1 may. 2017

Postpolio Syndrome Symptoms

Postpolio Syndrome

Synonyms and related keywords: PPS
  • Central 
    • Pathogenesis can include chronic pain, type A personality, depression, dysfunctional reticular-activated system, sleep disorders, and respiratory dysfunction. 
    • PPS produces somnolence and difficulty in concentrating and remembering.
  • Peripheral 
    • Pathogenesis may be metabolic exhaustion of the enlarged motor units, neuromuscular junction transmission defects, scarring within the motor neurons, or loss of motor units due to aging. 
    • PPS produces decreased muscular endurance and increased muscular fatigability.
  • Weakness 
    • A number of functional etiologies for weakness have been hypothesized, including disuse, overuse, and chronic weakness, as well as weight gain. 
    • Asymmetric and scattered weakness may be present. 
    • Some authors have found evidence that previously unaffected muscles later become weak; in these cases, they discovered that the patient was unaware or had not been told that the particular muscle had been affected during the acute episode.
  • Muscle pain 
    • Deep aching pain may be a component of a myofascial pain syndrome or fibromyalgia. 
    • This feature is extremely prevalent in PPS.
  • Gait disturbance: Difficulty with gait is caused by progressive weakness, pain, osteoarthritis, or joint instability; it is common in patients who previously used assistive devices but later discarded them.
  • Respiratory problems 
    • Respiratory disorders are most prevalent in patients with residual respiratory muscle weakness. 
    • These changes cause chronic microatelectasis, diminished pulmonary compliance, increased chest wall tightness, chronic alveolar hypoventilation, decreased cough and expiratory flow, and decreased clearing of secretions. 
    • The new respiratory difficulties are not only related to new respiratory muscle weakness but also to scoliosis, pulmonary emphysema, cardiovascular insufficiency, or poor posture. 
    • A central component also may occur because acute bulbar polio often affects the medullary structures, including the reticular formation and sleep regulatory system.
  • Swallowing problems 
    • These difficulties can occur in patients with bulbar and nonbulbar postpolio. 
    • Subclinical asymmetrical weakness in the pharyngeal constrictor muscles is almost always present in all postpolio muscular atrophy (PPMA) patients, including those who do not complain of new swallowing difficulties.
  • Autonomic dysfunction: The cause is unclear; the peripheral component could include muscular atrophy and, therefore, diminished heat production.
  • Sleep apnea
  • This disorder is not uncommon in patients left with residual bulbar dysfunction or severe respiratory compromise.
  • Sleep apnea appears to be due to a combination of the following:
    • Central apnea, due to a residual dysfunction of the surviving bulbar reticular neurons 
    • Obstructive apnea, due to pharyngeal weakness and increased musculoskeletal deformities from scoliosis or emphysema 
    • PPMA, resulting in diminished muscle strength of the respiratory, intercostal, and abdominal muscle groups
  • Flat back syndrome
  • Another possible symptom in some patients with PPS is the flat back syndrome, which consists of the inability to stand erect because of forward flexion of the trunk and pain in the low back and legs.
  • The flat back syndrome typically occurs in patients with diminished lumbar lordosis as a result of instrumentation of the spine for scoliosis, vertebral fracture, or degenerative joint disease.
  • The trunk extensor musculature plays an essential role in maintaining upright posture, and it may be that PPS-related weakness in this musculature represents a major contributing factor to the flat back syndrome in these patients.

Author: Flor M Muñiz, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, Thomas Jefferson UniversityCoauthor(s): Gerald Herbison, MD, Clinical Professor, Department of Physical Medicine and Rehabilitation, Thomas Jefferson University
Flor M Muñiz, MD, is a member of the following medical societies: American Medical Association
Editor(s): Martin K Childers, DO, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Missouri School of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, Pharmacy, eMedicine; Kat Kolaski, MD, Adjunct Clinical Assistant Professor, Department of Pediatrics, University of North Carolina; Director, Pediatric and Adolescent Rehabilitation, Charlotte Institute of Rehabilitation; Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center; and Denise I Campagnolo, MD, MS, Clinical Director of Spinal Cord Injury Program, Associate Professor, Department of Physical Medicine and Rehabilitation, New Jersey Medical School

Post Polio Litaff, Association A.C _APPLAC Mexico

Mayo Clinic Epidural Stimulation Trial Enables Movement and Stepping

On April 3, the Mayo Clinic published the results of a new trial that further validates the effectiveness of epidural stimulation for functional improvement in spinal cord injury subjects. In this trial, a 26-year-old, three years out from a motor-complete SCI at T6, regained volitional motor function below his level of injury while using an implanted epidural stimulation device. The study sought to replicate the results of a previous epidural stimulation trial conducted at the University of Louisville, in collaboration with the research team of V. Reggie Edgerton at UCLA.
The Mayo Clinic trial began with the subject, Jered Chinnock, undergoing 22 weeks of three times per week locomotor and task-specific strength training. Following the initial period of motor training, surgeons implanted an epidural stimulation device made by Medtronics and FDA approved for pain (with off-label approval for functional rehabilitation purposes) and connected it to an electrode array positioned on the dorsal epidural surface of the lumbosacral spine. After three weeks of post-surgical recovery, the team began epidural stimulation — with Chinnock attempting volitional leg movements while researchers tuned the settings of the stimulation device.
In the first two weeks of epidural stimulation, with the device turned on, Chinnock was able to:
•  Control his muscles while lying on his side, resulting in leg movements
•  Make step-like motions while lying on his side and standing with partial support
•  Stand independently using his arms on support bars for balance
Previous trials had produced standing and some volitional movement of lower limbs while reclining, but only after 17 weeks of stimulation and motor rehabilitation. The Mayo Clinic trial marks the first time a subject has been able to voluntarily make step-like movements while standing with partial support, and is the quickest turnaround for functional improvement with epidural stimulation.
“We’re really excited, because our results went beyond our expectations,” says neurosurgeon Kendall Lee, M.D., Ph.D., principal investigator and director of Mayo Clinic’s Neural Engineering Laboratory. “These are initial findings, but the patient is continuing to make progress.”
The preliminary results in this trial show functional return only while the epidural stimulation device is turned on. Previous studies have shown that after prolonged therapy, some volitional control of previously paralyzed muscles remains even when the stimulator is turned off.
It remains to be seen if Chinnock will regain even more function with continued therapy and adjustment of the stimulation settings, but even the initial findings are enough to show that functional return with epidural stimulation continues to move forward, one step at a time.
For more about Chinnock’s journey, see the below video.

Post Polio Litaff, Association A.C _APPLAC Mexico

Polio Film



Salk Institute

Polio Video

Polio Lungs




México Post Polio Una Vida Un Camino Una Experiencia

Post Polio LITAFF A.C.

Postpoliolitaff.- Asociación Post Polio Litaff A.C Primera Organización oficial sobre Síndrome de Post Poliomielitis En México.

Polio y Efectos Secundarios SPP
- See more at: http://polioamigossinfronteras.blogspot.mx/#sthash.6PkHAkfM.dpuf


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