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 / Flexor hallucis longus transfer in a patient with post-polio syndrome with posterior tibial tendon dysfunction. Case report and surgical technique

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. Nivel de Evidencia: IV

Post-polio syndrome with posterior tibial tendon dysfunction may present a flexible clubfoot and steppage gait in some patients. We describe the case of a patient who only preserved flexor hallucis longus tendon function; therefore, we decided to transfer it to the midfoot to obtain a plantigrade foot and restore dorsiflexion. Level of Evidence: IV

Conhecimentos dos enfermeiros de unidades básicas de saúde sobre a síndrome pós-poliomielite / Knowledge of nurses from basic health units on post-poliomielite syndrome

Objetivo: Verificar o conhecimento dos enfermeiros sobre a Síndrome pós-póliomielite em unidades básicas de saúde. Metodologia: Estudo descritivo, explicativo de campo com abordagem quanti-qualitativa, desenvolvido em setembro e outubro de 2017, com 11 profissionais de unidades básicas de saúde. Utilizou-se instrumento semiestruturado com questões de abordagem relativa ao tema. Os resultados foram analisados pelo programa Microsoft Excel (2010) e analise de conteúdo de Bardin, e representados em gráficos e tabelas. Todo o percurso metodológico respeitou os princípios éticos de pesquisa com seres humanos. Resultados: Constatou-se como faixa etária mais prevalente dos profissionais entre 20 a 35 anos(72,73%), 90,91% eram do sexo feminino, 63,64% possuiam pós graduação Latu Sensu e 63,64% atuam na UBS entre seis e dez anos, 73% dos profissionais não conhecem a patologia. Conclusão: Identificou-se, deficiência de conhecimentos sobre a Síndrome pós-pólio, o que sinaliza necessidade de capacitação sobre a temática.

Objective: To verify nurses’ knowledge about post-poliomielite syndrome in basic health units. Methodology: Descriptive, explanatory field study with quantitative-qualitative approach, developed in September and October 2017, with 11 professionals from basic health units. A semistructured instrument was used with questions related to the topic. The results were analyzed by the program Microsoft Excel (2010) and analysis of content of Bardin, post and represented in graphs and tables. The whole methodological course respected the ethical principles of research with human beings. Results: The most prevalent age group was between 20 to 35 years old (72.73%), 90.91% were female, 63.64% had a Latu Sensu postgraduate course and 63.64% worked in the UBS between six and ten years, 73% of the professionals do not know the pathology. Conclusion: We identified a lack of knowledge about post-polio Syndrome among professionals, which indicates a need for training on the subject.

Objetivo: Verificar el conocimiento de los enfermeros sobre el Síndrome post-poliomielite en unidades básicas de salud. Metodología: Estudio descriptivo, explicativo de campo con abordaje cuantitativo, desarrollado en septiembre y octubre de 2017, con 11 profesionales de unidades básicas de salud. Se utilizó un instrumento semiestructurado con cuestiones de abordaje relativas al tema. Los resultados fueron analizados por el programa Microsoft Excel (2010) y análisis de contenido de Bardin, poste y representados en gráficos y tablas. Todo el recorrido metodológico respetó los principios éticos de investigación con seres humanos. Resultados: Se constató como grupo de edad más prevalente de los profesionales entre 20 a 35 años (72,73%), 90,91% eran del sexo femenino, 63,64% poseían post graduación Latu Sensu y 63,64% actúan en la UBS entre seis y diez años, el 73% de los profesionales no conocen la patología. Conclusión: Se identificó, deficiencia de conocimientos sobre el Síndrome post-polio, lo que señala necesidad de capacitación sobre la temática.

Resultados de um programa de exercício físico combinado na força muscular e capacidade funcional de um indivíduo com síndrome Pós-Poliomielite: relato de caso / Effects of a combined exercise program in muscle strength and functional capacity in a individual with Postpoliomyelitis syndrome: case report

A Poliomielite Anterior Aguda (PAA) é uma patologia causada por um enterovírus, que predominantemente prejudica os neurônios motores inferiores, o que causa a paralisia muscular flácida e assimétrica, principalmente nos membros inferiores e que, tardiamente causa sintomas neuromusculares e declínio funcional denominados como Síndrome Pós-Poliomielite (SPP). Objetivo: Aplicar um programa de exercícios combinado e verificar os resultados na força muscular e capacidade funcional de um indivíduo idoso, com SPP. Métodos: A amostra foi composta por 1 mulher, idade 66 anos, com SPP, hipertensão arterial sistêmica, dislipidemia, hipotireoidismo. A força muscular foi mensurada por meio do teste de 7 ­ 10 repetições máximas (RM). A distância percorrida ao pedalar foi realizada por meio do Teste 12 minutos adaptado e o equilíbrio dinâmico foi avaliado por meio do Timed Up & Go Test. Os exercícios foram realizados em 2 séries de 10 repetições, com intensidade de 60% de 1 RM, por 24 semanas. Resultados: Após 24 semanas, a força muscular de MMII apresentou aumento de 333,3% e a força de MMSS 216,5%. O equilíbrio dinâmico melhorou 34,3%. A distância percorrida ao pedalar aumentou 11,8%. Conclusão: Os dados por nós obtidos sugerem que pessoas com SPP, mesmo que idosas, poderão se beneficiar de um programa de exercícios para aumento da força muscular e melhora da capacidade funcional, porém é importante que outros estudos sejam desenvolvidos para verificar esses resultados em um número maior de pessoas.

Postpoliomyelitis Syndrome is a enterovirus pathology, which predominantly damages the lower muscles, which cause flaccid and asymmetric muscle paralysis, based on lower and late neuromuscular and functional symptoms denominate Postpoliomyelitis Syndrome (PPS). Objective: To apply a combined exercise program and to verify the results on the muscle strength and functional capacity of an elderly individual with PPS. Methods: The sample was one women, 66 years old, with comorbities hypertension, dyslipidemia, hypothyroidism. Muscle strength was measured by 7 - 10 maximal repetitions (MR) test. The distance traveled pedaling was performed by Adapted 12-minute Test and the balance was evaluated by Timed Up & Go Test. The muscle strength training was intensity 60% of a one maximum repetition. Results: After 24 weeks, the muscular strength of lower limbs increased 333.3% and the upper limbs, 216.5%. The balance improved 34.3%. The distance traveled pedaling increased 11.8%. Conclusion: The results suggest that individuals with PPS, even if elderly, may benefit from an exercise program to increase muscle strength and improve functional capacity, but it is important that other studies are developed to verify these results in a larger number of individuals.

Psychometric Properties of Three Fatigue Rating Scales in Individuals With Late Effects of Polio

OBJECTIVE: To evaluate the psychometric properties of the Fatigue Severity Scale (FSS), the Fatigue Impact Scale (FIS), and the Multidimensional Fatigue Inventory (MFI-20) in persons with late effects of polio (LEoP). More specifically, we explored the data completeness, scaling assumptions, targeting, reliability, and convergent validity. METHODS: A postal survey including FSS, FIS, and MFI-20 was administered to 77 persons with LEoP. Responders received a second survey after 3 weeks to enable test-retest reliability analyses. RESULTS: Sixty-one persons (mean age, 68 years; 54% women) responded to the survey (response rate 79%). Data quality of the rating scales was high (with 0%–0.5% missing item responses), the corrected item-total correlations exceeded 0.4 and the scales showed very little floor or ceiling effects (0%–6.6%). All scales had an acceptable reliability (Cronbach’s α≥0.95) and test-retest reliability (intraclass correlation coefficient, ≥0.80). The standard error of measurement and the smallest detectable difference were 7%–10% and 20%–28% of the possible scoring range. All three scales were highly correlated (Spearman’s correlation coefficient r(s)=0.79–0.80; p < 0.001). CONCLUSION: The FSS, FIS, and MFI-20 exhibit sound psychometric properties in terms of data completeness, scaling assumptions, targeting, reliability, and convergent validity, suggesting that these three rating scales can be used to assess fatigue in persons with LEoP. As FSS has fewer items and therefore is less time consuming it may be the preferred scale. However, the choice of scale depends on the research question and the study design.

Post-polio syndrome report of two cases

ABSTRACT Introduction. Post-polio syndrome (PPS) is a neurological syndrome that appears decades after an acute episode of polio. This condition decreases functional capacity until completing affecting daily activities. This event occurs in 20-80% of the people who were affected by the polio virus. It is more frequent in women and a direct correlation between the risk of developing this syndrome and the severity of the sequelae of polio has been reported. Case presentation. The objective of this article is to present two clinical cases of patients who developed post-polio syndrome approximately forty years after the initial infection. Discussion. This article seeks to question the concept of polio as a static disease, since it is a process difficult to diagnose and treat, as in both cases presented here. Conclusion. The psychological and functional impact of this disease on patients is regarded as a challenge for the health professional, since clinical needs must be identified and current barriers care reduced.

RESUMEN Introducción. 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. Presentación del caso. 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. Discusión. 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. Conclusión. 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.

Assessment of energy expenditure in individuals with post-poliomyelitis syndrome / Avaliação do gasto energético nos indivíduos com síndrome pós-poliomielite

ABSTRACT The objective of this study was to identify energy expenditure, retrospectively, in individuals with post-poliomyelitis syndrome (PPS) in the Brazilian population. Methods The Baecke questionnaire for the evaluation of habitual physical activity (HPA), assessment of quality of life (WHOQOL-Bref), and the Fatigue Severity Scale were administered to patients with PPS, poliomyelitis sequelae (PS) and to a control group (CG). Participated in the study 116 individuals (PPS=52,PS= 28,CG=36). Results Patients with PPS tended to increase their HPA from 10 to 20 years of age, compared with those in the PS group and the CG. In the period from 21 to 30 years of age, there was significant increase in the PPS group’s occupational physical activity compared to the PS group, and the occupational physical activity (21-30 years of age) correlated with the onset of symptoms of PPS. Conclusion Patients with PPS had a higher energy expenditure during life, especially in occupational physical activity at ages 21-30 years, suggesting this decade is critical for the development of PPS.

RESUMO O objetivo deste estudo foi identificar o gasto energético, retrospectivamente, em indivíduos com síndrome pós-poliomielite (SPP) na população brasileira. Métodos Foi utilizado o questionário Baecke para avaliação da atividade física habitual (AFH) nos pacientes com SPP, sequela de poliomielite (SP) e grupo controle (GC). Participaram do estudo 116 indivíduos (SPP = 52, SP = 28, GC = 36). Resultados Pacientes com SPP tendem a aumentar a AFH dos 10 aos 20 anos, comparados com os grupos SP e GC. No período dos 21 aos 30 anos, houve aumento significativo da atividade física ocupacional do grupo SPP em relação ao grupo SP e a atividade física ocupacional (21-30 anos) correlacionou-se com o aparecimento dos sintomas da SPP. Conclusão Pacientes com SPP apresentam maior gasto de energia durante a vida, especialmente na atividade física ocupacional nas idades 21-30 anos, sugerindo que esta década é crítica para o desenvolvimento da SPP.

Health related quality of life in Turkish polio survivors: impact of post-polio on the health related quality of life in terms of functional status, severity of pain, fatigue, and social, and emotional functioning / Qualidade de vida relacionada com a saúde em sobreviventes turcos da pólio: impacto pós-pólio na saúde relacionada com a qualidade de vida em termos de estado funcional, gravidade da dor, fadiga e funcionamento social e emocional

ABSTRACT Objective: To determine the impact of postpolio-syndrome on quality of life in polio survivors. Methods: Forty polio survivors were included in the study. Twenty-one patients fulfilling the Halstead's postpolio-syndrome criteria participated in postpolio-syndrome group. The remaining nineteen patients formed non-postpolio-syndrome group. Control group was composed of forty healthy subjects. Quality of life was evaluated by Nottingham Health Profile, depression by Beck Depression Scale and fatigue by Fatigue Symptom Inventory. Isometric muscle strength was measured by manual muscle testing. Results: Total manual muscle testing score was 26.19 ± 13.24 (median: 29) in postpolio-syndrome group and 30.08 ± 8.9 (median: 32) in non-postpolio-syndrome group. Total manual muscle testing scores of non-postpolio-syndrome group were significantly higher than that of postpolio-syndrome group. Patients with postpolio-syndrome reported significantly higher levels of fatigue and reduced quality of life in terms of physical mobility, pain and energy when compared with patients without postpolio-syndrome and control group. It was not reported a statistically significant difference in social and emotional functioning and sleep quality between postpolio-syndrome, non-postpolio-syndrome and control groups. Also it was not found any statistically significant difference in Beck Depression Scale scores among the groups. Conclusions: Postpolio-syndrome has a negative impact on quality of life in terms of functional status, severity of pain and energy. The identification, early recognition and rehabilitation of postpolio-syndrome patients may result in an improvement in their quality of life.

RESUMO Objetivo: Determinar o impacto da síndrome pós-pólio na qualidade de vida nos sobreviventes da pólio. Métodos: Quarenta sobreviventes da pólio foram incluídos no estudo. Participaram do grupo de síndrome pós-pólio 21 pacientes que atenderam aos critérios de síndrome pós-pólio de Halstead. Os 19 restantes formaram o grupo não síndrome pós-pólio. O grupo controle foi composto por 40 indivíduos saudáveis. A qualidade de vida foi avaliada pelo Nottingham Health Profile, a depressão pela Escala de Depressão de Beck e a fadiga pelo Inventário de Sintomas de Fadiga. A força muscular isométrica foi medida por teste muscular manual. Resultados: O escore total do teste muscular manual foi 26,19 ± 13,24 (mediana: 29) no grupo de síndrome pós-pólio e 30,08 ± 8,9 (mediana: 32) no grupo não síndrome pós-pólio. Escores totais de teste muscular manual de grupo não síndrome pós-pólio foram significativamente maiores do que os do grupo de síndrome pós-pólio. Os pacientes com síndrome pós-pólio relataram níveis significativamente maiores de fadiga e qualidade de vida reduzida em termos de mobilidade física, dor e energia quando comparados com pacientes sem síndrome pós-pólio e grupo controle. Não se relatou uma diferença estatisticamente significativa no funcionamento social e emocional e na qualidade do sono entre grupos de síndrome pós-pólio, não síndrome pós-pólio e controle. Além disso, não se encontrou diferença estatisticamente significativa nos escores da Escala de Depressão de Beck entre os grupos. Conclusões: A síndrome pós-pólio tem um impacto negativo na qualidade de vida em termos de estado funcional, gravidade da dor e energia. A identificação, o reconhecimento precoce e a reabilitação dos pacientes com síndrome pós-pólio podem resultar em uma melhoria da qualidade de vida.

Currents issues in cardiorespiratory care of patients with post-polio syndrome / Tópicos atuais no tratamento cardiorrespiratório de pacientes com síndrome pós-poliomielite

ABSTRACT Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus. Most often, polio survivors experience a gradual new weakening in muscles that were previously affected by the polio infection. The actual incidence of cardiovascular diseases (CVDs) in individuals suffering from PPS is not known. However, there is a reason to suspect that individuals with PPS might be at increased risk. Method A search for papers was made in the databases Bireme, Scielo and Pubmed with the following keywords: post polio syndrome, cardiorespiratory and rehabilitation in English, French and Spanish languages. Although we targeted only seek current studies on the topic in question, only the relevant (double-blind, randomized-controlled and consensus articles) were considered. Results and Discussion Certain features of PPS such as generalized fatigue, generalized and specific muscle weakness, joint and/or muscle pain may result in physical inactivity deconditioning obesity and dyslipidemia. Respiratory difficulties are common and may result in hypoxemia. Conclusion Only when evaluated and treated promptly, somE patients can obtain the full benefits of the use of respiratory muscles aids as far as quality of life is concerned.

RESUMO Síndrome pós-polio (SPP) é uma condição que afeta sobreviventes da poliomielite aguda (PAA), anos após a recuperação de um ataque agudo inicial do vírus. Na maioria das vezes, os sobreviventes da polio começam a apresentar nova paresia gradual nos músculos que foram previamente afetados pela infecção. A incidência real de doenças cardiovasculares (DCV) em indivíduos que sofrem de SPP não é conhecida. Entretanto, há indícios para suspeitar de que sujeitos com SPP podem estar em maior risco. Método Realizou-se uma busca de artigos nas bases de dados: Bireme, Scielo e Pubmed, utilizando as seguintes palavras-chave: síndrome pós-poliomielite, função cardiorrespiratória e reabilitação, nos idiomas Inglês, Francês e Espanhol. Embora tenhamos selecionado um número expressivo de artigos, somente foram considerados os duplo-cegos, randomizados-controlados, além de consensos. Resultados e Discussão Certas características da SPP, tais como fadiga muscular, paresia, dor muscular e/ou articulares podem resultar em descondicionamento por inatividade física, além de obesidade e dislipidemia. Dificuldades respiratórias são comuns e podem resultar em hipoxemia. Conclusão Somente quando avaliados e tratados em tempo hábil, alguns pacientes são capazes de obter os benefícios do uso dos músculos respiratórios auxiliares em termos de qualidade de vida.

Treinamento muscular inspiratório e desmame ventilatório de paciente com síndrome pós-pólio / Inspiratory muscle training and ventilation weaning in patient with post-polio syndrome

A síndrome pós-pólio (SPP) é a recidiva dos sintomas da poliomielite anterior aguda (PAA), e o quadro é caracterizado por fraqueza muscular flácida assimétrica, com frequente comprometimento respiratório e de deglutição, além dos distúrbios de sono. O presente estudo relata o caso de uma paciente idosa, em ventilação mecânica domiciliar. Investiu-se no treinamento muscular inspiratório (TMI) com Powerbreathe® por 30 repetições por 2 vezes ao dia, durante 4 semanas, associado a um programa de exercícios físicos. Tal estratégia apresentou como desfecho o desmame da ventilação mecânica (VM), assim como melhora concomitante na Pimax e Mensuração de Independência Funcional (MIF), retornando ao final deste curto programa de reabilitação a realizar atividades laborais em domicílio. O presente relato de caso conclui que o emprego da TMI em pacientes com SPP pode ser uma estratégia promissora para o desmame ventilatório. (AU)

The post-polio syndrome (PPS) is the recurrence of the symptoms of acute anterior poliomyelitis (AAP), and characterized by asymmetrical flaccid muscle weakness, with respiratory and swallowing impairment, in addition to sleep disorders. The present study reports the case of an elderly patient in home mechanical ventilation. We invested in inspiratory muscle training (IMT) ® with Powerbreathe for 30 repetitions, twice daily, during 4 weeks, associated with a program of physical exercise. This strategy showed weaning from mechanical ventilation (MV), as well as a concomitant improvement in Pimax and Functional Independence Measure (FIM), returning at the end of this short rehabilitation program to perform work activities at home. This case study concludes that the use of IMT in patients with PPS may be a promising strategy for weaning. (AU)

Falls in Korean Polio Survivors: Incidence, Consequences, and Risk Factors

Falls and fall-related injuries are important issue among polio survivors. The purpose of this study was to determine the incidence of, and consequences and factors associated with falls among Korean polio survivors. A total of 317 polio survivors participated in this study. All participants completed a questionnaire including fall history, symptoms related to post-polio syndrome and other information through a telephone interview. Among them, 80 participants visited our clinic for additional physical measurements and tests. Of the 317 respondents, 68.5% reported at least one fall in the past year. Of the fallers, 42.5% experienced at least one fall during one month. Most falls occurred during ambulation (76.6%), outside (75.2%) and by slipping down (29.7%). Of fallers, 45% reported any injuries caused by falls, and 23.3% reported fractures specifically. Female sex, old age, low bone mineral density, the presence of symptoms related to post-polio syndrome (PPS), poor balance confidence, short physical performance battery and weak muscle strength of knee extensor were not significantly associated with falls. Only leg-length discrepancy using spine-malleolar distance (SMD) was a significant factor associated with falls among Korean polio survivors. Our findings suggest that malalignment between the paralytic and non-paralytic limb length should be addressed in polio survivors for preventing falls.

Una enfermedad lejana: la información sobre poliomielitis y síndrome post-polio en la prensa hispanolusa, 1995-2009 / A disease of the distant past: information about poliomyelitis and post- poliomyelitis syndrome in the Spanish/Portuguese press, 1995-2009

Se explora el cambio en la percepción social de la polio en la Península Ibérica a través del análisis de contenidos, entre 1995 y 2009, de dos periódicos de gran tirada. La desaparición en la agenda periodística de la polio y de las personas que viven con sus secuelas influyó en el olvido de la misma en la agenda pública. La poliomielitis se vinculó a la pobreza y la ignorancia en países lejanos, susceptibles de acciones de cooperación, siendo objeto de atención solo cuando es percibida como amenaza para Occidente, vinculada a crisis sanitarias o en un sentido metafórico. Así, el síndrome post-polio fue invisibilizado en el caso portugués y débilmente representado en España por el movimiento asociativo.

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.

Foot Drop of Contralateral Limb after Deformity Correction in a Polio Patient: A Case Report / 대한족부족관절학회지

Postpoliomyelitis syndrome is a common neurological disorder that occurs in patients who have experienced paralytic poliomyelitis. Recently, as a result of vaccination against poliovirus, incidence of poliomyelitis is exceedingly low. However, many patients with postpolio syndrome may encounter anesthesia when undergoing surgery, such as for correction of foot deformity and other operations. We report on a 45-year-old woman who experienced paralysis of her contralateral limb after operation on the left foot under spinal anesthesia. Postoperative electromyography/nerve conduction study (EMG/NCS) was performed in order to determine the cause of paralysis. Motor power of the sequelae involved leg showed improvement with time and recovered fully to the preoperative level at six months after the index operation. A precise evaluation, including a physical examination and EMG/NCS, should be performed preoperatively when spinal anesthesia is planned for postpolio syndrome patients.

Post-Polio Syndrome and Risk Factors in Korean Polio Survivors: A Baseline Survey by Telephone Interview

OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2+/-8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5+/-11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. CONCLUSION: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.

Síndrome pós pólio: um desafio para educação física adaptada / Post-poliomyelite syndrome: a challenge for adapted physical education

A Síndrome pós-poliomielite é definida como uma nova desordem neurológica, desenvolvendo nova fraqueza muscular e fadiga muscular anormal em indivíduos que tiveram poliomielite aguda. Objetivo: apresentar conhecimentos básicos sobre a Síndrome pós-poliomielite, esclarecendo as peculiaridades deste quadro clínico e realizar uma reflexão acerca da adequação da atividade física para as pessoas acometidas por esta doença. Além de refletirmos sobre esta questão, neste trabalho também sumarizamos as condutas para o treinamento e prescrição de exercícios usadas nestes últimos 10 anos. Métodos: trata-se de um ensaio teórico, exploratório. Conclusões: a questão relevante que se apresenta para a atividade física adaptada é a carga ideal de treinamento físico a ser prescrita para as pessoas que tiveram poliomielite, uma vez que o supertreinamento é um fator de risco para o desenvolvimento Síndrome pós-poliomielite...

Post-poliomyelitis syndrome is defined as a new neurological disorder, with the development of new muscular weakness and abnormal muscular fatigue in people that had acute poliomyelitis. Objectives: the aim was to present the basic post-poliomyelitis syndrome knowledge, clarifying the peculiarities of this clinical condition, and make a reflection about the physical activity adequacy for whom had this disease. Besides reflect about this, we summarized the approach for physical training and exercise prescription proposed on those last 10 years. Methods: this is atheoretical exploratory study. Conclusions: the big issue for the adapted physical education is about the ideal amount overload that should be prescribed in physical training, considering that overtraining is a risk factor for Post-poliomyelitis syndrome...

Muscle Weakness in a Patient with History of Poliomyelitis: A Differential Diagnosis for Post-polio Syndrome (PPS) and Dermatomyositis

Dermatomyositis (DM) is an idiopathic inflammatory myopathy, characterized by inflammation of the proximal skeletal muscles and typical skin manifestations, which results in symmetric muscle weakness. A 43-year-old man was presented with skin rash and left leg weakness, and he had a history of poliomyelitis. Initially, he was diagnosed as having post-polio syndrome (PPS) due to unilateral muscle weakness and a result of an the electromyography (EMG), which had shown patterns of PPS. After 4 months with conservative therapy for PPS, weakness of bilateral upper arms had developed and skin rashes on his entire body had aggravated and progressed. He was diagnosed as having dermatomyositis, based on elevated muscle enzyme levels, typical skin rashes, and typical EMG findings, which indicated muscle disease. When a patient with previous poliomyelitis has a newly developed muscle weakness or pain, we should consider various possible causes other than PPS.

Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome / Variacao circadiana da fadiga em ambos os grupos de pacientes com poliomielite paralitica e sindrome pos-poliomielite

Objective It was to evaluate the degree of fatigue in patients with paralytic poliomyelitis (PP) and with post-polio syndrome (PPS), and correlate it with parameters of sleep and the circadian cycle. Methods Thirty patients, 17 female (56.7%), participated in the study: they answered the Revised Piper Fatigue Scale and performed a nocturnal polysomnographic study. Eleven had PP (mean age±standard deviation of 47.9±6.4 years), and 19 had PPS (mean age±standard deviation of 46.4±5.6 years). Results Our study showed that fatigue was worse in the afternoon in the PP Group and had a progressive increase throughout the day in the PPS Group. We also observed compromised quality of sleep in both groups, but no statically significant difference was found in the sleep parameters measured by polysomnography. Conclusion Fatigue has a well-defined circadian variation, especially in PPS Group. Poor sleep quality is associated with fatigue and, therefore, sleep disturbances should be evaluated and treated in this group of PPS. .

Objetivo Foi avaliar o grau de fadiga em pacientes com poliomielite paralítica (PP) e com síndrome pós-poliomielite (SPP), e correlaciona-lo com parâmetros de sono e ciclo circadiano. Método Trinta pacientes, 17 do sexo feminino (56,7%), participaram do estudo: responderam à Escala de Fadiga de Piper Revisada e submeteram-se à avaliação polissonográfica noturna. Onze apresentavam PP (média de idade±desvio padrão de 47,9±6,4 anos), e 19 apresentavam SPP (média de idade±desvio padrão de 46,4±5,6 anos). Resultados Nosso estudo mostrou que a fadiga é pior no período da tarde no grupo com PP e piora progressivamente ao longo do dia no grupo SPP. Observamos também comprometimento na qualidade do sono em ambos os grupos. Contudo, os parâmetros do sono avaliados pela polissonografia não demonstraram diferenças estatísticas significantes entre os grupos PP e SPP. Conclusão A fadiga apresenta variação circadiana bem definida, especialmente nos pacientes do grupo SPP. Pobre qualidade do sono está associada com fadiga e, portanto, distúrbios do sono deveriam ser mais bem avaliados e tratados no grupo de pacientes com SPP. .

Lung function in post-poliomyelitis syndrome: a cross-sectional study / Funcao pulmonar em pessoas com sindrome pos-poliomielite: um estudo transversal

OBJECTIVE: To compare lung function between patients with post-poliomyelitis syndrome and those with sequelae of paralytic poliomyelitis (without any signs or symptoms of post-poliomyelitis syndrome), as well as between patients with post-poliomyelitis syndrome and healthy controls. METHODS: Twenty-nine male participants were assigned to one of three groups: control; poliomyelitis (comprising patients who had had paralytic poliomyelitis but had not developed post-poliomyelitis syndrome); and post-poliomyelitis syndrome. Volunteers underwent lung function measurements (spirometry and respiratory muscle strength assessment). RESULTS: The results of the spirometric assessment revealed no significant differences among the groups except for an approximately 27% lower mean maximal voluntary ventilation in the post-poliomyelitis syndrome group when compared with the control group (p = 0.0127). Nevertheless, the maximal voluntary ventilation values for the post-poliomyelitis group were compared with those for the Brazilian population and were found to be normal. No significant differences were observed in respiratory muscle strength among the groups. CONCLUSIONS: With the exception of lower maximal voluntary ventilation, there was no significant lung function impairment in outpatients diagnosed with post-poliomyelitis syndrome when compared with healthy subjects and with patients with sequelae of poliomyelitis without post-poliomyelitis syndrome. This is an important clinical finding because it shows that patients with post-poliomyelitis syndrome can have preserved lung function. .

OBJETIVO: Comparar a função pulmonar de pacientes com síndrome pós-poliomielite à de pacientes com sequelas de poliomielite paralítica (sem quaisquer sinais ou sintomas de síndrome pós-poliomielite) e à de sujeitos saudáveis. MÉTODOS: Vinte e nove sujeitos do sexo masculino foram divididos em três grupos: controle, poliomielite (pacientes que sofreram de poliomielite paralítica, mas que não apresentaram síndrome pós-poliomielite) e síndrome pós-poliomielite. Os voluntários foram submetidos a avaliações da função pulmonar (espirometria e avaliação da força muscular respiratória). RESULTADOS: Os resultados da espirometria não revelaram diferenças significantes entre os grupos, à exceção da ventilação voluntária máxima, cuja média no grupo síndrome pós-poliomielite foi aproximadamente 27% mais baixa que no grupo controle (p = 0,0127). No entanto, os valores de ventilação voluntária máxima observados no grupo pós-poliomielite foram comparados aos da população brasileira e se apresentaram dentro da faixa normal. Não foram observadas diferenças significantes entre os grupos no tocante à força muscular respiratória. CONCLUSÕES: À exceção da ventilação voluntária máxima mais baixa, não houve comprometimento significante da função pulmonar em pacientes ambulatoriais com diagnóstico de síndrome pós-poliomielite quando comparados a pacientes com sequelas de poliomielite, mas sem a síndrome pós-poliomielite e a sujeitos ...

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

Post-poliomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients several years after their acute poliomyelitis paralysis. Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. The diagnosis is essentially clinical after excluding other neurological, orthopedic or rheumatologic problems. Temporomandibular disorders (TMD) are usually diagnosed by means of comprehensive review of patient history and clinical examination and the symptoms are pain/ discomfort in the jaw, mainly in the region of the temporomandibular joints (TMJs) and/or masticatory muscles, limitation of mandibular function and/or TMJ sounds. In the same way as PPS, the diagnosis of TMD is challenging. This study reports the case of a patient that presented thesymptoms of both conditions in the stomatognathic system, and discusses how to achieve the differential diagnosis for proper management of the cases.

Fatigue in progressive neurological conditions: a literature review

This paper reviews the current literature examining the pervasive symptom of fatigue experienced in three of the most common degenerative neurological conditions: multiple sclerosis [MS], Parkinson's disease [PD] and post-polio syndrome [PPS]. The existing literature can be considered under four headings; definition and prevalence, type, cause, impact of fatigue. Fatigue is a common symptom in degenerative conditions and has physical, cognitive and psychosocial manifestations. Although the causes of fatigue seem to differ between conditions, its pattern, with few exceptions, is very similar regardless of diagnosis. The literature consistently shows that the impact of fatigue on the person's physical and mental performance considerably increasing the risk of unemployment and reduced quality of life. Fatigue is one of the most disabling symptoms in degenerative neurological conditions. With few pharmacological solutions, non-pharmacological solutions for fatigue management should be considered when determining rehabilitation interventions for this group of people

Effects of Dăoyĭn Qìgōng in postpolio syndrome patients with cold intolerance / Efeitos do Dăoyĭn Qìgōng em pacientes com síndrome pós-pólio com queixa de intolerância ao frio

Postpolio syndrome (PPS) is characterized by progressive muscle weakness due to former infection with poliomyelitis and can be associated with other symptoms such as cold intolerance (CI). Dăoyĭn Qìgōng (DQ) is a technique in Traditional Chinese Medicine that impacts the circulation of energy and blood. OBJECTIVE: It was to verify the effects of DQ in PPS patients complaining of cold intolerance. METHODS: Ten PPS patients were assessed using the visual analogue scale (VAS) adapted for CI before and after intervention with DQ; patients practiced it in a sitting position for 40 minutes, 3 times per week over 3 consecutive months. Patients were reassessed three months after ceasing DQ. RESULTS: There was a statistically significant difference in local and systemic VAS-Cold both at the end of DQ training and three months past the end of this. CONCLUSION: The DQ technique ameliorated CI complaints in patients with PPS.

A síndrome pós-poliomielite (SPP) é caracterizada por instalação de nova fraqueza muscular às manifestações residuais da poliomielite, associada a outros sintomas, como intolerância ao frio (IF). O Dăoyĭn Qìgōng (DQ) é uma técnica da medicina tradicional chinesa que interfere na circulação da energia e do sangue. OBJETIVO: Foi verificar os efeitos do DQ em pacientes com SPP com queixa de intolerância ao frio. MÉTODO: Dez pacientes com SPP foram avaliados com a escala visual analógica (EVA) adaptada para IF antes e após intervenção com DQ, adaptados para a posição sentada, com duração de 40 minutos, 3 vezes por semana, durante 3 meses. RESULTADOS: Verificou-se diferença estatisticamente significante, na EVA-frio local e sistêmica, após o término do treinamento. CONCLUSÃO: O DQ é uma técnica que interferiu positivamente na queixa de IF em pacientes com SPP.