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Title: Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee
Author: Jinny Tavee MD (1), Thomas H. Brannagan III MD (2), Michael W. Lenihan MD (3), Sri Muppidi MD (4), Liz Kellermeyer BA, MLS (1), Peter D Donofrio MD, AANEM (5)
Affiliation: (1) National Jewish Health, Division of Neurology, Denver, Colorado, USA
(2) Vagelos College of Physicians and Surgeons, Neurological Institute, Columbia University, New York, New York, USA
(3) Adirondack Neurology Associates, PC, Glens Falls, New York, USA
(4) Stanford Neuroscience Health Center, Palo Alto, California, USA
(5) Neurology Clinic, Vanderbilt University, Nashville, Tennessee, USA
Journal: Muscle & Nerve
Citation: Tavee, J, Brannagan, TH, Lenihan, MW, et al. Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee. Muscle & Nerve. 2023; 1-19. doi:10.1002/mus.27922
Publication Year and Month: 2023 07
Abstract: Intravenous immune globulin (IVIG) is an immune-modulating biologic therapy that is increasingly being used in neuromuscular disorders despite the paucity of high-quality evidence for various specific diseases. To address this, the AANEM created the 2009 consensus statement to provide guidance on the use of IVIG in neuromuscular disorders. Since then, there have been several randomized controlled trials for IVIG, a new FDA-approved indication for dermatomyositis and a revised classification system for myositis, prompting the AANEM to convene an ad hoc panel to update the existing guidelines.New recommendations based on an updated systemic review of the literature were categorized as Class I-IV. Based on Class I evidence, IVIG is recommended in the treatment of chronic inflammatory demyelinating polyneuropathy, Guillain-Barré Syndrome (GBS) in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome and myasthenia gravis exacerbations but not stable disease. Based on Class II evidence, IVIG is also recommended for Lambert-Eaton myasthenic syndrome and pediatric GBS. In contrast, based on Class I evidence, IVIG is not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy and small fiber neuropathy that is idiopathic or associated with tri-sulfated heparin disaccharide or fibroblast growth factor receptor-3 autoantibodies. Although only Class IV evidence exists for IVIG use in necrotizing autoimmune myopathy, it should be considered for anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase myositis given the risk of long-term disability. Insufficient evidence exists for the use of IVIG in Miller-Fisher syndrome, IgG and IgA paraproteinemic neuropathy, autonomic neuropathy, chronic autoimmune neuropathy, polymyositis, idiopathic brachial plexopathy and diabetic lumbosacral radiculoplexopathy.
Conclusions: IVIG is not recommended for Post-Polio Syndrome (PPS) as there is no long-term benefit.
Outcome of Research: More research required
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Category: Late Effects of Polio
Title: The risk of post-polio syndrome among immigrant groups in Sweden
Author: Per Wändell (1,2), Kristian Borg (3), Xinjun Li (2), Axel C. Carlsson (1,4), Jan Sundquist (2,5,6) & Kristina Sundquist (2,5,6)
Affiliation: (1) Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
(2) Center for Primary Health Care Research, Lund University, Malmö, Sweden
(3) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
(4) Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
(5) Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
(6) Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Scientific Reports volume 13, Article number: 6044 (2023)
https://doi.org/10.1038/s41598-023-33240-w
Publication Year and Month: 2023 04
Abstract: To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52–2.07) and 1.39 (1.19–1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17–10.59) and 8.39 (5.44–12.95), respectively, and Asia, HRs 6.32 (5.11–7.81) and 4.36 (3.38–5.62) respectively, and in men from Latin America, HR 3.66 (2.17–6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.
Conclusions: In conclusion, we found a higher risk of PPSs in individuals from non-Western regions, especially from Africa and Asia. It is of importance to be aware of PPS in the whole healthcare system in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. PPS patients need treatment and follow-up for their lifetime. PPS will only disappear decades after the worldwide eradication of polio.
Outcome of Research: Not applicable
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Category: Diagnosis and Management, Differential Diagnosis
Title: Plasma CHI3L1 in Amyotrophic Lateral Sclerosis: A Potential Differential Diagnostic Biomarker
Author: Alessandro Bombaci*, Umberto Manera, Giovanni De Marco, Federico Casale, Paolina Salamone, Giuseppe Fuda, Giulia Marchese, Barbara Iazzolino, Laura Peotta, Cristina Moglia, Andrea Calvo and Adriano Chiò
Affiliation: “Rita Levi Montalcini” Department of Neuroscience, University of Turin, 10126 Turin, Italy
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: J. Clin. Med. 2023, 12(6), 2367; https://doi.org/10.3390/jcm12062367
Publication Year and Month: 2023 03
Abstract: Background: Motor neuron diseases (MNDs) are fatal neurodegenerative diseases. Biomarkers could help with defining patients’ prognoses and stratifications. Besides neurofilaments, chitinases are a promising family of possible biomarkers which correlate with neuroinflammatory status. We evaluated the plasmatic levels of CHI3L1 in MNDs, MND mimics, and healthy controls (HCs).
Methods: We used a sandwich ELISA to quantify the CHI3L1 in plasma samples from 44 MND patients, 7 hereditary spastic paraplegia (HSP) patients, 9 MND mimics, and 19 HCs. We also collected a ALSFRSr scale, MRC scale, spirometry, mutational status, progression rate (PR), blood sampling, and neuropsychological evaluation.
Results: The plasma levels of the CHI3L1 were different among groups (p = 0.005). Particularly, the MND mimics showed higher CHI3L1 levels compared with the MND patients and HCs. The CHI3L1 levels did not differ among PMA, PLS, and ALS, and we did not find a correlation among the CHI3L1 levels and clinical scores, spirometry parameters, PR, and neuropsychological features. Of note, the red blood cell count and haemoglobin was correlated with the CHI3L1 levels (respectively, p < 0.001, r = 0.63; p = 0.022, and r = 0.52).
Conclusions: The CHI3L1 plasma levels were increased in the MND mimics cohort compared with MNDs group. The increase of CHI3L1 in neuroinflammatory processes could explain our findings. We confirmed that the CHI3L1 plasma levels did not allow for differentiation between ALS and HCs, nor were they correlated with neuropsychological impairment.
Keywords: biomarker; chitinases; cognitive impairment; differential diagnosis; early diagnosis; MND mimics; red blood cells
Conclusions: The measurement of the plasmatic levels of CHI3L1 could be useful in the differential diagnosis between MNDs and MND mimics. This is an important issue, since the early diagnosis of an MND is a determinant in the early starting of neuroprotective therapy and in clinical trial recruitment.
Further multicentre and longitudinal studies on a larger patient cohort, testing alongside other fluid biomarkers, are needed to better explain the role of CHI3L1 in the diagnosis and prognosis of MNDs and, also, of MND mimics.
Outcome of Research: More research required
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Category:
Title: Late effects of polio: Interviewing general practitioners and health professionals about the need for and the means of promoting continuing professional development.
Author: Petra Quinlan-Turner (1), Phyllis Lau (2), Keith R McVilly (3)
Affiliation: (1) MBBS, PMETB GP (UK), MPH(Hons), Policy Officer, Surgery Recovery and Reform Branch, Commissioning and System Improvement Division, Victorian Department of Health, Melbourne, Vic. (1 author)
(2) BPharmSci (Hons), GradDip Drug Eval Pharm Sci, PhD, Senior Research Fellow, Department Of General Practice, Faculty of Medicine, Dentistry and Health Science, The University Of Melbourne, Carlton, Vic. (1 author)
(3) PhD, MAPS, FCClP, FIASSIDD, Professor of Disability and Inclusion, School of Social and Political Sciences, The University of Melbourne, Melbourne, Vic. (1 author)
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Australian Journal of General Practice, 01 May 2023, 52(5):317-323
DOI: 10.31128/ajgp-07-22-6504 PMID: 37149772
Publication Year and Month: 2023 03
Abstract: Background and objectives
Polio Australia estimates tens of thousands of polio survivors are experiencing late effects of polio (LEoP), including increased cases among young women of childbearing age in some migrant communities. Because polio has been declared eradicated in Australia, the provision and uptake of education by general practitioners (GPs) and healthcare professionals (HCPs) is minimal. We explored the awareness of LEoP among HCPs and ways to enhance knowledge dissemination to improve clinical practice.
Method
A qualitative study was undertaken, informed by a descriptive (transcendental) phenomenological approach. Semistructured interviews were audio recorded, transcribed and analysed inductively, with a conciliation among the research team used to finalise the themes.
Results
HCPs expressed the importance of learning about LEoP and how this may help build supportive patient-practitioner relationships and contribute to patient outcomes. Factors influencing the uptake of professional development included motivation, possibly stemming from a lack of awareness of LEoP, together with the time and logistical limitations of practice generally.
Discussion
Online learning activities followed by an assessment may be attractive for some HCPs, but peer-based and multidisciplinary continuing professional development activities remain preferred.
Conclusions: Thousands of Australian and New Zealand polio survivors are experiencing sequelae from past polio infections, many in migrant communities and including women of childbearing age. HCPs need to be aware of LEoP and PPS and incorporate this knowledge into their assessment and management of patients. A lack of awareness of LEoP and PPS, combined with time constraints for CPD, serves to perpetuate a serious gap in clinical knowledge, with potential adverse consequences for patients at risk of not being diagnosed or poorly managed.
Professional organisations could combine to develop multidisciplinary peer learning modules on LEoP. Existing online resources, such as the LEoP module on HealthPathways, could be more widely promoted. Organising dedicated symposia, such as that co-hosted by the University of Otago and Polio New Zealand , could also help with the dissemination of knowledge. Importantly, exploring the views of polio survivors and involving them in the co-development and delivery of educational materials could improve the relevance to all stakeholders involved.
Outcome of Research: Not applicable
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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: 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: 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: Brain, Diagnosis and Management, Late Effects of Polio, Post-Polio Motor Unit
Title: Spinal cord gray matter atrophy is associated with functional decline in post-polio syndrome
Author: Maria Janina Wendebourg (1,2), Matthias Weigel (1,2,3,4,5), Laura Richter (1), Vanya Gocheva (6), Patricia Hafner (6), Anna-Lena Orsini (6), Valentina Crepulja (1,2), Simone Schmidt (6), Antal Huck (4), Johanna Oechtering (1), Maria Blatow (7), Tanja Haas (3,4), Cristina Granziera (1,2,5), Ludwig Kappos (1,2,5), Philippe Cattin (4), Oliver Bieri (3,4) Dirk Fischer (6), Regina Schlaeger (1,2,5)
Affiliation: 1. Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
2. Translational Imaging in Neurology (ThINk), Department of Biomedical Engineering, University of Basel, Basel, Switzerland
3. Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland
4. Department of Biomedical Engineering, University of Basel, Basel, Switzerland
5. MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
6. Division of Pediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
7. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich,
Journal: European Journal of Neurology
Citation: Eur J Neurol. 2022;00:1–11.
DOI: 10.1111/ene.15261
Publication Year and Month: 2022 01
Abstract: Objective: To determine if patients with post- polio syndrome (PPS) show spinal cord gray matter (SCGM) atrophy and to assess associations between SCGM atrophy, muscle strength and patient- reported functional decline.
Methods: Twenty patients diagnosed with PPS (March of Dimes criteria) and 20 age- and sex- matched healthy controls (HC) underwent 3T axial 2D- rAMIRA magnetic resonance imaging at the intervertebral disc levels C2/C3–C6/C7, T9/T10 and the lumbar enlarge-ment level (Tmax) (0.5 × 0.5 mm2 in- plane resolution). SCGM areas were segmented manu-ally by two independent raters. Muscle strength, self-reported fatigue, depression and pain measures were assessed.
Results: Post- polio syndrome patients showed significantly and preferentially re-duced SCGM areas at C2/C3 (p= 0.048), C3/C4 (p= 0.001), C4/C5 (p< 0.001), C5/C6 (p= 0.004) and Tmax (p= 0.041) compared to HC. SCGM areas were significantly associated with muscle strength in corresponding myotomes even after adjustment for fatigue, pain and depression. SCGM areaTmax together with age and sex explained 68% of ankle dorsiflexion strength variance. No associations were found with age at or time since infection. Patients reporting PPS- related decline in arm function showed significant cervical SCGM atrophy compared to stable patients adjusted for initial disease severity.
Conclusions: Patients with PPS show significant SCGM atrophy that correlates with mus-cle strength and is associated with PPS- related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not ex-plained by aging or residua of the initial infection alone. Confirmation by longitudinal studies is needed. The described imaging methodology is promising for developing novel imaging surrogates for SCGM diseases.
Conclusions: The rAMIRA approach is a novel, promising, clinically feasible and sensitive method for segment-wise quantitation of GM atrophy in the cervical and thoracic SC in patients with lower motor neuron disorders. This study demonstrated its clinical applicability and vali-dated it in patients with PPS, a presumed pure, lower motor neuron disorder, which can serve as a model for other neurodegenerative, genetic or autoimmune diseases of the SCGM.
Patients with PPS show significant SCGM atrophy, particularly at levels close to the cervical and lumbar enlargements. Even after adjustment for the level of depression, fatigue and pain, potential confounding symptoms frequently observed in PPS, SCGM atrophy is significantly and segment-wise associated with muscle strength in corresponding myotomes. Moreover, SCGM atrophy is associated with patient-reported PPS-related functional decline. Secondary analyses suggest that SCGM atrophy is rather due to a second dis-ease phase than being a sole residuum of the initial infection or a pure aging effect. These observations support the hypothesis of a focally accentuated neurodegenerative process in the SC underlying PPS. Larger, ideally multicentric, longitudinal studies conducted over a sufficiently long timespan are an important next step to confirm our results and gain more insights into the development of SCGM atrophy over time and its correlation to clinical symptom evolution in patients with PPS.
Outcome of Research: More research required
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Category: Late Effects of Polio, Muscle Strength, Post-Polio Motor Unit
Title: Treatment with LâCitrulline in patients with postâpolio syndrome: A single center, randomized, double blind, placeboâcontrolled trial
Author: Niveditha Putananickal (1), Anna-Lena Orsini (1), Simone Schmidt (1), Vanya Gocheva (1), Daniela Rubino (1), Tanja Haas (2), Sabine Schädelin (3), Xeni Deligianni (2), Oliver Bieri (2), Dirk Fischer (1), Patricia Hafner (1)
Affiliation: (1) Division of Pediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, Switzerland
(2) Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland
(3) Department of Clinical Research, Clinical Trial Unit, University of Basel Hospital, Basel, Switzerland
Journal: Neuromuscular Disorders
Citation: Volume 31, Issue 11, p. 1136-1143
DOI: https://doi.org/10.1016/j.nmd.2021.08.011
Publication Year and Month: 2021 11
Abstract: This single-centered, randomized, double-blind, placebo-controlled study reports the results of L-Citrulline treatment for 24 weeks in patients with post-polio syndrome (PPS). Twenty-nine patients were randomized and assigned into receiving a treatment of 15âŻg L-Citrulline or placebo. The primary endpoint was the change of the 6 min walking distance test. Secondary endpoints included motor function measure, quantitative muscle strength, quantitative MRI and self-reported impairment questionnaires. Patients receiving L-Citrulline walked 17.5 longer in the 6 min walking distance test when compared to placebo group, however not statistically significant (95% CI = -14.69; 49.68, pâŻ=âŻ0.298). None of the secondary endpoints showed a statistically significant change in the L-Citrulline group when compared to placebo group. The motor function measure showed a change of -0.78 (95% CI= [-3.39; 1.83] pâŻ=âŻ0.563). Muscle degeneration of leg muscles assessed with quantitative MRI indicated no significant change (estimate= -0.01, 95% CI =-0.13; 0.11, pâŻ=âŻ0.869). L-Citrulline was safe and well tolerated. In conclusion, administration of 15âŻg L-Citrulline daily for 24 weeks to patients with PPS showed no beneficial treatment effect in timed muscle function.
Keywords:
Post-polio syndrome, Late effects of poliomyelitis, L-Citrulline, 6MWT, Quantitative MRI
Conclusions: Our results demonstrate that 15âŻg of daily CIT treatment for 24 weeks did not show a beneficial treatment effect on timed muscle function assessment in patients with PPS. None of the secondary outcomes indicated a beneficial effect due to the CIT treatment.
The chosen qMRI method for detecting muscle degeneration of lower calf muscles seems not appropriate for future studies in a population with PPS. Furthermore, an appropriate endpoint integrating the asymmetric and slow decline has to be still determined in patients with PPS. To further evaluate the therapeutic effect of CIT in individuals with PPS trials, potentially a combination with Metformin is proposed.
Outcome of Research: More research required
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Category: Cardiorespiratory
Title: Cardiopulmonary exercise testing in neuromuscular disease: a systematic review
Author: Gabriela Barroso de Queiroz Davoli (1), Bart Bartels (2), Ana Claudia Mattiello-Sverzut (3), Tim Takken (4*)
Affiliation: (1) University of São Paulo, Ribeirão Preto Medical School, Brazil, 0000-0002-4981-3868 – ORCID, [email protected].
(2) Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands, 0000-0002-5801-6692–ORCID, [email protected].
(3) University of São Paulo, Ribeirão Preto Medical School, Brazil, 0000-0002-4181-0718 –ORCID, [email protected].
(4) Child Development & Exercise Center Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands, 0000-0002-7737-118X –ORCID, [email protected].
* Corresponding author: Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht The Netherlands. Heidelberglaan 100 3584 CX Utrecht, The Netherlands. Tel +31887554030.
Email [email protected].
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Expert Review of Cardiovascular Therapy
Gabriela Barroso de Queiroz Davoli, Bart Bartels, Ana Claudia
Mattiello-Sverzut & Tim Takken (2021): Cardiopulmonary exercise testing in neuromuscular
disease: a systematic review, Expert Review of Cardiovascular Therapy, DOI:
10.1080/14779072.2021.2009802
Publication Year and Month: 2021 11
Abstract: INTRODUCTION:
Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs’ physical fitness, the applicability of CPET remains largely unknown.
AREAS COVERED:
This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient’s aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Except for reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations.
EXPERT OPINION:
CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are considered. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.
Keywords: exercise test, exercise modality, feasibility, muscle disease, rehabilitation, aerobic fitness.
ARTICLE HIGHLIGHTS:
â Standardizations in CPET protocols are needed because of low adherence to ATS/ACCP recommendations;
â High completion rates and few adverse events support the feasibility of CPET in pediatric and adult patients with NMD;
â Low cardiopulmonary stress (e.g. low peak heart rate), despite high metabolic demand (e.g. peak respiratory exchange ratio >1), might be a feature of NMDs, except for patients with glycogen storage disease or motor neuron disease;
â The upright cycle ergometer with ramp-wise increment is advisable to assess various ambulatory adults and some pediatric patients with NMD;
â On the treadmill, the Naughton and the Dubowy protocols are alternatives for some adults and the young patients with NMD when an upright cycle ergometer is not available.
Conclusions: The knowledge about exercise limiting factors and aerobic fitness in NMDs is increasing and brings the need to understand the applicability and safety of the goldstandard method, CPET, in assessing these variables for this specific group. Our results direct that CPET is feasible for adult and young patients with NMDs when the patient’s functional level and the exercise modality of CPET are considered. However, to safety favour the implementation of CPET in the routine assessment of patients with NMDs, clinicians are urged to follow the ATS/ACCP recommendations for performing and Information Classification: General reporting CPET. Furthermore, there is vast potential for standardization and design of disease-specific CPET protocols for patients with NMDs.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Late Effects of Polio
Title: Risk factors for functional deterioration in a
cohort with late effects of poliomyelitis:
A ten-year follow-up study
Author: Zeev Meiner (1*), Anat Marmor (1), Murad Jalagel (1), Hagai Levine (2), Shimon Shiri (1) and Isabella Schwartz (1)
Affiliation: (1) Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
(2) Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
Journal: NeuroRehabilitation
Citation: vol. 49, no. 3, pp. 491-499.
DOI:10.3233/NRE-210216
Publication Year and Month: 2021 11
Abstract: Background:
More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome.
Objective:
To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years.
Methods:
A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires.
Results:
Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions.
Conclusions:
Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.
Keywords: ADL; Poliomyelitis; functional outcomes; wheelchair use.
Conclusions: The results of the present study indicate that aging has a significant effect on the independence and quality of life of people with LEoP. Other risk factors for deterioration in functional independence were ethnicity, use of a wheelchair, and use of an orthotic device in childhood. These findings emphasize the need for specific rehabilitation programs for to prevent further deterioration in this population.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: 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 (NâŻ=âŻ25), Charcot-Marie-Tooth disease (NâŻ=âŻ34) and other slowly progressive NMD (NâŻ=âŻ10).
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-predictedâŻ=âŻ- 64.308âŻ+âŻ45.743 x gender (0âŻ=âŻfemale; 1âŻ=âŻmale)âŻ+âŻ1.060 x MRCsumâŻ+âŻ0.287âŻ×âŻ6MWT distance (R2âŻ=âŻ0.58). No significant difference was found between Wpeak-measured (meanâŻ=âŻ127.7 ± 56.5 Watts) and Wpeak-predicted (meanâŻ=âŻ122.1 ± 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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Link to Full Paper (if available): Click here to view Abstract
Category: Falls
Title: Falls in Post-Polio Patients: Prevalence and Risk Factors
Author: Yonah Ofran (1,2), Isabella Schwartz (1,2), Sheer Shabat (1,2), Martin Seyres (1,2), Naama Karniel (2,3) and Sigal Portnoy (3,*).
Affiliation: (1) Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 91905, Israel
(2) Department of Physical Medicine & Rehabilitation, Hadassah University Hospital, Jerusalem 9765418, Israel
(3) Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
* Author to whom correspondence should be addressed.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Biology
Biology 2021, 10(11), 1110; https://doi.org/10.3390/biology10111110
Publication Year and Month: 2021 10
Abstract: Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. Methods: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. Results: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). Conclusion: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.
Keywords: gait analysis; coefficient of variability; gait symmetry; timed up and go
Conclusions: We conclude that the gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for PPS patients.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: 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 (NâŻ=âŻ11), Charcot-Marie-Tooth disease (NâŻ=âŻ12) and other slowly progressive NMD (NâŻ=âŻ8) 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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Link to Full Paper (if available): Click here to view Abstract
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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Link to Full Paper (if available): Click here to view Abstract
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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Link to Full Paper (if available): Click here to view Abstract
Category: Surgery
Title: An algorithmic approach to total hip arthroplasty in patient with post-polio paralysis and fixed pelvic obliquity
Author: Rajesh Malhotra, Deepak Gautam, Saurabh Gupta, Krishna K. Eachempati
Affiliation: Orthopedics Department, All India Institute of Medical Sciences, New Delhi, India
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Bone & Joint Open
Bone Jt Open 2021;2-9:696–704. doi: 10.1302/2633-1462.29.BJO-
2021-0084.R1
Publication Year and Month: 2021 09
Abstract: Aims
Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only
imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner
wear, and early loosening.
Methods
In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as
per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment.
Results
The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6o (SD 7.9o) to 1.8o (SD 2.4o; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months.
Conclusion
Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic
obliquity.
Conclusions: In conclusion, the results of this series have re-emphasized that THA can be considered a feasible treatment for hip arthritis in patients with PPRP. This is the first study to report on the additional soft tissue procedures performed along with THA in patients with post-polio paralysis so as to simultaneously correct the deformity, and give a squared or a nearly squared painless pelvis. In addition to pain relief, correction of soft tissue contractures is also needed for hip stability and pelvic balance. Given the risk of implant loosening with the use of constrained prosthesis, the authors advocate the use of dual mobility prosthesis whenever possible. One should also consider gluteus maximus transfer if the abductor power is compromized due to the contracture release. Although a general conclusion cannot be made with a limited number of patients, this study proves that simultaneous correction of bilateral contractures is an important aspect of treating hip arthritis in patients with PPRP. New cases of poliomyelitis are unlikely to be seen in developed countries (as they have been eliminated or eradicated by vaccinations), it is intuitive that patients infected before the eradication era are still there in the age range for THA in developing countries, and will be approaching orthopaedic surgeons for a few decades in the future.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Assistive Technology, Orthoses
Title: Commonly Used Types and Recent Development of Ankle-Foot Orthosis: A Narrative Review
Author: Yoo Jin Choo and Min Cheol Chang
Affiliation: Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Healthcare 2021, 9(8), 1046; https://doi.org/10.3390/healthcare9081046
Publication Year and Month: 2021 08
Abstract: (1) Background: ankle-foot orthosis (AFO) is the most commonly prescribed orthosis to patients with foot drop, and ankle and foot problems. In this study, we aimed to review the commonly used types of AFO and introduce the recent development of AFO.
(2) Methods: narrative review.
(3) Results: AFO prevents the foot from being dragged, provides a clearance between the foot and the ground in the swinging phase of gait, and maintains a stable posture by allowing heel contact with the ground during the stance phase. In clinical practice, the most commonly used AFO include plastic AFO, walking boot, UD-Flex, and carbon fiber AFO. In addition, for compensating the demerits of these conventional AFOs, new types of AFOs, including AF Servo, TurboMed, three-dimensionally printed AFO, and AFO made from kenaf composites, were developed.
(4) Conclusions: we think that our review can guide clinicians in selecting and prescribing the appropriate AFO for each patient in accordance with their specific physical conditions.
Keywords: ankle-foot orthosis; orthosis; review
Conclusions: In this study, we described the most commonly used and recently developed AFO. Compared to conventional AFOs, recently developed AFOs have better durability, shorter production time, more sophisticated shape-making ability, easier donning, or improved appearance, depending on their types. However, these superior qualities do not necessarily preclude conventional AFOs. The convergence of high-intensity materials and high technology may be economically burdensome, and patients may not want to prematurely use recently developed AFOs because they have no confidence in the products. A variety of new AFOs have been developed, but the most widely used in clinical practice is plastic AFOs because they are relatively inexpensive, vary in type depending on the additional materials used, and can be worn regardless of shoe type. However, plastic AFOs are slightly less durable than recently developed AFOs.
The selection of an appropriate AFO that considers both the physical and psychological state of the user is important to achieve the most successful rehabilitation and increase convenience in daily living. Because different AFOs have different indications, contraindications, features, and user preferences, the appropriate AFO should be selected depending on the status of the user. Future research should consistently be conducted to continuously update AFO selection guidelines and systematically classify which AFO type is most effective for each disease, increasing user preference. In addition, the effectiveness of AFOs that are still being developed should be obtained through clinical trials.
We consider our review to be useful for clinicians when prescribing the appropriate AFO for the specific needs of patients in the future. In addition, this review provides information to broaden the choices of AFO during AFO prescription by clinicians.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
Link to Full Paper (if available): Click here to view full text or to download
Category: Diagnosis and Management, Late Effects of Polio
Title: Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study
Author: Claudio Andre Barbosa de Lira (I), Douglas Assis Teles Santos (II), Ricardo Borges Viana (III), Juliana Moreira Guimarães (IV), Jéssica Nathalia Soares Oliveira (V), Bolivar Saldanha Sousa (VI), Marcos Gonçalves de Santana (VII), Rodrigo Luiz Vancini (VIII),
Marília Santos Andrade (IX), Pantelis Nikolaidis (X), Thomas Rosemann (XI), Beat Knechtle (XII)
Affiliation: (I) BSc, PhD. Associate Professor, Faculdade de Educação Física e Dança (FEFD), Universidade Federal de Goiás (UFG), Goiânia (GO), Brazil. https://orcid.org/0000-0001-5749-6877
(II) BSc, MSc. Assistent Professor, Colegiado de Educação Física, Universidade do Estado da Bahia (UNEB), Teixeira de Freitas (BA), Brazil. https://orcid.org/0000-0002-7664-5468
(III) BSc, PhD. Professor, Escola Superior de Educação Física e Fisioterapia do Estado de Goiás (ESEFFEGO), Universidade Estadual de Goiás (UEG), Goiânia (GO), Brazil. https://orcid.org/0000-0001-9200-3185
(IV) BSc. Nurse, Unidade Acadêmica Especial de Ciências da Saúde, Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0002-6729-0335
(V) BSc. Biomedic, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU),
Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0002-9531-4277
(VI) MD, PhD. Physician, Hospital Israelita Albert Einstein, São Paulo-Brazil, São Paulo (SP), Brazil. https://orcid.org/0000-0001-9682-5987
(VII) BSc, PhD. Associate Professor, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil. https://orcid.org/0000-0001-7674-3263
(VIII) BSc, PhD. Adjunct Professor, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil. https://orcid.org/0000-0003-1981-1092
(IX) PhD. Physical Therapist and Associate Professor, Department of Physiology, Universidade Federal de São Paulo (USP), São Paulo (SP), Brazil. https://orcid.org/0000-0002-7004-4565
(X) BSc, PhD. Professor, School of Health and Caring Sciences, University of West Attica, Athens, Greece. https://orcid.org/0000-0001-8030-7122
(XI) MD, PhD. Physician and Professor, Institute of Primary Care, University of Zurich, Zurich, Switzerland. https://orcid.org/0000-0002-6436-6306
(XII) MD, PhD. Physician and Scientific Assistant, Institute of Primary Care, University of Zurich, Zurich, Switzerland; and Researcher, Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland https://orcid.org/0000-0002-2412-9103
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Sao Paulo Med. J.
139 (5) • Aug-Sep 2021
https://doi.org/10.1590/1516-3180.2020.0617.16032021
Publication Year and Month: 2021 08
Abstract: BACKGROUND:
Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors.
OBJECTIVE:
Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals.
DESIGN AND SETTING:
Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás.
METHODS:
The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed).
RESULTS:
In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%.
CONCLUSIONS:
The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.
KEYWORDS (MeSH terms):
Poliomyelitis; Physicians; Nervous system; Postpoliomyelitis syndrome; Knowledge
AUTHORS’ KEY WORDS:
Medical education; Neuromuscular disease; Late effects of polio
Conclusions: Our study showed that, overall, there is a lack of knowledge about PPS and poliomyelitis, especially among psychologists and nutritionists. Therefore, the services provided by these professionals may become compromised. Furthermore, government initiatives should be implemented to increase knowledge among healthcare professionals.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Falls, Late Effects of Polio
Title: Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study
Author: Christina Brogårdh (1,2), Jan Lexell (1,2) and Catharina Sjödahl Hammarlund (1,3)
Affiliation: 1) Department of Health Sciences, Lund University, 221 00 Lund, Sweden
2) Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden
3) The PRO-CARE Group, School of Health and Society, Kristianstad University, 291 39 Kristianstad, Sweden
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Int. J. Environ. Res. Public Health 2021, 18(13), 7202; https://doi.org/10.3390/ijerph18137202
Publication Year and Month: 2021 07
Abstract: Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
Keywords: activities of daily living; fear of falling; postpoliomyelitis syndrome; qualitative research
Conclusions: Fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Fatigue
Title: Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis
Author: Sungha Kim (1), Ying Xu (1), Kelly Dore (2), Rebecca Gewurtz (1), Nadine Larivière (2) and Lori Letts (1)
Affiliation: (1) School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
(2) Department of Medicine, McMaster Education Research, Innovation & Theory (MERIT), David Braley Health Science Centre, Hamilton, ON, Canada
Corresponding author:
Sungha Kim, School of Rehabilitation Science, McMaster University, 1400 Main Street West, Hamilton, ON, Canada L8S
1C7. Email: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Chronic Illness
https://doi.org/10.1177/17423953211039783
Publication Year and Month: 2021 07
Abstract: Objective
The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions.
Methods
Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management.
Results
Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:−0.62 to − 0.21); standardised mean difference of the seven exercise studies was −0.55 (95% confidence interval: −0.78 to −0.31).
Discussion
Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
Keywords
Fatigue, self-management, occupational therapy, physiotherapy, chronic conditions
Conclusions: Fatigue is a complicated symptom with different aspects, including fatigue severity, impact, and multidimensional aspects.91 We did not differentiate these aspects because of a lack of information about the exact differences among them.92 Researchers will need to work to understand and explicitly explain the differences among fatigue’s different dimensions. Only then can future reviews focus on a specific aspect of fatigue and determine the effectiveness of a fatigue self-management programme in addressing it.
In summary, although the evidence for the effectiveness of some fatigue self-management programmes is not convincing, physical exercises inspired by self-management principles may reduce fatigue symptoms, improve quality of life, and enhance other functional abilities. Further research is needed to determine the optimal type, duration, and intensity of a fatigue self-management exercise.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Women's Health
Title: Paralysed with Fear a Literature Review on Aspects of Pregnancy in Polio Survivors
Author: Tanmayee Pore (1) & Pallavi Wakode (2)
Affiliation: 1) Smt. Kashibai Navale College of Physiotherapy, Narhe, Pune, India.
2) Department of Community Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Narhe, Pune, India.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Asian Journal of Pregnancy and Childbirth
Pore, T., & Wakode, P. (2021). Paralysed with Fear a Literature Review on Aspects of Pregnancy in Polio Survivors. Asian Journal of Pregnancy and Childbirth, 4(2), 31-37. Retrieved from https://www.journalajpcb.com/index.php/AJPCB/article/view/30136
Publication Year and Month: 2021 06
Abstract: After several decades of stability, female polio survivors often experience new signs and symptoms of their condition, characterized by global and muscular fatigue, decreased muscular strength and pain along with secondary changes in body anatomy and physiology with respect to pregnancy. Problems of ante-partum care and delivery of women who have been victims of poliomyelitis are fortunately rarely encountered. These women have a higher occurrence of pre-eclampsia, gestational proteinuria, renal disease prior to pregnancy, vaginal bleeding and urinary tract infection during pregnancy. Deliveries complicated by obstruction of the birth process are more common in the polio group, and cesarean section is performed at a higher rate throughout the time period. The prognosis of the disease when it occurs during pregnancy may be less predictable, but it is generally good for both mother and infant. Although the incidence of abortion is relatively high, if the pregnancy goes to term parturition is expected to be normal. An amalgamation of good antenatal assessment & care, psychological counselling and support groups have been found to be successful in providing them with the best possible outcome. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming along with the effects of post-polio syndrome on pregnancy and possible interventions to achieve symptomatic relief & aid in better quality of life.
Keywords: Polio pregnancy post-polio syndrome disability rehabilitation
Conclusions: Post-polio syndrome can precipitate in all trimesters of pregnancy. Multidimensional approach of managing these individuals has shown a great effect in reducing the number of associated complications such as pre-eclampsia, vaginal bleeding and UTIs while providing them with better health related quality of life.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Psychology
Title: Psychiatric Approaches and Outcomes
Author: Stephanie T. Machell PsyD
Affiliation: Independent Practice, Belmont, MA, USA
Independent Practice, Framingham, MA, USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Physical Medicine and Rehabilitation Clinics of North America - https://www.journals.elsevier.com/physical-medicine-and-rehabilitation-clinics-of-north-america
Phys Med Rehabil Clin N Am - (2021) -–-
https://doi.org/10.1016/j.pmr.2021.03.002 pmr.theclinics.com
1047-9651/21/ - 2021 Elsevier Inc.
Publication Year and Month: 2021 05
Abstract: INTRODUCTION:
In 1946, Morton Seidenfeld was appointed director of psychological services for the National Federation for Infantile Paralysis (NFIP). He believed that once polio’s acute phase ended, 75% to 90% of a patient’s needs had a psychological component that should be addressed by making psychological services an integral part of the care provided.1 Despite his advocacy (seen as newsworthy enough to be reported by The New York Times2), his vision never was realized. Few polio rehabilitation programs included mental health professionals. The vast majority of those that included mental health facets provided only the most cursory services. Seidenfeld’s 1952 survey of the polio literature showed that less than 2% focused on psychological needs.1
Based on the negative memories of interactions with mental health professionals reported in polio survivors’ memoirs,3,4 it may be just as well. Mid–twentieth century psychotherapy’s psychoanalytic framework was ill suited to address issues related to medical trauma or disability. The few pioneers in the new specialty of rehabilitation psychology subscribed to what had been referred to as the “polio zeitgeist,”5 guiding patients toward a form of emotional, social, and cognitive “adjustment” analogous to the physical and occupational therapist’s efforts to make polio bodies acceptable to the cultural surround they would need to inhabit in order to succeed.
And succeed they did, becoming the best educated, highest achieving, and most frequently married of all people with disabilities. This success came at a high price, exacting a physical toll in the form of post-polio syndrome (PPS). As Seidenfeld predicted, it exacted a psychological toll as well. In the postwar era, when the specialty of rehabilitation psychology was coming into being, providing psychological services in general hospitals and rehabilitation units was a radical idea. Now, although it is common to find mental health professionals providing care in rehabilitation settings, accessing polio-informed mental health care remains challenging due to lack of information and awareness about polio and the number of polio survivors in the population at large.
The goal of this article is to help those already working with this population, in particular
medical providers, infuse psychological principles into their work. Providers ought to know how to find and integrate mental health professionals into their teams and/or make appropriate community referrals. Mental health professionals currently working with polio survivors must consider ways of expanding this work and encourage those trained in working with chronic illness, physical disability, and psychological trauma to develop an interest in joining their ranks. After a brief review of the literature, discussions around the psychological issues polio survivors face, the provision of polioinformed mental health treatment, and ways providers and clinics can address mental health issues that may arise during medical treatment. Finally, this article explores future directions for providing polio-informed mental health services, including the promise of telehealth to expand such services and the need to train the next generation of providers.
A word about terminology. For the purposes of the article, ‘polio survivor’ is used to refer to any individual with a history of polio. Mental health professional or psychotherapist is used if a specialty (eg, psychiatry, psychology, social work, or licensed counseling) is irrelevant. Provider generically refers to any provider, including mental health professionals.
KEY POINTS:
Although polio survivors benefit from addressing the energy drain created by unresolved mental health issues, their psychological needs often are overlooked.
Polio-informed psychological treatment and medical treatment informed by the survivor’s psychological needs enable patients to address polio within a whole-life context.
By providing empathic support for their patients’ mental health needs, physicians and other medical providers can create a culture of mental health within the polio clinic.
KEYWORDS:
Post-polio syndrome, Psychotherapy, Medical trauma
Conclusions: When polio survivors’ mental health issues are addressed by both medical and mental health providers, treatment outcomes improve. They report improved functioning and life satisfaction and are far more likely to comply with treatment. Unfortunately, more than 70 years after Morton Seidenfeld first attempted to raise awareness of their importance, these needs often are left unaddressed. It is my hope that this article inspires providers to try to change this and make his vision for integrated whole-person care a reality.
Outcome of Research: More research required
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Category: Brain, Late Effects of Polio, Post-Polio Motor Unit
Title: Imaging data indicate cerebral reorganisation in poliomyelitis survivors: Possible compensation for longstanding lower motor neuron pathology
Author: Stacey Li Hi Shing (a), Jasmin Lope (a), Rangariroyashe H. Chipika (a), Orla Hardiman (a), Peter Bede (a, b, ∗)
Affiliation: (a) Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
(b) Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
∗ Corresponding author: Peter Bede, Room 5.43, Computational Neuroimaging Group, Trinity Biomedical Sciences In- stitute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland.
E-mail address: [email protected] (P.Bede).
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Neurological Sciences
424 (2021) 117361
DOI: https://doi.org/10.1016/j.jns.2021.117361
Publication Year and Month: 2021 05
Abstract: BACKGROUND
Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting.
OBJECTIVE
The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics.
METHODS
Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton.
RESULTS
In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.
CONCLUSIONS
Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
Keywords
Post-polio syndrome, Motor neuron disease, Neuroimaging, Pathology, Poliomyelitis
Conclusions: Contrary to previous reports, we found no evidence of cerebral grey or white matter degeneration in a cohort of polio survivors using a validated quantitative neuroimaging protocol. The brainstem, corticospinal tracts and the cerebellum exhibit superior integrity in poliomyelitis survivors compared to healthy controls.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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
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
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, Post-Polio Motor Unit
Title: A Longitudinal Motor Unit Number Index (MUNIX) Estimation Study in Poliomyelitis (2815)
Author: Taha Omer (1), Bahman Nasseroleslami (1), Fiona Molloy (2), Gerard Mullins (2), Orla Hardiman (3)
Affiliation: (1) Trinity College Dublin
(2) Beaumont Hospital
(3) Trinity Biomedical Sciences Institute
Journal: Neurology
Citation: 96.15 Supplement (2021): 2815. Web. 08 Feb. 2022.
Publication Year and Month: 2021 04
Abstract: Objective:
We aimed at establishing MUNIX repository of Poliomyelitis survivors, determining the rate of MUNIX decline longitudinally and comparing patient characteristics and disease parameters among polio subgroups.
Background:
Motor Unit Number index (MUNIX) is a non-invasive method that that involves utilizing the surface-recorded compound muscle action potential (CMAP) and electromyographic (EMG) interference pattern to compute the motor unit number index (MUNIX). This is the first study of this scale that applied MUNIX in Poliomyelitis (Polio).
Design/Methods:
We performed longitudinal MUNIX measurements in 6 muscles in 41 Polio patients, 3-monthly, over 21 months period on the least affected side or the side with clinically not affected fourth limb. Detailed clinical data was also collected.
Results:
Of 41 (34 spinal and 7 spinobulbar) enrolled patients (M: F= 19:21), subgroup results varied.
Mean age (±SD) of patients was 62.1(±6.8) years. Mean disease duration at visit1 was 59.8(±6.6) years.
Slight longitudinal decline in MUNIX values were recorded in 7 participants (17%). There were no differences between the later cohort and the rest of participants as regards to: demographics, polio onset age, gender, subtype, duration or post-polio syndrome (PPS) metrics (symptoms, onset age, duration and recovery type).
MUSIX values temporarily increased in 8 participants (19.5%) at time of muscle pain, returning to about 80–90% of baseline. Disease metrics were similar in this subgroup compared to other participants.
Conclusions:
This is the largest scale MUNIX study in Poliomyelitis. Our observation of the effect of pain on MUSIX needs further research perhaps using a combination of Neurophysiological techniques.
Conclusions: This is the largest scale MUNIX study in Poliomyelitis. Our observation of the effect of pain on MUSIX needs further research perhaps using a combination of Neurophysiological techniques.
Outcome of Research: More research required
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Category: Diagnosis and Management, Late Effects of Polio
Title: Post-polio syndrome and the phantom of acute previous poliomyelitis: a systemic entity
Author: Jacqueline Stephanie Fernandes do Nascimento (1), Nicolle dos Santos Moraes Nunes (1), Thais de R. Bessa-Guerra (1*), Marco Antonio Alves Azizi (2), Adalgiza Mafra Moreno (2), Antônio Marcos da Silva Catharino (2), Paulo Henrique de Moura (2), Thiago Rodrigues Gonçalves (2), Renata R. T. Castro (2), Acary Souza Bulle Oliveira (3), Marcos RG de Freitas (4) and Marco Orsini (2)
Affiliation: (1) Graduanda de Medicina na Universidade lguaçu (UNIG) - Nova lguaçu, RJ -Brasil
(2) Professor titular na Universidade lguaçu (UNIG). Nova lguaçu, RJ -Brasil
(3) Neurologista, Doutor em Neurologia pela Escola Paulista de Medicina (UNIFESP) - São Paulo (SP) - Brasil
(4) Neurologista, Doutor, Professor Titular e Chefe do Serviço de Neurologia da UFF, Niterói-RJ - Brasil
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: International Journal of Current Research
Vol. 13, Issue, 04
Publication Year and Month: 2021 04
Abstract: Introduction:
Poliomyelitis, often referred to as infantile paralysis or polio, was first described in 1840 by Jakob Von Heine, a German orthopedic physician. It is an acute and infectious disease caused by an enterovirus of worldwide distribution. With the implementation of immunization, the incidence of cases has reduced exponentially worldwide. However, a portion of individuals who have already developed polio, are now manifesting the late effects of polio, called post polio syndrome (PPS).
Case Report:
PRF, male, system analyst. Diagnosis of acute previous polio at the 18th month of age in a hospital in Fortaleza in 1965. At the age of 18 he started to present a new clinic of muscle fatigue, weakness and inability to perform his daily activities.
Discussion:
The Post-polio syndrome (PPS) was first reported in 1875, by Raymond, when reporting the case of a 19-year-old man, previously infected with acute previous polio and at that time had presented a new clinic of muscle weakness and atrophy. Post-poliomyelitis syndrome is defined as a presentation of the delayed effects of polio with the appearance of new neuromuscular symptoms that occur at least 15 years after clinical and functional stability in the natural history of patients with a previous history of acute previous polio. It can be characterized by: new muscle weakness, atrophy and pain, fatigue, sleep disorders, joint pain, cold intolerance, recent weight gain, respiratory distress and dysphagia. Criteria that support the diagnosis are used, such as: (1) Having been affected with acute previous polio; (2) at least 15 years of clinical stability; (3) new clinic of muscle weakness and fatigue; (4) complete or partial recovery of the functions lost in the poliomyelitis period, with a subsequent decline; (5) no other clinical conditions that explain the case. However, effective monitoring by a multidisciplinary team is necessary to assess the degree of functional and motor deterioration, respiratory capacity, as well as the psychological assessment of the patient.
Conclusion:
Although acute previous poliomyelitis has been eradicated in Brazil, as well as in several countries in the world, it is estimated that today there are still about 12 million individuals with poliomyelitis after-effects.
Conclusions: Although acute previous polio has been eradicated in Brazil, as well as in several countries in the world, it is estimated that today there are still about 12 million individuals with poliomyelitis after-effects. These patients overload the health system, especially those diagnosed with post-polio syndrome. Therefore, studies in different areas of health sciences are extremely important for understanding the pathophysiological mechanisms and with the aim of improving the quality of life of these patients.
Studies that address the biochemical and physiological issue can be useful for understanding the neurodegeneration that occurs in PPS, in addition to composing material for the study of the repercussion of a physical / motor after-effect on one or more organic systems and on functional capacity.
Outcome of Research: More research required
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Cardiorespiratory, Late Effects of Polio, Respiratory Complications and Management
Title: Living the Present with an Enemy from the Past: The Role of Noninvasive Ventilation in a Poliomyelitis Survivor
Author: Adelaide Alves, Sara Conde, and Carla Ribeiro
Affiliation: Pulmonology Department of Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
Journal:
Citation: Clin Case Rep Open Access. 2021;4(2):185.
https://dx.doi.org/10.46527/2582-5038.185
Publication Year and Month: 2021 04
Abstract: Poliomyelitis epidemics of the twentieth century boosted the development of noninvasive positive-pressure ventilation which has changed the natural history and extended survival in a wide range of disorders with chest wall and muscular involvement. Poliomyelitis has almost been eradicated from developed countries since the introduction of vaccination. However, challenges keep coming since there are a substantial number of survivors of the disease who need particular clinical care, namely in the respiratory field. We present a case report of a polio survivor attempting to demonstrate that even after so many years the respiratory approach of these patients remains a current issue in clinical practice with noninvasive ventilation as a cornerstone element.
Keywords: Poliomyelitis; Respiratory failure; Noninvasive ventilation
Conclusions: Finally, we should be aware of a post-polio syndrome referring to a sub-category of the late effects of polio several years following the initial recovery, including muscle weakness and fatigability [11]. This late muscle involvement may also affect the respiratory muscles leading to chronic respiratory failure several years after primary infection [12,13].
For all these reasons, polio continues to represent a current clinical condition in the field of Pulmonology not only because there are many survivors with established thoracic deformities and neuromuscular involvement, but also because of the possibility of late respiratory effects.
Outcome of Research: Not applicable
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Pain, Late Effects of Polio
Title: Effectiveness of Intravenous Immunoglobulin for Management of Pain in Patients with Postpolio Syndrome
Author: Min Cheol Chang (1), Jin-Sung Park (2), Jong-moon Hwang (3), and Donghwi Park (4)
Affiliation: (1) Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
(2) Department of Neurology, School of Medicine, Kyungpook National University,
Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
(3) Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
(4) Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine,
Ulsan, Republic of Korea
Journal: Pain Research and Management
Citation: Volume 2021, Article ID 6637705, 4 pages
https://doi.org/10.1155/2021/6637705
Publication Year and Month: 2021 03
Abstract: Objective.
Many patients with postpolio syndrome (PPS) experience pain. In this study, we aimed to review previous studies to investigate the eďŹectiveness of intravenous immunoglobulin (IVIG) for managing pain in patients with PPS. We performed a narrative review.
Methods.
In PubMed, we searched for the keywords ((Immunoglobulin OR IVIG) AND (poliomyelitis OR poliomyelitis syndrome)). We included articles in which IVIG was infused in patients with PPS and pain severity was measured before and after treatment.
Results.
In the results, ďŹve articles (4 randomized controlled trials and 1 prospective observational study) were included in this review. Four of the studies reported that IVIG had a positive pain-reducing eďŹect in patients with PPS. In addition, 4 studies evaluated the outcomes related to muscle strength and function. Of these studies, 3 showed some improvement in measurements for muscle strength and function.
Conclusion.
In conclusion, IVIG might be one of the beneďŹcial options for managing pain in PPS. Pain reduction might be responsible for the improvement of muscle strength or function. To conďŹrm the beneďŹts of IVIG in reducing pain, more high-quality studies are required.
Conclusions: In conclusion, this review shows that IVIG administration might be useful for managing pain in patients with PPS. In the 5 articles reviewed, no major adverse effects were reported. Owing to the small number of studies and inconsistent results between the studies, we cannot make a definite conclusion on the effect of IVIG on pain in PPS. However, we think that the previous studies showed a possibility that IVIG can safely manage pain in patients with PPS. To confirm the benefits of IVIG in reducing pain in patients with PPS, more high-quality studies are required. Moreover, the protocols for IVIG infusion used in each study were heterogeneous; therefore, the most effective protocol for IVIG infusion for controlling pain should be evaluated in the future.
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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category:
Title: Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration
Author: Stacey Li Hi Shing, Jasmin Lope, Mary Clare McKenna, Rangariroyashe H. Chipika, Orla Hardiman, Peter Bede
Affiliation: Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of the Neurological Sciences
Stacey Li Hi Shing, Jasmin Lope, Mary Clare McKenna, Rangariroyashe H. Chipika, Orla Hardiman, Peter Bede, Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration, Journal of the Neurological Sciences, Volume 424, 2021, 117361, ISSN 0022-510X, https://doi.org/10.1016/j.jns.2021.117361.
Publication Year and Month: 2021 02
Abstract: Background
Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting.
Objective
The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics.
Methods
Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton.
Results
In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes.
Conclusions
Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
Keywords
Post-polio syndrome, Motor neuron disease, Neuroimaging, Pathology, Poliomyelitis
Conclusions: Contrary to previous reports, we found no evidence of cerebral grey or white matter degeneration in a cohort of polio survivors using a validated quantitative neuroimaging protocol. The brainstem, corticospinal tracts and the cerebellum exhibit superior integrity in poliomyelitis survivors compared to healthy controls.
Outcome of Research: More research required
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Category: Falls and Bone Density, Surgery
Title: Total Hip Arthroplasty in Patients With Postpolio Residual Paralysis: A Systematic Review
Author: Gaurav K. Upadhyaya, MS Orthopaedics (1)
Mohit K. Patralekh, MS Orthopaedics (2)
Vijay K. Jain, MS Orthopaedics (3)
Karthikeyan.P. Iyengar, FRCS (TR & Orth) (4)
Deepak Gautam, MS Orthopaedics (5)
Raju Vaishya, MS Orthopaedics (6)
Rajesh Malhotra, MS Orthopaedics (5)
Affiliation: 1. Department of Orthopaedics, All India Institute of Medical Sciences, Rae Bareli, Uttar Pradesh, India
2. Department of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
3. Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, India
4. Orthopaedics and Trauma, Southport and Ormskirk NHS Trust, Southport, UK
5. Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
6. Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, India
Journal: The Journal of Arthroplasty
Citation: Volume 36, Issue 6, June 2021, Pages 2239-2247
DOI:https://doi.org/10.1016/j.arth.2021.01.046
Publication Year and Month: 2021 01
Abstract: BACKGROUND
Patients with postpolio residual paralysis can develop disabling hip arthritis in paralytic as well as a nonparalytic limb, warranting total hip arthroplasty (THA). Limited literature is available on the results of THA among these patients in the form of small series or case reports. We have undertaken a systematic review to evaluate the clinical outcome of THA in patients with poliomyelitis with hip pathologies.
METHODS
A systematic search of electronic databases of PubMed, Scopus, and Web of Science pertaining to English literature was undertaken from 1945 to August 2020 to assess the results of THA in patients with poliomyelitis. Information was gathered about demographics, indication, clinical course, complications, functional outcome, survival, and need for any revision surgery in these patients.
RESULTS
The literature search revealed 81 articles. Finally, after deduplication and manual selection, 16 relevant articles (128 hips) were included for evaluation. There is a paucity of literature evaluating THA in patients with poliomyelitis over the last 2 decades. The principal reason for arthroplasty was osteoarthritis of the hip in the ipsilateral (paralyzed) limb. A combination of cemented, uncemented, and hybrid implant fixation system was found to be used by surgeons. Addressing instability and perioperative management of limb length discrepancy were found to be challenging propositions.
CONCLUSION
THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.
Conclusions: THA remains an effective intervention to relieve pain and improve quality of life in patients of poliomyelitis afflicted with either primary or secondary arthritis of the hip. The use of uncemented nonconstrained hip implant designs appears to demonstrate better results than constrained implants.
Outcome of Research: Effective
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Category: Late Effects of Polio, Muscular Atrophy, Sleep Analysis
Title: Neuronopathies and Sleep Disorders: Spinal Muscular Atrophy, Amyotrophic Lateral Sclerosis and Post-polio Syndrome
Author: Gülçin Benbir Ĺenel
Affiliation: Ä°stanbul Üniversitesi-CerrahpaĹa, CerrahpaĹa TÄąp Fakültesi, Nöroloji Anabilim DalÄą, Uyku BozukluklarÄą Bilim DalÄą, Ä°stanbul, Türkiye
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Turkish Sleep Medicine 2021;2:90-96
DOI: 10.4274/jtsm.galenos.2021.39306
Publication Year and Month: 2021
Abstract: Neuronopathies are defined as diseases affecting the bodies of neuron cells. These disorders may be inherited, sporadic or acquired and may be observed in children or adults. Spinal muscular atrophies, amyotrophic lateral sclerosis and Post-polio syndrome are prototype disorders in this group. The clinical course, time for diagnosis and therapeutic processes are very compelling for the patients, their relatives and physicians. Disturbances in sleep structure, an increase in cyclic alternating pattern and sleep-related disorders, especially of sleep-related breathing disorders, are commonly reported in these patients. More importantly, changes in sleep microstructure and associated sleep-related disorders have a negative effect on the course of the neuronopathies. By contrast, beneficial outcomes on the clinical course and prognosis of neuronopathies have been reported upon the diagnosis and treatment of sleep-related disorders early in the disease course.
Keywords:
Spinal muscular atrophies, amyotrophic lateral sclerosis, Post-polio syndrome, sleep-related disorders
Conclusions: Investigating and treating deteriorations in the microstructure of sleep and sleep-related disorders in patients with spinal muscular atrophies, amyotrophic lateral sclerosis or Post-polio syndrome are important.
Outcome of Research: Not applicable
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Category: 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: Women's Health
Title: Primary breast cancer patient with poliomyelitis: A case report
Author: Xing-Miao Wang, Yi-Zi Cong, Guang-Dong Qiao, Song Zhang, and Li-Juan Wang
Affiliation: Xing-Miao Wang, Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264400, Shandong Province, China.
Yi-Zi Cong, Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264400, Shandong Province, China.
Guang-Dong Qiao, Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264400, Shandong Province, China.
Song Zhang, Department of Breast Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264400, Shandong Province, China.
Li-Juan Wang, Department of Radiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264400, Shandong Province, China. [email protected].
Journal: World Journal of Clinical Cases
Citation: 2020 Dec 6; 8(23): 6190–6196.
Published online 2020 Dec 6. doi: 10.12998/wjcc.v8.i23.6190
Publication Year and Month: 2020 12
Abstract:
BACKGROUND
Poliomyelitis is an acute infection caused by an enterovirus, which primarily infects the human gastrointestinal tract. In general, patients with polio have no association with the occurrence of cancer. The present case study presents a rare case of poliomyelitis combined with primary breast cancer.
CASE SUMMARY
A 61-year-old woman who was diagnosed with poliomyelitis at 5 years old and confirmed invasive breast cancer by core needle biopsy (CNB) after hospitalization. The patient received a modified radical mastectomy and four cycles of chemotherapy with the TC (docetaxel and cyclophosphamide) regimen. The patient was also prescribed endocrine therapy without radiotherapy after chemotherapy. The patient had no evidence of lymphedema in the right upper extremities and no evidence of either regression or distant metastasis at the 1-year follow-up.
CONCLUSION
The pectoral muscles of patients with polio are easily damaged in traumatic procedures, such as CNB, local anesthesia for tumor excision, and general anesthesia for surgery. A CNB, modified radical mastectomy, and four cycles of TC chemotherapy were successfully completed for the present case and the adverse reactions were found to be tolerable. This case may indicate the relationship between breast cancer and polio, and the examination and treatment methods used could be used as a guide for similar cases in the future.
Keywords: Breast cancer, Diagnostic imaging, Follow-up, Poliomyelitis, Surgery, Case report
Core Tip: This is the first case report on poliomyelitis combined with primary breast cancer. Due to the poliomyelitis, the pectoral muscles of patients with polio are easily damaged in traumatic procedures, such as core needle biopsy (CNB), local anesthesia for tumor excision, and general anesthesia for surgery. A CNB, modified radical mastectomy, and four cycles of TC chemotherapy were successfully completed for the present case and the adverse reactions were found to be tolerable. This case may indicate the relationship between breast cancer and polio, and the examination and treatment methods used could be used as a guide for similar cases in the future.
Conclusions: In conclusion, the present paper reports a case of breast cancer following poliovirus infection, and to the best of our knowledge, this is the first report demonstrating this occurrence. In addition, we did not find precedent of chemotherapy in almost all instances of reported poliomyelitis. The patient received a chemotherapy regimen of TC (75 mg/m2 i.v. docetaxel and 600 mg/m2 i.v. cyclophosphamide on 1st day) every 3 wk for 4 cycles following the operation and did not receive radiotherapy following the chemotherapy. The patient was also prescribed endocrine therapy consisting of 2.5 mg letrozole and 600 mg vitamin D3 once a day. After 1 year of follow-up, local recurrence and distant metastasis were not present, and the patient will continue to be monitored in the future.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: The Lancet: New polio vaccine against strain that threatens eradication is safe and generates immune response in adults, young children, and infants
Author: THE LANCET (News release 9-Dec-2020)
Affiliation: The Lancet
Journal: The Lancet
Citation: EruekAlert! AAAS - Research News - THE LANCET (News release 9-Dec-2020)
Publication Year and Month: 2020 12
Abstract: Phase 2 trials in 1,200 adults, young children, and infants suggest new poliovirus vaccine may have the potential to overcome outbreaks caused by a mutated polio strain linked to the oral vaccine that typically circulates in areas of low immunisation coverage, and poses one of biggest barriers to eradication.
Scientists have developed the first poliovirus vaccine against a mutated form of the disease that is causing disease outbreaks across Africa and Asia. Designed to be more genetically stable than the licensed Sabin oral vaccine [1], the new vaccine appears to be as safe and provides similar immune responses when tested in healthy adults, children, and infants, according to new research published in two papers in The Lancet.
The new vaccine, known as nOPV2, is directed against poliovirus type 2, and has improved genetic stability and is less likely to mutate and revert into a form of the virus that can cause infection and paralytic disease.
Based on the results from these phase 2 clinical trials, nOPV2 vaccine has received an Emergency Use Listing (EUL) recommendation from WHO making it the first vaccine ever to go through this pathway that is meant for global health emergencies. The aim is to now use the vaccine for outbreak response for vaccine-derived poliovirus that is increasing across Africa as well as Afghanistan, Pakistan, the Philippines, Malaysia, and other countries. Currently, outbreaks are being tackled using the original Sabin oral vaccine for type 2 polio, which risks seeding further outbreaks in areas of persistently low immunisation coverage.
Conclusions: Lead author of the study in adults, Professor Pierre Van Damme from the University of Antwerp in Belgium says: “Millions of people potentially have no immunity to the spread of vaccine-derived virus, which is caused when the weakened live virus in oral polio vaccines mutates and regains its ability to become infectious, cause disease, and spread in communities with low vaccination rates. The nOPV2 vaccine appears at least as safe and effective as the Sabin vaccine and genetically more stable, and could be a key breakthrough towards a polio-free world." [2]
Outcome of Research: Effective
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Category: Epidemiology, Late Effects of Polio
Title: Epidemic poliomyelitis, post-poliomyelitis sequelae and the eradication program
Author: Margaret Peel
Affiliation: University of Melbourne - Department of Microbiology and Immunology Melbourne, Australia
Position: Principal Microbiologist
Description: Retired
Journal: Microbiology Australia
Citation: 41(4):196 DOI: 10.1071/MA20053
Publication Year and Month: 2020 11
Abstract: Epidemics of paralytic poliomyelitis (polio) first emerged in the late 19th and early 20th centuries in the United States and the Scandinavian countries. They continued through the first half of the 20th century becoming global. A major epidemic occurred in Australia in 1951 but significant outbreaks were reported from the late 1930s to 1954. The poliovirus is an enterovirus that is usually transmitted by the faecal–oral route but only one in about 150 infections results in paralysis when the central nervous system is invaded. The Salk inactivated polio vaccine (IPV) became available in Australia in 1956 and the Sabin live attenuated oral polio vaccine (OPV) was introduced in 1966. After decades of stability, many survivors of the earlier epidemics experience late-onset sequelae including post-polio syndrome. The World Health Organization launched the global polio eradication initiative (GPEI) in 1988 based on the easily administered OPV. The GPEI has resulted in a dramatic decrease in cases of wild polio so that only Pakistan and Afghanistan report such cases in 2020. However, a major challenge to eradication is the reversion of OPV to neurovirulent mutants resulting in circulating vaccine-derived poliovirus (cVDPV). A novel, genetically stabilised OPV has been developed recently to stop the emergence and spread of cVDPV and OPV is being replaced by IPV in immunisation programs worldwide. Eradication of poliomyelitis is near to achievement and the expectation is that poliomyelitis will join smallpox as dreaded epidemic diseases of the past that will be consigned to history.
Conclusions: Eradication of poliomyelitis is near to achievement and the expectation is that poliomyelitis will join smallpox as dreaded epidemic diseases of the past that will be consigned to history.
Outcome of Research: Effective
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Category: 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: Psychology
Title: Healthy together: A systematic review of theory and techniques used in health interventions for persons with chronic neurological conditions and their caregivers
Author: Afolasade Fakolade (1), Alexandra J. Walters (2), Julie Cameron (1), Amy E. Latimer-Cheung (2), Lara A. Pilutti (1)
Affiliation: (1) Interdisciplinary School of Health Sciences, Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
(2) School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
Journal: Patient Education and Counseling
Citation: Volume 103, Issue 4, April 2020, Pages 788-803
https://doi.org/10.1016/j.pec.2019.10.022
Publication Year and Month: 2020 04
Abstract: Objective
To evaluate the level of theory application and use of behaviour change techniques (BCTs) in dyadic health interventions for persons with chronic neurological conditions (CNCs) and their caregivers.
Methods
A systematic review of five databases was conducted to locate articles published before January 2019. Methodological quality was assessed, study characteristics, theory application and BCTs were narratively summarized.
Results
More than half of the studies identified (59% [16/27]) did not mention theory, and only 22% (6/27) were explicitly theory-based. Across the 27 studies, two to 17 BCTs (meanâŻ=âŻ6.8⯱âŻ4.02) were used. Common BCTs were related to intervention implementation (e.g., credible source), knowledge (e.g., instruction on how to perform behaviour) and skill development (e.g., behavioural practice/rehearsal).
Conclusions: Conclusions
Researchers need to incorporate theory-based dyadic techniques that target both people with CNCs and their caregivers into the design and implementation of future health interventions.
Practice implications
Health professionals require explicitly theory-based interventions to provide dyads with CNCs techniques that they can apply in their daily life to the benefit of each individual and the partnership.
Outcome of Research: Not applicable
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Category: Late Effects of Polio, Quality of Life
Title: Life Satisfaction in Persons With Late Effects of Polio: A TestâRetest Reliability Study
Author: Elisabeth Ekstrand RPT, PhD; Jan Lexell MD, PhD, DPhil h.c.; Christina Brogårdh RPT, PhD
Affiliation: E.E. - Department of Health Sciences, Lund University, Lund, Sweden; andDepartmentof Hand Surgery, Skåne University Hospital, Malmö, Sweden. Address correspondenceto: E.E., Department of Health Sciences,Physiotherapy Research Group, Lund Univer-sity, Box 157, SE-221 00 Lund, Sweden; e-mail: [email protected]
Disclosure: nothing to disclose.
J.L. and C.B. - Department of Health Sciences, Lund University, Lund, Sweden; andDepartment of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics,Skåne University Hospital, Lund, Sweden
Disclosure: nothing to disclose.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Volume 12, Issue 10 p.997-1002
https://doi.org/10.1002/pmrj.12325
Publication Year and Month: 2020 01
Abstract:
Background
The Life Satisfaction Questionnaire (LiSatâ11), including one global item and 10 domainâspecific items, is used to evaluate life satisfaction in persons with the late effects of polio (LEoPs). However, there is a lack of knowledge about its psychometric properties.
Objective
To evaluate the testâretest reliability of the LiSatâ11 and the associations between the global and domainâspecific items in persons with LEoPs.
Design
A testâretest design, where data were collected by a postal survey.
Setting
University Hospital, Outpatient Clinic.
Participants
A crossâsectional sample of persons (20 women and 31 men; mean age 72 years) with LEoPs.
Main Outcome Measurements
LiSatâ11, assessing how satisfied a person is with different aspects of life, such as life as a whole, vocation, economy, leisure, contacts with friends and acquaintances, sexual life, activities of daily living (ADLs), family life, partner relationship, somatic health, and psychological health.
Methods
LiSatâ11 was administered on two occasions, 2 weeks apart. The testâretest reliability was evaluated by Kappa statistics, the percent agreement (PA), and the Svensson rankâinvariant method. The association between the items was evaluated with the Spearman rank correlation coefficient (rho).
Results
The Kappa coefficients showed good to excellent agreement (0.64â0.90) and the PA ≤1 point was high (>92%) for all items. No items showed any systematic or random disagreements according to the Svensson method. All domainâspecific items correlated significantly with the global item “Life as a whole” (P < .01; rhos 0.41 to 0.75).
Conclusions
LiSatâ11 is reliable for assessing life satisfaction in persons with LEoPs. The global item “Life as a whole” is useful as an overall measure but cannot fully replace the information obtained from the domainâspecific items of LiSatâ11.
Conclusions: LiSatâ11 is a reliable outcome measure to assess life satisfaction in persons with LEoPs. The association between the global item “Life as a whole” and the domainâspecific items indicates that LiSatâ11 measures various aspects that can affect a personĘźs life satisfaction. The global question “Life as a whole” is useful as an overall measure but cannot fully replace the information obtained from the domainâspecific questions of LiSatâ11.
Outcome of Research: Effective
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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: 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: Diagnosis and Management
Title: Lipid metabolic pathways converge in motor neuron degenerative diseases
Author: Olivia J Rickman, Emma L Baple, and Andrew H Crosby
Affiliation: Medical Research (Level 4), RILD Wellcome Wolfson Centre, University of Exeter Medical School, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
Correspondence to: Professor Andrew Crosby Professor of Human Genetics University of Exeter Medical School Medical Research (Level 4) RILD Wellcome Wolfson Centre Royal Devon and Exeter NHS Foundation Trust Barrack Road, Exeter, EX2 5DW, UK E-mail: [email protected]
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Brain. 2020 Apr; 143(4): 1073–1087.
Published online 2019 Dec 18. doi: 10.1093/brain/awz382
Publication Year and Month: 2019 12
Abstract: Motor neuron diseases (MNDs) encompass an extensive and heterogeneous group of upper and/or lower motor neuron degenerative disorders, in which the particular clinical outcomes stem from the specific neuronal component involved in each condition. While mutations in a large number of molecules associated with lipid metabolism are known to be implicated in MNDs, there remains a lack of clarity regarding the key functional pathways involved, and their inter-relationships. This review highlights evidence that defines defects within two specific lipid (cholesterol/oxysterol and phosphatidylethanolamine) biosynthetic cascades as being centrally involved in MND, particularly hereditary spastic paraplegia. We also identify how other MND-associated molecules may impact these cascades, in particular through impaired organellar interfacing, to propose ‘subcellular lipidome imbalance’ as a likely common pathomolecular theme in MND. Further exploration of this mechanism has the potential to identify new therapeutic targets and management strategies for modulation of disease progression in hereditary spastic paraplegias and other MNDs.
Keywords: HSP, MND, cholesterol, mitochondria, lipidome imbalance
Conclusions: The development of new methodologies and approaches are important to delineate the specific subcellular biomarker deficits, such as oxysterol and PE imbalance, in HSP and MND. As well as providing potentially powerful biomarkers of disease, such tools may enable monitoring of treatment efficacy of therapeutics to re-address disease-associated lipidome imbalances. Specific genetic subtypes may be more amenable to treatment at targeting (for example) feedback systems, such as CDCA in CTX, or addressing oxysterol imbalance in SPG5. Genetic subtypes of disease leading to more complex subcellular outcomes may require multiple treatment approaches to address the specific mechanistic basis of each condition, and it may be unlikely that one approach will entail a ‘fix all’ treatment. Ultimately, clearer definition of the subcellular lipidome (and other) biological pathways underlying MND and HSP will pave the way for a more elegant approaches for predicting onset and severity of disease, and for designing and monitoring new therapeutic approaches.
Outcome of Research: More research required
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Category: Ageing, Exercise, Falls
Title: Relationship Between Fear of Falling and Physical Activity in People Aging With a Disability
Author: Patricia N. Matsuda PT, PhD, DPT (1) Thomas Eagen PhD, MPH (1) Kimberly P. Hreha EdD, OTR/L (2) Marcia L. Finlayson PhD, OT Reg (Ont), OTR (3) Ivan R. Molton PhD (1)
Affiliation: 1. Department of Rehabilitation Medicine, University of Washington, Seattle, WA
2. Division of Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX
3. School of Rehabilitation Therapy, Queen's University, Kingston, Canada
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Volume 12, Issue 5 p. 454-461
https://doi.org/10.1002/pmrj.12289
Publication Year and Month: 2019 11
Abstract: BACKGROUND
An estimated one billion people worldwide live with some form of disability and may face many challenges as they age, including increased fall risk. Understanding the risk factors linking falls, fear of falling, and activity restriction is critical for developing effective programs to increase activity levels among persons with disabilities.
OBJECTIVES
To determine if differences exist in the level of physical activity in people with different types of conditions associated with disability and to investigate if fear of falling is associated with physical activity in individuals who are aging with a longâterm disability.
DESIGN
Crossâsectional retrospective design.
SETTING
Community.
PARTICIPANTS
A convenience sample of 1812 communityâdwelling individuals who had one of four diagnoses: multiple sclerosis (MS), muscular dystrophy (MD), spinal cord injury (SCI), or postâpolio syndrome (PPS).
METHODS
Descriptive statistics, chiâsquare, and analysis of variance, followed by multivariate linear regression analysis were used to examine the association between physical activity status and fear of falling.
MAIN OUTCOME MEASUREMENTS
Physical activity volume and fear of falling.
RESULTS
After controlling for age, sex, duration of disability, and mobility level, there was variation across diagnostic groups (P < .001). People with SCI reported greater physical activity (M = 25.19) compared to other groups (MS: M = 18.70; MD: M = 21.83; PPS: M = 15.47). Patients with PPS had the greatest concerns about falling (M = 16.08), and patients with MS had the lowest (M = 13.12). Fear of falling was associated with physical activity (P < .001), which remained significant after controlling for diagnosis type, falls history, and level of mobility.
CONCLUSION
Level of physical activity appears to vary among disability diagnoses. These results highlight the importance of addressing fear of falling in people with longâterm disability because fear of falling is associated with physical activity.
Conclusions: Level of physical activity appears to vary among disability diagnoses. These results highlight the importance of addressing fear of falling in people with longâterm disability because fear of falling is associated with physical activity.
Outcome of Research: More research required
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Category: Cultural Context, Disability Rights, Late Effects of Polio, Quality of Life, Vocational Implications
Title: “The car is my extra legs” – Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio
Author: Helena Selander, Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing,1,2,* Iolanda Santos Tavares Silva, Formal analysis, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing,1,3 Felicia Kjellgren, Conceptualization, Investigation, Methodology, Writing – review & editing,1 and Katharina S. Sunnerhagen, Conceptualization, Data curation, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing1
Wen-Jun Tu, Editor
Affiliation: 1 Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
2 The Swedish National Road and Transport Research Institute (VTI), Gothenburg, Sweden
3 Department of Occupational Therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden
Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: [email protected]
Journal: PLoS One
Citation: 14(10), e0224685. https://doi.org/10.1371/journal.pone.0224685
Publication Year and Month: 2019 10
Abstract: Background
The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture.
Method
A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis.
Results
The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem.
Conclusions
Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants’ mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.
Conclusions: More work is needed on young immigrants with late effects of polio to identify their mobility needs and find solutions that could minimize barriers and help them to be more independent outdoors. This group in Sweden has often been overlooked in clinical settings and in society generally. It is important to consider the need of care and support for persons with late effects polio as the need for care has been questioned and decision makers (such as health commissioners) believe persons with late effects of polio no longer exist in Sweden. Moreover, they are not prioritized despite needing rehabilitation interventions that could increase their outdoor mobility. Independent mobility is a major enabler for ongoing employment and the ability to access a car can increase their chances for social integration. According to participants in this study, public transport is not adequate or efficient enough for their needs. For young immigrants with late effects of polio, driving can prevent involuntary isolation and facilitate participation. A car may increase quality of life and reduce the demand for societal support.
Outcome of Research: More research required
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Category: 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: 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: 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⯱âŻ4.2âŻms, 22.4⯱âŻ5.0âŻms, 83.1⯱âŻ42.2, 72.3⯱âŻ29.9) as compared to PS (18.3⯱âŻ1.0âŻms, 19.2⯱âŻ2.0âŻms, 101.6⯱âŻ15.9, 98.1⯱âŻ14.9), MEP/M% in ADM were lower in PS group (56.0⯱âŻ13.4) as compared to controls (85.2⯱âŻ23.9). 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) (SI95âŻ−âŻSI5)/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⯱âŻ10.98, 46.19⯱âŻ12.42 respectively) were lower than control group (37.21⯱âŻ17.37, 36.44⯱âŻ11.99) (pâŻ<âŻ0.05). Median nerve,excitability parameters of patients (SI 5%; 14.81⯱âŻ6.97, SI 50%; 19.07⯱âŻ9.2, SI 95%; 24.06⯱âŻ11.52), ARW (9.26⯱âŻ5.79), RW (0.65⯱âŻ0.31) were higher than those of the controls (SI 5%; 9.64⯱âŻ2.57, SI 50%; 11.64⯱âŻ3.27, SI 95%; 13.64⯱âŻ3.66, ARW; 4.00⯱âŻ1.56, RW; 0.42⯱âŻ0.13) (pâŻ<âŻ0.05). Median and ulnar nerve step size parameters, step number and step% in the patients were also significantly higher (pâŻ<âŻ0.05).
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
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: 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: 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: 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, ElĹźbieta 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⯱âŻ282.6 (right 6 muscles) and 561.27⯱âŻ281.1 (left) significantly lower than in control group (six muscles 1139.6⯱âŻ164.5) (pâŻ<âŻ0.05). 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: 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: An algorithm for automatic detection of repeater F-waves and MUNE studies
Author: N. TuÄrulArtuÄ, N. Görkem Ĺirin, Emel OÄuz 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: 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: Late Effects of Polio, Quality of Life
Title: Quality of life assessment scales in polio survivors: a scoping review
Author: Surajo Kamilu Sulaiman (1), Heather Michelle Aldersey (1), Nora Fayed (1), Bashir Kaka (2) & Christiana Okyere (1)
Affiliation: (1) School of Rehabilitation Therapy, Queen’s University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3N6, Canada
(2) Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, PMB 3011, Kano, Nigeria
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Quality of Life Research volume 28, pages 2341–2357 (2019)
https://doi.org/10.1007/s11136-019-02185-x
Publication Year and Month: 2019 04
Abstract: Background
Quality of life evaluation is essential to explore the effect of paralytic polio on the daily life experience of the polio survivor. Researchers have employed a range of assessment instruments to evaluate quality of life among polio survivors. Hence, to select the appropriate scale, it is crucial to compare the contents and psychometric properties of these instruments.
Purpose
This scoping review explores quality of life instruments that are used in polio literature and analyzes their contents and psychometric properties using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria.
Method
Using the Arksey and O’Malley framework, we conducted a literature search in the following electronic databases Medline, CINAHL, Web of Science, Embase, and Google Scholar to identify relevant studies that focused on quality of life of polio survivors. Of the 88 articles that qualify for full-text screening, 34 studies met our inclusion criteria. Two independent reviewers extracted data from the selected studies via Covidence, a reference manager that allows for blinding of reviews.
Results
Most of the instruments included in this review are generic, self-reported, and multidimensional. Despite having mostly adequate psychometric properties, these properties were not evaluated in polio survivors.
Conclusion
The information provided in this review could be used to guide instrument selection and identify the need to develop a new tool or to adapt a pre-existing scale for measuring quality of life among polio survivors.
Conclusions: The information provided in this review could be used to guide instrument selection and identify the need to develop a new tool or to adapt a pre-existing scale for measuring quality of life among polio survivors.
Outcome of Research: More research required
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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: 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: 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: 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: Anaesthesia, Surgery
Title: Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations
Author: Jie Li, Zongshan Hu, Changchun Tseng, Zhihui Zhao, Yiwen Yuan,Zezhang Zhu, Yong Qiu, Zhen Liu
Affiliation: Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
Journal: World Neurosurgery
Citation: Volume 122, February 2019, Pages e1111-e1119
Publication Year and Month: 2019 02
Abstract: Background
We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity (PSD) using 3 types of pelvic fixation and investigated the incidence and risk factors for complications.
Methods
We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016. Of the 42 patients, 15 had been treated with the Galveston technique, 13 with iliac screw fixation, and 14 with S2-alar-iliac (S2AI) screw fixation. Demographic data, radiographic parameters, and complications were analyzed. Health-related quality of life was determined using Scoliosis Research Society (SRS) 22-item questionnaires and the Oswestry Disability Index scores.
Results
After surgery, the correction rate of the main curve was 51.7%, 57.8%, and 52.1% in the 3 groups, with significant improvement in regional kyphosis, coronal balance, and pelvic obliquity (PO) (P < 0.05). The correction of PO was similar among the 3 types of pelvic fixation; however, the patients treated with S2AI fixation required significantly less operative time (P < 0.05) and blood loss (P < 0.006). The overall complication rate was 40.5%, with a major complication rate of 23.8%. Age at surgery (P = 0.006) and grade >2 SRS-Schwab osteotomy (P = 0.036) were significant risk factors for complications. Significant improvement was found in the SRS-22 and Oswestry Disability Index scores at the final follow-up examination in the 3 groups.
Conclusions: Conclusions
The present study showed satisfactory correction of spinopelvic deformity for 42 patients with PSD. Compared with the Galveston technique and iliac screw fixation, the use of S2AI significantly decrease the operative time and estimated blood loss and obtained similar correction of PO. Patient age at surgery and grade >2 SRS-Schwab osteotomy were significant risk factors for complications.
Outcome of Research: More research required
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Category: 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: 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
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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 (NâŻ=âŻ1159) 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: Orthoses
Title: Knee exoskeletons for gait rehabilitation and human performance augmentation: A state-of-the-art
Author: Bing Chen, Bin Zi, Zhengyu Wang, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China
Jiangsu Key Laboratory of Mine Mechanical and Electrical Equipment, China University of Mining and Technology, China
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong SAR, China
Journal: Mechanism and Machine Theory
Citation: Volume 134, April 2019, Pages 499-511
Publication Year and Month: 2019
Abstract: The number of patients with knee impairments caused by a stroke, spinal cord injury, post-polio, injury, osteoarthritis, or other related diseases is increasing worldwide. Robotic devices such as knee exoskeletons have been studied and adopted in gait rehabilitation, as they can provide effective gait training for the patients and release the physical therapists from the intensive labor required by the traditional physical therapy. In addition, knee exoskeletons can augment human performance in normal walking, loaded walking, and even running by enhancing the strength of the wearers’ knee joints. A systematic review of knee exoskeletons is presented in this paper. The biomechanics of the human knee joint is firstly presented. Then, the design concepts of knee exoskeletons, including the actuators and sensors, are provided, followed by the introduction of the corresponding control strategies. Finally, the limitations of the available devices and the research and development directions in the field of knee exoskeletons are discussed, thus providing useful information to the researchers developing knee exoskeletons that are suitable for practical applications.
Conclusions:
Outcome of Research: More research required
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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: 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: 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: 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: Polio Immunisation
Title: Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of environmental surveillance data
Author: Andrew F. Brouwer, Joseph N. S. Eisenberg, Connor D. Pomeroy, Lester M. Shulman, Musa Hindiyeh, Yossi Manor, Itamar Grotto, James S. Koopman, and Marisa C. Eisenberg
Affiliation: Department of Epidemiology, University of Michigan, Ann Arbor, MI
Journal: Proceedings of the National Academy of Sciences
Citation: Nov 2018, 115 (45) E10625-E10633
Publication Year and Month: 2018 11
Abstract: Israel experienced an outbreak of wild poliovirus type 1 (WPV1) in 2013–2014, detected through environmental surveillance of the sewage system. No cases of acute flaccid paralysis were reported, and the epidemic subsided after a bivalent oral polio vaccination (bOPV) campaign. As we approach global eradication, polio will increasingly be detected only through environmental surveillance. We developed a framework to convert quantitative polymerase chain reaction (qPCR) cycle threshold data into scaled WPV1 and OPV1 concentrations for inference within a deterministic, compartmental infectious disease transmission model. We used this approach to estimate the epidemic curve and transmission dynamics, as well as assess alternate vaccination scenarios. Our analysis estimates the outbreak peaked in late June, much earlier than previous estimates derived from analysis of stool samples, although the exact epidemic trajectory remains uncertain. We estimate the basic reproduction number was 1.62 (95% CI 1.04–2.02). Model estimates indicate that 59% (95% CI 9–77%) of susceptible individuals (primarily children under 10 years old) were infected with WPV1 over a little more than six months, mostly before the vaccination campaign onset, and that the vaccination campaign averted 10% (95% CI 1–24%) of WPV1 infections. As we approach global polio eradication, environmental monitoring with qPCR can be used as a highly sensitive method to enhance disease surveillance.
Conclusions: Our analytic approach brings public health relevance to environmental data that, if systematically collected, can guide eradication efforts.
Outcome of Research: Effective
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Category: 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: Respiratory Complications and Management
Title: Respiratory Muscle In Post-Polio Syndrome: Highlights
Author: Marco Orsini, Mauricio De Sant Anna, Carlos Henrique Melo Reis, Ricardo Martello, Eduardo Trajano,
Carlos Eduardo Cardoso, Marcos RG de Feritas and Acary SB Oliveira
Affiliation: Masters Program in Science Applied Health - Vassouras University and Masters Program in Local Devolopment - Unisuam. CASF Ramon Freitas - Neurology
Service- Nova Iguaçu- RJ- Brazil
IFRJ. Federal Institute of Rio de Janeiro - Brazil. Physical Therapy Service
Rio de Janeiro Federal University - UFRJ, Brazil
Masters Program in Science Applied Health - Vassouras University- Brazil
Masters Program in Science Applied Health - Vassouras University
Masters Program in Science Applied Health - Vassouras University
Federal University of Rio de Janeiro - Neurology Service - UFRJ
São Paulo Federal University - Unifesp - Neurology Service - Brazil
Journal: Biomedical Journal of Scientific & Technical Research (BJSTR)
Citation:
Publication Year and Month: 2018 11
Abstract: The main function of the respiratory muscles is the movement
of the thoracic wall, thus exerting ventilation, and the increase in
the work of this muscle is directly proportional to the intensity
of the activity performed De Troyer et al. [1-3]. During basal
respiration, the slow-twitch fibers are used, while the fast-twitch
fibers are recruited because of increased heart rate Sinderby et
al. [4]. The diaphragm moves caudal approximately 1 to 3cm.
Under conditions of ventilatory effort this incursion can reach
up to 10cm. For an adequate work performed by the ventilatory
muscles, approximately 1 to 3% of the oxygen consumption
(VO2) Kress et al. [5,6]. Several clinical conditions can modify
this process, leading to a greater demand for breathing muscles,
such as obesity Sant Anna Junior M et al. [7], chronic obstructive
pulmonary disease, heart failure, amyotrophic lateral sclerosis
among others.
Conclusions:
Outcome of Research: More research required
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Category: Complementary Therapies
Title: Whole body vibration on people with sequelae of polio
Author: Da Silva CP, Szot CL, de Sa N.
Affiliation: School of Physical Therapy, Texas Woman's University, Houston, USA
Supported by the Post-polio Health International 2013–2014
Journal: Physiotherapy Theory and Practice
Citation: (2018). DOI: 10.1080/09593985.2018.1454559
Publication Year and Month: 2018 10
Abstract: Purpose: The purpose was to explore the feasibility of whole body vibration (WBV) on polio survivors with/without post-polio syndrome (PPS) by studying its effects on walking speed (10-m walk test), endurance (2-min walk test), pain severity/interference (Brief Pain Inventory [BPI]), sleep quality (Pittsburg Sleep Quality Index), fatigue (Fatigue Severity Scale), leg strength (manual muscle testing and hand-held dynamometry), and muscle cramping (written logs). Methods: Fifteen individuals completed the study, participating in eight sessions in two 4-week blocks. Participants started with ten 1-min vibration bouts/session, increasing to 20 min. Low (amplitude 4.53 mm, g force 2.21) and higher (amplitude 8.82 mm, g force 2.76) intensity blocked intervention occurred in random order crossover design. Blinded testing ensued before/after intervention blocks and at follow-up. Results: No study-related adverse events occurred. Participants starting first with higher intensity intervention improved in walking speed (p = 0.017). BPI pain severity significantly improved (p = 0.049) after higher intensity intervention. No significant changes were found after low intensity vibration or in other outcome measures. Conclusions: WBV appears to be a safe exercise for this population. Long-term use in polio survivors needs to be researched, particularly in reducing barriers to participation to promote the physical aspects of health.
Conclusions:
Outcome of Research: More research required
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Category: Surgery
Title: Ultrasound-Guided Carpal Tunnel Release Using Dynamic Expansion of the Transverse Safe Zone in a Patient With Postpolio Syndrome: A Case Report
Author: Troy Henning DO, Daniel Lueders MD, Kate Chang, Lynda Yang MD
Affiliation: Swedish Medical Group, Swedish Spine, Sports and Musculoskeletal Medicine, 1600 E. Jefferson Street, Suite 300, Seattle, WA 98122
Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM&R Volume 10, Issue 10, October 2018, Pages 1115-1118
Publication Year and Month: 2018 10
Abstract: The prevalence of carpal tunnel syndrome (CTS) in patients with postpolio syndrome occurs at a rate of 22%. Irrespective of those with CTS, 74% of postpolio patients weight bear through their arms for ambulation or transfers. As open carpal tunnel release is performed along the weight-bearing region of the wrist, their functional independence may be altered while recovering. This case demonstrates that ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.
Conclusions: Ultrasound-guided carpal tunnel release was successfully performed in a patient with postpolio syndrome allowing him to immediately weight bear through his hands after the procedure so he could recover at home.
Outcome of Research: Effective
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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: Restless Legs Syndrome
Title: Do you have restless leg syndrome? I understood from your eyes
Author: Hatice Kose Ozlece, Volkan Solmaz, SadÄąk Altan Özal, Yahya Çelik
Affiliation: Department of Neurology AcÄąbadem Private Hospital Kayseri Turkey
Department of Neurology Private Konak Hospital Sakarya Turkey
Department of Eye Disease Trakya University Medical Faculty Edirne Turkey
Department of Neurology AdatÄąp Private Hospital Sakarya Turkey
Journal: Sleep and Breathing (Book)
Citation: pp 1–7
Publication Year and Month: 2018 10
Abstract: Purpose
According to many studies in the literature, there is a strong association between restless leg syndrome and dopaminergic dysfunction. Dopamine is also the major catecholamine in the retina and is also a possible transmitter of the amacrine and interplexiform cells. The aim of this study is to investigate the possible association between RLS and retinal thickness.
Methods
In this study, we included 33 patients who were diagnosed with idiopathic RLS according to the “International RLS Study Group” criteria and 31 healthy subjects. All the patients and controls underwent routine ophthalmologic examination and had spectral-domain optical coherence tomography (OCT) performed. We compared the retinal thickness of the patients and control subjects.
Results
In the RLS group, foveal thickness was thinner then controls. Also, only inferior, superior, and temporal quadrant retina nerve fiber layer (RNFL) thickness were significantly thinner in the RLS group. The parafoveal ganglion cell complex (GCC) in the superior temporal, inferior temporal, inferior nasal quadrant, and perifoveal superior nasal thickness was also significantly thinner in the patient group. Pearson correlation analyses showed that there were statistically significant negative correlations between disease duration and macular GCC and RNFL thickness. Negative correlations were also detected between parafoveal superior, temporal, inferior and nasal macular thickness, parafoveal superior nasal, inferior temporal GCC thickness, and perifoveal superior nasal GCC thickness and disease duration.
Conclusions: According to our results; most retinal layers are thinner in RLS patients, so it can be considered that OCT has a predictive value for progression of RLS.
Outcome of Research: More research required
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Category: 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: 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: Falls and Bone Density
Title: Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio
Author: Beth Grill PT, DPT, NCSa, Pamela K. Levangie PT, DSc, DPT, FAPTA, Maria ColeOTR/L, Darren Rosenberg DO, Leah Jensen PT, DPT
Affiliation: Spaulding Outpatient Center Framingham, MA
MGH Institute of Health Professions, Boston, MA; and 500 Lexington Street, Unit 3, Woburn, MA 01801
Spaulding Outpatient Center Framingham, MA
Spaulding Outpatient Center Framingham, MA
Spaulding Outpatient Center Framingham, MA
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: Available online 7 September 2018
Publication Year and Month: 2018 09
Abstract: Background
Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) deficiencies related to muscle weakness. Where weakness is asymmetrical, bone densitometry (BDt) measured only on the stronger LE may misclassify BMD.
Objective
To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck.
Design
Retrospective study.
Setting
Outpatient postpolio center.
Participants
Patients >18 years old with complete relevant data.
Main Outcome Measures
BDt T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score.
Results
Forty-three subjects had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had BDt only on their weaker LE and 14 (32.5%) had BDt only on their stronger LE. Of the 15 subjects with BDt done on both femoral necks, T scores (mean [standard deviation]) were lower in the weaker LE (–1.73 [1.09]) than the stronger LE (–0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively).
Conclusions: In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group.
Outcome of Research: More research required
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Category: Activity Levels
Title: 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: 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: 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 (>4,4âŻms). 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 (pâŻ=âŻ0,01) of the SHI between ALS patients (0,97⯱âŻ0,84) and the NR-group (1,26⯱âŻ0,72). The SHI of the PPS-group (0,91⯱âŻ0,55) was not significantly different compared to the NR group (pâŻ=âŻ0,08), but showed a trend. Comparing the ALS-group with the PPS-patients, we found no statistically relevant difference (pâŻ=âŻ0,83).
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: Orthoses
Title: Ankle-foot orthoses for rehabilitation and reducing metabolic cost of walking: Possibilities and challenges
Author: Bing Chen, Bin Zi, Yishan Zeng, Ling Qin, Wei-Hsin Liao
Affiliation: School of Mechanical Engineering, Hefei University of Technology, Hefei, China
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Hong Kong, China
Journal: Mechatronics
Citation: Volume 53, August 2018, Pages 241-250
Publication Year and Month: 2018 08
Abstract: People with diseases such as stroke, spinal cord injury, and trauma usually have paretic ankle involvement because of the plantar flexor and dorsiflexor muscle weakness. Individuals with paretic ankle normally have the drop-foot gait, which has the complications of foot-slap after heel contact and toe-drag during the swing phase of a gait cycle. This could cause slow walking speed, short step-length, high metabolic cost, and high risk of tripping. Ankle-foot orthotic intervention is mostly prescribed to treat paretic ankle impairments. In addition, ankle-foot orthoses (AFOs) have been developed to assist human walking, which can reduce the wearer's metabolic cost of walking. To date, three kinds of AFOs have been developed, including the passive AFOs, semi-active AFOs, and active AFOs. This paper provides a systematic review on these three types of AFOs, where the biomechanics of normal and pathological gaits of human, the design concepts of the AFOs, and motion data collection of the human-machine system in human trials are described. The limitations of the currently developed AFOs and future research and development directions of AFOs are discussed, which would provide useful information for researchers to develop suitable AFOs.
Conclusions:
Outcome of Research: More research required
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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: 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: Quality of Life
Title: Growing older with post-polio syndrome: Social and quality-of-life implications
Author: Andrea Duncan and Zinnia Batliwalla
Affiliation: 1Department of Occupational Science & Occupational Therapy, University
of Toronto, Toronto, ON, Canada
2March of Dimes Canada, Toronto, ON, Canada
Journal: SAGE Open Medicine
Citation: Volume 6: 1–7
Publication Year and Month: 2018 07
Abstract: Objectives: To understand the quality-of-life implications for post-polio syndrome survivors.
Methods: For this qualitative study, a focus group methodology, with a case study design, was used. The data were analyzed
for themes using a social ecological conceptual framework.
Results: Three focus groups were conducted with a total of 24 participants (N=24). Participants defined quality of life as
being able to engage in meaningful activities of daily living. Participants shared experiences of adapting to declining physical
health and embracing new activities of daily living. They expressed hope and shared stories that demonstrated resiliency.
Conclusions: The literature states that individuals aging with post-polio syndrome express concern that health providers
often know little about their disability condition. The participants in this study reflected this experience by sharing feelings of
misunderstanding from the medical community and expressing a desire to have more dynamic education for health providers.
Outcome of Research: More research required
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Category: 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: Falls and Bone Density
Title: Mechanoadaptation: articular cartilage through thick and thin
Author: Tonia L. Vincent, Angus K. T. Wann
Affiliation:
Journal: The Journal of Physiology
Citation: https://doi.org/10.1113/JP275451
Publication Year and Month: 2018 06
Abstract: The articular cartilage is exquisitely sensitive to mechanical load. Its structure is largely defined by the mechanical environment and destruction in osteoarthritis is the pathophysiological consequence of abnormal mechanics. It is often overlooked that disuse of joints causes profound loss of volume in the articular cartilage, a clinical observation first described in polio patients and stroke victims. Through the 1980s, the results of studies exploiting experimental joint immobilisation supported this. Importantly, this substantial body of work was also the first to describe metabolic changes that resulted in decreased synthesis of matrix molecules, especially sulfated proteoglycans. The molecular mechanisms that underlie disuse atrophy are poorly understood despite the identification of multiple mechanosensing mechanisms in cartilage. Moreover, there has been a tendency to equate cartilage loss with osteoarthritic degeneration. Here, we review the historic literature and clarify the structural, metabolic and clinical features that clearly distinguish cartilage loss due to disuse atrophy and those due to osteoarthritis. We speculate on the molecular sensing pathways in cartilage that may be responsible for cartilage mechanoadaptation.
Conclusions: Mechanoadaptation in cartilage is rapid and reversible, and potentially of a similar scale to that seen in muscle and bone. Comprehensive studies of cartilage atrophy in vivo have been carried out although largely during the ‘preâmolecular’ era and prior to the discovery of direct chondrocyte mechanosensing mechanisms. Advances in newly available glycobiology and proteomic techniques, in combination with genetic modification in rodents, will add considerable value to future studies. Cartilage atrophy is readily distinguished from osteoarthritis at the clinical, tissue and molecular level but cannot be discerned on a plain radiograph except by noting the absence of bone remodelling. As joint space narrowing is typically used to diagnose OA, it is important to consider atrophy as a differential diagnosis. Harnessing the molecules that drive mechanoadaption in articular cartilage may provide novel strategies to prevent or treat OA.
Outcome of Research: More research required
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Category: Late Effects of Polio, Surgery
Title: Total hip arthroplasty in patients affected by poliomyelitis
Author: C. M. DeDeugd, K. I. Perry, W. H. Trousdale, M. J. Taunton, D. G. Lewallen, M. P. Abdel
Affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: The Bone & Joint Journal
Bone Joint J 2018;100-B:733–9
Doi: https://doi.org/10.1302/0301-620X.100B6.BJJ-2018-0127.R1
Publication Year and Month: 2018 06
Abstract: Aims
The aims of this study were to determine the clinical and radiographic outcomes, implant survivorship, and complications of patients with a history of poliomyelitis undergoing total hip arthroplasty (THA) in affected limbs and unaffected limbs of this same population.
Patients and Methods
A retrospective review identified 51 patients (27 male and 24 female, 59 hips) with a mean age of 66 years (38 to 88) and with the history of poliomyelitis who underwent THA for degenerative arthritis between 1970 and 2012. Immigrant status, clinical outcomes, radiographic results, implant survival, and complications were recorded.
Results
In all, 32 THAs (63%) were performed on an affected limb, while 27 (37%) were performed on an unaffected limb. The overall ten-year survivorship free from aseptic loosening, any revision, or any reoperation were 91% (95% CI 0.76 to 0.99), 91% (95% CI 0.64 to 0.97) and 87% (95% CI 0.61 to 0.95), respectively. There were no revisions for prosthetic joint infection. There were no significant differences in any of the above parameters if THA was on the affected or unaffected control limbs.
Conclusion
Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed.
Conclusions: Patients with a history of poliomyelitis who undergo THA on the affected or unaffected limbs have similar results with overall survivorship and complication rates to those reported results in patients undergoing THA for osteoarthritis. At long-term follow-up, previous clinical concerns about increased hip instability due to post-polio abductor weakness were not observed.
Outcome of Research: Not applicable
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Category: 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: 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 41âŻyears were included. Patient 1 had PPMA for 8âŻyears and his TA muscle strength was 3-/5, whereas Patient 2 showed PPMA findings for 1âŻyear 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 1.65âŻmV CMAP constituting of 4 very large steps and Patient 2 revealed a 5.5âŻmV 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: Psychology
Title: Childhood Health Shocks, Comparative Advantage, and Long-Term Outcomes: Evidence from the Last Danish Polio Epidemic
Author: Miriam Gensowski, Torben Heien Nielsen, Nete Munk Nielsen, Maya Rossin-Slater, Miriam Wüst
Affiliation:
Journal: The National Bureau of Economic Research
Citation: DOI 10.3386/w24753
Publication Year and Month: 2018 05
Abstract: A large literature documents that childhood health shocks have lasting negative consequences for adult outcomes. This paper demonstrates that the adversity of childhood physical disability can be mediated by individuals' educational and occupational choices, which reflect their comparative advantage. We merge records on children hospitalized with poliomyelitis during the 1952 Danish epidemic to census and administrative data, and exploit quasi-random variation in paralysis incidence. While childhood disability increases the likelihood of early retirement and disability pension receipt at age 50, paralytic polio survivors obtain higher education and are more likely to work in white-collar and computer-demanding jobs than their non-paralytic counterparts.
Conclusions:
Outcome of Research: Not applicable
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Category: Diagnosis and Management
Title: Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations.
Author: Lo JK, Robinson LR.
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, Canada
Journal: Muscle & Nerve
Citation: https://doi.org/10.1002/mus.26168
Publication Year and Month: 2018 05
Abstract: Postpolio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. Many theories exist regarding the pathogenesis of PPS, which remains incompletely understood. In contrast, the late effects of poliomyelitis are often a consequence of biomechanical alterations that occur as a result of polioârelated surgeries, musculoskeletal deformities, or weakness. Osteoporosis and fractures of the polioâinvolved limbs are common. A comprehensive clinical evaluation with appropriate investigations is essential to fulfilling the established PPS diagnostic criteria. PPS is a diagnosis of exclusion in which a key clinical feature required for the diagnosis is new muscle weakness and/or muscle fatigability that is persistent for at least 1 year. Electromyographic and muscle biopsy findings including evidence of ongoing denervation cannot reliably distinguish between patients with or without PPS.
Conclusions: Electromyographic and muscle biopsy findings including evidence of ongoing denervation cannot reliably distinguish between patients with or without PPS.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Postâpolio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis.
Author: Lo JK, Robinson LR.
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
Journal: Muscle & Nerve
Citation: https://doi.org/10.1002/mus.26167
Publication Year and Month: 2018 05
Abstract: Postâpolio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760–769, 2018
Conclusions: The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis.
Outcome of Research: More research required
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Category: Orthoses
Title: Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis
Author: Julian K. Lo MD, Lawrence R. Robinson MD
Affiliation: Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
Correspondence to: J. K. Lo; e-mail: [email protected]
Journal: Muscle & Nerve
Citation: Muscle Nerve. 58:760–769, May 2018. https://doi.org/10.1002/mus.26167
Publication Year and Month: 2018 05
Abstract: Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment.
Conclusions:
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: Repetitive transcranial magnetic stimulation in treatment of post polio syndrome
Author: Pastuszak, Z., Piusaska-Macoch, R., Stepieri, A., Czernicki, Z.,
Affiliation: Department of Neurosurgery, Mossakowski Medical Research Centre, Polish Academy of Sciences, A. PawiĹskiego 5, 02-106 Warsaw, Poland
Department of Neurology, Military Institute of Medicine, Szaserów 128, 04-141 Warsaw, Poland
Department of Neurosurgery, Warsaw University of Medicine, CegĹowska 80, 01-809 Warsaw, Poland
Journal: Neurologia i Neurochirurgia Polska
Citation: Volume 52 (2): 2018, Pages 281-284
Publication Year and Month: 2018 03
Abstract: Post polio syndrome is a rare disease that occurs decades after polio virus infection. Repetitive transcranial magnetic stimulation (rTMS) is a treatment option with proved effectiveness in drug resistant depression. Possibly it can be helpful in therapy of other neurological diseases including post polio syndrome.
Conclusions: rTMS can be an effective method in treatment of post polio syndrome but further studies with larger group need to be done to confirm that data.
Outcome of Research: More research required
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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: 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: Fatigue
Title: Measuring Physical and Cognitive Fatigue in People With Post-Polio Syndrome: Development of the Neurological Fatigue Index for Post-Polio Syndrome (NFI-PP).
Author: Young CA, Wong SM, Quincey AC, Tennant A
Affiliation: Walton Centre NHS Trust, Lower Lane, Liverpool, L9 7LJ, United Kingdom.
Walton Centre NHS Trust, Liverpool, United Kingdom.
Swiss Paraplegic Research, Nottwil, Switzerland.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: 2018 Feb;10(2):129-136.
Publication Year and Month: 2018 02
Abstract: BACKGROUND:
Fatigue in post-polio syndrome (PPS) has been shown to affect quality of life adversely. There is currently no disease-specific measure of fatigue for PPS.
OBJECTIVE:
To develop a scale to measure fatigue in PPS that meets rigorous psychometric standards.
DESIGN:
Qualitative followed by validation and test-retest studies.
SETTING:
Polio clinic followed by national questionnaire studies.
PARTICIPANTS:
A total of 45 participants from polio clinic for qualitative; 319 participants from clinic or self-referral for validation study, of whom 87 completed the retest questionnaire.
METHODS:
Draft questionnaire items on PPS fatigue were derived from transcripts of qualitative interviews. After cognitive debriefing, the draft measure was administered by mail along with comparator questionnaires to a new sample.
MAIN OUTCOME MEASUREMENTS:
Draft PPS fatigue measure, Fatigue Severity Scale, and visual analog scale for fatigue.
RESULTS:
Analysis of 271 of 319 (85%) questionnaires identified a 2-factor solution (RMSEA 0.058). For the physical subscale, a 20-item scale showed good fit (χ2P = .189), strict unidimensionality (t-test 5.17%), and reliability 0.91. For the cognitive subscale, a 7-item scale showed excellent fit (χ2P = .917), strict unidimensionality (t-test 5.2%), and reliability 0.89. Evidence of a "difficulty factor" emerged also supporting a total score that showed good fit (χ2P = .151), strict unidimensionality (t-test 0.4%), and reliability consistent with group use at 0.73. Test-retest correlations for all scales were greater than 0.85. Standard error of measurement on metric ranges was 5.4 for total, 2.9 for physical, and 1.69 for cognitive domains. With the latent estimate of the total score transformed to a 0-100 scale, the mean score was 49.5 (SD 6.9). Spearman correlations with the Fatigue Severity Scale and visual analog scale were 0.60 and 0.55, respectively.
Conclusions: CONCLUSIONS:
A patient-derived Neurological Fatigue Index for PPS, with physical and cognitive subscales and a total score, has demonstrated good reliability, appropriate concurrent validity, and satisfies the Rasch measurement model. A raw-score to interval scale transformation is available for parametric applications and the calculation of change scores.
Outcome of Research: More research required
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Category: Complementary Therapies
Title: Immediate and Long-Term Effects of Qigong on Cold Intolerance in Patients with Post-Poliomyelitis Syndrome
Author: Ramos, PS, Abe, GC, Pradella-Hallinan, M, Quadros, AAJ, Tao, T, Oliveira, ASB.
Affiliation: Federal University of Sao Paulo, Brazil
Tianjin University of Traditional Chinese Medicine (TUTCM), Tianjin, China.
Department of Tuina and Orthopedics, Tuina and Orthopedics Clinic, The First Teaching Hospital, Tianjin, China.
Journal: Scientific Research
Citation: Vol1(1). DOI:10.4236/health.2017.101004
Publication Year and Month: 2018 01
Abstract: Post-poliomyelitis syndrome (PPS) is a disorder in individuals who have had poliomyelitis, characterized by new muscle weakness and often associated with other symptoms, including cold intolerance (CI). Qigong is a Traditional Chinese Medicine technique to adjust energy and blood circulation. Objective: To verify the effects and late repercussions of Qigong on CI complaints in PPS patients. Methods: PPS patients (n = 22, 14 females, 8 males; ages 35 - 60) performed Qigong exercises in 40-minute sessions, three times per week, for three consecutive months. They were evaluated at baseline, the end of treatment and every three months for a year using a visual analogue scale adapted for CI (VAS-cold). Results: The systemic VAS-cold scores exhibited significant differences between the baseline, the end of treatment and throughout 12 months of follow-up. Conclusion: The CI scores were low and bearable at the end of intervention and for the following 12 months without activity.
Conclusions: We found that following DQ training, the complaints of CI exhibited statistically significant improvement in all the participants, and the sensitivity to cold exhibited low scores and bearable levels at the end of intervention and in the evaluations performed during the following 12 months.
Outcome of Research: Effective
Comments (if any): The full text of this paper has been generously made available by the publisher.
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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: Diagnosis and Management
Title: Sense of Coherence in persons with late effects of polio
Author: Nolvi M, Brogardh C, Jacobsson L, Lexell J
Affiliation: Maria Nolvi, MD, Department of Health Sciences, PO Box 157, Lund University, SE-221 00 Lund, Sweden
Journal: NeuroRehabilitation
Citation: Vol. 42, no. 1, pp. 103-111, 2018
Publication Year and Month: 2018 01
Abstract: BACKGROUND:Sense of Coherence (SOC) is important for successful adaptation and mental well-being in people with life-long medical conditions. Late effects of polio (LEoP) often lead to a life-long disability, but no study has assessed SOC in this population. OBJECTIVE:To assess SOC in persons with LEoP and to explore the association between SOC, demographics (age, gender, marital status and level of education) and variables related to LEoP (age at polio onset, number of years from polio until onset of LEoP and self-rated disability). METHOD:Ninety-three community-dwelling persons with clinically verified LEoP responded to a postal survey with the Sense of Coherence Scale (SOC-13). A hierarchical multiple regression analysis was performed to explore the associations with SOC. RESULTS:SOC varied considerably among the participants. The mean and median SOC-13 total sum score was 71.8 and 76 points, which is similar to age-matched non-disabled people. The number of years before onset of LEoP and self-rated disability together with the participants’ marital status and level of education explained 37% (pâ<â0.001) of the variance in SOC.
Conclusions: CONCLUSION:Persons with LEoP have a level of sense of coherence (SOC) indicating that they generally have the ability to understand, handle and being motivated when dealing with stressful events and problems arising in their lives as a result of their disability. Being married and having a higher education, living many years before onset of LEoP and perceiving a mild to moderate disability contributed to a strong SOC.
Outcome of Research: More research required
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Category: Orthoses
Title: Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome
Author: Kiriakos Daniilidis, Eike Jakubowitz, Daiwei Yao
Affiliation:
Journal: Part of the Biosystems & Biorobotics book series (BIOSYSROB, volume 19) pp 399-414
Citation: Daniilidis K., Jakubowitz E., Yao D. (2018) Introducing a Surgical Procedure for an Implantable FES Device and Its Outcome. In: Sandrini G., Homberg V., Saltuari L., Smania N., Pedrocchi A. (eds) Advanced Technologies for the Rehabilitation of Gait and Balance Disorders. Biosystems & Biorobotics, vol 19. Springer, Cham. https://doi.org/10.1007/978-3-319-72736-3_27
Publication Year and Month: 2018 01
Abstract: The adult paralytic foot or drop foot is a secondary related foot deformity, which usually arises due to neurogenic damage (Kunst et al. in Stroke 42:2126–2130, 2011; Truelsen et al. in European Journal of Neurology 13:581–598, 2006). The lack of neural innervation of the muscles, which play a major role in ankle dorsiflexion—M. tibialis anterior, Mm. peronei, M. extensor digitorum longus, and M. extensor halluces longus—can cause a secondary malposition of the foot. As a dorsiflexion of the ankle cannot be actively provoked, this leads to a domination of the flexors and as a secondary outcome to a shortening of these muscles and their tendons. Similarly, it may also lead to a malposition in supination (www.mayoclinic.org/diseases-conditions/foot-drop/basics/definition/con-20032918).
Conclusions:
Outcome of Research: More research required
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Category: 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: Post-Polio Motor Unit
Title: Motor unit number estimation (MUNE)
Author: Clifton L Gooch, MD.; Robert Henderson, MD.
Affiliation: Department of Neurology
University of South Florida, Royal Brisbane & Women's Hospital
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Clifton L Gooch, MD; Robert Henderson, MD
Section Editor: Jeremy M Shefner, MD, PhD
Deputy Editor: April F Eichler, MD, MPH
Publication Year and Month: 2018
Abstract: Electrophysiologic testing of nerve and muscle function has played a critical role in the diagnosis of neuromuscular disease for over half a century. Advances in computer technology and technical refinements have enabled the development of more sophisticated electrodiagnostic methods, which are providing information on the motor nerve and its function in health and disease. Motor unit number estimation (MUNE) is a technique that can be used to determine the approximate number of motor neurons in a muscle or group of muscles. In addition, MUNE methods provide a means of measuring motor unit size, enabling tracking of both loss of motor units and the compensatory phenomenon of collateral reinnervation. MUNE is used most often in neuromuscular disorders such as amyotrophic lateral sclerosis and spinal muscular atrophy.
This topic will review the methodology and utility of MUNE.
Conclusions:
Outcome of Research: More research required
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Category: Orthoses
Title: Functional walking capacity of subjects with paralyzed knee extensors while walking with an SCO in locked vs unlocked mode
Author: Sarah Schroder, Eva Probsting, Thomas Schmalz, Andreas Kannenberg, Hartmut Stinus
Affiliation: Ottobock SE & Co. KGaA, Duderstadt, Germany
Journal: Physical Medicine and Rehabilitation Research (PM&R)
Citation: DOI: 10.15761/PMRR.1000168
Publication Year and Month: 2018
Abstract: People with a paresis or paralysis of the knee extensors depend on knee-ankle-foot orthoses (KAFOs) to restore walking ability. Unlike locked KAFOs whose orthotic
knee joints are only unlocked for sitting down, stance control orthoses (SCOs) may utilize various mechanisms to lock the orthotic knee joint during the stance phase
and unlock it for a free swing phase. Thus far, all studies comparing SCOs to locked KAFOs have only used laboratory-based measures, but no clinical performance
measures commonly used in rehabilitation medicine. Therefore, the aim of this study was to investigate functional walking capacity using the 6-minute walk test
(6MWT), combined with objective 3D gait measurements, in established SCO users when using the orthosis in the unlocked and locked mode, respectively. In
addition, satisfaction with the SCO was surveyed using the QUEST questionnaire. A total of eight subjects participated in this study. The results show that in the
locked condition, subjects walked a significantly shorter distance (284.4±53.0 m vs. 316.9±59.6 m, p=.04) in the 6MWT than in the unlocked condition. Gait was
more physiological in the unlocked mode with a mean knee flexion angle during swing of 57°±15° vs. full extension in the locked mode. QUEST scores showed a
high overall satisfaction with the E-MAG Active SCO.
Conclusions: Compared to the unlocked condition, the locked mode imposed a clinically meaningful restriction to the functional walking capacity on the subjects. Therefore, fitting
of an SCO may be considered beneficial in individuals dependent on a KAFO to improve their functional walking capacity.
Outcome of Research: More research required
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Category: Continence
Title: Pelvic floor and poliomyelitis. Case report
Author: Gabriella Fizzotti, Michelangelo Buonocore, Eliana Giambelluca, Antonio Nardone
Affiliation: Spinal Unit, ICS Maugeri, Pavia, Italy
Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, ICS Maugeri, Pavia, Italy,
School of Specialization in Physical Medicine and Rehabilitation, University of Pavia, Pavia, Italy;
Department of Clinical-Surgical, Diagnostic and Pediatric Sciences University of Pavia, Pavia
Journal: Archives of Physical Medicine and Rehabilitation
Citation: Open Access 2:1-3 (2018)
Publication Year and Month: 2018
Abstract: Introduction: Living with polio increases the risk of having bladder dysfunction. Normal pelvic visceral function depends on the complex interactions
of intact somatic and autonomic nervous systems. Tests that are used to investigate the integrity of the somatic innervation of the pelvic floor muscles and urinary and anal sphincters include electromyography (EMG), nerve conduction studies and the evaluation of the sacral reflexes.
Clinical Picture and Investigation: A 53-year-old South-American man who had a history of poliomyelitis which affected his lower right limb
when he was 2 years old. Patient was unable to empty his bladder completely. The aim of this paper is to describe the correlation between pelvic
floor dysfunction, bladder symptoms and neurophysiological tests in poliomyelitis.
Conclusions: Conclusion: Neurophysiological diagnostic procedures adopted in our study can discern the degree of central and peripheral nervous system damage and confirmed that pelvic floor and detrusor muscles have been paralyzed by the poliovirus.
Outcome of Research: More research required
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Category: Falls and Bone Density
Title: Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects
Author: Thaiana Santos Galvão PT, Egídio Sabino Magalhães Júnior PT, MSc, Marco Antonio Orsini Neves PhD, MD & Arthur de Sá Ferreira PhD, PT
Affiliation: This study was supported by the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) [Grant numbers E-26/200.564/2015 and E-26/202.769/2015].
Journal: Physiotherapy Theory and Practice
Citation: DOI: 10.1080/09593985.2018.1512178
Publication Year and Month: 2018
Abstract: Introduction: This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman’s ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = –13, CI 95% −16 to −9 points), lower dynamic postural stability (MD = –14, CI 95% −19 to −8 points), and increased fear of falling (MD = 14, CI 95% 10–18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738–0.351), risk of falling (ρ = −0.746), and fear of falling (ρ = −0.432). Dynamic postural stability was correlated with risk of falling (ρ = −0.841), fear of falling (ρ = −0.277), and static postural stability (ρ = −0.869 to −0.435; ρ = −0.361 to −0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.
Conclusions:
Outcome of Research: More research required
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Category: Quality of Life
Title: Sleep Disorders in Neuromuscular Diseases
Author: Eric J Gartman
Affiliation: The Warren Alpert School of Medicine of Brown University Division of Pulmonary, Critical Care, and Sleep Medicine, Providence VA Medical Center,
Providence, RI, US
Journal: US Respiratory & Pulmonary Diseases
Citation: 2018;3(1):27–32
Publication Year and Month: 2018
Abstract: Disturbances in sleep are common in patients with neuromuscular diseases (NMDs) and are the source of a significant amount of morbidity.Underlying these disorders of sleep are the physiologic alterations that result from progressive changes in muscle strength, effective ventilation, and control of respiration. This review will discuss the normal changes that occur during sleep, how the physiologic alterations present in neuromuscular and chest wall disorders affect these normal processes, how to assess patients for the presence of sleep disorders, and how to approach treatment.
Conclusions:
Outcome of Research: More research required
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Category: 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: 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: Respiratory Complications and Management
Title: Respiratory adjuncts to NIV in neuromuscular disease
Author: Nicole Sheers, Mark E. Howard, David J. Berlowitz
Affiliation: Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, VIC, Australia
Institute for Breathing and Sleep, Melbourne, VIC, Australia
The University of Melbourne, Melbourne, VIC, Australia
Journal: Respirology
Citation: Asian Pacific Society of Respirology (2018) doi: 10.1111/resp.13431
Publication Year and Month: 2018
Abstract: Muscle weakness is an intrinsic feature of neuromuscular diseases (NMD). When the respiratory muscles are involved, the ability to take a deep breath is compromised, leading to reduced lung volumes and a restrictive ventilatory impairment. Inspiratory, expiratory and bulbar muscle weakness can also impair cough, which may impede secretion clearance. Non-invasive ventilation (NIV) is an established and indispensable therapy to manage hypoventilation and respiratory failure. The role of other therapies that support respiratory health is less clearly defined, and the evidence of efficacy is also harder to summarize as the underlying data are of a lesser quality. This narrative review appraises the evidence for respiratory therapies in adults with NMD and respiratory system involvement. Techniques that assist lung inflation and augment cough, such as lung volume recruitment (LVR) and mechanical insufflation-exsufflation (MI-E), are a particular focus of this review.The evidence suggests that LVR, MI-E and various com-binations thereof have clinical utility generally, but important methodological limitations limit the strength of clinical recommendations and hamper the integration of evidence into practice.
Conclusions: Future trials should prospectively assess the long-term impact of LVR and cough augmentation on clinical outcomes and burden of care in addition to lung mechanics, as well as deter-mine clear predictors of benefit from these techniques.
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
Comments (if any):
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Category: Anaesthesia, Surgery
Title: Percutaneous Tracheostomy
Author: Al-Shathri Z, Susanto I
Affiliation: Division of Pulmonary, Critical Care Medicine, Allergy and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Journal: Seminars in Respiratory and Critical Care Medicine
Citation: 2018 Dec;39(6):720-730
Publication Year and Month: 2018
Abstract: Tracheostomy is a commonly performed surgical procedure in intensive care units (ICUs). Over the past three decades, there has been a substantial body of evidence to suggest percutaneous tracheostomy (PT) is at least as safe as surgical tracheostomy (ST) in the hands of trained clinicians. In most institutions, PT is more readily performed at bedside than ST in the ICU; hence, PT is an attractive alternative to ST in the ICU. Bedside PT generates significant cost savings by eliminating operating room and anesthesia charges. Bronchoscopy is commonly used as a visual aid during PT. Ultrasound (US)-guided PT is gaining popularity. It can be used as an adjunct or alternative to bronchoscopic-guided PT, especially in hospitals where access to bronchoscopy remains fairly limited and US is more widely available. There are many benefits in converting translaryngeal intubation to tracheostomy. It is widely accepted that tracheostomy is preferred if there is an anticipation of prolonged need for an artificial airway. The timing of this conversion from translaryngeal intubation to tracheostomy remains a subject of controversy. Limited data are available regarding the safety of PT on patients who are on dual antiplatelet therapy or active anticoagulation. Given the heterogeneity of PT techniques, adequate training and experience with the technique, coupled with careful planning are essential in minimizing any potential complication.
Conclusions:
Outcome of Research: More research required
Comments (if any):
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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: 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: Post-Polio Motor Unit
Title: How long does denervation take in poliomyelitis? Or is it a lifetime?
Author: Senol, M.G., Kaplan, C., OzdaÄ, F., SaraçoÄlu, M.
Affiliation: GATA Haydarpasa Training Hospital, Istanbul
Journal:
Citation: Journal of Neurosciences in rural practice
Senol, M.G., Kaplan, C., OzdaÄ, F., SaraçoÄlu, 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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Coping Styles and Strategies
Title: Aging With Long-Term Mobility Impairment: Maintaining Activities of Daily Living via Selection, Optimization, and Compensation
Author: Remillard, E.T., Bailey Fausset, C., Fain, W.B.
Affiliation: Georgia Institute of Technology, Atlanta, Georgia 30318
Journal: The Gerontologist
Citation: gnx186, https://doi.org/10.1093/geront/gnx186
Publication Year and Month: 2017 11
Abstract: There is a growing number of adults with long-term mobility impairment aging into the older adult population. Little is known about the experiences of these individuals in maintaining activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as they face age-related changes in addition to a pre-existing mobility impairment.
Research Design and Methods
Through in-home interviews with 21 participants (ages 52–86) with long-term mobility impairment, the present study employed a qualitative description design to explore perceptions of how and why select ADL/IADL routines (e.g., bed transfer, toileting) have changed over time. The selection, optimization, and compensation (SOC) model was used as a framework to organize participants’ adaptations.
Results
Among the ADL/IADL routine changes mentioned, elective selection strategies, in which a person continues to work at maintaining a task, were more frequently endorsed than loss-based selection strategies, in which a person does a task less or gets help from someone. Findings suggest that this population is actively adapting their routines to preserve their involvement in, and frequency of doing, these ADLs/IADLs. Counter to expectation, perceived age-related changes underlying activity routine changes were subtle and generally did not include sensory and cognitive declines.
Discussion and Implications
Findings provide insights into the difficulties adults with long-term mobility impairment experience as they age, as well as the adaptations they employ to overcome those challenges. Results highlight the need for customizable, mobility supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span.
Conclusions: Despite challenges, this population is actively adapting their routines to maintain ADLs/IADLs and preserve their involvement in, and frequency of doing, these activities. For older adults with long-term mobility impairment, age-related changes underlying ADL/IADL routine changes are often subtle and can be difficult for individuals to identify and articulate about themselves. More research is necessary to understand the aging trajectories among this understudied population. Results highlight the need for customizable, supports (e.g., assistive technologies, home modifications) that can adjust to an individual’s changing abilities across the life span to promote independence at home.
Innovations in design and technology hold great potential to empower individuals aging with mobility impairment to maintain everyday activities and thrive. However, access to supportive devices, equipment, and housing remains a barrier for many individuals in this population. Income and insurance coverage are just a few of the factors that could limit one’s options for overcoming ADL/IADL challenges in the home. There is a need for convergence among aging and disability services, which tend to operate in silos, serving older adults, or people with disabilities; this divide is echoed in how supportive devices and equipment are accessed, delivered, and paid for in terms of eligibility and insurance. By moving from a model that emphasizes aging or disability, to one that addresses impairment as a spectrum, practitioners, and policy makers can better meet the needs of a diverse older adult population (Putnam, 2014).
Outcome of Research: Effective
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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
Comments (if any): The full text of this paper has been generously made available by the publisher.
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Category: Exercise
Title: Daily Well-Being Benefits of Physical Activity in Older Adults: Does Time or Type Matter?
Author: Whitehead BR, Blaxton JM
Affiliation: 1 Behavioral Sciences Department, University of Michigan-Dearborn.
2 Department of Psychology, University of Notre Dame, Indiana.
Journal: The Gerontologist
Citation: 2017 Nov 10;57(6):1062-1071
Publication Year and Month: 2017 11
Abstract: PURPOSE OF THE STUDY:
There is little debate that maintaining some level of physical activity in later life conveys positive benefits both physically and psychologically. What is less understood is the extent to which the type of activity or the length of time spent doing it matters when it comes to these benefits on the daily level. Here, we investigated (a) whether the presence of daily purposeful exercise (Exercise) or non-exercise physical activity (Activity) is sufficient for experiencing day-level benefits, or if time spent matters, and (b) whether there are differential well-being benefits of Exercise and Activity on the daily level.
DESIGN AND METHODS:
Older adults (N = 127; aged 60-95, Mage = 79.4) filled out surveys for 14 days, reporting daily Exercise and Activity behaviors as well as Positive and Negative Affect (PA/NA), Perceived Stress (PS), Perceived Health (PH), and Sleep Quality (SQ).
RESULTS:
Multilevel regression models showed that for purposeful exercise, more time spent was beneficial for PA, NA, and PH, but for PS, only the presence of exercise was important (time did not matter). For non-exercise activity, time did not have as great an influence as presence-doing any form of activity was beneficial for both PA and SQ. Exercise and Activity had largely independent (additive) effects.
Conclusions: Results reveal that both purposeful exercise and non-exercise activity convey independent daily well-being benefits, and that for some aspects of daily well-being, duration does matter. Findings can be applied in the development of physical activity education or engagement programs for older adults.
Outcome of Research: Effective
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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: 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: 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: 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: Fatigue, Late Effects of Polio, Pain
Title: The Association of Pain, Fatigue and Functional Capacity with Function in Subjects with Post-Polio Syndrome in Gujarat, India
Author: Sheth Megha S Sheth, MPT (1); Srishti S Sharma, PhD Scholar (2)
Affiliation: (1) SBB College of Physiotherapy
(2) CM Patel College of Physiotherapy
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Society of Indian Physiotherapists
Volume 1, Issue 2. p. 42-46. Doi No:-10.18231
Publication Year and Month: 2017 08
Abstract: Background:
Almost 80 lakh people are affected by polio in India. Post-polio syndrome (PPS) refers to a clinical disorder affecting polio survivors’ years after the initial polio attack. These patients report new, late onset, neuromuscular symptoms like fatigue, pain, new and unusual muscular deficits, and decreased functional abilities. Although these are common problems in individuals with PPS, less research especially in India, has examined the role that these symptoms might exert on physical or psychological function.
Aims:
To find co-relation of pain, fatigue, functional capacity with function in subjects with Post-Polio Syndrome.
Design:
Co-relational study.
Methods:
A convenience sample of 20 subjects with PPS according to Halstead criteria 1985 was selected. Pain was examined using Brief Pain Inventory (BPI), Fatigue by fatigue severity scale (FSS) and functional capacity by 2 minute walk distance. Physical and psychological functions were examined using PROMIS (Patient Reported Outcomes Measurement Information System) and PHQ-9 (Patient Health Questionnaire-9) questionnaires.
Statistical Analysis:
Spearman’s test for co-relation was applied.
Results:
A positive linear co-relation was found between functional capacity and physiological function (r = 0.873); negative linear co-relation between functional capacity and psychological function (r = -0.743). Fatigue showed a positive linear correlation with psychological function (r = 0.486). A negative correlation was calculated between pain and fatigue with physical function (r = -0.258; r = -0.396 respectively). Correlation of pain and psychological function (r = 0.130) was weak.
Conclusion:
Reduced functional capacity co-relates with the physical and psychological function of subjects with PPS, and fatigue co-relates with psychological function. Physiotherapy for decreasing pain, fatigue and improving functional capacity may improve physical and psychological function.
Keywords: Physical function, Psychological function, Pain, Fatigue, Functional capacity.
Conclusions: Conclusion
There is a strong correlation between functional capacity and physical and psychological function of subjects with PPS, and moderate correlation of fatigue with psychological function. Correlation of pain and fatigue with physical function and of pain and psychological function was weak.
Implications
There is a need for effective and accessible management options in polio survivors. Physiotherapy for decreasing pain, fatigue and improving functional capacity may improve physical and psychological function. The study highlights the need to screen subjects with PPS and suggest interventional strategies to reduce their problems.
Outcome of Research: More research required
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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 (nâ
=â
23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (nâ
=â
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: Respiratory Complications and Management
Title: Comparison of activity and fatigue of the respiratory muscles and pulmonary characteristics between post-polio patients and controls: A pilot study
Author: David Shoseyov, Tali Cohen-Kaufman, Isabella Schwartz, Sigal Portnoy,
Affiliation: Pediatric department, Hadassah Mount Scopus, Jerusalem, Israel
Physical Medicine and Rehabilitation department, Hadassah Mount Scopus, Jerusalem, Israel
Department of Physiotherapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
National Yang-Ming University, TAIWAN
Journal: PLoS One
Citation: 2017; 12(7): e0182036.
Publication Year and Month: 2017 07
Abstract: Objectives
To compare pulmonary function measures, maximal respiratory pressure and fatigue of respiratory muscles between patients with Post-Polio Syndrome (PPS) and controls.
Design
Cross-sectional study.
Patients
Patients with PPS (N = 12; age 62.1±11.6 years) able to walk for 6 minutes without human assistance; age-matched controls with no history of polio or pulmonary dysfunction (N = 12; age 62.2±6.5 years).
Measurements
A body plethysmograph was used to quantify Residual Volume (RV), Total Lung Capacity (TLC), and Thoracic Gas Volume (TGV) etc. A manometer was used to measure Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure. A spirometer was used to measure Maximal Voluntary Ventilation (MVV). Surface electromyography (sEMG) recorded diaphragmatic muscle activity while performing MVV.
Results
The control group had significantly higher TGV and showed improvement in MIP following the effort (difference of 5.5±4.0cmH2O) while the PPS group showed deterioration in MIP (difference of -2.5±5.0cmH2O). Subjects with scoliosis had significantly higher RV/TLC values compared with subjects without scoliosis. The 25th frequency percentile of the sEMG signal acquired during MVV was reduced in the PPS group.
Conclusions: Maximal respiratory pressure test and sEMG measurements may identify fatigue of respiratory muscles in patients with PPS. Early diagnosis of respiratory impairment may delay respiratory decline and future need of invasive respiratory aids.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: Rotary’s PolioPlus Program: Lessons Learned, Transition Planning, and Legacy
Author: John L. Sever Michael McGovern Robert Scott Carol Pandak Amy Edwards David Goodstone
Affiliation:
Journal: The Journal of Infectious Diseases
Citation: Volume 216, Issue suppl_1 S355–S361, https://doi.org/10.1093/infdis/jiw556
Publication Year and Month: 2017 06
Abstract: Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary PolioPlus program, participating in national immunization days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication, assisting at immunization posts and clinics, and mobilizing their communities for immunization activities (including poliovirus and other vaccines) and other health benefits. Rotary has contributed more than $1.61 billion for the global eradication of polio and has committed to provide an additional $35 million each year until 2018 (all dollar amounts represent US dollars). Its unwavering commitment to eradicate polio has been vital to the success of the program. Rotary is providing additional support for routine immunization and healthcare. When polio is finally gone, we will have the knowledge from the lessons learned with PolioPlus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health. Rotary has already transitioned its grants program to include 6 areas of focus: disease prevention and treatment, water and sanitation, maternal and child health, basic education and literacy, economic and community development, and peace and conflict prevention/resolution. Funding for these grants in 2015–2016 was $71 million. The legacy of the polio program will be the complete eradication of poliovirus and the elimination of polio for all time.
Conclusions: Through Rotary’s polio eradication efforts, the organization has learned how to raise funds with coordinated campaigns, and raise awareness with innovative communications methods and celebrity engagement. In addition, Rotary members learned how to work with other organizations to implement large-scale projects that required advocacy, security planning, and coordination in the field. Finally, the launch of PolioPlus as Rotary’s flagship project has a legacy of uniting Rotary members around the world behind a common goal. Ending polio will be a major stepping stone for the United Nations’ sustainable development goals, particularly goal 3, to “ensure healthy lives and promote well-being for all at all ages” [33]. When polio is finally gone, we will have the blueprint for tackling other global issues, even those beyond public health.
Outcome of Research: Not applicable
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Category: 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: Falls
Title: Relationship of depression and medications on incidence of falls among people with late effects of polio
Author: Da Silva, C.P.; Zuckerman, B.; Olkin, R.
Affiliation: School of Physical Therapy, Texas Women's University, Houston Texas, USA
Journal: Physiotherapy Theory and Practice
Citation: Volume 33, 2017 - Issue 5
Publication Year and Month: 2017 04
Abstract: The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence.
Conclusions: Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.
Outcome of Research: More research required
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Category: Diagnosis and Management
Title: The 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: 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: 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: Polio Immunisation
Title: Genetically Thermo-Stabilised, Immunogenic Poliovirus Empty Capsids; a Strategy for Non-replicating Vaccines
Author: Fox, H., Knowlson, S., Minor, P.D., Macadam, A.J.
Affiliation: This work was supported by the WHO Polio Research Committee (http://www.polioeradication.org/Research/Grantsandcollaboration.aspx) through I8-TSA-043 & I8-TSA-083 as well as by NIBSC (National Institute for Biological Standards and Control) through core funding received from the UK Department of Health to fund biological standards and control. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Journal: PLoS Pathog
Citation: 13(1): e1006117. https://doi.org/10.1371/journal.ppat.1006117
Publication Year and Month: 2017 01
Abstract: While wild type polio has been nearly eradicated there will be a need to continue immunisation programmes for some time because of the possibility of re-emergence and the existence of long term excreters of poliovirus. All vaccines in current use depend on growth of virus and most of the non-replicating (inactivated) vaccines involve wild type viruses known to cause poliomyelitis. The attenuated vaccine strains involved in the eradication programme have been used to develop new inactivated vaccines as production is thought safer. However it is known that the Sabin vaccine strains are genetically unstable and can revert to a virulent transmissible form. A possible solution to the need for virus growth would be to generate empty viral capsids by recombinant technology, but hitherto such particles are so unstable as to be unusable. We report here the genetic manipulation of the virus to generate stable empty capsids for all three serotypes. The particles are shown to be extremely stable and to generate high levels of protective antibodies in animal models.
Conclusions: The final preparations studied were extremely stable compared to IPV and could conceivably give rise to a vaccine that would not require a cold chain; moreover they were more immunogenic than IPV made from the equivalent strains in the animal model used for testing IPV potency and in challenge studies in transgenic mice. It is possible that this is partly because the particles, unlike IPV, were not treated with formalin. The viruses from which they were derived had lost infectivity presumably because they were unable to uncoat by virtue of their hyperstable capsids. A suitable expression platform would be required to make this a viable vaccine production system and is the focus of one strand of current work of the Consortium, but the properties of the particles are very promising.
Outcome of Research: More research required
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Category: Speech Pathology
Title: Dysphonia as the initial presenting symptom in postpolio syndrome: a case report
Author: Ference, T. & Cutler, J.
Affiliation: Miller School of Medicine, University of Miami, USA
Journal: Research on Chronic Diseases
Citation: (2017) 1(1):4-5
Publication Year and Month: 2017 01
Abstract: Post-polio syndrome is a slowly progressive condition that affects polio survivor’s years after their initial infection with polio virus. Individuals with post-polio syndrome suffer from a variety of symptoms that negatively impact their independence and overall happiness, including daily general fatigue (48- 93%), pain (72-91%), respiratory issues (11- 41%), depression (13.45%), and sleep disorders (13-48%). Here, we present a patient with post-polio syndrome who presents with an unusual symptom manifestation of hoarseness.
Conclusions: In treating post-polio syndrome patients with hoarse voice a multidisciplinary team can help maximize and preserve function. Weakness of the abdominal muscles, diaphragm, and laryngeal muscles should be considered in persons with history of polio.
Outcome of Research: More research required
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Category: Orthoses
Title: Predictors of changes in gait performance over four years in persons with late effects of polio.
Author: Flansbjer, Lexell, Brogårdh
Affiliation: Department of Health Sciences, Lund University, Lund, Sweden.
Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
Department of Health Science, Luleå University of Technology, Luleå, Sweden.
Journal: NeuroRehabilitation
Citation: 2017;41(2):403-411.
Publication Year and Month: 2017
Abstract: BACKGROUND:
Reduced gait performance is common in persons with late effects of polio.
OBJECTIVE:
To identify predictors of change in gait performance over four years in persons with late effects of polio.
METHODS:
Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength.
RESULTS:
There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; pâ<â0.05), FGS (1.7%; pâ<â0.001), and 6MWT (0.7%; pâ<â0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (pâ<â0.001).
Conclusions: CONCLUSION:
The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.
Outcome of Research: More research required
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Category: 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: 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: 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: Ageing
Title: Currents issues in cardiorespiratory care of patients with post-polio syndrome
Author: Marco Orsini, Agnaldo J. Lopes, Fernando S. Guimarães, Marcos R. G. Freitas, Osvaldo J. M.
Nascimento, Mauricio de Sant’ Anna Junior, Pedro Moreira Filho, Stenio Fiorelli, Ana Carolina A. F.
Ferreira, Camila Pupe, Victor H. V. Bastos, Bruno Pessoa, Carlos B. Nogueira, Beny Schmidt,
Olivia G. Souza, Eduardo R Davidovich, Acary S. B. Oliveira, Pedro Ribeiro
Affiliation: Centro Universitário Augusto Motta, Programa de Pós-Graduação em Ciências da Reabilitação, Rio de Janeiro RJ, Brasil
Journal: Arquivos de Neuro-Psiquiatria
Citation: Arq. Neuro-Psiquiatr. vol.74 no.7 São Paulo July 2016
Publication Year and Month: 2016 07
Abstract: Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk.
Method
A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered.
Results and Discussion
Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia.
Conclusions: Conclusion
Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.
Outcome of Research: More research required
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Category: Assistive Technology
Title: The extent of using mobility assistive devices can partly explain fatigue among persons with late effects of polio – a retrospective registry study in Sweden
Author: Santos Tavares SilvaEmail author, K. S. Sunnerhagen, C. Willén and I. Ottenvall Hammar
Affiliation:
Journal: BioMed Central Neurology
Citation:
Publication Year and Month: 2016 06
Abstract: Background
Fatigue is reported as one of the most disabling symptoms and is common among persons living with late effects of polio. Although fatigue has been studied in the context of people living with late effects of polio, there is a lack of knowledge concerning the association of fatigue and variables of importance for participation in daily life. Therefore, the aim of this study was to explore possible factors associated with fatigue among persons with late effects of polio in Sweden.
Methods
This retrospective registry study consisted of 89 persons with late effects of polio living in Sweden. Fatigue was measured with the Multidimensional Fatigue Inventory (MFI-20) scale, Swedish version. Pearson’s correlation coefficient was used to analyse the correlation between the factors and fatigue, and a multiple linear regression was carried out to explore factors for fatigue.
Results
Fatigue statistically significantly correlated with age (r = 0.234, p < 0.05) and the use of mobility assistive devices (r = 0.255, p < 0.05). The multiple linear regression model showed that the factors age (β = 0.304, p < 0.019) and mobility assistive devices (β = 0.262, p < 0.017) were associated with fatigue among persons living with late effects of polio, and the model partly explained 14% of the variation of fatigue.
Conclusions: Conclusions
Fatigue could partly be explained by the extent of using mobility assistive devices and age. Healthcare professionals should provide and demonstrate the importance of assistive devices to ensure management of fatigue in persons living with late effects of polio.
Outcome of Research: More research required
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Category: Quality of Life
Title: 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: 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: Diagnosis and Management
Title: Characteristics of Patients at First Visit to a Polio Clinic in Sweden
Author: Skough Vreede, K. and Sunnerhagen, K.S.
Affiliation: Goteborg University
Journal: PLoS One
Citation: https://doi.org/10.1371/journal.pone.0150286
Publication Year and Month: 2016 03
Abstract: Aim
Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957.
Design
A consecutive cohort study.
Patients
Prior polio patients.
Methods
All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study.
Results
More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61–71% slower, and were 53–77% weaker in muscle strength of the knee and foot as well as grip strength.
Conclusion
The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years.
Conclusions: Polio in lower extremities was more common than polio in upper extremities, verified both
by EMG and clinical classification. This is in accordance with earlier studies. Polio in lower
extremities was also classified as clinically unstable or severely atrophic to a higher extent than
polio in upper extremities (as shown in Fig 1). This is in accordance with an earlier study by
Sandberg et al [20] indicating a more pronounced ongoing denervation-reinnervation process
over time in a lower extremity muscle compared to upper extremity muscle (tibialis anterior
and biceps brachii respectively). The same pattern was also seen in patients studied in Minnesota where patients with leg weakness were twice as likely to complain of new problems compared to those with arm weakness [10].
The ongoing denervation-reinnervation process in patients with PPS results in larger motor
units.When motor-unit size has reached an upper limit, further losses of neurons can no longer
be compensated for and this results in increased muscle weakness [21]. The patients
showed to be stronger in isometric endurance compared to normal population. This may be
explained by the fact that the patients were weaker than the normal population in isometric
peak torque, which the measure of isometric endurance was based on. An increase in type I
(slow) muscle fibres has also been described in prior polio patients [22–23] and may be due to
a transition of type II (fast) to type I (slow).
An important study limitation were seen in the classification of polio as polio were classified
for left and right arm and leg, respectively, and not per muscle group. This can explain why a
polio affected leg in some cases was stronger compared to normal values as the muscles
involved in the strength measured i.e. knee flexion and knee extension muscles may not be
affected of polio. And the same is applicable regarding muscle strength of the foot as well as
grip strength. Data of muscle strength from some of the subjects were missing for different reasons i.e. they may have just not had time to participate, or refused to participate and some were too weak to perform the strength test. Some of the patients with muscle strength data missing, tried to perform the test, but were too weak to get a result. In the future, the use of ultrasound may be used to assess muscle function [24]. This would give the possibility to have more information of muscle function since this does not require that the patient has muscle strength to overcome gravity, which is a requirement for isokinetic testing.
Outcome of Research: Effective
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Category: Late Effects of Polio
Title: Experiences and perspectives of patients with post-polio syndrome and therapists with exercise and cognitive behavioural therapy
Author: Minne Bakker, Karen Schipper, Fieke S. Koopman, Frans Nollet and Tineke A. Abma
Affiliation: Department of Medical Humanities, EMGO+ Institute, VU Medical Center
(VUmc), Amsterdam, The Netherlands
Journal: BioMed Central Neurology
Citation: BMC Neurology (2016) 16:23
Publication Year and Month: 2016
Abstract: Background: Many persons affected with poliomyelitis develop post-polio syndrome (PPS) later in their life.
Recently, the effectiveness of Exercise Therapy (ET) and Cognitive Behavioural Therapy (CBT) for PPS has been evaluated in a randomized controlled trial, but did not show a decrease in fatigue or improvement in secondary endpoints like Quality of Life and self-perceived activity limitations. The aim of this explorative study was to gain insight in the perceived effects and experiences of the interventions from the perspectives of the patients and
therapists.
Methods: Qualitative data were collected through semi-structured interviews with 17 patients and 7 therapists. All participants were involved in the trial. A thematic analysis of the data was performed.
Results: Some patients experienced a short term enhanced endurance and a better use of energy during the day. However, in general patients did not experience a long lasting reduction of fatigue from the CBT or ET. Mainly patients of the CBT, but also some patients of the ET described an increase of self-esteem and self-acceptance. As a result, patients were sometimes better able to perform physical activities during the day. In contrast to the CBT, the
ET was in general perceived by the patients as an intensive therapy, which was difficult to fit into their daily routine. Therapists of both the CBT and the ET struggled with a low intrinsic motivation of the patients in the study.
This made it sometimes difficult for the therapists to follow the protocol.
Conclusions: Conclusion: Confirming the negative quantitative study outcome, the qualitative results did not demonstrate lasting effects on fatigue. Patients did, however, experience some benefits on self-esteem and acceptance of the disease. This study showed that it is of great importance to work with feasible interventions; they should fit the patients’ needs on a practical (fit into their daily routine) and mental (fit their need for support) level.
Outcome of Research: More research required
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Category: 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: 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: Late Effects of Polio
Title: People living with post-polio syndrome must not be forgotten
Author: Hill T
Affiliation: British Polio Fellowship
Journal: Nursing Standard
Citation: Nurs Stand. 2015 Nov 4;30(10):30-1. doi: 10.7748/ns.30.10.30.s38
Publication Year and Month: 2015 11
Abstract: As research conducted by YouGov reveals, only 7% of people in Britain are aware of the neurological condition post-polio syndrome (PPS). The British Polio Fellowship is keen to highlight what is now an urgent need for more support for those living with PPS, from both the public and the nursing and medical community.
Conclusions:
Outcome of Research: Not applicable
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Category: Polio Immunisation
Title: A cross-sectional survey of healthcare workers on the knowledge and attitudes towards polio vaccination in Pakistan
Author: Khan MU (1), Ahmad A (1), Aqeel T (2), Akbar N (2), Salman S (3), Idress J (4)
Affiliation: (1) Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia; (2) Department of Pharmacy Practice, Faculty of Pharmacy, University of Baluchistan, Quetta, Pakistan; (3) Department of Pharmacy, University of Peshawar, Peshawar, Pakistan; (4) Department of Integrated Sciences, Post Graduate Nursing College, Peshawar, Pakistan.
Journal: Public Library of Science
Citation: PLoS One. 2015 Nov 11;10(11):e0142485. doi: 10.1371/journal.pone.0142485. eCollection 2015.
Publication Year and Month: 2015 11
Abstract: INTRODUCTION: Pakistan accounts for 85.2% of the total polio cases reported worldwide. Healthcare workers (HCWs) are an integral part of immunization campaigns and source of education for the general public. This study aimed to assess the knowledge and attitudes towards polio vaccination among HCWs providing immunisation and education to general public in Quetta and Peshawar divisions of Pakistan.
METHODS: A cross-sectional survey of 490 HCWs was conducted in two major referral public teaching hospitals of Quetta and Peshawar divisions. During February to April, 2015, a random sample of 490 HCWs was invited to participate in this study. Knowledge and attitudes were assessed by using self-administered, anonymous and pretested questionnaire. Descriptive and logistic regression analyses were used to express the results.
RESULTS: A total of 468 participants responded to the questionnaire, giving a response rate of 95.5%. Overall, participants demonstrated good knowledge and positive attitudes towards polio vaccination. The mean knowledge score of HCWs about polio was 13.42±2.39 (based on 18 knowledge questions) while the mean attitude score was 28.75±5.5 (based on 9 attitudes statements). Knowledge gaps were identified about the incubation period of poliovirus (19.5%), management issues (31.9%), use of polio vaccine in mild illnesses (34.7%) and the consequences of the polio virus (36.9%). The majority of participants agreed that all children should be vaccinated for polio (95.1%), while reservations were noted about the need of a booster (38.9%), and sterility issues associated with polio vaccines (43.6%). Internet (n = 167, 37%) and Posters (n = 158, 35%) were the main sources used by HCWs to educate themselves about polio.
Conclusions: Participants in this study had good knowledge and positive attitudes towards polio vaccination. Although the data are indicative of gaps in the knowledge of HCWs, the findings may not be generalized to other hospitals in Pakistan.
Outcome of Research: Not applicable
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Category: Muscular Atrophy, Post-Polio Motor Unit
Title: An autopsy case of progressive generalized muscle atrophy over 14 years due to post-polio syndrome
Author: Oki R (1), Uchino A, Izumi Y, Ogawa H, Murayama S, Kaji R
Affiliation: (1) Department of Clinical Neuroscience, Institute of Health Bioscience, University of Tokushima Graduate School
Journal: Rinsho Shinkeigaku (Clinical Neurology)
Citation: Rinsho Shinkeigaku. 2015 Nov 30
Publication Year and Month: 2015 11
Abstract: We report the case of a 72-year-old man who had contracted acute paralytic poliomyelitis in his childhood. Thereafter, he had suffered from paresis involving the left lower limb, with no relapse or progression of the disease. He began noticing slowly progressive muscle weakness and atrophy in the upper and lower extremities in his 60s. At the age of 72, muscle weakness developed rapidly, and he demonstrated dyspnea on exertion and dysphagia. He died after about 14 years from the onset of muscle weakness symptoms. Autopsy findings demonstrated motoneuron loss and glial scars not only in the plaque-like lesions in the anterior horns, which were sequelae of old poliomyelitis, but also throughout the spine. No Bunina bodies, TDP-43, and ubiquitin inclusions were found. Post-polio syndrome is rarely fatal due to rapid progressive dyspnea and dysphagia. Thus, the pathological findings in the patient are considered to be related to the development of muscle weakness.
Conclusions:
Outcome of Research: Not applicable
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Category: Polio Immunisation
Title: Effect of substituting IPV for tOPV on immunity to poliovirus in Bangladeshi infants: An open-label randomized controlled trial
Author: Mychaleckyj JC (1), Haque R (2), Carmolli M (3), Zhang D (4), Colgate ER (3), Nayak U (4), Taniuchi M (5), Dickson D (3), Weldon WC (6), Oberste MS (6), Zaman K (2), Houpt ER (5), Alam M (2), Kirkpatrick BD (7), Petri WA Jr (8)
Affiliation: (1) Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA; (2) Center for Vaccine Sciences, International Centre for Diarrhoeal Disease Research, Mohakhali 1212, Dhaka, Bangladesh; (3) Vaccine Testing Center, University of Vermont College of Medicine, Burlington, VT 05405, USA; (4) Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA; (5) Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22908, USA; (6) Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (7) Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA; (8) Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA 22908-1340, USA
Journal: Vaccine
Citation: Vaccine. 2015 Nov 28. pii: S0264-410X(15)01695-3. doi: 10.1016/j.vaccine.2015.11.046. [Epub ahead of print]
Publication Year and Month: 2015 11
Abstract: BACKGROUND: The Polio Endgame strategy includes phased withdrawal of oral poliovirus vaccines (OPV) coordinated with introduction of inactivated poliovirus vaccine (IPV) to ensure population immunity. The impact of IPV introduction into a primary OPV series of immunizations in a developing country is uncertain.
METHODS: Between May 2011 and November 2012, we enrolled 700 Bangladeshi infant-mother dyads from Dhaka slums into an open-label randomized controlled trial to test whether substituting an injected IPV dose for the standard Expanded Program on Immunization (EPI) fourth tOPV dose at infant age 39 weeks would reduce fecal shedding and enhance systemic immunity. The primary endpoint was mucosal immunity to poliovirus at age one year, measured by fecal excretion of any Sabin virus at five time points up to 25 days post-52 week tOPV challenge, analyzed by the intention to treat principle.
FINDINGS: We randomized 350 families to the tOPV and IPV vaccination arms. Neither study arm resulted in superior intestinal protection at 52 weeks measured by the prevalence of infants shedding any of three poliovirus serotypes, but the IPV dose induced significantly higher seroprevalence and seroconversion rates. This result was identical for poliovirus detection by cell culture or RT-qPCR. The non-significant estimated culture-based shedding risk difference was -3% favoring IPV, and the two vaccination schedules were inferred to be equivalent within a 95% confidence margin of -10% to +4%. Results for shedding analyses stratified by poliovirus type were similar.
Conclusions: Neither of the vaccination regimens is superior to the other in enhancing intestinal immunity as measured by poliovirus shedding at 52 weeks of age and the IPV regimen provides similar intestinal immunity to the four tOPV series, although the IPV regimen strongly enhances humoral immunity. The IPV-modified regimen may be considered for vaccination programs without loss of intestinal protection.
Outcome of Research:
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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: 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: 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 signiďŹcant 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, Orthoses, Surgery
Title: Polio revisited: reviving knowledge and skills to meet the challenge of resurgence
Author: Benjamin Joseph (1) and Hugh Watts (2)
Affiliation: (1) Aster Medcity, Kochi, Kerala India, 18 HIG HUDCO Colony, Manipal, Karnataka 576104 India
(2) Shriners Hospital for Children, Los Angeles, CA USA
Journal: NEW - PUT DETAILS IN CITATION FIELD
Citation: Journal of Children's Orthopaedics
9 (5): 325–338, doi: 10.1007/s11832-015-0678-4
Publication Year and Month: 2015 09
Abstract: Purpose
To date, polio has not been eradicated and there appears to be a resurgence of the disease. Hence, there is a need to revive decision-making skills to treat the effects of polio.
Methods
Here, we outline the aspects of treatment of paralysis following polio based on the literature and personal experience of the authors. The surgical treatment of the lower and upper extremities and the spine have been reviewed. The scope of bracing of the lower limb has been defined.
Results
The effects of polio can be mitigated by judicious correction of deformities, restoration of muscle balance, stabilising unstable joints and compensating for limb length inequality.
Conclusions
As polio has not been eradicated and there is a risk of resurgence of the disease, paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques for managing the effects of paralysis following polio is needed.
Keywords: Poliomyelitis, Resurgence, Surgical decision-making, Bracing, Paralytic deformity
Conclusions: Polio has not been eradicated and there is a risk of resurgence of the disease. Paediatric orthopaedic surgeons need to be prepared to deal with fresh cases of polio. Revival of old techniques of managing the effects of paralysis following polio is needed.
Outcome of Research: Not applicable
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Category: Assistive Technology, Orthoses
Title: Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis
Author: Arazpour M (1), Ahmadi F (2), Bahramizadeh M (2), Samadian M (3), Mousavi ME (2), Bani MA (4), Hutchins SW (5)
Affiliation: (1) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; (2) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (3) Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran; (4) Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran; (5) Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
Journal: Prosthetics and Orthotics International
Citation: Prosthet Orthot Int. 2015 Aug 12. pii: 0309364615596063
Publication Year and Month: 2015 08
Abstract: BACKGROUND: Compared to able-bodied subjects, subjects with post-polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry.
OBJECTIVES: The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop-locked knee-ankle-foot orthosis or a newly developed powered knee-ankle-foot orthosis.
STUDY DESIGN: Quasi experimental study.
METHODS: Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis.
RESULTS: There were no significant differences in the gait symmetry index of step length (p = 0.085), stance time (p = 0.082), double-limb support time (p = 0.929), or speed of walking (p = 0.325) between the two test conditions. However, using the new powered knee-ankle-foot orthosis improved the symmetry index in step width (p = 0.037), swing time (p = 0.014), stance phase percentage (p = 0.008), and knee flexion during swing phase (p ⊽ 0.001) compared to wearing the drop-locked knee-ankle-foot orthosis.
Conclusions: The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase.
CLINICAL RELEVANCE: A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis.
Outcome of Research: Effective
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Category: Polio Immunisation
Title: Preparation for global introduction of inactivated poliovirus vaccine: safety evidence from the US Vaccine Adverse Event Reporting System, 2000–12
Author: Iqbal S (1), Shi J (1), Seib K (2), Lewis P (1), Moro PL (1), Woo EJ (3), Shimabukuro T (1), Orenstein WA (2)
Affiliation: (1) Immunization Safety Office, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA; (2) Emory University, School of Medicine, Division of Infectious Diseases, Atlanta, GA, USA; (3) Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
Journal: The Lancet Infectious Diseases
Citation: DOI: http://dx.doi.org/10.1016/S1473-3099(15)00059-6
Publication Year and Month: 2015 08
Abstract: BACKGROUND: Safety data from countries with experience in the use of inactivated poliovirus vaccine (IPV) are important for the global polio eradication strategy to introduce IPV into the immunisation schedules of all countries. In the USA, IPV has been included in the routine immunisation schedule since 1997. We aimed to analyse adverse events after IPV administration reported to the US Vaccine Adverse Event Reporting System (VAERS).
METHODS: We analysed all VAERS data associated with IPV submitted between Jan 1, 2000, and Dec 31, 2012, either as individual or as combination vaccines, for all age and sex groups. We analysed the number and event type (non-serious, non-fatal serious, and death reports) of individual reports, and explored the most commonly coded event terms to describe the adverse event. We classified death reports according to previously published body-system categories (respiratory, cardiovascular, neurological, gastrointestinal, other infectious, and other non-infectious) and reviewed death reports to identify the cause of death. We classified sudden infant death syndrome as a separate cause of death considering previous concerns about sudden infant syndrome after vaccines. We used empirical Bayesian data mining methods to identify disproportionate reporting of adverse events for IPV compared with other vaccines. Additional VAERS data from 1991 to 2000 were analysed to compare the safety profiles of IPV and oral poliovirus vaccine (OPV).
FINDINGS: Of the 41â792 adverse event reports submitted, 39â568 (95%) were for children younger than 7 years. 38â381 of the reports for children in this age group (97%) were for simultaneous vaccination with IPV and other vaccines (most commonly pneumococcal and acellular pertussis vaccines), whereas standalone IPV vaccines accounted for 0·5% of all reports. 34â880 reports were for non-serious events (88%), 3905 reports were for non-fatal serious events (10%), and 783 reports were death reports (2%). Injection-site erythema was the most commonly coded term for non-serious events (29%), and pyrexia for non-fatal serious events (38%). Most deaths (96%) were in children aged 12 months or younger; most (52%) had sudden infant death syndrome as the reported cause of death. The safely profiles of combined IPV and whole-cell pertussis vaccines, OPV and whole-cell pertussis vaccines, and OPV and acellular pertussis vaccines were similar. We noted no indication of disproportionate reporting of adverse events after immunisation with IPV-containing vaccines compared with other vaccines between 1990 and 2013.
INTERPRETATION: Fairly few adverse events were reported for the more than 250 million IPV doses distributed between 2000 and 2012. Sudden infant death syndrome reports after IPV were consistent with reporting patterns for other vaccines. No new or unexpected vaccine safety problems were identified for fatal, non-fatal serious, and non-serious reports in this assessment of adverse events after IPV.
Conclusions:
Outcome of Research: Not applicable
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Category: 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: Activity Levels, Psychology,
Title: No reduction of severe fatigue in patients with postpolio syndrome by exercise therapy or cognitive behavioral therapy: results of an RCT
Author: Koopman FS (1), Voorn EL (1), Beelen A (1), Bleijenberg G (2), de Visser M (1), Brehm MA (1), Nollet F (1)
Affiliation: (1) University of Amsterdam, Amsterdam, The Netherlands; (2) Radboud University Medical Centre, Nijmegen, The Netherlands
Journal: Neurorehabilitation & Neural Repair
Citation: Neurorehabil Neural Repair. 2015 Aug 7. pii: 1545968315600271
Publication Year and Month: 2015 08
Abstract: BACKGROUND: People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL).
OBJECTIVES: To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS.
METHODS: We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months.
RESULTS: A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = -2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = -2.24 to 5.98, for CBT versus UC), activities, or HRQoL.
Conclusions: Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.
Outcome of Research: More research required
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Category: 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: Diagnosis and Management
Title: Unraveling the transmission ecology of polio
Author: Martinez-Bakker M (1), King AA (1,2), Rohani P (1,2)
Affiliation: (1) Department of Ecology & Evolutionary Biology, University of Michigan, Ann Arbor, Michigan, United States of America; (2) Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan, United States of America; Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
Journal: Public Library of Science
Citation: PLoS Biol. 2015 Jun;13(6): e1002172. doi:10.1371/journal.pbio.1002172
Publication Year and Month: 2015 06
Abstract: Sustained and coordinated vaccination efforts have brought polio eradication within reach. Anticipating the eradication of wild poliovirus (WPV) and the subsequent challenges in preventing its re-emergence, we look to the past to identify why polio rose to epidemic levels in the mid-20th century, and how WPV persisted over large geographic scales. We analyzed an extensive epidemiological dataset, spanning the 1930s to the 1950s and spatially replicated across each state in the United States, to glean insight into the drivers of polio’s historical expansion and the ecological mode of its persistence prior to vaccine introduction. We document a latitudinal gradient in polio’s seasonality. Additionally, we fitted and validated mechanistic transmission models to data from each US state independently. The fitted models revealed that: (1) polio persistence was the product of a dynamic mosaic of source and sink populations; (2) geographic heterogeneity of seasonal transmission conditions account for the latitudinal structure of polio epidemics; (3) contrary to the prevailing “disease of development” hypothesis, our analyses demonstrate that polio’s historical expansion was straightforwardly explained by demographic trends rather than improvements in sanitation and hygiene; and (4) the absence of clinical disease is not a reliable indicator of polio transmission, because widespread polio transmission was likely in the multiyear absence of clinical disease. As the world edges closer to global polio eradication and continues the strategic withdrawal of the Oral Polio Vaccine (OPV), the regular identification of, and rapid response to, these silent chains of transmission is of the utmost importance.
Conclusions:
Outcome of Research: Not applicable
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Category: Quality of Life
Title: Factors associated with reduced quality of life in polio survivors in Korea
Author: Yang EJ (1), Lee SY (2), Kim K (3), Jung SH (4), Jang S-N (5), Han SJ (6), Kim W-H (7), Lim J-Y (1)
Affiliation: (1) Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; (2) Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Gyeonggi, Republic of Korea; (3) Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea; (4) Department of Rehabilitation Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea; (5) Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea; (6) Department of Rehabilitation Medicine, Ewha Womans University Medical Center Seoul, Republic of Korea; (7) Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Republic of Korea; Xi'an Jiaotong University School of Medicine, China
Journal: Public Library of Science
Citation: PLoS One. 2015; 10(6): e0130448. doi: 10.1371/journal.pone.0130448
Publication Year and Month: 2015 06
Abstract: The purpose of this study is to assess health-related quality of life in polio survivors (PS) compared with that in the general population in Korea. Polio survivors (n = 120) from outpatient clinics at two hospitals, healthy controls (HC, n = 121) and members of the general population with activity limitations (AL, n = 121) recruited through a proportional-allocation, systematic sampling strategy from the Fourth Korean National Health and Nutrition Examination Survey were surveyed with self-rated health-related quality of life (Euro QoL five-dimensions). The proportion of participants who reported problems in mobility, usual activity, and symptoms of anxiety/depression were higher in the PS group compared with the HC and AL groups. There was no significant difference in the self-care dimension across the groups. Polio-specific questionnaire, pain, depression, fatigue, Modified Barthel Index (K-MBI) and Short Physical Performance Battery (SPPB) were assessed in the PS group. Those with post-poliomyelitis syndrome had greater problems in mobility, usual activity, and depression/anxiety. Polio survivors, especially those with more pain and fatigue symptoms, and those who did not have access to medical services had poorer health-related quality of life. These findings afford useful information for potential intervention improving quality of life in polio survivors.
Conclusions: In conclusion, the QoL of polio survivors is worse than that of the general population in terms of physical and functional status. Polio survivors experienced greater restriction in mobility and activity, greater pain, and greater depression/anxiety compared with controls, although there was no difference in the self-care domain. To improve the HRQoL of polio survivors, we need to provide better rehabilitation services.
Outcome of Research: Not applicable
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Category: Polio Immunisation
Title: New vaccine strategies to finish polio eradication
Author: Grassly NC
Affiliation: Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London W2 1PG, UK; Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
Journal: The Lancet Infectious Diseases
Citation: Lancet Infect Dis, Volume 15, Issue 8, 864-865
Publication Year and Month: 2015 06
Abstract: The Global Polio Eradication Initiative (GPEI) currently faces two specific challenges. First, all the cases in the past 9 months caused by ongoing wild-virus transmission were in Afghanistan and Pakistan—Africa has had a remarkable 9 months without detection of the disease. Second, circulating vaccine-derived polioviruses are continuing to cause poliomyelitis in a few countries, a rare outcome associated with continued use of the live-attenuated oral poliovirus vaccine (OPV). In The Lancet Infectious Diseases, the results of two clinical trials of OPV that address these challenges are reported by Fatima Mir and colleagues and Concepción Estívariz and colleagues.
Conclusions:
Outcome of Research: Not applicable
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Category: 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: 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: 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: Respiratory Complications and Management
Title: Sleep-disordered breathing in neuromuscular disease
Author: Aboussouan LS
Affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
Journal: American Journal of Respiratory and Critical Care Medicine
Citation: Am J Respir Crit Care Med. 2015 May 1;191(9):979-89. doi: 10.1164/rccm.201412-2224CI
Publication Year and Month: 2015 05
Abstract: Sleep-disordered breathing in neuromuscular diseases is due to an exaggerated reduction in lung volumes during supine sleep, a compromised physiologic adaptation to sleep, and specific features of the diseases that may promote upper airway collapse or heart failure. The normal decrease in the rib cage contribution to the tidal volume during phasic REM sleep becomes a critical vulnerability, resulting in saw-tooth oxygen desaturation possibly representing the earliest manifestation of respiratory muscle weakness. Hypoventilation can occur in REM sleep and progress into non-REM sleep, with continuous desaturation and hypercarbia. Specific characteristics of neuromuscular disorders, such as pharyngeal neuropathy or weakness, macroglossia, bulbar manifestations, or low lung volumes, predispose patients to the development of obstructive events. Central sleep-disordered breathing can occur with associated cardiomyopathy (e.g., dystrophies) or from instability in the control of breathing due to diaphragm weakness. Mitigating factors such as recruitment of accessory respiratory muscles, reduction in REM sleep, and loss of normal REM atonia in some individuals may partially protect against sleep-disordered breathing. Noninvasive ventilation, a standard-of-care management option for sleep-disordered breathing, can itself trigger specific sleep-disordered breathing events including air leaks, patient-ventilator asynchrony, central sleep apnea, and glottic closure. These events increase arousals, reduce adherence, and impair sleep architecture. Polysomnography plays an important role in addressing pitfalls in the diagnosis of sleep-disordered breathing in neuromuscular diseases, identifying sleep-disordered breathing triggered by noninvasive ventilation, and optimizing noninvasive ventilation settings.
Conclusions:
Outcome of Research: Effective.
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Category: Muscle Strength
Title: Men With Late Effects of Polio Decline More Than Women in Lower Limb Muscle Strength: A 4-Year Longitudinal Study
Author: Flansbjer UB (1), Brogårdh C (2), Horstmann V (3), Lexell J (4)
Affiliation: (1) 1Department of Health Sciences, Lund University, Rehabilitation Medicine Research Group, Box 157, SE221 00 Lund, Sweden; (2) Department of Health Sciences, Lund University, Physiotherapy Research Group, Box 157, SE221 00 Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden; (3) Department of Health Sciences, Lund University, Research Group Active and Healthy Ageing, Box 157, SE221 00 Lund, Sweden; (4) Department of Health Sciences, Lund University, Rehabilitation Medicine Research Group, Box 157, SE221 00 Lund, Sweden; Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2015 May 12. pii: S1934-1482(15)00233-6. doi: 10.1016/j.pmrj.2015.05.005
Publication Year and Month: 2015 05
Abstract: BACKGROUND: In persons with prior paralytic poliomyelitis, progressive muscle weakness can occur after a stable period of at least 15 years. Knowledge is limited about which factors influence changes in lower limb muscle strength in these persons.
OBJECTIVE: To assess changes in lower limb muscle strength annually over 4 years in persons with late effects of polio and to identify prognostic factors for changes in muscle strength.
DESIGN: A prospective, longitudinal study.
SETTING: University hospital outpatient program.
PARTICIPANTS: Fifty-two ambulant persons (mean age ± standard deviation: 64 ± 6 years) with verified late effects of polio.
METHODS: Mixed linear models were used to analyze changes in muscle strength and to identify determinants among the following covariates: gender, age, age at acute polio infection, time with late effects of polio, body mass index, and estimated baseline muscle weakness.
MAIN OUTCOME MEASUREMENTS: Knee extensor and flexor and ankle dorsiflexor muscle strength were measured annually with a Biodex dynamometer.
RESULTS: The men (n = 28) had significant linear change over time for all knee muscle strength measurements, from -1.4% (P < .05) per year for isokinetic knee flexion in the less-affected lower limb to -4.2% (P < .001) for isokinetic knee extension in the more-affected lower limb, and for 2 ankle dorsiflexor muscle strength measurements (-3.3%-1.4% per year [P < .05]). The women (n = 24) had a significant linear change over time only for ankle dorsiflexor measurements (4.0%-5.5% per year [P < .01]). Gender was the strongest factor that predicted a change in muscle strength over time.
Conclusions: Over 4 years, men had a greater decline in muscle strength than did women, but the rate of decline did not accelerate. This finding indicates that gender could be a contributing factor to the progressive decline in muscle strength in persons with late effects of polio.
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Repeater F-waves are signs of motor unit pathology in polio survivors
Author: Hachisuka A (1), Komori T, Abe T, Hachisuka K
Affiliation: (1) Department of Rehabilitation Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan
Journal: Muscle & Nerve
Citation: Muscle Nerve. 2015 May;51(5):680-5. doi: 10.1002/mus.24428
Publication Year and Month: 2015 05
Abstract: INTRODUCTION: The purpose of this study was to determine whether F-waves reveal electrophysiological features of anterior horn cells in polio survivors.
METHODS: Forty-three polio survivors and 20 healthy controls underwent motor nerve conduction studies of the median and tibial nerves bilaterally, including sampling of F-waves elicited by 100 stimuli and the determination of motor unit number estimation (MUNE).
RESULTS: A significant increase in abnormally stereotyped ("repeater") F-waves and a reduction of F-wave persistence were observed in both nerves in the polio group as compared with the control group. Repeater F-waves had a negative correlation with MUNE.
Conclusions: These trends in F-wave persistence and repeater F-waves after motor unit loss are characteristic findings in polio survivors. Repeater F-waves are a sign of motor unit pathology.
Outcome of Research: Not applicable
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Category: 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: 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.
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Category: Respiratory Complications and Management
Title: Feasibility of lung volume recruitment in early neuromuscular weakness: a comparison between amyotrophic lateral sclerosis, myotonic dystrophy, and postpolio syndrome
Author: Kaminska M (1,2), Browman F (3), Trojan DA (4), Genge A (4), Benedetti A (2,5), Petrof BJ (6,7)
Affiliation: (1) Respiratory Division, McGill University Health Centre, 1001 Decarie Blvd, D05.2504 Montreal, Quebec, Canada H4A 3J1; (2) Respiratory Epidemiology and Clinical Research Unit, McGill University, Montreal, Quebec, Canada; (3) Department of Respiratory Therapy, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada; (4) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada; (5) Departments of Medicine and Epidemiology, Biostatistics & Occupational Health, McGill University Health Centre, Montreal, Quebec, Canada; (6) Meakins-Christie Laboratories, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; (7) Respiratory Division, McGill University Health Centre, 1001 Decarie Blvd, D05.2506 Montreal, Quebec, Canada H4A 3J1
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2015 Apr;1-8
Publication Year and Month: 2015 04
Abstract: BACKGROUND: Lung volume recruitment (LVR) is a cough assistance technique used in persons with neuromuscular disorders (NMDs), most typically in those requiring noninvasive ventilation (NIV). Whether it may be useful in persons with NMDs who have milder respiratory impairment is unknown.
OBJECTIVE: To assess the feasibility, impact on quality of life (QOL), and preliminary physiological effects of daily LVR in different categories of persons with NMDs who have an early stage of respiratory impairment.
DESIGN: Feasibility study.
SETTING: Academic tertiary care center.
PARTICIPANTS: Outpatients diagnosed with amyotrophic lateral sclerosis (n = 8), postpolio syndrome (n = 10), and myotonic dystrophy (n = 6) who had restrictive respiratory defects but were not yet using NIV.
METHODS: Participants were asked to perform LVR up to 4 times daily and log their LVR use in a diary. Physiological measurements and questionnaires were completed at baseline and after 3 months.
MAIN OUTCOME MEASUREMENTS: Compliance with LVR use was assessed, along with QOL and willingness to continue the treatment. Physiological measurements included forced vital capacity (FVC), lung insufflation capacity (LIC), and the LIC minus FVC difference.
RESULTS: Of the 24 recruited subjects, 7 with amyotrophic lateral sclerosis, 7 with postpolio syndrome, and 5 with myotonic dystrophy completed the study (n = 19). At baseline, mean values for FVC and spontaneous peak cough flow were 59.9% predicted and 373.1 L/min, respectively. For subjects completing the study, 74% were willing to continue long-term LVR use, and QOL scores were not adversely affected by LVR in any NMD subgroup. The LIC-FVC difference increased from baseline to follow-up by a mean of 0.243 L (P = .006) in all subjects (n = 19), suggesting a possible improvement in respiratory system mechanics.
Conclusions: In patients with NMDs who have early restrictive respiratory defects but do not yet require NIV, regular use of LVR is feasible with no negative impact on QOL over a 3-month period and may have physiological benefits. Further work is needed to determine whether early institution of LVR can improve respiratory system mechanics and help delay ventilatory failure in persons with NMDs.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: 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: 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: Drugs
Title: Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis
Author: Huang Y-H (1), Chen H-C (2,3), Huang K-W (4,5,6), Chen P-C (1,7), Hu C-J (1,8), Tsai C-P (5,9), Tam K-W (2,10,11,12,13,14), Kuan Y-C (1,5,8,14)
Affiliation: (1) Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (2) Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (3) Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (4) Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan; (5) Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; (6) Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; (7) College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; (8) Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan; (9) Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; (10) Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (11) Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (12) Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan; (13) Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; (14) Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan
Journal: BioMed Central Neurology
Citation: BMC Neurology 2015, 15:39 doi:10.1186/s12883-015-0301-9
Publication Year and Month: 2015 03
Abstract: BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial.
METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels.
RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity.
Conclusions: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
Outcome of Research: More research required
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Category: 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: Activity Levels
Title: Change in physical mobility over 10 years in post-polio syndrome
Author: Bickerstaffe A (1), Beelen A (2), Nollet F (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands; (2) Department of Rehabilitation, Academic Medical Center (AMC), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Neuromuscular Disorders
Citation: Neuromuscul Disord. 2015 Mar;25(3):225-30. doi: 10.1016/j.nmd.2014.11.015
Publication Year and Month: 2015 03
Abstract: Post-polio syndrome is characterised by progressive muscle weakness and other symptoms which can limit physical mobility. We assessed the rate of decline in mobility over 10 years in relation to strength decline; and investigated potential predictors for the rate of decline of walking capacity, a measure of mobility, in 48 patients with post-polio syndrome and proven quadriceps dysfunction at baseline. Average walking capacity and self-reported physical mobility declined over 10 years, by 6 and 14%, respectively. Concomitantly people lost an average of 15% of isometric quadriceps strength. Significantly more people used walking aids offering greater support at follow-up. Notably, there was much individual variation, with 18% of participants losing a substantial amount of walking capacity (27% decline) and concomitant self-reported physical mobility (38% decline). Loss of quadriceps strength only explained a small proportion of the variance of the decline in walking capacity (R = 11%) and the rate of decline could not be predicted from baseline values for strength, walking capacity, self-reported physical mobility or basic demographics. The individual variability, yet lack of predictive factors, underscores the need for personally tailored care based on actual functional decline in patients with post-polio syndrome.
Conclusions: • The majority of post-polio patients experienced modest declines in physical mobility in 10 years.
• One-fifth of patients experienced substantial declines in walking capacity.
• The rate of decline in walking capacity could not be predicted from baseline quadriceps strength.
• These findings underscore the need for personally tailored care based on actual functional
decline.
Outcome of Research: Not applicable
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Category: Exercise
Title: Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs
Author: Orsini M (1), de Souza JA (2), Araújo Leite MA (2), Teixeira S (3), de Sá Ferreira A (4), Bastos VH (3), de Freitas MR (2), Oliveira AB (5)
Affiliation: (1) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; Neurology Service, Fluminense Federal University, Niterói, Brazil; (2) Neurology Service, Fluminense Federal University, Niterói, Brazil; (3) Physical Therapy Department, Federal University of Piauí, Brazil; (4) Rehabilitation Sciences, Augusto Motta University Center, UNISUAN, Bonsucesso, Brazil; (5) Neurology Service, Paulista School of Medicine, Federal University of São Paulo, Brazil
Journal: Neurology International
Citation: Neurol Int. 2015 Mar 9;7(1):5452. doi: 10.4081/ni.2015.5452. eCollection 2015
Publication Year and Month: 2015 03
Abstract: NO ABSTRACT AVAILABLE - THIS IS AN EXTRACT:
Previous acute poliomyelitis (PAP) can be defined as an endemic human disease caused by an enterovirus of worldwide distribution, which compromises the anterior horn cells of the spinal cord. Poliovirus has infected and victimized thousands of people all over the world. Only after the development of the inactivated virus vaccine by Jonas Salk, in 1955, and then with the attenuated virus vaccine, by Albert Bruce Sabin, in 1961, we saw a reduction in the number of poliomyelitis cases in the world.
The patients present clinical status characterized by muscle atrophy and paresis, especially in the lower limbs, under asymmetrical and disproportional form. There is a second form, bulbar, which compromises the motor neurons of the medulla, resulting in impairments in speech, swallowing and breathing. The purpose of this letter to the Editor is to alert readers about the risks of therapeutic exercise for this group of patients.
Conclusions:
Outcome of Research: Not applicable
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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: 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: Ageing
Title: Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging
Author: McNalley TE, Yorkston KM, Jensen MP, Truitt AR, Schomer KG, Baylor C, Molton IR.
Affiliation: From the Department of Rehabilitation Medicine, University of Washington, Seattle
Journal: American Journal of Physical Medicine & Rehabilitation
Citation: 2015 Feb;94(2):139-45.
Publication Year and Month: 2015 02
Abstract: OBJECTIVE:
This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging.
DESIGN:
A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables.
RESULTS:
The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS.
Conclusions: CONCLUSIONS:
Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
Outcome of Research: More research required
Comments (if any):
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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: Muscle Strength
Title: Quantitative muscle ultrasound and quadriceps strength in patients with post-polio syndrome
Author: Bickerstaffe A (1), Beelen A, Zwarts MJ, Nollet F, van Dijk JP
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, Postbus 22660, 1100 DD, Amsterdam, The Netherlands
Journal: Muscle & Nerve
Citation: Muscle Nerve. 2015 Jan;51(1):24-9. doi: 10.1002/mus.24272
Publication Year and Month: 2015 01
Abstract: INTRODUCTION: We investigated whether muscle ultrasound can distinguish muscles affected by post-polio syndrome (PPS) from healthy muscles and whether severity of ultrasound abnormalities is associated with muscle strength.
METHODS: Echo intensity, muscle thickness, and isometric strength of the quadriceps muscles were measured in 48 patients with PPS and 12 healthy controls.
RESULTS: Patients with PPS had significantly higher echo intensity and lower muscle thickness than healthy controls. In patients, both echo intensity and muscle thickness were associated independently with muscle strength. A combined measure of echo intensity and muscle thickness was more strongly related to muscle strength than either parameter alone.
Conclusions: Quantitative ultrasound distinguishes healthy muscles from those affected by PPS, and measures of muscle quality and quantity are associated with muscle strength. Hence, ultrasound could be a useful tool for assessing disease severity and monitoring changes resulting from disease progression or clinical intervention in patients with PPS.
Outcome of Research: Effective
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Category: Diagnosis and Management
Title: Physiotherapy for poliomyelitis: a descriptive study in the Republic of Congo
Author: Mancini S, Coldiron ME, Nicholas S, Llosa AE, Mouniaman-Nara I, Ngala J, Grais RF, Porten K
Affiliation: Epicentre, Paris, France - [email protected].
Journal: BioMedCentral Research Notes
Citation: BMC Res Notes. 2014 Oct 23;7:755. doi: 10.1186/1756-0500-7-755
Publication Year and Month: 2014 10
Abstract: BACKGROUND: A large poliomyelitis outbreak occurred in 2010 in the Republic of Congo. This paper describes the demographic and clinical characteristics of poliomyelitis cases and their outcomes following physiotherapy.
FINDINGS: Demographic and clinical data were collected on 126 individuals between November 23, 2010 and March 23, 2011. The male/female ratio was 2.5 and the median age was 19 years (IQR: 13.5-23). The most severe forms of the disease were more common in older patients, 81 of the 126 patients (64.3%) had multiple evaluations of muscle strength. Among patients with multiple evaluations, 38.1% had improved strength at final evaluation, 48.3% were stable and 13.6% had decreased strength.
Conclusions: Most acute poliomyelitis patients receiving physiotherapy had improved or stable muscle strength at their final evaluation. These descriptive results highlight the need for further research into the potential benefits of physiotherapy in polio affected patients.
Outcome of Research: More research required.
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Category: 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: 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: 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: Vocational Implications
Title: Occupations that people with late effects of polio perceive difficult to perform
Author: Appelin K, Lexell J, Månsson Lexell E
Affiliation: Department of Rehabilitation Medicine, Skåne University Hospital, Sweden
Journal: Occupational Therapy International
Citation: Occupational Therapy International - Occup Ther Int. 2014 Sep;21(3):98-107. doi: 10.1002/oti.1368
Publication Year and Month: 2014 09
Abstract: The aims of this study were to describe which occupations that people with late effects of polio perceive difficult to perform, which occupational area the occupations were related to and their level of complexity. The aims were also to describe their own perception of the importance, performance and satisfaction with these occupations. Sixty-two participants (mean age 61 years) were assessed with the Canadian Occupational Performance Measure. A total of 431 occupations were reported (43% self-care, 32% productivity and 25% leisure). Two subcategories, household management (27 %) and functional mobility (23 %), represented half of all the reported occupations. Ratings for prioritized occupations (N = 300) were high for importance and generally low for performance and satisfaction. A wide variety of occupations were reported, related to both occupational areas and different levels of complexity within an occupational area. The results underscore the importance of using assessment tools that can capture both the variety and complexity of occupations. By obtaining more detailed information about occupations that people with late effects of polio perceive difficult to perform, this will enable occupational therapists to offer targeted interventions that can facilitate engagement in meaningful and purposeful occupations. A larger and more heterogeneous sample may enable the results to be generalized to more people with late effects of polio. Future studies should focus on methods that can facilitate engagement in meaningful and purposeful occupations for people with late effects of polio.
Conclusions:
Outcome of Research: Not applicable
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Category: Post-Polio Motor Unit
Title: Motor unit number estimation: A technology and literature review
Author: Clifton L. Gooch MD (1); Timothy J. Doherty MD, PhD (2); K. Ming Chan MD (3); Mark B. Bromberg MD, PhD (4); Richard A. Lewis MD (5); Dan W. Stashuk PhD (6); Michael J. Berger MD, PhD (7); Michael T. Andary MD (8); Jasper R. Daube MD (9)
Affiliation: (1) Department of Neurology, University of South Florida, Tampa, Florida, USA
(2) Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
(3) Division of Physical Medicine and Rehabilitation/Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
(4) Department of Neurology, University of Utah, Salt Lake City, Utah, USA
(5) Department of Neurology, CedarsâSinai, Los Angeles, California, USA
(6) Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
(7) School of Kinesiology, University of Western Ontario, London, Ontario, Canada
Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
(8) College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
(9) Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
Journal: Muscle & Nerve
Citation: 50: 884–893, 2014; https://doi.org/10.1002/mus.24442
Publication Year and Month: 2014 09
Abstract: Introduction: Numerous methods for motor unit number estimation (MUNE) have been developed. The objective of this article is to summarize and compare the major methods and the available data regarding their reproducibility, validity, application, refinement, and utility.
Methods: Using specified search criteria, a systematic review of the literature was performed. Reproducibility, normative data, application to specific diseases and conditions, technical refinements, and practicality were compiled into a comprehensive database and analyzed.
Results: The most commonly reported MUNE methods are the incremental, multipleâpoint stimulation, spikeâtriggered averaging, and statistical methods. All have established normative data sets and high reproducibility. MUNE provides quantitative assessments of motor neuron loss and has been applied successfully to the study of many clinical conditions, including amyotrophic lateral sclerosis and normal aging.
Conclusions: MUNE is an important research technique in human subjects, providing important data regarding motor unit populations and motor unit loss over time.
Conclusions: MUNE is an important research technique in human subjects, providing important data regarding motor unit populations and motor unit loss over time.
Outcome of Research: More research required
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Category: 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: Muscle Strength
Title: Reliability of contractile properties of the knee extensor muscles in individuals with post-polio syndrome.
Author: Voorn EL (1,2), Brehm MA (1), Beelen A (1), de Haan A (2), Nollet F (1), Gerrits KH (2)
Affiliation: (1) Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; (2) MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, The Netherlands
Journal: Public Library of Science (PLoS One)
Citation: PLoS One. 2014 Jul 14;9(7):e101660. doi: 10.1371/journal.pone.0101660.
Publication Year and Month: 2014 07
Abstract: OBJECTIVE: To assess the reliability of contractile properties of the knee extensor muscles in 23 individuals with post-polio syndrome (PPS) and 18 age-matched healthy individuals.
METHODS: Contractile properties of the knee extensors were assessed from repeated electrically evoked contractions on 2 separate days, with the use of a fixed dynamometer. Reliability was determined for fatigue resistance, rate of torque development (MRTD), and early and late relaxation time (RT50 and RT25), using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM, expressed as % of the mean).
RESULTS: In both groups, reliability for fatigue resistance was good, with high ICCs (>0.90) and small SEM values (PPS: 7.1%, healthy individuals: 7.0%). Reliability for contractile speed indices varied, with the best values found for RT50 (ICCs>0.82, SEM values <2.8%). We found no systematic differences between test and retest occasions, except for RT50 in healthy subjects (pâ=â0.016).
SIGNIFICANCE: This was the first study to examine the reliability of electrically evoked contractile properties in individuals with PPS. Our results demonstrate its potential to study mechanisms underlying muscle fatigue in PPS and to evaluate changes in contractile properties over time in response to interventions or from natural course.
Conclusions: Both in individuals with PPS and in healthy individuals, the reliability of fatigue resistance, as obtained from electrically evoked contractions of the knee extensor muscles is high. The reliability of contractile speed indices is only moderate, except for RT50 in PPS, demonstrating high reliability. Considering these results, the assessment of contractile properties in PPS is sufficiently reliable to identify those patients with impaired contractile functioning of their knee extensor muscles, and, accordingly, to evaluate changes over time or following interventions in this patient group. Based on its potential in PPS, future research may also focus on the feasibility of this method in other slowly progressive neuromuscular diseases where muscle fatigue is a major problem.
Outcome of Research: Effective
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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: 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: Drugs
Title: Immunoglobulin g for the treatment of chronic pain: report of an expert workshop
Author: Tamburin S (1), Borg K, Caro XJ, Jann S, Clark AJ, Magrinelli F, Sobue G, Werhagen L, Zanette G, Koike H, Späth PJ, Vincent A, Goebel A
Affiliation: (1) Department of Neurological and Movement Sciences, University of Verona, Verona, Verona, Italy
Journal: Pain Medicine
Citation: Pain Med. 2014 Jul;15(7):1072-82. doi: 10.1111/pme.12319
Publication Year and Month: 2014 07
Abstract: BACKGROUND: The treatment of chronic pain is still unsatisfactory. Despite the availability of different drugs, most patients with chronic pain do not receive satisfactory pain relief or report side effects. Converging evidence implicates involvement of the immune system in the pathogenesis of different types of nociceptive and neuropathic chronic pain.
DESIGN: At a workshop in Liverpool, UK (October 2012), experts presented evidence suggesting immunological involvement in chronic pain and recent data supporting the concept that the established immune-modulating drug, polyvalent immunoglobulin G (IgG), either given intravenously (IVIg) or subcutaneously (SCIg), may reduce pain in some peripheral neuropathies and a range of other pain disorders. Workshop's attendees discussed the practicalities of using IVIg and SCIg in these disorders, including indications, cost-effectiveness, and side effects.
RESULTS: IgG may reduce pain in a range of nociceptive and neuropathic chronic pain conditions, including diabetes mellitus, Sjögren's syndrome, fibromyalgia, complex regional pain syndrome, post-polio syndrome, and pain secondary to pathological autoantibodies.
Conclusions: IgG is a promising treatment in several chronic pain conditions. IgG is a relatively safe therapeutic strategy, with uncommon and mild side effects but high costs. Randomized, controlled trials and predictive tests are needed to better support the use of IgG for refractory chronic pain.
Outcome of Research: More research required
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Category: 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: 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: Immune Response
Title: Normal serum levels of immune complexes in postpolio patients
Author: Melin E (1), Sohrabian A (2), Rönnelid J (2), Borg K (1)
Affiliation: (1) Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; (2) Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
Journal: Results in Immunology
Citation: Results in Immunology. 2014; 4: 54–57. doi: 10.1016/j.rinim.2014.06.001
Publication Year and Month: 2014 06
Abstract: OBJECTIVE: The pathophysiology of the postpolio syndrome is not fully understood. Increased cytokine levels in cerebrospinal fluid and peripheral blood indicate a systemic inflammatory process. Decreased cytokine levels and the clinical effect of intravenous immunoglobulin treatment further indicate an inflammatory/immunological pathogenesis. The aim of the present study was to evaluate whether an autoimmune process follows the initial infection, by means of analyzing immune complexes.
PATIENTS AND METHODS: Circulating immune complexes were analyzed from blood samples of 20 postpolio patients and 95 healthy controls. To compensate for differences in age between patients and controls, a sub-analysis was performed using only the 30 oldest controls. Tumor necrosis factor-inducing properties of polyethylene glycol-precipitated immune complexes were compared between the postpolio patients and 10 healthy controls.
RESULTS: When comparing levels in postpolio patients to the whole control group, including the 30 oldest investigated, there were no statistically significant differences. No difference was found in tumor necrosis factor levels induced by immune complexes when comparing patients and controls.
Conclusions: There was no increase in circulating immune complex or in tumor necrosis factor-inducing effects of circulating immune complex between postpolio patients and healthy controls, indicating that the postpolio syndrome is not due to an autoimmune reaction.
Outcome of Research: More research required.
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Category: Quality of Life
Title: Quality of life in Swedish patients with post-polio syndrome with a focus on age and sex
Author: Jung TD (1), Broman L, Stibrant-Sunnerhagen K, Gonzalez H, Borg K
Affiliation: (1) Department of Clinical Sciences, Division of Rehabilitation Medicine, Karolinska Institutet, Danderyds Hospital, Stockholm; Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden; Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, South Korea
Journal: International Journal of Rehabilitation Research
Citation: Int J Rehabil Res. 2014 Jun;37(2):173-9. doi: 10.1097/MRR.0000000000000052
Publication Year and Month: 2014 06
Abstract: To investigate the health-related quality of life (QOL) in Swedish patients with post-polio syndrome (PPS), with a focus on sex and age. A total of 364 patients were recruited from five Swedish post-polio clinics. Analysis was carried out using SF-36 and data were compared with those of a normal population. QOL was significantly lower in PPS patients for all eight subdomains and the two main scores (physical compound score and mental compound score) when compared with the controls. Male patients had a significantly higher QOL than female patients for all subdomains and also for mental compound score and physical compound score, a phenomenon also observed in the normal population. There was a decrease in QOL in the physical domains and an increase in vitality with age. PPS decreases health-related QOL in both sexes, more in female patients. QOL for physical domains decreases whereas vitality increases with age in both sexes.
Conclusions:
Outcome of Research: Effective
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Category: Post-Polio Motor Unit
Title: 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: Restless Legs Syndrome
Title: Restless legs syndrome in patients with sequelae of poliomyelitis
Author: Kumru H (1), Portell E (2), Barrio M (2), Santamaria J (3)
Affiliation: (1) Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain; Univ Autonoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain; (2) Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 08916 Badalona, Barcelona, Spain; Univ Autonoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain; (3) Hospital Clinic, Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
Journal: Parkinsonism & Related Disorders
Citation: Parkinsonism Relat Disord. 2014 Oct;20(10):1056-8. doi: 10.1016/j.parkreldis.2014.06.014
Publication Year and Month: 2014 06
Abstract: BACKGROUND: No studies have examined the association between RLS and the sequelae of poliomyelitis (PM). We studied the frequency and severity of RLS in a group of consecutive patients with the sequelae of poliomyelitis (PM) and the effect of treatment with dopaminergic drugs.
METHODS: A diagnosis of RLS was made according to the criteria of the International RLS Study Group, and severity was assessed by the RLS rating scale. Information on sex, age, age at onset, site affected by PM, disease duration of PM, and history of post-polio syndrome (pPS) was obtained in a cohort of 52 PM patients.
RESULT: The mean age was 55.9 ± 6.5 years; 39 patients had post-polio syndrome (75%). RLS was diagnosed in 21 (40.4%) patients. Sixteen of the 21 patients (76.2%) with RLS had pPS, which was similar to the non-RLS group (74.2% patients with pPS). RLS symptoms were very severe in 5 patients, severe in 13, moderate in 2 and mild in 1. Nineteen of the 21 patients with RLS had symptoms predominantly in the more affected lower limb (90% of patients). Sixteen patients received dopaminergic agonist treatment with a significant reduction in their scores on the RLS severity scale from 28.3 ± 4.7 to 6.9 ± 7.3 (p < 0.001).
DISCUSSION: RLS occurs frequently in patients with PM, both in those with and without pPS, and responds well to treatment with dopaminergic drugs.
Conclusions:
Outcome of Research: Effective
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Category: Exercise
Title: 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: Exercise
Title: Assessment of subjective and motor fatigue in Polio survivors, attending a Postpolio clinic, comparison with healthy controls and an exploration of clinical correlates.
Author: Murray D, Hardiman O, Meldrum D.
Affiliation: Department of Physiotherapy, Beaumont Hospital , Beaumont, Dublin , Ireland .
Journal: Physiotherapy Theory and Practice
Citation: 2014 May;30(4):229-35.
Publication Year and Month: 2014 05
Abstract: PURPOSE:
Polio survivors experience declining mobility, pain and fatigue. The extent of motor fatigue and its impact on mobility and quality of life, in addition to other commonly reported impairments requires evaluation.
METHODS:
An observational, case-control, cross-sectional design was used to assess 30 Polio survivors and 30 age- and sex-matched controls. Muscle strength and motor fatigue were assessed using fixed dynamometry. Fatigue, pain and quality of life were assessed using the Piper Fatigue Scale, the Fatigue Severity Scale, visual analogue scales and the RAND Short Form-36, respectively. An 8-min walking test, including physiological cost index (PCI), evaluated mobility.
RESULTS:
A significant difference in motor fatigue was identified only in hand grip (p = 0.03). Polio survivors were significantly weaker (p < 0.001) and more fatigued (p < 0.001) than controls. Motor fatigue was not related to subjective fatigue, mobility or quality of life. Muscle strength predicted mobility. Pain and fatigue were associated with lower mental quality of life, while PCI was associated with physical quality of life.
Conclusions: Motor fatigue has been identified in Polio survivors but was only significantly different in hand grip, using this approach. Pain, fatigue and elevated energy cost of walking negatively influenced quality of life. Motor fatigue was unrelated to subjective fatigue, mobility or quality of life.
Outcome of Research: More research required
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Category: Quality of Life
Title: Surviving polio in a post-polio world
Author: Groce NE (1), Banks LM (2), Stein MA (3)
Affiliation: (1) Leonard Cheshire Disability and Inclusive Development Centre, University College London, London, UK; (2) London School of Hygiene and Tropical Medicine, London, UK; (3) Harvard Law School Project on Disability, Harvard Law School, Cambridge, USA
Journal: Social Science & Medicine
Citation: Social Science & Medicine. 2014 Apr;107;171-178
Publication Year and Month: 2014 04
Abstract: Excitement mounts as the global health and international development communities anticipate a polio-free world. Despite substantial political and logistical hurdles, only 223 cases of wild poliovirus in three countries were reported in 2012. Down 99% from the estimated 350,000 annual cases in 125 countries in 1988—this decline signals the imminent global eradication of polio.
However, elimination of new polio cases should not also signal an end to worldwide engagement with polio. As many as 20 million continue to live with the disabling consequences of the disease. In developed countries where polio immunization became universal after dissemination of the polio vaccine in the 1950s, almost all individuals who have had polio are now above age 50. But in many developing countries where polio vaccination campaigns reached large segments of the population only after 1988, millions disabled by polio are still children or young adults. Demographically, this group is also different. After three decades of immunization efforts, those children unvaccinated in the late 1980s were more likely to be from poorer rural and slum communities and to be girls—groups not only harder to reach than more affluent members of the population but also individuals who, if they contract polio, are less likely to have access to medical and rehabilitation programs or education, job training, employment and social support services.
The commitment to eradicate polio should not be considered complete while those living with the disabling sequelae of polio continue to live in poor health, poverty and social isolation. This paper reviews what is currently known about disabled survivors of polio and highlights areas of need in public health research, policy and programming. Based on a literature review, discussion and field observations, we identify continuing challenges posed by polio and argue that the attention, funding and commitment now being directed towards eradication be shifted to provide for the rehabilitative, medical, educational and social needs of those for whom the disabling sequelae of polio will remain a daily challenge for decades to come.
Conclusions:
Outcome of Research: Not applicable
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Category: Fatigue
Title: Brain volume and fatigue in patients with postpoliomyelitis syndrome
Author: Trojan DA (1), Narayanan S (2), Francis SJ (3), Caramanos Z (4), Robinson A (5), Cardoso M (6), Arnold DL (7)
Affiliation: (1) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, 3801 University Street, Montreal, Quebec, Canada H3A 2B4; (2) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (3) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (4) Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (5) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada; (6) Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada; (7) Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Journal: PM&R: The Journal of Injury, Function, and Rehabilitation
Citation: PM R. 2014 Mar;6(3):215-20. doi: 10.1016/j.pmrj.2013.09.009
Publication Year and Month: 2014 03
Abstract: BACKGROUND: Acute paralytic poliomyelitis is associated with encephalitis. Early brain inflammation may produce permanent neuronal injury with brain atrophy, which may result in symptoms such as fatigue. Brain volume has not been assessed in postpoliomyelitis syndrome (PPS).
OBJECTIVE: To determine whether brain volume is decreased compared with that in normal controls, and whether brain volume is associated with fatigue in patients with PPS.
DESIGN: A cross-sectional study.
SETTING: Tertiary university-affiliated hospital postpolio and multiple sclerosis (MS) clinics.
PARTICIPANTS: Forty-nine ambulatory patients with PPS, 28 normal controls, and 53 ambulatory patients with MS.
METHODS: We studied the brains of all study subjects with magnetic resonance imaging by using a 1.5 T Siemens Sonata machine. The subjects completed the Fatigue Severity Scale. Multivariable linear regression models were computed to evaluate the contribution of PPS and MS compared with controls to explain brain volume.
MAIN OUTCOME MEASUREMENTS: Normalized brain volume (NBV) was assessed with the automated program Structured Image Evaluation, using Normalization, of Atrophy method from the acquired magnetic resonance images. This method may miss brainstem atrophy.
RESULTS: Technically adequate NBV measurements were available for 42 patients with PPS, 27 controls, and 49 patients with MS. The mean (standard deviation) age was 60.9 ± 7.6 years for patients with PPS, 47.0 ± 14.6 years for controls, and 46.2 ± 9.4 years for patients with MS. In a multivariable model adjusted for age and gender, NBV was not significantly different in patients with PPS compared with that in controls (P = .28). As expected, when using a similar model for patients with MS, NBV was significantly decreased compared with that in controls (P = .006). There was no significant association between NBV and fatigue in subjects with PPS (Spearman ρ = 0.23; P = .19).
Conclusions: No significant whole-brain atrophy was found, and no association of brain volume with fatigue in PPS. Brain atrophy was confirmed in MS. It is possible that brainstem atrophy was not recognized by this study.
Outcome of Research: Not effective
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Category: 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: 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: Assistive Technology, Orthoses
Title: Wearable monitoring devices for assistive technology: case studies in post-polio syndrome
Author: Andreoni G (1), Mazzola M (1), Perego P (1), Standoli CE (1), Manzoni S (1), Piccini L (2), Molteni F (3)
Affiliation: (1) Design Department, Politecnico di Milano, via G. Durando 38/A, Milan 20158, Italy; (2) 6SXT-Sistemi per Telemedicina s.r.l., via M. D'Oggiono 18/A, Lecco 23900, Italy; (3) Villa Beretta Rehabilitation Center, Valduce Hospital, Via N.Sauro, 17 - 23845 Costa Masnaga (LC), Italy
Journal: Sensors
Citation: Sensors (Basel). 2014 Jan 24;14(2):2012-27. doi: 10.3390/s140202012
Publication Year and Month: 2014 01
Abstract: The correct choice and customization of an orthosis are crucial to obtain the best comfort and efficiency. This study explored the feasibility of a multivariate quantitative assessment of the functional efficiency of lower limb orthosis through a novel wearable system. Gait basographic parameters and energetic indexes were analysed during a Six-Minute Walking Test (6-MWT) through a cost-effective, non-invasive polygraph device, with a multichannel wireless transmission, that carried out electro-cardiograph (ECG); impedance-cardiograph (ICG); and lower-limb accelerations detection. Four subjects affected by Post-Polio Syndrome (PPS) were recruited. The wearable device and the semi-automatic post-processing software provided a novel set of objective data to assess the overall efficiency of the patient-orthosis system. Despite the small number of examined subjects, the results obtained with this new approach encourage the application of the method thus enlarging the dataset to validate this promising protocol and measuring system in supporting clinical decisions and out of a laboratory environment.
Conclusions:
Outcome of Research: More research required
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Category: 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, ĹiĹli 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: Polio Immunisation
Title: Next generation inactivated polio vaccine manufacturing to support post polio-eradication biosafety goals
Author: Thomassen YE (1), van 't Oever AG (1), van Oijen MG (1), Wijffels RH (2), van der Pol LA (1), Bakker WA (1)
Affiliation: (1) Institute for Translational Vaccinology (Intravacc), Bilthoven, The Netherlands; (2) Bioprocess Engineering, Wageningen University, Wageningen, The Netherlands
Journal: Public Library of Science
Citation: PLoS One. 2013 Dec 12;8(12):e83374. doi: 10.1371/journal.pone.0083374
Publication Year and Month: 2013 12
Abstract: Worldwide efforts to eradicate polio caused a tipping point in polio vaccination strategies. A switch from the oral polio vaccine, which can cause circulating and virulent vaccine derived polioviruses, to inactivated polio vaccines (IPV) is scheduled. Moreover, a manufacturing process, using attenuated virus strains instead of wild-type polioviruses, is demanded to enhance worldwide production of IPV, especially in low- and middle income countries. Therefore, development of an IPV from attenuated (Sabin) poliovirus strains (sIPV) was pursued. Starting from the current IPV production process based on wild type Salk strains, adaptations, such as lower virus cultivation temperature, were implemented. sIPV was produced at industrial scale followed by formulation of both plain and aluminium adjuvanted sIPV. The final products met the quality criteria, were immunogenic in rats, showed no toxicity in rabbits and could be released for testing in the clinic. Concluding, sIPV was developed to manufacturing scale. The technology can be transferred worldwide to support post polio-eradication biosafety goals.
Conclusions:
Outcome of Research: Effective
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Category: 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: 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: Quality of Life
Title: Multiple Chronic Medical Conditions and Health-Related Quality of Life in Older Adults, 2004–2006
Author: John P. Barile, PhD,corresponding author William W. Thompson, PhD, Matthew M. Zack, MD, Gloria L. Krahn, PhD, MPH, Willi Horner-Johnson, PhD, and Sonya E. Bowen, MSW
Affiliation: William W. Thompson, Matthew M. Zack, Gloria L. Krahn, Centers for Disease Control and Prevention, Atlanta, Georgia; Willi Horner-Johnson, Oregon Health and Science University, Portland, Oregon; Sonya E. Bowen, Centers for Medicare and Medicaid Services, Baltimore, Maryland.
Corresponding Author: John P. Barile, PhD, University of Hawai‘i at MÄnoa, 2530 Dole St, Sakamaki Hall, C404, Honolulu, HI 96822. Telephone: 808-956-6271. E-mail: ude.iiawaH@eliraB.
Journal: Preventing Chronic Disease
Citation: Published online 2013 Sep 26. doi: 10.5888/pcd10.120282
Publication Year and Month: 2013 09
Abstract: Introduction
Understanding longitudinal relationships among multiple chronic conditions, limitations in activities of daily living, and health-related quality of life is important for identifying potential opportunities for health promotion and disease prevention among older adults.
Methods
This study assessed longitudinal associations between multiple chronic conditions and limitations in activities of daily living on health-related quality of life among older adults (≥65 years) from 2004 through 2006, using data from the Medicare Health Outcomes Survey (N = 27,334).
Results
Using a longitudinal path model, we found the numbers of chronic conditions at baseline and 2-year follow-up were independently associated with more limitations in activities of daily living at 2-year follow-up. In addition, more limitations in activities of daily living at 2-year follow-up were associated with worse health-related quality of life during the follow-up time period. The association between multiple chronic conditions and indices of health-related quality of life was mediated by changes in limitations in activities of daily living.
Conclusions: Both baseline and new multiple chronic conditions led to worse health in terms of activities of daily living and health-related quality of life and should be considered important outcomes to intervene on for improved long-term health. In addition, public health practitioners should consider addressing classes of multiple chronic conditions by using interventions designed to reduce the emergence of multiple chronic conditions, such as physical activity, reductions in smoking rates, and improved and coordinated access to health care services.
Outcome of Research: More research required
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Category: Respiratory Complications and Management
Title: 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: Acute Flaccid Paralysis
Title: Potential for the Australian and New Zealand paediatric intensive care registry to enhance acute flaccid paralysis surveillance in Australia: a data-linkage study
Author: Hobday LK (1), Thorley BR (1), Alexander J (2), Aitken T (1), Massey PD (3,4), Cretikos M (5,6), Slater A (2,7), Durrheim DN (3,8)
Affiliation: (1) National Enterovirus Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, North Melbourne, Victoria, Australia; (2) Australian and New Zealand Intensive Care Society, Herston, Queensland, Australia; (3) Hunter New England Population Health, Wallsend, NSW, Australia; (4) School of Health, University of New England, Armidale, NSW, Australia; (5) School of Public Health, University of Sydney, Darlington, NSW, Australia; (6) Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia; (7) Paediatric Intensive Care Unit, Royal Children’s Hospital, Herston, Queensland, Australia; (8) Hunter Medical Research Institute, New Lambton, NSW, Australia
Journal: BioMed Central Infectious Diseases
Citation: BMC Infect Dis. 2013 Aug 21;13:384. doi: 10.1186/1471-2334-13-384.
Publication Year and Month: 2013 08
Abstract: BACKGROUND: Australia uses acute flaccid paralysis (AFP) surveillance to monitor its polio-free status. The World Health Organization criterion for a sensitive AFP surveillance system is the annual detection of at least one non-polio AFP case per 100,000 children aged less than 15 years, a target Australia has not consistently achieved. Children exhibiting AFP are likely to be hospitalised and may be admitted to an intensive care unit. This provides a potential opportunity for active AFP surveillance.
METHODS: A data-linkage study for the period from 1 January 2005 to 31 December 2008 compared 165 non-polio AFP cases classified by the Polio Expert Panel with 880 acute neurological presentations potentially compatible with AFP documented in the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry.
RESULTS: Forty-two (25%) AFP cases classified by the Polio Expert Panel were matched to case records in the ANZPIC Registry. Of these, nineteen (45%) cases were classified as Guillain-Barré syndrome on both registries. Ten additional Guillain-Barré syndrome cases recorded in the ANZPIC Registry were not notified to the national AFP surveillance system.
Conclusions: The identification of a further ten AFP cases supports inclusion of intensive care units in national AFP surveillance, particularly specialist paediatric intensive care units, to identify AFP cases that may not otherwise be reported to the national surveillance system.
Outcome of Research: Not applicable
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Category: Late Effects of Polio
Title: Living with polio and postpolio syndrome in the United Kingdom
Author: Atwal A (1), Giles A, Spiliotopoulou G, Plastow N, Wilson L
Affiliation: (1) School of Health Science and Social Care, Brunel University, Kingston Lane, Uxbridge, Middlesex, London, UK - [email protected]
Journal: Scandinavian Journal of Caring Sciences
Citation: Scand J Caring Sci. 2013 Jun;27(2):238-45. doi: 10.1111/j.1471-6712.2012.01029.x
Publication Year and Month: 2013 06
Abstract: The term Postpolio Syndrome (PPS) is used to describe new and late manifestations of poliomyelitis that occur later in life in polio survivors. Polio had been eradicated in the United Kingdom (UK) and most of Europe, although this is not the case in all countries. Research in this area has tended to focus upon the impact of polio and PPS on health status and functional health rather than its overall effect on people's lives. This study's two main aims were to explore the ways in which polio and PPS in the UK has affected the respondents' lives and to ascertain their views about how the quality of life could be improved. The two questions were as follows: (1) How has the health of people with polio and PPS affected their quality of life? (2) What would people with polio and PPS change to improve their quality of life? Deductive content analysis using existing qualitative data from a cross-sectional survey of 336 returned questionnaires from persons with polio and PPS was carried out. The average age of the participants was 54 years. Our research found that polio survivors valued social occupations and participation in family life. Our research has also shown that healthcare professionals still do not understand polio and PPS and this lack of understanding influences their clients' quality of life. Finances and accessibility of environments also influence participation in chosen occupations. Rehabilitation programmes for people with polio and PPS need to be targeted towards maintaining and improving accessible environments and participation in chosen occupations, and healthcare professionals need to ensure that persons with polio and PPS are referred to persons with specific expertise in this area.
Conclusions:
Outcome of Research: Not applicable
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Category: 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: Pain
Title: Activity pacing in chronic pain: concepts, evidence, and future directions
Author: Nielson WR, Jensen MP, Karsdorp PA, Vlaeyen JW.
Affiliation: St Joseph's Health Care London, Lawson Research Institute, London, ON, Canada. [email protected]
Journal: The Clinical Journal of Pain
Citation: 2013 May;29(5):461-8. doi: 10.1097/AJP.0b013e3182608561
Publication Year and Month: 2013 05
Abstract: BACKGROUND:
Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects.
OBJECTIVE:
To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research.
METHODS:
A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion.
RESULTS:
The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain.
Conclusions: DISCUSSION:
Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.
Outcome of Research: More research required
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Category: Polio Immunisation
Title: Expert Review on Poliovirus Immunity and Transmission
Author: Radboud J. Duintjer Tebbens Mark A. Pallansch Konstantin M. Chumakov Neal A. Halsey Tapani Hovi Philip D. Minor John F. Modlin Peter A. Patriarca Roland W. Sutter Peter F. Wright Steven G. F. Wassilak Stephen L. Cochi JongâHoon Kim Kimberly M. Thompson
Affiliation: Kid Risk, Inc., P.O. Box 590129 Newton, MA, USA
Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, MD, USA
Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
National Institute for Health and Welfare (THL), Helsinki, Finland
Journal: Risk Analysis
Citation: Volume33, Issue4 April 2013 Pages 544-605
Publication Year and Month: 2013 04
Abstract: Successfully managing risks to achieve wild polioviruses (WPVs) eradication and address the complexities of oral poliovirus vaccine (OPV) cessation to stop all cases of paralytic poliomyelitis depends strongly on our collective understanding of poliovirus immunity and transmission. With increased shifting from OPV to inactivated poliovirus vaccine (IPV), numerous risk management choices motivate the need to understand the tradeoffs and uncertainties and to develop models to help inform decisions. The U.S. Centers for Disease Control and Prevention hosted a meeting of international experts in April 2010 to review the available literature relevant to poliovirus immunity and transmission. This expert review evaluates 66 OPV challenge studies and other evidence to support the development of quantitative models of poliovirus transmission and potential outbreaks. This review focuses on characterization of immunity as a function of exposure history in terms of susceptibility to excretion, duration of excretion, and concentration of excreted virus. We also discuss the evidence of waning of host immunity to poliovirus transmission, the relationship between the concentration of poliovirus excreted and infectiousness, the importance of different transmission routes, and the differences in transmissibility between OPV and WPV. We discuss the limitations of the available evidence for use in polio risk models, and conclude that despite the relatively large number of studies on immunity, very limited data exist to directly support quantification of model inputs related to transmission. Given the limitations in the evidence, we identify the need for expert input to derive quantitative model inputs from the existing data.
Conclusions:
Outcome of Research: More research required
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Category: Drugs
Title: Efficacy of Modafinil on fatigue and excessive daytime sleepiness associated with neurological disorders: a systematic review and meta-analysis
Author: Sheng P, Hou L, Wang X, Wang X, Huang C, Yu M, Han X, Dong Y.
Affiliation: Department of Neurosurgery, Shanghai Institute of Neurosurgery, Military Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
Journal: Public Library of Science
Citation: PLoS One. 2013 Dec 3;8(12):e81802. doi: 10.1371/journal.pone.0081802
Publication Year and Month: 2013 03
Abstract: BACKGROUND: Modafinil is a novel wake-promoting agent approved by the FDA ameliorating excessive daytime sleepiness (EDS) in three disorders: narcolepsy, shift work sleep disorder and obstructive sleep apnea. Existing trials of modafinil for fatigue and EDS associated with neurological disorders provided inconsistent results. This meta-analysis was aimed to assess drug safety and effects of modafinil on fatigue and EDS associated with neurological disorders.
METHODS: A comprehensive literature review was conducted in order to identify published studies assessing the effects of modafinil on fatigue and EDS associated with neurological disorders. Primary outcomes included fatigue and EDS. Secondary outcomes included depression and adverse effects.
FINDINGS: Ten randomized controlled trials were identified including 4 studies of Parkinson's disease (PD), 3 of multiple sclerosis (MS), 2 of traumatic brain injury (TBI) and 1 of post-polio syndrome (PPS). A total of 535 patients were enrolled. Our results suggested a therapeutic effect of modafinil on fatigue in TBI (MD -0.82 95% CI -1.54 - -0.11 p=0.02, I(2)=0%), while a beneficial effect of modafinil on fatigue was not confirmed in the pooled studies of PD or MS. Treatment results demonstrated a clear beneficial effect of modafinil on EDS in patients with PD (MD -2.45 95% CI -4.00 - -0.91 p=0.002 I(2)=14%), but not with MS and TBI. No difference was seen between modafinil and placebo treatments in patients with PPS. Modafinil seemed to have no therapeutic effect on depression. Adverse events were similar between modafinil and placebo groups except that more patients were found with insomnia and nausea in modafinil group.
Conclusions: Existing trials of modafinil for fatigue and EDS associated with PD, MS, TBI and PPS provided inconsistent results. The majority of the studies had small sample sizes. Modafinil is not yet sufficient to be recommended for these medical conditions until solid data are available.
Outcome of Research: More research required.
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Category: Muscle Strength
Title: Muscle strength is only a weak to moderate predictor of gait performance in persons with late effects of polio.
Author: Flansbjer, UB, Brogardh, C, Lexell, J
Affiliation: Department of Rehabilitation Medicine, Lund University Hospital, Lund, Sweden Department of Health Sciences, Lund University, Lund, Swede
Journal: NeuroRehabilitation
Citation: 2013;33(3):457-64. doi: 10.3233/NRE-130978
Publication Year and Month: 2013 03
Abstract: OBJECTIVE:
To assess muscle strength in the knee extensors, knee flexors and ankle dorsiflexors in persons with late effects of polio, and determine how much muscle strength, gender, age and BMI are related to gait performance.
METHODS:
Ninety community-dwelling ambulant persons (47 men and 43 women; mean age 64 years SD 8) with late effects of polio participated. Isokinetic concentric knee extensor and flexor muscle strength was measured at 60°/s and ankle dorsiflexor muscle strength at 30°/s. Gait performance was assessed by the Timed "Up & Go", the Comfortable and Fast Gait Speed tests, and the 6-Minute Walk test.
RESULTS:
There were significant correlations between knee extensor and flexor muscle strength and gait performance (p < 0.01), and between ankle dorsiflexor muscle strength and gait performance (p < 0.05), for both lower limbs. Muscle strength in the knee extensors and flexors explained 7% to 37% and 9% to 47%, respectively, of the variance in gait performance. Strength in the ankle dorsiflexors explained 4% to 24%, whereas gender, age and BMI contributed at most an additional 9%.
CONCLUSION:
Knee muscle strength, and to some extent ankle dorsiflexor muscle strength, are predictors of gait performance in persons with late effects of polio, but the strength of the relationships indicates that other factors are also important.
Conclusions:
Outcome of Research: More research required
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Category: 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: Fatigue, Late Effects of Polio, Sleep Analysis
Title: Transcranial direct current stimulation (tDCS) for sleep disturbances and fatigue in patients with post-polio syndrome
Author: Michele Acler, Tommaso Bocci, Diana Valenti, Mara Turri, Alberto Priori, Laura Bertolasi
Affiliation: Sezione di Neurologia, Dipartimento di Scienze Neurologiche e del Movimento, Università di Verona, Verona, Italy.
Journal: Restorative Neurology and Neuroscience
Citation: Restor Neurol Neurosci. 2013;31(5):661-8. doi: 10.3233/RNN-130321.
Publication Year and Month: 2013
Abstract: PURPOSE:
Post-polio syndrome develops about 20-40 years after acute paralytic poliomyelitis, and manifests with progressively deteriorating muscle strength and endurance. Here, we assessed whether transcranial direct current stimulation (tDCS) improves sleep and fatigue symptoms in patients with post-polio syndrome.
METHODS:
We enrolled 32 patients with a diagnosis of post-polio syndrome. tDCS (1.5 mA, 15 min) was delivered by a direct current stimulator connected to three electrodes: two anodal electrodes on the scalp over the right and left pre-motor cortex and the other above the left shoulder (cathode). 16 patients received anodal tDCS and the remainder sham tDCS. We evaluated changes induced by tDCS (daily for five days a week, for three weeks) on clinical scales (Short Form Health Survey [SF-36], Piper Fatigue Scale [PFS], Fatigue Severity Scale [FSS], 101-Point Numerical Rating [PNR-101], Hamilton Rating Scale for Depression [HRSD], Pittsburgh Sleep Quality Index [PSQI]) at baseline (T0) and three weeks later (T1).
RESULTS:
At T1 SF-36 sub-items physical functioning, role physical, vitality, social functioning and role emotional improved significantly more in patients who received tDCS (p < 0.01) than in sham-treated patients. Also, PSQI scores improved more in treated patients (p < 0.05, two-way ANOVA with "stimulation" and "time" as factors: p < 0.01). tDCS-induced benefits were more pronounced in patients who were younger at primary infection (p < 0.05).
CONCLUSION:
Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.
KEYWORDS: Poliomyelitis, post-polio syndrome, fatigue, rehabilitation, transcranial direct current stimulation, tDCS, sleep
Conclusions: Anodal tDCS over the pre-motor areas for fifteen days improved sleep and fatigue symptoms in patients with post-polio syndrome. tDCS could be a non-invasive and valuable new tool for managing post-polio patients.
Outcome of Research: More research required
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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: 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: 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: 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: Psychology
Title: Psychological Resilience and Depressive Symptoms in Older Adults Diagnosed with Post-polio Syndrome (2012)
Author: Diana Pierini, RN, BSN (1)
Alexa Stuifbergen, PhD, RN, FAAN (2)
Affiliation: (1) [Doctoral Student] and The University of Texas at Austin, School of Nursing, Austin, TX
(2) Professor and Associate Dean of Research at The University of Texas at Austin, School of
Nursing, Austin, TX
Journal: Rehabilitation Nursing
Citation: 35(4): 167–175. DOI: 10.1002/j.2048-7940.2010.tb00043.x
Publication Year and Month: 2012 09
Abstract: Depression is a serious comorbidity in people with disabilities; however, few studies have focused on depressive symptoms in older adults with post-polio syndrome (PPS). This study used a resilience conceptual framework that focused on patient psychosocial strengths to investigate the relationship between psychological resilience factors (e.g., acceptance, self-efficacy, personal resources, interpersonal relationships, self-rated health, spiritual growth, stress management) and depressive symptoms in a large sample (N = 630) of people older than 65 years who were diagnosed with PPS. Forty percent of the sample scored > or = 10 on the Center for Epidemiologic Studies Short Depression Scale (CES-D10), which is a higher percentage than what has been previously cited in other studies; however, 53% of the sample had good or excellent self-rated health, suggesting psychological resilience. Depression scores were regressed on seven selected resilience factors after controlling for functional limitations. Four of the seven variables accounted for 30% of the variance in depressive symptoms, with spiritual growth representing the main predictor (beta = -.26). The implications for rehabilitation nurses in developing a patient-strengths perspective in the assessment and counseling of older adults with PPS are discussed.
Conclusions: Preventing depressive symptoms from developing into depression is a worthwhile goal for health promotion in older adults diagnosed with PPS. While no causal relationships are posited as a result of the study, future studies should explore the potential for psychological resilience factors to ameliorate depressive symptoms. Rehabilitation nurses are in an ideal position to encourage resiliency while providing emotional support. Although the vicissitudes of life cannot be altered, patients diagnosed with PPS can be helped in positive ways by offering encouragement and hope.
Outcome of Research: More research required
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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: 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):
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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: Acute Flaccid Paralysis
Title: Human Enteroviruses isolated during acute flaccid paralysis surveillance in Ghana: implications for the post eradication era
Author: Odoom JK, Obodai E, Barnor JS, Ashun M, Arthur-Quarm J, Osei-Kwasi M
Affiliation: Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
Journal: Pan African Medical Journal
Citation: Pan Afr Med J. 2012; 12: 74
Publication Year and Month: 2012 07
Abstract: INTRODUCTION: Surveillance of acute flaccid surveillance (AFP) has been used world-wide to monitor the control and eradication of circulating wild polioviruses. The Polio Laboratory since its accreditation in 1996 has supported the Disease Surveillance Department for AFP surveillance. This study aims to isolate and characterize human enteroviruses from patients with AFP in Ghana.
METHOD: Stool suspension was prepared from 308 samples received in 2009 from the surveillance activities throughout the country and inoculated on both RD and L20B cell lines. Isolates that showed growth on L20B were selected for real-time RT-PCR using degenerate and non-degenerate primers and probes. RD isolates were however characterized by microneutralisation technique with antisera pools from RIVM, The Netherlands and viruses that were untypable subjected to neutralization assay using antibodies specific for E71.
RESULTS: Of the 308 samples processed, 17 (5.5%) grew on both L20B and RD cells while 32 (10.4%) grew on RD only. All 28 isolates from L20B were characterized by rRT-PCR as Sabin-like polioviruses. No wild poliovirus or VDPV was found. However from the microneutralisation assay, six different enteroviruses were characterized. Among these, Coxsackie B viruses were most predominant followed by Echovirus. Three children from whom non-polio enteroviruses were isolated had residual paralysis while one child with VAPP found. The non-polio enteroviruses circulated throughout the country with the majority (20.7%) from Ashanti region.
Conclusions: This study showed the absence of wild or vaccine-derived poliovirus circulation in the country. However, the detection of three non-polio enteroviruses and one Sabin-like poliovirus with residual paralysis call for continuous surveillance even in the post polio eradication era.
Outcome of Research: Not applicable
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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: 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: 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: Renal Complications
Title: Renal failure in a patient with postpolio syndrome and a normal creatinine level
Author: Leming MK (1), Breyer MJ
Affiliation: (1) Department of Emergency Medicine, Christiana Care Health System, Newark, DE 19718, USA. [email protected]
Journal: The American Journal of Emergency Medicine
Citation: Am J Emerg Med. 2012 Jan;30(1):247.e1-3. doi: 10.1016/j.ajem.2010.07.026
Publication Year and Month: 2012 01
Abstract: Patients with renal failure who are taking trimethoprim have an increased risk of