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Post-Polio Health (ISSN 1066-5331)

Vol. 8, No. 3, Summer 1992

Read selected articles from this issue ...

U.S. Post-Polio Clinic Survey Results    

Coalition Update    

Co-sponsors of National Polio Awareness Week


U.S. Post-Polio Clinic Survey Results

Since 1985 International Polio Network has compiled a listing of self-identified polio clinics. In an effort to better inform our readers, IPN surveyed approximately 70 clinics listed in the Post- Polio Directory. Sixty clinics responded to the questions which have been tallied in chart form on pages 3 through 8.

Post-polio clinics are typically headed by physiatrists or neurologists.

A physiatrist is a doctor of medicine (MD) or doctor of osteopathy (DO) who is a specialist in physical medicine and rehabilitation (PM&R) . Physiatrists specialize in the diagnosis of certain conditions causing neck and back pain, weakness, and a variety of other nerve and muscle problems. Through their specialized knowledge of electromyography, physiatrists are able to diagnose conditions causing pain, numbness, tingling, and weakness.

Rehabilitation medicine involves specialized medical care and training of patients, both adults and children, who have loss of function; enabling patients to obtain their potential – physically,
psychologically, socially, and vocationally. The physiatrist directs these rehabilitation programs for individuals by prescribing and supervising physical therapy, occupational therapy, speech therapy,
rehabilitation nursing, and other allied health personnel contributing to the team. The physiatrist evaluates the patient, prescribes the medical management, and orders the physical restoration
program.

There are two common models for post-polio clinics led by physiatrists – the triage model, and the multidisciplinary model.

The Post-Polio Clinic at St. Mary's Medical Center (Clinic No. 4), San Francisco, CA, utilizes the rehab triage model. Patients are seen in the clinic initially by the physiatrist who formulates a working diagnostic impression and treatment plan based on the history and physical findings, as well as other available lab data provided by the referring physician. At that time the treatment plan may include additional diagnostic laboratory tests such as EMG or x-rays and may include additional consultation with other medical or surgical specialists to rule out other treatable diseases.

The polio survivor returns to the clinic for a second visit after having obtained the additional diagnostic tests and consultations, and a more definitive treatment plan is formulated and discussed with the polio survivor in order to meet his or her particular needs. It is at that time that orders are written and referral is made to a spectrum of treating therapists, including a physical therapist, occupational therapist, speech pathologist, rehab psychologist, and orthotist, depending on their particular needs. The patient then is scheduled to return to the outpatient rehabilitation center where he or she may be seen by one or more therapists for a customized treatment
program for flexibility exercises, non-fatiguing general conditioning exercises, pacing, training
in use of a new brace or orthosis, evaluation and measurement for a wheelchair, energy conservation in day-to-day activities, consideration for new adaptive equipment, psychological counseling, relaxation techniques, etc. Particularly difficult to manage functional problems may require a joint meeting between the attending physiatrist and the post-polio therapists.

Utilizing this model requires that a polio survivor return to the clinic on more than one occasion to
take advantage of the full array of services. Utilizing this model allows for shorter diagnostic and treatment sessions which are not so tiring for polio survivors. Additionally, they are not bombarded
with a lot of information from multiple individuals on one particular occasion, which polio survivors
have sometimes felt overwhelming and confusing. It allows for more of a customized treatment program as opposed to a one or two visit consultation with multiple disciplines, some of which may or may not necessarily be relevant for that particular polio survivor.

The Post-Polio Clinic at St. John's Mercy Medical Center (Clinic No. 28), St. Louis, MO, was established in 1987 using the multidisciplinary model.

The professionals are led by a physiatrist whose formal training is in physical medicine and rehabilitation.

The multidisciplinary treatment team also includes a physical therapist, occupational therapist, speech therapist, recreational therapist, rehabilitation psychologist, rehabilitation social worker, rehabilitation nurse, a dietitian, orthotist (brace fabricator), and a vocational counselor. There is access to specialists in pulmonary medicine, neurology, and orthopedic surgery.

The selected team members have developed special expertise to evaluate and treat individuals with post-polio syndrome. They are well versed in treatment techniques utilized in the past as well as newer protocols.

The individual completes a medical history information sheet prior to the initial evaluation. The
client is then seen by a physiatrist who will review the client's medical history and perform a thorough neurologic and musculoskeletal examination. When appropriate, further evaluations by the
above-men tioned treatment team will be arranged that day.

After the polio survivor has been through the appropriate evaluation and treatment program, the
clinic staff collaborates to ensure that all of the special needs of the client have been addressed. If
not, the coordinated treatment program is modified.

In one to two months, the individual returns for a follow-up physician appointment to assess the
success of the program and to make sure the client's perceived needs, and the needs perceived by the professional staff, have been met. If needed, further evaluation and treatment is prescribed.

Some post-polio clinics are also led by neurologists.

A neurologist is a doctor of medicine (MD) or a doctor of osteopathy (DO) who specializes in
diseases of the nervous system. Some neurologists subspecialize in neuromuscular diseases, which is a subspecialty of diseases of the peripheral nerves (nerves in the arms and legs), the neuromuscular junctions (the nerve muscle junction), and the muscles, which includes the problems of the post-polio patient. Through their specialized knowledge of neuromuscular diseases, electormyography (EMG), and neuro-rehabilitation, these neurologists are able to diagnose and treat conditions causing pain, weakness, numbness, and tingling.

Post-polio clinics directed by neurologists may also follow the triage or the multidisciplinary model.
At the SUNY Health Science Center at Syracuse, NY (Clinic No. 32), patients with the post-polio problem are treated by a triage team of professionals, including a neurologist, a nurse practitioner, and a physical therapist.

The initial evaluation includes a complete medical and neurological history and examination, and a
physical/occupational therapy evaluation if appropriate. Based upon the presumptive diagnosis,
patients will be sent for diagnostic testing. These diagnostic tests include blood tests, electromyograms (EMG), pulmonary function tests, swallowing tests, and various imaging modalities (X-rays, MRI, CT) as needed. This detailed evaluation is necessary, not only for treatment of post-polio syndrome but also to exclude other diseases that cause similar problems which may be contributing to dysfunction. The post-polio patient returns to the clinic for a follow-up visit after completion of testing for discussion of the diagnosis and formulation of the treatment plan. Additional referrals for social work evaluations and speech therapy assessments
as well as to a pulmonary specialist, an orthopedist, a neuropsychiatrist, or a nutritionist
may be necessary. Appropriate exercise techniques (non-fatiguing, conditioning, flexibility) and energy saving techniques are taught, lifestyle modification counseling is provided, and when necessary, brace and other ortho tic modifications are prescribed with referral to the orthotist. Patients are followed on a periodic basis to monitor strength and functional status, and to make treatment adjustments.

W. Clinton Maxwell, MD, Plano Rehab Hospital (Clinic No. 60) has available a videotape
in which he describes his clinical approach to the treatment of polio survivors. To purchase this
video tape (approximately $ 15.00), contact Dr. Maxwell at Plano Rehab Hospital, 2800 W. 15 th
St., Plano, TX 75075 (2141946-0666).

Lauro S. Halstead, MD, National Rehab Hospital (Clinic No. 8) described his approach in
Post-Polio Sequelae: Assessment and Differential Diagnosis for Post-Polio Syndrome, Orthopedics, Vol. 14, No. 11, November, 1991.

Post-Polio Directory - 1992 was published March 1, 1992 and lists the names, addresses, and phone numbers of clinics, health professionals, and support groups. It is available with an appendix of additions and corrections to polio survivors for $3.00 and to other interested individuals for $6.00. Canadian and overseas surface add $1.00. Overseas air add $2.00.

 

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