Post Polio Syndrome - Management & Treatment in Primary

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Occupational Therapy and Post Polio Syndrome 13 Mobility An occupational therapist is responsible for the assessment of mobility devices that do not include walking aids. This area primarily consists of assessment regarding the need for transit wheelchairs, manual wheelchairs, powered wheelchairs and scooters. Occupational therapists should advise against the use of manual wheelchairs as a primary mobility device and they should not be used as a prescription for exercise. 21 Research indicates that post polio survivors are experiencing the long term effects of chronic musculoskeletal overuse where upper limb muscle group strength deteriorates at a rate higher than that associated with normal aging. 22 McConnell 21 points out that continuing to use manual wheelchairs remains a contraindication for post polio survivors as it fails to alleviate the chronic musculoskeletal overuse prevalent in post polio syndrome. Environmental modifications to home area Occupational therapists are commonly involved in advising persons with post polio on housing and home environmental modifications. Occupational therapists are usually required to assess a person’s functional capabilities and the home environment for clients when they apply for a Disabled Persons Housing Grant. This grant is available from the Department of the Environment through local housing authorities and is provided towards the cost of long term home modifications to accommodate for the home occupier’s disability. Long-term modifications should consider appropriate accessibility throughout with emphasis on size and layout, and modifications should be carried out in close consultation with a client. Recommendations usually include advice on appropriate access and on building or converting existing home space to accessible shower rooms, kitchens and living areas. Hospital based occupational therapists’ remit does not extend to occupational therapy assessments for Disabled Persons Housing Grant applications. This falls within the remit of community based occupational therapy or alternatively private occupational therapy. PPS Mngt and Treat.indb 13 02/07/2007 16:07:49
14 Post Polio Syndrome Vocational rehabilitation Many individuals with post polio syndrome are employed and hence advice and recommendations around workplace modification is a necessary feature of rehabilitation. In addition, the physical and emotional aspects of working whilst living with post polio syndrome may have a substantial impact and many persons with post polio may find themselves needing an occupational change in later life. 23 Occupational therapists may acquire expertise in the area of vocational rehabilitation where advice on appropriate access, ergonomics, assistive technology and adaptive techniques for work activities and/or alternative employment remain the primary focus. Driving Persons with post polio syndrome often experience difficulties driving as a result of limb weakness, reduced range of movement and muscle fatigue on prolonged activity. Occupational therapists may be involved in assessment of functional capabilities for driving and commonly refer clients to appropriate services that assess for the specific adaptations required for driving safely and without undue strain. A driving assessment by a qualified driving assessor or an occupational therapist specifically trained in this area is appropriate for persons with post polio syndrome who are unable to control regular car controls to maintain independence in driving. In Ireland, the Disabled Drivers Association of Ireland and the Irish Wheelchair Association provide a driving assessment service for persons with varying degrees of physical disability. This is referred to as the Motorist Advice, Assessment & Tuition service (MAATS Program). Persons who hold a primary medical certificate are entitled to a number of cost exemptions on adapted vehicles. Lifestyle changes: coping and adaptation Persons with post polio syndrome may experience a number of psychological difficulties as illness alters self-perceptions and forces PPS Mngt and Treat.indb 14 02/07/2007 16:07:49
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