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.

The experiences of using polio outbreak simulation exercises to strengthen national outbreaks preparedness and response plans in sub-Saharan Africa.

INTRODUCTION: globally, by 2020 the paralytic poliomyelitis disease burden decreased to over 99% of the reported cases in 1988 when resolution 41.8 was endorsed by the World Health Assembly (WHA) for global polio eradication. It is clearly understood that, if there is Wild Poliovirus (WPV) and circulating Vaccines Derived Poliovirus (cVDPV) in the world, no country is safe from polio outbreaks. All countries remain at high risk of re-importation depending on the level of the containment of the types vaccine withdrawn, the laboratory poliovirus isolates, and the population immunity induced by the vaccination program. In this regard, countries to have polio outbreak preparedness and response plans, and conducting the polio outbreak simulation exercises for these plans remain important. METHODS: we conducted a cross-section qualitative study to review to 8 countries conducted polio outbreak simulation exercises in the East and Southern Africa from 2016 to 2018. The findings were categorized into 5 outbreak response thematic areas analyzed qualitatively and summarized them on their strengths and weaknesses. RESULTS: we found out that, most countries have the overall technical capacities and expertise to deal with outbreaks to a certain extent. Nevertheless, we noted that the national polio outbreak preparedness and response plans were not comprehensive enough to provide proper guidance in responding to outbreaks. The guidelines were inadequately aligned with the WHO POSOPs, and IHR 2005. Additionally, most participants who participated in the simulation exercises were less familiar with their preparedness and response plans, the WHO POSOPs, and therefore reported to be sensitized. CONCLUSION: we also realized that, in all countries where the polio simulation exercise conducted, their national polio outbreak preparedness and response plan was revised to be improved in line with the WHO POSOPs and IHR 2005. we, therefore, recommend the polio outbreak simulation exercises to be done in every country with an interval of 3-5 years.

Health care seeking behavior of parents with acute flaccid paralysis child.

INTRODUCTION: Despite the tremendous increase in the number of modern health institutions, traditional medical practices still remain alternative places of health care service delivery and important sites for disease notification in the disease surveillance system. The objectives of this study are to describe the patterns and factors associated with health care seeking behavior of parents and care takers with acute flaccid paralysis child and see how the traditional practice affect the surveillance system. METHODS: A cross-sectional descriptive study was conducted to assess the health seeking behavior of parents with an acute flaccid paralysis child. Data were collected throughout the country as a routine surveillance program. RESULTS: Of 1299 families analyzed, 907(69.3%) of families with AFP child first went to health institutions to seek medical care, while. 398 (30.7%) of parents took their child first to other traditional sites, including holy water sites (11.8%), traditional healers (9.1%) and prayer places (5.4%). Over half of the parents with AFP child reported practicing home measures before first seeking health service from modern health institutions. Home measures (OR, 0.1202, 95% CI 0.0804-0.1797), decision by relatives (OR, 0.5595, 95% CI 0.3665-0.8540) and More than 10km distance from health facility (OR, 0.5962, 95% CI, 0.4117-0.8634) were significantly associated to first seeking health service from health institutions (p<0.05). CONCLUSION: Program strategies must certainly be developed to expand and capture all traditional sites in the surveillance network, and intensify sensitization and active surveillance visit in these areas.

Fisioterapia aquática no paciente sobrevivente da Poliomielite traqueostomizado com suporte ventilatório: relato de caso / Aquatic physical therapy for a poliomyelitis survivor with tracheostomy and ventilatory support: a case report

Muitos pacientes sobreviventes da poliomielite apresentam importante comprometimento da função respiratória. A fisioterapia aquática é indicada para esta população, porém, a presença da traqueostomia leva a uma maior dificuldade de tratamento no meio líquido pela dificuldade da manipulação. O objetivo deste trabalho é verificar os benefícios que uma paciente traqueostomizada, com suporte ventilatório não invasivo, pode ter com a abordagem da fisioterapia aquática. A paciente sofreu intervenção de vinte sessões de fisioterapia aquática. Para avaliação foram usadas as Escalas de Fadiga, Dor e Qualidade de vida e analisados os parâmetros: Saturação de Oxigênio (SatO2), Freqüência Cardíaca (FC)e Freqüência Respiratória (FR). Foi constatada melhora na pontuação de todas as escalas de fadiga utilizadas:inicial 55 e final 28, demonstrando ao final do estudo ausência de fadiga Fator esse também verificado na qualidade de vida principalmente na dimensão de vitalidade inicial 29,16 e final 50. A FC, a (excluir) FR e a SatO2 não sofreram alterações significativas, observando dessa maneira a segurança durante o atendimento. No término do tratamento, o quadro álgico cessou nos principais grupos articulares. Os resultados demonstraram que o meio líquido foi favorável para o tratamento dessa paciente, garantindo a segurança, diminuindo a fadiga e a dor, melhorando assim a qualidade de vida.

Survivors of polio exhibit significant impairment of respiratory function. Aquatic physical therapy is recommended for this population, however, the presence of tracheostomy produces greater difficulty in treatment when using water because of the difficulty involved in moving the patient. The aim of this study is to assess the benefits that a tracheostomized patient with non-invasive ventilatory support, may have with an aquatic therapy approach. The patient underwent an intervention/treatment of twenty sessions of aquatic therapy. The fatigue, pain and quality of life scales were used for evaluation and the parameters were analyzed: Oxygen Saturation (SaO2), heart rate (HR), Respiratory Rate (RR). It was a striking improvement in the scores of all scales used for fatigue: initial 55 and final 28, demonstrating an absence of fatigue at the end of the study. This factor was also observed in the quality of life mainly in the initial (29.16) and final (50) periods of vitality. The HR, RR and SaO2 did not change significantly, demonstrating the safety during the treatment. The pain ceased in the major joints at the end of treatment. The results showed that the use of water was favorable for the treatment of the patient, ensuring safety, reducing fatigue and pain, thereby improving the quality of life.

Historical aspects of critical care and the nervous system.

The appropriate starting point for a history of neurocritical care is a matter of debate, and the organization of facts and conjectures about it must be somewhat arbitrary. Intensive care for neurosurgical patients dates back to the work of Walter Dandy at the Johns Hopkins Hospital in the 1930s; many consider his creation of a special unit for their postoperative care to be the first real ICU. The genesis of neurocritical care begins in prehistory, however. This article gives a predominantly North American history, with some brief forays into the rest of the world community of neurointensivists.

Electromyographic biofeedback: behavioral treatment of neuromuscular disorders.

Electromyographic biofeedback is becoming widely used to help patients regain voluntary control of specific muscles affected by neuromuscular disorders. Electromyographic feedback training has been employed in the rehabilitation of patients affected by poliomyelitis, cerebrovascular accident, torticollis, nerve injury, temporomandibular joint syndrome, bruxism, and other disorders. While EMG biofeedback appears to be a promising treatment technique, the research literature on its effectiveness consists mainly of uncontrolled case reports and clinical trials. It is concluded that new studies with more sophisticated design and more careful control are needed to demonstrate that EMG biofeedback makes a unique contribution to the treatment of neuromuscular disorders. Research is needed to identify relevant patients characteristics predictive of success, specify appropriate muscle groups for the treatment of particular disorders, determine how feedback can be most efficiently combined with more conventional techniques in achieving a therapeutic effect, and establish meaningful criteria of success in the treatment of neuromuscular disorders.