Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis

Serial electrodiagnostic testing: Utility and indications in adult neurological disorders

Although existing guidelines address electrodiagnostic (EDX) testing in identifying neuromuscular conditions, guidance regarding the uses and limitations of serial (or repeat) EDX testing is limited. By assessing neurophysiological change longitudinally across time, serial electrodiagnosis can clarify a diagnosis and potentially provide valuable prognostic information. This monograph presents four broad indications for serial electrodiagnosis in adult peripheral neurological disorders. First, where clinical change has raised suspicion for a new or ongoing lesion, EDX reassessment for spatial spread of abnormality, involvement of previously normal muscle or nerve, and/or evolving pathophysiology can clarify a diagnosis. Second, where diagnosis of a progressive neuromuscular condition is uncertain, electrophysiological data from a second time point can confirm or refute suspicion. Third, to establish prognosis after a static nerve injury, a repeat study can assess the presence and extent of reinnervation. Finally, faced with a limited initial study (as when complicated by patient or environmental factors), a repeat EDX study can supplement missing or limited data to provide needed clarity. Repeat EDX studies carry certain limitations, however, such as with prognostication in the setting of remote or chronic lesions, sensory predominant fascicular injury, or mild axonal injury. Nevertheless, serial electrodiagnosis remains a valuable and underused tool in the diagnostic and prognostic evaluation of neuromuscular conditions.

Changes in self-perceived performance and satisfaction with performance of daily activities following interdisciplinary rehabilitation in people with late effects of polio

BACKGROUND

People with late effects of polio (LEoP) may need rehabilitation to manage everyday life but knowledge of the benefits of interdisciplinary rehabilitation is limited.

OBJECTIVE

To evaluate changes in performance and satisfaction with performance of activities among people with LEoP following interdisciplinary rehabilitation.

METHODS

A pre-post retrospective study based on data on 102 participants with LEoP from a rehabilitation clinic. Changes in performance and satisfaction with performance of daily activities before and after interdisciplinary rehabilitation were assessed with the Canadian Occupational Performance Measure (COPM).

RESULTS

There were statistically significant increases in the mean performance and mean satisfaction with performance COPM scores from admission to discharge. Twenty-three percent and 19% of the participants, respectively, had improved their performance and satisfaction with performance, 25% and 26% of the participants had no changes, and 19% and 22% of the participants, respectively, rated their performance and satisfaction lower at discharge compared to admission.

CONCLUSION

Interdisciplinary rehabilitation can enhance self-rated performance and satisfaction with performance of daily activities among people with LEoP. Future studies of rehabilitation for people with LEoP should use a prospective design and capture the participants' process of change related to their rehabilitation period.

Kaempferol: A Review of Current Evidence of Its Antiviral Potential

Kaempferol and its derivatives are flavonoids found in various plants, and a considerable number of these have been used in various medical applications worldwide. Kaempferol and its compounds have well-known antioxidant, anti-inflammatory and antimicrobial properties among other health benefits. However, the antiviral properties of kaempferol are notable, and there is a significant number of experimental studies on this topic. Kaempferol compounds were effective against DNA viruses such as hepatitis B virus, viruses of the alphaherpesvirinae family, African swine fever virus, and pseudorabies virus; they were also effective against RNA viruses, namely feline SARS coronavirus, dengue fever virus, Japanese encephalitis virus, influenza virus, enterovirus 71, poliovirus, respiratory syncytial virus, human immunodeficiency virus, calicivirus, and chikungunya virus. On the other hand, no effectiveness against murine norovirus and hepatitis A virus could be determined. The antiviral action mechanisms of kaempferol compounds are various, such as the inhibition of viral polymerases and of viral attachment and entry into host cells. Future research should be focused on further elucidating the antiviral properties of kaempferol compounds from different plants and assessing their potential use to complement the action of antiviral drugs.

Spontaneous pulmonary herniation in post-polio syndrome

Pulmonary hernias are typically a result of trauma, thoracic operations, or congenital defects. Spontaneous lung hernias without a prior overt injury are notably rare. The presence of spontaneous lung hernias has not been reported in post-polio syndrome. Post-polio syndrome is a late sequela of poliomyelitis that usually presents 30-40 years after the initial illness with new presentations of progressive muscle weakness, abnormal muscle fatigue, muscle atrophy, and myalgia. This case report describes the presentation and imaging of a post-polio patient with an atraumatic, spontaneous lung hernia. A discussion on pulmonary hernias, diagnostic imaging, and management is also included.

Quality appraisal of clinical practice guidelines for motor neuron diseases or related disorders using the AGREE II instrument

Objectives

This study aimed to systematically assess the quality of CPGs for motor neuron diseases (MNDs) or related disorders and identify the gaps that limit evidence-based practice.

Methods

Four scientific databases and six guideline repositories were searched for eligible CPGs. Three researchers assessed the eligible CPGs using the Appraisal of Guidelines Research and Evaluation II instrument. The distribution of the level of evidence and strength of recommendation of these CPGs were determined. The univariate regression analysis was used to explore the characteristic factors affecting the quality of CPGs.

Results

Fifteen CPGs met the eligibility criteria: 10 were for MND and 5 were for spinal muscular atrophy. The mean overall rating score was 44.5%, and only 3 of 15 CPGs were of high quality. The domains that achieved low mean scores were applicability (24.4%), rigor of development (39.9%), and stakeholder involvement (40.3%). Most recommendations were based on low-quality evidence and had a weak strength. The CPGs that were updated, meant for adults, and evidence based, and used a CPG quality tool and a grading system were associated with higher scores in certain specific domains and overall rating.

Conclusion

The overall quality of CPGs for MNDs or related disorders was poor and recommendations were largely based on low-quality evidence. Many areas still need improvement to develop high-quality CPGs, and the use of CPG quality tools should be emphasized. A great deal of research on MNDs or related disorders is still needed to fill the large evidence gap.

Peri-implant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge

Key Clinical Message

The treatment of long bone fractures in post-polio survivors is indubitably an exacting task. Out of this complicated case presented in this paper, it can be deduced that it is attainable to repair a peri-implant subtrochanteric refracture or a complex non-union of the proximal femur with plate and screws with grafting.

Abstract

Post-polio survivors are prone to low-energy bone fractures. The management of such cases is exigent, as no literature data indicate the best surgical approach. This paper presents an intricate peri-implant proximal femoral fracture in a polio survivor treated in our institution and accentuates the various challenges we encountered.

Post-Polio Syndrome Revisited

Post-polio syndrome (PPS) is characterized by recrudescence or worsening of motor neuron disease symptoms decades after recovery from acute paralytic poliovirus infection, i.e., poliomyelitis. PPS afflicts between 25% and 40% of poliomyelitis survivors and mimics motor neuron diseases (MNDs), such as amyotrophic lateral sclerosis (ALS), due to its selective impairment, degeneration, or death of motor neurons in the brainstem and spinal cord. Herein, we report a case of PPS in a 68-year-old man with a remote history of bulbar and cervical cord involvement by poliomyelitis, review the relevant literature, and contrast the salient histopathologic features that distinguish our case of PPS from ALS.

Spinal cord motor disorders

Spinal cord diseases are frequently devastating due to the precipitous and often permanently debilitating nature of the deficits. Spastic or flaccid paraparesis accompanied by dermatomal and myotomal signatures complementary to the incurred deficits facilitates localization of the insult within the cord. However, laboratory studies often employing disease-specific serology, neuroradiology, neurophysiology, and cerebrospinal fluid analysis aid in the etiologic diagnosis. While many spinal cord diseases are reversible and treatable, especially when recognized early, more than ever, neuroscientists are being called to investigate endogenous mechanisms of neural plasticity. This chapter is a review of the embryology, neuroanatomy, clinical localization, evaluation, and management of adult and childhood spinal cord motor disorders.

Biobehavioural Physiotherapy through Telerehabilitation during the SARS-CoV-2 Pandemic in a Patient with Post-polio Syndrome and Low Back Pain: A Case Report

Post-polio syndrome refers to the physical and psychological sequelae caused by poliovirus infection. For this reason, according to which the emotional and sensorimotor sphere is affected, we consider a biobehavioural approach based on education and therapeutic exercise to be necessary. The aim of this case report is to evaluate the effect of a biobehavioural approach in a patient with post-polio syndrome and low back pain. We describe a 57-year-old man with post-polio syndrome and low back pain following a fall at the end of February 2020. The pain, disability and lack of functionality caused by both processes led him to contact a physiotherapy service. A therapeutic planning was carried out for 3 months, where a biobehavioural approach based on therapeutic exercise and education, with an assessment and three face-to-face sessions which were complemented by online follow-up and finalised due to the Sars-Cov-2 pandemic in a telerehabilitation approach. It was organised in two phases; the initial phase lasted 2 weeks with the aim of reducing the symptoms of the lumbar region, and the advanced phase in which the aim was to improve his physical condition. During the three-month intervention, four assessments were conducted (Pre, at 4 weeks, at 8 weeks and at 12 weeks). At follow-up, improvements in functional and psychological variables were obtained. This case suggests that a biobehavioural approach through telerehabilitation was a useful option in this reported case and could be an option of treatment to improve psychological, physical and functional variables in this patient.

SARS-CoV-2 Psychiatric Sequelae: A Review of Neuroendocrine Mechanisms and Therapeutic Strategies

From the earliest days of the coronavirus disease 2019 (COVID-19) pandemic, there have been reports of significant neurological and psychological symptoms following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. This narrative review is designed to examine the potential psychoneuroendocrine pathogenic mechanisms by which SARS-CoV-2 elicits psychiatric sequelae as well as to posit potential pharmacologic strategies to address and reverse these pathologies. Following a brief overview of neurological and psychological sequelae from previous viral pandemics, we address mechanisms by which SARS-CoV-2 could enter or otherwise elicit changes in the CNS. We then examine the hypothesis that COVID-19-induced psychiatric disorders result from challenges to the neuroendocrine system, in particular the hypothalamic-pituitary-adrenal stress axis and monoamine synthesis, physiological mechanisms that are only further enhanced by the pandemic-induced social environment of fear, isolation, and socioeconomic pressure. Finally, we evaluate several FDA-approved therapeutics in the context of COVID-19-induced psychoneuroendocrine disorders.

Falls in Post-Polio Patients: Prevalence and Risk Factors

Simple Summary

People with post-polio syndrome (PPS) suffer frequent falls due to muscle weakness and problems with their balance. In order for a rehabilitation clinician to fit the patient with the optimal treatment plan to prevent imbalance and falls, we performed a simple 10-min walking test with 50 PPS patients. We also asked the patients how many falls they had experienced in the last year and they filled out a questionnaire regarding their balance confidence. We found that we can predict the occurrence of falls in PPS patients based on the consistency of their walking pattern. Since it is very easy to measure the walking pattern, our results may help rehabilitation clinicians to identify individuals at risk of fall and reduce the occurrence of falls in this population.

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.

Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study

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.

The neurological sequelae of pandemics and epidemics

Neurological manifestations in pandemics frequently cause short and long-term consequences which are frequently overlooked. Despite advances in the treatment of infectious diseases, nervous system involvement remains a challenge, with limited treatments often available. The under-recognition of neurological manifestations may lead to an increase in the burden of acute disease as well as secondary complications with long-term consequences. Nervous system infection or dysfunction during pandemics is common and its enduring consequences, especially among vulnerable populations, are frequently forgotten. An improved understanding the possible mechanisms of neurological damage during epidemics, and increased recognition of the possible manifestations is fundamental to bring insights when dealing with future outbreaks. To reverse this gap in knowledge, we reviewed all the pandemics, large and important epidemics of human history in which neurological manifestations are evident, and described the possible physiological processes that leads to the adverse sequelae caused or triggered by those pathogens.

Joint and Back Pain: Medications and Role of Injection Therapy for Destructive Joint

Postpolio syndrome (PPS) is a sequela with symptoms that often occur in patients who previously survived poliomyelitis. Pain is a characteristic feature of PPS. Although poliomyelitis is no longer commonly seen in the western world, there is a significant portion of patients living with PPS. Recognizing the signs of PPS is integral in developing treatment plans. Conservative management is routinely considered first-line therapy; however, alternate treatments, pharmacologic and minimally invasive, are used in more refractory cases. Approaching patients living with pain and PPS requires a holistic approach and an understanding of the efficacy of available treatment modalities.

Approach to Fatigue and Energy Conservation

Fatigue, a common complaint in individuals with postpolio syndrome (PPS), is defined as an overwhelming sustained feeling of exhaustion and diminished capacity for physical and mental work. A comprehensive medical work-up is needed to rule out all other causes of fatigue. A sleep study should be considered for individuals with PPS who complain of fatigue. Self-reported outcome measures, such as the Fatigue Severity Scale, are reliable and valid tools to measure fatigue in this population. Fatigue management consists of individualized treatment of underlying medical conditions, energy conservation, pacing techniques, and lifestyle modifications.

Primary breast cancer patient with poliomyelitis: A case report

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.

The value of a post-polio syndrome self-management programme

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.

Health-related quality of life and multidimensional fitness profile in polio survivors

PURPOSE

To assess and compare the HRQoL and physical fitness of polio survivors with healthy individuals.

METHODS

Thirty-seven polio survivors and 40 healthy individuals were recruited in this cross-sectional study. The Fatigue Severity Scale (FSS) was used to evaluate participant's level of fatigue; Short Form 36 (SF-36) was used for evaluating HRQoL, and hand-grip strength, lumbar trunk muscle endurance, flexibility, balance, and aerobic endurance were used as measures for physical fitness.

RESULTS

Polio survivors had lower HRQoL in most of the dimensions of the SF-36, and they showed a lower level of physical fitness than controls. In particular, mobility-related variables were 20-40% lower in people with PP.

CONCLUSIONS

Subjects with PP had lower scores for the physical component of the HRQoL questionnaire, reduced physical fitness, increased fatigue, less mobility, and a higher fall risk than controls. The outcomes of the study can be useful to the design of future programs tailored specifically to improve the assessment of the physical fitness of subjects with paralytic polio and to facilitate interventions based on appropriate physical exercise regimens.Implications for rehabilitationPost-polio syndrome is a disabling disease that impacts in fitness, physical and psychological health-related quality of life of polio survivors.Polio survivors should undergo physical activity programs that focus on improving mainly their mobility and physical functioning (walking, self-care, and climbing stairs), thereby reducing fall risk and fatigue.Individual tailored physical exercise programs should be promoted in order to improve HRQoL in this population.