Complex decongestive therapy in a patient with poliomyelitis, bilateral lymphoedema and a deep wound: a case study.

OBJECTIVE: The aim of this case report is to describe the results of complex decongestive therapy (CDT) in a patient with poliomyelitis and bilateral lymphoedema, and to emphasise the effect of CDT on wound healing. METHOD: A 48-year-old female patient was given CDT for bilateral grade 3 lymphoedema in the lower extremities and a deep wound on the right foot. She had been diagnosed with poliomyelitis sequela and mobilised with a wheelchair for 26 years. The lymphoedema on both legs and the wound on the right foot sole had been present for five years and eight months, respectively. Detailed wound care had been performed previously upon the green, malodorous infected wound, without healing. The patient received skin care education, manual lymphatic drainage, multilayer bandaging and exercises for 4 weeks in a total of 20 sessions. The improvement was assessed by limb volumes prior to and at the end of the treatments. RESULTS: The right and left lower limb volumes were decreased significantly at the end of treatments (3042cm³ (R) and 3165cm³ (L) before versus 2702cm3 (R) and 2401cm3 (L) afterward). The wound size decreased considerably and the green malodorous flow ceased. The patient continued self-massage and self-bandaging after hospital discharge. The control follow-up, one month later, revealed a completely healed wound with maintained volume. CONCLUSION: In conclusion CDT for a duration of 4 weeks in a female patient with poliomyelitis, bilateral lymphoedema and an infectious hard-to-heal wound, improved both the lymphoedema and wound healing.

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

OBJECTIVE: To determine if coenzyme Q(10) alleviates fatigue in the late-onset sequelae of poliomyelitis. DESIGN: Parallel-group, randomized, placebo-controlled trial. BACKGROUND SETTING: Coenzyme Q(10) has been shown to boost muscle energy metabolism in post-polio subjects but it does not promote muscle strength, endurance or function in polio survivors with post-poliomyelitis syndrome. However, the collective increased energy metabolism might contribute to a reduction in post-polio fatigue. PARTICIPANTS: Polio survivors from the Australian post-polio networks in Queensland and New South Wales who attribute a moderate to high level of fatigue to their diagnosed late-onset sequelae of poliomyelitis. Those with fatigue-associated comorbidities of diabetes, anaemia, hypothyroidism and fibromyalgia were excluded. METHOD: Participants were assigned (1:1), with stratification of those who use energy-saving mobility aids, to receive 100 mg coenzyme Q(10) or matching placebo daily for 60 days. Participants and investigators were blinded to group allocation. Fatigue was assessed by the Multidimensional Assessment of Fatigue as the primary outcome and the Fatigue Severity Scale as secondary outcome. RESULTS: Of 103 participants, 54 were assigned to receive coenzyme Q(10) and 49 to receive the placebo. The difference in the mean score reductions between the two groups was not statistically significant for either fatigue measure. Oral supplementation with coenzyme Q(10) was safe and well-tolerated. CONCLUSION: A daily dose of 100 mg coenzyme Q(10) for 60 days does not alleviate the fatigue of the late-onset sequelae of poliomyelitis. The registration number for the clinical trial is ACTRN 12612000552886.

[Spinal anesthesia in a patient with hemiparesis after poliomyelitis].

A seventy-year-old man who underwent transurethral resection of the prostate (TUR-P), had carried over the palsy after poliomyelitis inflicted at one year of age. Spinal anesthesia using with 7 mg of hyperbaric tetracaine with dextrose solution was performed for this surgery. The running pressure of D-sorbitol solution was 50 cmH2O during the operation. The operation time was 41 minutes and the balance of running water was -200 ml. After this TUR-P, there was no progression of his palsy, muscle atrophy or no aggravation of autonomic system immediately after the operation, 3 months later and 6 months later, respectively. This case suggests that spinal anesthesia can be applied in post-poliomyelitis patients. The perioperative maintenance of electrolyte control for endoscopic surgery with water running is more important than anesthetic procedure itself in this case.

[A electromyographical observation on the treatment of poliomyelitis sequelae with series electroacupuncture].

We observed the changes of quadriceps femoris EMG before and after treatment on treatment 41 cases of poliomyelitis sequelae with series electroacupuncture. In 41 patients muscles strength of quadriceps femoris before treatment in 35 cases was below 0 degree and 1 degree. The changes of EMG, Most had no motor unit potential, some only a few but duration was long, and amplitude decreased markedly. A few had fibrillation or positive sharp wave. The changes in EMG accorded with the diagnosis of poliomyelitis sequelae. After 3 month treatment, tee EMG findings were decreasing or there was loss of fibrillation, appearance of motor unit potentials, increase of the amount of motor unit potentials, prolongation of duration and increasing of amplitude of motor unit potentials, appearance of polyphasic potentials etc. Through analysis of EMG, 32 among 41 cases were improved, effective rate was 78%, P less than 0.01. EMG indices indicate the efficacy of series mg electroacupuncture in treating the sequelae of poliomyelitis and confirm the clinical therapeutic effect of the treatment. The indices indicate that the pathological changes of damaged anterior horn cells of the spinal cord were decreased and partial recovery of nervous function. The EMG changes paralleled those in clinical therapeutic effect of treatment and changes of muscle strength.

Self-regulation treatment of post-polio cold limb.

Decreased limb temperature in the affected limb is one of the aftereffects of poliomyelitis. The decrease in limb temperature can be painful as well as subjectively unpleasant. A search of the current literature failed to reveal a cost-effective treatment for post-polio cold limbs. Since thermal biofeedback and other physiologic self-regulatory therapies have been shown to be effective in increasing peripheral blood flow in a number of disorders, they were used in the treatment of a patient with a post-polio cold limb. The patient showed foot warming during therapy sessions. This effect generalized to situations outside the therapy environment. The patient's self-report also indicated treatment to be successful. Replication and studies of the warming and cooling mechanism are suggested.

Late postpoliomyelitis muscular atrophy: a case report and clinical discussion.

Late postpoliomyelitis muscular atrophy (PPMA), a condition afflicting those who contracted poliomyelitis before the discovery of the vaccines in the 1950s, is a pathology that has only recently been described. A brief case report of a late PPMA patient is followed by a discussion of the etiology of the condition. Diagnostic and differential diagnostic considerations are presented, along with treatment goals and treatment paradigms.

EMG biofeedback in tendon transplantation for foot drop.

EMG biofeedback training was used successfully to obtain the desired new function of dorsiflexion in the transplanted muscle for two patients with foot drop. The transplanted muscles are not working effectively, not only the active movement but also during a walk. It is concluded that EMG biofeedback training is useful in rehabilitation following tendon transplantation for foot drop.