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Laffont I, Duflos C, Hirtz C, Bakhti K, Gelis A, Palayer C, Macioce V, Soler M, Pradalier F, Galtier F, Jentzer A, Lozano C, Vincent T, Morales RJ. Post-polio syndrome is not a dysimmune condition. Eur J Phys Rehabil Med 2024; 60:270-279. [PMID: 38252127 PMCID: PMC11112507 DOI: 10.23736/s1973-9087.23.08158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN Cross-sectional study. SETTING Montpellier University Hospital. POPULATION Forty-seven PPS and 27 healthy controls. METHODS PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1β, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-β, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.
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Affiliation(s)
- Isabelle Laffont
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France -
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France -
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Christophe Hirtz
- Institute for Regenerative Medicine and Biotherapy, INSERM 1183, Montpellier University, Montpellier, France
| | - Karima Bakhti
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France
| | - Anthony Gelis
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Physical and Rehabilitation Medicine, Propara, Montpellier, France
| | - Claire Palayer
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Marion Soler
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Fanny Pradalier
- Department of Physical and Rehabilitation Medicine, Nimes University Hospital, Montpellier University, Nimes, France
| | - Florence Galtier
- Inserm CIC 1411, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Claire Lozano
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Thierry Vincent
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Raul J Morales
- Department of Neurology, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Li KJ, Wong NLY, Law MC, Lam FMH, Wong HC, Chan TO, Wong KN, Zheng YP, Huang QY, Wong AYL, Kwok TCY, Ma CZH. Reliability, Validity, and Identification Ability of a Commercialized Waist-Attached Inertial Measurement Unit (IMU) Sensor-Based System in Fall Risk Assessment of Older People. BIOSENSORS 2023; 13:998. [PMID: 38131758 PMCID: PMC10742152 DOI: 10.3390/bios13120998] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/23/2023]
Abstract
Falls are a prevalent cause of injury among older people. While some wearable inertial measurement unit (IMU) sensor-based systems have been widely investigated for fall risk assessment, their reliability, validity, and identification ability in community-dwelling older people remain unclear. Therefore, this study evaluated the performance of a commercially available IMU sensor-based fall risk assessment system among 20 community-dwelling older recurrent fallers (with a history of ≥2 falls in the past 12 months) and 20 community-dwelling older non-fallers (no history of falls in the past 12 months), together with applying the clinical scale of the Mini-Balance Evaluation Systems Test (Mini-BESTest). The results show that the IMU sensor-based system exhibited a significant moderate to excellent test-retest reliability (ICC = 0.838, p < 0.001), an acceptable level of internal consistency reliability (Spearman's rho = 0.471, p = 0.002), an acceptable convergent validity (Cronbach's α = 0.712), and an area under the curve (AUC) value of 0.590 for the IMU sensor-based receiver-operating characteristic (ROC) curve. The findings suggest that while the evaluated IMU sensor-based system exhibited good reliability and acceptable validity, it might not be able to fully identify the recurrent fallers and non-fallers in a community-dwelling older population. Further system optimization is still needed.
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Affiliation(s)
- Ke-Jing Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
| | - Nicky Lok-Yi Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
| | - Man-Ching Law
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Jockey Club Smart Ageing Hub, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Freddy Man-Hin Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Hoi-Ching Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Jockey Club Smart Ageing Hub, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Tsz-On Chan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Jockey Club Smart Ageing Hub, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kit-Naam Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Jockey Club Smart Ageing Hub, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Jockey Club Smart Ageing Hub, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Qi-Yao Huang
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Arnold Yu-Lok Wong
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
| | - Timothy Chi-Yui Kwok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China;
| | - Christina Zong-Hao Ma
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; (K.-J.L.); (N.L.-Y.W.); (M.-C.L.); (H.-C.W.); (T.-O.C.); (K.-N.W.); (Y.-P.Z.)
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China;
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Vu PD, Blazek G, Cowan M, Philip K, Sambasivan A. Spontaneous pulmonary herniation in post-polio syndrome. J Ultrasound 2023:10.1007/s40477-023-00812-5. [PMID: 37566195 DOI: 10.1007/s40477-023-00812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
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.
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Affiliation(s)
- Peter D Vu
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA.
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA.
| | - Gregory Blazek
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
| | - Mogran Cowan
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
| | - Kemly Philip
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
| | - Ajai Sambasivan
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
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Castellanos-Alonso S, Tomás-Hernández J, Teixidor-Serra J, Selga-Marsà J, Piedra-Calle CA, Andrés-Peiró JV. Non-prosthetic implant-related femur fractures in post-polio patients. Trauma Case Rep 2023; 46:100843. [PMID: 37251433 PMCID: PMC10213328 DOI: 10.1016/j.tcr.2023.100843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023] Open
Abstract
The overall societal impact of poliomyelitis worldwide is decreasing, rendering it almost absent in most developed countries. However, even there, patients are still seen who contracted it in endemic areas or developed polio before vaccinations became widely available. Post-polio syndrome (PPS) causes skeletal and neurological changes that increase affected individuals' likelihood of fractures, including fractures requiring complex surgical treatment. The existence of previous internal fixation creates a particularly difficult challenge. We present here the surgical management of four post-polio patients who suffered non-prosthetic implant-related femoral fractures. Injuries occurred at earlier ages than implant-related fractures in non-polio patients and three of the four fractures occurred around plates, a phenomenon which is usually rare. The treatment of implant-related fractures in patients with post-polio syndrome poses significant technical challenges, often creating problematic functional sequelae for patients and high costs for healthcare systems.
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Affiliation(s)
- Sara Castellanos-Alonso
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Teixidor-Serra
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Jordi Selga-Marsà
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carlos Alberto Piedra-Calle
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - José Vicente Andrés-Peiró
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Orthopaedic Surgery and Traumatology, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
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Ou JY, Liu JJ, Xu J, Li JY, Liu Y, Liu YZ, Lu LM, Pan HF, Wang L. Quality appraisal of clinical practice guidelines for motor neuron diseases or related disorders using the AGREE II instrument. Front Neurol 2023; 14:1180218. [PMID: 37528849 PMCID: PMC10388716 DOI: 10.3389/fneur.2023.1180218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
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.
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Affiliation(s)
- Jia-Yin Ou
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun-Jun Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jia-Yu Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Liu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - You-Zhang Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Li-Ming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hua-Feng Pan
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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Sakellariou E, Galanis A, Vavourakis M, Papagrigorakis E, Vlachos C, Zachariou D, Vasiliadis E, Pneumaticos S. Peri-implant proximal femur fracture in a poliomyelitis survivor: A surgical and medical challenge. Clin Case Rep 2023; 11:e7465. [PMID: 37287621 PMCID: PMC10242085 DOI: 10.1002/ccr3.7465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
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.
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Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Athanasios Galanis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Michail Vavourakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Eftychios Papagrigorakis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Christos Vlachos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Dimitrios Zachariou
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Elias Vasiliadis
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic SurgeryNational & Kapodistrian University of AthensKAT General HospitalAthensGreece
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Wändell P, Borg K, Li X, Carlsson AC, Sundquist J, Sundquist K. The risk of post-polio syndrome among immigrant groups in Sweden. Sci Rep 2023; 13:6044. [PMID: 37055461 PMCID: PMC10098995 DOI: 10.1038/s41598-023-33240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
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.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristian Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- 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
- Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- 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
- Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
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de Lira CAB, Minozzo FC, Costa TG, de Oliveira VN, Costa GCT, Oliveira ASB, Quadros AAJ, Vancini RL, Sousa BS, da Silva AC, Andrade MS. Functional exercise capacity in maximal and submaximal activities of individuals with polio sequelae. Eur J Appl Physiol 2023; 123:711-719. [PMID: 36401622 DOI: 10.1007/s00421-022-05095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Poliomyelitis is an infectious disease that can cause total paralysis. Furthermore, poliomyelitis survivors may develop new signs and symptoms, including muscular weakness and fatigue, years after the acute phase of the disease, i.e., post-polio syndrome (PPS). Thus, the objective was to compare the functional exercise capacity during maximal and submaximal exercises among individuals with polio sequelae (without PPS diagnosis), PPS, and a control group. METHODS Thirty individuals participated in three groups: a control group (CG, n = 10); a group of individuals with polio sequelae but without PPS diagnosis (PG, n = 10); and a PPS group (PPSG, n = 10). All participants underwent (i) a cardiopulmonary exercise test to determine their maximal oxygen uptake ([Formula: see text]) and (ii) a series of functional field tests (i.e., walking test, sit-to-stand test, and stair climbing test). RESULTS [Formula: see text]O2max was 30% lower in PPSG than in CG and PG. Regarding functional field tests, walking and stair climbing test performances were significantly different among all groups. The PPSG sit-to-stand performance was lower than CG. CONCLUSION The sequelae of paralytic poliomyelitis impair functional exercise capacity obtained from maximal and submaximal tests, especially in patients with PPS. Furthermore, submaximal variables appear to be more negatively impacted than maximal variables.
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Affiliation(s)
- Claudio Andre Barbosa de Lira
- Faculty of Physical Education and Dance, Federal University of Goiás, Avenida Esperança s/n, Campus Samambaia, Goiânia, Brazil.
| | | | - Thalles Guilarducci Costa
- Faculty of Physical Education and Dance, Federal University of Goiás, Avenida Esperança s/n, Campus Samambaia, Goiânia, Brazil
| | - Vinnycius Nunes de Oliveira
- Faculty of Physical Education and Dance, Federal University of Goiás, Avenida Esperança s/n, Campus Samambaia, Goiânia, Brazil
| | - Gustavo Conti Teixeira Costa
- Faculty of Physical Education and Dance, Federal University of Goiás, Avenida Esperança s/n, Campus Samambaia, Goiânia, Brazil
| | | | | | - Rodrigo Luiz Vancini
- Center of Physical Education and Sports, Federal University of Espírito Santo, Vitória, Brazil
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Liu KB, Guan J, Zang JC, Hua QK, Qin SH. The epidemiological characteristics of neurogenic limb deformity disorder in China: a national-based study from Qin Sihe orthopedic center. BMC Public Health 2023; 23:567. [PMID: 36973707 PMCID: PMC10041791 DOI: 10.1186/s12889-023-15470-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Neurogenic limb deformity disorder (NLDD) refers to limb deformity disorders caused by various neurogenic disorders. However, there are no studies to systematically summarize and analyze these diseases in China, and we first proposed the concept of NLDD. We describe the epidemiological characteristics of NLDD in China based on the largest case database of limb orthopedics in China. METHODS This study analyzed parameters from the Qin Sihe Orthopedic Surgery Case Data (QSHOSCD). The database is based on the Rehabilitation Hospital affiliated to National Research Center for Rehabilitation, which has collected nearly 37,000 patients to date and includes a wide variety of limb deformities. The types of diseases are summarized and classified for all patients studied. Statistical analysis was based on the type of etiology, age, regional distribution, and historical surgical volume. Partial outcomes were statistically analyzed separately by common diseases (polio and cerebral palsy) and rare diseases (37 other diseases). RESULTS From 1979 to 2019, 30,194 patients with NLDD were treated surgically for 39 neurogenic disorders. The male to female ratio was 1.48:1, the mean age was 19.65 years, and most patients (82.38%) were aged between 6 and 30 years. Patients included from 32 provinces and cities across China, mainly concentrated in populous central provinces and Heilongjiang Province. The peak of annual surgical procedures was from 1988 to 1994, and the number of annual surgical procedures for common diseases gradually decreased from 1994 onwards, but the trending is opposite for rare diseases. CONCLUSIONS This study is the first to demonstrate the disease types, population characteristics and incidence trends of NLDD in China. It suggests that the prevention and treatment of NLDD should focus on the adolescent population and enhance the treatment of neurogenic diseases that cause limb deformities. The growth and adaption of the Ilizarov technique and its practice in Chinese orthopedic benefits the treatment of neurogenic limb deformity disorders.
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Affiliation(s)
- Kai-Bing Liu
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jack Guan
- Bay Area Foot and Ankle Medical Clinic, San Jose, USA
| | - Jian-Cheng Zang
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China
| | - Qi-Kai Hua
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Si-He Qin
- Department of Orthopaedics, Rehabilitation hospital, National Research Center For Rehabilitation, Beijing, China.
- Key Laboratory of Intelligent Control and Rehabilitation Technology, Ministry of Civil Affairs, Beijing, China.
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10
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Rosales Anderica FE, Raimondi N. Transferencia del flexor hallucis longus en un paciente con síndrome pospoliomielítico con déficit de la función del tendón tibial posterior. Reporte de un caso y técnica quirúrgica. REVISTA DE LA ASOCIACIÓN ARGENTINA DE ORTOPEDIA Y TRAUMATOLOGÍA 2023. [DOI: 10.15417/issn.1852-7434.2023.88.1.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
El síndrome pospoliomielítico con déficit de la función del tendón tibial posterior puede presentarse con un pie equino flexible y marcha equina (steppage) en algunos pacientes. Se describe el caso de una paciente que solo conservaba la función muscular del tendón flexor hallucis longus y se decidió su transferencia al mediopié para obtener un pie plantígrado y restaurar la dorsiflexión.
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11
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Fidancı H, Buturak Ş, Öztürk İ, Arlıer Z. Needle electromyography abnormalities in the upper trapezius muscle in neuromuscular disorders. Turk J Med Sci 2023; 53:233-242. [PMID: 36945948 PMCID: PMC10387837 DOI: 10.55730/1300-0144.5578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : Needle electromyography (EMG) abnormalities in the trapezius muscle (TM) can be seen in neuromuscular disorders. The aim was to determine the characteristics of needle EMG abnormalities observed in the TM in neuromuscular disorders. METHODS The data of patients who applied to the Clinical Neurophysiology Laboratory of University of Health Sciences Adana City Training and Research Hospital between December 2018 and October 2021 were reviewed. Polio survivors, amyotrophic lateral sclerosis (ALS) patients, patients with sensorimotor polyneuropathy, patients with spinal cord lesions involving C2/C3/C4 segments, patients with spinal accessory nerve (SAN) lesions, neuralgic amyotrophy (NA) patients, and patients with myopathy were included. Needle EMG findings of the upper TM of the patients were analyzed. Positive sharp waves, fibrillation potentials, fasciculation potentials, myotonic discharges, and motor unit action potential (MUAP) changes were considered needle EMG abnormalities. RESULTS Eighty-one polio survivors, 23 ALS patients, 39 patients with sensorimotor polyneuropathy, 10 patients with cervical spinal lesions, eight NA patients, seven patients with SAN lesions, and three patients with myopathy were included in the study. Fifteen (65.2%) ALS patients, 18 (22.2%) polio survivors, three (30%) patients with cervical spinal lesions, two (5.1%) patients with sensorimotor neuropathy, one (12.5%) NA patient, seven (100%) patients with SAN lesions, and two (66.7%) patients with myopathies had at least one needle EMG abnormality in the TM. Fasciculation potentials in the TM were seen in 10 (43.5%) ALS patients. In four patients with SAN lesions and one polio survivor, MUAP could not be obtained from the TM. DISCUSSION There may be more frequent needle EMG abnormalities, particularly in ALS patients and patients with SAN lesions. Since the number of patients with myopathy included in this study was low, it is difficult to comment on the needle EMG features of the TM for these patients. In addition, this study indicated that fasciculation potentials in the TM are typical in ALS patients and that MUAP may not be obtained from the TM in patients with SAN lesions.
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Affiliation(s)
- Halit Fidancı
- Division of Clinical Neurophysiology, Department of Neurology,University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Şencan Buturak
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - İlker Öztürk
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Zülfikar Arlıer
- Department of Neurology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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12
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Molinares DM, Gater DR, Daniel S, Pontee NL. Nontraumatic Spinal Cord Injury: Epidemiology, Etiology and Management. J Pers Med 2022; 12:1872. [PMID: 36579590 PMCID: PMC9694799 DOI: 10.3390/jpm12111872] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a traumatic spinal cord injury (SCI), supraspinal influences on the peripheral nervous system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, sympathetic blunting, and parasympathetic dominance, resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions, and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of the less reported nontraumatic SCI (NTSCI), its classification, its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue. Finally, management strategies for NTSCI will be provided.
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Affiliation(s)
- Diana M. Molinares
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Scott Daniel
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Nicole L. Pontee
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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13
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Quarleri J. Poliomyelitis is a current challenge: long-term sequelae and circulating vaccine-derived poliovirus. GeroScience 2022; 45:707-717. [PMID: 36260265 PMCID: PMC9886775 DOI: 10.1007/s11357-022-00672-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 02/03/2023] Open
Abstract
For more than 20 years, the World Health Organization Western Pacific Region (WPR) has been polio-free. However, two current challenges are still polio-related. First, around half of poliomyelitis elderly survivors suffer late poliomyelitis sequelae with a substantial impact on daily activities and quality of life, experiencing varying degrees of residual weakness as they age. The post-polio syndrome as well as accelerated aging may be involved. Second, after the worldwide Sabin oral poliovirus (OPV) vaccination, the recent reappearance of strains of vaccine-derived poliovirus (VDPV) circulating in the environment is worrisome and able to persistent person-to-person transmission. Such VDPV strains exhibit atypical genetic characteristics and reversed neurovirulence that can cause paralysis similarly to wild poliovirus, posing a significant obstacle to the elimination of polio. Immunization is essential for preventing paralysis in those who are exposed to the poliovirus. Stress the necessity of maintaining high vaccination rates because declining immunity increases the likelihood of reemergence. If mankind wants to eradicate polio in the near future, measures to raise immunization rates and living conditions in poorer nations are needed, along with strict observation. New oral polio vaccine candidates offer a promissory tool for this goal.
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Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. .,Consejo de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.
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14
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Khan A, Virani A. Post-Polio Syndrome in a Primary Care Setting: A Case Report. Cureus 2022; 14:e29361. [PMID: 36284819 PMCID: PMC9583888 DOI: 10.7759/cureus.29361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Post-Polio Syndrome (PPS) is a sequela of poliovirus infection that causes weakness in previously infected polio patients years after the initial infection. The diagnosis is one of exclusion and entails the following: 1) a prior episode of poliomyelitis with residual motor neuron function loss, 2) a period of at least 15 years or more after the acute onset of polio with neurologic and functional stability, and 3) a gradual onset of new weakness and abnormal muscle fatigability that has persisted for at least one year. While the exact etiology is unknown, the prevalence of PPS has increased as patients who have previously survived polio are getting older. In this report, we discuss a patient presenting to his primary care provider for evaluation of worsening lower extremity weakness over the course of the past three years. In addition to general characteristics of PPS, we will review the use of electromyography (EMG)/nerve conduction studies and imaging for evaluation. This report will also review prevention methods with vaccinations and identify potential treatment regimens including aerobic exercise and medications ranging from tricyclic antidepressants (TCAs) to dopamine agonists. The goal of this paper is to not only shine a light on PPS in general, but to show how social determinants i.e., economic stability, healthcare access and quality of health may affect the diagnosis of uncommon conditions.
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Affiliation(s)
- Ammar Khan
- Physical Medicine and Rehabilitation, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
| | - Anna Virani
- Family Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
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15
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Mercier MR, Moore HG, Wolfstadt JI, Rubin LE, Grauer JN. Outcomes Following Total Hip Arthroplasty in Patients With Postpolio Syndrome: A Matched Cohort Analysis. J Arthroplasty 2022; 37:1822-1826. [PMID: 35447277 DOI: 10.1016/j.arth.2022.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with postpolio syndrome (PPS) may be afflicted by hip arthritis in either the paralytic or contralateral limb. Total hip arthroplasty (THA) may be considered in these patients. However, short-term and long-term outcomes following THA in PPS patients remain poorly characterized. METHODS The PearlDiver MHip administrative database was queried for patients undergoing THA. Patients with a diagnosis of PPS were matched 1:4 with control patients on the basis of age, gender, and comorbidity burden. Incidence of postoperative adverse events and readmission in the 90 days following surgery and occurrence of revision arthroplasty in the five-year postoperative period were assessed between the two cohorts. RESULTS In total, 1,519 PPS patients were matched to 6,076 control patients without PPS. After controlling for patient demographics and comorbidities, PPS patients demonstrated higher 90-day odds of urinary tract infection (odds ratio [OR] = 1.34, P = .016), pneumonia (OR = 2.07, P < .001), prosthetic dislocation (OR = 1.63, P = .018), and readmission (OR = 1.49, P = .002). Five years following surgery, 94.7% of the PPS cohort remained revision-free, compared to 96.7% of the control cohort (P = .001). CONCLUSION Compared to patients without PPS, patients with PPS demonstrated a higher incidence of urinary tract infection, pneumonia, prosthetic dislocation, and hospital readmission. In addition, five-year incidence of revision arthroplasty was significantly higher among the PPS cohort. In light of these increased risks, special considerations should be made in both preoperative planning and postoperative surveillance of PPS patients undergoing THA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michael R Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | | | - Jesse I Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
| | - Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT
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16
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Verschueren A, Palminha C, Delmont E, Attarian S. Changes in neuromuscular function in elders: Novel techniques for assessment of motor unit loss and motor unit remodeling with aging. Rev Neurol (Paris) 2022; 178:780-787. [PMID: 35863917 DOI: 10.1016/j.neurol.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
Abstract
Functional muscle fiber denervation is a major contributor to the decline in physical function observed with aging and is now a recognized cause of sarcopenia, a muscle disorder characterized by progressive and generalized degenerative loss of skeletal muscle mass, quality, and strength. There is an interrelationship between muscle strength, motor unit (MU) number, and aging, which suggests that a portion of muscle weakness in seniors may be attributable to the loss of functional MUs. During normal aging, there is a time-related progression of MU loss, an adaptive sprouting followed by a maladaptive sprouting, and continuing recession of terminal Schwann cells leading to a reduced capacity for compensatory reinnervation in elders. In amyotrophic lateral sclerosis, increasing age at onset predicts worse survival ALS and it is possible that age-related depletion of the motor neuron pool may worsen motor neuron disease. MUNE methods are used to estimate the number of functional MU, data from MUNIX arguing for motor neuron loss with aging will be reviewed. Recently, a new MRI technique MU-MRI could be used to assess the MU recruitment or explore the activity of a single MU. This review presents published studies on the changes of neuromuscular function with aging, then focusing on these two novel techniques for assessment of MU loss and MU remodeling.
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Affiliation(s)
- A Verschueren
- Reference Centre for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, 264, rue Saint Pierre, 13005 Marseille, France.
| | - C Palminha
- Reference Centre for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, 264, rue Saint Pierre, 13005 Marseille, France
| | - E Delmont
- Reference Centre for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, 264, rue Saint Pierre, 13005 Marseille, France
| | - S Attarian
- Reference Centre for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, 264, rue Saint Pierre, 13005 Marseille, France
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17
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Wendebourg MJ, Weigel M, Richter L, Gocheva V, Hafner P, Orsini AL, Crepulja V, Schmidt S, Huck A, Oechtering J, Blatow M, Haas T, Granziera C, Kappos L, Cattin P, Bieri O, Fischer D, Schlaeger R. Spinal Cord Gray Matter Atrophy is associated with functional decline in Post-Polio Syndrome. Eur J Neurol 2022; 29:1435-1445. [PMID: 35102676 PMCID: PMC9310958 DOI: 10.1111/ene.15261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/30/2021] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
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 enlargement level (Tmax) (0.5 × 0.5 mm2 in‐plane resolution). SCGM areas were segmented manually by two independent raters. Muscle strength, self‐reported fatigue, depression and pain measures were assessed. Results Post‐polio syndrome patients showed significantly and preferentially reduced 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 muscle strength and is associated with PPS‐related functional decline. Our findings suggest a secondary neurodegenerative process underlying SCGM atrophy in PPS that is not explained 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.
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Affiliation(s)
- Maria Janina Wendebourg
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Matthias Weigel
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Laura Richter
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vanya Gocheva
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Patricia Hafner
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Anna-Lena Orsini
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Valentina Crepulja
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Simone Schmidt
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Antal Huck
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Johanna Oechtering
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maria Blatow
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja Haas
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Cristina Granziera
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Ludwig Kappos
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Philippe Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Dirk Fischer
- Division of Paediatric Neurology, University of Basel Children's Hospital, Basel, Switzerland
| | - Regina Schlaeger
- Neurology Clinic and Policlinic, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.,ThINK Basel, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
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18
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Finder JD. Respiratory Complications in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Comley LH, Kline RA, Thomson AK, Woschitz V, Landeros EV, Osman EY, Lorson CL, Murray LM. OUP accepted manuscript. Hum Mol Genet 2022; 31:3107-3119. [PMID: 35551393 PMCID: PMC9476628 DOI: 10.1093/hmg/ddac097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/19/2022] [Accepted: 04/23/2022] [Indexed: 11/14/2022] Open
Abstract
Spinal muscular atrophy (SMA) is a childhood motor neuron disease caused by anomalies in the SMN1 gene. Although therapeutics have been approved for the treatment of SMA, there is a therapeutic time window, after which efficacy is reduced. Hallmarks of motor unit pathology in SMA include loss of motor-neurons and neuromuscular junction (NMJs). Following an increase in Smn levels, it is unclear how much damage can be repaired and the degree to which normal connections are re-established. Here, we perform a detailed analysis of motor unit pathology before and after restoration of Smn levels. Using a Smn-inducible mouse model of SMA, we show that genetic restoration of Smn results in a dramatic reduction in NMJ pathology, with restoration of innervation patterns, preservation of axon and endplate number and normalized expression of P53-associated transcripts. Notably, presynaptic swelling and elevated Pmaip levels remained. We analysed the effect of either early or delayed treated of an antisense oligonucleotide (ASO) targeting SMN2 on a range of differentially vulnerable muscles. Following ASO administration, the majority of endplates appeared fully occupied. However, there was an underlying loss of axons and endplates, which was more prevalent following a delay in treatment. There was an increase in average motor unit size following both early and delayed treatment. Together this work demonstrates the remarkably regenerative capacity of the motor neuron following Smn restoration, but highlights that recovery is incomplete. This work suggests that there is an opportunity to enhance neuromuscular junction recovery following administration of Smn-enhancing therapeutics.
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Affiliation(s)
- Laura H Comley
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Rachel A Kline
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Alison K Thomson
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Victoria Woschitz
- Centre for Discovery Brain Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
- Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Eric Villalón Landeros
- Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2185, USA
| | - Erkan Y Osman
- Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Christian L Lorson
- Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Lyndsay M Murray
- To whom correspondence should be addressed at: College of Medicine and Veterinary Medicine, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9XD, UK. Tel: +44 131 651 5985;
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20
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Meiner Z, Marmor A, Jalagel M, Levine H, Shiri S, Schwartz I. Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study. NeuroRehabilitation 2021; 49:491-499. [PMID: 34542042 DOI: 10.3233/nre-210216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anat Marmor
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Murad Jalagel
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Shimon Shiri
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Isabella Schwartz
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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21
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Gebauer D, Schittek GA, Zoidl P, Sandner-Kiesling A. [Post-polio Syndrome in the Perioperative Phase]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:628-634. [PMID: 34507385 DOI: 10.1055/a-1220-4689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Due to the numerous poliomyelitis epidemics that have continued over the last decades and the post-polio syndrome (PPS) that occurs 10 - 30 years after poliomyelitis infection, the prevalence of PPS is also expected to increase in Europe. At the same time, due to the musculoskeletal disorders associated with the underlying disease, PPS patients often require surgery for which special anaesthetic requirements must be taken into account. In this analysis we summarise the current evidence and recommendations.
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22
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de Lira CAB, Santos DAT, Viana RB, Guimarães JM, Oliveira JNS, Sousa BS, de Santana MG, Vancini RL, Andrade MS, Nikolaidis P, Rosemann T, Knechtle B. Knowledge of healthcare professionals about poliomyelitis and postpoliomyelitis: a cross-sectional study. SAO PAULO MED J 2021; 139:464-475. [PMID: 34378735 PMCID: PMC9632530 DOI: 10.1590/1516-3180.2020.0617.16032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Claudio Andre Barbosa de Lira
- BSc, PhD. Associate Professor, Faculdade de Educação Física e Dança (FEFD), Universidade Federal de Goiás (UFG), Goiânia (GO), Brazil.
| | - Douglas Assis Teles Santos
- BSc, MSc. Assistent Professor, Colegiado de Educação Física, Universidade do Estado da Bahia (UNEB), Teixeira de Freitas (BA), Brazil.
| | - Ricardo Borges Viana
- BSc, PhD. Professor, Escola Superior de Educação Física e Fisioterapia do Estado de Goiás (ESEFFEGO), Universidade Estadual de Goiás (UEG), Goiânia (GO), Brazil.
| | - Juliana Moreira Guimarães
- BSc. Nurse, Unidade Acadêmica Especial de Ciências da Saúde, Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Jéssica Nathalia Soares Oliveira
- BSc. Biomedic, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Bolivar Saldanha Sousa
- MD, PhD. Physician, Hospital Israelita Albert Einstein, São Paulo-Brazil, São Paulo (SP), Brazil.
| | - Marcos Gonçalves de Santana
- BSc, PhD. Associate Professor, Unidade Acadêmica Especial de Ciências da Saúde (UA-CISAU), Universidade Federal de Jataí (UFJ), Jataí (GO), Brazil.
| | - Rodrigo Luiz Vancini
- BSc, PhD. Adjunct Professor, Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo (UFES), Vitória (ES), Brazil.
| | - Marília Santos Andrade
- PhD. Physical Therapist and Associate Professor, Department of Physiology, Universidade Federal de São Paulo (USP), São Paulo (SP), Brazil.
| | - Pantelis Nikolaidis
- BSc, PhD. Professor, School of Health and Caring Sciences, University of West Attica, Athens, Greece.
| | - Thomas Rosemann
- MD, PhD. Physician and Professor, Institute of Primary Care, University of Zurich, Zurich, Switzerland.
| | - Beat Knechtle
- 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
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Albanese CV, Reddy S. The Current State: Epidemiology and Working Toward Eradication. Phys Med Rehabil Clin N Am 2021; 32:467-476. [PMID: 34175007 DOI: 10.1016/j.pmr.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Acute polio, once epidemic and a significant source of paralysis and disability, has been dramatically reduced through global vaccination programs. Although vaccination efforts have experienced a setback because of COVID-19, resulting in increased number of vaccine-associated and wild virus infections, polio eradication is still a realistic goal that will result in significant cost savings. The secondary health issues related to aging with the residual effects of polio, including postpolio syndrome, will persist for many years posteradication. Continued education of medical professionals is essential to ensure provision of the necessary care to this population.
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Affiliation(s)
- Carol Vandenakker Albanese
- Department of Physical Medicine and Rehabilitation, UC Davis School of Medicine, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA.
| | - Shailesh Reddy
- Department of Physical Medicine and Rehabilitation, UC Davis Health, 4860 Y Street, Suite 3850, Sacramento, CA 95817, USA
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Werner JM, Berggren J, Kim G, Loffredo K, Pascual M, Tiongson E, Seruya M. Recommendations for Therapy following Nerve Transfer for Children with Acute Flaccid Myelitis. Phys Occup Ther Pediatr 2021; 41:209-226. [PMID: 33016189 DOI: 10.1080/01942638.2020.1822981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To provide recommendations for pre- and post-operative occupational and physical therapy for children with acute flaccid myelitis (AFM). METHODS Writing panel members consisted of an interdisciplinary team of seven healthcare professionals specializing in the care of children with AFM. The panel reviewed background material on AFM, nerve transfer, and rehabilitation principles applied to pediatrics. Recommendations were prioritized if evidence was available. Where there was no known evidence to support a recommendation, this was noted. RECOMMENDATIONS Communication and coordination among interprofessional team members are vital to a comprehensive family-centered rehabilitation program. Surgical planning should include team preparation accounting for frequency, duration, and timing of treatment, as well as individual characteristics and developmental status of the child. Recommendations for pre-operative and six phases of post-operative therapy address assessment, strengthening, range of motion, orthoses, performance of functional activity, and support of the family. CONCLUSION Rehabilitation following nerve transfer in children with AFM requires interdisciplinary collaboration and a multisystem approach to assessment and treatment. As new evidence becomes available, recommendations may be revised or replaced accordingly.
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Affiliation(s)
- Julie M Werner
- Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jamie Berggren
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Gina Kim
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kimberly Loffredo
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Marielle Pascual
- Division of Pediatric Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Emmanuelle Tiongson
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Mitchel Seruya
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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25
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Sherf RM, Cantrell D, Or K, Marcus E, Shapira A, Benbassat C, Ish-Shalom S, Koren R. The Risk of Bone Fractures in Post-Poliomyelitis Patients Transitioning to Middle Adulthood. Endocr Pract 2020; 26:1277-1285. [PMID: 33471657 DOI: 10.4158/ep-2020-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/01/2020] [Indexed: 11/15/2022]
Abstract
ObjectiveWhile osteoporotic fractures are reported in up to 40% of adults with post-poliomyelitis syndrome (PPS), clinical guidelines regarding bone mineral density (BMD) and indications for treatment are scarce. We investigated the characteristics of PPS patients, focusing on fractures and osteoporosis as the primary outcomes. METHODS A cross-sectional retrospective data analysis from medical records of 204 PPS patients regarding their clinical characteristics and long-term outcome, with emphasis on bone metabolism status. RESULTS Our cohort included 53% women; mean age was 65 years at study entry and 1.7 years at the diagnosis of acute poliomyelitis. The lower limb was involved in 97.5% of patients, and the BMD in the affected limb tended to be lower than the unaffected, with a mean T-score of -1.64 vs. -1.19, respectively (P = .06). Recurrent falls were documented in 39.2% of patients, and osteoporosis in 20.6%, being more frequent in women (P = .003) and patients with fractures (P = .002). At least one fracture occurred in 52.2% of patients, and more than one in 40.3%. The median age for the first fracture was 57.5 years (range, 30 to 83 years), and most fractures occurred in the affected limb (73.2%). CONCLUSIONS Underdiagnosis and delayed treatment of osteoporosis in late-adulthood post-poliomyelitis patients underlie the need for comprehensive clinical guidelines to manage these patients, including recommendations on bone health assessment, medical treatment, and their inclusion as a high-risk group for bone fractures.
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Affiliation(s)
- Rutie Mamlok Sherf
- Internal Medicine A, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Dror Cantrell
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Internal Medicine C, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Karen Or
- Internal Medicine A, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Efrat Marcus
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Alex Shapira
- Polio Clinic Department of Orthopedics, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Carlos Benbassat
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv.
| | | | - Ronit Koren
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
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26
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Curtis A, Lee JS, Kaltsakas G, Auyeung V, Shaw S, Hart N, Steier J. The value of a post-polio syndrome self-management programme. J Thorac Dis 2020; 12:S153-S162. [PMID: 33214920 PMCID: PMC7642628 DOI: 10.21037/jtd-cus-2020-009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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.
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Affiliation(s)
| | - Jeong Su Lee
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Georgios Kaltsakas
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Vivian Auyeung
- Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Simon Shaw
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Joerg Steier
- Guy's and St Thomas' NHS Foundation Trust, London, UK.,Faculty of Life Sciences and Medicine, King's College, London, UK
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27
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Garceau SP, Igbokwe EN, Warschawski Y, Neufeld ME, Safir OA, Wade JP, Guy P, Wolfstadt JI. Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review. JBJS Rev 2020; 8:e0146. [PMID: 32487976 DOI: 10.2106/jbjs.rvw.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.
Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.
Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Yaniv Warschawski
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael E Neufeld
- Division of Orthopaedics, Department of Adult Joint Reconstruction, Western University, London, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John P Wade
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
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28
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Angerová Y, Mezian K, Kara M, Pudilová V, Sobotová K, Michalčinová K, Konopáčová E, Özçakar L. Ultrasonographic evaluation of the distal femoral and talar cartilage thicknesses in patients with poliomyelitis: a cross-sectional observational study. Eur J Phys Rehabil Med 2020; 56:421-426. [PMID: 32329587 DOI: 10.23736/s1973-9087.20.06127-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sequelae of poliomyelitis, coupled with asymmetric impairment and weight-bearing, typically alter walking biomechanics which can be associated with the knee and ankle osteoarthritis. AIM We aimed to investigate whether the distal femoral and talar cartilage thicknesses were different in patients with poliomyelitis. DESIGN Cross-sectional observational study. SETTING Outpatients, tertiary care center. POPULATION Thirty-six patients (12 males, 24 females) with a history of poliomyelitis and 36 age, gender and body mass index similar healthy subjects (11 males, 25 females) were enrolled. Mean values for age, body mass index and age of the poliomyelitis onset were 70.2±4.6 years, 27.2±5.7 kg/m2, and 3.6±2.4 years. METHODS Visual Analogue Scale (VAS) was used to assess pain. Lower limb muscle strengths were measured by manual muscle testing. The more affected side was identified according to the lower limb manual muscle testing. Bilateral distal femoral cartilage from the lateral femoral condyle, intercondylar area, medial femoral condyle and talar cartilage thicknesses were measured using ultrasound imaging. RESULTS Among patients, the onset of poliomyelitis was at 3.6±2.4 years of age, and Functional Ambulation Category scores were 5 (3-5). VAS scores were similar between the sides affected more and less by poliomyelitis. All cartilage thicknesses (except the talar cartilage) of the patients were found to be thinner on the more affected side than the less affected side (all P<0.001). The thickness of talar cartilage was thinner compared to control subjects (P<0.001). Among the patients, quadriceps muscle strength was positively correlated with medial condyle (r=0.377, P=0.024), intercondylar area (r=0.399, P=0.016) and lateral condyle (r=0.363, P=0.030) thicknesses. Knee VAS scores were negatively correlated with talar cartilage thicknesses (r=-0.393, P=0.018). CONCLUSIONS We found a thinning of the distal femoral condyle in the more affected paretic sides of poliomyelitis patients as compared to both those of less affected sides and those of healthy controls. Talar cartilages on both sides of the patients were thinner compared to control subjects. CLINICAL REHABILITATION IMPACT Our preliminary findings may contribute to the long-term management of patients with long-term poliomyelitis sequelae.
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Affiliation(s)
- Yvona Angerová
- Department of Rehabilitation Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic -
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Veronika Pudilová
- Department of Rehabilitation Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Karolína Sobotová
- Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Klaudia Michalčinová
- Department of Rehabilitation Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic.,Department of Rehabilitation and Sports Medicine, Second Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Eva Konopáčová
- Department of Rehabilitation Medicine, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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29
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Ghelman R, Akiyama IY, de Souza VT, Falcão J, Orgolini V, Hosomi JK, Quadros AAJ, Oliveira ASB. A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial to evaluate the efficacy and safety of an anthroposophic multimodal treatment on chronic pain in outpatients with postpolio syndrome. Brain Behav 2020; 10:e01590. [PMID: 32162497 PMCID: PMC7177555 DOI: 10.1002/brb3.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chronic pain and fatigue are the main symptoms of postpoliomyelitis syndrome (PPS). This study aimed to evaluate the efficacy and safety of an anthroposophic multimodal treatment for chronic pain in PPS outpatients. METHODS A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial was designed to compare four groups (n = 48): groups A and B received daily active experimental transdermal gel (ETG) or placebo gel (PTG), respectively; groups C and D received weekly external therapies, art therapies, and neurofunctional reorganization, plus either daily ETG or PTG, respectively. The pain symptoms were evaluated through a visual analogue scale (VAS), the McGill questionnaire, and thermography. Quality of life and resilience were evaluated by the WHOQOL-BREF and Antonovsky sense of coherence questionnaires applied at baseline and after the interventions. RESULTS No related adverse events occurred, and 10% of the patients reports dysphagia improvement. In the groups C and D, pain reduction was statistically significant in both the placebo group (p = .02, d = 1.315) and in the ETG (p = .005, d = 2.035). However, following the week-to-week evolution of pain with the concomitant use of the ETG, this significant pain reduction occurred earlier from the 4th week and continued to decrease (p = .016, d = 1.369). In the group that received the complete multimodal treatment, the greatest significant benefit in increasing quality of life occurred in the physical domain and elevation in resilience with an emphasis on meaning and comprehension domains. CONCLUSIONS The anthroposophic multimodal treatment group presented both safety and efficacy as an analgesic in the groups that received the nonpharmacological therapies, much earlier when associated with the ETG. The multimodal approach corresponded to the pattern of better efficacy for both pain reduction and improvement in quality of life and resilience.
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Affiliation(s)
- Ricardo Ghelman
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil.,Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Ivete Y Akiyama
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Valeria T de Souza
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jussara Falcão
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Vera Orgolini
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jorge K Hosomi
- Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Abrahão A J Quadros
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
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