Post-Polio Health (ISSN 1066-5331)
Vol. 6, No. 1, Winter 1990
Lynette Jenkins, MCSP, MCPA, ONC, Toronto Rehabilitation Centre, Toronto, Ontario, Canada
Post-polio survivors referred to the Toronto Rehabilitation Centre from Dr. William Franks and other physicians in Toronto are assessed by the Centre's own physician, an occupational therapist, a social worker and a physiotherapist.
The pool is approximately 30' by 18', with a "stepped" floor providing four depths, 2'6", 2'11", 3'5", 4'5". Access is either by shallow steps or by a mechanical hoist. The temperature of the water is kept at approximately 96 degrees Fahrenheit. The pool is equipped with "furniture," consisting of aluminum chairs and parallel bars.
The Hydrotherapy Program
Polio-affected muscles are weak and in some cases paralyzed. This can lead to a tightening or even a contracture of the affected tissue. Slow, gentle stretches, always within a pain-free range, help to alleviate this tension, reduce contractures and relieve cramping. While it may be impossible to strengthen muscles affected by polio, it is possible to strengthen the unaffected muscle groups. Very often extra strain is exerted on them, and so strengthening routines can help prevent damage because of the overload.
It is easy to work in the security and warmth of the water, and it may be possible to overwork. Survivors are constantly reminded to work within their own exercise tolerance level and to take frequent rest periods to ensure that muscles do not get overtired. Exercising the individual part at the expense of the whole body is constantly guarded against.
Postural corrections are taught, as inefficient posture can aggravate joint aches and pains. Body mechanics and activities of daily living are also discussed because an increase in body awareness leads to a decrease in body use.
On land people with polio often cannot raise their level of physical activity to bring about a rise in the heart and respiratory rate. It is possible to do this in the water, so quick repetitive, small-range movements are taught to help improve cardiopulmonary efficiency. Pool sessions last for approximately half an hour, with two-thirds of the time being given to formal exercising and the remainder to "free" time.
It may be impossible for the person with polio-affected hip flexor muscle to stand on one leg and bend the other knee up to the chest on land. The muscle has to have a certain strength to produce movement to resist the downward pull of gravity. The effects of gravity are eliminated when that person is in a pool. The buoyancy of the water acts as an upthrust that actively assists the movement, making the action possible.
When the bent leg is brought down next to the standing leg, buoyancy may also be used as a resistance for exercising (Figure 2a). The hip extensors work against the buoyancy of the water making the exercise more difficult to perform.
Buoyancy, either as an assistance or resistance, determines the starting position. Available muscle strength also determines the starting position for every exercise. Sometimes buoyancy is just too efficient and webbing straps are used as seat belts to stop people from floating away when they are doing sitting exercises.
Figures 2a & 2b
Exercising under the water is eas ier than exercising out of it, but the water itself can also act as a resistance. At the point of change from water to air or air to water (Figure 2b), the surface tension of the water acts as an extra resistance to the movement. The speed of the exercises may be increased or decreased depending on the available muscle strength. The faster the exercise, the harder it becomes because the mass of the water now acts as a resistance. When performing an exercise that involves a change of direction, the turbulence of the water created by the initial movement acts as a resistance at the changeover position.
The various depths of water are needed not only because of the various heights of people, but also the deeper water exerts greater hyloostatic pressure on the limbs. This pressure, combined with the warmth of the water, aids the return of venous blood to the heart and helps prevent edema in the extremities.
The Physical Effects of Hydrotherapy
The stretching routines help to increase flexibility, prevent contractures and relieve cramping in all muscles. Strengthening exercises improve muscle tone,strength and endurance. The duration and pace of the program helps raise the cardio-respiratory efficiency. An increase in body awareness, joint conservation, and postural control encourages a greater level of responsibility on the swimmer's part.
The Psychological Effects of Hydrotherapy
Thee, warmth and buoyancy of the water promotes a general reassuring environment. There is a freedom from restrictive braces, canes, crutches and wheelchairs.
Follow-up exercises to be done in a bathtub are taught, hut the lack of space is rather limiting. As we received more and more referrals from West Park, the original group of patients had to make way for the newcomers. The graduates formed the Post-Polio Penguins, with the motto "wobbling on land...waltzing in the water," and since discharge from the Centre have continued to meet as a group, using community pools for their exercise sessions.
Hydrotherapy is, of course, pleasurable for the patient. We can all attest to that. However, I should stress that I am speaking from my own experience. There are doubtless other centers which can claim equally good results from specially designed dry-land regimes. For those areas where therapeutic pools are not available, therapist and institutions must devise and apply other forms of assistive exercise programs to help control the potentially progressive problems of post-polio.
The Post-Polio Penguins
Dorothy Gowen, Scarborough, Ontario, Canada
The Post-Polio Penguins is a self-help group which evolved from a handful of people meeting twice a week for water therapy at the Toronto Rehabilitation Centre. We were given an hour each week following our pool time to assemble, together with our physiotherapist, to discuss mutual experiences, problems and possible solutions for them.
During these sessions we would often discover that one or more members of our group had coped with a similar situation to the one being discussed. Many times these problems were resolved. When they were not, the person facing them had the positive support and caring of a concerned group. We also gained a more healthy approach to admitting that we had weaknesses. Some of us had been loath to share our problems with family members, thinking it unfair to burden the family; but through this group we learned to share the knowledge we had gained.
The group has given many of us the determination and the courage to say to others that we are no longer able to do certain things. We no longer place ourselves in the harmful position of having to say "Yes" to every request. In fact, if our group hears of a member attempting to do something rash or too tiring, we do not hesitate to butt in and advise that person against it.
We are learning to take charge of our own lives. We make decisions that are good for us. We have gained enough confidence in our worth to recognize that it is not selfish to do this.
When we had to leave Rehab to allow room for other post-polio clients to use the pool, we felt the need to function as a group, so we organized ourselves into the Post-Polio Penguins. Our express goals are to support each other and to find suitable therapy pools to continue our beneficial exercise and recreation program as a group.
Post-polio people do not necessarily feel the benefit of hot water therapy, nor are they interested in locating suitable pools. The Penguins belong to the larger group of Toronto/Peel Post-Polio Chapter under the March of Dimes, and we applaud and support its efforts; nevertheless, we feel the need to retain a separate identity. We are a much smaller group and have the opportunity to become closer to one another. This results in closer communication, better knowledge of each other, and a very caring colony of Penguins.
We have made an observation we should like to pass on to others – the happiest Penguins are the ones who are ready to accept change and adopt a new lifestyle. We are all trying to learn to "go with the 'floe'."