Jpn J Rehabil Med 2015 ; : 625.633 1 2 3 2 4 5 6 7 8 9 1 Post-polio Syndrome Yoichiro AOYAGI, 1 Satoru SAEKI, 2 Koshiro SAWADA, 3 Yasuyuki MATSUSHIMA, 2 Megumi TOKI, 4 Emiko WADA, 5 Atsushi KINOSHITA, 6 Nobuyuki KAWATE, 7 Hirotaka KOBAYASHI, 8 Izumi KONDO, 9 Eiich SAITOH 1 Abstract : Post-polio syndrome PPS is the term used to describe the symptoms that may develop many years after acute paralytic poliomyelitis APP. In the case of PPS, the symptoms and signs include progressive muscle wasting and weakness, limb pain, and or fatigue, occurring one or more decades after maximal recovery from APP. An overuse of enlarged motor units is suspected to cause the deterioration of some nerve terminals or the loss of the motor units themselves. This could in turn induce PPS symptoms such as new muscle weakness and atrophy. Electromyography EMG is often a strong tool to diagnose and evaluate PPS. Some studies have shown that mild to moderate intensity muscular strengthening has a positive effect in patients affected by PPS. Rehabilitation for PPS patients should utilize a multiprofessional and multidisciplinary approach. PPS patients should be advised to avoid both inactivity and overuse of the affected muscles. Finally, patient evaluation is often required to access the need of orthoses and assistive devices. Jpn J Rehabil Med. Key words : electromyography overuse orthosis exercise 2015 5 25 2015 7 6 1 470.1192 1.98 Department of Rehabilitation Medicine School of Medicine, Fujita Health University 2 807.8555 1.1 Department of Rehabilitation Medicine, University of Occupational and Environmental Health 3 602.0841 465 Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine 4 060.8543 16 Department of Rehabilitation Medicine, Sapporo Medical University School of Medicine 5 780.8522 2.22 Chikamori Rehabilitation Hospital 6 761.8057 1114 Kagawa General Rehabilitation Center 7 227.8518 2.1.1 Department of Rehabilitation Medicine, Showa University School of Medicine 8 222.0035 1770 Yokohama City Rehabilitation Counseling Office for the Disabled People 9 474.8522 7 430 The National Center for Geriatrics and Gerontology E-mail : yyy@rc5.so-net.ne.jp Jpn J Rehabil Med VOL. 52 NO. 10 2015 625
1940 1960 1961 1 3 1980 post-polio syndrome PPS 4 5 1981 6 PPS PPS PPS 2003 PPS 7 10 PPS Special Interest Group SIG SIG 19 1980 PPS 5 PPS PPS 8 PPS 28 64 9 10 24.1 10 PPS 18.0 10 PPS 75 11 12 13 PPS 76 PPS 14 5 PPS 4 15 PPS PPS 16 17 reinnervationgiant-size motor units PPS PPS 5 626 Jpn J Rehabil Med VOL. 52 NO. 10 2015
Halstead PPS 4 1 2 3 15 4 2 5 18 19 PPS 20 Dalakas PPS 15 21 22 1 post-poliomyelitis muscular atrophy PPMA 2 23 25 26 27 PPS 4 22 Halstead 4 15 2 PPS PPS 1 17 28 Halstead PPS electromyography EMG PPS March of Dimes 28 F 10 F F F F M 10 Jpn J Rehabil Med VOL. 52 NO. 10 2015 627
F F F 10 29 F PPS 29 single fiber EMG PPS 10 30 CT CT PPS 31 PPS 6 32 CPK creatine phosphokinase 28 33 ADL IADL QOL PPS IADL Frenchay activities index Community Integration Questionnaire 34 PPS PPS PPS PPS PPS 28 PPS 35 1 28 36 Chan PPS 3 5 50 8 3 3 12 37 PPS 41 29 PPS 38 PPS 1 1 PPS PPS 628 Jpn J Rehabil Med VOL. 52 NO. 10 2015
FO 1 14 17 33 39 PPS 4 PPS 40 41 PPS AFO AFO AFO KAFO 42 KAFO KAFO PPS 14 43 1 2 3 PPS 4 5 43 41 1 carbon-fiber-reinforced plastic CFRP 40 44 Jpn J Rehabil Med VOL. 52 NO. 10 2015 629
AFO APS type Heavy support type Moderate support type Light support type CEPA Dorsal support type 44 AspirinAcetaminophen Ibuprofen PPS Randomized clinical trial RCT 35 Modafinil Pyridostigmine Amantadine Prednisone IVIG intravenous immunoglobulin PPS Lamotrigine 50 100 mg 45 PPS 17 630 Jpn J Rehabil Med VOL. 52 NO. 10 2015
KAFO NRH National Rehabilitation Hospital 46 60 80 6 9 METs 1 15 30 3 5 60 80 5 7 METs 1 15 30 3 5 4 5 1 60 80 5 7 METs 1 15 20 3 4 2 3 1 15 30 3 5 2 3 1 2 19 19 33 46 1 PPS PPS PPS 1995 2001 2006 2009 PPS PPS 1990 PPS Jpn J Rehabil Med VOL. 52 NO. 10 2015 631
2000 8 47 PPS PPS 39 47 2001 47 PPS PPS PPS 65 65 65 65 PPS 2006 PPS PPS PPS PPS PPS QOL SIG 1 Farbu E, Gilhus NE, Barnes MP, Borg K, de Visser M, Driessen A, Howard R, Nollet F, Opara J, Stalberg E : EFNS guideline on diagnosis and management of postpolio syndrome. Report of an EFNS task force. Eur J Neurol 2006 ; : 795.801 2 Raymond M : Paralysie essentielle de l enfance, atrophie musculaire consecutive. C R Soc Biol 1875 ; : 158 3 Anderson AD, Levine SA, Gellert H : Loss of ambulatory ability in patients with old anterior poliomyelitis. Lancet 1972 ; : 1061.1063 4 Halstead LS, Rossi CD : Post-polio syndrome : clinical experience with 132 consecutive outpatients. Birth Defects Orig Artic Ser 1987 ; : 13.26 5,, :. 1988 ; : 513.518 6 :. J Clin Rehabil 2007 ; : 114.120 7 :. 2003 ; : 771.779 8 Halstead LS, Silver JK : Nonparalytic polio and postpolio syndrome. Am J Phys Med Rehabil 2000 ; : 13.18 9 Ivanyi B, Nollet F, Redekop WK, de Haan R, Wohlgemuht M, van Wijngaarden JK, de Visser M : Late onset polio sequelae : disabilities and handicaps in a population-based cohort of the 1956 poliomyelitis outbreak in The Netherlands. Arch Phys Med Rehabil 1999 ; : 687.690 10,, :. 2012 ; : 43.47 632 Jpn J Rehabil Med VOL. 52 NO. 10 2015
11 Takemura J, Saeki S, Hachisuka K, Aritome K : Prevalence of post-polio syndrome based on a cross-sectional survey in Kitakyushu, Japan. J Rehabil Med 2004 ; : 1.3 12 :. 2009 ; 293.325 13,,,, :. 2012 ; : 359.363 14,,,,,,, :. 2014 ; : 166.170 15 : Available from URL : http: www.mhlw.go.jp toukei list 108.1b. html 2015 6. 16 Dalakas MC : Pathogenic mechanisms of post-polio syndrome : morphological, electrophysiological, virological, and immunological correlations. Ann N Y Acad Sci 1995 ; : 167.185 17 Kilgore EM, Halstead LS :,. J Clin Rehabil 2007 ; 1 :. 18,,, :. MOOK 10.,, 2005 ; pp 235.240 19 :. J Clin Rehabil 2007 ; : 129.134 20,, : overwork weakness. Jpn J Rehabil Med 2013 ; : 795.798 21 Dalakas MC, Elder G, Hallett M, Ravits J, Baker M, Papadopoulos N, Albrecht P, Sever J : A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl J Med 1986 ; : 959.963 22 Dalakas MC : The post-polio syndrome as an evolved clinical entity. Definition and clinical description. Ann N Y Acad Sci 1995 ; : 68.80 23 Buchholz DW : Postpolio dysphagia. Dysphagia 1994 ; : 99.100 24 Ivanyi B, Phoa SS, de Visser M : Dysphagia in postpolio patients : a videofluorographic follow-up study. Dysphagia 1994 ; : 96.98 25 Coelho CA, Ferranti R : Incidence and nature of dysphagia in polio survivors. Arch Phys Med Rehabil 1991 ; : 1071.1075 26 Dolmage TE, Avendano MA, Goldstein RS : Respiratory function during wakefulness and sleep among survivors of respiratory and non-respiratory poliomyelitis. Eur Respir J 1992 ; : 864.870 27 Dean AC, Graham BA, Dalakas M, Sato S : Sleep apnea in patients with postpolio syndrome. Ann Neurol 1998 ; : 661.664 28 Gonzalez H, Olsson T, Borg K : Management of postpolio syndrome. Lancet Neurol 2010 ; : 634.642 29 Hachisuka A, Komori T, Abe T, Hachisuka K : Repeater F-waves are signs of motor unit pathology in polio survivors. Muscle Nerve 2014 ; : 680.685 30 Saeki S, Hachisuka K : Changes in lower limb isokinetic muscle strength of polio survivors over 5-year follow up. J UOEH 2009 ; : 131.142 31,,, :. MB Med Reha 2014 ; : 83.88 32 Vreede KS, Henriksson J, Borg K, Henriksson M : Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome. J Rehabil Med 2013 ; : 924.928 33 Jubelt B, Agre JC : Characteristics and management of postpolio syndrome. JAMA 2000 ; : 412.414 34, : QOL. 2011 ; : 73.77 35 Koopman FS, Uegaki K, Gilhus NE, Beelen A, de Visser M, Nollet F : Treatment for postpolio syndrome. Cochrane Database Syst Rev 2011 : CD 007818 36 Tiffreau V, Rapin A, Serafi R, Percebois-Macadré L, Supper C, Jolly D, Boyer FC : Post-polio syndrome and rehabilitation. Ann Phys Rehabil Med 2010 ; : 42.50 37 Chan KM, Amirjani N, Sumrain M, Clarke A, Strohschein FJ : Randomized controlled trial of strength training in post-polio patients. Muscle Nerve 2003 ; : 332.338 38 Willén C, Sunnerhagen KS, Grimby G : Dynamic water exercise in individuals with late poliomyelitis. Arch Phys Med Rehabil 2001 ; : 66.72 39 Halstead LS :., 2004 40,, :,. 2012 ; : 145.150 41,,,,,, :. 2014 ; : 11.14 42, :. J Clin Rehabil 2007 ; : 135.139 43,,,, :. 2009 ; : 94.100 44,, : 2013 ; : 18.21 45 On AY, Oncu J, Uludag B, Ertekin C : Effects of lamotrigine on the symptoms and life qualities of patients with post polio syndrome : a randomized, controlled study. NeuroRehabilitation 2005 ; : 245.251 46 Halstead L, Gawne AC : NRH proposal for limb classification and exercise prescription. Disabil Rehabil 1996 ; : 311.316 47.,, 2013 Jpn J Rehabil Med VOL. 52 NO. 10 2015 633