Aug 23, 2019

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Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 22, 2019

Original Report Vitality Among Patients With Postpolio

J Rehabil Med 2008; 40: 709–714

Gunilla Östlund, MSci1, Åke Wahlin, PhD2, Katharina S. Sunnerhagen, MD, PhD3,4 and Kristian Borg, MD, PhD1.

From the 1Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, 2Department of Psychology, Stockholm University, Stockholm, 3Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden and 4Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway.

Objective: To evaluate vitality and fatigue in post-polio pa- tients, and the relative contributions of physiological and psychological parameters to the level of vitality. DesignMulti-centre study.

Subjects: One hundred and forty-three patients with post- polio syndrome.

MethodsInventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regres- sion models were constructed to examine predictors of varia- tions in vitality, pain, reduced activity and physical fatigue.

Results: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiologi- cal indicators. After controlling for age, physiological para- meters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.

Conclusion: Vitality in post-polio patients depends on physio- logical parameters. Mental fatigue is not a prominent pre- dictor. Subgroups with or without fatigue, independent of age, need further study.

Key words: post-polio, fatigue, vitality, quality of life. J Rehabil Med 2008; 40: 709–714
Correspondence address: Gunilla Östlund, Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, 3rd Floor, SE-182 88 Stockholm, Sweden. E-mail:

Submitted September 21, 2007; accepted May 29, 2008


Poliomyelitis leads to muscle weakness due to destruction of the anterior horn cells. After an initial recovery there is a phase
*This article has been fully handled by one of the Associate Editors, who has made the decision for acceptance, as it originates from the institute where the Editor-in-Chief is active.
© 2008 The Authors. doi: 10.2340/16501977-0253 Journal Compilation © 2008 Foundation of Rehabilitation Information.

of functional stability that usually lasts from 10 to 40 years. during this phase the life circumstances of polio survivors do not differ much from the general population with respect to work and family situation (1). However, after the stable phase deterioration may occur; a condition termed post-polio syndrome (PPS) (2). The most commonly reported symptoms of PPS are increased muscle weakness, fatigue and pain in the muscles and joints. The last epidemic of polio in Sweden was in 1953 when more than 5000 people contracted poliomyelitis. Today, the prevalence of polio-affected individuals in Sweden is estimated to be 186/100,000 (3). Reported estimates of polio survivors eventually developing PPS vary from 20% to 68% (2, 4). Thus, the majority of polio survivors in Sweden are now middle-aged or older, and consequently at risk of developing PPS. Risk factors for developing PPS include time since the acute polio infection (5), age at presentation of symptoms, muscle pain at exercise, recent weight gain, joint pain (6) and female gender.

During the last decade, increasing research interest has fo- cused on fatigue in patients with PPS (7). Jubelt & Agre (8) re- ported generalized fatigue as one of the most common symptoms in PPS. Mental, as well as physical, fatigue has been reported by both Bruno et al. (9) and Schanke & Stanghelle (10).
Interestingly, and related to mental fatigue, there are con- tradicting reports regarding cognitive dysfunction in patients with PPS. Difficulties with attention, word finding, maintaining wakefulness and ability to think clearly have been reported by Bruno et al. (11). However, in most other studies cognitive function is reported to be unaffected by mental fatigue (12, 13). Furthermore, fatigued polio survivors are reported to have more mental health problems than controls or polio survivors without severe fatigue (5). In a study by Conrady et al. (14) patients, both at a post polio-clinic and in a post-polio support group, experienced significantly elevated levels of psychologi- cal distress, such as somatization and depression. Gonzalez et al. (15) reported an increase in cytokines in the cerebrospinal fluid of patients with PPS, indicating an inflammatory proc- ess.

The inflammatory processes were down-modulated by treatment with intravenous immunoglobulin followed by a clinical effect, especially on vitality, as evaluated by means of Short Form 36 (SF-36). This indicates that vitality has a central role in PPS that may be improved by means of phar- macological treatment. The subjective experience of vitality
ISSN 1650-1977J Rehabil Med 40
Neuropsychiatry, Neuropsychology, & Behavioral Neurology:

A Neuropsychological Study of the Postpolio Syndrome: Support for Depression Without Neuropsychological Impairment

Hazendonk, Kim M. B.BSc.; Crowe, Simon F. Ph.D.

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Objective: This study aimed to examine cognitive functioning in postpolio syndrome (PPS) after controlling for the effects of depression and illness behavior.
Background: Few studies have investigated the possible cognitive sequelae of PPS, despite widespread documented subjective complaints of "mental fatigue."
Method: A total of 23 PPS sufferers, 20 polio survivors without PPS, and 22 matched controls were compared using the Beck Depression Inventory-II; the Illness Behaviour Questionnaire; a chronic fatigue syndrome symptom checklist; and several measures of memory, attention, and concentration, including the Brown-Petersen Task, Stroop Test, Austin Maze, California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, and Symbol-Digit Modalities Test.
Results: In those participants with a medically confirmed diagnosis of PPS, there was a significantly higher level of depressive and hypochondriacal symptomatology as compared with the other two groups. Nevertheless, no significant differences existed between the three groups on neuropsychological measures.
Conclusions: These results indicate that the attention and memory difficulties reported by PPS sufferers may be linked to the physical or psychological manifestations of the illness rather than to objective decrements in cognitive performance. (NNBN 2000;13:112-118)
Neuropsiquiatría, Neuropsicología, Neurología y del Comportamiento:

Un estudio neuropsicológico del síndrome postpolio: Apoyo a la depresión sin deterioro neuropsicológico

Hazendonk, MBBSc Kim;. Crowe, Simon F. Ph D..


Objetivo: El presente estudio tuvo como objetivo examinar el funcionamiento cognitivo en el síndrome postpolio (SPP) después de controlar por los efectos de la depresión y el comportamiento de la enfermedad.
Antecedentes: Pocos estudios han investigado las posibles secuelas cognitivas del SPP, a pesar de amplia documentado quejas subjetivas de "fatiga mental".
Método: Un total de 23 enfermos de PPS, 20 supervivientes de la polio sin PPS, y 22 controles emparejados se compararon mediante el Inventario de Depresión de Beck-II, la enfermedad Cuestionario de Comportamiento, un síndrome de fatiga crónica lista de síntomas, y varias medidas de la memoria, la atención y concentración, incluyendo la tarea de Brown-Petersen, prueba de Stroop, Laberinto de Austin, California Verbal Learning Test, Trail Making Test, controlada oral Palabra Test de Asociación, y el símbolo dígitos Modalidades de prueba.
Resultados: En los participantes con un diagnóstico médico confirmado de PPS, hubo un nivel significativamente mayor de depresión y sintomatología hipocondríaca, en comparación con los otros dos grupos. Sin embargo, no existen diferencias significativas entre los tres grupos en las medidas neuropsicológicas.
Conclusiones: Estos resultados indican que las dificultades de atención y la memoria reportado por las víctimas del PPS puede estar relacionado con las manifestaciones físicas o psicológicas de la enfermedad en lugar de decrementos objetivo en el rendimiento cognitivo. (NNBN 2000, 13:112-118)

Editor (s): 

Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 21, 2019

DVT: How We Treat These Blood Clots and Tips to Prevent Them

Deep vein thrombosis (DVT) is a condition in which a blood clot forms in one or more deep veins in your body—most often in the legs and sometimes in the arms. People who have DVT in the lower extremities often experience:
  • A hot burning sensation in the legs
  • New pain or intense cramping while walking
  • Swelling in an extremity
DVT affects as many as 900,000 Americans each year. People often develop DVT because they have a known or undiagnosed bleeding disorder, recently had an invasive surgery, or have been temporarily immobile due to a long plane ride or bed rest.
Our team successfully identifies and treats people with DVT every day. Recently, we saw a patient who frequently flew all around the world for work. After her flight landed in Washington, D.C., the patient experienced a swollen, painful leg. Under our care, the patient was seen and diagnosed with DVT. We were able to perform minimally invasive rapid clot removal for her and also identified the reason for her DVT—a central venous compressive syndrome called May-Thurner Syndrome—which we were able to treat with a stent. The patient returned home that night and was back at work the next day.
LISTEN: Dr. Abramowitz discusses DVT treatment and prevention in the Medical Intel podcast.

How We Diagnose and Treat DVT

To diagnose DVT, we typically begin with taking patient’s history to identify potential provoking risk factors and perform a physical exam. We’ll often perform an ultrasound to detect any blood clots. The ultrasound is a considerably quick test that’s usually done at the bedside and doesn’t require patients to experience radiation exposure.
Most people with DVT are treated with an anticoagulation agent, also known as a blood thinner. Anticoagulation agents are effective because they reduce the chances of additional blood clots forming while patients’ bodies naturally break down the blood clot. The body’s own process can take three to six months to dissolve the clot. For some patients with extensive blood clot formation, we can use minimally invasive techniques to remove the clot using a catheter (a plastic tube or hose). This allows us to directly remove the clot in a procedure called mechanical thrombectomy, which removes the clot using retrieval devices, such as a vacuum suction. We use clot-busting medication to assist with this process.
The risk of leaving DVT untreated depends on where in the body the DVT is and how long it’s left untreated.  Blood clots below the knee usually cause swelling short-term but don’t necessarily result in long-term damage to the leg. However, blood clots above the knee, especially those that extend above the groin and into the veins in your belly and pelvis, can lead to long-term drainage problems from the leg. These issues sometimes result in post-thrombotic syndrome, or long-term swelling, wounds on the legs and pain. Untreated DVT can also result in clots breaking free. Once in circulation, clots can travel to the lungs and causing a pulmonary embolism, a potentially fatal condition in which one or more arteries in the lungs become blocked.

Can DVT Be a Sign of a More Serious Condition?

While DVT is a condition in and of itself, it’s important to determine what caused a patient’s blood clots to ensure they don’t recur and identify any serious underlying medical conditions. DVT can be caused by genetic conditions, inflammatory autoimmune disorders, or even be the first sign that someone has cancer.
#DVT, or #bloodclots in the deep veins, can be linked to other medical conditions. Vascular surgeons work to not only treat blood clots but also attempt to identify what caused them. via @MedStarWHC

Tips to Prevent DVT

The best thing people can do to prevent DVT is to get up and move around. If you travel long distances by car, train, or airplane, or if you sit at a desk during work for long hours every day, make sure you stand up and move every hour or so. If you’re immobile due to surgery or another health condition, keep your blood circulating by doing exercises, such as ankle flexes or leg lifts, to activate the muscles in your legs.
Our team at MedStar Washington Hospital Center offers the latest, most effective techniques for treating DVT. And after treating DVT, we make sure we identify the reason you developed it in the first place. Make sure to reach out to a doctor if you’re experiencing symptoms of DVT—we’re here to help.

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