Polio Place

One excellent reason for seeing a PT in the absence of declining physical function is to undergo a well-rounded baseline evaluation against which future problems might be measured.

Individuals who have not experienced recent functional decline may seek the services of a PT so that they may be educated in ways to minimize the effects of their polio problems on their bodies. For example, a PT can set up a muscle-specific exercise program that can be used to normalize (to the extent that is possible) the biomechanic forces acting on the body. A PT can also serve to educate a person in lifestyle modifications that may make it easier for a person to function in daily life and may also help slow the progression of symptoms in the future. The PT may also recommend the use of certain appliances during activities of daily living (ADL) that might make it easier for a person to function.

Finally, the most common reason for polio survivors to seek the services of a PT is because they have noticed pain or functional decline in strength, flexibility, endurance, ability to walk, climb stairs, etc. Physicians must rule out the possibility that conditions other than polio are responsible for problems such as these. However, it is the PT who has special skills to implement programs to address the symptoms noted above.

How does one obtain access to a PT?
In some states, physical therapists are permitted to evaluate, or to evaluate and treat patients without referrals from physicians. In other states, referrals from physicians are required by law. In either case, almost always a referral from a physician to a physical therapist is needed for third party payers (insurance companies) to cover physical therapy services.

For people who live in relatively close proximity to one of the established post-polio clinics around the country, evaluation by a physician at one of these clinics is certainly ideal. A physician from one of these clinics can write a referral for physical therapy. However, if polio survivors do not live in close proximity to one of these established post-polio clinics or must wait a long time to obtain an appointment at such clinics, referrals to physical therapy in their own locale from their family physicians can certainly be appropriate.

Family physicians are sometimes hesitant to write physical therapy prescriptions because of lack of knowledge about polio or about specific instructions to write on the referral. However, all states accept simply-written referrals such as "physical therapy to evaluate and treat." A diagnosis must be written on the referral. If a physician feels comfortable making the diagnosis of the "late effects of polio," this should be written on the referral. Otherwise descriptive diagnoses such as, "postural dysfunction" "back pain," "gait disturbance," or "muscle weakness" may be listed.

Specialists such as physical medicine specialists, orthopedists or neurologists may prefer to write more specific instructions on the physical therapy referral. Hopefully, however, they have a good rapport with the PT with whom they are going to refer, and they will trust them enough to also write "evaluate and treat" on the referral in addition to their specific instructions. This allows the PT to use their expertise fully to address the patient's problems.

Choosing a PT
If you live near a physical therapist who is listed in the Post-Polio Directory published by International Polio Network (now Post-Polio Health International), of course attempting to obtain services from such a person would be optimal. If you do not live in close proximity to a PT listed in the Directory, I suggest that you look in The Yellow Pages, in a phone book under "PHYSICAL THERAPY," and call several offices in your area to determine if anyone is knowledgeable in any way about the late effects of polio. Most hospitals will also have the capacity to treat outpatients, and you may also consider calling a hospital physical therapy department.

If you are unable to find a physical therapist in your vicinity who has any knowledge of treatment of the late effects of polio, my next suggestion is that you inquire if there is anyone who is willing to learn about this problem. If you sense that a PT has a willingness to learn about the late effects of polio, share any polio-related information you have access to and share the information contained in this article with him/her.

Then request that an evaluation be conducted and a program implemented based on this or similar information. You may also direct PTs to an article in the October 1991 issue of Physical Therapy magazine by Elizabeth Dean, PT, entitled, "Clinical Decision Making in the Management of the Late Sequelae of Poliomyelitis."

Marianne T. Weiss, PT (deceased)