life.
Recently, the effectiveness of Exercise Therapy (ET) and Cognitive Behavioural Therapy (CBT) for PPS has been evaluated in a randomized controlled trial, but did not show a decrease in fatigue or improvement in secondary endpoints like Quality of Life and self-perceived activity limitations. The aim of this explorative study was to gain insight in the perceived effects and experiences of the interventions from the perspectives of the patients and
therapists.
Methods: Qualitative data were collected through semi-structured interviews with 17 patients and 7 therapists. All participants were involved in the trial. A thematic analysis of the data was performed.
Results: Some patients experienced a short term enhanced endurance and a better use of energy during the day. However, in general patients did not experience a long lasting reduction of fatigue from the CBT or ET. Mainly patients of the CBT, but also some patients of the ET described an increase of self-esteem and self-acceptance. As a result, patients were sometimes better able to perform physical activities during the day. In contrast to the CBT, the
ET was in general perceived by the patients as an intensive therapy, which was difficult to fit into their daily routine. Therapists of both the CBT and the ET struggled with a low intrinsic motivation of the patients in the study.
This made it sometimes difficult for the therapists to follow the protocol.
Conclusions: Conclusion: Confirming the negative quantitative study outcome, the qualitative results did not demonstrate lasting effects on fatigue. Patients did, however, experience some benefits on self-esteem and acceptance of the disease. This study showed that it is of great importance to work with feasible interventions; they should fit the patients’ needs on a practical (fit into their daily routine) and mental (fit their need for support) level.
Outcome of Research: More research required
Comments (if any):
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Category: Respiratory Complications and Management
Title: Protocol for diaphragm pacing in patients with respiratory muscle weakness due to motor neurone disease (DiPALS): a randomised controlled trial.
Author: McDermott C, Maguire C, Cooper CL, Ackroyd R, Baird WO, Baudouin S, Bentley A, Bianchi S, Bourke S, Bradburn MJ, Dixon S, Ealing J, Galloway S, Karat D, Maynard N, Morrison K, Mustfa N, Stradling J, Talbot K, Williams T, Shaw PJ.
Affiliation: Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, 385A Glossop Road, Sheffield, S10 2HQ, UK.
Journal: BioMed Central Neurology
Citation: 2012 Aug 16;12:74.
Publication Year and Month: 2012 08
Abstract: BACKGROUND:
Motor neurone disease (MND) is a devastating illness which leads to muscle weakness and death, usually within 2-3 years of symptom onset. Respiratory insufficiency is a common cause of morbidity, particularly in later stages of MND and respiratory complications are the leading cause of mortality in MND patients. Non Invasive Ventilation (NIV) is the current standard therapy to manage respiratory insufficiency. Some MND patients however do not tolerate NIV due to a number of issues including mask interface problems and claustrophobia. In those that do tolerate NIV, eventually respiratory muscle weakness will progress to a point at which intermittent/overnight NIV is ineffective. The NeuRx RA/4 Diaphragm Pacing System was originally developed for patients with respiratory insufficiency and diaphragm paralysis secondary to stable high spinal cord injuries. The DiPALS study will assess the effect of diaphragm pacing (DP) when used to treat patients with MND and respiratory insufficiency.
METHOD/DESIGN:
108 patients will be recruited to the study at 5 sites in the UK. Patients will be randomised to either receive NIV (current standard care) or receive DP in addition to NIV. Study participants will be required to complete outcome measures at 5 follow up time points (2, 3, 6, 9 and 12 months) plus an additional surgery and 1 week post operative visit for those in the DP group. 12 patients (and their carers) from the DP group will also be asked to complete 2 qualitative interviews.
DISCUSSION:
The primary objective of this trial will be to evaluate the effect of Diaphragm Pacing (DP) on survival over the study duration in patients with MND with respiratory muscle weakness. The project is funded by the National Institute for Health Research, Health Technology Assessment (HTA) Programme (project number 09/55/33) and the Motor Neurone Disease Association and the Henry Smith Charity.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available):
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):
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Category: Diagnosis and Management
Title: Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo
Author: Mancini S, Coldiron ME, Nicholas S, Llosa AE, Mouniaman-Nara I, Ngala J, Grais RF, Porten K
Affiliation: Epicentre, Paris, France - [email protected].
Journal: BioMedCentral Research Notes
Citation: BMC Res Notes. 2014 Oct 23;7:755. doi: 10.1186/1756-0500-7-755
Publication Year and Month: 2014 10
Abstract: BACKGROUND: A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.
FINDINGS: Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength.
Conclusions: Most acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.
Outcome of Research: More research required.
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Respiratory Complications and Management
Title: Respiratory Muscle In Post-Polio Syndrome: Highlights
Author: Marco Orsini, Mauricio De Sant Anna, Carlos Henrique Melo Reis, Ricardo Martello, Eduardo Trajano,
Carlos Eduardo Cardoso, Marcos RG de Feritas and Acary SB Oliveira
Affiliation: Masters Program in Science Applied Health - Vassouras University and Masters Program in Local Devolopment - Unisuam. CASF Ramon Freitas - Neurology
Service- Nova Iguaçu- RJ- Brazil
IFRJ. Federal Institute of Rio de Janeiro - Brazil. Physical Therapy Service
Rio de Janeiro Federal University - UFRJ, Brazil
Masters Program in Science Applied Health - Vassouras University- Brazil
Masters Program in Science Applied Health - Vassouras University
Masters Program in Science Applied Health - Vassouras University
Federal University of Rio de Janeiro - Neurology Service - UFRJ
São Paulo Federal University - Unifesp - Neurology Service - Brazil
Journal: Biomedical Journal of Scientific & Technical Research (BJSTR)
Citation:
Publication Year and Month: 2018 11
Abstract: The main function of the respiratory muscles is the movement
of the thoracic wall, thus exerting ventilation, and the increase in
the work of this muscle is directly proportional to the intensity
of the activity performed De Troyer et al. [1-3]. During basal
respiration, the slow-twitch fibers are used, while the fast-twitch
fibers are recruited because of increased heart rate Sinderby et
al. [4]. The diaphragm moves caudal approximately 1 to 3cm.
Under conditions of ventilatory effort this incursion can reach
up to 10cm. For an adequate work performed by the ventilatory
muscles, approximately 1 to 3% of the oxygen consumption
(VO2) Kress et al. [5,6]. Several clinical conditions can modify
this process, leading to a greater demand for breathing muscles,
such as obesity Sant Anna Junior M et al. [7], chronic obstructive
pulmonary disease, heart failure, amyotrophic lateral sclerosis
among others.
Conclusions:
Outcome of Research: More research required
Comments (if any):
Link to Full Paper (if available): Click here to view full text or to download
Category: Post-Polio Motor Unit
Title: An algorithm for automatic detection of repeater F-waves and MUNE studies
Author: N. TuğrulArtuğ, N. Görkem Şirin, Emel Oğuz Akarsu, M. Baris Baslo, A. EmreÖge
Affiliation: Electrical and Electronics Engineering, Istanbul Arel University, Tepekent, Buyukcekmece, Istanbul, Turkey
Istanbul Medical Faculty, Istanbul University, Fatih, Capa, Istanbul, Turkey
Journal: Biomedical Signal Processing and Control
Citation: Volume 51, May 2019, Pages 264-276
Publication Year and Month: 2019 05
Abstract: The present study aims to develop an algorithm and software that automatically detects repeater F-waves which are very difficult to analyze when elicited as high number of recordings in motor unit number estimation studies. The main strategy of the study was to take the repeater F waves discriminated by the neurologist, from limited number of recordings, as the gold standard and to test the conformity of the results of the new automated method.
Ten patients with ALS and ten healthy controls were evaluated. 90 F-waves with supramaximal stimuli and 300 F-waves with submaximal stimuli were recorded. Supramaximal recordings were evaluated both manually by an expert neurologist and automatically by the developed software to test the performance of the algorithm. The results both acquired from the neurologist and from the software were found compatible. Therefore, the main expected impact of the present study is to make the analysis of repeater F waves easier primarily in motor unit number estimation studies, since there is currently a continuing need for such automated programs in clinical neurophysiology.
Submaximal recordings were examined only by the developed software. The extracted features were: maximum M response amplitude, mean power of M response, mean of sMUP values, MUNE value, number of baskets, persistence of F-waves, persistence of repeater F-waves, mean of F-waves’ powers, median of F-waves’ powers. Feature selection methods were also applied to determine the most valuable features. Various classifiers such as multi-layer perceptron (MLP), radial basis function network (RBF), support vector machines (SVM) and k nearest neighbors (k-NN) were tested to differentiate two classes. Initially all features, then decreased numbers of features after feature selection process were applied to the aforementioned classifiers. The classification performance usually increased when decreased features were applied to intelligent systems. Ulnar recordings under submaximal stimulation showed better performance when compared with supramaximal equivalents or median nerve equivalents. The highest performance was obtained as 90% with k-NN algorithm which was a committee decision based classifier. This result was achieved with only two features, namely mean of sMUP amplitude and MUNE value.
Conclusions:
Outcome of Research: More research required
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Category: Quality of Life
Title: Perceived consequences of ageing with late effects of polio and strategies for managing daily life: a qualitative study
Author: Catharina Sjödahl Hammarlund, Jan Lexell and Christina Brogårdh
Affiliation: 1Department of Health Sciences, Lund University, Box 157, SE-221 00 Lund, Sweden
2The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
3Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
4Department of Health Science, Luleå University of Technology, Luleå, Sweden
Catharina Sjödahl Hammarlund, Phone: +46462228961,
Email: es.ul.dem@dnulrammaH_lhadojS.anirahtaC.
Journal: BMC Geriatrics
Citation: 2017; 17: 179.
Publication Year and Month: 2017
Abstract: Background
New or increased impairments may develop several decades after an acute poliomyelitis infection. These new symptoms, commonly referred to as late effects of polio (LEoP), are characterised by muscular weakness and fatigue, generalised fatigue, pain at rest or during activities and cold intolerance. Growing older with LEoP may lead to increased activity limitations and participation restrictions, but there is limited knowledge of how these persons perceive the practical and psychological consequences of ageing with LEoP and what strategies they use in daily life. The aim of this qualitative study was therefore to explore how ageing people with LEoP perceive the their situation and what strategies they use for managing daily life.
Methods
Seven women and seven men (mean age 70 years) were interviewed. They all had a confirmed history of acute poliomyelitis and new impairments after a stable period of at least 15 years. Data were transcribed verbatim and analysed using systematic text condensation.
Results
The latent analysis resulted in three categories ‘Various consequences of ageing with LEoP’, ‘Limitations in everyday activities and participation restrictions’, and ‘Strategies for managing daily life when ageing with LEoP’ and 12 subcategories. The new impairments led to decreased physical and mental health. The participants perceived difficulties in performing everyday activities such as managing work, doing chores, partaking in recreational activities and participating in social events, thereby experiencing emotional and psychological distress. They managed to find strategies that mitigated their worries and upheld their self-confidence, for example finding practical solutions, making social comparisons, minimising, and avoidance.
Conclusions: Ageing with LEoP affected daily life to a great extent. The participants experienced considerable impact of the new and increased impairments on their life situation. Consequently, their ability to participate in various social activities also became restricted. Social comparisons and practical solutions are strategies that facilitate adaptation and acceptance of the new situation due to LEoP. This emphasises the need to design rehabilitation interventions that focus on coping, empowerment and self-management for people ageing with LEoP.
Outcome of Research: More research required
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Category: Epidemiology
Title: A systematic review of the world wide prevalence of survivors of poliomyelitis reported in 31 studies
Author: Kelly M Jones (1), Shivanthi Balalla (1), Alice Theadom (1), Gordon Jackman (2),
Valery L Feigin (1)
Affiliation: 1) National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 2006, Auckland, New Zealand
2) Polio New Zealand Inc., New Plymouth, New Zealand
Journal: BMJ Open
Citation: 2017;7:e015470.
http://dx.doi.org/10.1136/bmjopen-2016-015470
Publication Year and Month: 2017 04
Abstract: Background
Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis.
Methods
Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates.
Results
Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years.
Conclusions
These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates.
Conclusions: In conclusion, this review reported prevalence of poliomyelitis survivors worldwide from all identified studies. The majority of research to date has been limited to the examination of children and adolescents in low-income to lower middle-income countries (predominantly India) who reside in geographical regions that are not representative of the national population (eg, in terms of age, sex, ethnic distributions) and face high rates of non-polio AFP. Further research of the prevalence of survivors of poliomyelitis is required using a population-based approach, examining nationally representative samples of all ages, particularly in high-income countries including those declared to be polio free. Such efforts will reduce risks for sampling and measurement bias and improve capacity to provide reliable and more robust worldwide prevalence estimates.
Outcome of Research: More research required
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Category: 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
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Category: Quality of Life
Title: Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning
Author: Yesim Garip (1), Filiz Eser (2), Hatice Bodur (2), Bedriye Baskan (2), Filiz Sivas (2), Ozlem Yilmaz (2)
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Ankara Basak Medical Center, Ankara, Turkey; (2) Department of Physical Medicine and Rehabilitation, Ankara Numune Training and Research Hospital, Ankara, Turkey
Journal: Brazilian Journal of Rheumatology (Revista Brasileira de Reumatologia)
Citation: Rev Bras Reumatol. 2015 Mar; dx.doi.org/10.1016/j.rbre.2014.12.006
Publication Year and Month: 2015 03
Abstract: OBJECTIVE: To determine the impact of postpolio-syndrome on quality of life in polio survivors.
METHODS: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing.
RESULTS: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups.
Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.
Outcome of Research: Not applicable
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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
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Category: Vocational Implications
Title: Developing vocational rehabilitation services for people with long-term neurological conditions: Identifying facilitators and barriers to service provision
Author: Kate Hayward, Bilal A Mateen, E Diane Playford, Gail Eva
Affiliation: Therapy and Rehabilitation Services, National Hospital for Neurology and Neurosurgery, London, UK
Journal: British Journal of Occupational Therapy (BJOT)
Citation:
Publication Year and Month: 2019 03
Abstract: Introduction
This study aimed to understand existing vocational rehabilitation service provision in one locality in London (population 3.74 million), identify any gaps and explore reasons for this, to support service development.
Method
Using soft systems methodology to guide the research process, semi-structured interviews were completed with nine participants, who were clinicians and managers providing vocational rehabilitation within a National Health Service context. Data were analysed thematically to build a ‘rich picture’ and develop a conceptual model of vocational rehabilitation service delivery. Findings were then ratified with participants at an engagement event.
Results
The findings indicate a spectrum of vocational rehabilitation service provision for long-term neurological conditions with differing levels of funding in place. Vocational rehabilitation often takes place ‘under the radar’ and therefore the true vocational rehabilitation needs of this population, and the extent of service provision, is not known. There is inconsistency of understanding across the services as to what constitutes vocational rehabilitation and outcomes are not routinely measured.
Conclusions: For vocational rehabilitation services to develop they require appropriate funding, driven by government policy to commissioners. Clear definitions of vocational rehabilitation, collecting and sharing outcome data and effective communication across services are needed at a local level. This is expressed in a conceptual model of vocational rehabilitation service delivery.
Outcome of Research: More research required
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Category: Psychology
Title: Psychological Trauma and Its Treatment in the Polio Epidemics
Author: Daniel J. Wilson
Affiliation: Department of History, Muhlenberg College
Journal: Bulletin of the History of Medicine
Citation: Vol. 82, No. 4 (Winter 2008), pp. 848-877
https://www.jstor.org/stable/44449627
Publication Year and Month: 2008
Abstract: In this paper, I explore the kinds of psychological trauma experienced by polio patients in the mid-twentieth century in the United States. I argue that the trauma was the result of the experience of sudden paralysis, the conditions under which patients were treated, and the expectations for rehabilitation derived from the psychosocial context of the period. Psychiatric and psychological counseling in hospitals was only beginning to be offered in this period, and most polio patients received little or no counseling or assistance in dealing with their psychological problems. Contemporary psychological studies suggest that many polio patients suffered from psychological problems but that they were relatively mild. However, compared with the many studies of the physical problems of polio patients, there were relatively few studies of the psychological issues associated with the disease. The narratives and memoirs of polio survivors vividly testify to the psychological burden they experienced as patients during both the acute phase of the illness and during rehabilitation.
Conclusions: The psychological consequences of polio could be significant. Sudden paralysis, isolation from family and friends, a long and often painful rehabilitation, permanent disability, feelings of guilt and shame, and a zeitgeist that exhorted the polio survivor to always try harder to achieve normalization all combined in various measures to create psychological distress in many polio patients and survivors. Not every polio patient or survivor experienced substantial psychological distress or damage, but the potential was always there, especially for those who brought to the polio experience already fragile personalities or who lacked supportive families. As the polio narratives make clear, for those survivors who experienced psychological problems, the psychic damage from polio could be severe and long-lasting.
Outcome of Research: More research required
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Category: Vocational Implications
Title: University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953–80
Author: Geraldine Huynh
Affiliation: University of Alberta
Journal: Canadian Bulletin of Medical History (CBMH)
Citation: https://doi.org/10.3138/cbmh.249-022018
Published Online: March 22, 2019
Publication Year and Month: 2019 03
Abstract: Following Canada’s largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta’s fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.
Conclusions:
Outcome of Research: More research required
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Category: Women's Health
Title: Cesarean delivery under ultrasound-guided spinal anesthesia [corrected] in a parturient with poliomyelitis and Harrington instrumentation.
Author: Costello, JF, Balki, M.
Affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, Ontario, Canada
Journal: Canadian Journal of Anesthesia
Citation: 2008 Dec;55(12):889
Publication Year and Month: 2008 12
Abstract: PURPOSE:
To describe the anesthetic implications, and management of a medically complex parturient, who presented for Cesarean delivery (CD). The patient had poliomyelitis complicated with severe kyphoscoliosis, which had been treated with extensive spinal surgery. We used ultrasound guidance to facilitate successful spinal analgesia and anesthesia.
CLINICAL FEATURES:
A 27-yr-old woman, with a history of poliomyelitis and moderate restrictive lung disease secondary to kyphoscoliosis, presented at 38 weeks gestation for elective CD because of cephalopelvic disproportion. The woman had Harrington rods in situ from the level of the second thoracic vertebra, to the level of the fourth lumbar vertebra. Ultrasound guidance enabled one intervertebral space to be visualized (L5-S1), 3 cm from the expected spinal midline, and spinal anesthesia was performed at this interspace without any complications. A healthy infant was delivered, and the mother recovered uneventfully.
CONCLUSIONS:
Spinal anesthesia can be effectively performed in patients with poliomyelitis and severe kyphoscoliosis, that has been treated with extensive Harrington instrumentation. To facilitate regional techniques in such patients, bedside ultrasound may be greatly beneficial in identifying the correct spinal interspace.
Conclusions: This case illustrates several points: first, the benefit of ultrasound in the placement of a spinal block in a patient with abnormal spinal anatomy; second, the choice of anesthetic technique in pregnant patients with poliomyelitits; and third, the management of a pregnant patient with severe kyphoscoliosis, spinal surgery, and restrictive lung disease.
Outcome of Research: Effective
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Category: Women's Health
Title: Menopause and post-polio symptoms as predictors of subjective sleep disturbance in poliomyelitis survivors.
Author: Kalpakjian CZ, Quint EH, Toussaint LL.
Affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, USA
Journal: Climacteric
Citation: 2007 Feb;10(1):51-62.
Publication Year and Month: 2007 02
Abstract: OBJECTIVES:
Sleep disturbance in polio survivors is a common complaint, yet little is known about the effects of the interaction of physical disability and menopause on sleep. The purpose of this study was to understand the relative contribution of menopause factors and disability to subjective sleep disturbance.
METHODS:
Participants were 465 women aged 50-65 years who had physical disabilities due to poliomyelitis. Hierarchical regression modeling was used to examine menopause (symptoms, status, hormone replacement use, ovarectomy status) and disability factors (post-polio symptoms) in sleep disturbance.
RESULTS:
In the final model, 19% (frequency) and 17% (severity) of sleep disturbance variance was explained. Psychological symptoms exerted the most influence (for both outcomes) followed by post-polio symptoms, vasomotor symptoms, an interaction of vasomotor and post-polio symptoms and estrogen use. For women with fewer post-polio symptoms, vasomotor symptoms exerted greater influence on sleep disturbance than for women with greater post-polio symptoms.
CONCLUSIONS:
Psychological symptoms had the strongest association with sleep disturbance in these women. Controlling for the influence of various menopause factors, our findings show that vasomotor symptoms were only one of several influences on sleep disturbance.
Conclusions:
Outcome of Research: More research required
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Category: 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
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Category: Polio Immunisation
Title: Intestinal Immunity to Poliovirus Following Sequential Trivalent Inactivated Polio Vaccine/Bivalent Oral Polio Vaccine and Trivalent Inactivated Polio Vaccine–only Immunization Schedules: Analysis of an Open-label, Randomized, Controlled Trial in Chilean Infants
Author: Elizabeth B Brickley Wendy Wieland-Alter Ruth I Connor Margaret E Ackerman Austin W Boesch Minetaro Arita William C Weldon Miguel G O’Ryan Ananda S Bandyopadhyay Peter F Wright
Affiliation: 1Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; 2Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical
Medicine, United Kingdom; 3
Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, 4Department of Microbiology and Immunology, Geisel School of Medicine, Dartmouth
College, and 5Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire; 6
Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan; 7
Division of Viral
Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; 8
Microbiology and Mycology Program and Millennium Institute of Immunology and Immunotherapy, Faculty of Medicine,
University of Chile, Santiago; and 9
Bill & Melinda Gates Foundation, Seattle, Washington
Journal: Clinical Infectious Diseases
Citation: Volume 67, Issue suppl_1, 15 November 2018, Pages S42–S50, https://doi.org/10.1093/cid/ciy603
Publication Year and Month: 2018 10
Abstract: Background
Identifying polio vaccine regimens that can elicit robust intestinal mucosal immunity and interrupt viral transmission is a key priority of the polio endgame.
Methods
In a 2013 Chilean clinical trial (NCT01841671) of trivalent inactivated polio vaccine (IPV) and bivalent oral polio vaccine (bOPV; targeting types 1 and 3), infants were randomized to receive IPV-bOPV-bOPV, IPV-IPV-bOPV, or IPV-IPV-IPV at 8, 16, and 24 weeks of age and challenged with monovalent oral polio vaccine type 2 (mOPV2) at 28 weeks. Using fecal samples collected from 152 participants, we investigated the extent to which IPV-bOPV and IPV-only immunization schedules induced intestinal neutralizing activity and immunoglobulin A against polio types 1 and 2.
Results
Overall, 37% of infants in the IPV-bOPV groups and 26% in the IPV-only arm had detectable type 2–specific stool neutralization after the primary vaccine series. In contrast, 1 challenge dose of mOPV2 induced brisk intestinal immune responses in all vaccine groups, and significant rises in type 2–specific stool neutralization titers (P < .0001) and immunoglobulin A concentrations (P < 0.0001) were measured 2 weeks after the challenge. In subsidiary analyses, duration of breastfeeding also appeared to be associated with the magnitude of polio-specific mucosal immune parameters measured in infant fecal samples.
Conclusions: Taken together, these results underscore the concept that mucosal and systemic immune responses to polio are separate in their induction, functionality, and potential impacts on transmission and, specifically, provide evidence that primary vaccine regimens lacking homologous live vaccine components are likely to induce only modest, type-specific intestinal immunity.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: Loss of motor unit size and quadriceps strength over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), van Dijk JP (2), Beelen A (3), Zwarts MJ (4), Nollet F (5)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected]; (2) Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology/Clinical Neurophysiology, Postbus 910, 6500 HB Nijmegen, The Netherlands; Epilepsy Centre Kempenhaeghe, Postbus 61, 5590 AB Heeze, The Netherlands. Electronic address: [email protected]; (3) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected]; (4) Epilepsy Centre Kempenhaeghe, Postbus 61, 5590 AB Heeze, The Netherlands. Electronic address: [email protected]; (5) Department of Rehabilitation, Academic Medical Center (AMC), Postbus 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: [email protected].
Journal: Clinical Neurophysiology
Citation: Clin Neurophysiol. 2014 Jun;125(6):1255-60. doi: 10.1016/j.clinph.2013.11.003
Publication Year and Month: 2014 06
Abstract: OBJECTIVE: To investigate whether strength decline in post-polio syndrome (PPS) results from excessive distal axonal degeneration of enlarged motor units.
METHODS: We assessed changes over 10 years in isometric quadriceps strength, mean motor unit action potential (MUAP) size, root mean squared (RMS) amplitude, and level of interference (LOI) in 47 patients with PPS and 12 healthy controls, using high density surface EMG. At baseline, all patients had symptomatic quadriceps dysfunction, evidenced by transmission defects on single-fibre EMG.
RESULTS: MU size and strength declined significantly by 20% and 15%, respectively in patients with PPS. Those with the largest initial MU sizes exhibited the greatest losses of mean MU size (27%) and proportional decreases in quadriceps strength (23%). Initial strength, change in LOI and change in RMS amplitude together explained 35% of the variability in strength changes in patients. MU size of controls did not change, although they lost 29% strength.
SIGNIFICANCE: This long term follow-up study provides evidence that size diminution of enlarged MUs combined with a reduced number of active MUs contributes to the gradual strength decline in PPS.
Conclusions: MU size and strength declined concomitantly in a homogeneous cohort of patients with PPS and quadriceps dysfunction.
Outcome of Research: Effective
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Category: Post-Polio Motor Unit
Title: CMAP scan and scanning EMG in the same muscle: Two cases with post-polio muscular atrophy
Author: Mehmet Baris Baslo, Nermin G.Sirin, EmelOguz-Akarsu, ElifKocasoy-Orhan, BaharErbas, ImranGoker, TugrulArtugAli EmreOge
Affiliation:
Journal: Clinical Neurophysiology
Citation: Volume 129, Supplement 1, May 2018, Page e32
Publication Year and Month: 2018 05
Abstract: Post-polio muscular atrophy (PPMA) is characterized by new onset or increased weakness in patients with prior poliomyelitis after a stable period of time. Loss of highly reinnervated motor units during ageing has been accused for the development of this syndrome which is also known as “unstable-polio”. These patients have less number of motor units that can be estimated by conventional electrophysiological methods. By showing the large steps, CMAP scan provides information about the amount of collateral reinnervation in the construction of total muscle response (CMAP). As well as the number of motor units, their territory is also an object of curiosity. It is possible to record bioelectrical activity of motor unit lengthwise by scanning EMG and depict the temporal and spatial features of motor unit action potential (MUAP). This presentation aims to combine the findings in CMAP scan with scanning EMG and draw attention to reinnervation status of 2 PPMA patients whose tibialis anterior (TA) muscles were affected in different degrees.
Methods
Two patients aged 39and 41 years were included. Patient 1 had PPMA for 8 years and his TA muscle strength was 3-/5, whereas Patient 2 showed PPMA findings for 1 year and his TA strength was 4/5. CMAP scan of TA muscle on recently affected side was performed with a commercially available software. In scanning EMG, MU territories were scanned with a concentric needle electrode (CNE) which is attached to a stepper motor. Another CNE is used for sweep triggering with the rate of selected motor units’ firing frequency. Acquired signals were processed by the dedicated software designed by the authors.
Results
CMAP scan of Patient 1 revealed a 1.65 mV CMAP constituting of 4 very large steps and Patient 2 revealed a 5.5 mV CMAP containing a few smaller steps. In scanning EMG, both patients’ motor units showed increased voltage in different parts corresponding to dense areas arisen from collateral reinnervation. Interestingly, the patient with more pronounced weakness for a longer period revealed both huge steps in his CMAP scan and also showed electrically silent areas in his scanned motor units. On the other hand, the patient with stronger TA muscle did not show very large steps or silent areas in his CMAP scan and MU scan, respectively.
Conclusions: Loss of dense motor units leads to PPMA. However, in PPMA patients with severe weakness which is depicted by less number of motor units and presence of huge steps in CMAP scan, loss of fractions in motor unit territory might be a principal contributing factor which can only be demonstrated by scanning EMG.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: The split hand syndrome in ALS and post-polio-syndrome
Author: M.Hoheisel, L.Burmeister, M.Tesch
Affiliation: Schlosspark-Klinik Berlin, Neurology, Berlin, Germany
Journal: Clinical Neurophysiology
Citation: Volume 129, Issue 8, August 2018, Pages e82-e83
Publication Year and Month: 2018 08
Abstract: Introduction
Electrodiagnostic evaluation for amyotrophic lateral sclerosis (ALS) relies on extensive measurements. As one diagnostic clue, the split-hand-index (SHI) was proposed. It compares the compound muscle action potential (CMAP) of the abductor pollicis brevis (APB) muscle with the CMAP of the abductor digiti minimi (ADM) muscle.
In ALS, asymmetric atrophy of APB and ADM results in the index being reduced compared to the healthy population. This holds true despite the fact, that there is the same segmental innervation C8 for both examined muscles, as was previously discussed. Several studies have shown a diagnostic value in differentiating ALS from other motorneuron-diseases by means of the SHI, claiming a specific form of neurodegeneration in ALS, which is less marked for example in lower motor neuron disease (LMND), spinal muscle atrophy (SMA) or Hirayama disease.
In our study, we aimed to compare the SHI of ALS-patients with our cohort of patients with post-polio-syndrome (PPS) to find out, whether it has a discriminative value in these patients too and to add knowledge to the proposed neuroscientific explanations of asymmetric thenar/hypothenar-atrophy.
Methods
We conducted a retrospective analysis of our post-polio cohort since 1997. All patients were screened whether CMAPs of APB and ADM were collected. For comparison, we screened electrodiagnostic reports of all patients with a diagnosis of ALS for collected CMAPs of APB and ADM. We excluded patients with neuropathy of the median nerve (NMN) by means of a prolonged distal motoric latency (>4,4 ms). Finally we randomly chose the same number of patients from our reports in that time period with normal results (NR), by excluding diagnosis of NMN, acute polyneuropathies and radiculo- and plexopathies of the arm. We calculated the SHI by dividing the CMAP of APB by the CMAP of ADM.
Results
We found a significant difference (p = 0,01) of the SHI between ALS patients (0,97 ± 0,84) and the NR-group (1,26 ± 0,72). The SHI of the PPS-group (0,91 ± 0,55) was not significantly different compared to the NR group (p = 0,08), but showed a trend. Comparing the ALS-group with the PPS-patients, we found no statistically relevant difference (p = 0,83).
Conclusions: As expected, we could reproduce a significant decrease of the SHI in ALS patients. However our results showed no statistically relevant difference between ALS-patients and PPS-patients when comparing the SHI. There is a broader distribution of values in the PPS-group, including cases of very high grade asymmetric atrophy of APB and ADM. A low SHI therefore is of no help in differentiating PPS from ALS-patients.
As a limitation of our study it is important to acknowledge the retrospective study type and a possible selection bias of patients who suffer from an already clinically visible asymmetry, possible increasing electrodiagnostic evaluation numbers of the hand.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: The treatment of fatigue by non-invasive brain stimulation.
Author: Lefaucheur JP, Chalah MA, Mhalla A, Palm U, Ayache SS, Mylius V.
Affiliation: Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Service de physiologie-Explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France. Electronic address: [email protected].
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Service de physiologie-Explorations fonctionnelles, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Munich, Germany.
Faculté de médecine de Créteil, université Paris Est Créteil, Créteil, France; Department of Neurology, Philipps University, Marburg, Germany; Department of Neurology, Center for Neurorehabilitation, Valens, Switzerland.
Journal: Clinical Neurophysiology
Citation: 2017 Apr;47(2):173-184.
Publication Year and Month: 2017 04
Abstract: The use of non-invasive brain neurostimulation (NIBS) techniques to treat neurological or psychiatric diseases is currently under development. Fatigue is a commonly observed symptom in the field of potentially treatable pathologies by NIBS, yet very little data has been published regarding its treatment. We conducted a review of the literature until the end of February 2017 to analyze all the studies that reported a clinical assessment of the effects of NIBS techniques on fatigue. We have limited our analysis to repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS). We found only 15 studies on this subject, including 8 tDCS studies and 7 rTMS studies. Of the tDCS studies, 6 concerned patients with multiple sclerosis while 6 rTMS studies concerned fibromyalgia or chronic fatigue syndrome. The remaining 3 studies included patients with post-polio syndrome, Parkinson's disease and amyotrophic lateral sclerosis. Three cortical regions were targeted: the primary sensorimotor cortex, the dorsolateral prefrontal cortex and the posterior parietal cortex. In all cases, tDCS protocols were performed according to a bipolar montage with the anode over the cortical target. On the other hand, rTMS protocols consisted of either high-frequency phasic stimulation or low-frequency tonic stimulation. The results available to date are still too few, partial and heterogeneous as to the methods applied, the clinical profile of the patients and the variables studied (different fatigue scores) in order to draw any conclusion. However, the effects obtained, especially in multiple sclerosis and fibromyalgia, are really carriers of therapeutic hope.
Conclusions:
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: P66-S Corticospinal function in poliomyelitis survivors
Author: Nermin Gorkem Sirin, Bahar Erbas, Gulsah Gula, Emel Oguz-Akarsu, Hava Ozlem Dede, Elif Kocasoy-Orhan, Mehmet Baris Baslo, Aysegul Ketenci, Halil Atilla Idrisoglu, Ali Emre Oge
Affiliation: Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey
Istanbul University, Istanbul Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
Journal: Clinical Neurophysiology
Citation: Volume 130, Issue 7, July 2019, Pages e111-e112
Publication Year and Month: 2019 07
Abstract: Poliomyelitis survivors (PS) become candidates to post-polio syndrome (PPS) in their later lives. The mechanism of PPS has been suggested to be multifactorial involving cortical, spinal and peripheral mechanisThe aim of this study was to evaluate TMS parameters in PS and to compare them with those of amyotrophic lateral sclerosis (ALS) patients and controls.
Material and methods
Single and paired TMS, contralateral and ipsilateral silent period (SP) and triple stimulation technique (TST) were performed by recording from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 18 PS, 31 ALS patients and 21 controls. The results were compared with mixed ANOVA and nonparametric independent tests.
Results
No significant difference was present for within and between subject factors except those for the different interstimuli intervals. Resting motor threshold and MEP/M% in ADM, MEP amplitudes and latencies and TST% in both ADM and APB were significantly different. In posthoc analyses, MEP latencies were higher and TST% were lower in both ADM and APB in ALS group (20.7 ± 4.2 ms, 22.4 ± 5.0 ms, 83.1 ± 42.2, 72.3 ± 29.9) as compared to PS (18.3 ± 1.0 ms, 19.2 ± 2.0 ms, 101.6 ± 15.9, 98.1 ± 14.9), MEP/M% in ADM were lower in PS group (56.0 ± 13.4) as compared to controls (85.2 ± 23.9). SPs, TST, MEP amplitudes and latencies and MEP/M amplitudes did not show any significant difference between ADM and APB in both patient groups.
Conclusions: Our results revealed upper motor neuron dysfunction in ALS compared to PS and may provide limited evidence about presence of an abnormal cortical drive to mostly uninvolved upper extremity muscles in PS.
Outcome of Research: More research required
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Category: Post-Polio Motor Unit
Title: P63-S Insidious neuromuscular deterioration in polio survivors demonstrated by CMAP scan analysis.
Author: Sirin NG, Erbas B, Akasu EO, et al.
Affiliation: Istanbul University Istanbul Medical Faculty, Neurology Department, Istanbul, Turkey
Istanbul University Istanbul Medical Faculty, Physical Therapy and Rehabilitation Department, Istanbul, Turkey
Journal: Clinical Neurophysiology
Citation: Volume 130, Issue 7, July 2019, Pages e110-e111
Publication Year and Month: 2019 07
Abstract: This study aimed to explore the subtle motor unit(MU) changes in asymptomatic muscles of poliomyelitis survivors (PS) using CMAP Scan analysis.
Material and method
Nineteen PS cases and 21 controls were recruited. CMAP Scan recordings were obtained from asymptomatic thenar and hypothenar muscles. CMAP Scan parameters indicating nerve excitability [stimulus intensities producing 50%, 95% and 5% of the CMAP amplitude (SI%5, SI%50, SI%95), absolute range width (ARW) (SI%95-SI%5), relative width (RW) (SI95 − SI5)/SI5], all step parameters and D50 which reflect the MU motor unit loss and reinnervation were analyzed. The new motor unit number estimation (MUNE) method, MscanFit was also calculated.
Results
There were no significant differences in ages, maximum CMAP amplitudes and MScanFit MUNE between the groups. PS group median and ulnar D50 values (46.76 ± 10.98, 46.19 ± 12.42 respectively) were lower than control group (37.21 ± 17.37, 36.44 ± 11.99) (p < 0.05). Median nerve,excitability parameters of patients (SI 5%; 14.81 ± 6.97, SI 50%; 19.07 ± 9.2, SI 95%; 24.06 ± 11.52), ARW (9.26 ± 5.79), RW (0.65 ± 0.31) were higher than those of the controls (SI 5%; 9.64 ± 2.57, SI 50%; 11.64 ± 3.27, SI 95%; 13.64 ± 3.66, ARW; 4.00 ± 1.56, RW; 0.42 ± 0.13) (p < 0.05). Median and ulnar nerve step size parameters, step number and step% in the patients were also significantly higher (p < 0.05).
Conclusions: CMAP Scan can show reduced axonal excitability and reveal insidious MU loss and reinnervation in presumably unaffected muscles of PS, regardless of the decrease in CMAP amplitudes or a significant reduction in MUNE values.
Outcome of Research: More research required
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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
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Category: Diagnosis and Management
Title: Treatment for postpolio syndrome
Author: Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F
Affiliation: Department of Rehabilitation, University of Amsterdam Academic Medical Center, PO Box 22660, Amsterdam, North Holland, Netherlands, 1100 DD
Journal: Cochrane Database of Systematic Reviews
Citation: Cochrane Database Syst Rev. 2015 May 18;5:CD007818
Publication Year and Month: 2015 05
Abstract: BACKGROUND: Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. This is an update of a review first published in 2011.
OBJECTIVES: To systematically review the evidence from randomised and quasi-randomised controlled trials for the effect of any pharmacological or non-pharmacological treatment for PPS compared to placebo, usual care or no treatment.
SEARCH METHODS: We searched the following databases on 21 July 2014: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL Plus. We also checked reference lists of all relevant articles, searched the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) Database and trial registers and contacted investigators known to be involved in research in this area.
SELECTION CRITERIA: Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.
DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS: We included 10 pharmacological (modafinil, intravenous immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (that is temperature ± 25°C, dry and sunny) and a cold climate (that is temperature ± 0°C, rainy or snowy), static magnetic fields) studies with a total of 675 participants with PPS in this review. None of the included studies were completely free from any risk of bias, the most prevalent risk of bias being lack of blinding.There was moderate- and low-quality evidence that IVIg has no beneficial effect on activity limitations in the short term and long term, respectively, and inconsistency in the evidence for effectiveness on muscle strength. IVIg caused minor adverse events in a substantial proportion of the participants. Results of one trial provided very low-quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations without generating adverse events. Data from two single trials suggested that muscle strengthening of thumb muscles (very low-quality evidence) and static magnetic fields (moderate-quality evidence) are safe and beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there was evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.
Conclusions: Due to insufficient good-quality data and lack of randomised studies, it was impossible to draw definite conclusions about the effectiveness of interventions for PPS. Results indicated that IVIg, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation to clarify whether any real and meaningful effect exists.
Outcome of Research: More research required.
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Category: 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
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Category: Respiratory Complications and Management
Title: 1246: Missed chronic respiratory failure in a post-polio syndrome patient
Author: Aljasmi M, Agarwal K, Uppalapati S, Bazan L
Affiliation: Not stated
Journal: Critical Care Medicine
Citation: Crit Care Med. 2015 Dec;43(12 Suppl 1):313
Publication Year and Month: 2015 12
Abstract: This is a brief Case Report which does not have an abstract. This is an extract:
INTRODUCTION: Prior to the introduction of the polio vaccine, paralytic poliomyelitis was a major cause of morbidity and death. Twenty-five to fifty percent of the survivors are known to develop post-polio syndrome. Symptoms include fatigue, insidious respiratory failure, obstructive sleep apnea, bulbar neuropathy, central ventilatory abnormalities, hemi-diaphragmatic paralysis and progressive functional decline with new onset weakness, among others. We present a case of post-polio syndrome presenting with hypercapnic respiratory failure.
Conclusions:
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Neurological manifestations of the post-polio syndrome
Author: Jubelt B, Cashman NR
Affiliation: Les Turner Amyotrophic Lateral Sclerosis Research Laboratory, Northwestern University Medical School, Chicago, Illinois
Journal: Critical Reviews in Neurobiology
Citation: Crit Rev Neurobiol. 1987;3(3):199-220
Publication Year and Month: 1987 03
Abstract: Patients with late effects of poliomyelitis, ie PPS, are being seen at an ever increasing frequency by general physicians, neurologists, and orthopedists. An appropriate time interval for the onset of late manifestations has elapsed since the major epidemics of poliomyelitis in the 1940s and 1950s. Post-polio neurological manifestations primarily include new weakness, atrophy, muscle pain, and fasciculations. Fortunately, the weakness is of a very slow, progressive nature. Abnormal laboratory studies include routine EMG, demonstrating chronic denervation; SFEMG, demonstrating increased fiber density, increased jitter, and blocking; and muscle biopsy most often revealing fiber-type grouping of chronic denervation and small isolated angular (or angulated) fibers and group atrophy in some series, both suggestive of active denervation. Unfortunately, both EMG and muscle biopsy studies suffer from a lack of specificity as they do not appear to distinguish asymptomatic from symptomatic (new weakness, PPMA) patients with prior poliomyelitis. Although the cause of PPMA is unknown, electrophysiological (SFEMG) and muscle biopsy studies suggest that the process involves a loss or dropout of axon terminals of reinnervated motor units. The axons terminal dropout could be due to dysfunction in the cell soma, the axon, or the terminals themselves. Whether motor neuron exhaustion, a persistent viral infection, or immune-mediated mechanisms play a role in the pathogenesis of the late weakness is unclear at present and will require further investigation. Treatment at this time is of a supportive nature. A major controversy involves the role of strengthening exercises in these patients since experimental animal studies suggest that excessive exercise of denervated muscles leads to increased weakness. Clearly, a better understanding of PPS and PPMA will allow more effective management of these patients’ problems and might also provide insight into other motor neuron and neuromuscular junction diseases.
Conclusions:
Outcome of Research:
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Category: Respiratory Complications and Management
Title: Central Sleep Apnea: a Brief Review
Author: M. Safwan Badr and Shahrokh Javaheri
Affiliation: 1.Department of Internal Medicine, Division of Pulmonary, Critical; Care and Sleep MedicineWayne State University School of MedicineDetroitUSA
2.John D. Dingell VA Medical CenterWayne State University School of MedicineDetroitUSA
3.Sleep LaboratoryBethesda North HospitalCincinnatiUSA
4.Division of Pulmonary Sleep and Critical Medicine, College of MedicineUniversity of CincinnatiCincinnatiUSA
5.Division of CardiologyThe Ohio State UniversityColumbusUSA
Journal: Current Pulmonology Reports
Citation: pp 1–8
Publication Year and Month: 2019 03
Abstract: Purpose of Review
The purpose of this review is to discuss the pathogenesis, clinical manifestations, diagnosis, and treatment, including areas of controversy and uncertainty.
Recent Findings
Central apnea may be due to hypoventilation or to hypocapnia following hyperventilation. The occurrence of central apnea initiates a cascade of events that perpetuates breathing instability, recurrent central apnea, and upper airway narrowing. In fact, breathing instability and upper airway narrowing are key elements of central and obstructive apnea. Clinically, central apnea is noted in association with obstructive sleep apnea, heart failure, atrial fibrillation, cerebrovascular accident tetraplegia, and chronic opioid use. Management strategies for central apnea aim to eliminate abnormal respiratory events, stabilize sleep, and alleviate the underlying clinical condition. Positive pressure therapy (PAP) remains a standard therapy for central as well as obstructive apnea. Other treatment options include adaptive servo-ventilation (ASV), supplemental oxygen, phrenic nerve stimulation, and pharmacologic therapy. However, ASV is contraindicated in patients with central sleep apnea who had heart failure with reduced ejection fraction, owing to increased mortality in this population.
Conclusions: There are several therapeutic options for central apnea. Randomized controlled studies are needed to ascertain the long-term effectiveness of individual, or combination, treatment modalities in different types of central apnea.
Outcome of Research: More research required
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Category: Activity Levels
Title: A Brief Questionnaire to Assess Post-Exertional Malaise
Author: Joseph Cotler, Carly Holtzman, Catherine Dudun and Leonard A. Jason
Affiliation:
Journal: Diagnostics
Citation: 11 September 2018
Publication Year and Month: 2018 09
Abstract: Post-exertional malaise (PEM) is a key symptom of myalgic encephalomyelitis (ME) and chronic fatigue syndrome (CFS). Currently, five PEM-items from the DePaul Symptom Questionnaire (DSQ) were recommended as a first step in measuring this symptom for patients with ME and CFS by the National Institutes of Health/Centers for Disease Control and Prevention (NIH/CDC) Common Data Elements’ (CDE) working group. The second step in this process, as recommended by the NIH/CDC CDE working group, involves assembling information from various sources to confirm the presence of PEM. There have not been any efforts, to date, to standardize this second-step process in the assessment of PEM. The current study examined whether five supplementary items on the DSQ could be used to operationalize the second step of the recommendations made by the NIH/CDC CDE working group. The five supplementary DSQ PEM duration items correctly categorized patients with ME or CFS 81.7% of the time, while incorrectly categorizing multiple sclerosis (MS) and post-polio syndrome (PPS) as ME or CFS only 16.6% of the time. The findings suggested that a PEM second-step process could be operationalized using supplementary DSQ items.
Conclusions:
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Identification of targets for improving access to care in persons with long term physical disabilities
Author: Jennifer L.Wong, Kevin N.Alschuler, Tracy M.Mroz, Kimberly P.Hreha, Ivan R.Molton
Affiliation: University of Washington, Rehabilitation Medicine, United States
Journal: Disability and Health Journal
Citation: Available online 20 January 2019
Publication Year and Month: 2019 01
Abstract: Background
People with long-term physical disability (LTPD) continue to experience difficulties in accessing health care despite the focus of highlighting disparities in the last two decades.
Objectives
To describe health care utilization, accommodations and barriers experienced while accessing health care, and reasons why individuals delay or skip health care among people with LTPD.
Methods
The current study was a part of a larger longitudinal survey administered to individuals with physical disability associated with one of four long-term conditions (MS; SCI; PPS; MD). Measures included demographics, health care utilization, barriers to health care, and reasons for delaying or skipping medical care from the sixth wave of data from 2015 to 2016.
Results
Roughly 90% of all participants (N = 1159) saw at least one medical provider within 12 months. The most encountered barrier participants reported experiencing within that time was an office that did not have a safe transfer device to move them to an exam table (69%). Participants’ physical function, quality of life, status of living with a spouse, diagnostic condition, and sex (male) were significantly associated with endorsing a barrier in accessing health care. The inability to afford out of pocket expenses was the highest reported reason for delaying health care.
Conclusions: People with LTPD access a variety of health care, including rehabilitation services, and continue to experience barriers when doing so. While understanding barriers individuals experience when accessing health care is important, it is equally important to document the type of care they delay or skip due to barriers.
Outcome of Research: More research required
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Category: 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
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Category: Quality of Life
Title: Post-polio syndrome: impact of hope on quality of life
Author: Shiri S, Wexler ID, Feintuch U, Meiner Z, Schwartz I
Affiliation: Department of Physical and Medical Rehabilitation, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil. 2012;34(10):824-30. doi: 10.3109/09638288.2011.623755. Epub 2011 Dec 10
Publication Year and Month: 2011 12
Abstract: PURPOSE: To determine the effect of future-oriented coping strategies on the quality of life (QOL) of individuals with post-polio syndrome (PPS).
METHODS: A correlative study, in which a cohort of 61 patients was surveyed and a group of 40 healthy, age-matched individuals served as controls. Patients were surveyed as to their QOL, levels of hope and utilization of proactive coping, employment status and degree of functionality.
RESULTS: PPS patients had lower total, physical and mental QOL indices compared to controls. Future-oriented coping strategies associated with hope were positively associated with physical and mental QOL in the PPS group, but not in the controls. In a multivariate analysis, hope and employment status predicted higher QOL among those with PPS.
Conclusions: Future-oriented coping strategies, particularly hope, are distinctively associated with improved QOL benefits in PPS patients. Fostering future-oriented coping related to hope may improve the self-perceived mental and physical status of patients with PPS.
Outcome of Research: Not applicable
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Category: Vocational Implications
Title: Overcoming barriers to work participation for patients with postpoliomyelitis syndrome
Author: Ten Katen K, Beelen A, Nollet F, Frings-Dresen MH, Sluiter JK
Affiliation: Department of Rehabilitation, Academic Medical Center, Amsterdam, The Netherlands
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil. 2011;33(6):522-9. doi: 10.3109/09638288.2010.503257. Epub 2010 Jul 12
Publication Year and Month: 2010 07
Abstract: PURPOSE: This study aimed to explore the perceived work ability of patients with postpoliomyelitis syndrome (PPS), to identify barriers and factors that are impeding or conducive, respectively, to work participation, and to identify possible interventions.
METHODS: Qualitative cross-sectional interview study with 17 subjects with PPS, 12 women and 5 men, mean age 49 years (SD: 11). Semi-structured interviews were held with the subjects in their homes, with the aid of a topic list. The COREQ criteria list for qualitative research was used as guideline in design and analysis.
RESULTS: Thirteen out of 17 subjects rated their work ability six or higher on a scale from 0 to 10. Most subjects worked in an administrative, educational or managerial function. Five subjects stopped working, four worked between 0 and 20 h/week and eight worked between 20 and 40 h/week. Factors conducive to working were physical adaptations in the workplace, accessibility of the workplace and high decision latitude. Barriers to full work ability in PPS patients were high physical job demands, low social support and the symptoms of PPS, especially fatigue and pain.
Conclusions: These findings suggest that work-oriented interventions aimed at preventing PPS patients from dropping out of the workforce should primarily focus on reducing physical job demands, arranging adaptations in the workplace and increasing job control.
Outcome of Research: Not applicable
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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
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Category: Psychology
Title: Long-standing poliomyelitis and psychological health
Author: Shiri S (1), Gartsman I, Meiner Z, Schwartz I
Affiliation: Department of Physical Medicine and Rehabilitation, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil. 2015 Jul 26:1-5
Publication Year and Month: 2015 07
Abstract: OBJECTIVE: To compare the psychological health of the individuals with long-standing poliomyelitis, with or without post-polio syndrome (PPS), to the general population and to identify the role of work as well as other variables with regard to their psychological health.
DESIGN: A cross-sectional study.
SUBJECTS: One hundred and ninety-five polio patients attending postpolio clinic in Jerusalem.
METHODS: Emotional distress (ED) was measured using the general health questionnaire (GHQ-12). Demographic, medical, social and functional data were recorded using a specific structured questionnaire. Each polio patient was compared to four age- and sex-matched controls.
RESULTS: ED was higher in the polio population as compared to the general population. Within the polio population ED was inversely correlated with work status. No correlation was found between ED and the functional level of polio participants and no difference was found in GHQ score between polio participants with or without post-polio. In addition, ED was less affected by subjective perception of physical health among polio patients as compared to the general population.
Conclusions: Long-standing poliomyelitis is associated with decreased psychological health as compared to the general population. Yet, the resilience of polio survivors is manifested by their ability to block further decline of their psychological health in spite of deterioration in their physical health. Work appears as a significant source of resilience in the polio population.
IMPLICATIONS FOR REHABILITATION: Individuals with long-standing poliomyelitis often suffer from high emotional distress and may benefit from psychotherapy aimed at reducing distress. As active employment status is associated with increased mental health among polio survivors, encouraging participation at work needs to be a significant component of psychotherapeutic programs. Polio survivors, although physically disabled, may be relatively resilient, as their mental health is less affected by their negative health perception. This and other expressions of resilience may serve as a platform for increasing personal growth among them by implementing hope-oriented psychotherapy.
Outcome of Research: Not applicable
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Category: Quality of Life
Title: The influence of post-polio syndrome on independence and life satisfaction
Author: Burger H (1), Marincek C
Affiliation: (1) Institute for Rehabilitation, Ljubljana, Slovenia
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil. 2000 May 10;22(7):318-22
Publication Year and Month: 2000 10
Abstract: PURPOSE: The aim of the study was to find out the influence of the new symptoms on life satisfaction and independent living and the most frequent disabilities in patients with post-polio syndrome that are affecting the satisfaction and independence.
METHOD: A questionnaire was sent to all the post-polio survivors (207) who visited the Rehabilitation Institute in Ljubljana at least once in the last ten years. We got 100 answers, which were analysed by SPSS (statistical package for social sciences).
RESULTS: Sixty nine reported that they had new symptoms that may be classified as post-polio syndrome.
Conclusions: We have found that the new symptoms in post-polio survivors, which may be classified as post-polio syndrome, increased their walking and climbing stairs disability, increased their disability to perform daily activities and also decreased their satisfaction with life.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Polio survivors perceptions of a multi-disciplinary rehabilitation programme
Author: Atwal, A., Duncan, H., Queally, C., Cedar, S.H.
Affiliation: Nil
Journal: Disability and Rehabilitation
Citation: Atwal, A., Duncan, H., Queally, C., Cedar, S.H. (2017) Polio survivors perceptions of a multi-disciplinary rehabilitation programme. Disability and Rehabilitation. DOI: 10.1080/09638288.2017.1381184
Publication Year and Month: 2017 10
Abstract: Purpose: Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor’s perceptions of an in-patient multi-disciplinary rehabilitation programme.
Methods: Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data.
Results: Participants’ experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme.
Conclusions: The research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production.
Implications for Rehabilitation
The patients’ expertise and lived experience must be at the centre of a rehabilitation programme.
Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions.
Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided.
When measuring outcomes patient preferences and views must be evaluated.
Outcome of Research: More research required
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Category: Pain
Title: Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing.
Author: Furrer, A., Michel, G., Terrill, A.L., Jensen, M.P., Müller, R.
Affiliation: Nil
Journal: Disability and Rehabilitation
Citation: Furrer, A., Michel, G., Terrill, A.L., Jensen, M.P., Müller, R. (2017) Modeling subjective well-being in individuals with chronic pain and a physical disability: the role of pain control and pain catastrophizing. Disability and Rehabilitation 23:1-10 doi: 10.1080/09638288.2017.1390614. [Epub ahead of print]
Publication Year and Month: 2017 10
Abstract: PURPOSE:
To investigate the associations between subjective well-being and pain intensity, pain interference, and depression in individuals with physical disabilities. We hypothesized that (1) pain control and (2) pain catastrophizing mediate the effects of subjective well-being on pain intensity, pain interference, and depression.
METHODS:
Analyses of cross-sectional data from 96 individuals diagnosed with spinal cord injury, multiple sclerosis, neuromuscular disease, or post-polio syndrome, with average pain intensity of ≥4 (0-10) on at least half the days in the past month. Two models tested study hypotheses using structural equation.
RESULTS:
Both models showed acceptable model fit. Pain catastrophizing significantly mediated the effect of subjective well-being on pain intensity and pain interference, but not on depression. Pain control did not significantly mediate the effect of subjective well-being on pain intensity, pain interference, or depression. Path coefficients showed significant direct effects of subjective well-being on pain control (β = 0.39), pain catastrophizing (β = -0.61), pain interference (β = -0.48; -0.42), and depression (β = -0.75; -0.78).
CONCLUSIONS:
This study supports the potential of enhancing subjective well-being and lowering pain catastrophizing for reducing pain intensity, pain interference, and depressive symptoms in individuals with chronic pain and a physical disability. The findings indicate that true experiments to test for causal associations are warranted. Implications for rehabilitation The majority of individuals with physical disabilities report having persistent moderate-to-severe pain that may negatively limit daily activities and quality of life. The present cross-sectional study indicates that individuals who reported greater subjective well-being showed significantly lower pain intensity via the mediating effect of lower pain catastrophizing. Since sample size and respective power are low, these findings should be taken as first indications of potential underlying mechanisms between subjective well-being and pain outcomes that need further confirmation in longitudinal research. However, the findings suggest that treatments which enhance subjective well-being (increasing positive affect and life satisfaction, and decreasing negative affect, e.g., via positive psychology exercises) and reducing pain catastrophizing (via e.g., cognitive-behavioral therapy) may have the highest potential for benefiting individuals with disability-associated chronic pain.
Conclusions: Treatments which enhance subjective well-being (increasing positive affect and life satisfaction, and decreasing negative affect, e.g., via positive psychology exercises) and reducing pain catastrophizing (via e.g., cognitive-behavioral therapy) may have the highest potential for benefiting individuals with disability-associated chronic pain.
Outcome of Research: More research required
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Category: Quality of Life
Title: Quality of life for post-polio syndrome: a patient derived, Rasch standard scale.
Author: Young CA, Quincey AC, Wong SM, Tennant A
Affiliation: Department of Neurology , Walton Centre NHS Trust , Lower Lane , Liverpool , UK.
ICF Unit , Swiss Paraplegic Research , Nottwil , Switzerland
Journal: Disability and Rehabilitation
Citation: 2018 Mar;40(5):597-602
Publication Year and Month: 2018 03
Abstract: OBJECTIVE:
To design a disease-specific quality of life (QoL) questionnaire for people with post-polio syndrome (PPS).
METHODS:
Qualitative interviews were conducted with 45 people with PPS to identify themes and derive potential items reflecting impact upon QoL. After cognitive debriefing, these were made into a questionnaire pack along with comparative questionnaires and posted to 319 patients. The 271 (85%) returned questionnaires were subjected to exploratory factor analysis (EFA) and Rasch analysis.
RESULTS:
A 25 item scale, the post-polio quality of life scale (PP-QoL), showed good fit to the Rasch model (conditional chi-square p = 0.156), unidimensionality (% t-tests 2.0: CI 0.7-3.8), and Cronbach's alpha of 0.87. With the latent estimate transformed to a 0-100 scale, the mean score was 56.9 (SD 18.5) with only 3.3% of respondents at the floor or ceiling of the scale. Test-retest reliability showed an intraclass correlation coefficient (ICC) (2.1) of 0.916, and correlation of 0.85.
Conclusions: CONCLUSION:
The disease-specific PP-QoL demonstrated excellent reliability, appropriate concurrent validity, and satisfied the standards of the Rasch model. It enables examination of the impact of health status upon perceived QoL, and the impact of rehabilitation interventions. The scale is freely available for academic or not-for-profit users to improve research in this neglected, disabling condition. Implications for Rehabilitation In post-polio syndrome (PPS), existing work examines aspects of health-related quality of life (HRQoL), such as activity limitations. A disease-specific QoL measure would enable researchers to model the impact of health status, such as fatigue or mobility restrictions, upon QoL in PPS. The post-polio quality of life scale (PP-QoL) is based on the patients' lived experience, meets Rasch standards and is free for use for academic and not-for-profit researchers. The raw score is reliable for individual use in clinical settings, and interval scale transformation is available for parametric applications and the calculation of change scores.
Outcome of Research: More research required
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Category: Quality of Life
Title: Disability and quality of life in individuals with postpolio syndrome.
Author: Ahlström G, Karlsson U.
Affiliation: Research and Development Unit, Psychiatry and Habilitation, Orebro Medical Centre Hospital, Sweden. [email protected]
Journal: Disability and Rehabilitation
Citation: 2000 Jun 15;22(9):416-22.
Publication Year and Month: 2000 06
Abstract: PURPOSE:
The purpose of the study is to investigate disability and quality of life in individuals with the characteristic symptoms of postpolio syndrome.
METHOD:
Disability is assessed by means of the self-report activities of daily living instrument, and quality of life by means of Kaasa's questionnaire and the quality of life profile.
RESULTS:
The 39 subjects have on average lived with polio sequelae for 52 years. Their main difficulties are with moving, lifting and carrying. This means restricted mobility, sedentary activities and a need to prioritize. Half of them feel that polio has lessened their possibilities in life, and a quarter have still not accepted the limitations polio has involved. Nevertheless the majority report a high level of psychosocial well-being, and almost a quarter say that living with polio has meant personal development and strength. We found a significant correlation between on the one hand disability with regard to ambulation, arm strength and finger strength on the self-report ADL, and on the other hand the number of negative problems on the quality of life profile (0.33-0.45).
Conclusions: The latter instrument needs further testing before its validity can be determined with certainty.
Outcome of Research: More research required
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Category: Quality of Life
Title: Life satisfaction in persons with late effects of polio. Applied Research in Quality of Life
Author: Lund ML, Lexell J.
Affiliation: Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden. [email protected]
Journal: Disability and Rehabilitation
Citation: 2009;31(19):1592-7.
Publication Year and Month: 2009 09
Abstract: PURPOSE:
To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio.
METHODS:
One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11).
RESULTS:
The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11.
Conclusions: Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.
Outcome of Research: More research required
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Category: Quality of Life
Title: Depression and life satisfaction among people ageing with post-polio and spinal cord injury.
Author: Kemp BJ, Krause JS.
Affiliation: Rehabilitaion Research and Training Center On Aging With Spinal Cord Injury, Rancho Los Amigos Medical Center, Downey, CA 90242, USA.
Journal: Disability and Rehabilitation
Citation: 1999 May-Jun;21(5-6):241-9.
Publication Year and Month: 1999 05
Abstract: PURPOSE AND BACKGROUND:
Attention has recently begun to focus on the ageing of individuals with disability, not only as a long-term follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a psychological perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression.
METHODS:
This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 non-disabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomatology and a 10-item life satisfaction scale with four-point ratings on each item used.
RESULTS:
Life satisfaction varied by the group, with the non-disabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomatology.
Conclusions: The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.
Outcome of Research: More research required
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Category: Psychology
Title: Growing up with a disability following paralytic poliomyelitis: experiences from persons with late effects of polio
Author: Catharina Sjödahl Hammarlund, Jan Lexell & Christina Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden
Journal: Disability and Rehabilitation
Citation: DOI: 10.1080/09638288.2019.1647296
Publication Year and Month: 2019 08
Abstract: Purpose: To describe the experiences of growing up after acute paralytic poliomyelitis and strategies used to adapt to the new situation.
Methods: Seven women and seven men (mean age 70 years, min–max 61–78 years) with late effects of polio, who had contracted paralytic polio in their childhood. Data were collected using semi-structured interviews, transcribed verbatim, and analyzed by systematic text condensation.
Results: Memories of contracting acute paralytic poliomyelitis involved being immobilized and sent away from home for surgical and physiotherapeutic treatment. Growing up in a social context that was often tough and unfriendly resulted in the development of strategies, such as optimistic thinking, trying to blend in, trusting one’s ability to manage, and to handle the preconceptions and expectations of others. At the onset of late effects of polio, some of these strategies were still functioning, whereas overachieving, disregarding pain, and weariness were not.
Conclusion: The challenges of growing up with a disability following paralytic polio led to the development of various psychological strategies for managing daily life. By understanding these experiences and strategies, knowledge may be gained in assisting rehabilitation professionals to better support persons with late effects of polio in adapting to the new situation.
Conclusions: Growing up with a disability after paralytic poliomyelitis presented both physical and psychological challenges, necessitating new strategies for managing daily situations, such as optimistic thinking, trying to blend in and trust in one’s ability to manage. At the onset of late effects of polio, some of these strategies were still functioning. Strategies that were obsolete were those that made the participants work too hard, for example overachieving, disregarding pain, and weariness. By understanding the experiences and evolved strategies from the past, rehabilitation professionals may better support persons with late effects of polio in their process of adaptation to the new situation.
Outcome of Research: Not applicable
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Category: Late Effects of Polio, Quality of Life
Title: Relationship between participation in life situations and life satisfaction in persons with late effects of polio
Author: Maria Larsson Lund & Jan Lexell
Affiliation: Maria Larsson Lund - Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University, Umeå, Sweden Correspondence: [email protected]
Jan Lexell - Department of Rehabilitation Medicine, Lund University Hospital, Lund, Sweden; Division of Rehabilitation Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
Journal: Disability and Rehabilitation
Citation: 31(19), 1592–1597. https://doi.org/10.1080/09638280802638881
Publication Year and Month: 2009 09
Abstract:
Purpose. To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio.
Methods. One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11).
Results. The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11.
Keywords: Activities of daily living, disability evaluation, disabled persons, personal autonomy, postpoliomyelitis syndrome, rehabilitation, quality of life
Conclusions: Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.
Outcome of Research: More research required
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Category: Orthoses
Title: The effect of footwear adapted with a multi-curved rocker sole in conjunction with knee-ankle-foot orthoses on walking in poliomyelitis subjects: a pilot study
Author: Ali Mojaver (1 2 3), Mokhtar Arazpour (1 2), Gholamreza Aminian (2), Monireh Ahmadi Bani (2), Mahmood Bahramizadeh (2), Guive Sharifi (4), Arash Sherafatvaziri (5)
Affiliation: 1 Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
2 Department of Orthotics and Prosthetics , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
3 Student Research Commute , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.
4 Department of Neurosurgery, Loghman Hakim Hospital , Shahid Beheshti University of Medical Sciences , Tehran , Iran.
5 Shariati Hospital , Tehran University of Medical Sciences , Tehran , Iran.
Journal: Disability and Rehabilitation
Citation: Disabil Rehabil Assist Technol. 2017 Oct;12(7):747-751. doi: 10.1080/17483107.2016.1260654. Epub 2016 Dec 16.
Publication Year and Month: 2017 10
Abstract: Background: Knee-ankle-foot orthoses (KAFOs) are used by people with poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use in KAFOs such the provision of stance control capability have proven efficacy, little attention has been paid to shoe adaptations which may also improve gait.
Aim: The aim of this study was to evaluate the alteration to the kinematics and temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled footwear when ambulating with KAFOs.
Method: Nine adults with a history of poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe rocker sole was added to footwear and worn on the affected side. A three-dimensional motion capture system was used to quantify the resulting alteration to specific gait parameters.
Results: Maximum hip joint extension was significantly increased (p = 0.011), and hip abduction and adduction were both significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with the rocker sole. A significant increase in stride length (p = 0.035) was demonstrated but there were no significant increases in either walking speed or cadence.
Keywords: Knee-ankle-foot orthosis; heel-to-toe rocker sole; poliomyelitis; walking.
Conclusions: Conclusions: A heel-to-toe rocker sole adaptation may be useful for walking in patients with poliomyelitis who use KAFOs. Implications for Rehabilitation The poor functionality and difficulty in walking when using an orthotic device such as a KAFO which keeps the knee locked during ambulation, plus the significant energy required to walk, are complications of orthoses using. Little evidence exists regarding the biomechanical effect of walking with a KAFO incorporating fixed knee joints, in conjunction with rocker-soled footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate forward progression of the tibia when used with an AFO or KAFO or to provide easier walking for patients who have undergone an ankle arthrodesis. In this study, a rocker sole profile adaptation produced no significant alteration to hip joint flexion, but hip joint maximum extension was significantly increased in subjects suffering from poliomyelitis, and maximum hip adduction and abduction were both significantly reduced. The most significant alterations were seen in stride length, and although there was a significant increase in this parameter, there was no statistically significant increase in walking velocity or cadence.
Outcome of Research: More research required
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Category: Drugs
Title: Beneficial Effect of Medical Cannabis in the Treatment of a Pharmacoresistant Nausea Associated with a Somatoform Disorder in a Patient with Post-Polio Syndrome
Author: Markus Bleckwenn, Klaus Weckbecker, Sebastian Voss
Affiliation: Markus Bleckwenn Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Klaus Weckbecker Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Sebastian Voss Institut für Hausarztmedizin der Medizinischen Fakultät der Universität Bonn
Journal: Dtsch Med Wochenschr.
Citation: 2018 Mar;143(5):344-348
Publication Year and Month: 2018 03
Abstract: HISTORY AND CLINICAL FINDINGS:
We report a 79-year-old patient with post-polio syndrome (PPS). In the course of this disease, recurrent upper abdominal pain and a therapy-resistant nausea developed without vomiting. In addition, the patient was limited by the combination of muscular weakness, obesity, dietary-treated diabetes and a degenerative spinal cord injury significantly in its mobility and physical capacity.
INVESTIGATIONS AND DIAGNOSIS:
Despite extensive diagnostics, no somatic cause could be found neither for the nausea nor for the upper abdominal pain. Due to the psychological stress within the scope of the PPS, the development of a somatoform autonomic function disorder of the upper gastrointestinal tract may have occurred.
TREATMENT AND COURSE:
Even under combination therapy of antiemetic and pain-modulating drugs, no adequate symptom control could be achieved. In the absence of therapy alternatives and increasing psychological strain the patient was prescribed medical cannabis. Under the therapy there was a relief of the nausea symptoms and decreased pain.
Conclusions: CONCLUSION:
Cannabis is a treatment option for treatment-resistant symptoms as part of a PPS.
Outcome of Research: More research required
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Category: Surgery
Title: Outcome of total knee arthroplasty in patients with poliomyelitis
Author: Anoop Prasad, Richard Donovan, Manoj Ramachandran, Sebastian Dawson-Bowling, Steven Millington, Rej Bhumbra, Pramod Achan, Sammy A. Hanna
Affiliation:
Journal: EFORT Open Rev
Citation: 2018;3:358-362. DOI: 10.1302/2058-5241.3.170028
Publication Year and Month: 2018 06
Abstract: Total knee arthroplasty (TKA) in patients affected by poliomyelitis is technically challenging owing to abnormal anatomical features including articular and metaphyseal angular deformities, external rotation of the tibia, excessive valgus alignment, bone loss, narrowness of the femoral and tibial canals, impaired quadriceps strength, flexion contractures, genu recurvatum and ligamentous laxity. Little information is available regarding the results and complications of TKA in this challenging group of patients.
We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of TKA in patients with poliomyelitis-affected knees. Six studies including 82 knees met the inclusion criteria and were reviewed. The mean patient age was 63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13).
All studies reported significant improvement in knee function following TKA. There were six failures requiring revision surgery in 82 cases (7%) occurring at a mean of 6.2 years (0.4 to 12). The reasons for revision surgery were aseptic loosening (17%, n=1), infection (33%, n=2), periprosthetic fracture (17%, n=1) and instability (33%, n=2). Thirty-six knees had a degree of recurvatum pre-operatively (44%), which was in the range of 5° to 30°. Ten of these knees (28%) developed recurrent recurvatum post-operatively.
The findings support the use of TKA in patients with poliomyelitis-affected knees. The post-operative functional outcome is similar to other patients; however, the revision rate is higher. Quadriceps muscle power appears to be an important prognostic factor for functional outcome and the use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength.
Conclusions: The findings of this review support the use of TKA to alleviate pain and functional limitation in poliomyelitis patients with knee arthropathy. Post-operative patient satisfaction and functional improvement is similar to other patients; however, the revision rate is higher. Quadriceps muscle power is an important prognostic factor for functional outcome and patients should be counselled about this pre-operatively. The use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength. Irrespective of the type of implant used, meticulous intra-operative balancing of soft tissues and restoration of alignment are crucial factors for achieving a good outcome.
Outcome of Research: More research required
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Category: Acute Flaccid Paralysis
Title: Acute Flaccid Paralysis Associated with Novel Enterovirus C105
Author: Horner LM, Poulter MD, Brenton JN, Turner RB
Affiliation: University of Virginia School of Medicine, Charlottesville, Virginia, USA
Journal: Emerging Infectious Diseases
Citation: Emerg Infect Dis. 2015 Oct. Vol. 21:10. http://dx.doi.org/10.3201/eid2110.150759
Publication Year and Month: 2015 10
Abstract: An outbreak of acute flaccid paralysis among children in the United States during summer 2014 was tentatively associated with enterovirus D68 infection. This syndrome in a child in fall 2014 was associated with enterovirus C105 infection. The presence of this virus strain in North America may pose a diagnostic challenge.
Conclusions:
Outcome of Research: Not applicable
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Category: 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:
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Category: Diagnosis and Management
Title: Post-polio syndrome and total health status in a prospective hospital study.
Author: Farbu E, Rekand T, Gilhus NE
Affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway
Journal: European Journal of Neurology
Citation: 2003 Jul;10(4):407-13.
Publication Year and Month: 2003 07
Abstract: New loss of function among patients with previous polio is frequently reported and has several causes. All patients referred to the Department of Neurology, Haukeland University Hospital, Bergen, for 13 months during 2000-2001 with diagnosis late effects of polio were examined prospectively to identify their symptoms and loss of function. Eighty-five patients aged 47-91 years with mean of 61 years were included. The most common complaints were pain (44%), muscular weakness (27%), and fatigue (16%). Muscular weakness occurred in lower limbs in 75%, in respiratory muscles in only 5%. Walking in stairs was impaired in 72% and outdoor walking in 65%. Seventeen patients (19%) reported no loss of function. Post-polio syndrome was diagnosed in 26% of the patients. Polio-related loss of function including cervical and lumbosacral radiculopathies, mononeuropathies and degenerative joint disease were found in an additional 53%. Eleven patients (13%) had distinct non-polio-related disorders that caused new loss of function. The remaining 8% had a stable condition.
Conclusions: In conclusion, the majority of polio patients who seek hospital, experience a new loss of function because of polio-related disorders. A careful neurological examination is necessary to identify the correct diagnosis and treatment.
Outcome of Research: More research required
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Category: Vocational Implications
Title: Education, occupation, and perception of health amongst previous polio patients compared to their siblings.
Author: Farbu E, Gilhus NE.
Affiliation: Department of Neurology, Haukeland University Hospital, Bergen, Norway. [email protected]
Journal: European Journal of Neurology
Citation: 2002 May;9(3):233-41.
Publication Year and Month: 2002 05
Abstract: Patients with previous polio represent a challenge for neurological rehabilitation. We examined 168 previous polio patients and 239 of their siblings, the patients either from the 1950-1954 epidemic cohort, or from a cohort of hospital-admitted rehabilitation patients. Ninety-four paralytic patients and 74 non-paralytic patients were included. All patients and siblings answered the same questionnaires for socioeconomic and health factors and chi-square comparisons were performed. Previous polio did not affect the level of education. Both patients and siblings rated their educational options to have been good. Significantly less patients were full-time employed at the age of 40 years compared to their siblings (P=0.015). This was the result of a lower full-time employment rate amongst the paralytic patients, only 52% of this group being employed full-time. Male patients and paralytic patients reported to have experienced reduced professional options. More patients were living alone compared to their siblings (P=0.035). The perception of general health was lower amongst patients than siblings, as was assessment of total life situation and patients reported more frequently symptoms like pain and tiredness. In conclusion, previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.
Conclusions: Previous polio had not lowered the polio patients' educational status, but fewer patients were employed full-time at the age of 40 years.
Outcome of Research: More research required
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Category: Late Effects of Polio, Restless Legs Syndrome
Title: Restless legs syndrome and post polio syndrome: a case-control study
Author: A Romigi, M Pierantozzi, F Placidi, E Evangelista, M Albanese, C Liguori, M Nazzaro, B U Risina, V Simonelli, F Izzi, N B Mercuri, M T Desiato
Affiliation: Neurophysiopathology Unit, Sleep Medicine Centre, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; IRCCS Neuromed Via Atinense 18, Pozzilli (IS), Italy.
Journal: European Journal of Neurology
Citation: 22(3):472-8.
doi: 10.1111/ene.12593.
Publication Year and Month: 2015 03
Abstract: Background and purpose
The aim was to investigate the prevalence of restless legs syndrome (RLS), fatigue and daytime sleepiness in a large cohort of patients affected by post polio syndrome (PPS) and their impact on patient health-related quality of life (HRQoL) compared with healthy subjects.
Methods
PPS patients were evaluated by means of the Stanford Sleepiness Scale and the Fatigue Severity Scale (FSS). The Short Form Health Survey (SF-36) questionnaire was utilized to assess HRQoL in PPS. RLS was diagnosed when standard criteria were met. Age and sex matched healthy controls were recruited amongst spouses or friends of PPS subjects.
Results
A total of 66 PPS patients and 80 healthy controls were enrolled in the study. A significantly higher prevalence of RLS (P < 0.0005; odds ratio 21.5; 95% confidence interval 8.17–57) was found in PPS patients (PPS/RLS+ 63.6%) than in healthy controls (7.5%). The FSS score was higher in PPS/RLS+ than in PPS/RLS− patients (P = 0.03). A significant decrease of SF-36 scores, including the physical function (P = 0.001), physical role (P = 0.0001) and bodily pain (P = 0.03) domains, was found in PPS/RLS+ versus PPS/RLS− patients. Finally, it was found that PPS/RLS+ showed a significant correlation between International Restless Legs Scale score and FSS (P < 0.0001), as well as between International Restless Legs Scale score and most of the SF-36 items (physical role P = 0.0018, general health P = 0.0009, vitality P = 0.0022, social functioning P = 0.002, role emotional P = 0.0019, and mental health P = 0.0003).
Conclusions: Our findings demonstrate a high prevalence of RLS in PPS, and that RLS occurrence may significantly influence the HRQoL and fatigue of PPS patients. A hypothetical link between neuroanatomical and inflammatory mechanisms in RLS and PPS is suggested.
Outcome of Research: More research required
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Category: Brain, Diagnosis and Management, Late Effects of Polio, Post-Polio Motor Unit
Title: Spinal cord gray matter atrophy is associated with functional decline in post-polio syndrome
Author: Maria Janina Wendebourg (1,2), Matthias Weigel (1,2,3,4,5), Laura Richter (1), Vanya Gocheva (6), Patricia Hafner (6), Anna-Lena Orsini (6), Valentina Crepulja (1,2), Simone Schmidt (6), Antal Huck (4), Johanna Oechtering (1), Maria Blatow (7), Tanja Haas (3,4), Cristina Granziera (1,2,5), Ludwig Kappos (1,2,5), Philippe Cattin (4), Oliver Bieri (3,4) Dirk Fischer (6), Regina Schlaeger (1,2,5)
Affiliation: 1. Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
2. Translational Imaging in Neurology (ThINk), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
3. Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
4. Department of Biomedical Engineering, University of Basel, Basel, Switzerland
5. MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
6. Division of Pediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
7. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich,
Journal: European Journal of Neurology
Citation: Eur J Neurol. 2022;00:1–11.
DOI: 10.1111/ene.15261
Publication Year and Month: 2022 01
Abstract: Objective: To determine if patients with post- polio syndrome (PPS) show spinal cord gray matter (SCGM) atrophy and to assess associations between SCGM atrophy, muscle strength and patient- reported functional decline.
Methods: Twenty patients diagnosed with PPS (March of Dimes criteria) and 20 age- and sex- matched healthy controls (HC) underwent 3T axial 2D- rAMIRA magnetic resonance imaging at the intervertebral disc levels C2/C3–C6/C7, T9/T10 and the lumbar enlarge-ment level (Tmax) (0.5 × 0.5 mm2 in- plane resolution). SCGM areas were segmented manu-ally by two independent raters. Muscle strength, self-reported fatigue, depression and pain measures were assessed.
Results: Post- polio syndrome patients showed significantly and preferentially re-duced SCGM areas at C2/C3 (p= 0.048), C3/C4 (p= 0.001), C4/C5 (p< 0.001), C5/C6 (p= 0.004) and Tmax (p= 0.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM areaTmax together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS- related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity.
Conclusions: Patients with PPS show significant SCGM atrophy that correlates with mus-cle strength and is associated with PPS- related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not ex-plained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.
Conclusions: The rAMIRA approach is a novel, promising, clinically feasible and sensitive method for segment-wise quantitation of GM atrophy in the cervical and thoracic SC in patients with lower motor neuron disorders. This study demonstrated its clinical applicability and vali-dated it in patients with PPS, a presumed pure, lower motor neuron disorder, which can serve as a model for other neurodegenerative, genetic or autoimmune diseases of the SCGM.
Patients with PPS show significant SCGM atrophy, particularly at levels close to the cervical and lumbar enlargements. Even after adjustment for the level of depression, fatigue and pain, potential confounding symptoms frequently observed in PPS, SCGM atrophy is significantly and segment-wise associated with muscle strength in corresponding myotomes. Moreover, SCGM atrophy is associated with patient-reported PPS-related functional decline. Secondary analyses suggest that SCGM atrophy is rather due to a second dis-ease phase than being a sole residuum of the initial infection or a pure aging effect. These observations support the hypothesis of a focally accentuated neurodegenerative process in the SC underlying PPS. Larger, ideally multicentric, longitudinal studies conducted over a sufficiently long timespan are an important next step to confirm our results and gain more insights into the development of SCGM atrophy over time and its correlation to clinical symptom evolution in patients with PPS.
Outcome of Research: More research required
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Category: Immune Response
Title: Factors Associated with the Severity of COVID-19 Outcomes in People with Neuromuscular Diseases: Data from the International Neuromuscular COVID-19 Registry
Author: Chiara Pizzamiglio (1,2), Robert D. S. Pitceathly (1,2), Michael P. Lunn (1), Stefen Brady (3), Fabiola De Marchi (4), Lucia Galan (5), Jeannine M. Heckmann (6), Alejandro Horga (5), Maria J. Molnar (7), Acary S. B. Oliveira (8), Wladimir B. V. R. Pinto (8), Guido Primiano (9,10), Ernestina Santos (11), Benedikt Schoser (12), Serenella Servidei (9,10), Paulo V. Sgobbi Souza (8), Venugopalan Vishnu (13), Michael G. Hanna (1,2), Mazen M. Dimachkie (14), Pedro M. Machado (1), The Neuromuscular Diseases and COVID-19 Study Group
Affiliation: For The Neuromuscular Diseases and COVID-19 Study Group. Individual affiliations are not listed.
Journal: European Journal of Neurology
Citation: Pizzamiglio, C., Pitceathly, R.D.S., Lunn, M.P., Brady, S., De Marchi, F., Galan, L., Heckmann, J.M., Horga, A., Molnar, M.J., Oliveira, A.S.B., Pinto, W.B.V.R., Primiano, G., Santos, E., Schoser, B., Servidei, S., Sgobbi Souza, P.V., Vishnu, V., Hanna, M.G., Dimachkie, M.M., Machado, P.M. and (2022), Factors Associated with the Severity of COVID-19 Outcomes in People with Neuromuscular Diseases: Data from the International Neuromuscular COVID-19 Registry. Eur J Neurol. Accepted Author Manuscript. https://doi.org/10.1111/ene.15613
Publication Year and Month: 2022 10
Abstract: BACKGROUND
To determine factors associated with the severity of COVID-19 outcomes in people with neuromuscular diseases (NMDs).
METHODS
NMD cases of any age and confirmed/presumptive COVID-19, submitted to the International Neuromuscular COVID-19 Registry up to 31/December/2021, were included. A mutually exclusive ordinal COVID-19 severity scale was defined: (1) no hospitalisation; (2) hospitalisation without oxygenation; (3) hospitalisation with ventilation/oxygenation; (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios for severe outcome, adjusting for age, sex, race/ethnicity, NMD, comorbidities, baseline functional status (modified Rankin scale [mRS]), use of immunosuppressive/immunomodulatory medication, and pandemic calendar period.
RESULTS
Of 315 patients from 13 countries (mean age 50.3 [±17.7] years, 154 [48.9%] female), 175 (55.5%) were not hospitalised, 27 (8.6%) were hospitalised without supplemental oxygen, 91 (28.9%) were hospitalised with ventilation/supplemental oxygen, and 22 (7%) died. Higher odds of severe COVID-19 outcomes were observed for: age≥50 years (50-64 years: OR=2.4, 95%CI 1.33-4.31; >64 years: OR=4.16, 95%CI 2.12-8.15; both vs. <50 years), non-White race/ethnicity (OR=1.81, 95%CI 1.07-3.06; vs. White), mRS moderately severe/severe disability (OR=3.02, 95%CI 1.6-5.69; vs. no/slight/moderate disability), history of respiratory dysfunction (OR=3.16, 95%CI 1.79-5.58), obesity (OR=2.24, 95%CI 1.18-4.25), ≥3 comorbidities (OR=3.2, 95%CI 1.76-5.83; vs. ≤2; if comorbidity count used instead of specific comorbidities), glucocorticoid treatment (OR=2.33, 95%CI 1.14-4.78), and Guillain-Barré syndrome (OR=3.1, 95%CI 1.35-7.13; vs. mitochondrial disease).
Conclusions: CONCLUSIONS
Among people with NMDs, there is differential risk of COVID-19 outcomes according to demographic and clinical characteristics. These findings could be used to develop tailored management strategies and evidence-based recommendations for NMD patients.
Outcome of Research: More research required
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Category: Falls 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
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Category: Diagnosis and Management
Title: Neurological Symptoms in Danes with a History of Poliomyelitis: Lifelong Follow-Up of Late Symptoms, their Association with Initial Symptoms of Polio, and Presence of Postpolio Syndrome
Author: Kay L. Nielsen N.M. Wanscher B. Jennum P.
Affiliation: Specialized Hospitalet for Polio and Accident Patients, Rødovre, Denmark
Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
Medical Department 3, Næstved, Slagelse and Ringsted Hospital, Slagelse, Denmark
Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
Journal: European Neurology
Citation: 2018, Vol.80, No. 5-6
Publication Year and Month: 2018
Abstract: Background: Previous studies suggest that patients with a history of poliomyelitis (PM) later in life experience a variety of symptoms. These studies were carried out in patients who later in life were admitted to hospital or became members of polio societies and may therefore not be representative of all polio patients. Little data have been published concerning patients actually discharged from hospital with a diagnosis of acute paralytic PM. Objectives: The aim of this study was to compare the prevalence of late symptoms in individuals with a history of paralytic PM with that of controls, and to study whether late symptoms in individuals with a history of PM were associated with symptoms at the acute stage of polio, and finally to compare the prevalence of symptoms in polio patients with postpolio syndrome (PPS) with the prevalence of symptoms in polio patients without PPS. Methods: A questionnaire concerning various symptoms was sent to a previously established cohort of patients, who during the polio epidemics were discharged from the Department of Infectious Disease at Blegdamshospitalet, Copenhagen, with a diagnosis of paralytic PM, and to age- and gender-matched controls without PM. Information about symptoms at the acute stage of disease was obtained from hospital records. Logistic regression analysis with adjustment for age and gender was applied to compare the occurrence of late symptoms in cases and controls and within the above-mentioned groups of individuals with a history of PM. Results: (i) Compared with controls, individuals with a history of polio significantly more often reported muscle symptoms, pain, neuropathic sensory symptoms, and bulbar symptoms; (ii) the occurrence of symptoms did not seem to be related to symptoms of the initial PM; and (iii) symptom prevalence was significantly higher in individuals with a history of polio who reported PPS as compared with those who did not.
Conclusions: Conclusion: Our data indicate that individuals with a history of PM late in life experience a variety of symptoms that cannot be attributed to lesions of the anterior horn. Furthermore, late symptoms do not seem to be related to initial symptoms of the acute stage of PM but to reported PPS. The last finding supports the perception that the cause of PPS is not just normal ageing.
Outcome of Research: More research required
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Category: Surgery
Title: Long-term results after triple arthrodesis: Influence of alignment on ankle osteoarthritis and clinical outcome
Author: Klerken, T., Kosse, N.M., Aarts, C.A.M., Louwerens, J.W.K.
Affiliation: Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
Journal: Foot and Ankle Surgery.
Citation: https://doi.org/10.1016/j.fas.2017.11.003
Publication Year and Month: 2017 11
Abstract: Background
Pain, deformity and instability are the main reasons for fusion of the tarsal joints, a triple arthrodesis. The short and midterm results show that mobility, function and satisfaction increase postoperatively. However, osteoarthritis (OA) of the adjacent ankle joint is described as a long-term complication. Alignment of the foot could be an influencing factor. The aim of this study was to examine whether malalignment after triple arthrodesis leads to a higher grade of OA at long-term follow-up.
Conclusions
Triple arthrodesis is a salvage procedure in patients with a painful and deformed hindfoot and results in a clinically beneficial outcome, even 15 years after surgery. The present study did not show that malalignment after triple arthrodesis results in a higher grade of OA of the ankle joint in the long-term. The cause of the aggravation of OA is still not fully understood and needs further research. Nevertheless, clinical results are satisfying 15 years postoperatively.
Conclusions: A triple arthrodesis was effective 15 years after surgery. Aggravation of ankle joint osteoarthritis does not relate to patient satisfaction. Slow radiographic aggravation of osteoarthritis of the ankle joint was seen in 42% of the patients.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: Patients with Primary Immunodeficiencies Are a Reservoir of Poliovirus and a Risk to Polio Eradication
Author: Aghamohammadi A (1), Abolhassani H (1), Kutukculer N (2), Wassilak SG (3), Pallansch MA (4), Kluglein S (5), Quinn J (6), Sutter RW (7), Wang X (8), Sanal O (9), Latysheva T (10), Ikinciogullari A (11), Bernatowska E (12), Tuzankina IA (13), Costa-Carvalho BT (14), Franco JL (15), Somech R (16), Karakoc-Aydiner E (17), Singh S (18), Bezrodnik L (19), Espinosa-Rosales FJ (20), Shcherbina A (21), Lau Y (22,23), Nonoyama S (24), Modell F (6), Modell V (6), The JMF Centers Network Investigators and Study Collaborators, Barbouche M (25), and McKinlay MA (5)
Affiliation: (1) Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children’s Medical Center, Tehran University of Medical Science, Tehran, Iran; (2) Faculty of Medicine, Department of Pediatric Immunology, Ege University, Izmir, Turkey; (3) Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, United States; (4) Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States; (5) Center for Vaccine Equity, Task Force for Global Health, Atlanta, GA, United States; (6) Jeffrey Modell Foundation, New York, NY, United States; (7) Research and Product Development, World Health Organization, Geneva, Switzerland' (8) Department of Clinical Immunology, Children’s Hospital of Fudan University, Shanghai, China; (9) Division of Immunology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey; (10) Department of Allergology and Immunotherapy, Institute of Immunology, Moscow, Russia; (11) Department of Pediatric Immunology and Allergy, Ankara University School of Medicine, Ankara, Turkey; (12) Department of Clinical Immunology, The Children’s Memorial Health Institute, Warsaw, Poland; (13) Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Yekaterinburg, Russia; (14) Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil; (15) Grupo de Inmunodeficiencias Primarias, Facultad de Medicina, Departamento de Microbiología y Parasitología, Universidad de Antioquia, Medellín, Colombia; (16) Pediatric Department A and the Immunology Service, Sheba Medical Center, Tel Hashomer, Jeffrey Modell Foundation Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (17) Division of Pediatric Allergy and Immunology, Marmara Medical Faculty, Istanbul, Turkey; (18) Pediatric Allergy and Immunology Unit, Advanced Pediatrics Centre, PGIMER, Chandigarh, India; (19) Dr. Ricardo Gutierrez Hospital de Niños, Buenos Aires, Argentina; (20) Clinical Immunology and Allergy Unit, Instituto Nacional de Pediatría, Ciudad de México, Mexico; (21) Department of Clinical Immunology, Dmitry Rogachev Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia; (22) Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong; (23) Shenzhen Primary Immunodeficiency Diagnostic and Therapeutic Laboratory, Hong Kong University-Shenzhen Hospital, Shenzhen, China; (24) Department of Pediatrics, National Defense Medical College, Saitama, Japan; (25) Department of Immunology, Institut Pasteur de Tunis, University Tunis El-Manar, Tunis, Tunisia.
Journal: Frontiers in Immunology
Citation: Front. Immunol. 8:685. doi: 10.3389/fimmu.2017.00685
Publication Year and Month: 2017 06
Abstract: Immunodeficiency-associated vaccine-derived polioviruses (iVDPVs) have been isolated from primary immunodeficiency (PID) patients exposed to oral poliovirus vaccine (OPV). Patients may excrete poliovirus strains for months or years; the excreted viruses are frequently highly divergent from the parental OPV and have been shown to be as neurovirulent as wild virus. Thus, these patients represent a potential reservoir for transmission of neurovirulent polioviruses in the post-eradication era. In support of WHO recommendations to better estimate the prevalence of poliovirus excreters among PIDs and characterize genetic evolution of these strains, 635 patients including 570 with primary antibody deficiencies and 65 combined immunodeficiencies were studied from 13 OPV-using countries. Two stool samples were collected over 4 days, tested for enterovirus, and the poliovirus positive samples were sequenced. Thirteen patients (2%) excreted polioviruses, most for less than 2 months following identification of infection. Five (0.8%) were classified as iVDPVs (only in combined immunodeficiencies and mostly poliovirus serotype 2). Non-polio enteroviruses were detected in 30 patients (4.7%). Patients with combined immunodeficiencies had increased risk of delayed poliovirus clearance compared to primary antibody deficiencies. Usually, iVDPV was detected in subjects with combined immunodeficiencies in a short period of time after OPV exposure, most for less than 6 months. Surveillance for poliovirus excretion among PID patients should be reinforced until polio eradication is certified and the use of OPV is stopped. Survival rates among PID patients are improving in lower and middle income countries, and iVDPV excreters are identified more frequently. Antivirals or enhanced immunotherapies presently in development represent the only potential means to manage the treatment of prolonged excreters and the risk they present to the polio endgame.
Conclusions: This study provides an estimate of the global iVDPV prevalence among PID patients without paralytic disease and supports expanded screening for iVDPV excretion in these patients. Although most previous studies focused on the risk of long-term iVDPV infection in antibody deficient patients, the predominance of risk in patients with combined immunodeficiencies included in the current study highlights the importance of considering this group of PID patients in any surveillance program. Reinfection with poliovirus and NPEV excretion in PID patients described elsewhere demonstrates the need for prolonged follow-up (17).
The Global Polio Eradication Initiative plans to cease use of OPV worldwide once WPV has been certified as eradicated, which will end the generation of new iVDPVs. However, there is currently no means for addressing the threat posed by existing immunodeficient persons infected with iVDPVs, either to the infected individual’s risk of paralytic disease, or to the community of a continuing source of poliovirus transmission. Antivirals represent a potential means to manage the treatment of iVDPV excreters and the risk they present to the eradication effort (32, 34). Two safe virus-specific antivirals acting by differing mechanisms are now being developed and may be used as a combination (e.g., pocapavir and V-7404). This strategy may resolve the individual’s infection, stop iVDPV excretion, and serve to eliminate the risk of poliovirus transmission in the community. Currently, pocapavir is being considered for use in poliovirus excreting PID patients on a compassionate use basis.
The potential risk posed by iVDPV excreters to the polio eradication effort indicates the immediate need to develop and implement a global iVDPV surveillance strategy. Utilizing this approach, individuals at risk of prolonged poliovirus excretion can be identified and antiviral treatment can be initiated.
Outcome of Research: More research required
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Category: Fatigue
Title: Circadian fatigue or unrecognized restless legs syndrome? The post-polio syndrome model
Author: Romigi A, Maestri M
Affiliation: Neurophysiopathology Unit, Department of Systems Medicine, Sleep Medicine Centre, Tor Vergata University and Hospital , Rome , Italy ; IRCCS Neuromed , Pozzilli , Italy; Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy.
Journal: Frontiers in Neurology
Citation: Front Neurol. 2014 Jul 7;5:115. doi: 10.3389/fneur.2014.00115
Publication Year and Month: 2014 07
Abstract: This paper does not have an abstract.
Conclusions:
Outcome of Research: More research required.
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Category: 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
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Category: Orthoses
Title: Compensations in lower limb joint work during walking in response to unilateral calf muscle weakness
Author: Niels F.J.Waterval, Merel-AnneBrehm, Hilde E.Ploegera, Frans Nollet, Jaap Harlaar
Affiliation: Amsterdam UMC, University of Amsterdam, Department of Rehabilitation, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
Department of Biomechanical Engineering, Delft University of Technology, The Netherlands
Journal: Gait & Posture
Citation: Volume 66, October 2018, Pages 38-44
Publication Year and Month: 2018 10
Abstract: Background
Patients with calf muscle weakness due to neuromuscular disorders have a reduced ankle push-off work, which leads to increased energy dissipation at contralateral heel-strike. Consequently, compensatory positive work needs to be generated, which is mechanically less efficient. It is unknown whether neuromuscular disorder patients compensate with their ipsilateral hip and/or contralateral leg; and if such compensatory joint work is related to walking energy cost.
Research question
Do patients with calf muscle weakness compensate for the increase in negative joint work by increasing positive ipsilateral hip work and/or positive contralateral leg work? And is the total mechanical work related with walking energy cost?
Methods
Seventeen patients with unilateral flaccid calf muscle weakness and 10 healthy individuals performed the following two tests: i) a barefoot 3D gait analysis at comfortable speed and matched control speed (i.e. 0.4 non-dimensional) to assess lower limb joint work and ii) a 6-minute walk test at comfortable speed to assess walking energy cost.
Results
Patients had a lower comfortable walking speed compared to healthy individuals (1.05 vs 1.36 m/s, p < 0.001) and did not increase positive lower limb joint work at comfortable speed. At matched speed (1.25 m/s), patients showed increased positive work at their ipsilateral hip (0.38 ± 0.08 vs 0.27 ± 0.07, p = 0.001) and/or contralateral leg (0.99 ± 0.14 vs 0.69 ± 0.14, p < 0.001). Patients with weakest plantar flexors used both strategies. No relation between total positive work and walking energy cost was found (r = 0.43, p = 0.122).
Conclusions: Significance
Patients with unilateral calf muscle weakness compensated for reduced ankle push-off work by lowering their comfortable walking speed or, at matched speed, by generating additional positive joint work at the ipsilateral hip and/or contralateral leg. The additional positive joint work at matched speed did not explain the elevated walking energy cost at comfortable speed, which needs further exploration.
Outcome of Research: More research required
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Category: Falls, Late Effects of Polio
Title: Polio survivors have poorer walking adaptability than healthy individuals
Author: Jana Tuijtelaars (1), Melvyn Roerdink (2), Bart Gerardus Hendricus Raijmakers (1), Frans Nollet (1), Merel-Anne Brehm (1)
Affiliation: (1) Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
(2) Department of Human Movement Sciences, Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, Amsterdam, the Netherlands
Journal: Gait & Posture
Citation: https://doi.org/10.1016/j.gaitpost.2021.04.031
Publication Year and Month: 2021 04
Abstract: Background:
Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role.
Research question:
Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals?
Methods:
In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0%, 20% and 30% variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection.
Results:
46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2mm), polio survivors stepped less accurately onto targets (36.4±0.9mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3%, ObR: 59±4%) than healthy individuals (100±0.3%, p < 0.001 and 94±3%, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001).
Significance:
Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.
Abbreviations:
CoP: Center of Pressure
CWS: Comfortable Walking Speed
ObA: Obstacle Avoidance Anticipatory
ObR: Obstacle Avoidance Reactive
ST0: Stepping Targets, 0% variation in step length and width relative to normal walking
ST20: Stepping Targets, 20% variation in step length and width relative to normal walking
ST30: Stepping Targets, 30% variation in step length and width relative to normal walking
VE: Variable stepping Error
%GDS: Percentage successful goal-directed steps
Keywords:
Poliomyelitis, walking adaptability, falling, fall, risk, C-Mill, muscle, weakness
Conclusions: Polio survivors had a demonstrable limited ability to adapt walking to environmental circumstances compared to community-dwelling healthy individuals of similar age. They had fewer successful goal-directed steps, stepped less consistently on stepping targets and, despite walking slower, had lower obstacle-avoidance success rates, especially under high time-pressure demands. This diminished walking adaptability could place them at higher risk of falling, especially in everyday life, where walking often needs to be adapted to expected and unexpected circumstances. Future research should study the validity and reproducibility of walking-adaptability assessment in polio survivors to determine its added value to the currently used methods of fall-risk assessment in clinical practice.
Outcome of Research: More research required
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Category: Falls and Bone Density
Title: Validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors
Author: Jana Tuijtelaars (a,c), Merel-Anne Brehm (a,c), Frans Nollet (a,c), Melvyn Roerdink (b)
Affiliation: (a) Amsterdam UMC location University of Amsterdam, Rehabilitation medicine, Meibergdreef 9, Amsterdam, The Netherlands
(b) Department of Human Movement Sciences, Faculty of Behavioural and Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, Amsterdam, the Netherlands
(c) Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
Journal: Gait & Posture
Citation: Jana Tuijtelaars, Merel-Anne Brehm, Frans Nollet, Melvyn Roerdink, Validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors, Gait & Posture, Volume 96, 2022, Pages 314-321, ISSN 0966-6362, https://doi.org/10.1016/j.gaitpost.2022.06.008.
Publication Year and Month:
Abstract: Background
The C-Mill interactive treadmill allows for a safe walking-adaptability assessment, unveiling reduced walking adaptability in polio survivors compared to healthy individuals, possibly related to their high fall rate. However, evidence on its validity and reproducibility is scarce.
Research question
What is the validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors?
Methods
Polio survivors with a history and/or fear of falling (n = 46) performed two walking-adaptability assessments, 1–2 weeks apart, including target-stepping tests (with 0%, 20% and 30% inter-target variance) and obstacle-avoidance tests (anticipatory and reactive). We examined (1) face validity by determining Group effects (for subgroups stratified for fall frequency, fear of falling and leg muscle weakness) and Condition effects (for difficulty level) on walking-adaptability outcomes, (2) construct validity by correlating walking-adaptability and balance outcomes, and (3) content validity by establishing possible ceiling effects. We determined whether face-validity findings were reproducible over test occasions and calculated Intraclass Correlation Coefficients (ICC) and the 95% Limits of Agreement (LoA) for walking-adaptability outcomes.
Results
Walking-adaptability outcomes differed in to-be-expected directions for subgroups stratified for fall frequency and leg muscle weakness and for difficulty levels, all reproducible over test occasions. Correlations between walking-adaptability and balance outcomes were mainly low (r < 0.587). Ceiling effects were present for anticipatory obstacle-avoidance and balance outcomes, but not for reactive obstacle avoidance. ICCs [95% confidence intervals] were good for the challenging 20% (0.80[0.67–0.88]) and 30% target-stepping conditions (0.74[0.57–0.85]) and for the reactive obstacle-avoidance (0.76[0.59–0.86]) condition, but not for 0% target-stepping and anticipatory obstacle–avoidance (ICC<0.62) conditions. Likewise, the narrowest LoA were observed for the 20% and 30% target-stepping conditions.
Significance
We proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors with a history of falls and/or fear of falling. Adding walking-adaptability assessment, particularly the more challenging tests given their superior reproducibility, to currently used clinical tests could improve fall-risk evaluation in this population.
Keywords: Polio survivors, Walking adaptability, Fall-risk assessment, Validity, Reproducibility
Conclusions: Results from this study proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors experiencing falls and/or FoF. Compared to balance tests, walking-adaptability tests address other mobility aspects and are more sensitive for identifying differences in subgroups stratified for established fall-risk factors, and therefore, might add value to the current fall-risk assessment in this population. Based on content validity and reproducibility outcomes, we propose that the more challenging variable target-stepping and reactive obstacle-avoidance tests are best suitable for assessing walking adaptability in polio survivors.
Outcome of Research: Effective
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Category: Orthoses
Title: Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness
Author: Hilde E Ploeger (1), Sicco A Bus (2), Merel-Anne Brehm (2), Frans Nollet (2)
Affiliation: 1 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands. Electronic address: [email protected].
2 Department of Rehabilitation, Academic Medical Center, University of Amsterdam, The Netherlands.
Journal: Gait & Posture
Citation: Gait Posture. 2014 Jul;40(3):391-8. doi: 10.1016/j.gaitpost.2014.05.016. Epub 2014 Jun 4.
Publication Year and Month: 2014 07
Abstract: In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group.
Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with a DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6 min walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires.
Compared with shoes-only, walking with the DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p < 0.05). Furthermore, walking energy cost was lower (-7%, p = 0.052) and gait speed was higher (p = 0.005). Patients were significantly more satisfied, felt safer, and less exhausted with the DR-AFO, compared to shoes-only (p < 0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO.
In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.
Keywords: Ankle-foot orthosis; Calf muscle weakness; Gait analysis; Poliomyelitis; Walking energy cost.
Conclusions: In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.
Outcome of Research: More research required
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Category: Differential Diagnosis
Title: Diagnosing Post-Polio Syndrome in the Elderly, a Case Report
Author: Amole, M. & Khouzam-Skelton, N.
Affiliation: Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA
Journal: Geriatrics
Citation: 2(2), 14; doi:10.3390/geriatrics2020014
Publication Year and Month: 2017 02
Abstract: Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome. Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.
Conclusions: Post-polio syndrome is an interesting disorder characterized by new neuromuscular deficits that present years after the resolution of a polio infection. There are several diagnostic criteria, but one of the most important is the exclusion of other possible diagnoses. Post-polio syndrome diagnosis is even more difficult in the elderly population due to the presence of multiple comorbid conditions. Extensive testing may be necessary for an appropriate diagnosis in this population.
Outcome of Research: Not applicable
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Category: Fatigue
Title: Multidimensional fatigue inventory and post-polio syndrome - a Rasch analysis
Author: Dencker A (1,3), Sunnerhagen KS (1,2), Taft C (1,3), Lundgren-Nilsson Å (1,2)
Affiliation: (1) Centre for Person-centred Care, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; (2) Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; (3) Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, 405 30, Sweden - [email protected].
Journal: Health and Quality of Life Outcomes
Citation: Health Qual Life Outcomes. 2015 Feb 12;13(1):20. doi: 10.1186/s12955-015-0213-9
Publication Year and Month: 2015 02
Abstract: BACKGROUND: Fatigue is a common symptom in post-polio syndrome (PPS) and can have a substantial impact on patients. There is a need for validated questionnaires to assess fatigue in PPS for use in clinical practice and research. The aim with this study was to assess the validity and reliability of the Swedish version of Multidimensional Fatigue Inventory (MFI-20) in patients with PPS using the Rasch model.
METHODS: A total of 231 patients diagnosed with PPS completed the Swedish MFI-20 questionnaire at post-polio out-patient clinics in Sweden. The mean age of participants was 62 years and 61% were females. Data were tested against assumptions of the Rasch measurement model (i.e. unidimensionality of the scale, good item fit, independency of items and absence of differential item functioning). Reliability was tested with the person separation index (PSI). A transformation of the ordinal total scale scores into an interval scale for use in parametric analysis was performed. Dummy cases with minimum and maximum scoring were used for the transformation table to achieve interval scores between 20 and 100, which are comprehensive limits for the MFI-20 scale.
RESULTS: An initial Rasch analysis of the full scale with 20 items showed misfit to the Rasch model (p < 0.001). Seven items showed slightly disordered thresholds and person estimates were not significantly improved by rescoring items. Analysis of MFI-20 scale with the 5 MFI-20 subscales as testlets showed good fit with a non-significant x (2) value (p = 0.089). PSI for the testlet solution was 0.86. Local dependency was present in all subscales and fit to the Rasch model was solved with testlets within each subscale. PSI ranged from 0.52 to 0.82 in the subscales.
Conclusions: This study shows that the Swedish MFI-20 total scale and subscale scores yield valid and reliable measures of fatigue in persons with post-polio syndrome. The Rasch transformed total scores can be used for parametric statistical analyses in future clinical studies.
Outcome of Research: Not applicable.
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Category: Orthoses
Title: Quality of life of prosthetic and orthotic users in South India: a cross-sectional study
Author: Lina Magnusson, Ritu GhoshKatrine Randbøll JensenKatharina GöbelJenny WågbergSofia WallénAlma SvenssonRebecka StavenheimGerd Ahlström
Affiliation: 1.Department of Health Sciences, Faculty of Medicine Lund University Lund Sweden
2.Mobility India Rehabilitation Research and Training Centre Bangalore India
Journal: Health and Quality of Life Outcomes
Citation: December 2019, 17:50
Publication Year and Month: 2019 12
Abstract: Background
The aim of this study was to compare QOL among people in India using lower-limb prostheses or orthoses with people without disability. A further aim was to compare subgroups and investigate whether QOL was associated with physical disability, gender, income, living area, and education.
Methods
A cross-sectional questionnaire study in which the World Health Organization Quality of Life-Bref was used to collect self-reported data. A total of 277 participants from India were included, 155 with disability and 122 without. Group comparisons were conducted using the Mann–Whitney U and the Kruskal–Wallis tests and associations were explored using regression analyses of the four QOL domains: physical health, psychological, social relationships, and environment.
Results
Participants with physical disability scored significantly lower than did participants without disability in three of the four QOL domains, i.e., physical health, (Median 14.29 vs 16.29; p < .001) psychological, (Median 14.67 vs. 15.33; p = .017) and environment (Median13.00 vs 14.00; p = .006). For people with disability those with no or irregular income and those not attending school having the lowest QOL scores in all four domains. Education was associated with all four QOL domains and income was associated with psychological and environment. Living in urban slums was associated with a higher risk of lower QOL in three QOL domains, i.e., physical health, psychology, and environment.
Conclusions: Despite rehabilitation services, people with physical disability experienced lower QOL in terms of the physical health, psychological, and environmental domains than did people without disability. Community-based rehabilitation programmes for prosthetic and orthotic users need to increase and improve their rehabilitation services to increase income and improve access to education. Priority could be given to those who have no or irregular income, live in urban slums, and have not attended school to further improve their QOL.
Outcome of Research: More research required
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Category: Quality of Life
Title: Polio survivors' perceptions of the meaning of quality of life and strategies used to promote participation in everyday activities
Author: Atwal A, Spiliotopoulou G, Coleman C, Harding K, Quirke C, Smith N, Osseiran Z, Plastow N, Wilson L
Affiliation: Division of Occupational Therapy, School of Health Sciences and Social Care, Brunel University, Uxbridge, UK
Journal: Health Expectations
Citation: Health Expect. 2014 Jan;doi:10.1111/hex.12152
Publication Year and Month: 2014 01
Abstract: INTRODUCTION: The term ‘post-polio syndrome’ (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life. Research in this area has focused upon health status rather than its effect on quality of life.
AIM: To gain an in-depth understanding of the meaning of quality of life for polio survivors and to determine the type of strategies that are used by people with PPS and the support that they consider as important to facilitate participation in everyday life activities that have an impact on their quality of life.
METHOD: Six focus groups were conducted with 51 participants from two regions in England. Data were audio-taped and analysed using thematic analysis.
RESULTS: Our research found that polio survivors used terms used to describe quality of life which could be associated with that of happiness. Our research has identified resolvable factors that influence quality of life namely inaccessible environments, attitudes of health-care professionals and societal attitudes. Polio survivors have tried alternative therapies, chiefly acupuncture and massage, and found them to be effective in enhancing their quality of life.
Conclusions: It is suggested that health-care professionals should consider factors which influence happiness and implement a person-centred approach with the views of the polio survivor being listened to. The three factors that influenced quality of life could be resolved by health-care professionals and by society. With regard to strategies used, we suggest that polio survivors should have access to the treatments that they perceive as important, although further research is required to design optimal interventions for this client group.
Outcome of Research: More research required
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Category: Ageing
Title: Cognitive Behavior Therapy combined with Exercise for Adults with Chronic Diseases: Systematic Review and Meta-Analysis
Author: Bernard P, Romain AJ, Caudroit J, Chevance G, Carayol M, Gourlan M, Dancause KN, Moullec G
Affiliation: Université du Québec à Montréal, Montréal, Quebec , Canada.
Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
Laboratory Epsylon, Dynamics of Human Abilities and Health Behavior, University of Montpellier,
Montpellier, France.
Journal: Health psychology : official journal of the Division of Health Psychology, American Psychological Association
Citation: May 2018, Vol.37(5), pp.433-450
Publication Year and Month: 2018 05
Abstract: Objective. The present meta-analysis aimed to determine the overall effect of cognitive behavior therapy combined with physical exercise (CBTEx) interventions on depression, anxiety, fatigue, and pain in adults with chronic illness; to identify the potential moderators of efficacy; and to compare the efficacy of CBTEx versus each condition alone (CBT and physical exercise).
Methods. Relevant randomized clinical trials, published before July 2017, were identified through database searches in Pubmed, PsycArticles, CINAHL, SportDiscus and the Cochrane Central Register for Controlled Trials.
Results. A total of 30 studies were identified. CBTEx interventions yielded small-to-large effect sizes for depression (SMC = -0.34, 95% CI [-0.53; -0.14]), anxiety (SMC = -0.18, 95% CI [-0.34; -0.03]) and fatigue (SMC = -0.96, 95% CI [-1.43; -0.49]). Moderation analyses revealed that longer intervention was associated with greater effect sizes for depression and anxiety outcomes. Low methodological quality was also associated with increased CBTEx efficacy for depression. When compared directly, CBTEx interventions did not show greater efficacy than CBT alone or physical exercise alone for any of the outcomes.
Conclusions: Conclusion. The current literature suggests that CBTEx interventions are effective for decreasing
depression, anxiety, and fatigue symptoms, but not pain. However, the findings do not support an additive effect of CBT and exercise on any of the four outcomes compared to each condition alone.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: 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
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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
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Category:
Title: Cancer risk in a cohort of polio survivors
Author: Neilsen NM, Wohlfahrt J, Aaby P, et al.
Affiliation: Department of Epidemiology, National University, Copenhagen, Denmark
Department of Infectious Diseases, National University, Copenhagen, Denmark
Journal: 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
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Category: Diagnosis and Management
Title: Post-poliomyelitis syndrome as a possible viral disease
Author: Baj A (1), Colombo M (1), Headley JL (2), McFarlane JR (3), Liethof MA (4), Toniolo A (5)
Affiliation: (1) Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy; (2) Post-Polio Health International, Saint Louis, Missouri, USA; (3) European Polio Union, Huldenberg, Belgium; (4) Polio Australia Incorporated, Kew, Victoria, Australia; (5) Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy. Electronic address: [email protected]
Journal: International Journal of Infectious Diseases
Citation: Int J Infect Dis. 2015 May 1;35:107-116. doi: 10.1016/j.ijid.2015.04.018
Publication Year and Month: 2015 05
Abstract: This review summarizes current concepts on post-polio syndrome (PPS), a condition that may arise in polio survivors after partial or complete functional recovery followed by a prolonged interval of stable neurological function. PPS affects 15-20 million people worldwide. Epidemiological data are reported, together with the pathogenic pathways that possibly lead to the progressive degeneration and loss of neuromuscular motor units. As a consequence of PPS, polio survivors experience new weakness, generalized fatigue, atrophy of previously unaffected muscles, and a physical decline that may culminate in the loss of independent life. Emphasis is given to the possible pathogenic role of persistent poliovirus infection and chronic inflammation. These factors could contribute to the neurological and physical decline in polio survivors. A perspective is then given on novel anti-poliovirus compounds and monoclonal antibodies that have been developed to contribute to the final phases of polio eradication. These agents could also be useful for the treatment or prevention of PPS. Some of these compounds/antibodies are in early clinical development. Finally, current clinical trials for PPS are reported. In this area, the intravenous infusion of normal human immunoglobulins appears both feasible and promising.
Conclusions:
Outcome of Research: Effective.
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Category: Quality of Life
Title: Quality of life in Swedish patients with post-polio syndrome with a focus on age and sex
Author: Jung TD (1), Broman L, Stibrant-Sunnerhagen K, Gonzalez H, Borg K
Affiliation: (1) Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyds Hospital, Stockholm; Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2014 Jun;37(2):173-9. doi: 10.1097/MRR.0000000000000052
Publication Year and Month: 2014 06
Abstract: To investigate the health-related quality of life (QOL) in Swedish patients with post-polio syndrome (PPS), with a focus on sex and age. A total of 364 patients were recruited from five Swedish post-polio clinics. Analysis was carried out using SF-36 and data were compared with those of a normal population. QOL was significantly lower in PPS patients for all eight subdomains and the two main scores (physical compound score and mental compound score) when compared with the controls. Male patients had a significantly higher QOL than female patients for all subdomains and also for mental compound score and physical compound score, a phenomenon also observed in the normal population. There was a decrease in QOL in the physical domains and an increase in vitality with age. PPS decreases health-related QOL in both sexes, more in female patients. QOL for physical domains decreases whereas vitality increases with age in both sexes.
Conclusions:
Outcome of Research: Effective
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Category: Fatigue
Title: Psychometric properties of fatigue severity and fatigue impact scales in postpolio patients
Author: Oncu J (1), Atamaz F, Durmaz B, On A
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Şişli Etfal Teaching Hospital, Istanbul; Department of Physical Medicine and Rehabilitation, Medical Faculty of Ege University, Bornova-Izmir, Turkey.
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2013 Dec;36(4):339-45. doi: 10.1097/MRR.0b013e3283646b56
Publication Year and Month: 2013 12
Abstract: We evaluate the reliability, validity, and responsiveness of the Fatigue Severity Scale (FSS) and the Fatigue Impact Scale (FIS) and to determine whether these scales are potentially applicable for measuring fatigue in postpolio patients (PPS). After the Turkish adaptation of FSS and FIS using a forward-backward procedure, the scales were administered to 48 PPS patients without additional health problems that may induce fatigue. Reliability studies were carried out by determination of intraclass correlation coefficient and internal consistency by the Cronbach-α coefficient. Validity was tested by within-scale analyses and analyses against the external criteria including convergent validity and discriminant validity. Correlations with the Notthingham Health Profile (NHP), fatigue, pain and cramp severity (visual analog scale), and manual muscle testing were performed. Sensitivity to changes was determined by standardized response mean values. All patients completed scales, suggesting their satisfactory acceptance. Reliability studies were satisfactory, with higher Cronbach-α values and intraclass correlation coefficients than 0.80. The FSS score was correlated moderately with visual analog scale-fatigue (r=0.41) and the NHP-energy dimension (r=0.29). All FIS scores except cognitive scores were moderately related to the NHP-social isolation score (r=0.40, 0.37, and 0.43 for FIS-physical, social, and total scores, respectively). There was also a significant correlation between the FIS-physical score and the NHP-energy score (r=0.31). On the basis of the standardized response mean values, response to treatment for these two questionnaires was satisfactory (P=0.00). The Turkish versions of FSS and FIS were reliable, sensitive to clinical changes, and also well accepted by patients with PPS. Although they had somewhat satisfactory convergent validity, the absence of strong correlations did not support the validity entirely.
Conclusions:
Outcome of Research: More research required
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Category: Diagnosis and Management, Late Effects of Polio
Title: Post-poliomyelitis syndrome (2019)
Author: Eric Chun Pu Chu1 and Kary Ka Wai Lam2
Affiliation: 1New York Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, People’s Republic of China
2Downtown Chiropractic Limited, Hong Kong, People’s Republic of China
Correspondence: Eric Chun Pu ChuNew York Chiropractic and Physiotherapy Centre, New York Medical Group, 41/F Langham Place Office Tower, 8 Argyle Street, Mongkok, Hong Kong, People’s Republic of China, Phone: Tel +852 3 594 7844, Fax: Fax +852 3 594 6193, Email [email protected]
Journal: International Medical Case Reports Journal
Citation: 12, 261–264. https://doi.org/10.2147/IMCRJ.S219481
Publication Year and Month: 2019 08
Abstract: Most developed countries eliminated paralytic poliomyelitis (polio) in the 1970s to 1980s. It was believed that after recovery from acute paralytic poliomyelitis, the physical condition of survivors would remain stable for the rest of their lives. However, the elimination of polio does not equate the end of medical management of polio. Hundreds of thousands of polio survivors worldwide are still at risk of developing the late effects of the disease. Here, we report a case of post-polio syndrome who attended our clinic for the presence of new weakness and neuromuscular problems six decades after recovery from paralytic polio. It is essential that health professionals be aware of these conditions and have an understanding of the underlying pathophysiology of the symptoms.
Conclusions: Post-polio syndrome is related to the exhaustion of the motor units that form decades after the polio attack. This case report describes the effectiveness of manual interventions in assisting our patient in restoring the level of function and alleviating pain. The limitation of the current report is that it is just a single case. Further comparison with more existing therapeutic regimens is warranted to clarify these issues.
Outcome of Research: Not applicable
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Category: Falls and Bone Density
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
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Category: Muscle Strength
Title: Patient-report as an option for describing muscle weakness: An integrative review
Author: Bohannon, Richard W.
Affiliation: Department of Physical Therapy, College of Pharmacy and Health Sciences, Buies Creek, NC 27506, USA | Tel.: +1 910 814 4096; E-mail: [email protected]
Journal: Isokinetics and Exercise Science
Citation: vol. Pre-press, no. Pre-press, pp. 1-4, 2019
Publication Year and Month: 2019
Abstract: BACKGROUND: Muscle strength, although usually measured by performance, can be measured by patient-report. OBJECTIVE: Review the utility and clinimetric properties of muscle strength assessed by patient-report. METHODS: PubMed and hand searches were used to identify relevant literature. Findings were systematically summarized. RESULTS: Most patient-report measures identified individuals with muscle weakness, however, the clinimetric properties of measures were highly limited. Particularly missing was information on reliability and responsiveness. CONCLUSIONS: There is a place for the inclusion of patient-reported muscle strength, but clinimetric support for its use is still limited.
Conclusions:
Outcome of Research: More research required
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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
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Category: Coping Styles and Strategies
Title: Post-polio syndrome: psychological adjustment to disability.
Author: Hollingsworth L, Didelot MJ, Levington C.
Affiliation: Purdue University-Calumet, School of Education G-5, 2200 169th Street, Hammond, IN 46323-2094, USA.
Journal: Issues Ment Health Nurs.
Citation: 23(2):135-56.
Publication Year and Month: 2002 03
Abstract: Although the Pan American Health Organization declared in 1995 that polio had been eliminated in the Western Hemisphere, life-altering effects of the disease continue for many survivors. It is known as Post-Polio Syndrome (PPS). The sheer number of individuals experiencing the symptoms has attracted the attention of the medical community. These physical symptoms are severe enough to change the quality of life and require lifestyle changes for people with PPS to cope with the disease. The psychological implications for individuals who must face the reemergence of a disease they thought they had defeated 30 to 40 years ago are staggering. Thus, there is a crucial need for health care professionals, especially mental health nurses and psychotherapists, to address mental health issues that individuals with PPS experience.
Conclusions: There is a crucial need for health care professionals, especially mental health nurses and psychotherapists, to address mental health issues that individuals with PPS experience.
Outcome of Research: More research required
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Category: Quality of Life
Title: FACTORS ASSOCIATED WITH QOL OF POLIO SURVIVORS IN JAPAN
Author: Satoru SAEKI and Kenji HACHISUKA
Affiliation: Department of Rehabilitation Medicine, University of Occupational and Environmental Health.
Moji Medical Center, Kitakyushu, Japan
Journal: JJOMT
Citation: 54 (2006): 84-90.
Publication Year and Month: 2006 02
Abstract: Objectives: To examine the association of impairments and functional disabilities with health-related quality of life (QOL) of polio survivors in Japan.
Design: Cross-sectional survey.
Settings: Post-polio clinic at a university hospital.
Participants: Polio survivors (N=39) with mild muscle weakness living in the community who voluntarily participated in a health examination for post-polio syndrome.
Interventions: Not applicable.
Main Outcome Measures: The Medical Outcome Study 36-Item Short-Form (SF-36).
Results: Mean score on the physical component scale (43.0) of the SF-36 was lower than that of the mental component scale (52.2), and the vitality subscale for men was higher than that for women. Multivariate analyses identified that the physical dimension of the SF-36 was affected by muscle weakness, while the mental dimension of the SF-36 was affected by personal care activities.
Conclusions: Conclusions: Polio survivors with reduced physical functioning may maintain the mental aspect of QOL using their previous coping strategies to fight functional limitations. Coping with new health problems and adapting to the environment should be examined from not only the physical but also the mental viewpoint of QOL for polio survivors.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: Lung function in post-poliomyelitis syndrome: a cross-sectional study
Author: Lira CABD, Minozzo FC, Sousa BS, Vancini RL, Andrade MDS, Quadros AAJ, Oliveira ASB, Silva ACD.
Affiliation: Federal University of Goiás at Jataí, Jataí, Brazil - [email protected]
Journal: Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology)
Citation: J Bras Pneumol. 2013 Jun-Aug; 39(4): 455–460. doi: 10.1590/S1806-37132013000400009
Publication Year and Month: 2013 08
Abstract: OBJECTIVE: To compare lung function between patients with post-poliomyelitis syndrome and those with sequelae of paralytic poliomyelitis (without any signs or symptoms of post-poliomyelitis syndrome), as well as between patients with post-poliomyelitis syndrome and healthy controls.
METHODS: Twenty-nine male participants were assigned to one of three groups: control; poliomyelitis (comprising patients who had had paralytic poliomyelitis but had not developed post-poliomyelitis syndrome); and post-poliomyelitis syndrome. Volunteers underwent lung function measurements (spirometry and respiratory muscle strength assessment).
RESULTS: The results of the spirometric assessment revealed no significant differences among the groups except for an approximately 27% lower mean maximal voluntary ventilation in the post-poliomyelitis syndrome group when compared with the control group (p = 0.0127). Nevertheless, the maximal voluntary ventilation values for the post-poliomyelitis group were compared with those for the Brazilian population and were found to be normal. No significant differences were observed in respiratory muscle strength among the groups.
Conclusions: With the exception of lower maximal voluntary ventilation, there was no significant lung function impairment in outpatients diagnosed with post-poliomyelitis syndrome when compared with healthy subjects and with patients with sequelae of poliomyelitis without post-poliomyelitis syndrome. This is an important clinical finding because it shows that patients with post-poliomyelitis syndrome can have preserved lung function.
Outcome of Research: Not applicable.
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Category: Psychology
Title: Illness narratives of persons with post-polio syndrome
Author: Wenneberg S (1), Ahlström G
Affiliation: (1) Department of Caring Sciences, University of Orebro, Sweden
Journal: Journal of Advanced Nursing
Citation: J Adv Nurs. 2000 Feb;31(2):354-61
Publication Year and Month: 2000 02
Abstract: This qualitative study investigated the lifetime illness experience of individuals with the 'late effects' of polio or post-polio syndrome. Fifteen individuals were interviewed twice about their illness experience and the interviews were transcribed verbatim. The empirical material first underwent a categorization process. The preliminary categories generated through this analysis were then condensed into broader categories which in the final analysis gave rise to the following temporal pattern or stages of the illness experience: (1) the acute phase of polio and subsequent treatment and care; (2) rehabilitation and care at institutions for the disabled; (3) adaptation to a new life; (4) living with the post-polio syndrome today, and finally, (5) memories of the past and apprehensions concerning the future. In spite of the difficult experiences of falling ill and slowly recovering from a life-threatening disease, these individuals have had a good life and accomplished most of their ambitions in the areas of work and family life. Their present psychosocial situation is complicated by the symptoms of the post-polio syndrome which make them more vulnerable to stress, but they are able to handle this burden except when any added strain makes it overwhelming. This potential vulnerability may sometimes express itself as a sudden flashback to traumatic polio experiences and it is therefore important that nurses are aware of the illness history of this patient group.
Conclusions:
Outcome of Research: Not applicable
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Category: Quality of Life
Title: The health-related quality of life of patients suffering from the late effects of polio (post-polio).
Author: Kling C, Persson A, Gardulf A.
Affiliation: Department of Occupational Therapy, Department of Rehabilitation Medicine and The Nursing Care Research and Development Unit, Huddinge University Hospital, Stockholm, Sweden
Journal: Journal of Advanced Nursing
Citation: 2000;32(1):164-73.
Publication Year and Month: 2000 07
Abstract: In Sweden alone, there are today approximately 10 000-16 500 polio survivors. Between 60% and 80% experience new symptoms several years after the initial attack of poliomyelitis. The aims of this study were to investigate and describe the self-rated health-related quality of life and functional status of a group of Swedish patients with post-polio, to investigate whether any differences within the group could be related to demographic or disease-specific data and to compare the post-polio patients with individuals sampled from the general population. Data were obtained by using two questionnaires, the Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL) and the Sickness Impact Profile (SIP). A total of 150 patients, 86 women and 64 men with median age 61 (20-82) years, were consecutively included. The study showed that the patients mainly reported that their physical, functional status was affected by their post-polio condition. Factors found to be associated with the physical, functional status were age and the number of parts of the body affected by the polio. On comparing the post-polio patients with two samples from the Swedish general population, it was found that the patients reported a poorer functional status and health-related quality of life. The women with post-polio reported more pain, as compared with both the men with post-polio and the women in the general population sample. The family life of the patients - in contrast to their physical abilities - did not seem to be affected by the new deteriorating condition. It is concluded that, owing to the wide range of symptoms, the patients with post-polio need care and support from multidisciplinary teams, including nurses and occupational therapists.
Conclusions:
Outcome of Research: More research required
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Category: 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
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Category: Muscular Atrophy
Title: Muscle atrophy is not always sarcopenia
Author: Russell T. Hepple
Affiliation: Department of Kinesiology, Department of Medicine, McGill University, Montreal, Canada
Journal: Journal of Applied Physiology
Citation: J Appl Physiol 113: 677–679, 2012;
doi:10.1152/japplphysiol.00304.2012.
Publication Year and Month: 2012 04
Abstract: The following Viewpoint article uses the histopathology of aging muscle to make the case that sarcopenia of aging is likely distinct from several other clinical causes of muscle atrophy, including some that are now using the term sarcopenia. As will be shown, many of the morphological features of sarcopenia resemble features seen in muscle that has been impacted by sporadic denervation, such as that seen in neurological disorders like amyotrophic lateral sclerosis (7). Due to space constraints, we will only consider how the histopathology of aging
muscle compares with cancer cachexia. However, many of the points made here to distinguish sarcopenia from cancer cachexia should also be considered in other clinical conditions
associated with muscle atrophy.
Conclusions: In summary, the available evidence strongly implicates sporadic and repeating cycles of denervation-reinnervation in the histopathology of aging muscle, including fiber size heterogeneity, fiber type grouping, and MHC coexpression. This point is consistent with the neuromuscular junction deterioration in both human (21) and rodent models (6). These alterations distinguish sarcopenia from cancer cachexia and may also differ from other clinical conditions where aging is not the cause of muscle atrophy but which are currently “borrowing” the term sarcopenia. It should also be pointed out that in contrast to recent arguments that rodents are not suitable models of human muscle aging (23, 32), rodent models faithfully reproduce these hallmark morphological traits of human muscle aging, supporting their value in understanding the mechanisms underlying these phenomena. Finally, although this Viewpoint has focused on histological traits resulting from denervation in aging muscle, there are likely many other morphological, physiological, and molecular traits that also distinguish sarcopenia from other forms of atrophy. Among additional traits that are likely to be relevant are things such as the slow time course of atrophy in sarcopenia, the electrophysiological response to activation (33), the excitation-contraction coupling response (15), alterations in the proteomic profile (13), and likely many others. Thus it is hoped that this Viewpoint will also stimulate broader appreciation for those features so they, too, can be used to further our understanding of the causes of sarcopenia and its treatment.
Outcome of Research: More research required
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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
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Category: Post-Polio Motor Unit
Title: Polioencephalitis and the Brain Fatigue Generator Model of Post-Viral Fatigue Syndromes
Author: Richard L. Bruno, Ph.D., Nancy M. Frick, Lh.D., Susan Creange, M.A., Jerald R. Zimmerman, M.D., and Todd Lewis, Ph.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: Journal of Chronic Fatigue Syndrome
Citation: 1996; Department of Physical Medicine and Rehabilitation (in press)
Publication Year and Month: 1996
Abstract: Fatigue is the most commonly reported and most debilitating Post-Polio Sequelae (PPS) affecting millions of polio survivors world-wide. Post-polio fatigue is associated with: 1) subjective reports of difficulty with attention, cognition, word-finding and maintaining wakefulness; 2) clinically significant deficits on neuropsychological tests of information processing speed and attention; 3) gray and white matter hyperintensities in the reticular activating system on magnetic resonance imaging of the brain; 4) neuroendocrine evidence of impaired activation of the HPA axis. Many of these findings are identical to those documented following a variety of viral encephalitides, including acute poliovirus infection, lethargic encephalitis, Iceland Disease, myalgic encephalomyelitis, and, most recently, Chronic Fatigue Syndrome. The clinical, historic, neuropsychologic, neuroanatomic and physiologic parallels between poliovirus infection, post-polio fatigue and post-viral fatigue syndromes (PVFS) will be explored in an attempt to describe the pathophysiology of PVFS. The disinhibition of a putative Brain Fatigue Generator will be implicated as a cause of the subjective symptoms and objective signs that accompany PVFS. The results of a pilot placebo-controlled study of a dopamine 2 receptor agonist to treat post-polio fatigue will also be described.
Conclusions:
Outcome of Research: Not applicable
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Category: Women's Health
Title: Caesarean Section in Post-polio Patient
Author: de Oliveira AR, Schutz Martinelli E, Lisiane L.
Affiliation: Roth and Roth Anesthesia Clinic, Rio Grande do Sul, Brazil
Hospital Moinhos de Vento, Rio Grande do Sul, Brazil
Hospital Nossa Senhora Conceicao, Rio Grande do Sul, Brazil
Journal: Journal of Clinical Research in Anesthesiology
Citation: 1(1):1-2
Publication Year and Month: 2018 01
Abstract: A 26-year-old primigravida patient, ASA I, 39-week gestation, presented with 24 h premature rupture of membranes, without active labor. She had been in anesthetic pre-operative clinic 2 weeks before and had described poliomyelitis with 1 year old and complete recovering in childhood. With 16-year-old, she was submitted to appendicectomy through spinal anesthesia presenting weakness in entire body for approximately 24 h. At physical examination, the only sign was shorter tibial tendon of both legs.
For the cesarean, after volume expansion with cristaloids, the choice was an epidural anesthesia with 15mg of bupivacaine 0.3% (without epinephrine) and morphine 2 mg. “The surgery was initiated after 4min of blockade with T4 sensitive level reached. Hypotension and tachycardia were corrected with metaraminol 1 mg.” After 50 min, the procedure was finished with the same metameric level of anesthesia, but with cardiovascular stability. The entire recovering from anesthesia has occurred after 11h. An elevated consume of analgesics (nonsteroidal inflammatory drugs and opioids) and antiemetics was observed.
Conclusions: Ultimately, the decision to use general or regional anesthesia should be made on an individual patient basis weighing the risks and benefits. This case report describes some of the fewest practical guidelines available about regional anesthesia in post-polio patients with minimal sequelae. The importance of communications about these cases and the anesthetic conduct in this setting needs more debate to
optimize the facilities in another similar case.
Outcome of Research: Effective
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Category: Polio Immunisation
Title: Field study of fecal excretion as a decision support tool in response to silent reintroduction of wild-type poliovirus 1 into Israel
Author: Moran-Gilad J (1), Mendelson E (2), Burns CC (3), Bassal R (4), Gdalevich M (5), Sofer D (6), Oberste MS (3), Shulman LM (2), Kaliner E (7), Hindiyeh M, Mor O (6), Shahar L (5), Iber J (3), Yishay R (8), Manor J (6), Lev B (9), Gamzu R (10), Grotto I (11)
Affiliation: (1) Public Health Services, Ministry of Health, Jerusalem, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; (2) Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel; School of Public Health, Tel-Aviv University, Tel-Aviv, Israel; (3) Viruses Branch, Centers for Disease Control and Prevention, Atlanta, USA; (4) Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Israel; (5) Southern District Health Office, Ministry of Health, Beer-Sheva, Israel; (6) Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Israel; (7) Public Health Services, Ministry of Health, Jerusalem, Israel; (8) Department of Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel; (9) Directorate, Ministry of Health, Jerusalem, Israel; (10) School of Public Health, Tel-Aviv University, Tel-Aviv, Israel; Directorate, Ministry of Health, Jerusalem, Israel; (11) Public Health Services, Ministry of Health, Jerusalem, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Journal: Journal of Clinical Virology
Citation: J Clin Virol. 2015 May;66:51-5. doi: 10.1016/j.jcv.2015.03.005. Epub 2015 Mar 10
Publication Year and Month: 2015 05
Abstract: BACKGROUND: Israel has used an inactivated polio vaccine (IPV)-only schedule since 2005 (95% coverage). Silent reintroduction of wild type poliovirus 1 (WPV1) into Israel in early 2013 was detected in Southern Israel via routine environmental surveillance without clinical cases.
OBJECTIVES: To estimate the rate of WPV1 excretion by age and residence and inform decision-making regarding supplemental immunization with OPV.
STUDY DESIGN: A convenience sample of Bedouin and Jewish residential areas in the epicenter of the incident, focusing on under 8 year-olds who not previously given OPV. Fecal samples were directly tested for WPV1 RNA using a novel qRT-PCR assay. Positive samples were confirmed by gold standard cell culture and subject to genotyping.
RESULTS: Overall, 2196 non-duplicate fecal samples were collected and analyzed. WPV1 was detected in 61 samples (2.8%), 55 of which (90.2%) were from Bedouins. WPV1 excretion rates were 5.4% among Bedouins and 0.6% among Jewish individuals. Respective age-specific rates among Bedouin and Jewish children were 4.9% and 0.2% for 0-2 years and 7.2% and 1.7% for 2-8 years. Molecular testing had 89.5% sensitivity (higher than culture) and 100% specificity.
Conclusions: The rapid performance of a field study to evaluate WPV1 excretion unequivocally demonstrated substantial WPV1 infection rates among children under 8 years in Southern Israel, thus informing the decision to vaccinate this age group with bOPV and risk communication to both healthcare personnel and the public. Rapid development and implementation of molecular screening can thus underpin risk assessment and management in complex epidemiological situations.
Outcome of Research:
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Category: Post-Polio Motor Unit
Title: Motor Unit Number Index (MUNIX) as a biomarker of motor unit loss in post-polio syndrome versus needle EMG
Author: Malgorzata Gawel, Ewa Zalewska, Elżbieta Szmidt-Salkowska, Marta Lipowska, Anna Lusakowska, Anna M.Kaminska, Anna Kostera-Pruszczyk
Affiliation: Department of Neurology, Medical University of Warsaw, 02-097 Warsaw, Banacha 1A str., Poland
Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, 02-109 Warsaw, Ks. Trojdena 4 str., Poland
Journal: Journal of Electromyography and Kinesiology
Citation: Volume 46, June 2019, Pages 35-40
Publication Year and Month: 2019 06
Abstract: MUNIX method (Motor Unit Number Index) had been not used to assess number of motor neurons in post-polio syndrome in contrary to needle electromyography.
Objectives
To confirm if MUNIX reflects motor unit loss and clinical stage and to assess difference in MUNIX and EMG results between muscles in different stage.
Methods
132 Muscles (MUNIX) and 96 (EMG) in 12 patients were studied and divided into groups: with normal strength(N), stable weakness and atrophy(S), new weakness and atrophy(W).
Results
In PPS group MUNIX global was 561.36 ± 282.6 (right 6 muscles) and 561.27 ± 281.1 (left) significantly lower than in control group (six muscles 1139.6 ± 164.5) (p < 0.05). MUNIX global correlated with MRC global. MUNIX was greater in muscles with normal strength (95–100% of normal values) than in those with stable weakness (48%-0% of normal values) and new weakness (65%-0% of normal values). Respectively to clinical stage of muscle MUP (motor unit potential) amplitude increased to 350% of normal value, from 250% to 110%, and from 300% to 700%. No correlation was found between MUP parameters and MRC values.
Conclusions: MUNIX reflects motor dysfunction and could be a good biomarker for loss of motor neurons in PPS.
Outcome of Research: More research required
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Category: Acute Flaccid Paralysis
Title: Acute Flaccid paralysis in adults: Our experience
Author: Kaushik R (1), Kharbanda PS (2), Bhalla A (1), Rajan R (2), Prabhakar S (2)
Affiliation: (1) Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India; (2) Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
Journal: Journal of Emergencies, Trauma, and Shock
Citation: J Emerg Trauma Shock. 2014 Jul-Sep; 7(3): 149–154. doi: 10.4103/0974-2700.136847
Publication Year and Month: 2014 07
Abstract: Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis.
MATERIALS AND METHODS: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried out. The patients were followed through their hospital stay till discharge or death.
RESULTS: The mean age was 33.27 (range 13-89) years with male preponderance (67.7%). The most common etiology was neuroparalytic snake envenomation (51.9%), followed by Guillain Barre syndrome (33.1%), constituting 85% of all patients. Hypokalemic paralysis (7.5%) and acute intermittent porphyria (4.5%) were the other important conditions. We did not encounter any case of acute poliomylitis in adults. In-hospital mortality due to respiratory paralysis was 9%.
Conclusions: Neuroparalytic snakebite and Guillain Barre syndrome were the most common causes of acute flaccid paralysis in adults in our study.
Outcome of Research: Not applicable
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Category: Complementary Therapies
Title: Pitting oedema in a polio survivor with lumbar radiculopathy complicated disc herniation
Author: Eric Chun Pu Chu, Aaron Ka Chun Chan, Andy Fu Chieh Lin
Affiliation: New York Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, China
Journal: Journal of Family Medicine and Primary Care
Citation: Volume : 8 | Issue : 5 | Page : 1765-1768
Publication Year and Month: 2019 05
Abstract: We report a 58-year-old male with sequelae of polio who presented with low back and left buttock pain, and pitting oedema of both legs for four months. The patient had a history of poliomyelitis at the age of 1 year which resulted in bilateral lower leg weakness, particularly on the left side. Magnetic resonance imaging showed cervical spinal stenosis secondary to posterior osteophyte formation, left paracentral disc extrusion at L2/L3 and L3/L4 levels with compression of the traversing L4 nerve root. The findings confirmed a diagnosis of lumbar radiculopathy caused by a herniated disc. The patient subsequently underwent a chiropractic treatment. The painful symptoms and pitting oedema in this case resolved with spinal adjustment in addition to scraping therapy to strengthen bilateral low back and the gluteal muscles. This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation. The pathophysiological mechanism is elusive, but might involve a complexity of cytokine-mediated inflammation and interconnection between somatic and autonomic nervous systems.
Conclusions: This case provides circumstantial evidence of a scarcely mentioned association between pitting oedema and lumbar radiculopathy caused by disc herniation.
Outcome of Research: More research required
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Category: Exercise
Title: The development of an instrument to assess post-exertional malaise in patients with myalgic encephalomyelitis and chronic fatigue syndrome
Author: Leonard A Jason, Carly S Holtzman, Madison Sunnquist, Joseph Cotler
Affiliation: Department of Psychology, DePaul University, Chicago, IL 60614, USA. Email: [email protected]
Journal: Journal of Health Psychology
Citation: Article first published online: October 24, 2018
Publication Year and Month: 2018 10
Abstract: Post-exertional malaise, or a variation of this term, is a key symptom of myalgic encephalomyelitis and chronic fatigue syndrome, as this symptom is mentioned in almost all myalgic encephalomyelitis and chronic fatigue syndrome case definitions. Until now there has not been a comprehensive questionnaire to assess post-exertional malaise. To rectify this situation, in this article we describe the development of a new questionnaire, called the DePaul Post-Exertional Malaise Questionnaire, which was based on input from hundreds of patients. Preliminary validation was provided by the findings of significant and predictable relationships between different domains of this post-exertional malaise questionnaire and physical functioning.
Conclusions:
Outcome of Research: More research required
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Category: Polio Immunisation
Title: Applying the concept of peptide uniqueness to anti-polio vaccination
Author: Kanduc D (1), Fasano C (1), Capone G (1), Pesce Delfino A (2), Calabrò M (2), Polimeno L (2)
Affiliation: (1) Department of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, 70126 Bari, Italy; (2) Department of Emergency and Organ Transplantation (DETO), University of Bari, 70124 Bari, Italy
Journal: Journal of Immunology Research
Citation: J Immunol Res. 2015;2015:541282. Epub 2015 Oct 19
Publication Year and Month: 2015 10
Abstract: BACKGROUND: Although rare, adverse events may associate with anti-poliovirus vaccination thus possibly hampering global polio eradication worldwide.
OBJECTIVE: To design peptide-based anti-polio vaccines exempt from potential cross-reactivity risks and possibly able to reduce rare potential adverse events such as the postvaccine paralytic poliomyelitis due to the tendency of the poliovirus genome to mutate.
METHODS: Proteins from poliovirus type 1, strain Mahoney, were analyzed for amino acid sequence identity to the human proteome at the pentapeptide level, searching for sequences that (1) have zero percent of identity to human proteins, (2) are potentially endowed with an immunologic potential, and (3) are highly conserved among poliovirus strains.
RESULTS: Sequence analyses produced a set of consensus epitopic peptides potentially able to generate specific anti-polio immune responses exempt from cross-reactivity with the human host.
Conclusions: Peptide sequences unique to poliovirus proteins and conserved among polio strains might help formulate a specific and universal anti-polio vaccine able to react with multiple viral strains and exempt from the burden of possible cross-reactions with human proteins. As an additional advantage, using a peptide-based vaccine instead of current anti-polio DNA vaccines would eliminate the rare post-polio poliomyelitis cases and other disabling symptoms that may appear following vaccination.
Outcome of Research: More research required
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Category: Drugs
Title: 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:
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Category: Inflammation
Title: Elevated plasma inflammatory mediators in post-polio syndrome: No association with long-term functional decline
Author: Bickerstaffe A, Beelen A, Lutter R, Nollet F
Affiliation: Department of Rehabilitation, AMC, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
Journal: Journal of Neuroimmunology
Citation: J Neuroimmunol. 2015 Dec 15;289:162-7. doi: 10.1016/j.jneuroim.2015.10.019. Epub 2015 Nov 11
Publication Year and Month: 2015 12
Abstract: A key feature of post-polio syndrome (PPS) is progressive loss of muscle strength. In other chronic diseases systemic inflammation has been linked to muscle wasting. In this study plasma TNF-α, IL-6, IL-8, and leptin levels were significantly increased in PPS-patients compared to healthy controls. There was however no association between these raised systemic levels of inflammatory mediators and long-term decline in quadriceps strength or other clinical parameters. In conclusion, there is evidence for systemic inflammation in PPS, yet the relationship with clinical deterioration remains tenuous.
Conclusions:
Outcome of Research: Not applicable
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Category: Drugs
Title: Intravenous immunoglobulin treatment of the post-polio syndrome: sustained effects on quality of life variables and cytokine expression after one year follow up
Author: Gonzalez H (1), Khademi M (2), Borg K (1), Olsson T (2)
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, blg 39, fl 3, S-192 88, Stockholm, Sweden; (2) Neuroimmunology Unit, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Journal: Journal of Neuroinflammation
Citation: Journal of Neuroinflammation. 2012; 9: 167. doi: 10.1186/1742-2094-9-167
Publication Year and Month: 2012 07
Abstract: BACKGROUND: Expression of inflammatory cytokines in cerebrospinal fluid (CSF) has led to the hypothesis of intrathecal chronic inflammation to explain the denervation observed in post-polio syndrome (PPS). It has been shown that therapy with intravenous immunoglobulin (IVIG) improves physical performance and dampens down the inflammatory process at 6 months in PPS patients. We here examined the effects of IVIG on cytokine expression and clinical outcome one year after IVIG treatment.
METHODS: From a previous study with 135 PPS patients included, 41 patients were further evaluated before un-blinding for one year (21 placebo and 20 treated with IVIG, Xepol® 50 mg/ml), and were assessed for clinical variables by performing the Short Form-36 survey (SF-36) questionnaire assessment, the 6 minute walk distance test (6MWT) and registering pain level by Visual Analogue Scale (VAS) after IVIG treatment. A separate cohort of 37 PPS patients went through lumbar puncture (LP) at baseline and 20 patients, treated with IVIG, repeated the LP one year later. Thirty patients affected with other neurological diseases (OND) were used as control group. Inflammatory cytokines TNF, TGFβ, IFNγ, IL-23, IL-13 and IL-10 were measured in blood cells and CSF cells with RT-PCR.
RESULTS: Scores of the physical components of SF-36 were significantly higher at the one year follow up time-point in the IVIG-treated patients when compared to baseline as well as to the control subjects. Pain VAS score and 6MWT improved significantly in the IVIG-treated patients when compared with baseline Relative expression of TNF and IFN-γ in both PBMCs and CSF from PPS patients were increased compared to OND subjects at baseline (p < 0.05). One year after IVIG-treatment a decreased expression of IFN-γ and IL23 was found in CSF of PPS patients, while anti-inflammatory IL-13 was increased (p < 0.05).
Conclusions: IVIG has effects on relevant QoL variables and inflammatory cytokines up to one year in patients with PPS. This gives a basis for scheduling IVIG in upcoming trials with this therapy.
Outcome of Research: More research required.
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Category: Pain
Title: Analysis of long-standing nociceptive and neuropathic pain in patients with post-polio syndrome
Author: Werhagen L, Borg K
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, Stockholm, Sweden. [email protected]
Journal: Journal of Neurology
Citation: J Neurol. 2010 Jun;257(6):1027-31. doi: 10.1007/s00415-010-5456-0
Publication Year and Month: 2010 06
Abstract: The purpose of this study was to analyze pain, both nociceptive and neuropathic, in patients with post-polio syndrome (PPS) and relate the pain to age at the initial polio infection, age at examination, to gender and disability. The study was conducted in a university hospital department. Patients with PPS were interviewed at their regular visits about pain, its character, intensity and localization. A clinical examination, including a thorough neurological examination, was performed. Data included age at time of polio infection, age at time of examination and gender. Pain intensity was measured with the VAS-scale and walking capability by the WISCI-scale. One hundred sixty-three (88 women, 75 men) patients were included in the study. Pain was present in 109 (67%). Pain was more frequently reported by women (82%) than by men (49%). 96 patients experienced nociceptive pain, 10 patients both neuropathic and nociceptive pain and three experienced pure neuropathic pain. Half of the patients with pain experienced pain in more than one body region. When neuropathic pain was present, another additional neurological disorder was diagnosed. Pain was more often found in younger patients (around 70%) than in older patients (around 50%). In summary pain is common in patients with PPS and most patients experienced nociceptive pain. Women have pain more often than men. Older patients experience pain more seldom than younger patients. Age at time of primary polio infection is important for the development of pain. When neuropathic pain is present, it is important to proceed with neurological examination to find an adequate diagnosis.
Conclusions:
Outcome of Research: Not applicable.
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Category: Drugs
Title: IVIG treatment in post-polio patients: evaluation of responders
Author: Ostlund G (1), Broman L, Werhagen L, Borg K
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Building 39, 3rd floor, 182 88 Stockholm, Sweden
Journal: Journal of Neurology
Citation: J Neurol. 2012 Dec;259(12):2571-8. doi: 10.1007/s00415-012-6538-y. Epub 2012 May 17
Publication Year and Month: 2012 05
Abstract: The aim of this work is to evaluate the outcome of IVIG treatment in patients with post-polio syndrome (PPS) and to identify responders. The study included 113 PPS patients who had received one IVIG treatment in an open trial, prospective follow-up study. Clinical examination was performed and clinical data were retrieved from medical records. The short form 36 (SF-36), physical activity scale for the elderly (PASE), and the visual analogue scale (VAS) were used as measurements of quality of life, physical activity, and the intensity of pain. Data before treatment and at 6-month follow-up were collected. Analysis was performed in subgroups based on demographic and medical parameters. A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. A trend was found in patients with PPS as the only diagnosis. IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. Age below 65 years, paresis in the lower extremities, and lack of concomitant disorders may be the main indicators for a future identification of responders.
Conclusions:
Outcome of Research: Effective
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Category: Drugs
Title: Pyridostigmine in postpolio syndrome: no decline in fatigue and limited functional improvement
Author: Horemans H (1), Nollet F (1), Beelen A (1), Drost G (2), Stegeman D (2), Zwarts M (2), Bussmann J (3), de Visser M (4), Lankhorst G (1)
Affiliation: (1) Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, Netherlands; (2) Department of Clinical Neurophysiology, University Medical Centre Nijmegen, Netherlands; (3) Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Netherlands; (4) Department of Neurology, Academic Medical Centre, University of Amsterdam, Netherlands
Journal: Journal of Neurology, Neurosurgery and Psychiatry
Citation: J Neurol Neurosurg Psychiatry 2003;74:1655-1661 doi:10.1136/jnnp.74.12.1655
Publication Year and Month: 2003 12
Abstract: OBJECTIVES: To investigate the effect of pyridostigmine on fatigue, physical performance, and muscle function in subjects with postpoliomyelitis syndrome.
METHODS: 67 subjects with increased fatigue and new weakness in one quadriceps muscle showing neuromuscular transmission defects, were included in a randomised, double blind, placebo controlled trial of 60 mg pyridostigmine four times a day for 14 weeks. Primary outcome was fatigue (on the "energy" category of the Nottingham health profile). Secondary outcomes included two minute walking distance and quadriceps strength and jitter. Motor unit size of the quadriceps was studied as a potential effect modifier. The primary data analysis compared the changes from baseline in the outcomes in the last week of treatment between groups.
RESULTS: 31 subjects treated with pyridostigmine and 31 subjects treated with placebo completed the trial. No significant effect of pyridostigmine was found on fatigue. The walking distance improved more in the pyridostigmine group than in the placebo group (by 7.2 m (6.0%); p<0.01). Subgroup analysis showed that a significant improvement in walking performance was only found in subjects with normal sized motor units. Quadriceps strength improved more in the pyridostigmine group than in the placebo group (by 6.7 Nm (7.2%); p = 0.15). No effect of pyridostigmine was found on jitter.
Conclusions: Pyridostigmine in the prescribed dose did not reduce fatigue in subjects with postpoliomyelitis syndrome. However, it may have a limited beneficial effect on physical performance, especially in subjects with neuromuscular transmission defects in normal sized motor units.
Outcome of Research: More research required.
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Category: Vocational Implications
Title: Workplace disability management in postpolio syndrome
Author: Saeki S, Takemura J, Matsushima Y, Chisaka H, Hachisuka K
Affiliation: Department of Rehabilitation Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka 807-8555, Japan
Journal: Journal of Occupational Rehabilitation
Citation: J Occup Rehabil. 2001 Dec;11(4):299-307
Publication Year and Month: 2001 12
Abstract: Postpolio 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. These new problems may lead to loss of employment as well as new deficits in instrumental activities in daily living (cleaning, washing, shopping, transportation, etc.), walking, climbing stairs, and personal assistance. We presented three cases of PPS with working disabilities in Japan, and stated the issues confronted with. Particularly at the workplace, PPS individuals need special supports from both rehabilitation medicine and occupational health services, including improved nutrition, achieving ideal body weight, regular and sensible exercise, frequent checkups, and modifying working conditions.
Conclusions:
Outcome of Research: Not applicable
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Category: Orthoses
Title: The Benefit of a Flexible Ankle-Foot Orthosis on Balance and Walking Ability in Persons With Late Effects of Polio: A Mixed-Methods Study
Author: Brogårdh, Christina RPT, PhD (1,2); Espelund, Christina RPT, MSc (2); Lexell, Jan MD, PhD, DPhilhc (1,3)
Affiliation: 1 Department of Health Sciences, Lund University, Lund, Sweden.
2 Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
3 Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
Journal: Journal of Orthotics and Prosthetics
Citation: Journal of Prosthetics and Orthotics 31(2):p 95-103, April 2019. | DOI: 10.1097/JPO.0000000000000249
Publication Year and Month: 2019 04
Abstract: Introduction
Many persons with late effects of polio (LEoP) have muscle weakness in the lower limbs, which affects their balance and walking ability. Although an ankle-foot orthosis (AFO) is commonly prescribed for these persons, there is limited knowledge if an AFO improves their balance and walking ability in terms of speed, distance, and perceived safety. The aims of this study were 1) to assess if a flexible AFO improves dynamic balance as well as indoor and outdoor walking in persons with mild to moderate LEoP and 2) to describe the participants' own perceptions of walking ability and safety, as well as advantages and disadvantages with an AFO.
Materials and Methods
A mixed-methods, repeated-measures, crossover design was used. Nineteen participants were assessed at two test occasions, with and without an AFO, with a 1-week interval. Dynamic balance was evaluated with the timed up and go (TUG) test and walking ability by the 10-m fast gait speed (FGS) tests, the 6-minute walk test (6MWT), and timed walking over a 340-m-long pathway outdoors. The Borg Rating of Perceived Exertion (RPE) scale was used to assess perceived exertion. The participants' perceptions of their walking ability and safety as well as advantages and disadvantages with an AFO were evaluated with questionnaires.
Results
The AFO significantly improved (P < 0.05) gait speed, outdoor walking, and reduced perceived exertion at one of the test occasions, but had no effect on dynamic balance (P > 0.6). A majority perceived significantly improved walking ability (P < 0.05) and increased walking safety (P < 0.01) with the AFO. Perceived advantages of the AFO were feelings of increased stability and walking distance and reduced risk of falling. Disadvantages were that it could be difficult to put on and uncomfortable to wear.
Conclusions: Conclusions
A flexible AFO marginally improves walking ability in persons with LEoP, as assessed quantitatively, but the subjective benefit of walking ability and safety suggests that a flexible AFO can be useful to improve daily functioning. In the future, the design of the AFOs needs to be more user-friendly.
Outcome of Research: More research required
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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
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Category: Inflammation
Title: Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation.
Author: Gonzalez H, Ottervald J, Nilsson KC, et al
Affiliation: Karolinska Institute, Sweden
AstraZeneca, Sweden
Lund Technical University, Sweden
Journal: Journal of Proteomics
Citation: 2009 Jan 30;71(6):670-81
Publication Year and Month: 2009 01
Abstract: Survivors of poliomyelitis often develop increased or new symptoms decades after the acute infection, a condition known as post-polio syndrome (PPS). The condition affects 20-60% of previous polio patients, making it one of the most common causes of neurological deficits worldwide. The underlying pathogenesis is not fully understood and accurate diagnosis is not feasible. Herein we investigated whether it was possible to identify proteomic profile aberrations in the cerebrospinal fluid (CSF) of PPS patients. CSF from 15 patients with well-defined PPS were analyzed for protein expression profiles. The results were compared to data obtained from nine healthy controls and 34 patients with other non-inflammatory diseases which served as negative controls. In addition, 17 samples from persons with secondary progressive multiple sclerosis (SPMS) were added as relevant age-matched references for the PPS samples. The CSF of persons with PPS displayed a disease-specific and highly predictive (p=0.0017) differential expression of five distinct proteins: gelsolin, hemopexin, peptidylglycine alpha-amidating monooxygenase, glutathione synthetase and kallikrein 6, respectively, in comparison with the control groups. An independent ELISA confirmed the increase of kallikrein 6. We suggest that these five proteins should be further evaluated as candidate biomarkers for the diagnosis and development of new therapies for PPS patients.
Conclusions: Protein analysis employing classical proteomics combined with multivariate modeling and identification using mass spectrometry resulted in the discovery of three differentially
expressed proteins or their fragments in PPS samples as compared to in controls. This firstly suggests that these proteins may exert key roles in PPS patophysiology. Secondly, these proteins and their fragments represent potential candidates as biomarkers for the disease. To merit as true biomarkers studies will be required in larger materials of PPS and a variety of other CNS diseases.
Notably, however, in comparison with samples from SPMS (being an age-matched control group with ongoing inflammation and neuronal destruction), the most predictive proteins were specific for PPS.
In conclusion, we herein demonstrate a protein profile, based on its high predictive value, has the potential to serve as a diagnostic biomarker for PPS. The proteins identified in this study are known to be involved in different pathways associated with tissue damage and apoptosis. These data and previous observations of inflammation and cytokine production provide strong support for the hypothesis that PPS is caused by an active inflammatory and neurodegenerative process. There is consequently potential for various modes of anti-inflammatory and/or neuroprotective therapy.
Outcome of Research: More research required
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Category: Quality of Life
Title: Quality of life in Hungarian polio survivors
Author: Erika Viktória Miszory (1), Melinda Járomi (2) & Annamária Pakai (3)
Affiliation: 1. University of Pécs Faculty of Health Sciences Doctoral School of Health Sciences, Hungary, Hungarian Defence Forces Medical Centre, Institute of Rehabilitation Hévíz, Hévíz, Hungary
2. University of Pécs Faculty of Health Sciences, Institute of Physiotherapy and Sport Science, Pécs, Hungary
3. University of Pécs Faculty of Health Sciences, Institute of Nursing Sciences, Basic Health Sciences and Health Visiting, Pécs, Hungary
Journal: Journal of Public Health
Citation: (Berl.) (2021).
https://doi.org/10.1007/s10389-020-01459-w
Publication Year and Month: 2021 02
Abstract: AIM
The number of Hungarian polio patients can be estimated at approximately 3000. Polio infection is currently affecting people 56–65 years of age. The aim of the study was to reveal the quality of life of patients living with polio virus in Hungary.
SUBJECT AND METHODS
The quantitative cross-sectional study was conducted in January–April 2017 among polyomyelitis patients living in Hungary. In the non-random, targeted, expert sample selection, the target group was composed of patients infected with poliovirus (N = 268). We have excluded those who refused to sign the consent statement. Our data collection method was an SF-36 questionnaire. Using the IBM SPSS Statistics Version 22 program, descriptive and mathematical statistics (χ2-test) were calculated (p < 0.05).
RESULTS
The mean age of the members of the examined population is 63.5 years; 68.1% were women and 31.90% were men. The majority of the respondents were infected by the polyovirus in 1956 (11.9%), 1957 (24.3%), and 1959 (19.5%). Polio patients, with the exception of two dimensions (mental health, social operation), on the scale of 100 do not reach the “average” quality of life (physical functioning 23 points, functional role 36 points, emotional role 47 points, body pain 48 points, general health 42 points, vitality 50 points, health change 31 points).
CONCLUSION
The quality of life of polio patients is far below the dimensions of physical function, while the difference in mental health compared to healthy people is minimal. It would be important to educate health professionals about the existing disease, to develop an effective rehabilitation method.
Conclusions: The quality of life of polio patients is far below the dimensions of physical function, while the difference in mental health compared to healthy people is minimal. It would be important to educate health professionals about the existing disease, to develop an effective rehabilitation method.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: Diaphragmatic dysfunction
Author: J.Ricoy, N.Rodríguez-Núñez, J.M.Álvarez-Dobaño, M.E.Toubes, V.Riveiro, L.Valdés
Affiliation: Pneumology Service, University Hospital Complex of Santiago, Santiago de Compostela, Spain
Interdisciplinary Research Group in Pulmonology, Institute of Sanitary Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
Journal: Journal of Pulmonology
Citation: PULMOE-1323;No. of Pages 13
Publication Year and Month: 2018
Abstract: The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival.
Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres.
This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.
Conclusions:
Outcome of Research: More research required
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Category: Pain, Quality of Life
Title: Impact of pain on quality of life in patients with post-polio syndrome
Author: Werhagen L, Borg K
Affiliation: Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2013; 45: 161–163. doi: 10.2340/16501977-1096
Publication Year and Month: 2013 00
Abstract: OBJECTIVE: Post-polio syndrome is a neurological disorder occurring several years after an acute polio infection. The main symptoms are increased muscular weakness and atrophy, fatigue and pain. Pain is present more often in younger individuals and in females and, according to the visual analogue scale (VAS), the intensity of pain is relatively high. The aim of the present study was to analyse the impact of pain on quality of life in patients with post-polio syndrome.
DESIGN: Transversal study.
PATIENTS AND METHODS: Patients with post-polio syndrome underwent a thorough neurological and general examination. They were interviewed about the presence and intensity of pain during the previous 3 months, then completed the quality of life inventory Short-Form 36 (SF-36), which included questions about pain during the previous 4 weeks, and rated their pain intensity during the previous 24 h according to the VAS.
RESULTS: Seventy-seven of the patients (68%) experienced pain at the examination. Pain was found to have a significant impact on the SF-36 subdomains Vitality and General health. A correlation was found between pain during the previous 3 months, the previous 4 weeks, and the previous 24 h.
DISCUSSION: Pain is common in patients with post-polio syndrome. Although patients have a high mean VAS score the pain only affects quality of life for Vitality and General Health, but not for other physical and mental domains.
Conclusions:
Outcome of Research: Not applicable.
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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.
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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.
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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.
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Category: Muscle Strength
Title: Reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio
Author: Flansbjer UB, Lexell J
Affiliation: Department of Rehabilitation, Skåne University Hospital, Orupssjukhuset, Lund, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Jun;42(6):588-92. doi: 10.2340/16501977-0561
Publication Year and Month: 2010 06
Abstract: OBJECTIVE: To assess the reliability of knee extensor and flexor muscle strength measurements in persons with late effects of polio.
DESIGN: A test-retest reliability study.
SUBJECTS: Thirty men and women (mean age 63 (standard deviation 6.4) years) with verified late effects of polio.
METHODS: Knee extensor and flexor muscle strength in both lower limbs were measured twice 7 days apart using a Biodex dynamometer (isokinetic concentric contractions at 60°/s and isometric contractions with knee flexion angle 90º) and a Leg Extension/Curl Rehab exercise machine with pneumatic resistance (HUR) (isotonic contractions). Reliability was assessed with the intraclass correlation coefficient (ICC1,1), the mean difference between the test sessions (đ) together with the 95% confidence intervals for đ, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%) and Bland-Altman graphs.
RESULTS: Test-retest agreements were high, (ICC1,1 0.93–0.99) and measurement errors generally small. The SEM% was 4–14% and the SRD% 11–39%, with the highest values for the isokinetic measurements.
Conclusions: Knee muscle strength can be measured reliably and can be used to detect real changes after an intervention for a group of persons with late effects of polio, whereas the values may be too high for single individuals or to detect smaller short-term changes over time for a group of individuals.
Outcome of Research: Not applicable.
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Category: Fatigue
Title: Cognitive functioning in post‐polio patients with and without general fatigue
Author: Ostlund G, Borg K, Wahlin A.
Affiliation: Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden.
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):147-51
Publication Year and Month: 2005 03
Abstract: OBJECTIVE AND DESIGN: This study examined 2 main hypotheses. First, whether patients with post-polio suffering from general fatigue (n=10) demonstrate cognitive deficits compared with patients with post-polio without general fatigue (n=10). Secondly, by systematically varied test order administration we examined whether such differences varied as a function of increasing cognitive load during cognitive testing.
SUBJECTS: Twenty patients diagnosed with post-polio syndrome, 10 with general fatigue and 10 without fatigue.
RESULTS: Neither of the 2 hypotheses were confirmed. The group with general fatigue reported elevated levels of depression. However, no systematic association between level of depression and cognitive performance could be detected.
Conclusions: The results of this study provide no evidence that general fatigue or cognitive load affects cognitive functioning in post-polio.
Outcome of Research: Not effective.
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Category: Activity Levels
Title: Walking in postpoliomyelitis syndrome: the relationships between time‐scored tests, walking in daily life and perceived mobility problems
Author: Horemans HL, Bussmann JB, Beelen A, Stam HJ, Nollet F
Affiliation: Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2005 May;37(3):142-6.
Publication Year and Month: 2005 05
Abstract: OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome.
SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome.
METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile.
RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity.
Conclusions: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.
Outcome of Research: Not applicable.
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Category: Drugs
Title: Effect of intravenous immunoglobulin in patients with post-polio syndrome - an uncontrolled pilot study
Author: Kaponides G, Gonzalez H, Olsson T, Borg K
Affiliation: Department of Public Health Sciences, Division of Rehabilitation Medicine, Stockholm, Sweden - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2006 Mar;38(2):138-40
Publication Year and Month: 2006 03
Abstract: OBJECTIVE: To analyse changes in muscle strength, physical performance and quality of life during intravenous immunoglobulin (IVIg) treatment in patients with post-polio syndrome.
DESIGN: Open clinical trial.
PATIENTS: A total of 14 patients (6 women, 8 men; mean age 57 years, range 43-67 years) were included in the study.
INTERVENTION: Treatment with 90 g IVIg (30 g daily for 3 days).
MAIN OUTCOME: Muscle strength, measured with dynamic dynamometry, muscle function, by means of performing the 6-minute walk test, and quality of life, analysed by means of the SF-36 questionnaire, were performed before and after treatment.
RESULTS: For quality of life there was a statistically significant improvement for all but one of the 8 multi-item scales of SF-36 when comparing data before and after treatment with IVIg. The multi-item scale most improved was Vitality. There was no significant increase in muscle strength and physical performance.
Conclusions: Data indicate that IVIg may have a clinically relevant effect, with an improvement in quality of life. The effect may be due to a decrease in an inflammatory process in the central nervous system, which earlier has been reported in patients with past-polio syndrome after IVIg treatment. Since a possible placebo effect cannot be ruled out, a randomized controlled study is needed.
Outcome of Research: More research required.
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Category: Speech Pathology
Title: Myasthenia gravis masquerading as post-poliomyelitis syndrome
Author: Singh R, Pentland B
Affiliation: Rehabilitation Medicine Unit, Astley Ainslie Hospital, Edinburgh, UK - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2006 Mar;38(2):136-7
Publication Year and Month: 2006 03
Abstract: A 79-year-old man with previous bulbar poliomyelitis developed dysphagia and was diagnosed as having post-polio syndrome. Over 2 years, his swallowing deteriorated and he suffered an aspiration pneumonia. Only after the subsequent development of fatigue and facial weakness was myasthenia gravis diagnosed. Diagnostic criteria for post-polio syndrome include the exclusion of all other neurological conditions such as myasthenia gravis. Moreover, in any instance where a patient develops new symptoms, it is advisable to reconsider the original diagnosis.
Conclusions:
Outcome of Research: Not applicable.
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Category: Fatigue
Title: Vitality among Swedish patients with post-polio: a physiological phenomenon
Author: Ostlund G (1), Wahlin A (2), Sunnerhagen KS (3,4), Borg K (1)
Affiliation: (1) Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Sweden; (2) Department of Psychology, Stockholm University, Stockholm, Sweden; (3) Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; (4) Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway - [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2008 Oct;40(9):709-14. doi: 10.2340/16501977-0253
Publication Year and Month: 2008 10
Abstract: OBJECTIVE: To evaluate vitality and fatigue in post-polio patients, and the relative contributions of physiological and psychological parameters to the level of vitality.
DESIGN: Multi-centre study.
SUBJECTS: One hundred and forty-three patients with post-polio syndrome.
METHODS: Inventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regression models were constructed to examine predictors of variations in vitality, pain, reduced activity and physical fatigue.
RESULTS: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiological indicators. After controlling for age, physiological para notmeters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.
Conclusions: Vitality in post-polio patients depends on physio-logical parameters. Mental fatigue is not a prominent predictor. Subgroups with or without fatigue, independent of age, need further study.
Outcome of Research: More research required.
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Category: Fatigue
Title: Measuring fatigue in polio survivors: content comparison and reliability of the Fatigue Severity Scale and the Checklist Individual Strength
Author: Koopman FS, Brehm MA, Heerkens YF, Nollet F, Beelen A
Affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2014 Sep;46(8):761-7. doi: 10.2340/16501977-1838
Publication Year and Month: 2014 09
Abstract: OBJECTIVES: To compare the content of the Fatigue Severity Scale and the subscale "subjective experience of fatigue" of the Checklist Individual Strength, and to assess the reliability of both questionnaires in polio survivors.
DESIGN: Repeated-measures at a 3-week interval.
SUBJECTS: Consecutive series of 61 polio survivors.
METHODS: Concepts contained in the questionnaire items were linked to the International Classification of Functioning, Disability and Health (ICF), using standardized linking rules. Reliability analyses included tests of internal consistency, test-retest reliability and measurement error.
RESULTS: Questionnaires differed in the extent to which they measured other than fatigue-related aspects of functioning (represented ICF components: "Body functions": 50% and 80%, "Activities and Participation": 30% and 0%, for the Fatigue Severity Scale and Checklist Individual Strength, respectively). Internal consistency and test-retest reliability were considered acceptable, while measurement error was large (Cronbach's α: 0.90 and 0.93, intraclass correlation coefficient: 0.80 and 0.85, smallest detectable change: 28.7% and 29.4% for the Fatigue Severity Scale and Checklist Individual Strength, respectively).
Conclusions: Considering the acceptable clinimetric properties, we conclude that both the Fatigue Severity Scale and the Checklist Individual Strength can be applied in research on post-poliomyelitis syndrome when measuring fatigue. However, because the 2 questionnaires differ in content they cannot be used interchangeably.
Outcome of Research: Not applicable.
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Category: Inflammation
Title: Elevated expression of prostaglandin E2 synthetic pathway in skeletal muscle of prior polio patients
Author: Melin E (1), Lindroos E, Lundberg IE, Borg K, Korotkova M
Affiliation: (1) Department of Clinical Sciences, Karolinska Institutet Danderyds Hospital, 18288 Stockholm, Sweden. [email protected].
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2014 Jan;46(1):67-72. doi: 10.2340/16501977-1230
Publication Year and Month: 2014 01
Abstract: OBJECTIVE: The aim of this study was to investigate signs of inflammation in muscle of patients with prior polio, since the main symptoms in these patients are muscle pain, weakness and fatigue. In the context of pain and inflammation, the prostaglandin E2 pathway is of interest. Prostaglandin E2 has many biological actions and is a mediator of inflammation and pain.
PATIENTS AND METHODS: Skeletal muscle biopsies from 8 patients with prior polio and post-polio symptoms, presenting with pain and muscular weakness, and from 6 healthy controls were studied. Immunohistochemistry, conventional microscopy, and computerized image analysis were performed.
RESULTS: There was statistically significant higher expression of enzymes of the prostaglandin E2 synthetic pathway, in muscle from patients, compared with controls. Expression of prostaglandin enzymes was mainly in scattered cells and blood vessels, and may indicate an inflammatory process of the muscle, which could be secondary to systemic inflammation.
Conclusions: This data may indicate an inflammatory process in muscle of prior polio patients. Up-regulation of the prostaglandin E2 pathway reveals a potential background to the pain experienced by these patients, and may provide opportunities for directed pharmacological and physical therapies, which could lead to better outcomes of rehabilitation interventions.
Outcome of Research: Effective
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Category: Falls and Bone Density
Title: Circumstances and consequences of falls in polio survivors
Author: Bickerstaffe A, Beelen A, Nollet F
Affiliation: Department of Rehabilitation AMC, Amsterdam, The Netherlands
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Nov;42(10):908-15. doi: 10.2340/16501977-0620
Publication Year and Month: 2010 11
Abstract: OBJECTIVES: Many polio survivors have symptoms that are known risk factors for falls in elderly people. This study aims to determine the: (i) frequency; (ii) consequences; (iii) circumstances; and (iv) factors associated with falls in polio survivors.
METHODS: A survey was conducted among 376 polio survivors. Participants completed a falls history questionnaire and additional information was obtained from their medical files.
RESULTS: Of the 305 respondents, 74% reported at least one fall in the past year and 60% two or more. Sixteen percent of fallers described a major injury after a fall in the last year and 69% reported fear of falling. One-third of fallers had reduced the amount they walked because of their fear of falling. Most reported falls in a familiar environment (86%), during ambulation (72%) and in the afternoon (50%). Quadriceps weakness of the weakest leg (Medical Research Council (MRC) ≤ 3), fear of falling and complaints of problems maintaining balance were independently associated with both falls and recurrent falls, while increasing age and medication use were not.
Conclusions: The high rate of falls and consequences thereof, merit the implementation of fall intervention strategies. To maximize effect, they should be tailor-made and target the fall mechanisms specific to polio survivors.
Outcome of Research: Not applicable
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Category: Continence
Title: Bladder symptoms among polio survivors
Author: Kay L, Bertelsen M
Affiliation: Danish Society of Polio and Accident Victims, Rødovre, Denmark
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med 2013; 45: 560–564
Publication Year and Month: 2013 05
Abstract: OBJECTIVE: To describe bladder symptoms among polio survivors and the inconvenience they cause.
DESIGN: A survey using the validated Danish Prostatic Symptom Score questionnaire concerning bladder symptoms.
SUBJECTS: A random age- and gender-stratified sample of polio survivors drawn from members of the Danish Society of Polio and Accident Victims.
METHODS: Eligible subjects were sent the questionnaire by post.
RESULTS: Of 453 eligible subjects 272 responded. Within 2 weeks 87.5% of respondents had experienced at least one bladder symptom, and 76.5% reported that they had been bothered by a bladder symptom. Out of the 12 symptoms in the questionnaire we found a significant gender difference, with straining and weak stream reported more often among men, and urge incontinence reported more often among women. Incontinence occurred significantly more often among women (73.3%) than among men (40.9%). Compared with a similar study of the background population, bladder symptoms overall occurred approximately twice as often among polio survivors.
Conclusions: The majority of polio survivors experience bladder symptoms, prevalences being approximately twice as high as in the background population. Furthermore, polio survivors to a much larger extent find their bladder symptoms bothersome. A successful rehabilitation programme should therefore also focus on these symptoms.
Outcome of Research: Not applicable
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Category: Quality of Life
Title: Impact of post-polio-related fatigue on quality of life
Author: On AY, Oncu J, Atamaz F, Durmaz B
Affiliation: Department of Physical Medicine and Rehabilitation, Ege University Medical School, Izmir, Turkey
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2006 Sep;38(5):329-32
Publication Year and Month: 2006 09
Abstract: OBJECTIVE: To assess the impact of post-polio-related fatigue on quality of life.
DESIGN: Cross-sectional case control study.
SUBJECTS: Patients without additional health problems that may induce fatigue were selected from among 82 polio survivors. Twenty-six patients with post-polio syndrome and 10 without post-polio syndrome were included. Control group consisted of 30 healthy volunteers.
METHODS: We assessed presence and severity of fatigue by Fatigue Severity Scale, quality of life by Nottingham Health Profile, and impact of fatigue on quality of life by Fatigue Impact Scale. Leg muscle strength was measured by manual muscle testing.
RESULTS: Strength of leg muscles showed no differences between the patients with and without post-polio syndrome. Patients with post-polio syndrome reported significantly higher levels of fatigue and reduced quality of life compared with both patients without post-polio syndrome and control group. Fatigue Impact Scale revealed that fatigue did not significantly impair mental health, but had a negative impact especially on physical and psychosocial functioning of the patients with post-polio syndrome.
Conclusions: Post-polio-related fatigue seems to be an important factor for further impairment of quality of life in polio survivors.
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: A positive turning point in life -- how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme
Author: Larsson Lund M (1), Lexell J
Affiliation: (1) Department of Community Medicine and Rehabilitation, Occupational Therapy , Umeå University, Umeå, Sweden
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2010 Jun;42(6):559-65. doi: 10.2340/16501977-0559
Publication Year and Month: 2010 06
Abstract: OBJECTIVE: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme.
PARTICIPANTS: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme.
METHODS: Qualitative research interviews analysed using the constant comparative method of grounded theory.
RESULTS: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence.
Conclusions: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their management of daily activities and in their view of their late effects of polio, their future and their self.
Outcome of Research: Effective
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Category: 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.
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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
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Category: Exercise
Title: Comparison of two 6-minute walk tests to assess walking capacity in polio survivors
Author: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD
Affiliation: The authors declare no conflicts of interest.
Journal: Journal of Rehabilitation Medicine
Citation: Merel-Anne Brehm, PhD, Suzan Verduijn, MSc, Jurgen Bon, MD, Nicoline Bredt, MSc and Frans Nollet, MD, PhD. Comparison of two 6-minute walk tests to assess walking capacity in polio survivors. J Rehabil Med 2017; 49: 00–00
Publication Year and Month: 2017 09
Abstract: Objective: To compare walking dynamics and test-retest reliability for 2 frequently applied walk tests in polio survivors: the 6-minute walk test (6MWT) to walk as far as possible; and the 6-minute walking energy cost test (WECT) at comfortable speed.
Design: Observational study.
Participants: Thirty-three polio survivors, able to walk ≥ 150 m.
Methods: On the same day participants performed a 6MWT and a WECT, which were repeated 1–3 weeks later. For each test, distance walked, heart rate and reduction in speed were assessed.
Results: The mean distance walked and mean heart rate were significantly higher in the 6MWT (441 m (standard deviation) (SD 79.7); 118 bpm (SD 19.2)) compared with the WECT (366 m (SD 67.3); 103 bpm (SD 14.3)); p < 0.001. Furthermore, during the 6MWT, patients continuously slowed down (–6%), while during the WECT speed dropped only slightly during the first 2 min, by –1.8% in total. Test-retest reliability of both tests was excellent (intraclass correlation coefficient (ICC) ≥ 0.95; lower bound 95% confidence interval (95% CI) ≥ 0.87). The smallest detectable change for the walked distance was 42 m (9.7% change from the mean) and 50 m (13.7%) on the 6MWT and WECT, respectively.
Conclusion: Both the 6MWT and the WECT are reliable to assess walking capacity in polio survivors, with slightly superior sensitivity to detect change for the 6MWT. Differences in walking dynamics confirm that the tests cannot be used interchangeably. The 6MWT is recommended for measuring maximal walking capacity and the WECT for measuring submaximal walking capacity.
Conclusions: In conclusion, this study of polio survivors with a minimum self-reported walking distance of 150 m shows that both the 6MWT and the WECT are reliable and can be used to evaluate changes in walking capacity, with the 6MWT showing slightly superior sensitivity to detect change. The study also shows a significantly higher heart rate (57%HRR on average) at the expense of a reduction in walking speed at this heart rate during the 6MWT compared with the WECT. These findings indicate distinct patterns of walking dynamics between the 6MWT and WECT, where the 6MWT is more likely a measure of maximal walking capacity (i.e. what a person can do) and the WECT of submaximal walking capacity (i.e. what a person does do). The difference in walking dynamics confirms that these tests cannot be used interchangeably, and that the choice to use either test should be tailored to the construct to be measured. Responsiveness to change in this patient population should be further investigated for both tests.
Outcome of Research: Effective
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Category: Differential Diagnosis
Title: Health and Social Considerations in Norwegian Polio Survivors: A 20-Year Follow-up Study
Author: Festvag L, Schanke A-K, Gilhus NE, et al.
Affiliation: Sunnaas Rehabilitation Hospital
University of Oslo
University of Bergen; Haukelund University Hospital, Bergen
Journal: Journal of Rehabilitation Medicine
Citation: J Rehabil Med. 2016;48(8):688-695
Publication Year and Month: 2016 10
Abstract: Objective: To explore the physical and social situation of the Norwegian polio population in 2014, and to compare the status of this population in 2014 with the results of a similar survey carried out 20 years previously, in 1994.
Design: The study was based on a questionnaire covering demographics, polio history, and current medical, psychological and social conditions.
Subjects: The questionnaire was prepared in cooperation with the National Society of Polio Survivors and others with known polio (n = 1,968). A total of 1,408 persons responded (72%), mean age 70 years (range 28–98 years).
Results: The most frequent health problems reported were muscle and joint pain, cold intolerance and insomnia. New muscle weakness and loss of muscle volume were reported more frequently in 2014 than in the 1994 study. The use of orthopaedic aids, assistive devices, ventilators and other respiratory aids had increased significantly, but 83% reported that they still had no home care or nursing services support. The 2014 polio population reported only minor subjective worsening of health and well-being compared with the 1994 cohort.
Conclusion: The present study indicates that the elderly polio population are experiencing new muscle weakness and increasing health problems, but that the deterioration occurs slowly and with fewer consequences for the subjective experience of general health and well-being, indicating that the patients are adapting to their life situation. However, subgroups of the elderly polio population are in need of special care.
Conclusions: The present study indicates that the elderly polio population are experiencing new muscle weakness and increasing health problems, but that the deterioration occurs slowly and with fewer consequences for the subjective experience of general health and well-being, indicating that the patients are adapting to their life situation. However, subgroups of the elderly polio population are in need of special care.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Cognitive behavioural therapy for reducing fatigue in post-polio syndrome and in facioscapulohumeral dystrophy: A comparison
Author: Koopman, Fieke S., Merel A. Brehm, Anita Beelen, Nicole Voet, Gijs Bleijenberg, Alexander Geurts, Frans Nollet
Affiliation: Department of Rehabilitation , Academic Medical Center, University of Amsterdam, PO 22660, 1100 DD Amsterdam, The Netherlands. E-mail: [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2017; 49: 585–590
Publication Year and Month: 2017
Abstract: Post-polio syndrome (PPS) and facioscapulohumeral dystrophy (FSHD) are two different neuromuscular disorders. Fatigue is a frequent complaint in both disorders. A recent study showed that cognitive behavioral therapy (CBT), which is a type of psychotherapy that helps patients to identify and reshape thoughts and behavior patterns that contribute to the fatigue was effective in alleviating fatigue in FSHD but not in PPS. In this study we investigated whether this difference in effectiveness might be explained by dissimilar fatigue-related thoughts (for example focusing on fatigue) in both conditions. We used questionnaires to measure the fatigue-related thoughts in 21 patients with PPS and 24 patients with FSHD . It appeared that fatigue-related thoughts in PPS were similar to those in FSHD and thus do not explain the difference in effectiveness of CBT.
Conclusions: Fatigue-related thoughts in PPS were similar to those in FSHD and thus do not explain the difference in effectiveness of CBT.
Outcome of Research: More research required
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Category: Quality of Life
Title: Quality of life and health conditions reported from two post-polio clinics in Israel.
Author: Jacob T, Shapira A.
Affiliation: Physical Therapy Department, Ariel University Center of Samaria, Ariel, Israel. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2010 Apr;42(4):377-9
Publication Year and Month: 2010 04
Abstract: OBJECTIVE:
To evaluate the perceptions of health and quality of life among a group of polio survivors in Israel and to identify potential activities for improving their quality of life.
DESIGN:
An observational study.
SUBJECTS:
The sample consisted of 101 polio survivors who sought treatment at 2 post-polio clinics in Israel. The majority of participants were between the ages of 45 and 65 years, and approximately 25% were wheelchair-bound.
METHODS:
Participants were invited to attend a seminar, where they were invited to complete a questionnaire on demographic variables, mobility, perceptions of and satisfaction with health status and quality of life, and the potential contribution of 16 activities to improve their quality of life.
RESULTS:
Participants had low physical scores and normative mental scores. Mean scores on the Short-Form-12 questionnaire for physical and mental components were 32.9 and 50.3, respectively. Approximately 70% expressed the belief that exposure to up-to-date information about post-polio, as well as participation in social activities, might improve their quality of life.
Conclusions: Information about the physical and mental components of polio survivors, as well as the desire to partake in specific activities for polio survivors, may serve as a basis for the operations and prioritization of service providers.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study.
Author: Bertelsen M, Broberg S, Madsen E.
Affiliation: Rehabilitation Centre of the Danish Society of Polio and Accident Victims (PTU), Rødovre, Denmark. [email protected]
Journal: Journal of Rehabilitation Medicine
Citation: 2009 Jan;41(1):85-7.
Publication Year and Month: 2009 01
Abstract: OBJECTIVE:
The aim of this study was to evaluate the outcome of physiotherapy as part of a multidisciplinary rehabilitation.
DESIGN:
Prospective uncontrolled intervention study.
SUBJECTS:
Fifty patients with late effects of polio, first time referred to physiotherapy at the Danish Society of Polio and Accident Victims (PTU) Rehabilitation Centre.
METHODS:
The intervention was physiotherapy as an essential part of an individually planned multidisciplinary rehabilitation. The outcome measures Six-Minute Walk Test and Timed-Stands Test were used to assess the functional capacity. Quality of life was evaluated by Medical Outcome Survey Short Form (SF-36) and fatigue by Multidimensional Fatigue Inventory (MFI-20). Patients were tested at baseline; 3 months after the start of rehabilitation and at one-year follow-up.
RESULTS:
The patients showed significantly better functional capacity on all measurements 3 months after start of intervention and at one-year follow-up. The patients showed significant improvement in 3 of the SF-36 dimensions regarding quality of life, but only the improvement in "general health" remained after one year.
Conclusions: This study shows that patients with late effects of polio, who experience new problems related to polio, can benefit from an individually planned multidisciplinary intervention with emphasis on physiotherapy, and the improvement in physical capacity and general health can remain at one-year follow-up.
Outcome of Research: More research required
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Category: 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
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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):
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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.
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Category: Cardiovascular, Exercise, Late Effects of Polio, Muscle Strength
Title: Effects of muscle strengthening and cardiovascular fitness activities for poliomyelitis survivors: A systematic review and meta-anaylsis.
Author: Akhilesh Kumar RAMACHANDRAN, MSc, BEng (1), Stephen P. J. GOODMAN, PhD, Hon BEXSc (2), Michael J. JACKSON, MPT, BEd, BACH (1) and Timothy J. H. LATHLEAN, PhD, MClinRehab, Hon BSc, BBehSc (2,3)
Affiliation: 1) Polio Australia Incorporated
2) Discipline of Exercise and Sports Science, School of Science and Technology, University of New England
3) Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide.
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: J Rehabil Med 2021; 53: jrm00184, doi: 10.2340/16501977-2832
Publication Year and Month: 2021 04
Abstract: Objective:
To evaluate and assess the effectiveness of muscle strengthening and cardiovascular interventions in improving outcomes in poliomyelitis (polio) survivors.
Data sources:
A systematic literature search was conducted in Medline, PubMed, CINAHL, PsychINFO, Web of Science, and Google Scholar for experimental and observational studies.
Study selection and extraction:
Screening, data-extraction, risk of bias and quality assessment were carried out independently by the authors. The quality appraisal and risk of bias were assessed using the Downs and Black Checklist. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to increase clarity of reporting.
Data synthesis:
A total of 21 studies that met all the inclusion criteria were subjected to statistical analyses according to intervention (muscle strengthening or cardiovascular fitness). A random-effects metaanalysis showed a statistically significant effect for the exercise interventions favouring improvement in outcomes according to the International Classification of Functioning, Disability and Health (ICF).
Conclusion:
This review provides further insight into the effects associated with muscle strengthening and cardiovascular interventions among polio survivors, and helps to further identify the current state of research in this area. Future research is needed, focusing on individualized approaches to exercise with polio survivors and specific exercise prescription recommendations, based on established frameworks, such as the ICF.
Conclusions: The findings of this review and analysis provide “very low level evidence” (according to the Grading of Recommendations Assessment, Development and Evaluate; GRADE) to polio survivors, clinicians and researchers. The main findings of this review relate specifically to changes in body function, and activity and participation, and include evidence of effect on improved functioning without furthering debility in polio survivors. This systematic review and meta-analysis provides additional insights into effects associated with exercise, across various types of interventions, in polio survivors, and advances the level of methodological quality of research in this area. Although there was evidence demonstrating effect across domains, due to inherent biases within the literature to date, further and high-quality primary exercise-focused research is required in order to strengthen the certainty of evidence regarding important research questions about the ongoing health of polio survivors.
Outcome of Research: More research required
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Category: Late Effects of Polio, Pain
Title: Pain in Post-Polio Syndrome: A separate pain entity?
Author: Evert Christiaan Boshuis, MD (1), Eva Melin, MD, PhD (2) and Kristian Borg, MD, PhD (2)
Affiliation: (1) Department of Psychiatry, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
(2) Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: Clinical Communications, 5, jrmcc00077.
DOI: https://doi.org/10.2340/20030711-1000077
Publication Year and Month: 2022 01
Abstract: Background: Most patients with polio recover from the initial infection, but develop muscle weakness, pain and fatigue after 15–40 years, a condition called post-polio syndrome. Although poliovirus has been almost eliminated, 12–20 million people worldwide still have polio sequelae. The pain is described mainly as nociceptive, but some patients experience neuropathic pain. The aim of this study was to further characterize post-polio pain.
Patients and methods: A total of 20 patients with post-polio syndrome participated in the study. Physical examination was performed, and questionnaires containing pain drawing and visual analogue scales (VAS) for pain intensity during rest and motion and VAS for fatigue were completed. A walk test was performed to evaluate physical performance.
Results: Pain intensity was high (42/100 on the VAS at rest and 62/100 while moving). The pain was localized in both joints and muscles. Pain in the muscles was of “deep aching” character, included “muscle cramps” and was located mainly in polio-weakened limbs.
Conclusion: Muscle pain in patients with post-polio syndrome does not fulfil the criteria for either nociceptive or neuropathic pain; thus, it is suggested that the pain is termed “post-polio muscular pain”. The intensity of post-polio muscular pain is higher while moving, but does not influence physical function, and is separate from fatigue.
LAY ABSTRACT
Most polio patients recover from the initial infection, but develop muscle weakness, pain and fatigue after 15–40 years, a condition called Post-Polio Syndrome. Though the poliovirus has almost been eliminated, 12-20 million people worldwide still have polio-equelae. The pain is mainly described as nociceptive, but some patients experience neuropathic pain. This study was undertaken to further characterize post-polio pain. We examined 20 Post-polio patients and found that the pain was localised in both joints and muscles. The pain in the muscles was of ‘deep aching’ character, included ‘muscle cramps’ and was mainly located in polio-weakened limbs. The intensity of the pain is higher while moving but does not influence the physical function. To know more about the characteristics of the pain perceived gives better possibilities for treatment and rehabilitation
Conclusions: In conclusion, pain in PPS is mostly of deep aching character and muscle cramps, localized in the polio-weakened limb. This type of pain seems to be specific to PPS. It is suggested that this pain is termed post-polio muscular pain (PPMP). Future studies should aim to characterize PPMP and to analyse the influence of motor and sensory dysfunction on the pain.
Outcome of Research: More research required
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Category: Orthoses
Title: Use and usability of custom-made knee-ankle-foot orthoses in polio survivors with knee instability: A cross-sectional survey
Author: Bart Raijmakers, Roelofine A Berendsen-de Gooijer, Hilde E Ploeger, Fieke S Koopman, Frans Nollet, Merel-Anne Brehm
Affiliation: Amsterdam University Medical Centers, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands. [email protected].
Journal: Journal of Rehabilitation Medicine (JRM) - formerly Scandanavian Journal of Rehabilitation Medicine
Citation: 54:jrm00261
doi: 10.2340/jrm.v53.1122.
Publication Year and Month: 2022 02
Abstract: Objective: To investigate the use of custom-made knee-ankle-foot orthoses in daily life and differences in usability factors of knee-ankle-foot orthoses between users and discontinued users.
Design: Cross-sectional survey study.
Subjects: A total of 163 polio survivors provided with a knee-ankle-foot orthosis at an outpatient clinic of a university hospital.
Methods: Use and usability of knee-ankle-foot orthoses in daily life were assessed with a postal questionnaire. Usability factors were formulated using the International Organization for Standardization (ISO) 9241-11 standard.
Results: A total of 106 respondents (65%) returned the questionnaire. Of these, 98 were eligible for analysis. Seventy-four respondents (76%) reported using their knee-ankle-foot orthosis. Compared with discontinued users (24%), users experienced more limitations when walking without an orthosis (p = 0.001), were more often experienced with wearing a previous orthosis (p < 0.001) and were more often prescribed with a locked rather than a stance-control knee-ankle-foot orthosis (p = 0.015). Furthermore, users reported better effectiveness of their knee-ankle-foot orthosis (p < 0.001), more satisfaction with goals of use and knee-ankle-foot orthosis-related aspects (p < 0.001).
Conclusion: The majority of polio survivors used their custom-made knee-ankle-foot orthoses in daily life. Factors related to continued use, such as walking ability without orthosis, expectations of the orthosis, previous orthosis experience and type of knee-ankle-foot orthosis provided, should be considered and discussed when prescribing a knee-ankle-foot orthosis in polio survivors.
Keywords: poliomyelitis, leg muscle weakness, knee-ankle-foot orthoses, usability, physical mobility, rehabilitation
Conclusions: A majority of 76% of the polio survivors provided with a custom-made KAFO used their orthosis in daily life. Important usability factors were low perceived walking ability status without orthosis, previous orthosis experience, prescribed KAFO type, high perceived effectiveness and satisfaction when standing and walking with a KAFO. When prescribing a KAFO, it is important to consider these factors and discuss goals of use and expected benefits of the KAFO with the individuals concerned, especially in relation to perceived walking limitations and activities in daily life. Providing proper guidance and training upon delivery of the KAFO may especially be important in the case of first-time orthosis users.
Outcome of Research: Effective
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Category: Ageing
Title: Symptom profiles in individuals aging with post-polio syndrome
Author: Amtmann D, Bamer AM, Verrall A, Salem R, Borson S
Affiliation: Rehabilitation Medicine, University of Washington, Seattle, Washington
Journal: Journal of the American Geriatrics Society
Citation: J Am Geriatr Soc. 2013 Oct;61(10):1813-5. doi: 10.1111/jgs.12465
Publication Year and Month: 2013 10
Abstract: This paper does not have an abstract.
Conclusions:
Outcome of Research: Not applicable
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Category: Surgery
Title: A Two-Stage Foot Repair in a 55-Year-Old Man with Poliomyelitis
Author: Daniel Pollack
Affiliation: Department of Podiatric Surgery, Wyckoff Heights Medical Center, 374 Stockholm Ave, Brooklyn, NY;Madison Podiatry, 52 Skyline Drive, Ringwood, NJ 07456
Journal: Journal of the American Podiatric Medical Association
Citation: Volume 108, Issue 1 (January 2018)
Publication Year and Month: 2018 01
Abstract: A 55-year-old man with poliomyelitis presented with a plantarflexed foot and painful ulceration of the sub–first metatarsophalangeal joint present for many years. A two-stage procedure was performed to bring the foot to 90°, perpendicular to the leg, and resolve the ulceration. The first stage corrected only soft-tissue components. It involved using a hydrosurgery system to debride and prepare the ulcer, a unilobed rotational skin plasty to close the ulcer, and a tendo Achillis lengthening to decrease forefoot pressure. The second stage corrected the osseous deformity with a dorsiflexory wedge osteotomy of the first metatarsal. The ulceration has remained closed since the procedures, with complete resolution of pain.
Conclusions:
Outcome of Research: More research required
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Category: Speech Pathology
Title: Otolaryngology manifestation of postpolio syndrome
Author: Baugh RF
Affiliation: Not Stated
Journal: Journal of the National Medical Association
Citation: J Natl Med Assoc. 1993 Sep;85(9):689-91
Publication Year and Month: 1993 09
Abstract: Twenty-one patients with postpolio syndrome were surveyed to determine otolaryngologic symptoms. An alteration in voice, dysphagia, and fatigue were the most common symptoms reported. Prevailing etiologic theories are presented, and treatment recommendations are offered.
Conclusions:
Outcome of Research: Not applicable.
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Category: 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:
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Category: Quality of Life
Title: The association between post-polio symptoms as measured by the Index of Post-Polio Sequelae and self-reported functional status
Author: Schwartz I, Gartsman I, Adler B, Friedlander Y, Manor O, Levine H, Meiner Z
Affiliation: Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Israel; The Hebrew University-Hadassah, Braun School of Public Health, Israel; Department of Physical Medicine and Rehabilitation, Hadassah Medical Center, Israel. Electronic address: [email protected]
Journal: Journal of the Neurological Sciences
Citation: J Neurol Sci. 2014 Oct 15;345(1-2):87-91. doi: 10.1016/j.jns.2014.07.012
Publication Year and Month: 2014 10
Abstract: OBJECTIVE: To evaluate the association between self-reported severity of polio sequelae and current functional status among polio survivors.
METHODS: This was a cross sectional study of 195 polio survivors attending a polio outpatient clinic at a university hospital. The main outcome measures of demographic, medical, social, and functional data were gleaned from a questionnaire adapted for the polio population. The severity of polio sequelae was evaluated with the self-reported Index of Post-Polio Sequelae (IPPS).
RESULTS: The mean age of our sample was 57.6 ± 10.5 years, 53% were men, 38% had acquired higher education and 37% were employed. We found significant correlations between the total IPPS score and independence in activity of daily living (P<0.05), the use of walking aids (P<0.005) and mobility in and out-of-doors (P<0.0001). A positive correlation was also found between the total IPPS score and subjective assessment of physical and mental health (P<0.0001).
Conclusions: Higher disability in ADL and mobility and lower perception of physical and mental health in polio survivors were associated with a higher score on the IPPS, reflecting greater severity of polio sequelae. These findings demonstrate the IPPS as a useful tool in the clinical evaluation of the polio population, however further data is needed in order to determine if this index can assess clinically significant changes over time.
Outcome of Research: More research required.
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Category: Drugs
Title: Anticholinesterase-responsive neuromuscular junction transmission defects in post-poliomyelitis fatigue
Author: Daria A. Trojan, Daniel Gendron and Neil R. Cashman
Affiliation: Department of Neurology, McGill University, Montreal Neurological Institute and Hospital
Journal: Journal of the Neurological Sciences
Citation: 114 (1993) 170-177
Publication Year and Month: 1992 08
Abstract: Disabling generalized fatigue and muscle fatiguability are common features of post-poliomyelitis syndrome (PPS). In 17 fatigued PPS patients, we measured jitter on stimulation single-fiber electromyography (S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium. We observed reduction in jitter (defined as a significant difference in jitter means before and after edrophonium, unpaired t-test P < 0.05) in 7 patients, no change in 8, and a significant increase in 2 patients. Blinded to their edrophonium results, the 17 patients were treated with pyridostigmine 180 mg/day for 1 month, with a subjective improvement of fatigue in 9 patients, and with a significant reduction in mean Hare fatigue scores in the entire group of 17 patients (pre = 2.71, and post = 1.71; Wilcoxan signed rank sum test, P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was significantly associated with pyridostigmine-induced subjective improvement of fatigue (Fisher's exact test, P < 0.04). A significant reduction in fatigue with pyridostigmine was observed only in the 7 patients who experienced a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum test, P = 0.03). In addition, the 9 pyridostigmine responders experienced a significant reduction in jitter means pre- and post-edrophonium (100% vs. 88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular transmission as measured by jitter on S-SFEMG can improve with edrophonium in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability in some patients with PPS may be due to anticholinesterase-responsive NMJ transmission defects.
Conclusions:
Outcome of Research: Not applicable
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Category: Complementary Therapies
Title: Risk assessment and prognostic in patients with post polio syndrome according to systematic tongue analysis adapted from traditional Chinese medicine
Author: Abe, G.C., Ramos, P.E. da Silva, B.L., Mello, C.A.D.S., Quadros, A.A.J., Oliveira, A.S.B.
Affiliation: Federal University of São Paulo, Neurology and Neurosurgery, São Paulo, Brazil
Journal: Journal of the Neurological Sciences
Citation: Volume 381, Supplement, 15 October 2017, Pages 1138-1139
Publication Year and Month: 2017 10
Abstract: Background: The tongue is used in traditional Chinese medicine for prognostic assessment. Muscle weakness, fatigue, pain and other symptoms occur with great variability in post polio syndrome (PPS).
Objective: Identify risk patients in a group with PPS through observation of tongue coating with systematic tongue analysis (STA).
Conclusions: Conclusion: STA identified, through the coating, a patient with worsening risk confirmed; and a patient with association of severe chronic diseases (her follow-up will be analyzed in a later work).
Outcome of Research: More research required
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Category: Complementary Therapies
Title: Clinical neurological and tongue inspection according to Traditional Chinese Medicine (TCM) – evaluation of post polio syndrome patients
Author: Abe, G.C., Ramos, P.E., da Silva, B.L., Quadros, A.J., Oliveira, A.S.B.
Affiliation: Universidade Federal de São Paulo, Neurologia e Neurocirurgia, São Paulo - SP, Brazil
Journal: Journal of the Neurological Sciences
Citation: Volume 381, Supplement, 15 October 2017, Pages 199-200
Publication Year and Month: 2017 10
Abstract: Objective: To describe tongue characteristics of PPS patients relating to neurology.
RESULTS
89 individuals were evaluated within a 12 month period, 61 (68,5%) females, 28(31,5%)males, aged from 32–57 years old (mean = 46). The most frequent characteristics were: decreased moisture (52.5%); thick whitish coating (60.7%); red color (46,1%), and normal movement (49.4%). The enlarged size (40.4%) prevailed over the small/thin size (15.7%). The presence of “other findings” (OF) was over 70%.
Conclusions: Conclusion: The frequency of enlarged size associated to minor normal characteristics in OF and in tongue coating suggests that the group has a less marked impairment within the natural history of PPS.
Outcome of Research: More research required
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Category: Women's Health
Title: Pregnancy, delivery and perinatal outcome in female survivors of polio.
Author: Veiby G, Daltveit AK, Gilhus NE.
Affiliation: Department of Clinical Medicine, University of Bergen, Norway
Journal: Journal of the Neurological Sciences
Citation: 2007 Jul 15;258(1-2):27-32.
Publication Year and Month: 2007 07
Abstract: OBJECTIVE:
To investigate possible effects on pregnancy, delivery and perinatal outcome in female survivors of polio.
METHODS:
In a cohort design, data from the national population based Medical Birth Registry of Norway (MBRN) were used to compare all 2495 births recorded 1967-1998 by female survivors of polio with all 1.9 mill non-polio deliveries. The results were adjusted for time period, maternal age, and birth order by unconditional logistic regression, with effects presented as adjusted Odds Ratios (OR) with a corresponding 95% Confidence Interval (CI) and p values.
RESULTS:
Female polio survivors had a higher occurrence of pre-eclampsia (3.4% vs. 2.8%, p=0.003, OR=1.4, CI=1.1-1.7), gestational proteinuria (1.3% vs. 0.5%, p<0.001, OR=2.0, CI=1.4-2.8), renal disease prior to pregnancy (1.4% vs. 0.9%, p=0.001, OR=1.8, CI=1.2-2.5), vaginal bleeding (3.8% vs. 2.0%, p<0.001, OR=1.7, CI=1.4-2.1), and urinary tract infection during pregnancy (3.5% vs. 2.4%, p<0.001, OR=1.7, CI=1.4-2.1). Deliveries complicated by obstruction of the birth process were more common in the polio group (6.1% vs. 2.0%, p<0.001, OR=4.8, CI=4.0-5.6), and cesarean section was performed at a higher rate throughout the time period (13.2% vs. 8.3%, p<0.001, OR=2.7, CI=2.4-3.1). Infants of polio mothers had a lower mean birth weight (3383 g vs. 3483 g, p<0.001), and more often had a birth weight below 2500 g (6.9% vs. 5.2%, p=0.001, OR=1.3, CI=1.1-1.5). There was no difference regarding pregnancy length. The risk of perinatal death was increased (2.1% vs. 1.1%, p=0.05, OR=1.3, CI=1.0-1.7).
CONCLUSION:
Pregnancy in female survivors of polio is associated with an increased risk for complications during pregnancy and delivery, as well as an adverse perinatal outcome. Awareness towards risk factors should improve pre-natal care and possibly prevent complications.
Conclusions: Pregnancy in female survivors of polio is associated with an increased risk for complications during pregnancy and delivery, as well as an adverse perinatal outcome. Awareness towards risk factors should improve pre-natal care and possibly prevent complications.
Outcome of Research: Effective
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Category: Late Effects of Polio
Title: Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.
Author: Paolo Ragonese, Brigida Fierro, Giuseppe Salemi, Giovanna Randisi, Daniela Buffa, Marco D'Amelio, Antonella Aloisio, Giovanni Savettieri
Affiliation: Dipartimento di Neurologia, Oftalmologia, Otorinolaringoiatria e Psichiatria, Università di Palermo, Italy.
Journal: Journal of the Neurological Sciences
Citation: 2005 Sep 15;236(1-2):31-5.
Publication Year and Month: 2005 09
Abstract: OBJECTIVE:
To investigate frequency and associated factors of post polio syndrome (PPS) in an Italian cohort of people with prior poliomyelitis.
METHODS:
We screened subjects admitted for poliomyelitis at the paediatric hospital of the University of Palermo during the time frame 1945-1960. Patients who developed PPS were identified through a structured questionnaire and a neurologic examination. PPS diagnosis was made according to specified diagnostic criteria. Frequency of PPS was calculated in the selected cohort of polio survivors. The association with the investigated risk factors (sex, age at onset of polio, extension and severity of polio, education, associated diseases, cigarette smoking, trauma, polio vaccination) was analysed by the calculation of the odds ratio.
RESULTS:
Forty-eight participants met the adopted diagnostic criteria for PPS, giving a prevalence of 31.0%. The prevalence rate was significantly higher in women than in men (p=0.02). Logistic regression analyses revealed a significant inverse association with onset of poliomyelitis at over 12 months of age (OR 0.33; CI 0.14-0.79) a higher degree of education (OR 0.20; CI 0.07-0.79), and a significant association with the presence of other diseases (OR 9.86; CI 3.69-26.34).
Conclusions: CONCLUSIONS:
In our survey one-third of patients with prior poliomyelitis had PPS. Higher age at onset of poliomyelitis is inversely associated with PPS. The association with other diseases may indicate that a chronic physical stress, particularly in already weak motor units, can contribute to the development of signs and symptoms of PPS. Our results also suggest the impact of socio-economic conditions on the risk of PPS.
Outcome of Research: More research required
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Category: Quality of Life
Title: Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients.
Author: Nielsen NM, Kay L, Wanscher B, Ibsen R, Kjellberg J, Jennum P.
Affiliation: 1 Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark. [email protected].
2 The PTU Rehabilitation Centre, Fjeldhammervej 8, 2610, Rødovre, Denmark.
3 Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Center for Healthy Ageing, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark.
4 Danish Institute for Local and Regional Government Research, Copenhagen, Denmark.
Journal: Journal of the Neurological Sciences
Citation: 2016 Jun;263(6):1120-8.
Publication Year and Month: 2016 06
Abstract: Worldwide 10-20 million individuals are living with disabilities after acute poliomyelitis. However, very little is known about the socio-economic consequences and health care costs of poliomyelitis. We carried out a historical register-based study including 3606 individuals hospitalised for poliomyelitis in Copenhagen, Denmark 1940-1954, and 13,795 age and gender-matched Danes. Participants were followed from 1980 until 2012, and family, socio-economic conditions and health care costs were evaluated in different age groups using chi-squared tests, boot-strapped t tests or hazard ratios (HR) calculated in Cox-regression models. The analyses were performed separately for paralytic and non-paralytic polio survivors and their controls, respectively. Compared with controls a higher percentage of paralytic polio survivors remained childless, whereas no difference was observed for non-paralytic polio survivors. The educational level among paralytic as well as non-paralytic polio survivors was higher than that among their controls, employment rate at the ages of 40, 50 and 60 years was slightly lower, whereas total income in the age intervals of 31-40, 41-50 and 51-60 years were similar to controls. Paralytic and non-paralytic polio survivors had a 2.5 [HR = 2.52 (95 % confidence interval (CI); 2.29-2.77)] and 1.4 [HR = 1.35 (95 % CI; 1.23-1.49)]-fold higher risk, respectively, of receiving disability pension compared with controls. Personal health care costs were considerably higher in all age groups in both groups of polio survivors. Individuals with a history of poliomyelitis are well educated, have a slightly lower employment rate, an income similar to controls, but a considerably higher cost in the health care system.
Conclusions: Individuals with a history of poliomyelitis are well educated, have a slightly lower employment rate, an income similar to controls, but a considerably higher cost in the health care system.
Outcome of Research: More research required
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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
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Category: Polio Immunisation
Title: Immunogenicity of two different sequential schedules of inactivated polio vaccine followed by oral polio vaccine versus oral polio vaccine alone in healthy infants in China
Author: Li RC (1), Li CG (2), Wang HB (3), Luo HM (3), Li YP (1), Wang JF (2), Ying ZF (2), Yu WZ (3), Shu JD (4), Wen N (3), Vidor E (5)
Affiliation: (1) Guangxi Center for Disease Prevention and Control, Nanning, China; (2) National Institutes for Food and Drug Control (NIFDC), Beijing, China; (3) Chinese Center for Disease Control and Prevention, Beijing, China; (4) Sanofi Pasteur, Beijing, China; (5) Sanofi Pasteur, Lyon, France
Journal: Journal of the Pediatric Infectious Diseases Society
Citation: J Pediatric Infect Dis Soc. 2015 Apr 16. pii: piv017
Publication Year and Month: 2015 04
Abstract: BACKGROUND: Two vaccination schedules where inactivated polio vaccine (IPV) was followed by oral polio vaccine (OPV) were compared to an OPV-only schedule.
METHODS: Healthy Chinese infants received a 3-dose primary series of IPV-OPV-OPV (Group A), IPV-IPV-OPV (Group B), or OPV-OPV-OPV (Group C) at 2, 3, and 4 months of age. At pre-Dose 1, 1-month, and 14-months post-Dose 3, polio 1, 2, and 3 antibody titers were assessed by virus-neutralizing antibody assay with Sabin or wild-type strains. Adverse events were monitored.
RESULTS: Anti-polio 1, 2, and 3 titers were ≥8 (1/dil) in >99% of participants, and Group A and Group B were noninferior to Group C at 1-month post-Dose 3 as assessed by Sabin strain-based assay (SSBA). In Group A 1-month post-Dose 3, there was no geometric mean antibody titers (GMT) differences for types 1 and 3; type 2 GMTs were ≈3-fold higher by wild-type strain-based assay (WTBA) versus SSBA. For Group B, GMTs were ≈1.7- and 3.6-fold higher for types 1 and 2 via WTBA, while type 3 GMTs were similar. For Group C, GMTs were ≈6.3- and 2-fold higher for types 1 and 3 with SSBA, and type 2 GMTs were similar. Antibodies persisted in >96.6% of participants. Adverse event incidence in each group was similar.
Conclusions: A primary series of 1 or 2 IPV doses followed by 2 or 1 OPV doses was immunogenic and noninferior to an OPV-only arm. SSBA was better at detecting antibodies elicited by OPV with antibody titers correlated to the number of OPV doses (NCT01475539 - https://clinicaltrials.gov/ct2/show/study/NCT01475539).
Outcome of Research: Effective
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Category: Late Effects of Polio, Psychology, Quality of Life
Title: The value of a post-polio syndrome self-management programme
Author: Alexandra Curtis,corresponding author1,# Jeong Su Lee,1,# Georgios Kaltsakas,1,2 Vivian Auyeung,2 Simon Shaw,1 Nicholas Hart,1,2 and Joerg Steier1,2
Affiliation: 1Guy’s and St Thomas’ NHS Foundation Trust, London, UK;
2Faculty of Life Sciences and Medicine, King’s College, London, UK
corresponding authorCorresponding author.
Contributions: (I) Conception and design: A Curtis, JS Lee, N Hart, J Steier, V Auyeung; (II) Administrative support: A Curtis, JS Lee, N Hart, J Steier; (III) Provision of study materials or patients: A Curtis, JS Lee, J Steier, S Shaw, V Auyeung; (IV) Collection and assembly of data: A Curtis, JS Lee; (V) Data analysis and interpretation: A Curtis, JS Lee, J Steier, V Auyeung, G Kaltsakas; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Correspondence to: Ms. Alexandra Curtis, MRes, BSc. Guy’s and St Thomas’ NHS Foundation Trust, Lane Fox Unit, Westminster Bridge Road, London SE1 7EH, UK. Email: [email protected].
Journal: Journal of Thoracic Disease
Citation: 12(Suppl 2), S153–S162. https://doi.org/10.21037/jtd-cus-2020-009
Publication Year and Month: 2020 10
Abstract: Background
Post-polio syndrome is characterised by symptoms of fatigue, pain and new-onset neuromuscular weakness, and emerges decades after the initial poliovirus infection. We sought to evaluate the only post-polio syndrome specific self-management programme in the United Kingdom.
Methods
This was a retrospective study of patients who had completed a residential self-management programme led by a multi-disciplinary clinical team. Following a confirmed diagnosis of post-polio syndrome by rehabilitation and neurology specialists, patients were offered to participate in the programme. Although group-based, patients also received individually tailored support on physical exercise and fatigue management. Physical effects, physical function, psychosocial well-being measures were assessed at baseline and 6 months follow-up. Knowledge was tested at baseline and immediately following the programme. Statistical comparisons were made using paired t-test and Wilcoxon signed rank test according to the data distribution.
Results
Over a period of 17 years, 214 participants (median age 61.3 years old, 63% female) attended 31 programmes. At 6 months the following post-polio syndrome specific symptoms improved significantly: fatigue, as measured by the Multidimensional Assessment of Fatigue scale [37.6 (7.1) vs. 34.2 (9.3), P=0.005]; and pain [15.0 (6.1) vs. 13.1 (6.7), P=0.001], atrophy [10.0 (8.0–12.0) vs. 9.0 (7.0–11.0), P=0.002] and bulbar symptoms [3.0 (1.0–5.0) vs. 2.0 (0–4.0), P=0.003] as measured by the Index of Post-polio Sequelae scale. Knowledge related to post-polio syndrome also significantly increased [14.0 (11.0–16.0) vs. 17.0 (16.0–19.0), P=0.001]. Participants were able to walk at a faster speed over 10 meters [0.77 (0.59–1.00) vs. 0.83 (0.67–1.10) m/s, P=0.003] and walked longer distances during the 2-minute walk test [76.9 (31.7) vs. 82.0 (38.4) m, P=0.029]. Depression and anxiety scores did not change over time [PHQ-9, 2.0 (0.3–10.8) vs. 2.0 (0.3–6.8), P=0.450; GAD-7, 2.0 (0–7.0) vs. 1.0 (0–3.0), P=0.460] nor was there change in self-reported quality of life {60 [50–70] vs. 60 [55–70], P=0.200}.
Conclusions
This study suggests that a post-polio syndrome self-management programme led to improvement in symptoms, knowledge and walking speed, but not quality of life. Anxiety and depression scores remained low.
Keywords: Rehabilitation, post-polio syndrome (PPS), fatigue, quality of life (QoL)
Conclusions: A self-management programme for PPS can improve fatigue, the severity to which pain, atrophy and bulbar function issues are experienced and the overall knowledge of PPS, as well as physical function over a 6-month period. Despite some limitations the study results are important to a wider audience given the difficulties in collecting systematic data in this cohort and the relatively sparse evidence for the current approach to PPS management. Experiences from PPS management might prove valuable at a time when a new viral pandemic requires us to design future rehabilitation and self-management programmes for many more survivors of a devastating viral condition.
Outcome of Research: More research required
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Category: 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
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Category: Continence
Title: Urologic manifestations of postpolio syndrome
Author: Johnson VY, Hubbard D, Vordermark JS
Affiliation: Not stated
Journal: Journal of Wound, Ostomy, and Continence Nursing
Citation: J Wound Ostomy Continence Nurs. 1996 Jul;23(4):218-23
Publication Year and Month: 1996 07
Abstract: To determine the character and prevalence of bladder dysfunction among persons with a history of polio, we conducted a survey of randomly selected polio survivors. The survey solicited information on the acute episode of polio and the nature of late-onset neurologic symptoms that could be attributed to postpolio syndrome. There were 242 female and 88 male respondents to the study. Symptoms attributable to postpolio syndrome were present in 87.2% of female subjects and 73.9% of male subjects. Respondents with postpolio syndrome had a significantly greater prevalence of urologic symptoms than seen among respondents without postpolio syndrome, although no dominant pattern of voiding dysfunction was noted. The early onset of erectile dysfunction was more common among male subjects with postpolio syndrome than among male subjects without postpolio syndrome. Genuine stress incontinence was seen in 36.3% of the survey population. Sixteen women with postpolio syndrome underwent surgical repair for urinary incontinence, with a success rate of 60.5%. Bladder disorders are common among persons with PPS, but further clinical and urodynamic data are necessary to define the nature and magnitude of this dysfunction.
Conclusions:
Outcome of Research: More research required
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Category: 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
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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 viru