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==ME/CFS patients as wheelchair users== [[Severe myalgic encephalomyelitis or chronic fatigue syndrome|Severe ME/CFS]] is typically described as causing severe difficulty with walking and sometimes standing, to the degree that a wheelchair is needed,<ref name="NHS" /> and these patients vary from being mostly housebound to fully bedbound.<ref name="niceng206">{{Cite web|url=https://www.nice.org.uk/guidance/ng206 | title = Myalgic Encephalomyelitis (or Encephalopathy)/Chronic Fatigue Syndrome:diagnosis and management. NICE guideline. | last=NICE Guideline Development Group | first = | authorlink = |publisher=[[National Institute for Health and Care Excellence]]| date = 2021-10-29}}</ref><ref name="CDC-symptoms"><nowiki>{{Cite web|url = </nowiki>https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/index.html | title = Presentation and Clinical Course of ME/CFS | Myalgic Encephalomyelitis/Chronic Fatigue Syndrome|website=[[Centers for Disease Control and Prevention]]|access-date=2022-03-25}q}</ref> Around 25% of people with [[ME/CFS]] are severe at some point in their illness, and many rely on a wheelchair as a result.<ref name="niceng206" /> Some people with [[Moderate myalgic encephalomyelitis or chronic fatigue syndrome|moderate ME/CFS]] may depend on or benefit from a wheelchair, or may use other [[:Category:mobility aids|walking or mobility aids]], because of their combination of symptoms.<ref name="NHS" /> ===Post-exertional malaise === [[Post-exertional malaise]] (PEM) is increasingly recognized as the hallmark symptom of ME/CFS, this means that patients suffer a [[relapse]] or [[crash]] when they exceed their limited [[energy limit]].<ref name="Vink2015" /><ref name="Vink2019">{{Cite journal | last = Vink | last2 = Vink-Niese | date = 2019-09-20 | title = Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies|url=https://www.mdpi.com/2075-4418/9/4/124|journal=Diagnostics|language=en|volume=9|issue=4|pages=124|doi=10.3390/diagnostics9040124|issn=2075-4418 | first = Mark | first2 = Alexandra|pmc=|pmid=|quote= | author-link = Mark Vink | authorlink2 = Alexandra Vink-Niese|via=}}</ref><ref name="NHS" /><ref name="CDC-symptoms" /> The [[Centers for Disease Control and Prevention|CDC]] states: <blockquote>"During PEM, any ME/CFS symptoms may get worse or first appear, including difficulty thinking, problems sleeping, sore throat, headaches, feeling dizzy, or severe tiredness. It may take days, weeks, or longer to recover from a crash. Sometimes patients may be house-bound or even completely bed-bound during crashes."<ref name="CDC-symptoms" /></blockquote> Dr [[Mark Vink]], a former marathon runner and international hockey player who now has severe ME states that walking the few steps from his bed to the toilet is only possible every 12 hours, due to the severe PEM it causes him.<ref name="marathon">{{Cite web|url=http://anilvanderzee.com/for-patients-with-cfs-going-to-the-bathroom-is-similar-to-running-a-marathon/ | title = For patients with CFS, going to the bathroom is similar to running a marathon. | last=de Visser | first=Ellen|authorlink=Ellen de Visser| date = 2017-10-03 | website = [[Anil van der Zee]]|language=en-GB|archive-url=|archive-date=|url-status=|access-date=2018-12-29}}</ref> === Orthostatic intolerance === A significant proportion of ME/CFS patients have forms of [[orthostatic intolerance]] e.g., [[Postural orthostatic tachycardia syndrome|POTS]], which can cause injuries or falls from [[Syncope|fainting]], in addition to [[tachycardia]], [[dizziness]] and blurred vision.<ref name="CDC-symptoms" /> === Periodic paralysis === Patients with ME/CFS may experience episodes of [[paralysis]], particularly affecting their legs and/or arms, making them unable to temporarily unable to walk. De Becker et al. (2001) conducted a large study of [[chronic fatigue syndrome]] patients, and found that 27.2% of patients meeting the [[Fukuda criteria]] and 33.2% of patients meeting the [[Holmes criteria]] for CFS experienced episodes of [[paralysis]].<ref name="DeBecker2001">{{Cite journal | last =De Becker | first=Pascale | author-link = Pascale De Becker | last2=McGregor | first2 = Neil | author-link2 = Neil McGregor | last3=De Meirleir | first3=Kenny | author-link3 = Kenny De Meirleir| date = Dec 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref> Crowhurst and Crowhurst (2013) surveyed patients with severe myalgic encephalomyelitis, and found yhat [[hypokalemic periodic paralysis]] was particularly common.<ref name="Crowhurst2013">{{Cite web|url=http://carersfight.blogspot.com/2013/08/paralysis-qualitative-study-of-people.html | title = Paralysis, a qualitative study of people with Severe Myalgic Encephalomyelitis | last =Crowhurst | first=Greg | authorlink=Greg Crowhurst | last2 = Crowhurst | first2 = Linda | authorlink2 = Linda Crowhurst | date = Aug 8, 2013 | website = [[Stonebird]]|archive-url=|archive-date=|url-status=|access-date=2018-12-28}}</ref> Hypokalemic periodic paralysis is a form of temporary paralysis caused by a rapid drop in [[potassium]] levels in cells, which prevents the nervous system from transmitting the signals needed to move despite the fact that the spinal cord is not damaged. This paralysis can be caused by a number of different triggers including [[Exertion|over-exertion]], and patients may have normal potassium levels between attacks. ===Muscle weakness=== Muscle weakness or paresis is common in patients with CFS, De Becker et al. (2001) found that 84% of patients with CFS had muscle weakness, which for some patients can be severe and affect walking or the ability to self-propel in a wheelchair.<ref name="DeBecker2001" />
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