TREATMENT OF YOUNG POLIO SURVIVORS IN TURKEY Prof.Dr .Arzu Yaz On - - PowerPoint PPT Presentation

TREATMENT OF YOUNG POLIO SURVIVORS IN TURKEY

Prof.Dr.Arzu Yağız On Ege University Medical Faculty Department of PM&R, TURKEY

Ege University Hospital

Over 4000 inpatient beds 125,000 inpatient /year 450,000 inpatient / year

Department of Physical Medicine and Rehabilitation

80 inpatient beds 700 inpatient /year 15,000 outpatient / year

• 1997: Fellow-ship in

Uppsala University Hospital, Department of Clinical Neurophysiology (Arne Sandberg, Erik Stålberg)

• 2001: Post-Polio Clinic was established

in Ege University Hospital, Department of Physical Medicine and Rehabilitation

Turkey is a Transcontinental Country (Eurasia)

The modern convention of the Europe-Asia boundary

Istanbul is a transcontinental city

Cultural influences in Turkey originate from both Asia and Europe

EUROPE

ASIA

Inter-regional differences in terms of development and welfare

Most developed Least developed

Development status of Turkey

Development status of Turkey cases of wild poliomyelitis in 1998

Most developed Least developed

History of polio eradication in Turkey

Immunization campaigns Polio eradication program National immunization days

1963: vaccination started with a coverage rate of 20%

20 40 60 80 100 20 40 60 80 100

%

Polio cases

National immunization days

Europe’s last case of wild poliomyelitis AĞRI-TURKEY

26 NOV 1998 MELİK MİNAS

Now, he is 16 years old. All our efforts are to keep him as the last child suffering from polio in Turkey.

• Eradicating polio is still a publich health

priority in Turkey.

• Insufficient attention has been paid to the

patients living with polio sequela, and their health and rehabilitation, social, financial and psychological needs…

Current situation of polio survivors in Turkey???

• Global number?
• Regional distribution?
• Age distribution ?

Challenges in accurately diagnosing and reporting the cases during epidemics

year population reported cases morbidity rate exes mortality rate

TOTAL NUMBER OF REPORTED CASES BETWEEN 1961-1999

12.953

year reported cases 1961 361 1962 1193 1963 954 1964 244 1965 629 1966 1975 1967 814 1968 2206 1969 384

Developed countries Developing countries Polio largely eradicated by the early 1980s eliminated the disease in the late 1990s / still not eradicated Polio survivors mostly older than 50 Polio survivors are often younger Secondary conditions Worsening disability due to PPS different needs and challenges to; Health-care and rehabilitation Education Social integration Economic self-sufficiency

The degree to which polio affected….

• Education
• Employement
• Life satisfaction

Onset of PPS creates further challenges

• Employement
• Psychosocial situation
• Independence
• Social participation
• Life satisfaction

Ege University PMR Post-polio clinic

Team members

• Physiatrist
• Physioterapist
• Orthotist
• Access to dietitian and speech therapist
• Access to specialists in psychiatry, pulmonary medicine,

neurology and orthopedic surgery

• ccupational therapist
• recreational therapist
• rehabilitation psychologist
• rehabilitation social worker
• rehabilitation nurse
• vocational counselor

medical history information sheet

• riginal illness and subsequent sequel,

use of orthotics and/or walking aids Previous surgeries social situation and life style new neuromuscular and musculoskeletal symptoms (Pain, Fatigue, Weakness, Changes in functional status

Physiatrist

• Neurologic and

musculoskeletal exam

• Assessment of fatigue

(VAS, FIS, FSS)

• Assessment of quality of life

(NHP)

• Four limbs needle EMG
• Further evaluations and

referral Physiotherapist

• ROM
• Strength
• Mobility status

Orthotist

• Need for orthosis,

ambulatory aids

• Confirmation of

poliomyelitis

• Extent of subclinical

involvement

• Diagnosis of PPS

Assessment

International Journal of Rehabilitation Research. 2013. Vol 36 No 4

174 patients with a history of poliomyelitis admitted to our clinic between 1997-2014

Confirmation of poliomyelitis by clinical and EMG examinations n 158 (90%) Misdiagnosis of polio n 16 (10%) Encephalitis Upper motor neuron syndromes Stroke

Demographic characteristics of 158 polio survivors admitted to our clinic between 1997-2014

Age (min-max) mean 37 min-max 19-65 Gender women 112 (71%) men 46 (29%) Marital status married 72 (46%) single 48 (30%) divorced 26 (16%) widowed 12 (8%) Educational level low 35 (22%) mid 71 (45%) high 52 (33%) Employment status employed 52 (33%) self-employed 11 (7%) student 21 (13%) retired 12 (8%) not employed 62 (39%)

Region of origin West 121 (77%) Middle 23 (14%) East-South East 14 (9%) Access route Internet / e-mail 92 (58%) referral 43 (27%)

• ther

22 (14%)

Turk Fiz Rehab Derg 2004;36:112-116 Turk J Phys Med Rehab 2004;36:112-116

Clnical characteristics of 158 polio survivors admitted to our clinic between 1997-2014

Diagnosis of PPS n 82 % 54 women 53 (65%) men 29 (35%) Concominant diseases n 36 % 23 neurologic 4 rheumatologic 28 cardiovascular 2 endocrine 2

Clinical management program

Education Individual and family counselling

• Late effects of polio, PPS, associated problems
• Instruction in energy conservation techniques

and work simplification

• Suggestions for adaptive techniques and

equipment

• Assistance in learning to adjust necessary

lifestyle changes

Modification of orthosis

• Repairing or modifiying older orthosis
• Fabrication of new custom orthosis

Nutritional counseling

• Providing therapeutic or weight-reduction diets

Personalized exercise program

• Specifically tailored to the individual’s functional

status and needs

• Emphasis the prevention of overuse
• Supervision for two months
• Close monitoring, modifications

Prof.Dr. Arzu Yağız On 2004 EL KİTABI

Education Handbook

• Late effects of polio
• Work simplification
• Energy conservation
• Home exercise programs
• Orthoses

Medical treatment

• Treatment of other disorders unrelated with polio
• Treatment of PPS symptoms (lamotrigine)

Clinical management program

Follow-up (one to two months)

• Success of the program
• Efficacy of the medical treatment
• Side/advers effects of medicine
• Modification or update of exercise program
• Further evaluation and treatment

Lacking members in our team…

Rehabilitation nurse

• Home visits
• Suggestions to make patient’s home accessible

and functional Rehabilitation social worker

• Inform about community resources available

Vocational counselor

• Vocational counseling and work evaluation
• Job training to return former job
• Alternate job training and placement

Future needs regarding polio survivors in Turkey

Future needs regarding polio survivors in Turkey

• The lack of accurate data has profound implications for national policy-

making.

• Situation of polio survivors should be documented.

– more accurate estimates of regional prevalence – the degree of residual disability

• Polio survivors will continue to be a major concern

– educational, social and economic needs of young- middle aged adults must be met – PPS will make additional demands on national health systems

• Care strategies for polio survivors should involve coordination
• f multiple skilled professionals.

– Adaptations of these strategies for resource-poor areas

Future needs regarding polio survivors in Turkey

Healthcare workers are largely unaware of PPS

• Currently, education among health professionals is almost

wholly on vaccination efforts.

• Education of healthcare professionals and patients

– Giving lectures – Publishing reviews – Joining the online support groups

• A more widespread effort combining support from government with

financial investments from global health organizations is needed

• Overdiagnosis of PPS should be prevented

Future needs regarding polio survivors in Turkey

• Despite polio survivors have been leaders in

disabled people’s organizations, there is no

• rganization or patients support group in

Turkey specific to polio. Future needs regarding polio survivors in Turkey

Positive note:

• Strong social support, especially

from family!!

• General health insurance covers all

rehabilitation services and equipments.

Thank you very much