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Post-Polio Health (ISSN 1066-5331)

Vol. 14, No. 1, Winter 1998

Gait and Post-Polio

Marianne Weiss, MS, PT, Assistant Professor, Physical Therapy, University of Findlay, Findlay, Ohio

Falls are a chief cause of death and increased disability in this country. Among the physical problems leading to falls are loss of balance, overall fatigue, repetitive motion leading to individual muscle fatigue, weak muscles and abnormalities in gait.(1) Many polio survivors exhibit one or more of these problems. Using assistive devices for walking can reduce the severity of these abnormalities or reduce the effect that they have on the lives of polio survivors.

Some survivors have used assistive gait devices for many years. Others used them only in the acute stage of recovery after polio, while others never used them. How do you know if you need an assistive device for walking or if you need to change the one you have?

Some signs that can help you answer those questions are these: lessening endurance for walking due to muscle fatigue, worsening of a limp, pain in the legs during walking, a history of falls, or the recent occurrence of new falls.(2) If you suspect that you need an assistive device in walking or a new type, discuss the matter with your doctor, who will probably refer you to a physical therapist for an evaluation.

The therapist will then assess: how your strength and flexibility affect your ability to walk and to get up and down from a seated position; whether you have enough upper body strength and flexibility to safely and effectively use an assistive device; how good your balance is (3); and how your heart and lungs react to walking. In many cases, the use of an assistive device reduces the strain on the heart and lungs because the device uses less energy than, for example, the limp it corrects. However, in some cases, using an assistive device may be more taxing on the heart and lungs than walking without a device (4). If this is the case, the assistive device that the therapist recommends may be an electric scooter or motorized wheelchair.

Finding an appropriate assistive device for walking for polio survivors can be a challenge. If a person has a one-sided problem in the legs, usually a one-sided device, such as a cane or a single crutch, is indicated (most often used in the hand opposite the affected leg). However, abnormalities of strength, pain, or flexibility in the arms may make using a one-sided device impossible.

Similarly, problems in the arms may make using two-sided devices such as walkers, two crutches, or two canes difficult, if not impossible. The trick is to find the device that provides enough assistance to compensate for the physical abnormality without causing other physical problems.

Sometimes the evaluation reveals too much disability for the survivor to benefit from an assistive gait device. This finding can free the survivor to make the decision to walk only in the home and to use motorized conveyances to move about in the community. Many who become motorized are pleasantly surprised to find how easily they can participate in community activities again and how much more energy they have after they make the decision to ride rather than walk outside their homes.

If the evaluation reveals that an assistive device would improve your gait, the therapist will recommend a specific device, assist you in obtaining it, fit it to you, teach you how to use it, and assess its effectiveness in meeting the goal for which it was recommended. Frequently the therapist may also recommend a gentle exercise program of strengthening and stretching to further assist your walking efforts. Certain types of braces or splints may also be recommended (5,6).

In working with polio survivors for the last 15 years, I have seen many of them helped significantly by their using appropriate assistive devices for walking. The devices can help reduce pain and fatigue and reduce limping. And, of course, all of this leads to a reduction in the incidence of falls – resulting in less chance of more serious disability or even premature death.

So what are you waiting for? If you think an assistive device might make your life easier, start the process described above by obtaining your physician's opinion.

References

1. Shumway-Cook, A., & Woolacott, M. (1995). Motor control, theory and applications. Philadelphia, PA: Williams and Wilkins.

2. Pierson, F. (1994). Principles and techniques of patient care. Philadelphia, PA: Williams and Wilkins.

3. Minor, M.A., & Minor, S.D. (1995). Patient care skills. Norwalk, CT: Appleton and Lange.

4. Perry, J. (1992). Gait analysis. Thorofare, NJ: Slack, Inc.

5. Smith, L.K., & Mabry, M. (1995). Poliomyelitis and the post polio syndrome. In D. Umphred (Ed.), Neurological Rehabilitation, 3rd ed. Philadelphia, PA: Mosby.

6. O'Sullivan, S.B., & Schmitz, T.J. (1995). Physical rehabilitation: Assessment and treatment, 3rd ed. Philadelphia, PA: F.A. Davis.

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