Post Polio Syndrome

NewsBot · Jul 31, 2013

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Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting.
Portnoy S, Schwartz I.
Ann Phys Rehabil Med. 2013 Jul 17.

OBJECTIVES:
To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data.
METHOD:
Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects (n=16), PPS patients walking with shoes with/without an ankle-foot-orthosis (n=11), PPS patients walking with knee-ankle-foot-orthosis (n=5), and PPS patients walking with a walker/crutches (n=10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot.
RESULTS:
Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids.
CONCLUSIONS:
The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design.
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Admin2 · Jul 31, 2013

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NewsBot · Jun 10, 2014

Gait characteristics of post-poliomyelitis patients: standardization of quantitative data reporting.
Portnoy S, Schwartz I.
Ann Phys Rehabil Med. 2013 Oct;56(7-8):527-41.

OBJECTIVES:
To evaluate the differences in gait characteristics and gait symmetry of post-polio syndrome (PPS) patients ambulating with or without shoes and between subgroups walking with different walking aids and orthoses, study the correlation of these data with personal data, illness condition, physical health, frequency of using aids and orthotics and frequency of falls, and derive recommendations for standardization of reporting these data.
METHOD:
Twenty-six PPS subjects ambulated with their own walking devices. We calculated spatio-temporal parameters and symmetry indices (SI) of gait using a data acquired by a motion capture system. We compared inter-subject differences in gait pattern for PPS groups that differed by questionnaire-obtained data of demographics, physical activity, polio history, falls and walking aids. Additional inter-subject comparisons were performed between normal subjects (n=16), PPS patients walking with shoes with/without an ankle-foot-orthosis (n=11), PPS patients walking with knee-ankle-foot-orthosis (n=5), and PPS patients walking with a walker/crutches (n=10). We also compared intra-subject variability in PPS subjects who were able to repeat the trials barefoot.
RESULTS:
Our main results show that subjects who reported participating in physical activity twice a week or more had significantly better step time and double support symmetry. Subjects who use walking aids on a daily basis had significantly higher gait cadence and shorter stride time. Also, subjects that do not require knee-ankle-foot orthoses and/or walking aids walked with a smaller base width and better symmetry in stance and swing durations than PPS subjects who require these aids.
CONCLUSIONS:
The gait pattern of PPS patients is related to numerous intrinsic and extrinsic factors. Standardization of the reporting protocol of gait-related data of PPS patients is crucial for patient evaluation and treatment design.
Click to expand...

Craig Payne · Jun 10, 2014

An alert was just sent out re suspected new case of polio here in Australia; the last reported 'wild' case was in 1972!

NewsBot · Jun 18, 2014

Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness
Ploeger Hilde , Bus Sicco A., Brehm Merel-Anne, Nollet Frans
Gait & Posture; Article in Press

Highlights
DR-AFOs as prescribed and fitted in clinical practice for polio survivors with calf muscle weakness:
• Improved gait biomechanics.
• Improved walking speed.
• Improved self-perceived walking ability.
• May improve walking efficiency, but the overall effect may depend on gait pattern characteristics and orthosis settings.
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Abstract

In polio survivors with calf muscle weakness, dorsiflexion-restricting ankle-foot orthoses (DR-AFOs) aim to improve gait in order to reduce walking-related problems such as instability or increased energy cost. However, evidence on the efficacy of DR-AFOs in polio survivors is lacking. We investigated the effect of DR-AFOs on gait biomechanics, walking energy cost, speed, and perceived waking ability in this patient group.

Sixteen polio survivors with calf muscle weakness underwent 3D-gait analyses to assess gait biomechanics when walking with a DR-AFOs and with shoes only. Ambulant registration of gas-exchange during a 6min walk test determined walking energy cost, and comfortable gait speed was calculated from the walked distance during this test. Perceived walking ability was assessed using purposely-designed questionnaires.

Compared with shoes-only, walking with the DR-AFOs significantly increased forward progression of the center of pressure (CoP) in mid-stance and it reduced ankle dorsiflexion and knee flexion in mid- and terminal stance (p<0.05). Furthermore, walking energy cost was lower (−7%, p=0.052) and gait speed was higher (p=0.005). Patients were significantly more satisfied, felt safer, and less exhausted with the DR-AFO, compared to shoes-only (p<0.05). DR-AFO effects varied largely across patients. Patients who walked with limited forward CoP progression and persisting knee extension during the shoes-only condition seemed to have benefitted least from the DR-AFO.

In polio survivors with calf muscle weakness, DR-AFOs improved gait biomechanics, speed, and perceived walking ability, compared to shoes-only. Effects may depend on the shoes-only gait pattern, therefore further study is needed to determine which patients benefit most from the DR-AFO.
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NewsBot · Jun 28, 2014

Circadian variation of fatigue in paralytic poliomyelitis and postpolio syndrome: just fatigue or masked restless legs syndrome?
Andrea Romigi, Fabio Placidi , Elisa Evangelista , Maria T. Desiato
Arq. Neuro-Psiquiatr. vol.72 no.6 São Paulo June 2014

We read with interest the manuscript published by Viana et al.1. These authors observed in a small cohort of paralytic poliomyelitis (PP) and postpolio syndrome (PPS) patients a significant circadian fatigue in both forms. The authors also evaluated polysomnographic variables lacking correlations between PSG data and fatigue. In PP, an acute disease resulting in flaccid paralysis, it has been shown that polio virus may induce apoptosis and consequently CNS injury, which leads to paralysis. Therefore during its clinical course an increasing and progressive fatigue may represent an integral part of motor symptoms, while PPS circadian impairment of fatigue may be more puzzling. Sleep disorders and particularly sleep related breathing disorders, restless legs syndrome and periodic limbs movement of sleep (PLMS) were described in PPS2,3. Small cohorts, single case reports, uncontrolled design, selected samples complaining of fatigue, sleepiness are critical issues for these reports. An intriguing model and a probable unifying hypothesis may be represented by restless legs syndrome (RLS). A circadian fatigue in PPS may be the expression of unrecognized RLS in PPS. The frequency of RLS and PLMS is higher than general population in several neurological diseases4,5. The 95% of highly associated RLS conditions are linked with inflammatory/immune changes. This observation suggested that RLS is mediated or affected by inflammation as recently demonstrated by elevated C-reactive protein (CRP) in RLS with severe PLMS4. Similarly in PPS it is still debated whether the denervation processes are caused by further loss of motor neurons due to normal aging or active disease processes, involving chronic inflammatory damage6. These observations are supported by the increased expression of pro-inflammatory cytokines in PPS6. The driver of these inflammatory mechanisms is still unclear. Therefore RLS and PPS may share a common pro-inflammatory condition. Viana et al.1 found more than one third of PPS patients had PLMS, although no statistical correlation was found between fatigue and PSG. In addition, as correctly stated in discussion, authors1 did not evaluate RLS in their PPS patients.

Although small PPS samples with RLS and/or PLMS do not allow any generalization, the common inflammatory pathways and also a natural propensity to circadian trend of fatigue in PPS, as interestingly demonstrated by Viana et al.1, may support the association of PPS with RLS. Epidemiological studies with controlled design are needed to explore the real magnitude of RLS in PPS and to evaluate possible common mechanisms involved in the development of RLS.
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NewsBot · Jul 23, 2017

Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness
Hilde E. Ploeger et al
Gait and Posture; Article in Press

Highlights
•In polio survivors, gait pattern characteristics due to calf muscle weakness have not been fully described.
•We examined gait pattern characteristics in association with underlying impairments.
•We found 7 different gait patterns with two dominant patterns present.
•Patients with a similar presentation of impairments did not necessarily walk alike.
•The gait pattern could not be accurately predicted from underlying impairments.
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The objective was to identify gait patterns in polio survivors with calf muscle weakness and associate them to underlying lower extremity impairments, which are expected to help in the search for an optimal orthosis.

Unilaterally affected patients underwent barefoot 3D-gait analyses. Gait pattern clusters were created based on the ankle and knee angle and ankle moment shown in midstance of the affected limb. Impairment clusters were created based on plantarflexor and knee-extensor strength, and ankle and knee joint range-of-motion. The association between gait patterns and underlying impairments were examined descriptively. The Random Forest Algorithm and regression analyses were used to predict gait patterns and parameters.

Seven gait patterns in 73 polio survivors were identified, with two dominant patterns: one with a mildly/non-deviant ankle angle, ankle moment and knee angle (n = 23), and one with a strongly deviant ankle angle and a mildly/non-deviant ankle moment and knee angle (n = 18). Gait pattern prediction from underlying impairments was 49% accurate with best prediction performance for the second dominant gait pattern (sensitivity 78% and positive predictive value 74%). The underlying impairments explained between 20–32% of the variance in individual gait parameters.

Polio survivors with calf muscle weakness who present a similar impairment profile do not necessarily walk the same. From physical examination alone, the gait pattern nor the individual gait parameters could be accurately predicted. The patient’s gait should therefore be measured to help in the prescription and evaluation of orthoses for these patients.
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NewsBot · Jul 28, 2017

Restless legs syndrome is highly prevalent in patients with post-polio syndrome
Luis Fabiano Marin et al
Sleep Medicine; Article in Press

Highlights
•Restless legs syndrome (RLS) is a very common condition in post-polio syndrome (PPS) patients.
•RLS and PPS have a concomitant onset in many patients.
•RLS should be considered in PPS patients with sensory-motor complaints in the legs.
•Symptoms of PPS such as cramps and muscle and joint pain can mimic those of RLS.
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Objective
Few studies have quantified the prevalence of restless legs syndrome (RLS) in patients with post-polio syndrome (PPS). Our objective was to assess the prevalence and severity of RLS in patients with PPS and to examine the demographic characteristics of this population.

Method
This was a cross-sectional study conducted from April 2010 to May 2012 at the outpatient Neuromuscular Disorders clinic of Universidade Federal de São Paulo, São Paulo, Brazil. We evaluated 119 patients with PPS, consecutively recruited, and investigated for RLS based on the diagnostic criteria established by the International Restless Legs Syndrome Study Group (IRLSSG). Patients were evaluated with the Brazilian version of the IRLSSG severity scale.

Results
The prevalence of RLS was 36% (n = 43; 32 women and 11 men). The ages at onset of RLS (median = 41 years) and PPS (median = 41 years) were concurrent, and the correlation between onset of symptoms of RLS and onset of symptoms of PPS was positive and very strong (Spearman r = 0.93, p = 0.01). The median RLS severity was 23 (range, 20−28). Low educational achievement and depression were predictive of RLS development.

Conclusion
In the largest population of patients with PPS studied to date, our results indicate a high prevalence of RLS, marked disease severity, and concomitant onset of both conditions in many patients with PPS. Further studies are needed to elucidate a possible pathophysiologic mechanism linking these two conditions. We suggest that all post-polio patients with sensory and motor complaints in the legs be investigated for RLS.
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Post Polio Syndrome

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Post Polio Syndrome

NewsBot The Admin that posts the news.

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

Craig Payne Moderator

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Proprioceptive Insoles used to Improve Postural Stability in Tennis Players

Case Discussion (reposted from "introductions")

Still turning blue and purple post healing

Posterior Tibial Artery anatomy

Stage 1 PTTD Treatment Plan - Posterior Tibial Tendon Dysfunction

Patient With Early Stage PTTD (Posterior Tibial Tendon Dysfunction)

Recommendation for Onychomycosis prophylaxis, post nail avulsion ?

Share This Page

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