Report of the post-polio program at the Montreal Neurological Hospital Institute

Despite the pandemic, the McGill University-affiliated Post-Polio Program continues to provide clinical care for post-polio patients, education and clinical research on post-polio syndrome (PPS) and the late effects of polio.

The post-polio program is based at both the Montreal Neurological Hospital Institute and the Réseau universitaire intégré de santé et de services sociaux du Centre -Ouest de Montréal (Lethbridge-Layton-Mackay Rehabilitation Centre, Constance- Lethbridge site), and is directed by Dr. Daria Trojan, physiatrist. Dr. Diane Diorio is the clinic's neurologist. Ms. Beatrice Stoklas is our clinic secretary at the Montreal Neurological Hospital, and Ms. Shannia See baran is the clinic secretary at the Lethbridge-Layton-Mackay Rehabilitation Centre. The clinic is held on Fridays once a month at the Lethbridge-Layton-Mackay Rehabilitation Centre. Both physicians work in the same area of the center at that time. Both doctors also see some of their patients at other times. Dr. Trojan sees post-polio patients at the Montreal Neurological Hospital and Dr. Dio rio also sees his patients in the affiliated McGill outpatient clinics. The past year and a half has been very difficult due to the pandemic, but we are now regularly assessing new patients, about 2-3 per month, mainly at the Lethbridge-Layton-Mackay Rehabilitation Centre. Many patients are followed up on a regular basis, approximately every 6-12 months.

Clinicians from the Neuromusculoskeletal Program at the Lethbridge-Layton-Mackay Rehabilitation Centre are involved in rehabilitation, and some physiotherapists work with us to assess new patients at the Lethbridge-Layton-Mackay Rehabilitation Centre. Following the assessment, patients may be referred to local rehabilitation centers or CLSCs for treatment and rehabilitation programs. Patients may also be referred to other physicians and health care professionals as needed. Due to the pandemic, our standard operating procedures have changed since mid-March 2020. During the first few waves of the pandemic, most of the patients being followed had phone visits. New patients were seen in person, but occasionally with an initial phone visit. With the advent of vaccinations in the last few months, most patients are now seen for in-person appointments.

We are involved in the training of health care professionals. Due to the pandemic, we had few trainees in our clinics for about 17 months, but that has now changed. Since the end of August 2021, Dr. Trojan has supervised four U of M physiatry residents during the clinic.

In April 2021, Dr. Trojan presented a lecture on post-polio syndrome to health sciences students at Carleton University in Ottawa. She gave a similar lecture to all physiatry residents at the University of Montreal on October 15, 2021. In addition, physiotherapists and occupational therapists from both centers teach physiotherapy and occupational therapy students at McGill University and the Université de Montréal.

We are involved in clinical studies on the subject of PPS and the late effects of polio. We are part of an international, multi-center, randomized, placebo-controlled clinical trial of intravenous immunoglobulin for post-polio syndrome. This is a potential treatment for post-polio syndrome. The study was initiated at the Montreal Neurological Institute-Hospital in August 2014. To date, twenty-four patients have been included at our center, and approximately 200 have been included at all study centers. The study is taking place in approximately 20 centers in Canada, the United States, and Europe. We are the only study center in Canada. The study was to be conducted in two parts. The first part of the study with data analysis is completed and the second part was initiated in our center in October 2018.Study recruitment was interrupted in our center for a while due to the pandemic and other reasons, but we have recently included two new patients and hope to include more.

We are also in the process of determining a study entitled "Markers of Bone Metabolism in Post-Polio Clinic Patients" with Dr. Pejman Madani (former fellow), Dr. Richard Kremer and Dr. Amichai Grunbaum. Data collection for this project has been completed and we are now in the process of analyzing the data.

The studies described above and already conducted involve or have involved the collaboration of many researchers. These include Dr. Andrea Benedetti, Dr. Diane Diorio, Dr. Angela Genge and members of the Clinical Research Unit of the Montreal Neurological Hospital Institute, Dr. Marta Kaminska, Dr. John Kim off, Dr. Richard Kremer, Dr. Erin O' Ferrall, Dr. Pejman Madani, Dr. Rami Massie, Dr. Basil Petrof, and Mrs. Ann Robinson. We are very grateful to all the people who gave their time and energy to participate in our studies. They made these studies possible.

In summary, our post-polio work continues despite the many challenges of the pandemic. Our work is now changing to include many more in-person visits, more teaching during clinic time, and more study patients. As usual, the continued help and support of the Polio Quebec Association in the many aspects of our work is, as usual, much appreciated.

By Drs. Daria A. Trojan and Diane Diorio