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ABSTRACT
Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.
A significant percentage of the 1,6 million, polio survivors in this country bave developed postpolio sequelae (PPS) - new muscle weakness, pain, excessive fatigue, and respiratory difficulties - that interfere with activities of daily living. Areas frequently affected are mobility, hranemakiDg, driving, bathing, dressing, eating and/or swallowing, and bladder or bowel function.1-3
Because the etiology of PPS is thought to be the overworking of polio-damaged nerves, individuals who develop symptoms are usually advised by physicians and occupational and physical therapists to make significant lifestyle changes to prevent a further decline in functionChanges may include rest periods, work simplification, energy conservation, modification of the work and home environments, the use of orthoses, adaptive equipment, or mobility aids, and may even encompass changing jobs or terminating employment.2,4-7
This therapeutic regimen is not acceptable to most polio survivors, because they equate success víith discarding assistile devices and doing all of the activities that other people do-8 However, the current physical problems that affect this group necessitate learning new coping styles that are totally at variance with those learned during their initial rehabilitation. The prevailing ideology in the treatment of acute polio stressed intense physical effort while ignoring pain and fatigue to achieve independence without the use of mechanical assistance.9 "Persistence in strenuous activity was the great rehabilitation virtue and the pursuit of ambulation second only to the quest for the Holy Grail."10
Because occupational therapy addresses problems in daily living, occupational therapists throughout the country are increasingly being called on to...