EXERCISE FOR POST-POLIO PATIENTS

          About postpolio syndrome

■ ABSTRACT

Decades after recovery from polio, many patients develop new muscle weakness and other symptoms that can lead to increased debility. Treatment is aimed at the most prominent symptoms. Medications may help, as well as physical therapy and a carefully paced exercise program. Screening for osteopenia and osteoporosis is recommended.

■ KEY POINTS

Postpolio syndrome affects an estimated 60% of “paralytic polio survivors, plus unknown numbers of patients who had subclinical polio.

Postpolio syndrome is a diagnosis of exclusion. Symptoms are related to new muscle weakness and may include muscle atrophy, myalgias, fatigue, and problems with swallowing and breathing.

No drugs specifically address postpolio syndrome. Pyridostigmine has had mixed results for treating weakness and fatigue, as have methylphenidate and bromocriptine. Modafinil may be helpful for fatigue. Nonsteroidal anti- inflammatory drugs are used to treat pain.

Rehabilitation professionals who have expertise in treating polio survivors can be va

EXERCISE FOR POST-POLIO PATIENTS

Report #6779 4/9/96

People who have muscle and nerve diseases, such as post-polio syndrome and multiple sclerosis, usually do not exercise because their muscles hurt during exercise and they feel extremely tired after they exercise. A recent report in The American Journal of Physical Medicine and Rehabilitation shows that can benefit greatly from a program to strengthen their muscles.

Your muscles are made up of thousands of individual fibers. Each muscle fiber is innervated by a single nerve. When a nerve dies, the muscle fiber that is attached to that nerve lacks a stimulus to make it contract, so that fiber dies also. Multiple sclerosis and post-polio syndrome destroy nerves, causing muscle fibers to disappear. When such people exercise, their muscles have fewer fibers, so the remaining fibers have to work much harder, fatigue earlier and take far longer to recover. Strengthening the fibers allows a person with nerve damage to do more work before the muscles fatigue during exercise.

However, all people who have nerve damage become extraordinarily weak on the day after they exercise. To avoid long recovery periods after exercise, they can start out by lifting very light weights in 3 sets of ten and stop exercising immediately when they feel burning, heaviness and fatigue. 

They can try again at least 48 hours later, provided that their muscles do not feel heavy before they start. When they can perform 3 sets of 10 with a certain weight comfortably and feel fresh on the next day, they are ready to try a slightly heavier weight in their next workout.By Gabe Mirkin, M.D., for CBS Radio News

1) JC Agre, AA Rodriquez, TM Franke, ER Swiggum, RL Harmon, JT Curt. Low-intensity, alternate-day exercise improves muscle performance without apparent adverse affect in postpolio patients. American Journal of Physical Medicine & Rehabilitation. 1996(Jan-Feb);75(1):50-58. 
luable resources in preserving function and preventing deconditioning. http://www.drmirkin.com/archive/6779.html

México a la vanguardia en el Síndrome de Post Polio

Post-polio syndrome (PPS) Neural fatigue

The precise mechanism that causes post-polio syndrome is unknown. It shares many features in common with myalgic encephalomyelitis, a form of chronic fatigue syndrome that is apparently caused by viral infections, but unlike those disorders it tends to be progressive, and can cause tangible loss of muscle strength.Treatment is primarily limited to adequate rest, conservation of available energy, and to supportive measures, such as leg braces and energy-saving devices such as powered wheelchairs, plus pain relievers, sleep aids, etc.

Neural fatigue

The most widely accepted theory is the "neural fatigue" one. Motor neuron fibers were originally damaged by the polio virus and were subsequently over-stressed because too few surviving neurons activated too many muscles. Eventually these neurons become fatigued and die, leading to the slowly advancing loss of muscle function that is typical of post-polio. This scenario may be accelerated by the fall-off in production of nerve growth factor (NGF) that occurs with menopause/andropause.

Mitochondrial disruption

This theory assumes that the major symptoms of PPS are a result of some interference with the action of mitochondria in the muscles and possibly the nerves. Failure of the mitochondria to produce sufficient energy would result in the muscle pain typical of PPS, and would, over time, cause muscle death (rhabdomyolysis) due to exerting the muscle beyond its ability to recover. The cause of this interference with mitochondrial action is presumably a change in the body's hormone balance, as mediated by the hypothalamus and other lower brain areas that control hormones (and which were, presumably, damaged by the original polio virus infection). As with the neural fatigue theory, menopause/andropause accelerates the process, though this time by most likely disrupting the NOTCH pathway that controls cell differentiation and damage repair. One significant argument in favor of the mitochondrial disruption theory is that it explains the fatigue and cognitive difficulties ("brain fog") symptoms that usually accompany post-polio better than the neural fatigue theory does.

Reticular activating system damage

Damage to the reticular activating system and related areas such as the thalamus can also produce most of the fatigue, "brain fog", and dysautonomia symptoms of post-polio, and may be able to cause hormonal changes that result in progressive muscle weakness. Post-mortem examinations of polio patients have shown damage to these areas, and some PPS patients show lesions in these areas when examined by MRI. Many authorities believe that these areas are damaged by the initial polio infection, either as a direct result of the polio virus, or due to an autoimmune reaction following the polio infection. One problem with this theory, though, is that it doesn't easily explain the delayed onset of PPS. It may be that this theory needs to be combined with one of the others to explain delayed onset.

Mechanical overwork

The stresses placed on nerves, muscles, and joints in a polio survivor are in many cases several times those experienced by other people. Problems with gait, in particular, can greatly over-stress joints and the surviving muscles, and the polio survivor is also likely to compensate for weakened arms by jerking more when lifting/pulling something. Over time (and again with menopause/andropause), this results in fatigue and damage 

Treatment

Treatment for post-polio is primarily palliative, as very few reliable therapies to reverse symptoms are known.

Very often fatigue is the most disabling symptom of PPS, and many of those with the disease have discovered that by carefully managing energy expenditure they can prevent or reduce the worst fatigue episodes. Further, for many this "energy management" approach appears to reduce pain. Though most authorities agree that rest is an important component of post-polio treatment, there is significant disagreement as to how much rest is necessary. Some hold that the best approach is to expend the absolute minimum amount of energy necessary to enjoy a reasonable lifestyle, while others feel that there is some threshold below which energy conservation is not helpful and may in fact be harmful (due to the general effects caused by lack of exercise).

Leg braces and other orthotics can reduce the stress on joints and, in some cases, muscles, and so may slow the progression of joint and muscle damage related to PPS. However, some authorities feel that many PPS patients rely on such items too much and for too long when they should be graduating to a wheelchair. Wheelchairs (particularly powered wheelchairs) and "scooters" (small battery-powered vehicles) are useful both to conserve energy and to reduce the stress on weakened joints and muscles. Non-powered wheelchairs, however, are not generally recommended since they place too much stress on arm muscles and joints and may take too much energy to operate. In some cases even the scooters are not recommended since operating the "tiller" of the typical scooter can be tiring to arm muscles. A standing frame can be used in conjunction with the wheelchair to provide alternative positioning and prevent secondary complications. http://www.livingwithcerebralpalsy.com

México a la vanguardia en el Síndrome de Post Polio

The World Health Organisation (WHO) on Saturday said the alleged fake immunisation conducted by Dr Shakil Afridi had nothing to do with polio campaigns as DNA cannot be collected orally.

WHO rejects polio rumours

Imran Ali Teepu | Metropolitan > Islamabad | From the Newspaper

18 hours ago

ISLAMABAD, Feb 25: 
Pakistan’s polio campaign came under immense pressure when people in Khyber Pakhtunkhwa and other parts of the country refused to administer drops to their children after reports that Dr Afridi had managed a fake polio campaign for taking DNA of Osama Bin Laden in Abbottabad.
In an interview with Dawn, WHO’s special envoy on global polio eradication and primary healthcare, Dr Hussain A. Gezari said:
“This person (Dr Afridi) was not supported either by the government of Pakistan or any international donor agency for any immunisation campaign, and secondly, we don’t collect blood samples during vaccination campaigns.”
Dr Afridi is currently under the custody of intelligence agencies and has been booked by the government on the charge of treason.
Setting aside rumours linked with efficacy of the vaccination in some section of the media, Dr Gezari said: “The vaccine being
used to eradicate polio globally is verified, cleared and checked for quality by WHO and has nothing to do with any type of transmission of disease to any child. No one has ever died or can die of the vaccine. The polio vaccine is sent to any country only for a short period of time and there is no chance for it to expire.
“This is nonsense if someone says that the vaccine will cause death and such people should not be taken seriously,” he insisted.
Read More  http://www.dawn.com/2012/02/26/who-rejects-polio-rumours.html

Protecting  every  girl—and  boy

By: Rina Jimenez-David
Philippine Daily Inquirer

10:19 pm | Thursday, February 23rd, 2012

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“Herd immunity” is a theory in immunology that holds that an entire population doesn’t need to get vaccinated against an infectious disease because once a significant portion of that population is vaccinated, even the un-vaccinated will be protected. As more and more people are vaccinated against an infectious disease such as polio, say, or measles, the chances of new infections among even the unprotected begin to fall.

Of course, the ideal is universal vaccination (who wants to take chances, right?). But as theorists of herd immunity propose, “in contagious diseases that are transmitted from individual to individual, chains of infection are likely to be disrupted when large numbers of a population are immune or less susceptible to disease” since there is less probability that an individual would come into contact with an infectious individual.

Herd immunity is one reason medical authorities now propose giving the anti-HPV vaccines to men and boys apart from women and girls. The HPV or human papillomavirus has been identified as causing over 80 percent of all cases of cervical cancer, a disease that afflicts only women. But as Dr. Ricardo Manalastas of UP-PGH pointed out in a talk at a recent Scientific Meeting of

AOGIN-Philippines, HPV, which Manalastas described as “ubiquitous” or common in humans, (it is also responsible for genital warts) has been implicated in other forms of cancer as well: penile and anal cancer and oral and oropharyngeal (mouth and throat) cancer among men; and vulvar and genital cancers among women.

But even if one were concerned only with cervical cancer, Manalastas points out that if men and boys were likewise vaccinated against HPV, then the chances of a woman being infected with HPV and risking cervical cancer (HPV is sexually transmitted) would fall as well. Vaccinated males would also in turn protect MSMs or men having sex with men, a side benefit.

The good news is that HPV vaccination for men and boys has already been approved by the local Food and Drug Administration. There are currently two types of HPV vaccines: the bivalent, which protects against infection by the two most common cancer-causing types of HPV; and the quadrivalent, which protects not just against the two most common cancer-causing types, but also the two most common types that cause genital warts.

http://opinion.inquirer.net/23645/protecting-every-girl—and-boy

Red more 

México a la vanguardia en el Síndrome de Post Polio.

History of polio Video on BBC

History of polio

Poliomyelitis has existed as long as human society, but became a major public health issue in late Victorian times with major epidemics in Europe and the United States. The disease, which causes spinal and respiratory paralysis, can kill and remains uncurable but vaccines have assisted in its almost total eradication today.

México a la vanguardia en el Síndrome de Post Polio

More than 500,000 Cuban children will be immunized

Anti-Polio Campaign in Cuba

Escrito por Redacción Digital Radio Florida

Sábado, 18 de Febrero de 2012 09:48

Havana, Feb 18 - More than 500,000 Cuban children will be immunized during the 51st National Polio Vaccine Campaign, starting in the Caribbean nation on March 2. The program includes two stages, the first for toddlers under three, and the second for nine-year-old children. Some 390,845 minors from three-year, one month old until 2 years, 11 months and 29 days old will receive the first dose of the vaccine. On April 20-27, those children will receive the second doses and, also in the same date, the vaccine will be reactivated for 34,217 nine-year-olds (up to 11 months and 29 days). Source: Prensa Latina  http://www.radioflorida.icrt.cu/index.php/en-ingles/10068-anti-polio-campaign-in-cuba-.html

México (Translation  include) a la vanguardia en el Síndrome de Post Polio

Speaking at the launch of a Nationwide Pulse Polio Campaign for 2012 at Rashtrapati Bhawan on Saturday

Polio monitoring strengthened along international borders

AARTI DHAR

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PTIPresident Pratibha Patil and Health Minister Ghulam Nabi Azad administer polio drops to an infant on the eve of Pulse Polio Immunisation programme day in New Delhi. Photo: PTI

 India has put in place an emergency preparedness and response plan to enforce its commitment to zero tolerance for polio in the country and any new polio case would be declared a public health emergency.

Rapid response teams have already been formed in all the States and Union Territories to respond to any polio case in the country. All States bordering neighboring countries have been put on alert and asked to strengthen surveillance for early detection of any imported polio case.

Speaking at the launch of a Nationwide Pulse Polio Campaign for 2012 at Rashtrapati Bhawan on Saturday, Health and Family Welfare Minister Ghulam Nabi Azad said Special booths have been established in the border areas including Wagah border and Attari railway station in Punjab and Munabao in Barmer district of Rajasthan, to ensure, that all children under five years of age coming from across the border are given polio drops.

Mr. Azad said his Ministry has taken major steps to reach every child in the country, even in areas hardest to reach, to ensure that mobile and migratory populations are not left uncovered.  The coverage of children even in the most endemic states such as Bihar and Uttar Pradesh has crossed 99 per cent.  “This level of coverage is unprecedented, not witnessed anywhere in the world,” the Minister added.  He hoped the efforts would be carried on with the same degree of vigour for at least the next two years, so that India could be declared as a Polio free country in January, 2014.

The campaign was launched by President Pratibha Devisingh Patil who administered polio vaccine drops to eight children. The Nationwide Immunization campaign for Polio will cover more than 17 crore children of less than 5 years of age.  More than 23 lakh volunteers will participate in this massive national effort and more than 1.5 lakh supervisors will monitor quality and coverage of the Immunization activity.  

Pointing out that India was making history in its fight against polio, Mr. Azad said:   “It is indeed a remarkable achievement that for the last one year, the country has remained completely free from polio without witnessing even a single case. In the past, India had a rather large share of global polio cases and only two years ago in 2009, we accounted for half of the total polio cases in the world.  Seen against this back drop, the achievement of one full year of zero polio case is extremely impressive.”

México a la vanguardia en el Síndrome de Post Polio

Despite WHO's recommendation to switch the poliomyelitis vaccine from oral polio vaccine (OPV) to inactivated polio vaccine (IPV) in countries

Vaccine-associated paralytic poliomyelitis in Japan

Miwako Hosoda a, Hajime Inoue a, Yasuo Miyazawa a, Eiji Kusumi b, Kenji Shibuya b

Despite WHO's recommendation to switch the poliomyelitis vaccine from oral polio vaccine (OPV) to inactivated polio vaccine (IPV) in countries where polio elimination has been achieved, Japan has continued to use OPV. In Japan, OPV is given twice to children aged from 3 to 18 months.1 More than 10 years after the elimination of wild polio virus, tragic cases of vaccine-associated paralytic poliomyelitis (VAPP) continue to be reported every year—most recently in May, 2011. The Ministry of Health, Labour and Welfare claims that IPV is still being developed by Japanese vaccine companies and that it will not be available until the end of 2012 at the earliest. The growing tension between the Government, which persists with domestically produced OPV, and the parents, who request IPV to avoid VAPP, has evoked huge media attention.

To understand OPV perceptions and practices among parents, we did a survey of 260 parents whose children attend day care or one of two nursery schools in Kanagawa Prefecture. 50 parents (19%) thought that OPV was dangerous and 81 (31%) wanted their children to take IPV. Because of the growing fear of OPV, the coverage of OPV has been decreasing. According to the Ministry, OPV coverage from April to June, 2011, was 17·5% lower than in the previous year.2 A paediatrician in the urban area of Tokyo has said that the inoculation rate is only about 50% there, which indicates an increased risk of retransmission of poliovirus once it is imported.3

Despite such concerns, the Japan Pediatric Society recommends that people should take OPV until domestically produced IPV becomes available.4 However, some paediatricians have begun to import IPV and administer it if parents are willing to pay out-of-pocket expenses of US$160—240. The Governor of Kanagawa Prefecture also announced the establishment of a system to provide IPV to respond to the needs of residents, despite strong opposition from the Government.

Japan has been a major driver of the Global Polio Eradication Initiative,5 but the lack of consistency between its domestic and global health policies is harming its own people. How long will the Japanese people need to wait for safe IPV to become available?

This study was reviewed by the Office of Human Research Administration of the Harvard School of Public Health. Protocol number 21402-101: “Polio vaccination status and parents' perception on polio vaccine.” We declare that we have no conflicts of interest.

References

1 Ministry of Health, Labour and Welfare. Basic information on polio and poliomyelitis vaccine.http://www.mhlw.go.jp/bunya/kenkou/polio/qa.html#q6. (accessed Dec 5, 2011).

2 Anon. Government should introduce IPV immediately. Akita Sakigake Nov 18, 2011.http://www.sakigake.jp/p/editorial/news.jsp?kc=20111118az. (accessed Dec 5, 2011).

3 Horigome K. Record of polio information session for the National Diet Members: November 15, 2011.http://lohasmedical.jp/blog/2011/11/post_2509.php. (accessed Jan 31, 2012).

4 Japan Pediatric Society, Committee of Immunization and Communicative Disease. Policy statement on polio vaccine.http://www.jpeds.or.jp/saisin/saisin_111114.pdf. (accessed Dec 5, 2011).

5 Anon. Japan to provide 900 million yen to fight polio. Asahi Shimbun Oct 26, 2011.http://ajw.asahi.com/article/behind_news/politics/AJ2011102615766. (accessed Dec 5, 2011).

México Post Polio a la vanguardia en el Síndrome de Post Polio

But polio stubbornly persists in pockets of poverty in Africa and Asia.

How we will eradicate the next polio

Recently, in San Diego, Microsoft Chairman Bill Gates and Rotary International announced a massive infusion of new money to finally eradicate polio worldwide. Polio is given little attention in American media today because it is no longer a public health issue in this country.

Decades ago, the deadly paralytic viral disease was purged from developed countries. But polio stubbornly persists in pockets of poverty in Africa and Asia.

Today the challenges to globally eliminating polio are largely political and cultural – overcoming local fears about vaccine safety, reaching people in war-torn areas, tracking people who are constantly moving and adequately strengthening the polio-fighting infrastructure.

We applaud Gates, Rotary and others for their enduring commitment to eradicating this viral menace that jeopardizes the health of poor children unlucky enough to be born in the slums of India, Afghanistan, Pakistan or Nigeria.

Of course, here at the Salk Institute we paid particular attention to the Gates/Rotary announcement because the original polio vaccine that halted the spread of the vicious disease was developed by our founder, Dr. Jonas Salk. Indeed, our highly regarded research institution owes its very existence to Salk's genius and persistence in conquering the poliovirus, and to the vision of the March of Dimes, which provided institute seed funding and continues to support our work.

For Americans too young to remember: Polio was once a public health terror, frightening families coast to coast. Each year thousands of children and teenagers died from polio outright. Many more, including President Franklin Delano Roosevelt, were severely crippled by it. Iron lungs, massive leg braces and wheelchairs were stark symbols of polio's life-altering effects.

The polio story deserves recalling because it is a shining example of innovation, dedication and resourcefulness in post-war America. Working under a mandate from FDR with public and private support and a great sense of urgency, scientists probed the biological properties of the polio virus. In 1948, the first breakthrough: Scientists in Boston successfully grew the virus in laboratory human tissue, facilitating vaccine research. Then, in Pittsburgh in 1952, Jonas Salk and his colleagues devised the first vaccine to boost immunity and show promise for large-scale use.

Our country then embarked on what, to this day, must be the most massive clinical testing ever. Some 1.8 million American children and teens were part of field trials in 44 states – from Maine to California. The study participants were dubbed “Polio Pioneers” and, whether they received the real vaccine, a placebo or were in the control group for comparison, each child was awarded a certificate attesting to his or her national contribution.

With testing on such an enormous scale, it rapidly became clear that the vaccine was both safe and effective. The trial was stopped in 1955 and the vaccine made available to the public.

Decades later Dr. Salk met an elderly man and his grandson in the Salk Institute courtyard. “There's the man who killed polio,” the grandfather told the boy. “What's polio?” the boy replied. Salk later described that moment as one of his proudest.

 “Polio Pioneers”

México a la vanguardia en el Síndrome de Post Polio