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 use of existing devices; or educate in lifestyle modification.
A comprehensive evaluation that may take up to a few hours should be performed. It includes an interview to obtain medical, social, work, and activity histories; current functional abilities and changes; an understanding of home accessibility and/or support; and a survey of currently and previously used assistive devices/equipment. The evaluation should also include assessment of the following:
- heart and lung function, as they relate to activity performance;
- flexibility (range of motion), with specific measurements at each joint in all planes of motion that exhibit limitations, pain, or hypermobility;
- strength (via manual muscle testing of each muscle and/or handheld dynamometry) and observation/palpation of muscle contractions to determine presence of twitching and/or compensatory muscles “cheating” for weak muscles;
- sitting and standing posture, screening for leg length discrepancy and scoliosis;
- ability to move in bed and get up and down from the seated position;
- walking ability with a timed walk test and gait analysis;
- fall and near fall history, with circumstances of those falls;
- skin integrity and presence of swelling;
- screen for depression, as it has been related to falling.
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. They need to be educated as to the possible benefits and risks associated with certain behaviors and treatment compliance. A report detailing the evaluation and recommendations should be sent to the referring physician.
PT intervention can seldom restore chronic survivors of polio, with or without post-polio syndrome, 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 exercise program. 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 locomotion; pain (new and/or chronic) management, and/or referral to other health professionals. Note that exercise was once considered harmful for polio survivors with the concern about causing more weakness. However, current but limited evidence exists that a carefully individualized exercise program can be helpful to many polio survivors, with the survivor and PT working together as a team to help the polio survivor to reach their goals.
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.