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Dahlgren D, Borg K, Melin E. Post-polio syndrome - somatosensory dysfunction and its relation to pain: a pilot study with quantitative sensory testing. J Rehabil Med 2024; 56:jrm26192. [PMID: 38915293 DOI: 10.2340/jrm.v56.26192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/17/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVE To explore and characterize somatosensory dysfunction in patients with post-polio syndrome and chronic pain, by conducting examinations with Quantitative Sensory Testing. DESIGN A cross-sectional, descriptive, pilot study conducted during 1 month. SUBJECTS/PATIENTS Six patients with previously established post-polio syndrome and related chronic pain. METHODS All subjects underwent a neurological examination including neuromuscular function, bedside sensory testing, a thorough pain anamnesis, and pain drawing. Screening for neuropathic pain was done with 2 questionnaires. A comprehensive Quantitative Sensory Testing battery was conducted with z-score transformation of obtained data, enabling comparison with published reference values and the creation of sensory profiles, as well as comparison between the study site (more polio affected extremity) and internal control site (less affected extremity) for each patient. RESULTS Derived sensory profiles showed signs of increased prevalence of sensory aberrations compared with reference values, especially Mechanical Pain Thresholds, with significant deviation from reference data in 5 out of 6 patients. No obvious differences in sensory functions were seen between study sites and internal control sites. CONCLUSION Post-polio syndrome may be correlated with a mechanical hyperalgesia/allodynia and might be correlated to a somatosensory dysfunction. With lack of evident side-to-side differences, the possibility of a generalized dysfunction in the somatosensory system might be considered.
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Affiliation(s)
- Daniel Dahlgren
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Kristian Borg
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Eva Melin
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
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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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Shiri S, Marmor A, Jalagil M, Levine H, Schwartz I, Meiner Z. Psychological Health in Late Effects of Poliomyelitis: Ten-Year Follow-Up. Healthcare (Basel) 2023; 11:3144. [PMID: 38132034 PMCID: PMC10743143 DOI: 10.3390/healthcare11243144] [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: 09/29/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Individuals with late effects of poliomyelitis (LEoP) cope with various physical and psychological symptoms throughout their entire life which become more severe as they are ageing. OBJECTIVES To perform a 10-year follow-up of the functional status and levels of psychological health of individuals with LEoP and to examine the associations of hope levels, work status, health perceptions, and life satisfaction with functional and psychological changes. DESIGN A within-subject 10-year follow-up study. PARTICIPANTS Eighty-two individuals with LEoP who participated in a previous study 10 years ago. METHODS Outcome measures included the functional status of individuals with LEoP assessed by the activities of daily living (ADL) questionnaire, emotional distress based on the Global Health Questionnaire (GHQ), hope based on the Hope Scale, life satisfaction as measured by the Satisfaction with Life Scale (SWLS), and subjective health perception. The McNemar test, paired t-test, Spearman's correlation coefficient, and linear regression were used for statistical analysis. RESULTS The mean age was 66.9 ± 8.5 years with a male-female ratio of 0.52. A significant functional deterioration was noticed during the follow-up years. Yet, the functional deterioration was not associated with changes in psychological health. Psychological health was associated with elevated levels of hope and life satisfaction. Individuals with LEoP who continued to work demonstrated higher psychological health, higher levels of hope, and greater life satisfaction. CONCLUSIONS Individuals with LEoP demonstrated significant psychological health, manifested in their ability to block emotional distress and maintain life satisfaction despite the deterioration in their functional status. Hope and psychological health were associated with increased life satisfaction. Work appeared to be a significant source of psychological health in this population.
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Affiliation(s)
- Shimon Shiri
- Faculty of Medicine, The Hebrew University, Jerusalem 91120, Israel; (A.M.); (M.J.); (I.S.); (Z.M.)
- The Departments of Physical Medicine & Rehabilitation, Hadassah Mount Scopus Hospital, Jerusalem 91120, Israel
| | - Anat Marmor
- Faculty of Medicine, The Hebrew University, Jerusalem 91120, Israel; (A.M.); (M.J.); (I.S.); (Z.M.)
- The Departments of Physical Medicine & Rehabilitation, Hadassah Mount Scopus Hospital, Jerusalem 91120, Israel
| | - Morad Jalagil
- Faculty of Medicine, The Hebrew University, Jerusalem 91120, Israel; (A.M.); (M.J.); (I.S.); (Z.M.)
- The Departments of Physical Medicine & Rehabilitation, Hadassah Mount Scopus Hospital, Jerusalem 91120, Israel
| | - Hagai Levine
- Hadassah Braun School of Public Health, The Hebrew University, Jerusalem 91120, Israel;
| | - Isabella Schwartz
- Faculty of Medicine, The Hebrew University, Jerusalem 91120, Israel; (A.M.); (M.J.); (I.S.); (Z.M.)
- The Departments of Physical Medicine & Rehabilitation, Hadassah Mount Scopus Hospital, Jerusalem 91120, Israel
| | - Zeev Meiner
- Faculty of Medicine, The Hebrew University, Jerusalem 91120, Israel; (A.M.); (M.J.); (I.S.); (Z.M.)
- The Departments of Physical Medicine & Rehabilitation, Hadassah Mount Scopus Hospital, Jerusalem 91120, Israel
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Pereira Motta M, Oliveira ASB, André Nogueira JA, Vieira de Souza Moscardi AA, Munhoz Teixeira C, Manchim Favaro V, Simcsik AO, Conde S, Patrizi MC, Rinaldi C, Fontani V, Rinaldi S. Improving Strength and Fatigue Resistance in Post-Polio Syndrome Individuals with REAC Neurobiological Treatments. J Pers Med 2023; 13:1536. [PMID: 38003851 PMCID: PMC10672477 DOI: 10.3390/jpm13111536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
Post-Polio Syndrome (PPS) is a chronic condition characterized by the emergence of new symptoms and functional decline in individuals who previously had polio. Despite advances in medical understanding, management of PPS remains challenging. This study aimed to evaluate the use of neurobiological modulation treatments using Radio Electric Asymmetric Conveyer (REAC) technology on fatigue and muscle strength. An open-label study was conducted with 17 patients submitted to four neuromodulation protocols: Neuro Postural Optimization (NPO), Neuro Psycho Physical Optimization (NPPO), Neuro Psycho Physical Optimization-Cervico Brachial (NPPO-CB), and Neuromuscular Optimization (NMO). The Time Up and Go (TUG) test, Handgrip Strength Test, and Revised Piper Fatigue Scale (RPFS) were used to assess participants' fatigue and muscle strength, being applied at the beginning and end of each protocol. The results obtained from the improvement in strength, physical endurance, and particularly the RPFS behavioral dimension, affective dimension, and psychological sensory dimension, through the utilization of REAC neurobiological modulation treatments, highlight this correlation. These results suggest that these treatments could be considered as a potential therapeutic approach for PPS.
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Affiliation(s)
- Monalisa Pereira Motta
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Acary Souza Bulle Oliveira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Jeyce Adrielly André Nogueira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | | | - Claudete Munhoz Teixeira
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Vanessa Manchim Favaro
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Amanda Orasmo Simcsik
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Salete Conde
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Maria Clara Patrizi
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo 01000-000, Brazil; (M.P.M.); (J.A.A.N.); (C.M.T.); (V.M.F.); (A.O.S.); (S.C.); (M.C.P.)
| | - Chiara Rinaldi
- Department of Neuroscience, Psychology, Drug Area, and Child Health (NEUROFARBA), University of Florence, 50134 Florence, Italy;
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy;
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Research Department, Rinaldi Fontani Foundation, 50144 Florence, Italy
| | - Vania Fontani
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy;
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Research Department, Rinaldi Fontani Foundation, 50144 Florence, Italy
| | - Salvatore Rinaldi
- Department of Adaptive Neuro Psycho Physio Pathology and Neuro Psycho Physical Optimization, Rinaldi Fontani Institute, 50144 Florence, Italy;
- Department of Regenerative Medicine, Rinaldi Fontani Institute, 50144 Florence, Italy
- Research Department, Rinaldi Fontani Foundation, 50144 Florence, Italy
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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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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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7
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Polio and Its Epidemiology. Infect Dis (Lond) 2023. [DOI: 10.1007/978-1-0716-2463-0_839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Abstract
A 73-year-old man presented with muscle weakness and atrophy of his right arm. Atrophy of his left brachia and left calf had occurred 13 years before without any improvement or deterioration. His sister and cousin had a history of paralytic poliomyelitis. Serum poliovirus type 2 neutralizing antibody was elevated to 128×. Electromyography revealed chronic denervation potentials not only in the muscles affected previously but also in the unaffected muscles. Acute and chronic denervation potentials were found in the newly affected muscle. Postpolio syndrome should be considered in patients with unilateral muscular atrophy even when they have no history of paralytic poliomyelitis.
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Affiliation(s)
- Kengo Maeda
- Department of Neurology, National Hospital Organization Higashi-Ohmi General Medical Center, Japan
| | - Yoshiko Sugihara
- Department of Neurology, National Hospital Organization Higashi-Ohmi General Medical Center, Japan
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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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10
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Kimura Y, Nitta Y, Shibuya M, Fujisawa T. Prolongation of the effect of a single dose of rocuronium in a patient with postpolio syndrome under desflurane anesthesia: a case report. J Dent Anesth Pain Med 2022; 22:233-237. [PMID: 35693355 PMCID: PMC9171338 DOI: 10.17245/jdapm.2022.22.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/15/2022] Open
Abstract
Postpolio syndrome (PPS) is widely known to manifest as muscle weakness in patients affected by poliomyelitis in early childhood. This is caused by the long-term overwork of motor nerves regenerated from surviving nerve cells. We report a characteristic delay in recovery from muscle relaxation after administering rocuronium to a patient with PPS under general anesthesia with desflurane. A 59-year-old woman was scheduled to undergo surgical debridement for jaw osteonecrosis. She had a history of poliomyelitis at the age of 2 years, and was diagnosed with PPS at the age of 51 years. General anesthesia was induced with 80 mg propofol, 50 µg fentanyl, and 30 mg (0.69 mg/kg) rocuronium, and maintained with desflurane and remifentanil. The durations of train-of-four (TOF) count 0 and 1 were 96 and 37 min, respectively. Five minutes after discontinuing desflurane, the TOF count was 4. Three minutes after administering 200 mg sugammadex, the TOF ratio was 0.83, and the tracheal tube was subsequently removed. In summary, the effect of a single dose of rocuronium on twitch in TOF monitoring was significantly prolonged in a patient with PPS, which may have been exacerbated by desflurane.
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Affiliation(s)
- Yukifumi Kimura
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Yukie Nitta
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Makiko Shibuya
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiaki Fujisawa
- Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
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11
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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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Groce NE, Banks LM, Stein MA. The Global Polio Eradication Initiative-polio eradication cannot be the only goal. LANCET GLOBAL HEALTH 2021; 9:e1211. [PMID: 34416208 DOI: 10.1016/s2214-109x(21)00314-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nora Ellen Groce
- UCL International Disability Research Centre, University College London, London, UK.
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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13
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Li Hi Shing S, Lope J, McKenna MC, Chipika RH, Hardiman O, Bede P. Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration. J Neurol Sci 2021; 424:117361. [PMID: 33773768 DOI: 10.1016/j.jns.2021.117361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting. OBJECTIVE The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics. METHODS Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton. RESULTS In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes. CONCLUSIONS Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Selva Sakthipalan SR, Sridhar K, Pandian SK, RajaSundaram S. Mandible reconstruction using a vascularized fibula flap from a post-polio paralytic limb. Int J Oral Maxillofac Surg 2020; 50:1009-1011. [PMID: 33358589 DOI: 10.1016/j.ijom.2020.11.020] [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: 07/04/2020] [Revised: 09/29/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
The case of 69-year-old man with a post-polio paralytic limb who was diagnosed with carcinoma of the lower alveolus is presented. A successful mandible reconstruction was performed using a vascularized fibula osteocutaneous flap harvested from the polio-affected limb. The skin perfusion and quality of the bone were good. The donor defect healed uneventfully. Harvesting the flap from the polio-affected limb also significantly reduced the donor site morbidity. This case is novel in presenting the successful use of a free fibula flap harvested from a leg affected by paralytic poliomyelitis.
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Affiliation(s)
| | - K Sridhar
- Institute of Craniofacial, Aesthetic and Plastic Surgery (ICAPS), SIMS Hospital, Chennai, India
| | - S K Pandian
- Institute of Craniofacial, Aesthetic and Plastic Surgery (ICAPS), SIMS Hospital, Chennai, India
| | - S RajaSundaram
- Global Institute of Oncology, Gleneagles Global Hospital, Chennai, India
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15
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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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Malekmohammad K, Rafieian-Kopaei M, Sardari S, Sewell RDE. Effective Antiviral Medicinal Plants and Biological Compounds Against Central Nervous System Infections: A Mechanistic Review. Curr Drug Discov Technol 2020; 17:469-483. [PMID: 31309894 DOI: 10.2174/1570163816666190715114741] [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: 12/20/2018] [Revised: 03/26/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Infectious diseases are amongst the leading causes of death in the world and central nervous system infections produced by viruses may either be fatal or generate a wide range of symptoms that affect global human health. Most antiviral plants contain active phytoconstituents such as alkaloids, flavonoids, and polyphenols, some of which play an important antiviral role. Herein, we present a background to viral central nervous system (CNS) infections, followed by a review of medicinal plants and bioactive compounds that are effective against viral pathogens in CNS infections. METHODS A comprehensive literature search was conducted on scientific databases including: PubMed, Scopus, Google Scholar, and Web of Science. The relevant keywords used as search terms were: "myelitis", "encephalitis", "meningitis", "meningoencephalitis", "encephalomyelitis", "central nervous system", "brain", "spinal cord", "infection", "virus", "medicinal plants", and "biological compounds". RESULTS The most significant viruses involved in central nervous system infections are: Herpes Simplex Virus (HSV), Varicella Zoster Virus (VZV), West Nile Virus (WNV), Enterovirus 71 (EV71), Japanese Encephalitis Virus (JEV), and Dengue Virus (DENV). The inhibitory activity of medicinal plants against CNS viruses is mostly active through prevention of viral binding to cell membranes, blocking viral genome replication, prevention of viral protein expression, scavenging reactive Oxygen Species (ROS), and reduction of plaque formation. CONCLUSION Due to the increased resistance of microorganisms (bacteria, viruses, and parasites) to antimicrobial therapies, alternative treatments, especially using plant sources and their bioactive constituents, appear to be more fruitful.
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Affiliation(s)
- Khojasteh Malekmohammad
- Department of Animal Sciences, Faculty of Basic Sciences, Shahrekord University, Shahrekord, Iran
| | - Mahmoud Rafieian-Kopaei
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Samira Sardari
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Robert D E Sewell
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, United Kingdom
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Gusi N, Madruga M, González-González MDLÁ, Pérez-Gómez J, Prieto-Prieto J. Health-related quality of life and multidimensional fitness profile in polio survivors. Disabil Rehabil 2020; 44:1374-1379. [PMID: 32790481 DOI: 10.1080/09638288.2020.1804629] [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: 10/23/2022]
Abstract
PURPOSE To assess and compare the HRQoL and physical fitness of polio survivors with healthy individuals. METHODS Thirty-seven polio survivors and 40 healthy individuals were recruited in this cross-sectional study. The Fatigue Severity Scale (FSS) was used to evaluate participant's level of fatigue; Short Form 36 (SF-36) was used for evaluating HRQoL, and hand-grip strength, lumbar trunk muscle endurance, flexibility, balance, and aerobic endurance were used as measures for physical fitness. RESULTS Polio survivors had lower HRQoL in most of the dimensions of the SF-36, and they showed a lower level of physical fitness than controls. In particular, mobility-related variables were 20-40% lower in people with PP. CONCLUSIONS Subjects with PP had lower scores for the physical component of the HRQoL questionnaire, reduced physical fitness, increased fatigue, less mobility, and a higher fall risk than controls. The outcomes of the study can be useful to the design of future programs tailored specifically to improve the assessment of the physical fitness of subjects with paralytic polio and to facilitate interventions based on appropriate physical exercise regimens.Implications for rehabilitationPost-polio syndrome is a disabling disease that impacts in fitness, physical and psychological health-related quality of life of polio survivors.Polio survivors should undergo physical activity programs that focus on improving mainly their mobility and physical functioning (walking, self-care, and climbing stairs), thereby reducing fall risk and fatigue.Individual tailored physical exercise programs should be promoted in order to improve HRQoL in this population.
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Affiliation(s)
- Narcís Gusi
- Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain
| | - Miguel Madruga
- Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain
| | | | - Jorge Pérez-Gómez
- Faculty of Sports Sciences, University of Extremadura, Cáceres, Spain
| | - Josué Prieto-Prieto
- University School of Education and Tourism of Avila, University of Salamanca, Salamanca, Spain
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Gocheva V, Hafner P, Orsini AL, Schmidt S, Schaedelin S, Rueedi N, Rubino-Nacht D, Weber P, Fischer D. Health-related quality of life, self-reported impairments and activities of daily living in relation to muscle function in post-polio syndrome. J Patient Rep Outcomes 2020; 4:59. [PMID: 32676980 PMCID: PMC7364696 DOI: 10.1186/s41687-020-00226-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The symptoms of post-polio syndrome (PPS) and its resulting disabilities can affect quality of life and the ability to perform daily activities. No study has comprehensively analysed how various patient-reported outcome measures (PROMs) are associated with objectively assessed physical function in patients with PPS. AIM To investigate health-related quality of life (HRQOL), self-reported impairments and activities of daily living during 6 months and evaluate their association with clinical muscle function outcomes in individuals with PPS. METHODS Twenty-seven patients with PPS were included in the study. At baseline and 6 months, patients were administered PROMs measuring HRQOL (WHOQOL-BREF), self-reported impairments related to PPS (SIPP-RS) and activities of daily living (IBM-FRS). Clinical muscle function outcomes included 6 min walking distance (6MWD) and motor function measure (MFM). RESULTS There were no changes in self-reported impairments (25.52 to 24.93, p = 0.40), activities of daily living (33.89 to 33.30, p = 0.20), 6MWD (391.52 to 401.85, p = 0.30) and MFM (83.87 to 85.46, p = 0.14) during 6 months, while the HRQOL psychological health decreased during this period (76.85 to 72.38, p = 0.05). A strong association was found between activities of daily living and clinical muscle function outcomes (6MWD: ß = 0.02, 95% CI: 0.02;0.03, t = 6.88, p < 0.01; MFM: ß = 0.25, 95% CI: 0.17;0.33, t = 6.69, p < 0.01). Self-reported impairments and HRQOL domains were not associated with the clinical muscle outcomes. CONCLUSIONS Study findings indicate that objectively measured walking and motor abilities do not reflect patient's perspectives of their HRQOL and impairment due to PPS. More research is needed to assess changes over time and capture clinically meaningful changes in individuals with PPS and to increase the understanding of how the patient's perspective of disability measured by PROMs is related to objectively measured walking and motor abilities. TRIAL REGISTRATION ClinicalTrials.gov Identifier ( NCT02801071 ) registered June 15, 2016.
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Affiliation(s)
- Vanya Gocheva
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland.
| | - Patricia Hafner
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Anna-Lena Orsini
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
- Division of Neurology, University Hospital Basel, Basel, Switzerland
| | - Simone Schmidt
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Vienna, Austria
| | - Sabine Schaedelin
- Department of Clinical Research, Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Nicole Rueedi
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Daniela Rubino-Nacht
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Peter Weber
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Dirk Fischer
- Division of Neuropediatrics and Developmental Medicine, University Children's Hospital of Basel (UKBB),University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
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Sawada K, Horii M, Imoto D, Ozaki K, Toyama S, Saitoh E, Mikami Y, Kubo T. Usefulness of Electromyography to Predict Future Muscle Weakness in Clinically Unaffected Muscles of Polio Survivors. PM R 2020; 12:692-698. [DOI: 10.1002/pmrj.12281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/24/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Koshiro Sawada
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Motoyuki Horii
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Daisuke Imoto
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Kenichi Ozaki
- Department of Rehabilitation Medicine 1School of Medicine, Fujita Health University Toyoake Japan
| | - Shogo Toyama
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine 1School of Medicine, Fujita Health University Toyoake Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
| | - Toshikazu Kubo
- Department of Rehabilitation Medicine, Graduate School of Medical ScienceKyoto Prefectural University of Medicine Kyoto Japan
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Corticomotor Excitability in Two Kinds of Motor Neuron Diseases: A Study on the Patients With Amyotrophic Lateral Sclerosis and Poliomyelitis Survivors. J Clin Neurophysiol 2020; 38:448-455. [DOI: 10.1097/wnp.0000000000000707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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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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Skough Vreede K, Broman L, Borg K. Is Intervention to Prevent Falls Necessary in Prior Polio Patients? JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2020; 3:1000023. [PMID: 33884127 PMCID: PMC8008737 DOI: 10.2340/20030711-1000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/19/2022]
Abstract
Objective To investigate whether intervention to prevent falls is necessary in prior polio patients, by identifying the frequency, circumstances and consequences of falls among patients in Sweden with prior polio. Subjects Patients with prior polio diagnosis. Methods A falls history questionnaire was completed by patients with prior polio visiting the outpatient clinic at the Department of Rehabilitation Medicine, Danderyd University Hospital, Stock-holm, Sweden, or participating in group activities organized by the patient organization. Results A total of 80 patients answered the questionnaire; 32 men and 48 women. Eighty-one percent (n = 63/77) of respondents walked outdoors, but rarely more than 1 km, or only inside and near the house. Three-quarters of patients had fallen one or more times over the past year and one-quarter of patients had fallen 5 times or more. The falls often occurred during daytime in an environment known to the patient. Sixty-nine percent (n = 40/58) of respondents had been injured due to falling during the past year. The most common injuries were minor injuries. Conclusion Falls are common in patients in Sweden with prior polio. Interventions to prevent falls in people with prior polio are therefore clinically relevant.
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Affiliation(s)
- Katarina Skough Vreede
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Broman
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Borg
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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Peel MM. Epidemic poliomyelitis, post-poliomyelitis sequelae and the eradication program. MICROBIOLOGY AUSTRALIA 2020. [DOI: 10.1071/ma20053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Epidemics of paralytic poliomyelitis (polio) first emerged in the late 19th and early 20th centuries in the United States and the Scandinavian countries. They continued through the first half of the 20th century becoming global. A major epidemic occurred in Australia in 1951 but significant outbreaks were reported from the late 1930s to 1954. The poliovirus is an enterovirus that is usually transmitted by the faecal–oral route but only one in about 150 infections results in paralysis when the central nervous system is invaded. The Salk inactivated polio vaccine (IPV) became available in Australia in 1956 and the Sabin live attenuated oral polio vaccine (OPV) was introduced in 1966. After decades of stability, many survivors of the earlier epidemics experience late-onset sequelae including post-polio syndrome. The World Health Organization launched the global polio eradication initiative (GPEI) in 1988 based on the easily administered OPV. The GPEI has resulted in a dramatic decrease in cases of wild polio so that only Pakistan and Afghanistan report such cases in 2020. However, a major challenge to eradication is the reversion of OPV to neurovirulent mutants resulting in circulating vaccine-derived poliovirus (cVDPV). A novel, genetically stabilised OPV has been developed recently to stop the emergence and spread of cVDPV and OPV is being replaced by IPV in immunisation programs worldwide. Eradication of poliomyelitis is near to achievement and the expectation is that poliomyelitis will join smallpox as dreaded epidemic diseases of the past that will be consigned to history.
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Oluwasanmi OJ, Mckenzie DA, Adewole IO, Aluka CO, Iyasse J, Olunu E, Fakoya AO. Postpolio Syndrome: A Review of Lived Experiences of Patients. Int J Appl Basic Med Res 2019; 9:129-134. [PMID: 31392174 PMCID: PMC6652271 DOI: 10.4103/ijabmr.ijabmr_333_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Postpolio syndrome (PPS) refers to a group of conditions that are present in patients, years after recovery from initial acute paralytic poliomyelitis. About 15%-80% of 20 million polio survivors worldwide will experience exacerbation of symptoms which typically appear 15-30 years after the resolution of initial poliomyelitis. Symptoms include new muscle weakness, fatigue, myalgia, joint pain, dysphagia, and difficulty breathing. Other reported symptoms include cold intolerance, sleep disorder, dysphonia, loss of stamina, musculoskeletal deformities, cardiovascular disorders, psychosocial problems, and restless legs syndrome. These symptoms are attributed to the superimposed neuronal loss of aging with inflammatory mechanisms, but without any convincing evidence of viral reactivation. Risk factors include female gender, respiratory symptoms, normal aging, permanent disability caused by motor neuron damage, muscle overuse and disuse, aging, and immunologic mechanisms. Hypothyroidism-induced myopathy and fibromyalgia are a differential diagnosis for PPS, and exclusion diagnosis is required as confirmatory criteria for PPS. The symptoms of PPS presented determine the course of management.
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Affiliation(s)
- Oluwaseyi Jacob Oluwasanmi
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - Devaunna Andrene Mckenzie
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - Idowu Oluwasegun Adewole
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - Christian O Aluka
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - James Iyasse
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - Esther Olunu
- Department of Microbiology, All Saints University School of Medicine, Commonwealth of Dominica, Roseau, Dominica
| | - Adegbenro Omotuyi Fakoya
- Department of Anatomical Sciences, University of Medicine and Health Sciences, Basseterre, St. Kitts and Nevis
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Li Hi Shing S, Chipika RH, Finegan E, Murray D, Hardiman O, Bede P. Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease. Front Neurol 2019; 10:773. [PMID: 31379723 PMCID: PMC6646725 DOI: 10.3389/fneur.2019.00773] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
Post-polio syndrome (PPS) is a neurological condition that affects polio survivors decades after their initial infection. Despite its high prevalence, the etiology of PPS remains elusive, mechanisms of progression are poorly understood, and the condition is notoriously under-researched. While motor dysfunction is a hallmark feature of the condition, generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS. The non-motor aspects of PPS are particularly challenging to evaluate, quantify, and treat. Generalized fatigue is one of the most distressing symptoms of PPS and is likely to be multifactorial due to weight-gain, respiratory compromise, poor sleep, and polypharmacy. No validated diagnostic, monitoring, or prognostic markers have been developed in PPS to date and the mainstay of therapy centers on symptomatic relief and individualized rehabilitation strategies such as energy conservation and muscle strengthening exercise regimes. Despite a number of large clinical trials in PPS, no effective disease-modifying pharmacological treatments are currently available.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Gensowski M, Nielsen TH, Nielsen NM, Rossin-Slater M, Wüst M. Childhood health shocks, comparative advantage, and long-term outcomes: Evidence from the last Danish polio epidemic. JOURNAL OF HEALTH ECONOMICS 2019; 66:27-36. [PMID: 31100634 DOI: 10.1016/j.jhealeco.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 06/09/2023]
Abstract
This paper examines the long-term effects of childhood disability on individuals' educational and occupational choices, late-career labor market participation, and mortality. We merge medical records on children hospitalized with poliomyelitis during the 1952 Danish epidemic to census and administrative data, and exploit quasi-random variation in paralysis incidence in this population. While childhood disability increases the likelihood of early retirement and disability pension receipt at age 50, paralytic polio survivors are more likely to obtain a university degree and to go on to work in white-collar and computer-demanding jobs than their non-paralytic counterparts. Our results are consistent with individuals making educational and occupational choices that reflect a shift in the comparative advantage of cognitive versus physical skills. We also find that paralytic polio patients from low socioeconomic status backgrounds are more likely to die prematurely than their non-paralytic counterparts, whereas there is no effect on mortality among polio survivors from more advantaged backgrounds.
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Affiliation(s)
- Miriam Gensowski
- University of Copenhagen, Department of Economics & CEBI, Denmark, and IZA, Germany.
| | | | | | | | - Miriam Wüst
- University of Copenhagen, Department of Economics and The Danish Centre for Social Science Research (VIVE), Øster Farimagsgade 5, DK 1353, Copenhagen K, Denmark.
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Da Silva CP, Miller LA, Morrel EC, Wang W. Predictive Abilities of Balance Confidence and Fear of Falling Measures on Falls in Polio Survivors. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1610542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Carolyn P. Da Silva
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- TIRR-Memorial Hermann Rehabilitation and Research Out-Patient Medical Specialty Clinic, Post-Polio Clinic, Houston, Texas, USA
| | - Lesley A. Miller
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- Physical Therapy Department, Lyndon B Johnson Hospital, Houston, Texas, USA
| | - Emily C. Morrel
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- Vitalico, Houston, Texas, USA
| | - Wanyi Wang
- Center for Research Design and Analysis, Office of Research and Sponsored Programs, Texas Woman's University, Houston, Texas, USA
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Li J, Hu Z, Tseng C, Zhao Z, Yuan Y, Zhu Z, Qiu Y, Liu Z. Radiographic and Clinical Outcomes of Surgical Correction of Poliomyelitis-Related Spinal Deformities: A Comparison Among Three Types of Pelvic Instrumentations. World Neurosurg 2018; 122:e1111-e1119. [PMID: 30439526 DOI: 10.1016/j.wneu.2018.10.238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND We compared the clinical and radiographic outcomes of corrective surgery in patients with poliomyelitis-related spinal deformity (PSD) using 3 types of pelvic fixation and investigated the incidence and risk factors for complications. METHODS We reviewed the data from 42 patients with PSD who had undergone spinopelvic reconstruction at a single institution from 2000 to 2016. Of the 42 patients, 15 had been treated with the Galveston technique, 13 with iliac screw fixation, and 14 with S2-alar-iliac (S2AI) screw fixation. Demographic data, radiographic parameters, and complications were analyzed. Health-related quality of life was determined using Scoliosis Research Society (SRS) 22-item questionnaires and the Oswestry Disability Index scores. RESULTS After surgery, the correction rate of the main curve was 51.7%, 57.8%, and 52.1% in the 3 groups, with significant improvement in regional kyphosis, coronal balance, and pelvic obliquity (PO) (P < 0.05). The correction of PO was similar among the 3 types of pelvic fixation; however, the patients treated with S2AI fixation required significantly less operative time (P < 0.05) and blood loss (P < 0.006). The overall complication rate was 40.5%, with a major complication rate of 23.8%. Age at surgery (P = 0.006) and grade >2 SRS-Schwab osteotomy (P = 0.036) were significant risk factors for complications. Significant improvement was found in the SRS-22 and Oswestry Disability Index scores at the final follow-up examination in the 3 groups. CONCLUSIONS The present study showed satisfactory correction of spinopelvic deformity for 42 patients with PSD. Compared with the Galveston technique and iliac screw fixation, the use of S2AI significantly decrease the operative time and estimated blood loss and obtained similar correction of PO. Patient age at surgery and grade >2 SRS-Schwab osteotomy were significant risk factors for complications.
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Affiliation(s)
- Jie Li
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zongshan Hu
- Department of Orthopaedics and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Changchun Tseng
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhihui Zhao
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yiwen Yuan
- Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Zezhang Zhu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- Department of Spine Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
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Galvão TS, Magalhães Júnior ES, Orsini Neves MA, de Sá Ferreira A. Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects. Physiother Theory Pract 2018; 36:899-906. [PMID: 30183497 DOI: 10.1080/09593985.2018.1512178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = -13, CI 95% -16 to -9 points), lower dynamic postural stability (MD = -14, CI 95% -19 to -8 points), and increased fear of falling (MD = 14, CI 95% 10-18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738-0.351), risk of falling (ρ = -0.746), and fear of falling (ρ = -0.432). Dynamic postural stability was correlated with risk of falling (ρ = -0.841), fear of falling (ρ = -0.277), and static postural stability (ρ = -0.869 to -0.435; ρ = -0.361 to -0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.
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Affiliation(s)
- Thaiana Santos Galvão
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Egídio Sabino Magalhães Júnior
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Marco Antonio Orsini Neves
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
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Zúñiga-Cerón LF, Saavedra-Torres JS, Zamora-Bastidas TO, Pinzón-Fernández MV. Post-polio syndrome, report of two cases. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n2.68235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El síndrome pospoliomielitis se reconoce como un trastorno neurológico que aparece décadas después de un episodio agudo de poliomielitis y disminuye la capacidad funcional hasta afectar las actividades cotidianas. El evento ocurre en un 20-80% de las personas que fueron afectadas por el virus de la poliomielitis, es más frecuente en las mujeres y existe una relación directa entre el riesgo de padecer este síndrome y el grado de severidad de las secuelas de la polio. El objetivo de este artículo es la presentación de dos casos clínicos de pacientes que presentaron este síndrome después de cerca de cuarenta años de haber presentado un episodio de poliomielitis. Se cuestiona el concepto de la poliomielitis como una enfermedad estática; además, en los casos presentados esta patología constituye un proceso de difícil diagnóstico y manejo. El impacto psicológico y funcional en los pacientes se asume como un reto para el profesional de salud, puesto que se deben identificar las necesidades clínicas y reducir las barreras asistenciales existentes en la actualidad.
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Prasad A, Donovan R, Ramachandran M, Dawson-Bowling S, Millington S, Bhumbra R, Achan P, Hanna SA. Outcome of total knee arthroplasty in patients with poliomyelitis: A systematic review. EFORT Open Rev 2018; 3:358-362. [PMID: 30034816 PMCID: PMC6026880 DOI: 10.1302/2058-5241.3.170028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Total knee arthroplasty (TKA) in patients affected by poliomyelitis is technically challenging owing to abnormal anatomical features including articular and metaphyseal angular deformities, external rotation of the tibia, excessive valgus alignment, bone loss, narrowness of the femoral and tibial canals, impaired quadriceps strength, flexion contractures, genu recurvatum and ligamentous laxity. Little information is available regarding the results and complications of TKA in this challenging group of patients. We carried out a systematic review of the literature to determine the functional outcome, complications and revision rates of TKA in patients with poliomyelitis-affected knees. Six studies including 82 knees met the inclusion criteria and were reviewed. The mean patient age was 63 years (45 to 85) and follow-up was 5.5 years (0.5 to 13). All studies reported significant improvement in knee function following TKA. There were six failures requiring revision surgery in 82 cases (7%) occurring at a mean of 6.2 years (0.4 to 12). The reasons for revision surgery were aseptic loosening (17%, n=1), infection (33%, n=2), periprosthetic fracture (17%, n=1) and instability (33%, n=2). Thirty-six knees had a degree of recurvatum pre-operatively (44%), which was in the range of 5° to 30°. Ten of these knees (28%) developed recurrent recurvatum post-operatively. The findings support the use of TKA in patients with poliomyelitis-affected knees. The post-operative functional outcome is similar to other patients; however, the revision rate is higher. Quadriceps muscle power appears to be an important prognostic factor for functional outcome and the use of constrained implant designs is recommended in the presence of less than antigravity quadriceps strength.
Cite this article: EFORT Open Rev 2018;3:358-362. DOI: 10.1302/2058-5241.3.170028
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Affiliation(s)
- Anoop Prasad
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | - Richard Donovan
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | | | | | - Steven Millington
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | - Rej Bhumbra
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | - Pramod Achan
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | - Sammy A Hanna
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
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Abstract
Poliomyelitis, often termed "polio," is an acute infectious disease caused by an enterovirus which damages the anterior horn cells of the spinal cord and brainstem. Progress to lower motor neurone cell death leads to disruption of motor units and subsequent muscle weakness or complete paralysis. Although the virus is mostly eradicated from the Western world, postpolio decline is prevalent among people aged 60 years and over. It is characterized primarily by fatigability and muscle weakness, but pain is also common. Reductions in lower-limb muscle strength, voluntary drive, and endurance are likely to contribute to the impaired balance control, slow gait, and dysfunctional lower-limb kinematics reported in polio survivors. Given these significant risk factors, polio survivors fall up to four times more often than their age-matched healthy peers. Interventions to improve function, reduce disability, and prevent falls in polio survivors are therefore clinically relevant but studies are lacking, limiting the evidence base. Balance training, cognitive behavioral therapy, and orthoses prescription might be recommended. Muscle-strengthening programs should be carefully designed and delivered due to their potential detrimental effects related to excessive use and potential dysfunction of motor neurones and their axons.
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Affiliation(s)
- Jasmine C Menant
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia.
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Atwal A, Duncan H, Queally C, Cedar SH. Polio survivors perceptions of a multi-disciplinary rehabilitation programme. Disabil Rehabil 2017; 41:150-157. [PMID: 28974103 DOI: 10.1080/09638288.2017.1381184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Post-polio syndrome refers to a late complication of the poliovirus infection. Management of post-polio syndrome is complex due to the extensive symptomology. European and United Kingdom guidelines have advised the use of rehabilitation programmes to manage post-polio syndrome. There is a paucity of research in relation to the effectiveness of rehabilitation interventions. The objective of this study is to explore polio survivor's perceptions of an in-patient multi-disciplinary rehabilitation programme. METHODS Semi-structured interviews of community dwelling polio survivors who attended in-patient rehabilitation programme in the United Kingdom. Thematic analysis was used to describe and interpret interview data. RESULTS Participants' experiences were influenced by past experiences of polio and their self-concept. Participants generally had a positive experience and valued being with other polio survivors. Positive strategies, such as pacing and reflection changed their mind-sets into their lives after the programme, though they still faced challenges in daily living. Some participants supported others with post-polio syndrome after completing the programme. CONCLUSIONS Our research identified that participants experienced long term positive benefits from attending a rehabilitation programme. Strategies that users found helpful that explored the effectiveness of interventions to manage polio are not cited within a Cochrane review. If we are to recognise the lived experience and service user empowerment within a model of co- production it is essential that patient preferences are evaluated and used as evidence to justify service provision. Further research is required with polio survivors to explore how best rehabilitation programmes can adopt the principles of co-production. Implications for Rehabilitation The patients' expertise and lived experience must be at the centre of a rehabilitation programme. Strategies such as pacing and reflection are perceived as important strategies to enable self-management of polio and post-polio syndrome despite the limited evidence base to support these interventions. Polio rehabilitation programmes should not be time limited and commissioners and therapists need to ensure that follow up support is provided. When measuring outcomes patient preferences and views must be evaluated.
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Affiliation(s)
- Anita Atwal
- a School of Health and Social Care , London Southbank University , London , UK
| | - Helen Duncan
- b School of Health and Social Care , Brunel University , London , UK
| | - Claire Queally
- b School of Health and Social Care , Brunel University , London , UK
| | - S H Cedar
- a School of Health and Social Care , London Southbank University , London , UK
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Restless legs syndrome is highly prevalent in patients with post-polio syndrome. Sleep Med 2017; 37:147-150. [DOI: 10.1016/j.sleep.2017.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/17/2017] [Accepted: 06/15/2017] [Indexed: 12/13/2022]
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Shoseyov D, Cohen-Kaufman T, Schwartz I, Portnoy S. Comparison of activity and fatigue of the respiratory muscles and pulmonary characteristics between post-polio patients and controls: A pilot study. PLoS One 2017; 12:e0182036. [PMID: 28750019 PMCID: PMC5531432 DOI: 10.1371/journal.pone.0182036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/11/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To compare pulmonary function measures, maximal respiratory pressure and fatigue of respiratory muscles between patients with Post-Polio Syndrome (PPS) and controls. DESIGN Cross-sectional study. PATIENTS Patients with PPS (N = 12; age 62.1±11.6 years) able to walk for 6 minutes without human assistance; age-matched controls with no history of polio or pulmonary dysfunction (N = 12; age 62.2±6.5 years). MEASUREMENTS A body plethysmograph was used to quantify Residual Volume (RV), Total Lung Capacity (TLC), and Thoracic Gas Volume (TGV) etc. A manometer was used to measure Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure. A spirometer was used to measure Maximal Voluntary Ventilation (MVV). Surface electromyography (sEMG) recorded diaphragmatic muscle activity while performing MVV. RESULTS The control group had significantly higher TGV and showed improvement in MIP following the effort (difference of 5.5±4.0cmH2O) while the PPS group showed deterioration in MIP (difference of -2.5±5.0cmH2O). Subjects with scoliosis had significantly higher RV/TLC values compared with subjects without scoliosis. The 25th frequency percentile of the sEMG signal acquired during MVV was reduced in the PPS group. CONCLUSIONS Maximal respiratory pressure test and sEMG measurements may identify fatigue of respiratory muscles in patients with PPS. Early diagnosis of respiratory impairment may delay respiratory decline and future need of invasive respiratory aids.
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Affiliation(s)
- David Shoseyov
- Pediatric department, Hadassah Mount Scopus, Jerusalem, Israel
| | - Tali Cohen-Kaufman
- Physical Medicine and Rehabilitation department, Hadassah Mount Scopus, Jerusalem, Israel
- Department of Physiotherapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Isabella Schwartz
- Physical Medicine and Rehabilitation department, Hadassah Mount Scopus, Jerusalem, Israel
| | - Sigal Portnoy
- Physical Medicine and Rehabilitation department, Hadassah Mount Scopus, Jerusalem, Israel
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jones KM, Balalla S, Theadom A, Jackman G, Feigin VL. A systematic review of the worldwide prevalence of survivors of poliomyelitis reported in 31 studies. BMJ Open 2017; 7:e015470. [PMID: 28694346 PMCID: PMC5734404 DOI: 10.1136/bmjopen-2016-015470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Accurate prevalence figures estimating the number of survivors of poliomyelitis (disease causing acute flaccid paralysis) following poliovirus infection are not available. We aim to undertake a systematic review of all literature concerning the prevalence of survivors of poliomyelitis. METHODS Electronic databases were searched from 1900 up to May 2016 for peer-reviewed studies using a population-based approach witha defined denominator and some form of diagnostic or clinical verification of polio. Exclusion criteria were any prevalence data that were unable to be extracted or calculated and studies reporting on incidence only. The quality of each included study was assessed using an existing tool modified for use in prevalence studies. Average crude prevalence rates were used to calculate worldwide estimates. RESULTS Thirty-one studies met criteria with 90% of studies conducted in low-income to lower middle-income countries. Significant variability in the prevalence of survivors of poliomyelitis was revealed, in low- income to lower middle-income (15 per 100 000 in Nigeria to 1733 in India) and upper-middle to high-income countries (24 (Japan) to 380 per 100 000 (Brazil). The total combined prevalence of survivors of poliomyelitis for those studies at low to moderate risk of bias ranged from 165 (high-income countries) to 425 (low-income to lower middle-income countries) per 100 000 person-years. Historical lameness surveys of children predominated, with wide variation in case definition and assessment criteria, and limited relevance to current prevalence given the lack of incidence of poliovirus infection in the ensuing years. CONCLUSIONS These results highlight the need for future epidemiological studies of poliomyelitis to examine nationally representative samples, including all ages and greater focus on high-income countries. Such efforts will improve capacity to provide reliable and more robust worldwide prevalence estimates.
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Affiliation(s)
- Kelly M Jones
- National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland, New Zealand
| | - Shivanthi Balalla
- National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland, New Zealand
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland, New Zealand
| | | | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Public Health & Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Dr, Northcote 0627, Private Bag 92006, Auckland, New Zealand
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Diagnosing Post-Polio Syndrome in the Elderly, a Case Report. Geriatrics (Basel) 2017; 2:geriatrics2020014. [PMID: 31011024 PMCID: PMC6371137 DOI: 10.3390/geriatrics2020014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/22/2017] [Accepted: 04/25/2017] [Indexed: 11/16/2022] Open
Abstract
Poliomyelitis is a disorder of the nervous system caused by an enterovirus. There are many survivors who, years later, develop a little-understood condition called Post-polio syndrome. Post-polio syndrome is a group of delayed sequalae of polio infection that can cause paralysis and bulbar symptoms in patients with a history of polio infection who have had a prolonged symptom-free period, often greater than two decades. Diagnosis of post-polio syndrome is difficult in the geriatric population because many of the symptoms overlap with other disease processes affecting older individuals. An extensive workup is necessary to exclude more concerning etiologies. Furthermore, several symptoms can be attributed to normal ageing. We present the case of an elderly patient with a history of poliomyelitis and multiple comorbidities who presented with complaints of weakness and fatigue.
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Da Silva CP, Zuckerman B, Olkin R. Relationship of depression and medications on incidence of falls among people with late effects of polio. Physiother Theory Pract 2017; 33:370-375. [PMID: 28398102 DOI: 10.1080/09593985.2017.1307889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to determine if falls in polio survivors, with or without post-polio syndrome (PPS), are related to number of medications taken, use of anti-depressant or psychoactive medications, or self-report of depression. A survey was sent to 300 members of a regional polio support group, asking them to document their fall history, medications used, and the presence of depression. Depression was measured by self-report and with the Geriatric Depression Scale, short form (GDS-15). One hundred and seventy-two usable surveys were returned with 146 of those completing the medication list. Sixty-two percent reported at least one fall in the past year. The multiple logistic regression was significant (p = 0.023), and it indicated depression to be a significant predictor (p = 0.012) of falls in polio survivors with and without PPS. The number of total medications or anti-depressant or psychoactive medications used was not related to fall incidence. Routine screening and treatment for depression may be one aspect of fall prevention which can be implemented through primary care.
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Affiliation(s)
- Carolyn P Da Silva
- a School of Physical Therapy , Texas Woman's University , Houston , TX , USA
| | - Bianca Zuckerman
- b RehabCare , Park Manor Skilled Nursing Facility , Humble , TX , USA.,c Department of Rehabilitation , Deerbrook Skilled Nursing Facility , Humble , TX , USA
| | - Rhoda Olkin
- d Department of Clinical Psychology , Alliant International University , San Francisco , CA , USA
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Arazpour M, Ahmadi F, Bahramizadeh M, Samadian M, Mousavi ME, Bani MA, Hutchins SW. Evaluation of gait symmetry in poliomyelitis subjects: Comparison of a conventional knee-ankle-foot orthosis and a new powered knee-ankle-foot orthosis. Prosthet Orthot Int 2016; 40:689-695. [PMID: 26269446 DOI: 10.1177/0309364615596063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/02/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Compared to able-bodied subjects, subjects with post-polio syndrome and poliomyelitis demonstrate a preference for weight-bearing on the non-paretic limb, causing gait asymmetry. OBJECTIVES The purpose of this study was to evaluate the gait symmetry of the poliomyelitis subjects when ambulating with either a drop-locked knee-ankle-foot orthosis or a newly developed powered knee-ankle-foot orthosis. STUDY DESIGN Quasi experimental study. METHODS Seven subjects with poliomyelitis who routinely wore conventional knee-ankle-foot orthoses participated in this study and received training to enable them to ambulate with the powered knee-ankle-foot orthosis on level ground, prior to gait analysis. RESULTS There were no significant differences in the gait symmetry index of step length (p = 0.085), stance time (p = 0.082), double-limb support time (p = 0.929), or speed of walking (p = 0.325) between the two test conditions. However, using the new powered knee-ankle-foot orthosis improved the symmetry index in step width (p = 0.037), swing time (p = 0.014), stance phase percentage (p = 0.008), and knee flexion during swing phase (p ⩽ 0.001) compared to wearing the drop-locked knee-ankle-foot orthosis. CONCLUSION The use of a powered knee-ankle-foot orthosis for ambulation by poliomyelitis subjects affects gait symmetry in the base of support, swing time, stance phase percentage, and knee flexion during swing phase. CLINICAL RELEVANCE A new powered knee-ankle-foot orthosis can improve gait symmetry for poliomyelitis subjects by influencing step width, swing time, stance time percentage, and knee flexion during swing phase when compared to ambulating with a drop-locked knee-ankle-foot orthosis.
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Affiliation(s)
- Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran.,Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fardin Ahmadi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Samadian
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ebrahim Mousavi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Stephen W Hutchins
- Institute of Health & Social Care Research (IHSCR), Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
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Werhagen L, Borg K. Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic. Neurol Sci 2016; 37:1597-601. [DOI: 10.1007/s10072-016-2629-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/03/2016] [Indexed: 11/28/2022]
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Vreede KS, Sunnerhagen KS. Characteristics of Patients at First Visit to a Polio Clinic in Sweden. PLoS One 2016; 11:e0150286. [PMID: 26981623 PMCID: PMC4794193 DOI: 10.1371/journal.pone.0150286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 02/11/2016] [Indexed: 11/18/2022] Open
Abstract
AIM Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957. DESIGN A consecutive cohort study. PATIENTS Prior polio patients. METHODS All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study. RESULTS More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61-71% slower, and were 53-77% weaker in muscle strength of the knee and foot as well as grip strength. CONCLUSION The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years.
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Affiliation(s)
- Katarina Skough Vreede
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Katharina S. Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Unusual MRI Findings in a Polio Survivor. Case Rep Orthop 2016; 2016:3179621. [PMID: 27069705 PMCID: PMC4812215 DOI: 10.1155/2016/3179621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/01/2016] [Indexed: 01/27/2023] Open
Abstract
A 63-year-old male consulted our institution due to worsening of right hip pain for approximately one month. The patient had no apparent functional disorders besides rigidity of the right ankle secondary to childhood poliomyelitis. Plain radiographs demonstrated narrowing of the right hip joint space. Magnetic resonance imaging (MRI) showed unusual findings in the right gluteus medius muscle, suspecting a malignant musculoskeletal tumor. Further examinations clarified acute inflammation caused by Staphylococcus aureus with no atypia. After treatment, serum inflammatory markers normalized and MRI showed homogeneous fat signal intensity in the muscle, which was consistent with poliomyelitis. Total hip arthroplasty was performed due to progression of osteoarthritis. Intraoperative findings showed flaccidity of the gluteus medius muscle, and histological examination of the specimen also was compatible with poliomyelitis. Postoperatively there was no hip instability and the patient has been able to resume his previous physical activity. To our knowledge, this is the first report regarding polio survivors combined with septic arthritis, and sole MRI examination was unable to lead to the diagnosis. The current patient demonstrates the possibility that the involved muscles in poliomyelitis exist even in asymptomatic regions, which will be helpful for accurate diagnosis and life guidance in polio survivors.
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RE. Am J Phys Med Rehabil 2015; 94:e92. [DOI: 10.1097/phm.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peel MM, Cooke M, Lewis-Peel HJ, Lea RA, Moyle W. A randomized controlled trial of coenzyme Q10 for fatigue in the late-onset sequelae of poliomyelitis. Complement Ther Med 2015; 23:789-93. [PMID: 26645517 DOI: 10.1016/j.ctim.2015.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/15/2015] [Accepted: 09/06/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To determine if coenzyme Q(10) alleviates fatigue in the late-onset sequelae of poliomyelitis. DESIGN Parallel-group, randomized, placebo-controlled trial. BACKGROUND SETTING Coenzyme Q(10) has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue. PARTICIPANTS Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded. METHOD Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q(10) or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome. RESULTS Of 103 participants, 54 were assigned to receive coenzyme Q(10) and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q(10) was safe and well-tolerated. CONCLUSION A daily dose of 100 mg coenzyme Q(10) for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis. The registration number for the clinical trial is ACTRN 12612000552886.
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Affiliation(s)
- Margaret M Peel
- NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia
| | - Marie Cooke
- NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia.
| | - Helen J Lewis-Peel
- NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia
| | - Rodney A Lea
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Wendy Moyle
- NHMRC Centre for Research Excellence in Nursing Interventions, Menzies Health Institute Queensland, Centre for Health Practice Innovation, Griffith University, Queensland, Australia
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Koopman FS, Voorn EL, Beelen A, Bleijenberg G, de Visser M, Brehm MA, Nollet F. No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy. Neurorehabil Neural Repair 2015; 30:402-10. [DOI: 10.1177/1545968315600271] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. People with postpolio syndrome (PPS) commonly experience severe fatigue that persists over time and negatively affects functioning and health-related quality of life (HRQoL). Objectives. To study the efficacy of exercise therapy (ET) and cognitive behavioral therapy (CBT) on reducing fatigue and improving activities and HRQoL in patients with PPS. Methods. We conducted a multicenter, single-blinded, randomized controlled trial. Over 4 months, severely fatigued patients with PPS received ET, CBT, or usual care (UC). The primary end point (fatigue) was assessed using the subscale fatigue severity of the Checklist Individual Strength (CIS20-F). Secondary end points included activities and HRQoL, which were assessed with the Sickness Impact Profile and the 36-Item Short-Form, respectively. End points were measured at baseline and at 4, 7, and 10 months. Results. A total of 68 patients were randomized. No differences were observed between the intervention groups and UC group for fatigue (mean differences in CIS20-F score = 1.47, 95%CI = −2.84 to 5.79, for ET versus UC; and 1.87, 95%CI = −2.24 to 5.98, for CBT versus UC), activities, or HRQoL. Conclusions. Our results demonstrate that neither ET nor CBT were superior to UC in reducing fatigue in severely fatigued PPS patients. Further research should investigate explanations for the lack of efficacy of these 2 currently advised approaches in clinical practice, which may provide clues to improving treatment aimed at reducing fatigue in PPS.
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Affiliation(s)
| | | | - Anita Beelen
- University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Frans Nollet
- University of Amsterdam, Amsterdam, The Netherlands
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Baliga S, Mcmillan T, Sutherland A, Sharan D. The Prevalence and Severity of Joint Problems and Disability in Patients with Poliomyelitis in Urban India. Open Orthop J 2015; 9:204-9. [PMID: 26161158 PMCID: PMC4493628 DOI: 10.2174/1874325001509010204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 04/18/2015] [Accepted: 04/26/2015] [Indexed: 11/22/2022] Open
Abstract
Poliomyelitis is caused by an enterovirus infection of the anterior horn cells in the spinal cord. Up to 40% of survivors recover full muscle strength, however 60–90% are left with varying degrees of residual paralysis, where the patient suffers from cramping myalgia and lower motor neuron pattern weakness. This study aimed to identify and quantify, in terms of prevalence and severity of the types of joint deformities encountered in polio sufferers. It also aimed to assess the disability caused by such problems. Finally we documented the provision and use of mobility aids, orthotics and surgery in the patient group. Impairment was confined to one lower limb, and this is consistent, as the majority of patients were infected in infancy. The study found that pes cavus, scoliosis, flexion deformity of the knee and true lower-limb shortening accounted for over half of the deformities found. The mean Barthel Disability score was 19 and over 80% of patients used at least one aid, usually in the form of a Knee-Ankle-Foot Orthosis (KAFO). Surgery also plays a large in role in the management of polio patients, however necessity needs to be assessed on an individual basis taking into account many aspects of the patient’s life.
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Affiliation(s)
- S Baliga
- University of Aberdeen, Aberdeen, Scotland
| | - T Mcmillan
- University of Aberdeen, Aberdeen, Scotland
| | | | - D Sharan
- Mobility India, Bangalore, India
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Melin E, Kahan T, Borg K. Elevated blood lipids are uncommon in patients with post-polio syndrome--a cross sectional study. BMC Neurol 2015; 15:67. [PMID: 25924966 PMCID: PMC4429706 DOI: 10.1186/s12883-015-0319-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 04/14/2015] [Indexed: 11/13/2022] Open
Abstract
Background The post-polio syndrome occurs in people who previously have had poliomyelitis. After the initial recovery, new or increasing neurologic symptoms occur. Inflammation and dyslipidaemia may play an important role in the development of atherosclerotic complications, for example myocardial infarction and angina pectoris. Previous studies on cardiovascular risk factors in the post-polio syndrome have found a higher prevalence of hypertension, ischemic heart disease, hyperlipidaemia, and stroke in these patients. The present study was undertaken in order to evaluate whether post-polio patients have elevated lipid values, and if blood lipid abnormalities could be correlated to signs of inflammation. Methods Cross-sectional study of 89 consecutive post-polio patients, (53 women, mean age 65 years) from the Post-Polio Outpatient Clinic, Danderyd University Hospital, Stockholm, Sweden. The lipid profiles of post-polio patients were compared to age and sex matched reference values from two earlier studies. Statistical analyses were performed by the Student’s t-test, and linear regression analyses were assessed by Pearson’s correlation coefficient. Results Mean total cholesterol levels (5.7 mmol/L) were low or normal in post-polio patients, whereas low density lipoprotein levels (3.6 mmol/L) were normal, and high density lipoprotein (1.5 mmol/L) and triglycerides (1.4 mmol/L) lower than reference values. The prevalence of diabetes (7%), hypertension (38%), concomitant cardiovascular disease, (including angina pectoris, myocardial infarction, heart failure, atrial fibrillation and stroke) (7%), and calculated 10 year risk of coronary heart disease according to Framingham risk score algorithm (8%) was not increased in post-polio patients. Conclusions Compared to reference populations, post-polio patients in Sweden appear to have low or normal total cholesterol and low density lipoprotein levels, whereas high density lipoprotein and triglyceride levels are low. Hence, a possible persisting inflammatory process in post-polio syndrome does not seem to be associated with increased lipids and an increased risk for coronary heart disease events.
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Affiliation(s)
- Eva Melin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
| | - Kristian Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
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Bridgens R. Does a subgroup of postpolio patients need different management? Disabil Health J 2015; 8:305-8. [PMID: 25899845 DOI: 10.1016/j.dhjo.2015.02.005] [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: 08/04/2014] [Revised: 12/10/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
Abstract
Throughout the 30 years of postpolio syndrome (PPS) research, there have been many puzzling anomalies in the data and not enough information to make sense of them. It is therefore welcome that Winberg et al have examined physical activity in relation to life satisfaction, sex and age. They hypothesized that activity would decrease with age and found the opposite. This result is not so surprising as Ostlund et al found that vitality was associated with older age and that younger age was associated with more pain, increasing physical fatigue, decreasing sleep quality and reducing activity. This commentary will examine past postpolio research with unexpected results in order to describe a subgroup of patients who may be more susceptible to overusing muscles and have particular exercise and activity needs.
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Affiliation(s)
- Ruth Bridgens
- 66 High Street, Marshfield, Chippenham, Wiltshire SN 14 8LP, UK.
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Huang YH, Chen HC, Huang KW, Chen PC, Hu CJ, Tsai CP, Tam KW, Kuan YC. Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis. BMC Neurol 2015; 15:39. [PMID: 25886512 PMCID: PMC4379590 DOI: 10.1186/s12883-015-0301-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/11/2015] [Indexed: 11/28/2022] Open
Abstract
Background Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. Methods We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. Results We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = −1.02, 95% confidence interval [CI] = −2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI −0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. Conclusion The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.
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Affiliation(s)
- Yao-Hsien Huang
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Hung-Chou Chen
- Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Kuang-Wei Huang
- Department of Gastroenterology, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Gastroenterology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Po-Chih Chen
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
| | - Chaur-Jong Hu
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chin-Piao Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan. .,Center for Evidence-Based Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
| | - Yi-Chun Kuan
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Department of Neurology, School of Medicine, Taipei Medical University, Taipei, Taiwan. .,Taipei Medical University-Shuang Ho Hospital, 291 Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
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Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging. Am J Phys Med Rehabil 2015; 94:139-45. [PMID: 25122095 DOI: 10.1097/phm.0000000000000166] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging. DESIGN A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables. RESULTS The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS. CONCLUSIONS Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
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