Post-Polio Health (ISSN 1066-5331)
Vol. 9, No. 2, Spring 1993
Part II: Becoming an Intelligent Consumer of Physical Therapy Services
Marianne T. Weiss, PT, Canton, Ohio
We Need to Speak to Be Heard
Joan L. Headley, MS, Executive Director, GINI
Serving Survivors on Ventilators
New Polio Clinics Open
A two-day conference, Meeting the Challenges of Aging with a Disability: Lessons Learned from Post-Polio and Stroke, was held in Long Beach, CA, March 1993. The conference was the culmination of a five-year project (Polio Network News, Vol. 6, No. 3) funded by the National Institute on Disability and Rehabilitation Research (NIDRR), Department of Education.
Most persons with a physical disability, like the population at large, can now be expected to live a longer life. However, as they age, many start to experience the onset of new health problems and secondary complications which threaten to further erode their independence and well-being. Among those individuals who are vulnerable to these "secondary disabilities" are the survivors of the two leading causes of paralysis in the United States today – polio and stroke.
The five-year Later Life Study conducted at the Rehabilitation Research and Training Center on Aging at Rancho Los Amigos Medical Center involved individuals 50 years or older, and compared persons with early onset of polio and spinal injury, to those with a stroke occurring after age 50, and non-disabled controls.
A total of 265 individuals, ranging in age from 50 to 88, participated in the study. These included 120 polio survivors (not all of whom were considered to have post-polio syndrome), 60 stroke survivors and 60 non-disabled controls, plus an additional 25 persons with spinal cord injury who were not reported on during the conference. Each participant received a comprehensive medical exam, including laboratory analysis of EKG, blood chemistry and bone density testing for osteoporosis; a physical therapy evaluation; a psychological evaluation by a clinical psychologist, and a personal history interview by a medical sociologist.
Although not all of the data had been analyzed by the time of the conference, principal investigator Margaret L. Campbell, PhD, co-principal investigators Bryan Kemp, PhD, and Kenneth Brummel-Smith, MD, presented some preliminary information at the meeting. The final report will be completed by August 15, 1993.
The Rancho Later Life Study concluded, in part, the following:
Polio survivors experiencing the greatest problem dealing with post-polio issues are those in the "sandwich" generation – individuals in their early 50s with responsibilities of launching children, aging parents and careers. This finding reinforces the idea that a "life course" perspective of disability will increase our understanding of how disability affects individuals and families.
The health evaluation found few statistically significant differences between the polio group and the control group, including no higher rates of obesity, cholesterol (actually lower), EKG changes (actually fewer), blood pressure and glucose levels. Age-associated diseases do not appear to be more common in polio survivors.
The study did show a higher rate of hypothyroidism in polio survivors. Routine health maintenance should probably include thyroid screening, particularly if survivors are experiencing symptoms such as fatigue, which, in some cases, could be alleviated if the hypothyroidism was treated.
For purposes of the study, depression was defined in two ways: One, by using clinical diagnostic criteria which included profound altered mood, six to eight symptoms (e.g., fatigue, thinking or sleep disturbances) and behavioral disturbances. The second definition of depression was based on clinically significant symptoms only and is less severe.
Overall findings indicate that polio survivors are somewhat less depressed than the non-disabled control group, although the mean differences were not statistically significant. However, among polio survivors, women reported significantly higher depression scores than men (although still within normal limits), and one group of survivors, those in their fifties who experienced acute polio after 1940, had scores consistent with clinically significant symptoms.
Funding was obtained to give one copy of the conference proceedings to each support group. They are being revised and will be available by July 1, 1993. Additional copies, as well as tapes from the conference, can be ordered. Contact Millie Sealana, Associate Training Director, Rehabilitation Research and Training Center on Aging, Rancho Los Amigos Medical Center, University of Southern California, 7066 Consuelo St., Downey, CA 90242 USA (310-940-7402, 310-940-8953).
The Center has been funded for another five years starting August 1993. It will continue its focus on aging and polio with an expanded sample of over 450 individuals, which will include a random sample of 60 individuals form the first five-year study, 300 from the Rancho Post-Polio Clinic and another 100 from the local community.
Polio survivors are, of course, as susceptible to stroke as anyone else.
Stroke Association of Southern California, 2001 South Barrington Ave #308, Los Angeles, CA 90025 USA
The most common warning of stroke is a TIA (transient ischemic attack). It is a disturbance of blood supply to a localized area of the brain. Complete and spontaneous recovery usually happens in 24 hours or less. You should suspect that you or a member of your family has had a TIA if one of the following happens, lasting perhaps one to 15 minutes and leaving no visible after-effects:
- Sudden weakness, paralysis or numbness of the face, arm or leg, especially on only one side of the body
- Difficulty in speaking or swallowing
- Mental confusion
- Changes in personality
- Double vision, clearing after a short time
- Temporary dimness or loss of vision, particularly in one eye
- Falling for no apparent reason
- Unexplained headaches or a change in the pattern of headaches