Feb 25, 2013

Canada News Centre

Canada News Centre
news.gc.ca
Richmond, British Columbia ― Countless children will be protected from contracting a debilitating disease, thanks to additional support to the 'Pennies and More for Polio matching fund initiative', augmenting its original commitment. The Honourable Julian Fantino, Minister of International Cooperation, announced today that Canada would not only match contributions of up to $1 million, as announced last September, but will match all contributions raised by Rotarians by March 1, 2013, in support of eradicatingpolio. The Bill & Melinda Gates Foundation also announced that it will be matching contributions, dollar for dollar.

"Canadian generosity is second to none, as shown by this tremendous initiative, which has not only met, but surpassed, its goal", said Minister Fantino. "The Harper Government is pleased to be a key partner in combating this devastating disease, but money alone cannot eradicate polio. We call on the leadership in those countries still affected to promote science-based information and ensure a safe environment for polio immunization workers."
Last September, Minister Fantino challenged Canadians to join in this fight by supporting Rotarians in Canada to reach their fundraising goal by March 1, 2013. Under Pennies and More for Polio, Canada and the Bill & Melinda Gates Foundation had each originally agreed to match dollar-for-dollar donations made by Canadians to the Rotary Foundation to a maximum of $1 million. With the outstanding achievement of Rotary's goal well in advance of its March deadline, both have now agreed to match the total amount of funds raised through the initiative, which is expected to reach more than $1.6 million, to be provided to the World Health Organization's Global Polio Eradication Initiative.
"Canada's support has been, and will continue to be, critical in the final push to end polio" said Dr. Robert Scott, Chair of Rotary's International Polio Eradication Committee. "We are on the verge of eradicating this deadly disease, and must redouble our efforts to ensure that the goal is reached."
In October 2011, Prime Minister Harper reaffirmed Canada's support for the Global Polio Eradication Initiative, which builds on CIDA's ongoing commitment to improve the health of mothers, newborns, and children.
"We have a unique window of opportunity to change history and end polio thanks to tremendous advances in 2012" said Chris Elias, President of the Global Development Program at the Bill & Melinda Gates Foundation. "This innovative program is another example of Canada's and Rotarians" long-time commitment and leadership to ensuring children are forever protected from this debilitating, but preventable, disease."
Since 1998, Canada and its partners have supported the immunization of hundreds of millions of children, which has led to the eradication of the polio virus from almost every country on earth, and continue to put an end to this disease in the few vulnerable pockets where it remains.
Post Polio Litaff, Association A.C _APPLAC Mexico

Feb 13, 2013

POST-POLIO AND PHYSICAL THERAPY



 Susan L Fish MAPT
During recent years, I have had the opportunity to meet and work with patients experiencing the late effects of polio. Many times I have detected some frustration and anger regarding my professionals’ lack of experience in treating Post-Polio patients. I write this brief article now for two reasons.
  1. To explain and help you understand this lack of knowledge on the part of many of my colleagues.
  2. To provide some guidelines regarding Do's and Don'ts when seeking physical therapy.
Most Physical Therapists (PT's) (Physiotherapists in UK) working today weren't even alive during the major polio epidemics. Their formal education regarding poliomyelitis was more historical than factual, with little more than definitions of pathology and no clinical experience. Post-Polio Syndrome is only recently being recognised and its existence is still questioned in some medical circles. Both acute polio and post polio syndrome present clinical pictures which are unlike any other neuromuscular condition. Without the experience of working with acute polio patients and with little documented information regarding the treatment of Post-Polio Syndrome, it is not surprising to find professionals lacking in knowledge.

Although, there may be reasons for a lack of knowledge, a responsible professional should NOT treat any condition that he or she is not confident and knowledgeable in treating. You may be able to direct a PT to appropriate resources. Please see the resources at the end of this article and I would be happy to help also.
Reasons for seeking physical therapy will vary. You may be referred to a PT to help you with your Post-Polio Syndrome. You may be referred for rehabilitation following corrective surgery for a polio related condition. You may also be referred for a condition not necessarily related to polio at all such as arthritis, bursitis, tendonitis, fractures, osteoporosis, low back pain, stiff neck, etc, etc. Your physical therapist is well trained to treat these other conditions. However, your post polio status should be taken into consideration when designing a program. Here is some advice.

Do's and Don'ts to keep in mind when going for physical therapy.

Do trust yourself and the knowledge you have gained over the years about your body.
Do be willing to alter your lifestyle.
Do avoid fatigue.
Do get enough rest.
Do pace your activities rather than discontinuing them.
Do conserve energy. It may make more sense to spread your activities out, allowing for rest periods, rather than eliminating interests and activities.
Do recognise that your body is aging and some physical changes will occur which are not related to post-polio. There IS a normal aging process even though post-polio may be a part of it.
Do respect your feelings. This may be a difficult adjustment time for you; seeking emotional as well as physical guidance may be a wise thing to consider.
Don't follow advice regarding physical exercise if you become fatigued while doing it.
Don't become short of breath with exercise.
Don't do more than your body feels comfortable doing.
Don't cause pain with activity or exercise.
Don't gain weight.
Don't reject using aids and assisting devices without giving them serious thought. (They are meant to conserve energy and preserve anatomical structures, i.e. joints, muscles, tendons, cartilage and ligaments.) Most are delighted and surprised by the increased endurance and energy they have with the use of canes,wheelchairs, motorized scooters or the many other easily found assisting devices.
Resources Dean, Elizabeth.Clinical Decision Making in the Management of Late Sequela Poliomyelitis.Physical Therapy Oct. 1991, Vol 71; 10 752 - 761.Weiss, Marianne R.Becoming an intelligent Consumer of Physical Therapy Services, Polio Network News Winter and Spring 1993, Vol. 9 Nos. 1 and 2.http://www.zynet.co.uk/ott/polio/lincolnshire/

Feb 6, 2013

Therefore, protein-rich meals may be the best choice for PPS patients.

Polio is caused by a virus that attacks nerve cells and sometimes produces muscle paralysis. It was once a common disease that reached a peak in the 1950s, according to MayoClinic.com. Vaccines were developed that are very effective, and few Americans contract polio today. However, some people who had polio years ago may experience new symptoms of muscle weakness and other changes that constitute post-polio syndrome, also called post-polio sequelae, or PPS. Lifestyle changes that may help relieve symptoms of PPS include conserving strength, avoiding activities that cause pain and eating a diet high in protein. Former polio patients should always consult a doctor before making changes to lifestyle or diet.


POST-POLIO SYNDROME

According to the New Mobility website, there are 1.8 million polio survivors in North America. Of these former polio patients, 76 percent experience some of the symptoms of PPS. Because of the new muscle weakness that accompanies this condition, many PPS sufferers use assistive devices such as canes, braces and crutches. Using these devices demands more activity from muscles that are often already weak. PPS sufferers require a steady supply of energy to fuel their muscles and are at greater risk for the effects of low blood sugar, according to Dr. Susan Creange at the Post Polio Institute.

In 1998, a national post-polio survey was conducted in the United States. The results indicated PPS patients who ate a low-protein breakfast had more severe weakness and fatigue than those who ate a protein-rich breakfast. According to Dr. Creange, post-polio patients need higher-than-normal levels of blood sugar to support function of the polio-damaged nervous system. Protein is converted into sugar in a steady, slow-release way that keeps the level of blood sugar at a constant, relatively high level. Therefore, protein-rich meals may be the best choice for PPS patients.

According to Dr. Richard Bruno, the best dietary plan for PPS patients is one that includes a healthy, balanced blend of protein and carbohydrate. He states breakfast is a crucial meal to give PPS patients energy to start the day. He describes a "Post-Polio Protein Power Diet" and recommends breakfast should include about 16 g of protein; the recommended daily allowance of protein for a 150-lb. person is 70 g. Each meal or snack later in the day should also contain protein in balance with healthy sources of carbohydrate and low levels of fat. A PPS patient should always check with a doctor before changing diets and should have yearly measurements of blood cholesterol and kidney function.

HIGH-PROTEIN, LOW-FAT FOODS

Dr. Bruno recommends a diet mainly consisting of low-fat sources of protein. Good choices are low-fat cottage cheese, with 28 g of protein and 2 g of fat in 1 cup; egg whites, with 6.8 g of protein and no fat in the white of one egg; salmon, with 17 g of protein and 5 g of fat in 3 oz. Some snack bars may provide suitable options for between meals, many with 15 to 25 g of protein and very low amounts of fat.

HIGH-PROTEIN, MODERATE-FAT FOODS

Other foods high in protein and moderately high in fat may also be useful in moderation. For example, cheeses such as swiss chess with 8 g of protein and 8 g of fat in 1 oz. may be consumed once in a while. Higher-protein cereals such as oatmeal or some prepared cereals have lots of protein and a modest amount of fat and may also be included. Choices that are not recommended, especially at breakfast, are high-fat meats such as bacon with 17 g of protein but 32 g of fat.Read more:



























Post Polio Litaff, Association A.C _APPLAC Mexico

Feb 2, 2013

Management of Postpolio Syndrome

Henrik Gonzalez MD a , Tomas Olsson MD bKristian Borg MD a
Postpolio syndrome is characterised by the exacerbation of existing or new health problems, most often muscle weakness and fatigability, general fatigue, and pain, after a period of stability subsequent to acute polio infection. Diagnosis is based on the presence of a lower motor neuron disorder that is supported by neurophysiological findings, with exclusion of other disorders as causes of the new symptoms. The muscle-related effects of postpolio syndrome are possibly associated with an ongoing process of denervation and reinnervation, reaching a point at which denervation is no longer compensated for by reinnervation. The cause of this denervation is unknown, but an inflammatory process is possible. Rehabilitation in patients with postpolio syndrome should take a multiprofessional and multidisciplinary approach, with an emphasis on physiotherapy, including enhanced or individually modified physical activity, and muscle training. Patients with postpolio syndrome should be advised to avoid both inactivity and overuse of weak muscles. Evaluation of the need for orthoses and assistive devices is often required.
Post Polio Litaff, Association A.C _APPLAC Mexico

Feb 1, 2013

Trauma and Illness as Precipitants of Post-Polio Sequelae.

FROM The Post-Polio Institute and The International Centre for Post-Polio Education and Research 

Post-Polio Sequelae Monograph Series. Volume 10 (2). Hackensack: Harvest Press, 2000.
Trauma and Illness as Precipitants of Post-Polio Sequelae.
Dr. Richard L. Bruno
About once a month I get a call from an attorney somewhere in these litigious United States. I am asked to be the expert witness for a polio survivor who's been rear-ended in their car, hit by a bus, taken a header down some stairs or simply slipped and fell. Regardless of the type of accident, the lawyer always asks the same question: Can a traumatic event trigger Post-Polio Sequelae, the new and sometimes disabling muscle weakness, fatigue, pain and respiratory problems that occur is as many as 77% of polo survivors? And regardless of the type of accident, my answer is always the same: Yes and no. PPS is not a disease that is just waiting inside polio survivors for a trigger to set it loose to wreak havoc throughout the body. So trauma can't trigger a disease that is not there.
But our 1985 National Survey did show that PPS symptoms are caused by physically or emotionally stressing the poliovirus-damaged motor nerves that remained after survivors' original bout with polio. Many polio survivors have been able to function for 40 years with about half the spinal motor nerves of someone who didn't have polio. So breaking a leg in a fall, having major surgery -- even a whiplash injury -- could sufficiently stress the remaining polio-damaged motor neurons to "blow a fuse" When those fuses blow, neurons function less well and muscle weakness, fatigue, pain may result.

Many polio survivors are terrified about about losing function after trauma. One survivor said, "I am afraid if I fall and break something I will never walk again." Fear also causes polio survivors to postpone even necessary surgery because, as one survivor put it, "I know I'll never survive the anesthetic. I will spend the rest of my days in an iron lung."
Because of the fear that an injury or surgery could cause PPS, we wanted to find out just how many of our patients actually experienced new symptoms after trauma, what those symptoms were, whether they spread throughout the body and whether they were irreversible or treatable.
Surgery, Spills and Other Ills.
We reviewed the histories of 244 consecutive polio survivors evaluated by Kessler Institute's Post-Polio Service who had no other conditions that might cause new fatigue, weakness or pain. Of those patients, 44 (18%) said that their PPS began after a traumatic event. The typical patient was 59 years old and had polio at age 8 in the early 1940's. There were as many men as women reporting these post-traumatic PPS.
The traumas that preceded new symptoms included medical illnesses and surgeries (pneumonia, viral infection, hysterectomy, mastectomy with chemotherapy, pregnancy), fractures of the ankle, leg or hip, falls, auto accidents, and injury or surgery to the leg (ankle sprains, knee surgery, hip or knee replacement) or the back (herniated discs, laminectomies, spinal fusions)(see graph). The most common injury was to the leg (71% of patients) while 26% had back injuries. Regardless of the type of trauma or location of the injury, the most common symptom reported was new muscle weakness (55% of patients) followed by pain (34%) and fatigue (11%).
There was no evidence that new symptoms began in an injured area and then "spread" throughout the body. Seventy-one percent of patients had new symptoms only in the body area that had been injured, while 26% had symptoms in the injured area plus one other nearby location. For example, 40% of those who injured one leg developed weakness or pain in the other leg. This is a common problem for polio survivors, who compensate for injury to one part of the body by overusing another part whose nerves were also damaged by the poliovirus.

Only 5% of patients developed symptoms in more than two body areas. One patient who had a hip replacement reported "loss of muscle tone all over," while another who had been in a coma after an auto accident reported weakness in all of his muscles. Two patients who had had fractures, two with back injuries and one with an ankle injury reported new fatigue. However, no patient reported that their trauma "triggered" symptoms unrelated to
the injury, such as arm weakness after breaking a leg or difficulty swallowing following a knee replacement.
Can Post-Traumatic PPS be Treated?
All of the clinical experience and research on treating non-traumatic PPS supports one conclusion: If patients decrease physical and emotional stress their symptoms will at very least stop progressing and typically will get noticeably better. Does this hold true for post-traumatic PPS? There's good news and bad news. The bad news is that the majority (63%) of patients with post-traumatic symptoms refused treatment altogether or refused to complete therapy for their symptoms; more than twice as many post- traumatic PPS patients actually quit therapy. What might cause this? Seventy-seven percent of those who had a psychiatric diagnosis refused therapy, versus 53% of those without psychological problems. The most frequent psychiatric problem was a major depressive episode; 89% of those who were depressed refused therapy. Depression has been identified before as a significant cause of therapy refusal in polio survivors and highlights how important it is for psychological problems to be identified and treated if therapies for PPS are to even begin.
The good news is that 86% of patients regardless of the type of trauma or severity of their injuries had significant reductions in pain, fatigue and muscle weakness after complying with therapies known to be effective in treating PPS: reducing physical and emotional stress, using appropriate assistive devices, energy conservation, adequate rest and the pacing of activities.
The remaining patients experienced a reduction in some symptoms, especially pain, but continued to report muscle weakness or fatigue. Two patients who did not stop strenuous work or recreational activities reported
slowly increasing muscle weakness and pain over several years. Another patient who had been thrown to the floor of a van in 1995 reported that muscle strength and endurance in her legs increased only slightly after therapy even though her severe back pain has been eliminated. It is noteworthy that this patient had completely recovered from two previous traumas: a fall early in 1995 that fractured her lower right leg and another auto accident seven years before that herniated a disc. This patient's ability to recover from two previous traumas is also good news. For each of our patients who reported PPS symptoms after a trauma there was at least one other patient who had had the same trauma but did not develop PPS. So while trauma can be sufficient to cause PPS, PPS do not necessarily "cometh after a fall."
The Golden Rule
These findings in our patients should put polio survivors' minds at ease. Neither major surgery nor even a fall that causes a fracture will necessarily push polio survivors down a slippery slope toward total disability. Still, caution must be exercised since damaged motor neurons make polio survivors more susceptible to problems that typically do follow trauma. A leg that has been in a cast for months can become weak, as can the opposite leg that has had to take up the slack for its damaged partner. And bed rest after surgery can more easily cause deconditioning and fatigue in polio survivors.
However, post-traumatic symptoms in polio survivors should not be treated aggressively as they often are in those who didn't have polio. All PPS need to be treated carefully and slowly. Polio survivors and their therapists should not assume that a leg weakened after being in a cast has merely "been resting too long" and will respond to an aggressive program of weight lifting. Polio survivors who have had surgery should not be rushed out of bed to prevent deconditioning, because the lingering effects of anesthetic and post-operative pain are more likely to cause falls than to prevent fatigue.
Regardless of the cause of PPS the "Golden Rule" for polio survivors always applies: If an activity causes fatigue, weakness or pain, don't do it!" Doctors, nurses, and therapists must listen carefully to their patients -- and polio survivors must listen carefully to their own bodies -- to determine how much exercise or therapy causes fatigue, weakness or pain, and to stop before
those symptoms appear, so that therapy for PPS does not become just another type of trauma. The experience of our patients is that post- traumatic PPS are treatable if polio survivors follow through with therapy. But even more important is that many traumas can be avoided, like the falls and fractures caused by compulsive overdoing, ignoring new muscle weakness and refusing to use a needed brace, cane or crutch. For polio survivors physical overexertion, like pride, does goeth before a fall.
RESOURCES
The text of articles on the cause and treatment of PPS can be downloaded from the harvest center web site:

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