Library Collections: Document: Full Text


The Treatment Of Polio In The Convalescent Stage

Creator: John Ruhrah (author)
Date: September 1931
Publication: The Polio Chronicle
Source: Roosevelt Warm Springs Institute for Rehabilitation Archives

Next Page   All Pages 


Page 1:

1  

EDITOR'S NOTE -- The author of this article is a patient at the Georgia Warm Springs Foundation. Dr. Ruhrah, from Baltimore, Maryland, is a well-known pediatrician, past president American Pediatric Society, and the author of several medical texts, including "Poliomyelitis in all its Aspects." He contracted infantile paralysis in September, 1930, while on a trip to Europe.

2  

THE acute stage is generally reckoned to the end of the tenderness on touching unless this should be unduly pro- longed, as it is in some instances, and lasts through the period during which spontaneous improvement is supposed to take place; that is, for about two years. This is an important period, for in it the patient may be greatly helped or greatly harmed. The patient should be under medical supervision; and if there are state or city nurses visiting such cases, the patient should be on the list unless it is certain everything possible is being done, and there is a surprising and lamentable ignorance on this point. Many patients are neglected and horrible contractions and deformities result.

3  

When to get the patient out of bed is a question on which there are differences of opinion, and each case must be considered on its own merits. From four to eight weeks' complete rest in bed are ordinary periods. Then, if there is not too much paralysis, the patient may be lifted out of bed into a chair. The patient should never be allowed to fatigue itself. At first the periods out of bed should be short and gradually increased according to the gain in strength. This getting up, if properly supervised, allows the bed to be aired, improves the nutrition, helps the mental side and allows the patient to be in the fresh air and sunshine if circumstances permit. It also makes it easier for the patient to regain its balance if the legs are affected. It is always best to be on the safe side and proceed a little too slowly rather than a little too rapidly, but it should be remembered that mistakes may be made both ways and the patient kept in bed too long.

4  

In severely paralyzed patients the getting up is preceded by propping up in bed and later lifting them into a reclining chair -- preferably one whose back can be raised to any angle.

5  

Contractions are to be prevented from the outset by properly fitting casts or other appliances and by passive motions; that is, exercises done by the operator without effort on the part of the patient and also by stretching. Stretching is best done by an expert, as it is a matter requiring skill and knowledge. It hurts, but it hurts less the earlier it is done, and if neglected leads to deformities requiring operations or may be beyond remedial aid.

6  

The back should be remembered. Many times the legs are cared for and the arms neglected. Casts or corsets should be used if needed. Paralyzed arms should be kept from hanging down, as the constant stretching may destroy the shoulder muscles. In this aeroplane splints which keep the arm at right-angles to the body are usually employed.

7  

Preventing contractions usually prevents deformities. Toe drop, foot drop and back deformities are the commonest, but other varieties are only too frequent.

8  

If the legs are involved, the time for the patient to walk will usually be from six months to a year after the onset, and some physicians advise at least a year's rest. In cases where there is great loss of power, braces are generally required. The patient should be prepared for this by telling him it will take time and much patience lest discouragement prevent his best efforts. The technique of teaching walking will be the subject of a later special article.

9  

During all this period hydrotherapy, massage and passive exercises should be systematically carried out.

10  

Hot baths or the application of hot moist towels are useful for relieving tenderness and in rendering stretching more easy. Other forms of heat by electrical appliances may be used.

11  

Massage is most useful in preventing atrophy of the muscles by maintaining the nutrition during the periods of imposed rest. It increases the flow of blood to the part and stimulates growth. It is best given by experts; but if this is not possible, anyone of average intelligence may be taught sufficient to be useful. It is best done every other day at first and then daily, starting with a few minutes at a time and gradually lengthening the time until a half to three-quarters of an hour is used for the entire body. Do not fatigue the patient. It is better to err on the side of too little rather than too much. Warmth first and then massage is a good rule. and the parts should be covered and kept warm afterwards.

12  

Electricity is often advised; but has no advantage over massage and should never be used except by an expert. In the hands of the ignorant -- and but few are skilled in its application in treating these cases -- it is capable of producing much pain and doing harm.

13  

Muscle training is most important, but requires skilled operators. It may be given at home, but best results are obtained at some well-equipped institution. It is best given. in warm water because the body is lighter and movements which cannot be made in the air can be made in the water. This, too, will be the subject of a later article in this series.

Next Page

Pages:  1  2    All Pages