Excerpt from the
Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©
Physical therapy (PT) can provide a comprehensive evaluation against which future problems might be measured; help with managing pain or decline in physical function; evaluate for new bracing and assistive devices or for use of existing devices; or educate in lifestyle modification.
A comprehensive evaluation that may take a few hours spread out over three to four visits should be performed. It includes an interview to obtain medical, social, work and activity histories; current functional complaints and abilities; idea of home arrangement; and a survey of currently used equipment and appliances. The evaluation should also include assessment of the following: heart and lung function, as they relate to activity performance; flexibility, with specific measurements at each joint in all planes of motion; strength (via manual muscle testing of each muscle) and quality of muscle contraction; sitting and standing posture; ability to move in bed and get up and down from the seated position; walking ability; and the skin and integrity of other soft tissues of the body.
The results of the evaluation should be explained by listing problem areas and the implications of these problems, along with proposed suggestions for treatment options to the survivor and significant others, if appropriate. Survivors should be permitted to choose those interventions in which they are willing to participate. A report detailing the evaluation should be sent to the referring physician.
PT intervention can seldom restore polio survivors to their peak level of functioning. However, with communication and cooperation among survivors, their significant others and the therapist, many goals can be achieved that contribute significantly to quality of life. Achievement of goals may require the use of bracing devices, canes, walkers, crutches, scooters or wheelchairs; implementation of changes in lifestyle; or commitment to a lifelong individualized, low-level exercise program (see Exercise). Survivors have choices in implementing such suggestions; however, their reluctance to consider such changes limits the benefits.
Treatment options may include: individualized therapeutic exercise for gentle stretching and strengthening; training to improve breathing, posture and gait; massage; treatment with devices that help to relieve pain, swelling and circulatory problems; assistance with ordering and instruction in the use of devices to assist with activities of daily living (ADL), walking or alternative means of loco-motion; and/or referral to other allied health professionals.
A physician's referral, or prescription, typically is required for insurance coverage of PT services. A referral with a specific diagnosis, such as gait dysfunction or knee ligament strain, is more likely to be covered than a general diagnosis of post-polio syndrome. Either specialists or primary care physicians may refer to PT, and polio survivors may consider asking for a referral.