Post-polio Syndrome Research Articles

Post polio syndrome

Post polio syndrome

Differential diagnosis between post-polio syndrome symptoms and temporomandibular disorder – Clinical case

Differential diagnosis between post-polio syndrome symptoms and temporomandibular disorder – Clinical case

A randomized controlled trial of coenzyme Q10 for fatigue in the late-onset sequelae of poliomyelitis

ObjectiveTo determine if coenzyme Q10 alleviates fatigue in the late-onset sequelae of poliomyelitis. DesignParallel-group, randomized, placebo-controlled trial. Background settingCoenzyme Q10 has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue. ParticipantsPolio 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. MethodParticipants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100mg coenzyme Q10 or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome. ResultsOf 103 participants, 54 were assigned to receive coenzyme Q10 and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q10 was safe and well-tolerated. ConclusionA daily dose of 100mg coenzyme Q10 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.

A disease of the distant past: information about poliomyelitis and post- poliomyelitis syndrome in the Spanish/Portuguese press, 1995-2009

The change in the social perception of poliomyelitis in the Iberian Peninsula through content analysis of two large-circulation newspapers between 1995 and 2009 is examined. The disappearance from the journalistic agenda of poliomyelitis and people living with the after-effects of the disease led it to be excluded from the public agenda. Poliomyelitis was associated with poverty and ignorance in distant countries that were susceptible to cooperation activities and only came to public attention when it was perceived as a threat to the West, linked to health crises or in a metaphorical sense. Thus, post-poliomyelitis syndrome was barely visible in the Portuguese case and poorly represented in Spain by association.

No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy

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.

Denial, Oblivion and New Fears: Poliomyelitis and the Post-Polio Syndrome in the Spanish and Portuguese Press (1995-2009)

n 1988 the World Health Assembly approved and launched the Global Polio Eradication Initiative, in which the governments of the member countries took part, as well as UNICEF, the US Centres for Disease Control and Prevention, the Rotary International and even the WHO, then followed by other organisations such as the United Nations Foundation, the World Bank and the Bill and Melinda Gates Foundation. This ambitious project not only had a strong scientific support regarding their viability, as well it was socially based on the success in eradicating smallpox, officially registered in 1980. The first results were obtained in the Region of the Americas, where the eradication certificate was achieved in 1994. The European Region, the third to achieve it, would have to wait until 2002. The initial optimism, sometimes close to a disproportionate triumphalism, led to the setting of a date for the worldwide eradication of poliomyelitis in the year of 2000, which was then moved to 2005 and further continuously postponed, although with setting a specific year. The situation in 2009 was not encouraging, with cases of polio in 23 countries, some of them countries in which polio had been considered eradicated. The following year would not be better, because although the number of cases decreased and there were only cases in 20 countries, 88.53% of the cases were in countries where polio was not considered endemic. In this scenario, the WHO launched its Strategic Plan 2010–2012 (OMS, 2010). However, continued attempts to achieve the objectives had been frustrated by repeated

Factors Associated with Reduced Quality of Life in Polio Survivors in Korea.

The purpose of this study is to assess health-related quality of life in polio survivors (PS) compared with that in the general population in Korea. Polio survivors (n = 120) from outpatient clinics at two hospitals, healthy controls (HC, n = 121) and members of the general population with activity limitations (AL, n = 121) recruited through a proportional-allocation, systematic sampling strategy from the Fourth Korean National Health and Nutrition Examination Survey were surveyed with self-rated health-related quality of life (Euro QoL five-dimensions). The proportion of participants who reported problems in mobility, usual activity, and symptoms of anxiety/depression were higher in the PS group compared with the HC and AL groups. There was no significant difference in the self-care dimension across the groups. Polio-specific questionnaire, pain, depression, fatigue, Modified Barthel Index (K-MBI) and Short Physical Performance Battery (SPPB) were assessed in the PS group. Those with post-poliomyelitis syndrome had greater problems in mobility, usual activity, and depression/anxiety. Polio survivors, especially those with more pain and fatigue symptoms, and those who did not have access to medical services had poorer health-related quality of life. These findings afford useful information for potential intervention improving quality of life in polio survivors.

Treatment for postpolio syndrome.

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. 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. 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. 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. We used standard methodological procedures expected by The Cochrane Collaboration. 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. 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.

Elevated blood lipids are uncommon in patients with post-polio syndrome – a cross sectional study

BackgroundThe 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.MethodsCross-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.ResultsMean 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.ConclusionsCompared 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.

Feasibility of Lung Volume Recruitment in Early Neuromuscular Weakness: A Comparison Between Amyotrophic Lateral Sclerosis, Myotonic Dystrophy, and Postpolio Syndrome

BackgroundLung volume recruitment (LVR) is a cough assistance technique used in persons with neuromuscular disorders (NMDs), most typically in those requiring noninvasive ventilation (NIV). Whether it may be useful in persons with NMDs who have milder respiratory impairment is unknown. ObjectiveTo assess the feasibility, impact on quality of life (QOL), and preliminary physiological effects of daily LVR in different categories of persons with NMDs who have an early stage of respiratory impairment. DesignFeasibility study. SettingAcademic tertiary care center. ParticipantsOutpatients diagnosed with amyotrophic lateral sclerosis (n = 8), postpolio syndrome (n = 10), and myotonic dystrophy (n = 6) who had restrictive respiratory defects but were not yet using NIV. MethodsParticipants were asked to perform LVR up to 4 times daily and log their LVR use in a diary. Physiological measurements and questionnaires were completed at baseline and after 3 months. Main Outcome MeasurementsCompliance with LVR use was assessed, along with QOL and willingness to continue the treatment. Physiological measurements included forced vital capacity (FVC), lung insufflation capacity (LIC), and the LIC minus FVC difference. ResultsOf the 24 recruited subjects, 7 with amyotrophic lateral sclerosis, 7 with postpolio syndrome, and 5 with myotonic dystrophy completed the study (n = 19). At baseline, mean values for FVC and spontaneous peak cough flow were 59.9% predicted and 373.1 L/min, respectively. For subjects completing the study, 74% were willing to continue long-term LVR use, and QOL scores were not adversely affected by LVR in any NMD subgroup. The LIC-FVC difference increased from baseline to follow-up by a mean of 0.243 L (P = .006) in all subjects (n = 19), suggesting a possible improvement in respiratory system mechanics. ConclusionsIn patients with NMDs who have early restrictive respiratory defects but do not yet require NIV, regular use of LVR is feasible with no negative impact on QOL over a 3-month period and may have physiological benefits. Further work is needed to determine whether early institution of LVR can improve respiratory system mechanics and help delay ventilatory failure in persons with NMDs.

Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis.

BackgroundPostpolio 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.

Does a subgroup of postpolio patients need different management?

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.

Previous Acute Polio and Post-Polio Syndrome: Recognizing the Pathophysiology for the Establishment of Rehabilitation Programs.

Not required

Resilience Predicts Functional Outcomes in People Aging With Disability: A Longitudinal Investigation

ObjectivesTo investigate the links between resilience and depressive symptoms, social functioning, and physical functioning in people aging with disability and to investigate the effects of resilience on change in functional outcomes over time. DesignLongitudinal postal survey. SettingSurveys were mailed to a community sample of individuals with 1 of 4 diagnoses: multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. The survey response rate was 91% at baseline and 86% at follow-up. ParticipantsA convenience sample of community-dwelling individuals (N=1594; age range, 20–94y) with multiple sclerosis, muscular dystrophy, postpoliomyelitis syndrome, or spinal cord injury. InterventionsNot applicable. Main Outcome MeasuresPatient Health Questionnaire-9 (to assess depressive symptoms) and Patient Reported Outcomes Measurement Information System (to assess social role satisfaction and physical functioning). ResultsAt baseline, resilience was negatively correlated with depressive symptoms (r=−.55) and positively correlated with social and physical functioning (r=.49 and r=.17, respectively). Controlling for baseline outcomes, greater baseline resilience predicted a decrease in depressive symptoms (partial r=−.12) and an increase in social functioning (partial r=.12) 3 years later. ConclusionsThe findings are consistent with a view of resilience as a protective factor that supports optimal functioning in people aging with disability.

Long-standing poliomyelitis and psychological health

Objective: To compare the psychological health of the individuals with long-standing poliomyelitis, with or without post-polio syndrome (PPS), to the general population and to identify the role of work as well as other variables with regard to their psychological health. Design: A cross-sectional study. Subjects: One hundred and ninety-five polio patients attending postpolio clinic in Jerusalem. Methods: Emotional distress (ED) was measured using the general health questionnaire (GHQ-12). Demographic, medical, social and functional data were recorded using a specific structured questionnaire. Each polio patient was compared to four age- and sex-matched controls. Results: ED was higher in the polio population as compared to the general population. Within the polio population ED was inversely correlated with work status. No correlation was found between ED and the functional level of polio participants and no difference was found in GHQ score between polio participants with or without post-polio. In addition, ED was less affected by subjective perception of physical health among polio patients as compared to the general population. Conclusions: Long-standing poliomyelitis is associated with decreased psychological health as compared to the general population. Yet, the resilience of polio survivors is manifested by their ability to block further decline of their psychological health in spite of deterioration in their physical health. Work appears as a significant source of resilience in the polio population.Implications for RehabilitationIndividuals with long-standing poliomyelitis often suffer from high emotional distress and may benefit from psychotherapy aimed at reducing distress.As active employment status is associated with increased mental health among polio survivors, encouraging participation at work needs to be a significant component of psychotherapeutic programs.Polio survivors, although physically disabled, may be relatively resilient, as their mental health is less affected by their negative health perception. This and other expressions of resilience may serve as a platform for increasing personal growth among them by implementing hope-oriented psychotherapy.

Using a driving simulator during vehicle adaptation

A major drawback with current vehicle modifications is the inability to provide a practice session before driving on the road. Quantitative measurements obtained using a static assembly rig and a virtual driving scenario enabled appropriate adaptive adjustments for a client with post-polio syndrome who complained of difficulties turning the steering wheel. This study describes the assessment process, emphasizing the potential of the system, discussing the limitations of the evaluation and aims to offer occupational therapists an empirical perspective regarding vehicle adaptations for individuals with a physical disability.

Síndrome post-polio, quejas cognitivas y exploración neuropsicológica

ObjectiveTo examine psychometric performance in a sample of patients with postpolio syndrome (PPS) with subjective cognitive complaints. Patients and methodsThe sample consisted of 37 PPS patients (17 men) referred to our outpatient neuropsychological service. The mean age at the neuropsychological assessment was 55 years (SD: 4.58 years). A total of 59.5% was receiving pharmacological treatment for anxiety-depression. The results obtained by patients in the neuropsychological assessment were compared with normative data to identify the percentage of patients with pathological scores on the tests applied. ResultsPatients with PPS had pathological scores on all the neuropsychological tests. A particularly significant finding was the percentage of patients with scores indicative of cognitive impairment in tests that assessed cognitive processing speed, verbal learning, phonemic verbal fluency and cognitive flexibility. No statistically significant differences were observed in patients’ performance depending on the presence or absence of anxiety or depression. ConclusionsPatients with PPS and subjective cognitive complaints performed less well on neuropsychological assessment than the general population.

If You Meet Erickson on the Road. . .

EtzelCardenaThe title of this review is a paraphrasis of the saying attributed to the Zen teacher LinjiYixuan: “If you meet the Buddha (on the road) kill him.” As with so much in Zen, there isnot a single interpretation of the saying, but the one that I choose here is that “to turn theBuddha into a religious fetish is to miss the essence of what he taught” (Harris, 2006). Inmy view, there is some resemblance between the fetishization of the Buddha and that of thevery influential hypnosis and therapy author Milton Erickson, to which I will return later inthe review.The documentary is described as revealing ”multiple dimensions of an unsung Americanhero,” and it is based on statements by Erickson’s students, patients, family, and,surprisingly, the director of the documentary himself, in addition to archival films andphotographs. Erickson was dealt a tough hand in life: He was dyslexic, color-blind, the poliohe contracted at 17 years of age brought him close to death, and in middle age hedeveloped post-polio syndrome. He partly recovered from the original polio paralysis byusing his muscle memory and fantasy to subtly activate his paralyzed muscles, a strategythat has just recently begun to be investigated (Jackson, Lafleur, Malouin, Richards, &Doyon, 2001). Besides the role of imagery, Erickson credited his original paralysis withhaving given him a strong motivation to observe carefully all those who were quarantinedwith him in the farm, noting discrepancies between what people said and their nonverbalbehaviors.As stated in the film, many of those who knew him credit him with an uncanny ability toread nonverbal behavior and know intimate matters about people he had just met. Anexample of this ability is given in

Restless Legs Syndrome and Poliomyelitis: New Evidences of an Old Observation?

Restless Legs Syndrome and Poliomyelitis: New Evidences of an Old Observation?

Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging.

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. 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. 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. 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.