Polio Place

Sara Kraft, PT, DPT, NCS, ATP, Assistant Professor, Medical University of South Carolina, Division of Physical Therapy, College of Health Professions, kraftsv@musc.edu

Navigating the seating and mobility world can be daunting for many with post-polio syndrome. Issues with scoliosis, back pain and even pressure problems can be quite serious for the person living with post-polio. If using a wheelchair, the solutions can be manageable and more easily rectified by customizing seat cushions or wheelchair backrests.

For those who are still walking, the solutions may not be so clear-cut. Walking is an activity that many take for granted but is a vital component to both quality of life and health. When problems such as scoliosis, back pain or pressure problems arise many people with post-polio are left with few choices that do not involve wheeled mobility. There are, however, options for these problems which may allow people to keep walking while avoiding secondary complications.

Pressure Problems
Let’s start with the pressure problems. The same cushions that are used in wheelchairs can often be used in regular chairs. These cushions can more evenly distribute pressure as well as provide pelvic support. Cushions come in a variety of materials including air, gel, fluid, foam or any combination of materials and have properties that are more effective at reducing pressure or providing pelvic support. A trained seating and mobility specialist can assist with the selection of the most appropriate cushion depending on the specific needs of that individual.

The Backrest Dilemma
The backrest dilemma is a more difficult one to address. Upright sitting is important for many reasons ranging from social to medical. Scoliosis can lead to problems with swallowing and breathing if left unchecked. Backrests designed for wheelchairs have many options for providing lateral trunk support to help maintain the most upright and midline posture possible. Unfortunately, unlike wheelchair cushions, fitting these back-rests onto everyday chairs is not easy due to the hardware and mounting requirements. Commercial lumbar supports do not provide adequate lateral trunk support although they can be helpful to prevent or reduce low back pain, and they can be attached to any chair.

Funding and Access
Funding and access must also be considered. Unfortunately, neither cushions nor backrests are covered by insurance unless they are being ordered for a wheel-chair. The average cost of cushions ranges from $300 to $500 and backrests from $300 to $600. The cost can be self-limiting depending on the person’s resources.

Access, however, in the form of an evaluation by a seating and mobility specialist is covered by insurance. People who are having postural or pressure difficulties should seek the help of a seating and mobility specialist to problem solve their unique case. This may entail modifying their everyday seating systems including office chairs, home chairs, etc., or recom-mending customized cushions that will help with their issues.

Both physical and occupational therapists can be trained as seating and mobility specialists. The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) tests and certifies health professionals as assistive technology professionals (ATP). Seeking such qualified and certified health professionals is an important first step in determining solutions to the seating and mobility conundrum faced by people.