Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects.

INTRODUCTION: This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = -13, CI 95% -16 to -9 points), lower dynamic postural stability (MD = -14, CI 95% -19 to -8 points), and increased fear of falling (MD = 14, CI 95% 10-18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738-0.351), risk of falling (ρ = -0.746), and fear of falling (ρ = -0.432). Dynamic postural stability was correlated with risk of falling (ρ = -0.841), fear of falling (ρ = -0.277), and static postural stability (ρ = -0.869 to -0.435; ρ = -0.361 to -0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.

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.

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.

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.

[Hypotonic syndrome in the newborn infant]. / Síndrome hipotónico del lactante.

Hypotonia is understood to refer to a pronounced decrease in muscle tone that affects normal motor development and that may affect the axial muscles as well as those of the limbs and, sometimes, the face. It is a very challenging clinical picture because it consists in a fairly wide range of conditions that affect different areas of the central and peripheral nervous system and may be the expression of pathologies that can be either benign or of an uncertain prognosis. These cover myopathies, metabolic disorders, diseases based on genetic causes, pathologies affecting the endocrine glands and progressive or chronic diseases, among other aetiologies. The important development of medicine today has made a number of tools available to the examiner with which to refine or pronounce a diagnosis. Such instruments include the developments achieved in genetic research, together with studies conducted in imaging and optical and electronic microscopy. However, in spite of having all this material available for use, it is still the clinical features that allow a rational use to be made of these advances to be able to point towards the possible causation, topographic location and developmental control. It is useful, for the diagnostic approach and the use of auxiliary methods, to know the topographic location of the disorder, whether it is situated in the brain, the cerebellum, the stem, the spinal cord, the peripheral nerves, the myoneural junction or the muscle.

TITLE: Sindrome hipotonico del lactante.Entendemos como hipotonia la disminucion acentuada del tono muscular que afecta al desarrollo motor normal y que puede afectar a la musculatura axial y de los miembros y, en ocasiones, a la facial. Es un cuadro que genera un gran desafio ya que, en su universo, comprende una serie bastante amplia de condiciones que afectan a distintas areas del sistema nervioso, tanto central como periferico, y que pueden ser expresion de patologias de corte benigno o de pronostico reservado. Abarcan miopatias, alteraciones metabolicas, enfermedades de corte genetico, endocrinopatias y enfermedades progresivas o cronicas, entre otras causas. El gran desarrollo de la medicina actual ha logrado poner a disposicion del examinador multiples herramientas que permiten afinar o aseverar el diagnostico, entre las que destacan los desarrollos logrados en las investigaciones geneticas, asi como los estudios de imagenes y de microscopia optica y electronica. Sin embargo, pese a toda esta oferta, sigue siendo la clinica la que permite usar racionalmente estos avances y orientar hacia la posible etiologia, localizacion topografica y control evolutivo. Es de utilidad, para el enfoque diagnostico y la utilizacion de metodos auxiliares, que la localizacion topografica de la afectacion ya este esta ubicada en el cerebro, el cerebelo, el tallo, la medula, los nervios perifericos, la union mioneural o el musculo.

Circadian variation of fatigue in both patients with paralytic poliomyelitis and post-polio syndrome.

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.

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. .

Composição corporal de esportistas com lesão medular e com poliomielite / Body composition of active persons with spinal cord injury and with poliomyelitis

O presente estudo teve por objetivos avaliar a composição corporal de esportistas com lesão medular traumática e poliomielite. Método: Dois grupos de homens e mulheres, esportistas, com idades e índice de massa corporal (IMC) similares, foram distribuídos em dois grupos, de acordo com a origem da deficiência: LM- lesão medular traumática baixa (T5-T12) e P- seqüelas de poliomielite em apenas um dos membros inferiores. Composição corporal analisada por DEXA (gordura e massa magra corporais); bioimpedância elétrica por análise vetorial- BIVA (resistência, reactância e ângulo de fase). Os participantes do mesmo gênero foram comparados de acordo com a origem da deficiência; os grupos foram comparados a uma população de referência, quando esses dados eram disponíveis. Resultados: Os vetores gerados na análise por bioimpedância foram avaliados pelo teste Hotelling's T2 e suas distâncias comparadas (Mahalanobis distance, D) entre si e com uma população de referência. Na análise por DEXA, os homens com LM apresentam maior quantidade absoluta de massa magra e consequentemente o maior índice de massa magra do que os P. Ambos apontaram valores inferiores à população de referência. Na análise por bioimpedância, os homens do grupo P apresentaram maior resistência que os LM, e como conseqüência, os menores ângulos de fase. O grupo LM foi o que mais se aproximou da população de referência. Conclusão: Considerando a composição corporal como indicador indireto do estado nutricional, o presente estudo aponta que, embora ambas as origens de deficiência apresentem valores de massa magra inferiores e valores de resistência superiores aos estudos de referência, as pessoas com poliomielite podem estar em risco nutricional aumentado em relação às pessoas com lesão medular. Esse risco parece ser maior nos homens do que nas mulheres. Dados adicionais de avaliação nutricional, como o uso de marcadores bioquímicos e dietéticos, e com um maior número de avaliados, certamente poderão explorar e elucidar melhor esses achados.

This study sought to evaluate the body composition of subjects with active spinal cord injuries and polio. Method: Two groups of males and females, active, free-living, of similar ages and body mass index (BMI), were distributed according to the source of deficiency: SCI - low spinal cord injury (T5-T12) and P - survivors of poliomyelitis infection. Body composition was analyzed by DEXA (fat and lean mass); bioelectrical impedance by vector analysis (BIVA analysis; resistance and reactance). Participants of the same gender were compared according to the source of deficiency, and both groups had their values compared to a reference population, when available. Results: Mean vectors were assessed with Hotelling's T2 test and compared by Mahalanobis distance (D). DEXA analysis pointed out the men of P group with higher absolute amount of lean mass, and consequently the higher body lean mass index; both groups presented lower values than a reference study. With regard to BIVA analysis, P men presented higher resistance than SCI men and, consequently, a lower phase angle. Conclusion: Considering body composition as an indirect indicator of nutritional status, the present study suggests that, even with both groups presenting lower values than a reference population, there is a possibility of an increased nutritional risk for polio individuals than SCI, and this risk seems to be higher in men than in women. Further investigation, adopting biochemical and dietetic markers, and a higher sample size, certainly could better explore and understand our results.

[The differential diagnosis of poliomyelitis and other acute flaccid paralyses]. / Diagnóstico diferencial de la poliomielitis y otras parálisis flácidas agudas.

Between June 1988 to January 1991 a total of 246 children with acute flaccid paralysis (AFP) were seen at Hospital Infantil de México, Federico Gómez which was the center of study for AFP for the Poliomyelitis Eradication Program of Mexico. Of the 246 children, 42 has poliomyelitis (17%); 156 has Guillain-Barré syndrome (GBS) (63.4%); 16 had traumatic neuritis of the sciatic nerve secondary to IM injections (TNC) (6.5%); five had transverse myelitis (2%); the rest (27) had other diseases misdiagnosed as polio (10.9%). The basic clinical characteristics for the diagnosis of poliomyelitis are: myalgias and fever at the onset AFP, paralysis is asymmetrical, of distal predominance and causes severe muscular atrophy and skeletal deformities; the GBS presents as an ascending, symmetrical, areflexic paralysis of distal predominance. It does not causes atrophy or deformities. TNC presents several days after IM injections with pain and hypothermia in the affected limbs; TM is a flaccid, symmetrical paraparesis with neurogenic bladder and a sensory level. CSF and neurophysiological studies (EMG and NCV) are very useful for diagnosis. Other entities misdiagnosed as poliomyelitis were: osteoarticular trauma, myopathies and dystrophies, viral myositis, acute cerebellitis, retroperitoneal tumors and upper motor neuron syndromes. Viral studies in stool specimens are essential for the diagnosis of poliomyelitis.

Inmunoprofilaxia de la poliomielitis / Inmunoprophilaxis of poliomielitis

La poliomielitis es una enfermedad viral, generalizada y aguda, que afecta al sistema nervioso central con severidad variable, y a veces se complica con parálisis. Si ocurre esto último, se trata de una parálisis fláccida, generalmente asimétrica, de diversos músculos estriados que a veces se acompaña de trastornos respiratorios y vasomotores. La poliomielitis solamente afecta al ser humano y al no haberse demostrado que en la naturaleza existen reservorios animales, se trata de una enfermedad que puede ser erradicada si se consigue inmunizar el número adecuado de sujetos como para interrumpir definitivamente la cadena de transmisión. Los subtítulos en que se divide el trabajo son: Historia, Agente, Patogenia, Diagnóstico, Inmunología, Epidemiología, Vacunas disponibles, Vacunas inactivadas, Vacuna atenuada, Reacciones diversas, Otros esquemas de inmunización, y Nuevas vacunas

Plan de erradicación de virus salvaje de la poliomielitis. Hasta 1990 / Es

En relación a la disminución de la morbilidad en años recientes como consecuencia de los resultados obtenidos mediante el Programa Ampliado de Inmunizaciones, el Director de la Oficiana Panamericana Sanitaria, Dr. Carlyle Guerra de Macedo, manifestó que es inadmisible que disponiendo actualmente de alta tecnología, algún niño en este hemisferio pueda padecer de parálisis poliomielítica e instó a los países de la región de las Américas a unificar esfuerzos hacia la erradicación del virus salvaje de la poliomielitis