Bracing; Any Appropriately Adapted Rehabilitation Programs for Mobility-Impaired Post-Polio Heart Patients?

Question: I contracted polio when I was six months old in Taiwan. I was able to walk without any assistive devices until I was 46 years old, at which point I decided to use a cane. I am now 61 and feel the need to do more to improve my balance and prevent tripping or falling. How do I start the process of getting a brace? How do I decide what kind of brace is best for me? Can I trust those websites selling braces without a doctor’s prescription? What are the best exercises for people like me with one polio leg?

Answer from Marny Eulberg, MD: The first step toward getting a brace that is designed to help your particular situation is to consult with a physician who can do a thorough evaluation of your muscle strengths and weaknesses, the challenges you are having with walking and standing, and any abnormal positioning of any of your joints in that limb. This can be a physiatrist (physical medicine and rehabilitation specialist), a neurologist (especially one who has a strong interest/expertise in neuromuscular conditions), or a primary care physician or geriatrician who has an interest in muscles and joints.

In my experience, especially if there is not a physiatrist or any kind of neuromuscular specialist in your area, a Doctor of Osteopathy, or D.O., may have a better understanding of how muscles and nerves work together than primary care physicians who have an M.D.

There are many considerations as to what kind of brace is best for you: What kind of walking/standing problems are you having? Foot drop—resulting in tripping over your toes or frequent stumbling/ falling over a crack in the sidewalk? Weakness around the knee so your knee buckles (bends forward and won’t hold you up)? Pain in any joint? Your ankle rolling inward or outward? Trouble lifting your whole leg up enough to step up a stair or curb?

There is a website that you can go to that can help answer that question. It is www.humangaitinstitute.org. If you click on “Ideal Brace” on the menu across the top of the home page and at the bottom of the page that comes up, there should be a workbook that you can use to determine what options you might have for a brace. Once you have a doctor’s prescription, you may either get a referral to an orthotist (brace maker) from the doctor’s office or you can get a list of credentialed orthotists by going to www.abcop.org. Once there you can scroll down to the orange box “search directory” and click on either “certified individual” or “accredited facility.” You can then enter your zip code and parameters for how far you are willing to drive to see an orthotist. It should then show you the names and contact information for orthotists in your area. You may also check PHI’s Post-Polio Directory at https://post-polio.org/networking/directory/. If there is a support group near you, you may want to ask other polio survivors to recommend healthcare providers in your area that they have found helpful.

It is very, very unlikely that the braces sold on websites that you can get without a doctor’s prescription will work because they are designed for persons who have normal-sized legs and normal proportions between the upper and lower leg.

As for the best exercises for someone with one polio leg—each polio survivor has a unique pattern of muscle weakness and strength, so the exercise plan needs to be designed just for you. You and your healthcare provider need to remember that even though the result of your polio is muscle weakness—the weakness is a result of damage to the nerves that come out from the spinal cord and go to that muscle(s). The amount of strengthening that is possible may be limited because we have no good treatment to improve nerve function. I hope some of this information is helpful at this point in your polio journey.

Post-Polio Health (Vol. 40, No. 4, Fall 2024)