Polio Place

WHO ESTABLISHES THE POST-POLIO CLINICS IN THE STATES AND HOW ARE THEY ORGANIZED?

Joan L. Headley, MS, Executive Director

To establish a post-polio clinic, a need has to be perceived for such a clinic. This need may be generated by the medical community, but more likely the catalyst will come from the demands of the post-polio population, in particular, the support groups. A post-polio clinic can be organized if the appropriate expertise exists in the community. A good resource is a rehabilitation center which has a full complement of professionals able to meet the various aspects of the post-polio survivors' special needs in a coordinated fashion.

The professionals should be led by a physician specially trained to meet the needs of individuals with physical disabilities. A physiatrist, whose formal training is a residency program in physical medicine and rehabilitation, is superbly qualified. (There are other medical disciplines who also have developed a special interest and expertise in helping polio survivors, most notably neurologists.)

The multidisciplinary treatment team should also include 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 should be access to specialists in pulmonary medicine, neurology and orthopedic surgery.

One person in the rehabilitation center should be designated to coordinate the clinic program. His or her responsibility is to assemble the many medical professionals described above who will dedicate part of their practice to the syndrome by examining the literature, attending seminars and conferences, and/or by visiting an established post-polio clinic. (Consult the Post-Polio Directory or contact info@post-polio.org.) The team members will need to be well versed in treatment techniques utilized in the past as well as newer protocols for the polio survivor.

Preliminary planning meetings of all disciplines are essential to:

• define roles,
   
• establish goals,
   
• determine treatment approaches, and
   
• evaluate outcomes.

In many post-polio clinics, the client completes a medical history information sheet prior to the initial evaluation. The client is then seen by a physiatrist who reviews the client's medical history and perform a thorough neurologic and musculoskeletal examination. When appropriate, further evaluations by the treatment team will be arranged.

One member of the treatment team, a physical therapist (PT), measures range of motion, strength and assesses mobility status. Based on the outcome of this evaluation, an individualized treatment is established to maintain or increase strength, to improve range of motion, to relieve pain, and to maximize mobility skills. An assessment may also be made to determine the need for ambulatory aids.

An occupational therapist (OT) evaluates daily living skills including an assessment of self-care and home management capabilities. This treatment may include instruction in energy conservation techniques and work simplification, as well as suggestions for adaptive techniques and equipment to maximize the individual's participation in home and work activities.

A speech therapist assesses any speech or swallowing difficulties, and therapy is developed to maximize communication and safe swallowing skills.

A clinical rehabilitation psychologist provides individual and family counseling. The primary focus of counseling is to identify coping styles and to assist in learning to adjust to necessary lifestyle changes. Nutritional counseling is provided to assist persons requiring therapeutic or weight-reduction diets.

A recreational therapist assists clients in maximizing their recreational and leisure skills.

A rehabilitation nurse makes home visits and offers suggestions to make a client's home as accessible and functional as possible.

A rehabilitation social worker informs clients of the community resources available to them. When appropriate, the state department of vocational rehabilitation (VR) is contacted to provide vocational counseling including work evaluation. VR can facilitate appropriate job training to assist a client to return to his or her former job, even if adaptive equipment is necessary. Alternate job training and placement also may be arranged.

An orthotist works with the rehabilitation physician and the therapists to repair or modify older orthoses. In addition, the orthotist may fabricate new custom upper extremity, lower extremity, or spinal orthoses, often using the latest lightweight plastics to maximize function, attractiveness and comfort.

After the client has been through the appropriate evaluation and treatment program, the clinic staff will collaborate to ensure that all of the special needs of the client have been addressed. If not, the coordinated treatment program will be modified. The client will usually return for a follow-up physician appointment in one to two months to assess the success of the program and to make sure the client's perceived needs and the needs perceived by the professional staff has been met. If needed, further evaluation and treatment is then prescribed.

Many times the initial evaluation is done on a Monday so individuals traveling long distances have the opportunity to travel over the weekend. Some arrange for overnight stays at a minimal cost. With an out-of-town client an attempt is made to do the entire evaluation in one or two days with rest periods provided. For clients who are within driving distance of the medical center, the various professional appointments are set up over several days to minimize fatigue.

Some clinics encourage their clients to join a local post-polio support group as peer interaction and support is an important complement to a medical treatment program. Many medical centers encourage their clinic personnel to give lectures and to lead discussions at support group meetings in the surrounding area. The education of the client is a key part of any clinic, and handouts have been developed explaining work simplification, energy conservation, home exercise programs, and describing durable medical equipment options with sources of supply. Other appropriate handouts to meet any special need of the client may also be available. Some clinics provide theHandbook on the Late Effects of Poliomyelitis for Physicians and Survivorsboth to the client and, if appropriate, to their primary care physician.

Their reimbursement for services is a billable item to the insurance companies within the guidelines of the client's policy. The ever-changing climate in Medicare, Medicaid, and various insurers continues to be a challenge for the consumer, physician, therapist, and the hospital. In order to receive the entitled benefits, consumers should be very familiar with their coverage.

©Post-Polio Health (ISSN 1066-5331), Vol. 5, No. 2, Spring 1989

Post-Polio Health International distributed this survey - "Post-Polio Medical Care: Post-Polio Specialist and Primary Care Physicians" - to its Membership and the community in mid-2014. The Results and Observations were published in the Fall of 2014.