The role of the physiotherapist in the management of the late effects

Report
The role of the physiotherapist in
the management of the late
effects of Polio
Anne Glynn
Clinical Specialist Physiotherapist
MSc MCSP
Neurorehabilitation Team
Colchester General Hospital
Essex
Anne Glynn
British Polio Fellowship Roadshow 2014
Plan
•
•
•
•
Why me?
The Colchester Service - Team
Experience of working with people with Polio
PPS – my understanding
▫ Management of PPS
• The role of the physiotherapist
▫ Neurophysiotherapist
▫ Who is the right physiotherapist for you?
▫ What do we do?
• Summary
Anne Glynn
British Polio Fellowship Roadshow 2014
Why me?
• Interest
▫ Orthotist
▫ British polio fellowship
• Evening meeting
• Background
▫
▫
▫
▫
Neurology over 20 years
MSc Health Sciences 2005
Non-medical Prescribing 2007
Specialist interests –vestibular rehabilitation, PD,
spasticity management, MND and now Polio!
Anne Glynn
British Polio Fellowship Roadshow 2014
The Colchester Neurorehab Team
• Established 1994
• “The Neuro-Rehabilitation Team works with
individuals suffering from neurological
impairment to facilitate their achievement of
optimal levels of functioning and quality of life”.
• Work with family, carers and voluntary
organisations
• Referrals
Anne Glynn
British Polio Fellowship Roadshow 2014
Area covered by the team
Anne Glynn
British Polio Fellowship Roadshow 2014
Patient Numbers
(recorded 24/3/2014)
MS
PD
Stroke
TBI
Vertigo
MND
HD
Other
Polio
386
372
127
53
135
32
30
288
(17)
Total
1423
Anne Glynn
British Polio Fellowship Roadshow 2014
• Some on a course of
current treatment
• Others on a review
system i.e. 6 month
contact
• All patients have
direct access to team
and encouraged to
contact us with
concerns
The Neurorehab Team
Consultant
Neurologists
Clinical
Psychologist
Nurse Specialists
•
•
•
–
–
–
•
Parkinson’s
Disease
Multiple Sclerosis
Traumatic Brain
Injury
Secretaries
Anne Glynn
British Polio Fellowship Roadshow 2014
• Physiotherapists
▫
▫
▫
▫
Clinical Specialist
2 Specialists
1 rotational
Rehab assistant
• Occupational
Therapists
▫
▫
▫
▫
2 Specialist OTs
1 rotational OT
Technical Instructor
Rehab assistant
Other services
• Orthotics
• Wheelchair services
• Speech and language
therapy
• Dieticians
• Respiratory Consultants
• Musculo-skeletal outpatient physiotherapists
• Hydrotherapy
Anne Glynn
British Polio Fellowship Roadshow 2014
Patient Pathway
• Referrals - discussed at a weekly Tuesday
team meeting
▫ Average 80 / month + 15 VR
•
•
•
•
•
Allocation of initial assessment
Single Assessment with team feedback
Joint appointments
Referral to appropriate services
Review/open contact
Anne Glynn
British Polio Fellowship Roadshow 2014
Experience of working with people
with Polio
• Stories
• Questionnaire
• Its complicated!
• Support group
• Compare to other neurological patients I see?
▫ Lack of progression – then progression
▫ SCI, Stroke, TBI – MS, PD, MND
Anne Glynn
British Polio Fellowship Roadshow 2014
Stories
Anne Glynn
British Polio Fellowship Roadshow 2014
Its complicated!
New difficulties
Lived your life
Support?
Medical?
Social?
Fulfilled
Fear?
Denial?
Acute phase
Individual muscles
Skeletal
Isolation
Memories
Rehab experience
Coping?
Dreams?
Success
Other health
issues
Other life
traumas?
Anne Glynn
British Polio Fellowship Roadshow 2014
Distanced
from the
voices of our
bodies
Dr Lauro Halstead
What was my role in working with
people with polio?
• It has been good to build up a relationship with
Anne and to have an open appointment to attend
for physio with someone who understands my
symptoms
• Better than any previous service that I have
received
• You helped me get my orthotics for my shoes
• All around encouragement and treatment – both
physical and emotional well-being.
• You got me the help I needed
Anne Glynn
British Polio Fellowship Roadshow 2014
What was my role in working with
people with polio?
• I felt I was being listened to and was given
advice and help with my walking as well as
given exercises to do
• I found your clinic a more personal programme
for my needs – others in the past have been
more general
• Very helpful suggestions for exercises
• Good luck with the road shows!
Anne Glynn
British Polio Fellowship Roadshow 2014
How did other members of the team
help?
Occupational therapy
• They helped to find funding for a mobility
scooter and a stair lift
• I have had a number of adaptations done
around my home e.g. banister rails, a step and
rails at the door.
• They came to my home to assess my needs
Anne Glynn
British Polio Fellowship Roadshow 2014
How did other members of the team
help?
Hydrotherapy
• In my individual case it has proved very
beneficial
• Beneficial while in the pool but did not make a
difference out of the pool
• It had a bad affect on my BP over the following
days
Anne Glynn
British Polio Fellowship Roadshow 2014
Was there a benefit in attending a
joint orthotic clinic?
• Nice to have Anne there to support me
• I have not been, but I am sure if it is needed the
team will advise me
• Yes I found it helpful; Anne came up with some
good ideas
• I was introduced by neuro team as I had not
seen an orthotist before
Anne Glynn
British Polio Fellowship Roadshow 2014
Would you recommend the team to
other people with Polio?
•
•
•
•
Definitely x2
Yes
I don’t know anyone else with Polio
Yes, I have often told people about how they
have helped me
• Most certainly, as Polio is a forgotten disease
Anne Glynn
British Polio Fellowship Roadshow 2014
What could we do better?
• I would like to meet up with others with the
same diagnosis
• I would be interested in attending any local
meetings
• Not sure – everything was good
• Nothing, you’re doing very well
• I feel post polio syndrome needs to be talked
about more. When I have spoken to my GP about
PPS she looked rather vague and had never
heard of it
Anne Glynn
British Polio Fellowship Roadshow 2014
PPS – My understanding
• Development of new weakness, fatigue, pain and
decreased function in people previously affected by
polio
• Diagnosis (Definition Halstead 1991)
Polio
Recovery and plateaux
Progressive weakness (gradual or abrupt)
Exclude other causes






•
Neurological, orthopaedic, anaemia, diabetes
Respiratory, depression
Treatment and rehabilitation management in PPS
is not yet established – Cochrane Review 2010
Anne Glynn
British Polio Fellowship Roadshow 2014
What happens?
• The construction worker analogy
Julie Silver 2001(Post-Polio Syndrome – A Guide for polio survivors
and their families)
Anne Glynn
British Polio Fellowship Roadshow 2014
Management of PPS
• Thorough assessment of symptoms
• Other conditions – cure! /management
1. Weakness
2. Fatigue
3. Pain
▫ Joint
▫ Muscle
•
Falls – each year 35% of over 65 year olds fall
(45% in over 80s)
Anne Glynn
British Polio Fellowship Roadshow 2014
Management of other conditions
•
•
•
•
•
•
•
Exclude in diagnosis of PPS
Cardiovascular risk
Diabetes
Mood
Respiratory conditions
Osteoporosis
Medication
▫ Side effects
Anne Glynn
British Polio Fellowship Roadshow 2014
1 Management of weakness
• Avoid over use – preserve to conserve
• Exercise
▫ Endurance . Aerobic – cardiovascular
conditioning – vary and enjoy!
▫ Stretch – flexible muscles and joints (care!)
▫ Strengthen
 When possible – disuse, unaffected and moderately
affected
 Not intensive . No pain
Anne Glynn
British Polio Fellowship Roadshow 2014
2 Management of fatigue
“My muscle power and endurance are as coins in
my purse: I have only so many and they will
only buy so much. I must live within my means,
and to do this I have to economise: what do I
want to buy and how can I buy it for the least
cost?”
“Growing old with polio is a matter of economics:
cost/ benefit analysis. How much expenditure
of limited energy for how much satisfaction.
Minimise the exertion; maximise the pleasure”
Anne Glynn
British Polio Fellowship Roadshow 2014
Hugh Gallagher 1995
Management of fatigue
Energy conservation
• Prioritise - Lifestyle changes
• Plan - Regular rests
• Pace -learning to recognise your own baseline of
activity and rest (Leaflet)
• Physical fitness
• Sleep
• Avoid excessive fatigue (Borg scale)
Anne Glynn
British Polio Fellowship Roadshow 2014
3 Management of Pain
Joint pain
•
•
•
•
Modification of activity
Gentle paced exercises
Postural alignment
Orthoses
▫ Brace unstable joints
▫ Rest overused muscles
• Equipment –wheelchair,
walking stick
• Medication
• Electrotherapy
Anne Glynn
British Polio Fellowship Roadshow 2014
Muscle pain
•
•
•
•
•
Activity reduction
Pacing
Lifestyle modification
Equipment
Diary
Physiotherapy in the management of
PPS
• Education and support
• Aim – Keep you as independent as possible and able
to maintain your optimum quality of life.
• Educate the need to:
• Learn to listen to your body (subjective)
• Learn to pace
• Encourage optimum general health – weight, diet.
• Learn to accept limits – adapt to changes – accept
support
• Long term follow up.
Anne Glynn
British Polio Fellowship Roadshow 2014
Physiotherapy in the management of
PPS
• Reduce symptoms of PPS
• Prevent worsening PPS
• Exercise
▫ “Lower intensity, short duration, intermittent
activity or exercise performed within subjects
limits of fatigue, weakness and pain – without
adverse responses”
E Dean, M Dallimore 2004
• Principle based approach – not standardised
treatment regime
Anne Glynn
British Polio Fellowship Roadshow 2014
Neurophysiotherapy vs the others!
• What is a neurophysiotherapist?
• Who is best for you?
▫ Team
▫ Shoulder pain? Neck pain?
• Your need /their skills
• You may be the 1st person with Polio and
symptoms of the late effects of Polio they see
▫ Get them interested
▫ Give them the information!
Anne Glynn
British Polio Fellowship Roadshow 2014
Physiotherapy Assessment
Subjective
• History. What are your concerns?
▫ Pain?
 Where? When? Anything help? Aggravate? Management
so far?
▫ Function?
 Stairs? Outdoor mobility? Dressing?
•
•
•
•
▫ Respiratory issues? Falls?
▫ Medication
What is your understanding of symptoms? Belief ?
Psychological
Social
GOALS
Anne Glynn
British Polio Fellowship Roadshow 2014
Physiotherapy Assessment
Objective
Clinical examination
• Observation
▫ Posture – lying, sitting, standing, walking
▫ Previous operations – fusion
• Movement
▫ Range, quality
▫ Muscle power (0- 5 ). Affected or not? Disuse or overuse
• Function
▫ On off bed.
• Gait . Walking aids
• Palpation
▫ Joint – pain, swelling, stability
Anne Glynn
British Polio Fellowship Roadshow 2014
Benefits of exercise
It's medically proven that people who do regular physical activity have:
• up to a 35% lower risk of coronary heart disease and stroke
• up to a 50% lower risk of type 2 diabetes
• up to a 50% lower risk of colon cancer
• up to a 20% lower risk of breast cancer
• a 30% lower risk of early death
• up to an 83% lower risk of osteoarthritis
• up to a 68% lower risk of hip fracture
• a 30% lower risk of falls (among older adults)
• up to a 30% lower risk of depression
• up to a 30% lower risk of dementia
What counts?
Moderate-intensity aerobic activity means you're working hard enough to raise
your heart rate and break a sweat. One way to tell if you're working at a
moderate intensity is if you can still talk but you can't sing the words to a
song.
Dr Nick Cavill www.nhs.uk/Livewell/fitness
Anne Glynn
British Polio Fellowship Roadshow 2014
Individual home exercise programme
Reduce risk
Risk
Benefits
Anne Glynn
British Polio Fellowship Roadshow 2014
1.Avoid overdoing it.
2. Pace
3. Rest
Link with team
• Gateway to help
▫ Accept physiotherapy
• Occupational therapy
• Refer to specialist physiotherapy colleagues
▫ Hydrotherapy
▫ Musculo-skeletal, spinal
▫ Pain management
• “Patient satisfaction with therapists is associated
with degree of emotional support and
understanding received”. P Ley 1988
Anne Glynn
British Polio Fellowship Roadshow 2014
You can change some of it
Ask for
help
Talk
Join a group
Set up a group!
New difficulties
Lived your life
Support?
Medical?
Social?
Fulfilled
Dreams?
Let go of
unrealistic
expectations
Anne Glynn
British Polio Fellowship Roadshow 2014
Acute phase
Individual muscles
Isolation
Memories
Fear?
Denial?
Coping?
Lifestyle
Pacing
Rehab experience
Success
Other health
issues
Other life
traumas?
Relaxation
LetExercise
go of
unrealistic
Keep healthy
expectations
Resources
• British Polio Fellowship
• Lincolnshire Post-Polio network
• Post Polio Syndrome – Management and Treatment
in Primary Care (PP Support Group Ireland 2007)
• Postpolio Syndrome J Silver, A Gawne (2004)
• Post-Polio Syndrome – A Guide for Polio Survivors
and Their Families J Silver (2001)
• Post-polio syndrome – advice on the management of
your symptoms. Information from the Lane Fox
Unit
Anne Glynn
British Polio Fellowship Roadshow 2014
References
• R S Howard (2005) Poliomyelitis and the postpolio
syndrome. BMJ 330: 1314-1319
• E Farbu (2005) Post-Polio Syndrome – Diagnosis
and Management. JACNR 5: 10-11
• R Bridgens, S Sturman, C Davidson (2010) Clinical
Medicine 10: 213-214
• E Farbu et al(2006) EFNS guideline on diagnosis
and management of post-polio syndrome. European
Journal of Neurology 13:795-801
• Treatment of Postpolio Syndrome - Cochrane
Review 2010
•Anne Glynn
British Polio Fellowship Roadshow 2014
Summary
“Find someone who will work with you and is
willing to learn and help” Roller and Maynard 2002
• You are the experts – be our teachers
• Thank you for the invite – I have learnt in the
process
• Now we all need to spread our knowledge and
experience
Anne Glynn
British Polio Fellowship Roadshow 2014
And finally!
• Thank you – my teachers /patients
• The future?
• My goal
▫ Support development of local support group
▫ Gain greater expertise in managing people with
PPS
▫ Offer study afternoon to ACPIN East
Anne Glynn
British Polio Fellowship Roadshow 2014
Anne Glynn
British Polio Fellowship Roadshow 2014

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