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  • Health Officials Unsure of Link Between Paralysis and Virus; Virus Now in 40 States

    Colorado health officials now report that 10 children are experiencing paralysis and muscle weakness that may or may not be linked to Enterovirus D-68 (EV-D68), a respiratory infection that has now spread to 40 states.

    According to a report in the Denver Post, 8 of 9 children originally diagnosed with myelitis were tested for viral outbreaks, with 4 testing positive for EV-D68, and 4 testing positive for rhinovirus or another enterovirus. At the time the Denver Post report was written, officials had not provided testing information on the 10th child.

    No definitive connection between EV-D68 and the paralysis and weakness has been established. The Denver Post reports that "there are no cases where the children are completely unable to move, just varying degrees of muscle weakness, difficulty swallowing, difficulty breathing, weakness in the neck and trunk, and difficulty walking."

    According to the Centers for Disease Control and prevention, the children tested negative for West Nile virus and polio.

    In response to the reports, the CDC has issued a health advisory asking that health departments inform the CDC of any patients under 21 who have experienced acute onset of focal limb weakness on or after August 1, and who have an MRI showing a spinal cord lesion largely restricted to gray matter.

    While researchers look to establish or eliminate EV-D68's role in the paralysis and weakness, the Washington Post reports that the virus has been found in 40 states and the District of Columbia. Children with asthma or other preexisting respiratory problems tend to be especially hard-hit by EV-D68. According to the Washington Post article,  277 cases have been reported to date.

    Earlier this year, 20 children in California were reported to be experiencing similar neurological symptoms, with 2 testing positive for EV-D68. According to a story from the Associated Press, the CDC is still unsure if there is a connection between the virus and the paralysis and weakness in the California cases.

    APTA Helps Spread the Word About Safe Needle Practices

    APTA has joined a national campaign to help raise awareness about safe needle practices and injections in health care.

    Led by the Centers for Disease Control and Prevention (CDC) and the Safe Injection Practices Coalition (SIPC), the One and Only Campaign brings together professional organizations, health care certification groups, health care systems, private companies, educational institutions, state and local health departments, and others to support the dissemination of safe injection messages using social media, electronic continuing medical education, advertising, and print materials for health care providers and patients.

    In addition to APTA, campaign members include the Ambulatory Surgery Center Association, the American Podiatric Surgery Association, and the Association of Occupational Health Professionals in Healthcare.

    Resources available from the One and Only website include a patient brochure (.pdf), patient frequently asked questions, and a provider training unit on bloodborne pathogens. The campaign also offers a YouTube channel with provider-focused informational videos.

    Safe conduct of any invasive procedure such as dry needling, some forms of wound care, and electromyography are important components of physical therapist practice. In addition the resources now available to members through APTA's partnership with the One and Only Campaign, the association has developed a paper outlining the safe and effective performance of dry needling (.pdf).

    Exercise Programs Likely to Help People With Lower Limb Amputations, But Best Combination Still Unclear

    There is a need for more definitive and rigorous studies, say researchers, but a new systematic review of the effects of exercise programs on gait performance in people with lower limb amputations points to some positive connections—even if specifics were hard to come by.

    The review, published in the September 28 issue of Prosthetics and Orthotics International (abstract only available for free), found 623 article citations for studies of gait among people with lower limb amputations and eventually whittled acceptable research down to 8 studies involving 199 participants. These studies allowed researchers to compare self-selected gait speed among patients who received specific functional exercise programs, but in the end they did not reveal a single exercise program or combination that could be deemed most effective.

    Authors focused on self-selected gait speed as "the only consistent measure of gait performance" among the studies.

    The actual degree of improvement difference was difficult to pin down, authors write, based in part on inconsistencies in the studies, and wide variation of exercise programs used. Still, they write, "The combined evidence suggests that a variety of different types of exercise can improve self-selected gait speed," and that "improvement in gait performance was seen throughout whether participants were in their third or seventh decade, and whether only men or men and women were combined." No study focused on women only.

    The range of exercises in the studies included activities targeted at supervised walking, specific muscle strengthening, balance, gait training exercise, and functional training focusing on coordination exercises "beyond walking and stair negotiation." Exercise treatment duration ranged from 3 days to 14 months, and from 2 to 40 individual sessions of 30 to 90 minutes. Physical therapists were identified as treatment providers in all but 1 study, which did not specify who provided treatment.

    "Little evidence consistently differentiated which type of exercise was most beneficial," authors write, although improvement occurred "whether most exercise was performed as an unsupervised home exercise program, in focused daily treatments provided within a single week, or in regular sessions spanning months."

    Overall, authors write, the evidence reviewed is only sufficient for a "Grade B" recommendation to support the use of exercise programs that use a range of methods, meaning that more research work needs to be done before a solid analysis can be conducted. "No consensus on a best approach emerged," they write. "This review underscores the need for more and higher quality research into the clinical benefits of specific exercise programs in lower limb amputation rehabilitation."

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.