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POLIO NE71'mK IT--- 13 International Polio Network nter 1993 + Vol. 9,No. 1 - b. - Becoming an Intelligent One Year without Consumer of Physical Polio in the Region Therapy Services of the Americas Marianne T. Weiss, P.T. August 23,1992 marked the first year that the Region of the Americas has been free OJ wild polio- In the nearly ten years that I have been treating polio virus. The last detected case occurrcd inJut~in,Perm survivors, 1 have found that the people who come to on August 23,1991. my door for assistance usually fall into one of two This achievement has been possible thanks to tlie categories. Some of these people have not had contact eradication campaign launched by the Director of with a physical therapist (ET.) since their acute phase the Pan American Health Organization (PAHO) , of polio. Others have become frustrated and often Dr. Carlyle Guerra de Macedo, in May of 1985. The seriously depressed after seeing several ET.'s and sev- principal strategies used were the National Vaccina- eral physicians prior to coming to see me. They could tion Days with applications of poliomyelitis' oral not find someone knowledgeable about the late effects vaccine and the intensified surveillance of reported of polio and how physical therapy can adequately cases of flaccid paralysis. These efforts succeeded in assist survivors in coping with these late effects. reducing the number of polio cases caused by wild It is my hope in this document to provide a two- virus from approximately 1,000 reported cases in fold service: 1986 to nine in 1991 (eight in Colombia and one in + 1 wish to describe the evaluation and treatment Peru). Since the virus was isolated from the Peruvian that a knowledgeable, skilled ET. should be able case, no other wild virus has been isolated in the to provide a polio survivor. By so doing, I hope to Region (Figure 1). significantly reduce the frequency with which polio survivors are turned away from physical therapy Flgute 3. Confirmed cases of polio in the clinics with the statement, "There's nothing we can Region of the Americas, I9861992 do for you. " CASES 4 I would also like to give encouragement to sllrvivors who have not yet found a ET. who has been 1200 (q3l knowledgeable about meeting their needs. Hopefully you can go armed with the data in [his article to request that certain services be performed. Certainly many health professionals other than F?T.'s can help to lessen the impact of the late effects or polio. In some cases, the services of other professionals overlap those of the ET. However, in this paper I will confine my comments primarily to P.T. services. This paper is based on principles in the resources * Information for 1992 through week 34 ** Source: PESWAIIO listed on the accompanying bibliography* Some of the following concepts listed under "STRENGTHS" At the inception of the Expanded Progra111on are derived from my own experience in treating Immunization in 1978, less tl~an25% of the childl-cn polio survivors. in the Region of the Americas were vaccinated against the principal childhood diseases (polio, measles, diphtheria, tetanus, pertussis, and tuberculosis). Ry *The bibliography will be made available 1991, the overall coverage extended to over 75% ~ol in the next Polio Network News. the population under one year of age.

Continued on page 2 Cor~tinueilon page 6 Becoming an Intelllgent Consumer own locale from their family physicians can certainly Continued from page 1 be appropriate. Family physicians are sometimes hesitant to write physical therapy prescriptions because of lack of should you consider knowledge about polio or about specific instructions Why to write on the referral. However, all states accept seeing a EX? simply-written referrals such as "physical therapy to evaluate and treat." A diagnosis must be written on + One excellent reason for seeing a ET. in the the referral. If a physician feels comfortable making absence of declining physical function is to undergo the diagnosis of the "late effects of polio," this should a well-rounded baseline evaluation against which be written on the referral. Otherwise descriptive future problems might be measured. diagnoses such as, "postural dysfunction," "back + Individuals who have not experienced recent func- pain," "gait disturbance," or "muscle weakness" tional decline may seek the services of a ET., so that may be listed. they may be educated in ways to minimize the effects Specialists such as physical medicine specialists, of their polio problems on their bodies. For example, orthopedists, or neurologists may prefer to write more a ET. can set up a muscle-specific exercise program specific instructions on the physical therapy referral. that can be used to normalize (to the extent that is Hopefully, however, they have a good rapport with the possible) the biomechanic forces acting on the body PI. with whom they are going to refer, and they will A PT. can also serve to educate a person in lifestyle trust them enough to also write "evaluate and treat" modifications that may make it easier for a person to on the referral in addition to their specific instiuc- function in daily life and may also help slow the pro- tions. This allows the ET. to use hisher expertise fully gression of symptoms in the future. The PT. may also to address the patient's problems. recommend the use of certain appliances during activities of daily living (A.D.L.) that might make it easier for a person to function. + Finally, the most common reason for polio survivors to seek the services of a PT. is because they If you live near a physical therapist who is listed have noticed pain or functional decline in strength, in the directory published by International Polio flexibility, endurance, ability to walk, climb stairs, etc. Network, of course attempting to obtain services Physiciails must rule out the possibility that condi- from such a person would be optimal. If you do not tioils other than pc3lio are responsible for problems live in close proximity to a P.T. listed in thc directory, such as these. However, it is the PT. who has special I suggest that you look in the Yellow Pagcs in a phone skills to implement programs to address the symp- book under "PHYSICAL THERAPY" and call scveral toms noted above. offices in your area to determine if anyone is knowledgeable in any way about the late effects of pt)lio. Most hospitals will also have the capacity to trefit out- does one obtain patients, and you may also consider calling n hospital How physical therapy department. access to a EX? If you are unable to find a physical therapist in your In somc states, physical therapists are permitted to vicinity who has any knowledge of treatment ol the evaluate, or to evaluate and treat patients without late effects of polio, my next suggestion is that you rrferrals from physicians. In other states, referrals inquire if there is anyone who is willing to leal-11about from physicians are required by law. In either case, this problem. If you sense that a PT. has a willingness alillost always a referral from a physician to a physical to learn about the late effects of polio, share any therapist is needed for third party payers (insurance polio-related information you have access to and compailies) to cover physical therapy services. share the information contained in this article with himher. Then request that an evaluation be conduct- For people who live in relatively close proximity to ed and a program implemented based on this or simi- of onc the established post-polio clinics around the lar information. You may also direct PT.5 to an article cotuntl.): evaluation by a physician at one of these clin- in the October, 1991, issue of Pltysicnl Therapy maga- ics is certainly ideal. A physician from one of these zine by Elizabeth Dean, ET., entitled, "Clinical clinics can write a referral for physical therapy Decision Making in the Management of the Late However, if polio survivors do not live in close prox- Sequelae of Poliomyelitis." imity to one of these established post-polio clinics or must wait a long time to obtain an appointment at such clinics, referrals to physical therapy in their

Winter 1993 Vol 9,No. 1 0 Polio Network News Keasonable Expectations What should you exp,ect in a Nearly every polio survivor comes to health care physical therapy evaluation, providers initially with the hope - whether clearly and how should the results be evident or secretly buried - that someone will be able to "make me as I was." Because of this hope, incorporated into treatment? some survivors are initially reluctant to hear about suggestions a P.T. may make regarding lifestyle + COMPREHENSIVENESS modifications, equipment options, etc. Often, polio In physical therapy school, students are taught all survivors consider accepting changes such as these the components of the following type of evaluation. as an act of "giving up." They are instructed to complete all of the components I would encourage su~vorsto consider that the only of the following evaluation on any body part that is true act of "giving up" is refusing to participate in affected by problems that the patient is being sent to activities and retreating from society Any suggestions physical therapy for. for changes in lifestyle or use of equipment should be Because polio is a systemic disease that initially viewed as suggestions for how to uget on with life," invades the body from head to toe, polio survivors are and survivors should attempt to look at these sugges- at risk for dysfunction of multiple body parts. There- tions as a means of continuing their participation in fore it follows that all these components of a physical society to the fullest extent possible. therapy evaluation should be performed on all body Reasonable goals that may be possible to achieve via parts for polio survivors. Comprehensive evaluations physical therapy intervention can include the follow- of this type can take as long as three to four hours ing. However, the survivor and PT. should work Continued on pitge 4 together to choose which goals should be worked on at ally given time. + pain reduction International Polio Network + edema reduction + improved skin integrity 5100 Oakland Avenue, #206 + improved endurance for activity St. Louis. MO 63110-1406 U.S.A. 3141534-0475 + iinproved flexibility 314/534-5070 Fax ISSN 1066-5331 + improved ability to move in bedltransfer + stabilization of balancdgait Polio Network News is an interttntiot~nlnewsletter + possible reduction of rate of strength loss and for polio survivors, support groups, yl~ysicians,healtl~ improvctl ability to use existing strength professionals, and resource centers, to exchange injor- Polio survivors should recognize that their bodies mation, encourage researcl~,and promote tlelworking may be especially sensitive to even subtle changes. among the post-polio comtnutlit.y. Sometimes small interventions may result in huge ISSUED QUARTERLY positivc benefits. For example, the provision of l/+-inch internal heel lift in one shoe may be enough EDITORIEXECUTIVE DIRECTOR +Joan Headlcy to greatly minimize low back pain. SPECIAL THANKS +Joseph B. Leone, hfari:tnne Wciss, I'.T., and Elibeth Reeves Other times small interventions may result in negative PUBLISHER + Gazette International Networking Institute ontcolues. For example, if the therapist would recom- (G.I.N.I.), 5100 Oakland Ave., #206. St. I-orris, MO 63110-1406 mend ~rovidinga low back support to stabilize the U.S.A., 314/534-0475 pelvis and minimize back pain, the patient's ability to use tlie pelvis to assist with certain phases of the ANNUAL SUBSCRIPTION: walking cycle might be impaired. Therefore, the U.S.A 4 Individual Consumer $1 Z; Health Professional. Aflilinted survivor must be able to communicate fully any Individual, Organization, Institution $20 (u.s.do~hrs only) negative results that occur when interveiitions are CANADA, MEXICO & OVERSEAS (Surface) + Individual implemented. Consumer $16; Health Professional, Affiliated Individual, Organization. institution $24 (u.S. dollnrs only) What is the moral of this story? Survivors should OVERSEAS (Air) + Individual Co~~sumerS2O; Health Professional, attempt to be flexible and should attempt to look Affiliated Individual, Organization, Institt~tion$28 (1.1,s.~OILWS OI,I\.) upon recommendations made with an open mind. However, survivors should also recognize- that several Copyright 01993 by Gazette International Networking h.;tirr~te interventions may need to be tried before one might Permission to reprint portions nlust be obtuinedfrom the Editor. be found that is beneficial.

Winter 1993 + Vol 9, No. 1 Q Polio Network News Becoming an lntelllgent Consumer Does the survivor use any special equipment? Co~~~inucdfrom page 3 (i.e., braces, crutches, canes, wheelchairs, feeding devices, breathing devices, etc.) Have these devices changed in recent years? Are there any problems spread out over three to four visits. (I am aware that using the current equipment? some PT. departments are not set up to allow this much time per patient. This may be another factor in 4 CARDIOPULMONARY your decision as to which PT. to choose.) EVALUATION. The components of a basic cardiopulmonary evaluation should be under consideration Most polio survivors envision that certain of their throughout the physical assessment. The survivor's body parts were minimally or not at all affected by resting blood pressure, heart rate, and respiratory rate polio. However, I think it is very helpful to survivors should be evaluated. Some description should be when a PT. can evaluate the whole body and possibly made of the survivor's ability to adequately o-xygenate con firnl that certain body parts were relatively spared each lung lobe and of the survivor's ability to cough fro111 dysfunction. Conversely, the PT. may point out and breathe deeply. I11 conjunction with coughing and to sllrvivors that certain body parts have been affected deep breathing, a description of the use of abdominal perhaps more than they thought. If this is the case, muscles and chest muscles for forces sl~ouldhe mcasures can be taken to minimize the effect of included. The P.T. should also describe any abnormal abnormalities. use of the neck or chest muscles for breathing purposes. After an evaluation such as that described below, the During the rest of the physical evaluation, rcpcat P.T. should sit down with the survivor (and family or measurements of the resting heart rate, bloocl pres- otller significant people, if the survivor so desires) to sures, and respiratory rate and quality should be peri- explain the results. A thorough explanation with a odically recorded to let the therapist, survivor, and prc>pc)saIof treatment options can take up to an hour. attending physician know how the survivor resl~onds Tlle survivor and others in attendance should be to mild activity such as is conductcd during a encournged to ask questions they may have regarding physical assessment. the results and the proposed treatment options. The s~~rvivorshould then decide which option to pursue. Some PT.3 have the kincl of cquipincllt to give thc survivor a modified aerobic exercise tcst using 3 uead- The therapist should compose a report detailing the mill or a stationary arm or leg cycle. (Of courw, if thc specifics of the evaluation and the therapist's recom- survivor has a l~istoryof heal t or lung diseasc, it is ilot illendations for approval by the referring physician. wise to do a test of this lund without proper c.11 dio- Thc therapist should work in conjunction with the pulmonary nlonitoring in an olficc with access to physician to implement a program based on the a physician.) An eight- to 12-minute tcst of tllis type results of the evaluation. may be performed to determine how the survivor + INTERVIEW PRIOR TO PHYSICAL responds to this kind of inore vigorous, srlstainetl ASSESSMENT activity, as compared to the iuterluittcnt, lower-level What is the survivor's complete medical history? activity performed in the resL of the evaluation. What is the survivor's vocational social history? A word of caution here is that perfomling a sustained aerobic activity before knowing the survivor's true What is thc survivor's perception of function in each strength as noted below under "STRENGTH TEST- major body part? ING" could be hazardous. Survivors can overcsert Has any decline of function occurred in recent years? themselves in the cardiopulmonary tcsting and suffer Are there symptomatic areas of pain? pain, muscle tremors, or temporarily incrensccl inuscle Are there body parts at circulatory risk, i.e., is there weakness as a result afterwards. cold intolerance, presence of swelling, discoloration of skin, etc.? TREATMENT. If cardiopulnlonary abnormalities are found in the evaluation, vital signs sho~~ldbe Are there any problems with sleeping? monitored during any treatment involving exercise. Are there any problems with breathing or swallowing? Almost all polio survivors will show a generalized What activities are common for the survivor on a deconditioned cardiopulmonary response to exercise. regular basis? They can benefit from instruction in work simplifica- How is endurance for activities? tion techniques, energy conservation techniques, body mechanics, etc., to reduce their daily cardio- How accessible is the survivor's home? pulmonary demands. How are the survivor's abilities to move in bed, get up and down from a chair, or to walk? All polio survivors, even in the absence of true lung function impairment, can benefit froin instruction in abdominal-diaphragmaticancl scgmental breathing.

Winter 1993 + Vol 9, No. 1 8 Polio Network News Many survivors have trunk abdominal weakness that Florence Kendall refers to as "stretch weakness." This, results in binding down of the soft tissues of the body too, makes it difficult to use the available strength. making it difficult to move the chest wall well during In general, 1 have always used the "normal" values as breathing. Proper breathing techniques can help a firm target to shoot for in most people to assure as address these problems. Survivors who have postural normal a biomechanic force at a joint as possihle. problems that impair oxygen flow will also be helped Surgeries, arthritis, or bony defonilities inay impair by using these techniques. Finally, normalizing respi- a person's ability to achieve "nonnal" ROM. Howcver rations is known to reflexively activate the part of the a good passive stretching program performed by a nervous system that promotes bodily relaxation. friend or fadymember goes a long way toward ~nin- Of course, for survivors who do have true respiratory imizing pain and normalizing movement patterns. impairment, learning all the above can be potentially Self-stretching is usually difficult to perform cluc to life-saving or life-prolonging. These survivors should pain, weakness, and substitution patterns. also learn assisted coughing techniques. In certain cases amongst polio survivors, some degree 4 FLEXIBILITY TESTING of "tightness" in certain muscles may assist function. For example, in a patient with weak forearm and EVALUATION. Flexibility testing refers to how finger muscles, a certain degree of tightness selective- far into n given movement a person can move a body ly permitted in these muscle groups can allow the part. 111 medical jargon, this is referred to as range of patient to have the appearance of more "strength" 111otion (ROM). ROM tests should be performed of than he/she would otherwise have. Another example all joints in all places. These measurements should be might be if a patient has weak knee extensor muscles taken accurately with an instrument called a gonio- and weak buttock muscles, a certain amount of tight- meter, which is a standard piece of equipment in all ness in the inner aspect of the thigh may make it casi- physical therapy departments. (A goniometer is a er for the patient to use the available strength in tile device similar to a protractor with arms on it that can thigh. However, these examples are quite variable and measure precisely in degrees, the amount of move- extremely dependent on all the symptoms that prc- ment present at any joint in any plane.) Simply sent in a given patient. Only a well-trained thcrapist "eyeballing" the available movement at the joints is can discern, in conjunction with the patient's physi- not acceptable. cian, if certain areas of selected tightness might be There are many texts that cite "normal" values for adaptive for a particular person. ROM at each joint in all planes. These various sources T. disagree on what "normal" is. PT.5 should define The conclusion of this article by Mnriarii~c Wciss, P.T. will be published in Vol. 9, No. 2. Polio Network Netus. whatever values they have chosen to use as represen- tative of "nonnal," in light of whether or not the choscn values are at the upper end or at the lower end of those noted in the available resources. I11 interpreting ROM values, the PT. should show Medigap Policy Choices survivors a ratio of their values over the value that the therapist is considering normal. For example, if the New Federal Medigap policy reqi~irernentshccan~e norn~alROM that the PT. is considering for straight effective July 30, 1992. As a result, Mcdicart's 35.5 leg raising is 80 degrees and the survivor's ROM is million beneficiaries may choose to supplement thcir 60 degrees, the ROM should be expressed at 60/80. Medicare insurance with one of the newly nvailallc This is helpful so that both the survivor and the Medigap policies with standardized benefits and simpli- therapist are aware that the survivor has a 25% deficit fied wording. Under the new requirements, every iu flexibility Medigap policy must offer basic benefits. The new Inw does not require that beneficiaries buy one of the stan- TREATMENT. The importance of adequate flex- dardized polices. If you have a policy you'rc satisfied bility in all patients, but especially in polio survivors, with, and it is guaranteed rcnewa1.)le,there is no nced cannot be overstressccl. It is well-documented by peo- to change. ple active ill the acute phase of polio treatment during More information about thc new stantlartlized plans is the epidemics earlier in this century (Sister Kenny available in the HCFA-NAIC publication, Guide to and current lecturer Dr. Thomas I? Anderson, for Health Insurance for People wit11 Medicarc. Singlc copics example), that muscles affected by polio easily may be ordered free of charge from the Consurncr become "stiff ," and must undergo continual stretching Information Center, Pueblo, Colorado 81009. Spcciry to maintain adequate flexibility Without adequate the title and publication nurliber 51 8-Y. flexibility, it becomes very difficult for a person to use whatever strength is available in that body part. Poor flexibility can also cause pain and deformity. Too much flexibility on the other hand can cause what

Winter 1993 + Vol 9, No. 1 @ Polio Network News One Year wlthout Polio of religious groups who have direct or indirect contact Continued from page 1 with members of Dutch religious groups among whom poliovirus is circulating. The task was made possible thanks to the joint back- UPDATE. The outbreak in the Netherlands of ing of various collaborating agencies, at a cost of poliomyelitis among unvaccinated persons who are approximately 542 million dollars (US). The govern- members of religious groups that generally do not ments from the countries have provided around accept vaccination is continued (1).From September 430 million and the rest has come from the collaborat- 17 through December 5,1992, 54 cases of ing agencies that include the Agency for International poliomyelitis were reported to the Netherlands' Office Development from the Government of the United of the Chief Medical Officer of Health. All of the States (USAID), Rotary International, UNICEF, the reported cases have occurred among unvaccinated hiter-American Development Bank (IDB) and the (n=53) or inadequately vaccinated (n=l) persons Canadian Public Health Agency (CPHA). belonging to a religious denomination that routinely does not accept vaccination. Patients range in age In addition to the national vaccination days, mass from <1month to 56 years (mean age: 18.5) year). Of communication was used extensively to inform the the 12 provinces in the Netherlands, seven have public and mobilize the population. Also, a laboratory reported cases of poliomyelitis; the most scverely network was used for diagnostic support. PAHO has affected provinces are South Holland and Geldcrland. established an impressive surveillance system of acute flaccid paralysis that includes more than 20,000 The risk for acquiring poliomyclitis while in the hralth units that report cases on a weekly basis. Netherlands is considered small because of the excellent sanitation in the country ant1 because transmis- The challenge now is to maintain the impetus by sion of the poliovirus has been limited primarily to increasing the vaccination coverage, consolidating the unvaccinated religious groups. Nonetheless, the polio gains made in eradication and achieving control and immunity of travelers to the Netherlands should be elimination of other childhood diseases, PAHO has evaluated, and persons with inadequate protection named a Poliomyelitis Eradication International should complete a primary vaccination series with Certification Commission that will verify the interrup- three doses of poliovirus vaccine before departure, tion of wild poliovirus transmission. It is estimated especially if extensive travel in the Netherlands or that the Commission will conclude its work in 1995. contact with persons in the affected religious groups In the meantime, high levels of coverage and surveil- is anticipated. lance should be maintained and three years should pass by without confirmed cases of polio before the Source: Morbidity and Mortality Weekly, 1992;41:775-8; Region of the Americas can be certified as free of 41:917-9. wild poliovirus. One of those three years has already passcd; PAHO will continue the effort and writc history! Source: EPI newsletter, Expanded Program on Immunila- Polio in the U.S. 1992. tion in the Americas, Vol. XIV, No. 4, August, No cases of s~tspectedpolio~nyolitis have bvei~ Editor's Note: The last wild poliovirus detected In the reported in 1993. Four cases of susyectetl polio- Americas to date was on September 5,1991,still over a year ago. myelitis have been reported in 1992; 6 of the 9 suspected cases with ottset in 1991 were collpinned, and 5 of the 8 suspected cases with onset in 1990 were confirmed; all were vaccine associated Polio Outbreak THE U.S. VACCINE DISTRIBUTION DEBATE In September 1992, the Netherlands reported an Fewer than 60% of U.S. children are properly immu- outbrealt of polio among members of a religious nized by age two. Federal health objectives for the group that refuses itnmunization services. year 2,000 say 90% should be vaccinated. Some blame rising vaccine costs and propose a Since this religious group also exists throughout the national vaccine program with a single, government Americas and its members frequently travel back and purchaser. It would reduce costs to private physicians. forth, couilmes of the Western Hemisphere are on Currently half the children who receive vaccination alert for importations. Attempts to educate and immu- get them from private physicians who pay manufac- nize ~nembersof this religious group are being made. turers' catalog prices, or get small discounts. The The 1979 outbreak in the United States and Canada other half are vaccinated in public clinics that receive clearly illustrated the risk for unvacchiated members substantial discounts through a Centers for Disease

Winter 1993 + Vol 9, No. 1 @ Polio Network News Control and Prevention grants program. (The oral polio price through the grant program is $2.09 per dose; manufacturers' catalog price is $9.91). Physicians and child advocates argue that lower costs would improve access and boost immunization rates. The drug industry counters that forced discounts would curtail research and development and low costs do not always yield higher vaccination levels. International, Inc. The government is investigating. Geoffrey Waters Source: Extracted from American Medical News, 655 Aspen Ridge Drive + Lafayette, CO 80026-9341 January 18, 1993. 3031666-9234 4 FAX 3031666-041 5 LIFECARE Europe GmbH, Downey Wright, RRT Postfach 20, Hauptstrasse 60, D-8031 Seefeld 2, Germany Accessible Worship 49/81 52-70728 + FAX4918152-781 99 U.S. DISTRICT OFFICES Phone: 8001669-9234 Elizabeth Reeves, Chicago, IL

Some people take going to churchfor granted Atlanta, Kathy Westerman, Los Angeles, Mark Hicks, RRT Howevev, if you have a disability, this simple activity CRRT 8210 Katella Ave., #B 2220 Northwest Pkwy., #I25 Stanton, CA 90680 can be a Iiucury, sometimes impossible. Marietta, GA 30067 Tel: 71 41895-1 781 Tel: 4041952-5559 FAX: 71 418976293 This was made very clear to me recently, as leader FAX: 4041952-5899 Minneapolis, Barb Platten, CRRT of the Northwestern Uiliversity Polio Support Group. Baltimore, JoeGolden, RRT 1230 Eagan Industrial Rd., #I75 One of our members revealed her frustrations with 7048F Golden Ring Rd. Eagan, MN 55121 this problem. She requires a scooter,just as I do, and Baltimore, MD 21 237 Tel: 61 21452-5229 e~~lainedthat during the past year she has not been Tel: 41 01574-2880 FAX: 61 21452-5314 FAX: 41 01391 -4407 able to attend her family's church of 30 years. Her legs New Orleans, Boston Coy Marshall, CRRT and arms have gotten progressively weaker, and she 267 Boston Rd., #16 1525 River Oaks Rd. East, #E can no longer "struggle" up and down her church's North Billerica, MA01862 Harahan, LA 701 23 many s~cps.She shared her sadness over losing her Tel: 5081670-5759 Tel: 5041733-191 1 l~cman-poweredmobility, as well as her church expe- FAX: 5081670-5764 FAX: 5041736-9231 rience which had been an important source of comfort Chicago, JoyMannella, RRT New York, Steve Savino, RRT in the past. 31 8 St. Paul Blvd. 22 Distribution Blvd. Carol Stream, IL60188 Edison, NJ0881 7 Listening to my friend I suddenly realized that I too Tel: 7081653-4477 Tel: 9081248-0863 had givcn up life in my protestant church - the place FAX: 7081653-5265 FAX: 9081248-0866 where my daughter was married, my granddaughter Cleveland, Bob Miller, RRT Oakland, JayNash, RCP 925-C Basset Rd. 4861 Sunrise Drive, #I06 christened. Westlake, OH44145 Martinez, CA94553 At first 1 wrote letters to my church, almost begging Tel: 21 61892-1480 Tel: 51 01370-0500 FAX: 21 61892-3984 FAX: 51 01370-1575 them to provide even the most minimal accessibility The responses were always polite, assuring me that Denver, Scott St. John, RRT Phoenix, Tony Rodela, RRT 4301 S. Federal Blvd, #I14 3822 E. University Dr., #4 within the next five years changes would be made. Englewood, CO 801 10 Phoenix, AZ 85304 Tel: 3031797-8418 Tel: 6021470-1288 Sec. 307 of the Americans with Disabilities Act FAX. 3031730-7808 FAX: 6021470-1292 exempts "religious organizations or entities controlled Detroit, Gary Kopczyk, RRT San Diego, Kelly Smith, CRRT by religious organizations, including places of worship," 11902-8 Farrnington Rd. 8837 ProductionAve. except for the employment provisions. Livonia, MI481 50 San Diego, CA 92121 Tel: 31 31458-51 70 Tel: 61 91549-7871 Following my dream to find accessible church services FAX: 31 31458-5175 FAX: 61 91549-3579 for myself and the support group, I found an answer Houston, Robert Garcia, RRT Seattle, Al Letterer, RRT until we can comfortably enjoy our own churches. , 8058 El Rio 1191 5 124thAve., N.E. I Houston, TX 77054 Kirkland, WA98034 I discoverecl that Sunday Catholic mass was held at Tel: 71 31747-8006 Tel: 2061823-5677 Chicago's North Pier entertainment complex. I also FAX: 71 31741 -5448 FAX: 2061823-8430 learned that the Rehabilitation Institute of Chicago Kansas City, JeffDavis, RRT Tampa, Peg Warren, CRRT (RIC) offers Iriterdenominational Sunday services. 108 N.W. Parkway 5808 BreckenridgePkwy., #F Riverside, MO 641 50 Tampa, FL 33610 Tel: 81 61741 -7667 Tel: 81 31621 -01 14 Continued on page 8 FAX: 81 61741 -4853 FAX: 81 61623-6935

Winter 1993 + Vol8, No. 4 Q Polio Network News Accessible Worshlp Jonl and Frlends (JAF), P.O. Box 3333, Agoura Hills, CA 91301 (818/707-5664,818/707-2391FAX, Continued from page 7 818/707-7006 TDD) offers many outreaches. Each sum- mer they hold retreats for families with a member who is I attended one of RICs services and for the first time disabled. Oregon, Florida, Pennsylvania, and California in a long while, 1 felt at home in a church setting. The are the sites for the 1993 retreats. ease and comfort of the accessibility and ministry was Christian Fund for the Disabled (CFD) is a match- like a soothing balm. The warmth and caring of those ing grant with a local church to fund equipment needs for around me quickly bridged the gap left by not seeing a disabled person. Although Wheels for the World is still old friends at my church. in the beginning stages, they plan to refurbish used manual wheelchairs and through churches match these Encouraged, 1 wrote a letter to area Protestant chairs with a needy person. churches requesting that they start a service at JAF Ministries also offer the following: Disability Chicago's North Pier entertainment complex. Awareness Sunday materials, Disability Awareness Study Dr. Eugene Winkler of the Temple Methodist Church, Guide, Curriculum List for the Mentally Disabled, and in the center of Chicago, picked up the challenge and Curriculum for Student Awareness. met with me there. He then met with his church and For details, contact JAF Ministries at the above the idea was approved. address. Heallng Communlty/The Carlng Congregation, I am happy to report that the first service will be 521 Harrison Ave., Claremont, CA 91711 USA Sunday February 28. (909/6214808, FAX 909/399-5552) has initiated Now, at last my quest for a Protestant church environ- Project Promised Land, a three year "Action for Access" ment that I can freely enjoy on my scooter has become program. They have materials to help congregations become accessible in attitude, architecture, and commu- a reality. I don't have to be helped in and out of the nication. Harold H. Wilke is the director. senice and I can "sit" anywhere I want. Natlonal Cathollc Offlce for Persons wlth Dlsabllltles I was alnused at an announcement recently in our (NCPD), P.O. Box 29113, Washington, DC 20017 church newsletter that there is now an accessible (202/529-2933 v/TDD), provides many services, includ- bathroom in the church. If you physically cannot get ing representing to bishops the needs and concerns of into tl~cchurch, who cares? persons with disabilities; providing workshops, retreats, presentations to pastoral ministers; developing and dis- I still attend my church on special occasions leaving seminating resource materials; sponsoring national train- my scooter at the foot of the sanctuary stairs, and, ing workshops, and publishing a quarterly newsletter, with the help of my daughter, walk to my seat. NCPD National Update. To be treated as an equal and enjoy access into any The NCPD has also published several booklets and church is a dream I will never give up. manuals and two videos entitled We Are One Flock and Welcome One, Welcome All. New projects include "Access to the Word" which will develop strategies and technology for bringing the good news to millions of Catholics with sensory disabilities. "Answering the Call" will encourage access to roles of leadership within the RESOURCES Catholic church. Contact the above address for a com- That All May Worshlp offers an interfaith approach plete listing of services and materials. to welcon~ingpeople with disabilities. The purpose of the handbook, That All May Worship, is to assist congregations, denominational groups, and seminaries to welcome people with disabilities into all aspects of worship and religious life. The handbook is interfaith in scope and and concerns people with all types of disabling conditions. That All May Worship is a "coaching manual" written MOV/NG? to change the ways people with disabilities are, or are not, included in their congregations. Please send both your old and new addresses to: Offered by Natlonal Otganlzatlon on Dlsablllty, 910 International Polio Network, 5100 Oakland Ave., 16th St., NW, Suite 600, Washington, DC 20006 #206. St. Louis. MO 63110-1406 USA. (800/24&2253,202/2935968TDD, 202/2937999 FAX), the handbook sells for $10.00 postpaid. Special ... when you move, POLIO NETWORK NEWS will not bulk rates are available. be forwarded by your post office. And, if you spend The National Organization on Disability (N.O.D.) part of your year in the South, please notify us. We promotes the acceptance and full participation in all will mail to your current residence. Remember to aspects of life, of America's forty-three million men, notify us when you move back. women, and children with physical, sensory, or mental disabilities.

Winter 1993 4 Vol 9, No. I 8 Polio Network News NATIONAL LIBRARY SERVICE Readers Write ... The National Library Service for the Blind and Physically Handicapped of the Library of Congress publishes books and magazines in braille and in recorded form on discs "My main problem in life remains the myoclonus. It and cassettes for readers who cannot hold, handle, or started as a problem at night and now has developed see well enough to read conventional print because of a into a 24-hour problem. I can't rest in the afternoon temporary or permanent visual or physical handicap. and every time my body settles down 1 start to twitch. Perhaps you could get used to it, but these are nerve Through a national network of state and local libraries, the materials are loaned free to eligible readers in the spasms right on the boarder of pain,and it is a very United States and to U.S.citizens living abroad. Materials unpleasant sensation. I have been through three sleep are sent to readers and returned by postage-free mail. lab tests. Currently, the only way to stop these impuls- es is to walk, or some kind of constant activity, typing, BOOKSAND MAGAZINES sorting stamps, etc., and 1 cannot go 24 hours a clay. Readers may borrow all types of popular-interest books, "Suggestions from physicians now have me trying including bestsellers, classics, mysteries, westerns, poet- several medications including Dopa~nin(for ry, history, biographies, religious literature, children's Parkinson's) who literally told me "to play around books, and foreign-language materials. Readers may also with them until I had some kind of result!" What subscribe to more than seventy popular magazines in braille and recorded formats. kind of fooling around is this, but 1 gucss this has been life all the way, figure it out yourself." Juliana Special equipment needed to play the discs and cassettes, Sawyer Stolle, Kaninchenbergweg 63, W-2400 Lubeck, which are recorded at slower than conventional speeds, Germany. is loaned indefinitely to readers. Headphones are provided on request. An amplifier is available for blind and The following is from a brochure of the Myoclonus physically handicapped readers who are also certified Research Foundation, Inc., 220 Hardenburgh Ave., as hearing impaired. Other devices are provided to aid Demarest, NJ 07627 (201/585-0770, readers with mobility impairments in using play- FAX 201/585-8114). back machines. What is Myoclonus? Myoclonus is a neurological impairment characterized You are eligible for the Library of Congress program if: by sudden, shock-like involuntary jerking movements You are legally blind - your vision in the better eye is which can interfere with wallung, speech, and manual 20/200 or less with correcting glasses, or your widest activities. In the illajority of patients, however, myo- diameter of visual field is no greater than 20 degrees. clonus is a serious and debilitating impairment. You cannot see well enough or focus long enough to Myoclonic jerks involve the motor system. Epileptic read standard print, although you wear glasses to correct seizures are a common accompaninlent of myoclonus, your vision. but intellect and sensation are spared unless affccted You are unable to handle print books or turn pages by diffuse cerebral damage. Awareness of the motor bcc~useof a physical handicap. deficits makes the myoclonus patient's life emotionally Or, you are certified by a medical doctor as having a more difficult. reading clisability, due to an organic dysfunction, which Myoclonus may occur in n variety of neurological is of sufficient severity to prevent reading in a normal disorders, such as toxic or vascular brain damage, manner. degenerative cerebral disorders and brain tutnors. Even more strilung, myoclonus has beell n co~nplica- How TO APPW tion of prolonged deprivation of oxygen. Myoclonus You may request an application by writing NLS or call- has been associated with epilepsy, vitamin deficicn- ing toll-free 1-R00/424-9100, and your narnc will be cies, metabolic disorders or can be a complicatio~~ referred to your cooperating library. of a movement disorder, stroke or Alzheimer's disease. Myoclonus does not discriminate by age or sex. It occurs in children as well as in the elderly and both women and men are its victims. At this Lime, only Since our feature on scoliosis, two of the three listed limited therapy is available. resources have moved. The new addresses are as follows: The Scoliosis Association, P.O. Box 811705, Boca Raton, What Causes Myoclonus? FL 33481-1705 (4071994-443s); Scoliosis Research The brain mechanisms which causc this disorder Society, 6300 N. River Rd., Suite 717, Rosemont, IL 60018. The National Scoliosis is still at 72 Mount remain an enigma. The fact that myoclonus can occur Aubura St., Watertown, MA 02172 (617/926-0397). in several distinctly different neurological disordcrs

Continued on page 10 Winter 1993 + Vol9. No. 1 O Polio Network News Readers Write ... What Is Myocionus? SURVIVING WINTER Continued from page 9 IPN has received several letters asking for suggestions on surviving winter. Polio Network News asks its confounds an understanding of its nature and impedes readers to send their ideas, equipment suggestions, attempt. to find its neurophysiological source. At this comments, etc. to IPN, 5100 Oakland Ave., #206, time, specific biochemical disturbances of the brain St. Louis, MO 63110 USA. are suspected to be factors for this condition. While Handi-Trak, Inc., 1521 S. 85th St., Milwaukee, WI there is no known way to restore malfunctioning brain 53214 (8001726-7718) USA makes Sno-Traks, special tissne, it may be possible to replace missing chemical chains for wheelchair tires. They are designed to keep agents in the brain, or to remove toxic materials from it. wheelchairs moving through snow, ice, and slush and Additional insights and information are needed to find are for powered and manual chairs, as well as three- a remedy which could significantly change the depen- wheeled scooters. dent life of the myoclonic patient. The Myoclonus Research Foundation, Inc. was estab- OTHER QUESTIONS AND COMMENTS lished to support clinical and basic research into the All medical problems of polio survivors cannot be cause and treatment of myoclonus. To comprehend and should not be blamed on polio. We know that. the complex nature of myoclonus, it is necessary for We also know that sharing problems, and, ultimately, clinical and research neurologists, physiologists, bio- solutions, is a very important part of networking. chemists, pharmacologists, anatomists, and members We have been asked to collect information about sur- of other disciplines to share expertise and knowledge. vivors who have had a problem with rash. A few reacl- ers report a rash which is migratory, very itchy, never completely disappears and, at times, is very wide- spread and severe; other times less so. They have been f Oet on the road to freedom'I unable to obtain a diagnosis from dernlatologists. with the WextStep" Additionally we have been asked to collect information from survivors about an allergic reaction to corn, Rolling Walker from ... or an allergic reaction to Prenlarin. Robert Vaughn, of Lubbock, TX, reporls "Seven years ago, I was having major depression over my declining health. Prozac (fluoxetine) was prescribed. Recently, when I switched insurance co~upanies,1 received a more complete brochure about the drug I was taking. Once I read the infornlation about Prozac's possible side effects -joint or muscle pain; tircclncss or weali- ness; trembling or quivering - sympton~ssimilar to my polio problems, I began tapering off thc drilg and have since stopped. Within two months, my pain level dropped. I encourage all survivors to investigate the side effects of any medication they are taking. Do not assume that your physician will point out possible side effects if hdshe feels your medicirie puts you .~t risk for any further complications with post-polio syndrome."

RESEARCH EFFORT International Polio Network thanks its rcadcrs for supporting the Polio Society's efforts to securc inore funds for research through Congress. The 1992 effort educated many more legislators about polio and its late effects. NobleMotion, Inc. Plans for 1993 include a postcard campaign in 5871 Centre Avenue P.O. Box 5366 conjunction with Congressional hearings. Individuals Pittsburgh, PA 15206 who signed up for the Coalition will receive informa- To order, call: tion soon, as will support group leaders.

Winter 1993 + Vol 9, No. 1 Q Polio Nehvork News Potpourri Maynard Accepts - New Position ILLINOIS I A Directory ofstate Sawices fmPeople with Dis- Frederick M. Maynard, M.D., abilities, published by the Illinois Department of has been appointed clinical Rehabilitation Services (DORS), lists a wide range of director of the Department services provided by 23 different state departments and of Physical Medicine and provides a quick and handy reference, complete with ~ehabilitationand medical addresses and phone numbers, on all agencies providing director of MetroHealth assistance to people with disabilities. Individuals or Center for Rehabilitation groups interested in obtaining a copy of the Directory in Cleveland, Ohio. Metro- can contact DORY Disabled Individual's Assistance Line I Health Center for Rehabilitation, the largest provider at 1-800/233-DIAL (Voice/TDD/TT). of inpatient and outpatient rehabilitation services in OHIO northeast Ohio, has long been regarded as the innova- Winnie Walker, olio survivor from New Philadelphia, tive leader in the field of medical rehabilitation. reports that their survivor group, along with other vol- Dr. Maynard will join the faculty of Case Westcrn unteers, have compiled and published an Access Guide Reserve University in Cleveland and will continue his to Twcarmoas County. It contains 80 pages of informa- clinical and research activities on the late effects of tion and covers about 140 buildings including churches, polio and on aging with a disability public buildings, restaurants, and stores. To find out how their group coordinated the effort, contact Winnie Dr. Maynard's involvement with polio and its late at 132 9th St., S.W., New Philadelphia, OH 44663. effects dates back to the early 80s. He has lrctured extensively to both professional and consumer audi- MICHIGAN ences. His many polio-related publications include The Polio Collection Library, formerly at the Brandon several professional journal articles aild book chapters Township Library, has moved to 4291 Squires Road, describing the physical and psychological challenges Quincy, MI 49082 USA. Nancy A. Miller, the new librar- facing polio survivors as post-polio sequclae occur, a ian, informs us an answering machine is on at times she research report that identifies secondary conclitiorls in is not available. Video and audio cassettes, periodicals, polio survivors, a videotape on coping successfully pamphlets, and book loans cost $5.00 handling fee for with the late effects of polio, and a manual for estab- health care professionals and out-of-state requests. Loan periods and charges to individuals in Michigan and lishing health promotion programs designed for polio nlembers of the state organization are different. For more survivors, titled Stay Well!He also co-cmted IPN's information about the collection and prices, contact Handbook on the Late Eflects of Poliortlyelitis for Nancy at 5171869-2996. Physicians and Survivors. NEW YORK Dr. Maynard is a fellow of the Ainericail Acadelny of Physical Medicine and Rehabilitation, an active 111~111- Polio survivors in New York state are still collecting ber of the American Congress of Rehabilitation itlrortllatiotl about the Shaw Act. Interested survivors Medicine, and the American Spinal lnjury Associa- should contactJanis Wolpin, 713 Mosley Rd., Fairport, of NY 14450. tion. He is currently a member of tlic Board Directors of Gazette International Networking Wheelchair accessible, one bedroom East 25th Street, Institute (G.I.N.I.). New York co-op apartillent on twentieth floor of luxury, 24-hour doorman building. Fully modified for wheel- He will assume his new duties in March 1993. His chair use by physician owner; roll in shower, lowered new address will be: Department of Physical Medicine kitchen counters, etc. $195,000 (maintenance $884). and Rehabilitation, 2500 MetroHealth Drive, Please call 203/966-5261 after 6 p.m. Cleveland, Ohio 44109-1998. WISCONSIN In the Spring of 1991, a barrier-free log cabin was constructed and gifted to the Department of Natural Resources (DNR) by the Telephone Pioneers of America, MASSACHUSETTS Wisconsin Chapter 4. The cabin is located in Mirror Wheelchair accessible hoine available for sumnier Lake State Park in the heart of the Wisconsin Dells area. vacation rental after June 1, Chathawcape Cod. Two- Since the campground cabin is the only cabin of its kind story with fully accessible first floor, including inodilied in the state park system, rules have been established for bath. Three bedrooms, living room, dining room, out- its use. Applications for reservations may be made by door deck, double garage. Short distance to shopping writing Department of Natural Resources, Box 7921, and beach. Weekly rentals from $675. depending on Madison, W 53707-7921, or by calling Mirror Lake dates. Contact: Sylvan Realty, 508/432-2344. State Park, 608/254-2333.

Winter 1993 + Vol 9, No. 1 Q Polio Network News Gazette International Non-Profit Org. U.S. Postage Networking Institute PAID (G.I.N.I.) St. Louis. MO Permit No. 1711 5100 Oakland Ave., #LO6 St. Louis, MO 63110-1406 U.S.A.

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International Polio Network CALENDAR Post-Polio Directory - 1993 The Post-Polio Directory - 1993 is now available. This international directory contains clinics and health profes- Ifyoo are planning a conference, please supply informa- sionals knowledgeable about the late effects of polio, as tion to Polio Network News for inclusion in the Calendar. well as support groups. The directo~yis available from Yearly deadline dates for our quarterly publication are: International Polio Network, 5100 Oakland Ave., #206, January 15, April 15, July 15, and October 15. St. Louis, MO 63110-1406 at $3 for consumers and + Meeting The Challenges of Aging with a Disability: $6 for others. Canada, Mexico, and overseas surface Lessons Learned from Polio and Stroke, Long Beach, add $1. Overseas air, add $2. CA, March 19-20, 1993. Contact: Mary Marquez- Ackerman, Rehabilitation Research and Training Center on Aging at Rancho Los Amigos Medical Center, 7600 Conseulo St., Downey, CA 90242 (310/940-7402). POLIO AWARENESS WEEK + Post-Polio Syndrome Conference, Ramada For the past several years IPN has initinted the process to Renaissance Hotel, Regina, Saskatchewan, April 23-25, declare June 1-7 National Polio Awarencss Week. Every 1993. Contact: Saskatchewan Awareness of PostPolio, year it has gotten more and lnore difficult to obtain the Inc., Box 22237, Regina, Saskatchewan, S4S 7H4, needed number of co-sponsors because many over- Canada. Canadians send a stamped, self-addressed, whelmed legislators refuse to co-sponsor commeruora- business sized envelope for registration materials. tives. They citc time and moncy and sometimc thc inaneness of the comme~norativesns rcasons. Oncc + First Annual Forum Luncheon with Frederick again, Congressman Dave McCurdy has sublnitted legis- Maynard, M.D., Allentown, PA, April 24, 1993. Contact: lation to move commenloratives from Congress to a Phyllis Kennedy, 524 New York Ave., Whitehall, PA commission. 18052 or Beverly Solomon, 924 N 33rd St., Allentown, Consequently, othcr avenues will bc cxplored this PA 18104. year. The Spring issue of Polio Network News will + Second Annual New Jersey State Symposium, feature the results of those efforts. Princeton Marriott, Princeton Forrestal, NJ, April 25, 1993. Contact: New Jersey Polio Network, P.O. Box 537, Martinsville, NJ 08836, or call Jean Brodgon, 908/356-9447. PERSONAL ASSISTANCE SERVICES + 1993 Post-Polio Update Conference, Holiday Inn Gazette International Networking Institute's January, Denver Southeast, Aurora, CO, September 10-12, 1993. 1993 Rehabilitation Gmette (Vol. 33, No. 1) features an Contact: Julia Beems, 303/2331666, or Bev Holst, examination of personal assistance services. Articles are 303/423-1179. authored by Cynthia Brown, Ira Holland, Bob Kafka, Alma Krekus, Margaret Nosek, Penny Reed, Max Copenhagen Post-Polio Conference, Copenhagen, + Starkloff, and Leah Welch. Denmark, September 23-24, 1993. Contact: Gertie E. Larsen, PTU (National Society of Polio and Accident The June, 1993 issue will continue the discussion. Victims), Tuborgvej 5, DK- 2900, Hellerup, Denmark Single copies are available for $6 postpaid. To receive (45 3162 9000). both the January issue immediately, and the June issue when published, send the subscription rate of $12. International surface add $2; International air add $4.