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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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Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve 2018; 58:760-769. [PMID: 29752826 DOI: 10.1002/mus.26167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760-769, 2018.
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Affiliation(s)
- Julian K Lo
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Lawrence R Robinson
- Sunnybrook Health Sciences Centre, Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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O'Connor J, McCaughan D, McDaid C, Booth A, Fayter D, Rodriguez-Lopez R, Bowers R, Dyson L, Iglesias CP, Lalor S, O'Connor RJ, Phillips M, Ramdharry G. Orthotic management of instability of the knee related to neuromuscular and central nervous system disorders: systematic review, qualitative study, survey and costing analysis. Health Technol Assess 2018; 20:1-262. [PMID: 27477023 DOI: 10.3310/hta20550] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients who have knee instability that is associated with neuromuscular disease (NMD) and central nervous system (CNS) conditions can be treated using orthoses, such as knee-ankle-foot orthoses (KAFOs). OBJECTIVES To assess existing evidence on the effectiveness of orthoses; patient perspectives; types of orthotic devices prescribed in the UK NHS; and associated costs. METHODS Qualitative study of views of orthoses users - a qualitative in-depth interview study was undertaken. Data were analysed for thematic content. A coding scheme was developed and an inductive approach was used to identify themes. Systematic review - 18 databases were searched up to November 2014: MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health, EMBASE, PASCAL, Scopus, Science Citation Index, BIOSIS Previews, Physiotherapy Evidence Database, Recal Legacy, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, Cochrane Central Register of Controlled Trials, Conference Proceedings Citation Index: Science, Health Management Consortium, ClinicalTrials.gov, International Clinical Trials Registry Platform and National Technical Information Service. Studies of adults using an orthosis for instability of the knee related to NMD or a CNS disorder were included. Data were extracted and quality was assessed by two researchers. Narrative synthesis was undertaken. Survey and costing analysis - a web survey of orthotists, physiotherapists and rehabilitation medicine physicians was undertaken. Telephone interviews with orthotists informed a costing analysis. RESULTS Qualitative study - a total of 24 people participated. Potential for engagement in daily activities was of vital importance to patients; the extent to which their device enabled this was the yardstick by which it was measured. Patients' prime desired outcome was a reduction in pain, falls or trips, with improved balance and stability. Effectiveness, reliability, comfort and durability were the most valued features of orthoses. Many expressed frustration with perceived deficiencies in service provision relating to appointment and administrative systems and referral pathways. Systematic review - a total of 21 studies (478 participants) were included of people who had post-polio syndrome, inclusion body myositis, were post stroke or had spinal cord injury. The studies evaluated KAFOs (mainly carbon fibre), stance control KAFO and hip KAFOs. All of the studies were at risk of bias and, in general, were poorly reported. Survey and costing analysis - in total, 238 health-care professionals responded. A range of orthoses is prescribed for knee instability that is related to NMD or CNS conditions, approximately half being custom-made. At least 50% of respondents thought that comfort and confidence in mobility were extremely important treatment outcomes. The cost of individual KAFOs was highly variable, ranging from £73 to £3553. CONCLUSIONS Various types of orthoses are used in the NHS to manage patients with NMD/CNS conditions and knee instability, both custom-made and prefabricated, of variable cost. Evidence on the effectiveness of the orthoses is limited, especially in relation to the outcomes that are important to orthoses users. LIMITATIONS The population included was broad, limiting any in-depth consideration of specific conditions. The response rate to the survey was low, and the costing analysis was based on some assumptions that may not reflect the true costs of providing KAFOs. FUTURE WORK Future work should include high-quality research on the effectiveness and cost-effectiveness of orthoses; development of a core set of outcome measures; further exploration of the views and experiences of patients; and the best models of service delivery. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010180. The qualitative study is registered as Current Controlled Trials ISRCTN65240228. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Joanne O'Connor
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Alison Booth
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Roy Bowers
- Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Lisa Dyson
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Lalor
- Queen Mary's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Rory J O'Connor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Gita Ramdharry
- Kingston University and St George's University of London, London, 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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McDaid C, Fayter D, Booth A, O'Connor J, Rodriguez-Lopez R, McCaughan D, Bowers R, Iglesias CP, Lalor S, O'Connor RJ, Phillips M, Ramdharry G. Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders. BMJ Open 2017; 7:e015927. [PMID: 28877943 PMCID: PMC5588970 DOI: 10.1136/bmjopen-2017-015927] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. DESIGN A systematic review of primary studies. SETTING Community. PARTICIPANTS Adults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee. INTERVENTIONS Orthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material. PRIMARY AND SECONDARY OUTCOME MEASURES Condition-specific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data. RESULTS Twenty-one studies including 478 patients were included. Orthotic devices were evaluated in patients with postpolio syndrome, poststroke syndrome, inclusion body myositis and spinal cord injury. The review included 2 randomised controlled trials (RCTs), 3 non-randomised controlled studies and 16 case series. Most were small, single-centre studies with only 6 of 21 following patients for 1 year or longer. They met between one and five of nine quality criteria and reported methods and results poorly. They mainly assessed outcomes related to gait analysis and energy consumption with limited use of standardised, validated, patient-reported outcome measures. There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls. CONCLUSIONS There is a need for high-quality research, particularly RCTs, of orthotic devices for knee instability related to neuromuscular and central nervous system conditions. This research should address outcomes important to patients. There may also be value in developing a national registry. REGISTRATION NUMBER SYSTEMATIC REVIEW PROSPERO (CRD42014010180).
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Affiliation(s)
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Booth
- Department of Health Sciences, University of York, York, UK
| | - Joanne O'Connor
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | | | - Roy Bowers
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | | | - Simon Lalor
- Queen Mary's Hospital, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Rory J O'Connor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Gita Ramdharry
- Kingston University, Kingston-Upon-Thames, London, UK
- St George's University of London, London, UK
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Arazpour M, Moradi A, Samadian M, Bahramizadeh M, Joghtaei M, Ahmadi Bani M, Hutchins SW, Mardani MA. The influence of a powered knee-ankle-foot orthosis on walking in poliomyelitis subjects: A pilot study. Prosthet Orthot Int 2016; 40:377-83. [PMID: 26184037 DOI: 10.1177/0309364615592703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 05/24/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Traditionally, the anatomical knee joint is locked in extension when walking with a conventional knee-ankle-foot orthosis. A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. OBJECTIVE The purpose of this study was to determine differences of the powered knee-ankle-foot orthosis compared to a locked knee-ankle-foot orthosis in kinematic data and temporospatial parameters during ambulation. STUDY DESIGN Quasi-experimental design. METHODS Subjects with poliomyelitis (n = 7) volunteered for this study and undertook gait analysis with both the powered and the conventional knee-ankle-foot orthoses. Three trials per orthosis were collected while each subject walked along a 6-m walkway using a calibrated six-camera three-dimensional video-based motion analysis system. RESULTS Walking with the powered knee-ankle-foot orthosis resulted in a significant reduction in both walking speed and step length (both 18%), but a significant increase in stance phase percentage compared to walking with the conventional knee-ankle-foot orthosis. Cadence was not significantly different between the two test conditions (p = 0.751). There was significantly higher knee flexion during swing phase and increased hip hiking when using the powered orthosis. CONCLUSION The new powered orthosis permitted improved knee joint kinematic for knee-ankle-foot orthosis users while providing knee support in stance and active knee motion in swing in the gait cycle. Therefore, the new powered orthosis provided more natural knee flexion during swing for orthosis users compared to the locked knee-ankle-foot orthosis. CLINICAL RELEVANCE This orthosis has the potential to improve knee joint kinematics and gait pattern in poliomyelitis subjects during walking activities.
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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
| | - Alireza Moradi
- 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, Department of Neurosurgery, Tehran, Iran
| | - Mahmood Bahramizadeh
- 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
- IHSCR, Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
| | - Mohammad A Mardani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
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Abstract
BACKGROUND Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. This is an update of a review first published in 2011. OBJECTIVES To systematically review the evidence from randomised and quasi-randomised controlled trials for the effect of any pharmacological or non-pharmacological treatment for PPS compared to placebo, usual care or no treatment. SEARCH METHODS We searched the following databases on 21 July 2014: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO and CINAHL Plus. We also checked reference lists of all relevant articles, searched the Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment (HTA) Database and trial registers and contacted investigators known to be involved in research in this area. SELECTION CRITERIA Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included 10 pharmacological (modafinil, intravenous immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (that is temperature ± 25°C, dry and sunny) and a cold climate (that is temperature ± 0°C, rainy or snowy), static magnetic fields) studies with a total of 675 participants with PPS in this review. None of the included studies were completely free from any risk of bias, the most prevalent risk of bias being lack of blinding.There was moderate- and low-quality evidence that IVIg has no beneficial effect on activity limitations in the short term and long term, respectively, and inconsistency in the evidence for effectiveness on muscle strength. IVIg caused minor adverse events in a substantial proportion of the participants. Results of one trial provided very low-quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations without generating adverse events. Data from two single trials suggested that muscle strengthening of thumb muscles (very low-quality evidence) and static magnetic fields (moderate-quality evidence) are safe and beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there was evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS. AUTHORS' CONCLUSIONS Due to insufficient good-quality data and lack of randomised studies, it was impossible to draw definite conclusions about the effectiveness of interventions for PPS. Results indicated that IVIg, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation to clarify whether any real and meaningful effect exists.
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Affiliation(s)
- Fieke Sophia Koopman
- University of Amsterdam Academic Medical CenterDepartment of RehabilitationPO Box 22660AmsterdamNorth HollandNetherlands1100 DD
| | - Anita Beelen
- University of Amsterdam Academic Medical CenterDepartment of RehabilitationPO Box 22660AmsterdamNorth HollandNetherlands1100 DD
| | | | - Marianne de Visser
- Academic Medical CentreDepartment of NeurologyMeibergdreef 9AmsterdamNorth HollandNetherlands1105 AZ
| | - Frans Nollet
- University of Amsterdam Academic Medical CenterDepartment of RehabilitationPO Box 22660AmsterdamNorth HollandNetherlands1100 DD
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8
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9
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Abstract
BACKGROUND Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. OBJECTIVES To review systematically the effects of any treatment for PPS compared to placebo, usual care or no treatment. SEARCH STRATEGY We searched the following databases on 1 October 2010: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO and CINAHL Plus from inception to September 2010. SELECTION CRITERIA Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self-perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected eligible studies, assessed risk of bias and extracted data. MAIN RESULTS Nine pharmacological (modafinil, intravenous immunoglobulin, pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (i.e. temperature ± 25°C, dry and sunny) and a cold climate (i.e. temperature ± 0°C, rainy or snowy), static magnetic fields) studies were included in this review. None of the included studies was completely free from any risk of bias and the most prevalent risk of bias was lack of blinding.There is moderate quality evidence that intravenous immunoglobulin has no beneficial effect on activity limitations and there is inconsistency in the evidence for effectiveness on muscle strength and pain. Results of one trial provide very low quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations. Data from two single trials suggest that muscle strengthening of thumb muscles (very low quality evidence) and static magnetic fields (moderate quality evidence) are beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there is evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS. AUTHORS' CONCLUSIONS Due to insufficient good quality data and lack of randomised studies it is impossible to draw definite conclusions on the effectiveness of interventions for PPS. Results indicate that IVIG, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation.
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Affiliation(s)
- Fieke Sophia Koopman
- Department of Rehabilitation, University of Amsterdam Academic Medical Center, PO Box 22660, Amsterdam, North Holland, Netherlands, 1100 DD
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10
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Farbu E. Update on current and emerging treatment options for post-polio syndrome. Ther Clin Risk Manag 2010; 6:307-13. [PMID: 20668713 PMCID: PMC2909497 DOI: 10.2147/tcrm.s4440] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Indexed: 12/24/2022] Open
Abstract
Post-polio syndrome (PPS) refers to the clinical deterioration experienced by many polio survivors several decades after their acute illness. The symptoms are new muscle weakness, decreased muscle endurance, fatigue, muscle pain, joint pain, cold intolerance, and this typical clinical entity is reported from different parts of the world. The pathophysiology behind PPS is not fully understood, but a combination of distal degeneration of enlarged motor units caused by increased metabolic demands and the normal aging process, in addition to inflammatory mechanisms, are thought to be involved. There is no diagnostic test for PPS, and the diagnosis is based on a proper clinical workup where all other possible explanations for the new symptoms are ruled out. The basic principle of management of PPS lies in physical activity, individually tailored training programs, and lifestyle modification. Muscle weakness and muscle pain may be helped with specific training programs, in which training in warm water seems to be particularly helpful. Properly fitted orthoses can improve the biomechanical movement pattern and be energy-saving. Fatigue can be relieved with lifestyle changes, assistive devices, and training programs. Respiratory insufficiency can be controlled with noninvasive respiratory aids including biphasic positive pressure ventilators. Pharmacologic agents like prednisone, amantadine, pyridostigmine, and coenzyme Q10 are of no benefit in PPS. Intravenous immunoglobulin (IVIG) has been tried in three studies, all having positive results. IVIG could probably be a therapeutic alternative, but the potential benefit is modest, and some important questions are still unanswered, in particular to which patients this treatment is useful, the dose, and the therapeutic interval.
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Affiliation(s)
- Elisabeth Farbu
- Neurocenter and National Competence Center for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
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11
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Genêt F, Schnitzler A, Mathieu S, Autret K, Théfenne L, Dizien O, Maldjian A. Orthotic devices and gait in polio patients. Ann Phys Rehabil Med 2010; 53:51-9. [DOI: 10.1016/j.rehab.2009.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/22/2009] [Indexed: 10/20/2022]
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12
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Koopman FS, Uegaki K, Gilhus NE, Beelen A, de Visser M, Nollet F. Treatment for postpolio syndrome. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2009. [DOI: 10.1002/14651858.cd007818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Cup EH, Pieterse AJ, ten Broek-Pastoor JM, Munneke M, van Engelen BG, Hendricks HT, van der Wilt GJ, Oostendorp RA. Exercise Therapy and Other Types of Physical Therapy for Patients With Neuromuscular Diseases: A Systematic Review. Arch Phys Med Rehabil 2007; 88:1452-64. [DOI: 10.1016/j.apmr.2007.07.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 07/24/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
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Hachisuka K, Arai K, Arai M. Carbon fibre reinforced plastic knee-ankle-foot orthosis with a partially flexible thigh cuff: a modification for comfort while sitting on a toilet seat. Prosthet Orthot Int 2007; 31:133-7. [PMID: 17520490 DOI: 10.1080/03093640600863844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
At the request of a polio survivor, a partially flexible thigh cuff made of leather and canvas for a carbon KAFO was devised to allow the wearer to feel more comfortable while sitting on a toilet seat. The original, acrylic resin, thigh cuff was partially excised to make an opening (15x10 cm), which was stuffed with rubber sponge, and was sealed with leather and canvas. The opening's surround was vertically and horizontally reinforced with carbon fibres. This modification provided relief to the polio survivor from the discomfort previously experienced while sitting on a toilet seat, and satisfied her needs in daily life.
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Affiliation(s)
- K Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka.
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15
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Farbu E, Gilhus NE, Barnes MP, Borg K, de Visser M, Driessen A, Howard R, Nollet F, Opara J, Stalberg E. EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force. Eur J Neurol 2006; 13:795-801. [PMID: 16879288 DOI: 10.1111/j.1468-1331.2006.01385.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.
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Affiliation(s)
- E Farbu
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway. European Federation of Neurological Society
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Hachisuka K, Makino K, Wada F, Saeki S, Yoshimoto N, Arai M. Clinical application of carbon fibre reinforced plastic leg orthosis for polio survivors and its advantages and disadvantages. Prosthet Orthot Int 2006; 30:129-35. [PMID: 16990223 DOI: 10.1080/03093640600574474] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A prospective study was carried out on the clinical application and features of a carbon fibre reinforced plastic leg orthosis (carbon orthosis) for polio survivors. The subjects comprised 9 polio survivors, and 11 carbon knee-ankle-foot orthoses (KAFOs) were prescribed, fabricated, and checked out at the authors' post-polio clinic. Walking was classified based on the functional ambulatory category, and the features of walking with a carbon orthosis were self-evaluated by using a visual analogue scale. The period from modelling a cast to completion was 55 +/- 25 days; the weight of a carbon KAFO was 27.8% lighter than that of the ordinary KAFO; the standard carbon KAFO was 50% more expensive than the ordinary KAFO. The carbon KAFO remained undamaged for at least 2 years. It improved the scores in the functional ambulation categories, but there was no difference between walking with an ordinary and with a carbon KAFO. The self-evaluation of walking with a carbon KAFO revealed that the subjects using a carbon KAFO were satisfied with their carbon KAFO. The carbon KAFO is lightweight, durable, slim and smart, and is positively indicated for polio survivors.
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Affiliation(s)
- K Hachisuka
- Department of Rehabilitation Medicine, University of Occupational and Environmental Health, Iseigaoka, Yahatanishi, Kitakyushu, Fukuoka, Japan.
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Farmer SE, Pearce G, Whittall J, Quinlivan RCM, Patrick JH. The use of stock orthoses to assist gait in neuromuscular disorders: a pilot study. Prosthet Orthot Int 2006; 30:145-54. [PMID: 16990225 DOI: 10.1080/03093640600585223] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This pilot study compares the effect on walking speed, in eight subjects with neuromuscular conditions, of wearing Ligaflex ankle-foot orthoses (AFO), Leafspring orthoses and shoes or with shoes alone. Range of motion, muscle strength and sensation were tested in the lower leg. Subjects underwent a standardized timed 10-m walking test five times in each of the orthoses and shoes as a measure of gait efficiency. A self-administered questionnaire was used to seek the subjects' perceptions of their functional difficulties and their opinions about the relative comfort and stability of these orthoses. Subjects had reduced ranges and strength of dorsiflexion and eversion. Some had proprioceptive deficiencies. Mean walking speed was 0.99 m/s (Leafspring) and 1.1 m/s (Ligaflex or shoes) compared to about 1.3 m/s for a normal population. Repeated measures ANOVA revealed that subjects were significantly slower in Leafspring compared to Ligaflex or to shoes. Questionnaire results rated the Leafspring as least comfortable and the Ligaflex most stable. Providing stability may be more important than assisting foot clearance when weakness is restricted to distal muscles. Further research is required to evaluate the comfort and effectiveness of orthoses to compensate for ankle instability in people with neuromuscular conditions.
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Affiliation(s)
- S E Farmer
- Orthotic Research and Locomotor Assessment Unit, Robert Jones and Agnes Hunt Orthopaedic and District NHS Hospital Trust, Oswestry, Shropshire, UK.
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