Polio Place

Any person who has a disability uses more energy than a nondisabled person to perform basic activities of daily living (ADL), because tasks are often performed using movement patterns that are not meant to be used. The process of using relatively nondisabled body parts to compensate for muscles that are weak or paralyzed saps energy. If a polio survivor attempts to perform activities after energy is depleted, the result can be pain, feelings of fatigue, and inability to carry out activities. Therefore, conserving energy is vital. The concepts which follow are basic to conserving energy.

Establish limits. Individuals should learn the limits of their personal endurance and tolerance for activity. Therapists and physicians often suggest using the “one-to-ten pain scale” to identify pain, with “one” equivalent to a bruise and “ten” as people imagine surgery without anesthesia. Using this scale, polio survivors should establish their baseline levels of pain. Any time pain rises more than one point over baseline during the performance of ADL, individuals should stop the activity and rest until the pain returns to baseline.

Rest, however, is relative. For some, all that is required after a certain amount of activity is to sit and take a five-minute “breather” in a comfortable chair. Performance of the same activity for others might necessitate a half-hour nap.

Other signals the body sends to indicate that a task is too strenuous include: a sense that the task requires more than mild to moderate effort; twitching of muscles, feeling of weakness or fatigue in muscles during or after the task, and inability of muscles to perform in their customary manner during or after the task; and shortness of breath. Recognizing these signals and stopping the activity to rest helps to avoid pain and fatigue (see Pacing). If these symptoms do not resolve quickly, seek medical assistance.

Be selective. Survivors should review their schedule each week and plan their activities, attempting to space them out through the week. Individuals who are still working may have to limit their non-working activities. It is important to balance rest/relaxation with mandatory activity. Working polio survivors should not eliminate leisure activities, but they should choose those that use different muscles than those required by their work.

Working from anatomic position uses the least energy. Maintenance of standard posture puts the body in correct anatomic position. The components of anatomic position are head in midline with ears lined up over the shoulders, shoulders relaxed and lined up over the hips, trunk in midline over the pelvis, arms relaxed at sides, slight low back curve and slight neck curve, and stomach tucked. When standing, anatomic position also includes: hips over ankles, buttocks tucked, legs lightly tensed without locking of knees, and feet two to four inches apart.

The results of trying to accomplish tasks for more than one minute if the body is not in anatomic position are excessive energy use, bodily malfunction, and pain. With weak or tight muscles and/or joint deformities, it is difficult for polio survivors to achieve anatomic position. The goal is to use a position as near as possible to anatomic position to accomplish any physical task – even a resting task, such as sleeping.

While seated or lying in bed, energy expenditure can be reduced by using pillows, molded seats, and cushions to help achieve anatomic position. Also, the bracing/splinting of weak muscles in the arms, legs, or back significantly reduces the energy required from a given set of muscles. However, there are limits to the benefits of braces and splints when used in the standing position. Additional assistive devices such as canes, crutches, or walkers may be needed, and in some cases of significant weakness, the use of powered wheelchairs or scooters may be necessary to effectively reduce energy expenditure to make a difference in the quality of life.

Moving with economy uses less energy. If possible, use the proper muscle for the job. Survivors should use the large muscles of the shoulders, upper arms, buttocks, abdomen, and thighs to perform the activities of daily living and should not use the small muscles of the neck, back, wrists, hands, feet, and ankles. For example, when closing the lid of a stiff cardboard box, use pressure from the palms of the hands instead of the finger tips.

The 15-minute rule suggests that individuals choose four activities that they wish to accomplish in a two- or four-hour period in the day. It is recommended that a variety of activities be chosen, so that no one set of muscles is overworked. Then the individual should rotate among the four activities every 15 minutes including a rest period each hour or half-hour. Survivors should customize this plan based on their ability.

To limit carrying, a good rule of thumb is to avoid carrying anything that weighs more than one pound for a distance of more than ten feet or for longer than one minute. To adhere to this rule, survivors should use dollies, rolling carts, or assistance from others.

Excerpt from PHI's "Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors." © 1999