This document discusses post-polio syndrome (PPS), including its definition, epidemiology, causes, clinical features, management, and prognosis. PPS is characterized by new symptoms that emerge decades after an initial bout of paralytic polio, including fatigue, muscle weakness, pain, and loss of function. While the exact pathophysiology is unknown, it is thought to involve the overuse and aging of motor neurons damaged during the initial polio infection. Management focuses on rehabilitation, medication for symptoms, lifestyle modifications, and assistive devices. Prognosis is generally good with treatment, though severe pulmonary or swallowing involvement can be life-threatening in rare cases.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
CIMT involves constraining the unaffected limb, along with intense therapy, in order to force the use of the affected limb with intent to improve motor function.
This presentation contains detailed knowledge about Down's Syndrome its types, clinical presentation, diagnosis, medical and physio therapeutic management of the condition.
Down syndrome is a condition in which a person has an extra chromosome. Chromosomes are small “packages” of genes in the body. They determine how a baby’s body forms and functions as it grows during pregnancy and after birth. Typically, a baby is born with 46 chromosomes. Babies with Down syndrome have an extra copy of one of these chromosomes, chromosome 21. A medical term for having an extra copy of a chromosome is ‘trisomy.’ Down syndrome is also referred to as Trisomy 21. This extra copy changes how the baby’s body and brain develop, which can cause both mental and physical challenges for the baby.
Retraining of motor control basing on understanding of normal movement & analysis of motor dysfunction.
Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movt. Components of activities & conscious elimination of unnecessary muscle activity.
In rehabilitation programme involve – real life activities included.
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Spina Bifida: Physiotherapy in the management of meningomyeloceleAyobami Ayodele
Spina bifida is a treatable spinal cord malformation that occurs in varying degrees of severity. Meningomyelocele is associated with abnormal development of the cranial neural tube, which results in several characteristic CNS anomalies. About 90% of babies born with Spina Bifida now live to be adults, about 80% have normal intelligence and about 75% play sports and do other fun activities. Most do well in school, and many play in sports.
This presentation is detail about Volta therapy which is commonly used in paediatric neurological conditions and also for adults. this presentation explains what are the various techniques, methods of application of Volta therapy, indications, contraindications, etc.
At the end of the lecture, the students should be able to:
Discuss the theoretical basis of the neurodevelopmental approaches
Discuss the concepts and principles underlying the Bobath approach
Discuss the concepts and principles underlying the Brunnstrom approach
Dear Doctor,
Its humbling that you liked the presentation and would like to use it for your purpose. Kindly find your requested presentation attached with this email.
The shortlink for your future reference is http://go.drankush.com/PolioFinal
We would always appreciate if you would place this reference as a due credit in your work and while sharing for others use.
Ankush, Amroskar S, Bhamaikar V, Barreto J. "Polio Final Presentation" Accessed from http://go.drankush.com/PolioFinal
-----------------------------------------------------
As we near eradication of this dreaded disease - "POLIO", we would like to share the following presentation we made for our Pediatrics seminar in 2012.
Best attempts have been made to cover most of the topic, keeping the size under 100 slides.
Hope you like it.
Ankush
Shahin Amroskar
Varsha Bhamaikar
Joyce Barreto
In this presentation you will find summary for poliomyelitis. what is polio ? what are the causes ? and what will be the prevention?
here you'll also find about the rehabilitation program for polio as well..
The evaluation of back pain can be a pain in the neck or a back-breaking exercise, so to speak. However, the diagnosis hinges always on a focused History and Physical Exam and not really on labs or imaging. Knowing what to ask and where to look can make the evaluation of this all-too-common condition manageable for the internist.
This lecture focuses on the evaluation of low back pain and will guide the reader on the key points in the Hx and PE and prevent unnecessary testing/imaging. It also presents 3 "unusual" cases of low back pain which may be disabling if not recognized immediately.
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
People with ME/CFS and FM often suffer from cognitive impairment that can lead to brain fog, trouble word finding and more debilitating symptoms. In this class, you will understand the types of cognitive issues that commonly occur, possible causes, and how to implement strategies for improving cognitive function.
Compassionate patient care is at the heart of what we do.
We set the standard for excellence in patient care through early diagnosis and evidence-based precision medicine. We reject the current healthcare system’s model of 10 minute visits. That doesn’t work for our patients. Our patient care is methodical, in-depth and allows us to really understand an individual and their illness.
We are a 501 c(3) dedicated to improving the lives of those that suffer from these devastating diseases.
Visit Batemanhornecenter.org to learn more.
Occupational Therapy Management for Parkinson's Disease - Webinar 2024Phinoj K Abraham
In this presentation, you'll learn:
- Impact of PD on daily life: Understand how PD affects a person's occupational performance and quality of life through the WHO's ICF (International Classification of Functioning, Disability, and Health) model.
- Current practice gaps in OT for PD: identify areas where occupational therapy management for PD can be improved based on current research.
- Comprehensive OT interventions: Discover evidence-based occupational therapy approaches for managing PD symptoms, including "what," "when," and "how" to implement them.
- Formulating PD rehab services: Gain insights on developing comprehensive PD rehabilitation programs tailored to your specific context.
- Extensive references: Access a complete list of references cited in the presentation for further exploration.
Post Stroke Upper Extremity Rehabilitation - A Clinical PerspectivePhinoj K Abraham
Guest Speak at 3rd Annual national conference of Indian Federation of Neurorehabilitation (IFNRCON 2015) at Mumbai by Phinoj K. Abraham, Neuro Occupational Therapy on "Post Stroke Upper Extremity rehabilitation - A Clinical Perspective"
For Video: http://youtu.be/uCnwdzLtPSQ
This presentation was prepared for educating the patients with stroke and their caregivers about the role of Occupational Therapy in Parkinson's Disease. It gives a very BRIEF over view about OT in Parkinson's Disease rehabilitation
BOT New Modified Syllabus & Regulations_TN Dr. MGR Medical Universisty, Chenn...Phinoj K Abraham
Finally find out today...!!
Dear all,
Herewith I am attaching our 'BOT syllabus' (Full, neat copy..!!) (TN Dr. MGR Medical University_New Modified Regulations & Syllabus (Semester) Bachelor of Occupational Therapy (B.O.T)) I hope this may be helpful for some of us during various academic credential evaluation..!!
This presentation was prepared for educating the patients with stroke and their caregivers about the role of Occupational Therapy in stroke. It gives a very BRIEF over view about OT in stroke rehabilitation
This presentation is primarily based on an article Titled "Rehabilitation of Unilateral Spatial Neglect: New Insights from Magnetic Resonance Perfusion Imaging" by Argye E Hillis., Arch Phys Med Rehabil 2006;87(12 Suppl 2):S43-9.
Aim of this presenattaion was to give an insight to my students about Rehabilitation of Unilateral Spatial neglect
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
3.
Virus [ Burnhilde, Lansing & Leon]
Contaminated water / food
Affinity for motor (muscle) nerves
Kills / Injures motor nerves
Results in weakness / paralysis
3
4.
There are four recognized stages:
Acute Paralysis and/or weakness
Recovery and Rehabilitation
Neurological Stability
Post Polio Syndrome / Sequelae
4
5.
A Neurological condition
New symptoms many years after acute polio typically 30-50 yrs.
New symptoms appear after a period of
neurological stability
Major sxs- New weakness, loss of function, intense
fatigue, pain in muscles / joints
5
6. Confirmed history of polio
Partial or fairly complete neurological and functional
recovery after the acute episode.
Period of at least 15 years with neurological and functional
stability
Two or more of the following health problems occurring
after the stable period:
Extensive fatigue
Muscle and or joint pain
New weakness in muscles previously affected or unaffected
New muscle atrophy
Functional loss
Cold intolerance
No other medical explanation found
Halstead LS. 1991
6
7.
The frequency of PPS ranges between 15%-80%,
Natural history data from post-polio clinic in Houston, Texas. A =
birth; B = onset of polio; C = maximum recovery; D = onset of new
health problems; E = time of evaluation; F = death. (Halstead, L. S. and
Rossi, C. D 1987)
7
8.
The pathological changes that cause the
symptoms of PPS are not well understood
There are four different theories on the cause of
PPS:
Disintegration of overused motor units
Reactivation of Polio virus
Immune system dysfunction
Neural loss due to ageing
8
9. Accelerated natural ageing
Falling nerve to muscle motor unit ratio
Inflammation and active immune response
Co-morbidity:
Orthopaedic problems
Radiculopathy and entrapment neuropathy
Respiratory failure
General medical problems
PPS is more likely with
Increasing age;
The more severe the initial weakness was
The more time that elapses after the attack of polio
9
11.
Higher age at onset of poliomyelitis
The association with other diseases may indicate
that a chronic physical stress, particularly in
already weak motor units, can contribute to the
development of signs and symptoms of PPS
Poor Socio-economic conditions (Ragonese P et
al)
Individuals who had polio exhibit "Type A"
behavior and experience chronic stress (Richard
L. Bruno et al)
11
12. Theories:
Remaining healthy
motor neurons can no
longer maintain new
sprouts
Decompensation /
chronic denervation
and reinervation
process.
Denervation exceeds
reinervation
Dalakas, M. C., et al 1985
12
13.
Motor neuronal loss
due to reactivation of a
persistent latent virus.
Infection of the polio
survivor’s motor
neuron by a different
enterovirus
Loss of strength
associated with
aging, in already
weakened muscles
Dalakas, M. C., et al 1985
13
14. Common
Fatigue
New Weakness
Decreased endurance
Muscle & joint pain
Loss of function
Less common
Muscle atrophy
Respiratory problems
Swallowing problems
Cold intolerance
Sleep apnoea
Gait disturbance
Climbing Stairs
Dressing
(Activities that require
repetitive muscular
contraction)
Julie K Silver, Anne C Gawne 2004
14
15.
Post Polio Fatigue
Central (evolved from CNS)
▪ Difficulty regarding cognition, concentration, memory
attention, maintaining wakefulness (because of the
affectation of RAS, Basal Ganglia etc..)
Peripheral (evolving from the peripheral nerves i.e.,
the motor unit.)
▪ Muscle weakness
According to Schanke and Stanghelle (2001),
physical, peripheral fatigue was greater problem for
the patients than mental, central Fatigue
15
16.
Extremely prevalent in PPS
Deep aching pain
Myofascial pain syndrome / Fibromyalgia
Small number of patients have muscle
tenderness on palpation
Julie K Silver, Anne C Gawne 2004
16
17.
Weakness and Functional Loss.
focal neurological disease such as a radiculopathy, focal
compressive neuropathy, or spinal cord lesion and
medical causes of neuropathy such as diabetes, thyroid
disease, uremia, alcohol, toxins, and, uncommonly, heredi
tary neuromuscular disease.
Fatigue.
anemia, chronic infections, collagen disorders, thyroid
disease, diabetes, cancer, depression .
Pain.
osteoarthritis, bursitis, tendinitis, and myofascial pain
polymyalgia rheumatica, fibromyalgia, polymyositis, and
rheumatoid arthritis
17
18. Medical management
Evaluation
Confirmation of previous Paralytic Polio
Exclusion of other causes of new symptoms
Medications
No well-proven pharmacologic treatment for this
▪ Pyridostigmine – fatigue (effectiveness ?)
▪ Amantadine (Anti viral agent) effectiveness ?
▪ High dose Prednisone (no significant improvement in M
Strength, however a trend to an increse in isometric strength)
Other symptomatic management
18
19.
Rehabilitative
Interdisciplinary team
assessment
▪ Physician, OT, PT,
SLP,P&O, SW, Respiratory
Therapist
Goal setting
Treat ment Planning &
intervention
▪ Management of Weakness
▪ Management of Fatigue
▪ Management of Pain
For the assessment of Fatigue
19
20.
OT interventions are tasks or activities that
promote health and improve occupational
performance .
Role of OT in PPS
Exercise program that involves the U/E
Prevention of overuse injuries
Treatment of any existing arm problems
Education about the principles of energy
conservation
20
21.
Interventions are
Orthoses for the U/E (e.g. splints )
Assistive technology
Modifications at home and work
Lifestyle modification
Exercise program
Discharge and follow-up
MOYERS P et al .AJOT 53:251-289,1999
21
22.
Energy conservation techniques
Life style changes
Regular rest periods or naps during the day
Pacing (rest periods during activity)
Improvement of sleep ( e. g relaxation
techniques)
Avoidance of excessive fatigue
22
23.
Most effective treatments for pain include:
Heat
Massage
Gentle exercise
Education
Stretching
Orthoses and Walking aids
Re-education of Movement
23
24.
Post-polio syndrome is not life-threatening
unless there is severe pulmonary involvement
or a swallowing disorder.
The symptoms are manageable and with
proper measures quality of life can remain
good.
24
25. 1.
2.
3.
4.
5.
Halstead LS. 1991. Assessment and differential diagnosis for
post-polio syndrome. Orthopedics. 14(11):1209.
Halstead, L. S. and Rossi, C. D., Post-polio syndrome: clinical
experience with 132 consecutive outpatients, in Research and
Clinical Aspects of the Late Effects of Poliomyelitis, Halstead, L. S.
and Weichers, D. O., Eds., March of Dimes Birth Defects
Foundation, 23(4), White Plains, NY, 1987, 13-26.
Halstead, L. S., Late complications of poliomyelitis, in
Rehabilitation Medicine, Goodgold, J., Ed., CV.
Mosby, Washington, D.C., 1988, 328-340.
Dalakas, M. C., Sever, J. L., Fletcher, M., Madden, D.
L., Papadopoulos, N., Shekarchi, I., and
Albrecht, P., Neuromuscular symptoms in patients with old
poliomyelitis: clinical, virological and immunological studies, in
Late Effects of Poliomyelitis, Halstead, L. S. and Weichers, D.
O., Eds., Symposia Foundation, Miami, FL, 1985, 73-90.
Julie K Silver, Anne C Gawne 2004 Post Polio Syndrome p 5 25
26.
Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio
M, Aloisio A, Savettieri G. Prevalence and risk factors of postpolio syndrome in a cohort of polio survivors. J Neurol
Sci. 2005 Sep 15;236(1-2):31-5.
Stress and "Type A" Behavior as Precipitants of Post-Polio
Sequelae: The Felician/Columbia Survey Richard L.
Bruno, PhD, and Nancy M. Frick, MDiv, LhD
26