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Post-Polio Health (ISSN 1066-5331)

Vol. 8, No. 1, Winter 1992

Read selected articles from this issue ...

Post-Polio Problems Featured in Prosthetic-Orthotic Publication

Update on Vaccine-Related Issues

New Braces Do Not Always Mean Ugly Shoes
Marge Torre, Philadelphia, PA

Foot Pharmacist for Doctors

The Three Types of Three Types of Polio

Ventilator Considerations: Lease vs. Purchase
Roberta Simon, R.N., Darien Park, IL

Post-Polio Problems Featured in Prosthetic-Orthotic Publication

International Polio Network provided information about polio's late effects to Robert Kidd & Associates of 836 Riverside Ave., Suite 1, Jacksonville, FL 32204 USA for inclusion in a P & O newsletter which was mailed to their clients across the country. With their permission, we reprint one article.

W.P., 76, is in many ways a classic post-polio syndrome patient. Afflicted with polio at 14 months, he experienced total paralysis of the lower extremities and partial paralysis of the trunk and neck. After "a lot of surgery," he first walked with the aid of crutches at age 6 but did not receive his first braces for another 16 years. Though those initial steel-and-leather orthoses were heavy and cumbersome, W.P. built a successful career as a plant chemist, demonstrating the fierce drive to achieve a normal existence that characterizes what some clinicians have come to call "the polio personality."

But at age 46, long after concluding he had polio licked, the patient began experiencing new muscle weakness, pain and fatigue, to the point that he was compelled to give us his chief chemist position in favor of a less-physically demanding job. Unfortunately, the year was 1961 – it would be another 22 years before doctors could tell him what was behind his polio symptoms' resurgence or begin to deal effectively with it.

With his advancing muscle weakness, W.P. adopted an exaggerated four-point stance, relying on his upper body for stability and support on two straight canes. This unnatural posture exacerbated his back and shoulder pain and seriously limited his mobility and ability to carry out customary daily activities. Compounding his progressive physical deterioration was what W.P. describes as his growing frustration at having to confront polio again.

By the mid-1980s, the patient's prospects began to improve significantly. First, medical science "discovered" post-polio syndrome and began to develop effective approaches to treatment. Moreover, after a 30-year virtual lull in brace development, the orthotics industry experienced a surge in new technology and materials, leading to lighter, more functional leg braces for polio patients.

As his PPS debility worsened, W.P. became a patient of an area polio clinic, where a determined team collaborated on design and fabrication of bilateral lightweight plastic KAFOs (knee-ankle-foot orthoses) with the goal of reducing pain, improving his ambulatory posture and reducing the energy required for donning and walking.

The team's certified orthotist constructed the orthoses with ischial weight-bearing rings – "I virtually sit in them," the patient notes – to provide added protection and support for his knees, which are also affected by arthritis. The braces feature plastic thigh shells, bail-type knee locks, and spring-actuated ankle dorsiflexion joints to counter drop foot.

With his new advanced braces, W.P. now stands more erect than at any time in his life. His pronounced "shoulder slouch" is diminished, he does not tire as easily, his functional capabilities are improved, and his psychological outlook is substantially brighter. "I now feel solid on my legs – I didn't before," he says. "That gives me a better sense of security, which enables me to do more and cuts down on my frustration level." His only complaint with the braces is itching and irritation brought on by perspiration, a problem ameliorated somewhat by absorbent clothing worn between his skin and the plastic brace components.

A distinct benefit of W.P.'s new UFO s – "the coupe de grace" as he describes it – is easier donning and doffing of the braces. Smooth plastic interface has replaced soft leather, and velcro straps now do the job of long laces, which he found "excruciating" and tiring to use.

This patient demonstrates the potential of new approaches to orthotic design and componentry for PPS patients, whose ability to function in older-style braces is deteriorating. Custom measurement, design and fabrication, close attention to patient needs and capabilities, and the skill of a certified orthotist can now provide an orthosis that can maximize the wearer's function capacity.

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