Reasonable Goals for Physical Therapy.

Nearly every polio survivor comes to health care providers initially with the hope – whether clearly evident or secretly buried – that someone will be able to “make me as I was.” Because of this hope, some survivors are initially reluctant to hear about suggestions a PT may make regarding lifestyle modifications, equipment options, etc. Often, polio survivors consider accepting changes such as these as an act of “giving up.”

I would encourage survivors to consider that the only true act of “giving up” is refusing to participate in activities and retreating from society. Any suggestions for changes in lifestyle or use of equipment should be viewed as suggestions for how to “get on with life,” and survivors should attempt to look at these suggestions as a means of continuing their participation in society to the fullest extent possible.

Reasonable goals that may be possible to achieve via physical therapy intervention can include the following. However, the survivor and PT should work together to choose which goals should be worked on at any given time.
 pain reduction
 edema reduction
 improved skin integrity
 improved endurance for activity
 improved flexibility
 improved ability to move in bed/transfer
 stabilization of balance/gait
 possible reduction of rate of strength loss and improved ability to use existing strength

Polio survivors should recognize that their bodies may be especially sensitive to even subtle changes. Sometimes small interventions may result in huge positive benefits. For example, the provision of ¼-inch internal heel lift in one shoe may be enough to greatly minimize low back pain.

Other times small interventions may result in negative outcomes. For example, if the therapist would recommend providing a low back support to stabilize the pelvis and minimize back pain, the patient’s ability to use the pelvis to assist with certain phases of the walking cycle might be impaired. Therefore, the survivor must be able to communicate fully any negative results that occur when interventions are implemented.

What is the moral of this story? Survivors should attempt to be flexible and should attempt to look upon recommendations made with an open mind. However, survivors should also recognize that several interventions may need to be tried before one might be found that is beneficial.

Marianne T. Weiss, PT