Los Angeles

Friday 25 April 2008

With an 8.30am start, today was jam packed with interesting things to do at Rancho Los Amigos Medical Complex. We started off meeting with Jan Furumasu, a physical therapy instructor working in the Seating Centre. The majority of people being seen at the Seating Centre would be those with spinal chord injury but they do see polio survivors on a regular enough basis to be familiar with the issues of finding an appropriate chair and cushion. They had cupboards full of different types of cushions, and a ‘seat mapping’ sensor pad that Jill tried out to see how it worked. This is particularly important for people with a spinal chord injury who are unable to feel the type of pressure that could potentially cause an ulcer. Polio survivors are simply able to identify the pain and rearrange themselves. However, it was very interesting to see the variety of chairs and cushions available.

We then moved on to meet with Molly Doyle, the Program Director for the Centre for Applied Rehabilitation Technology (C.A.R.T.) who in turn introduced us to Occupational Therapist, Kathleen Shanfield. Kathleen showed us a range of assistive devices for working on computers. Although I’m sure we have similar technology in Australia, I was amazed at the range of keyboard and mouse/toggle options available, as well as the voice activation software and physical support such as armrests. She then took us over to the model house which demonstrates a range of assistive technology to enable individuals with disabilities to live independently. The beauty of C.A.R.T. is that it’s all located in a ‘house’ on the hospital grounds.

Then we were off again for our next appointment to meet with Dr Jacquelin Perry who introduced us to her innovation, the Pathokinesiology Laboratory, which deals with instrumented diagnosis of complex gait dysfunction and the definition of disability. As mentioned in my report on Tuesday 22 April, Dr Perry is a living legend at Rancho Los Amigos and is widely acclaimed as an expert in the area of orthopedics and rehabilitation for polio survivors – both professionally and by the polio community. It was a true privilege to be able to spend time with Dr Perry and learn about her 50+ years experience at Rancho and the methods she developed for working with polio survivors. She is still very passionate about her work, consulting at the age of 90. She has also had the added challenge of living with Parkinson’s disease over the last decade or so. Dr Perry consults for the post polio clinics run at Rancho every Friday and is still seeing ageing polio’s she operated on when they were children. For example, she performed a spinal fusion on Richard Daggett when he was just a teenager. With the passing years, they have both developed have a great deal of respect for each other’s contribution to the polio community.

After lunch at the hospital canteen, we were introduced to Dr Sophia Chun who now heads up the post polio clinical team made up of an orthopedic specialist, physiotherapist, occupational therapist and nurse. Each new clinical assessment can take up to 2 hours. They see around 20 polio’s per clinic, of which 3-4 are new assessments. People are referred to the Rancho post polio clinic from all over America, so any referrals for the additional respiratory, speech therapy, dietary or psychological services that may be required are usually directed to local service providers. However, Dr Chun made a point of saying that those physicians/health workers should be knowledgeable about post polio syndrome and/or be willing to communicate with the Rancho post polio team. Their particular focus is on muscle function and overuse of particular muscle groups. Dr Chun cited a protein experiment done with polio’s that was successful in improving muscle function in the short term, but eventually left people weaker a few days on – simply because they had then proceeded to overwork those newly ‘strengthened’ muscle groups. As the sign off to one of her articles, Dr Perry wrote “Be an ‘Intelligent Hypochondriac’ – Listen to your body and adopt a program that avoids the strain.” In other words . . . PACE!

It was really interesting to sit in on an evaluation for one of the polio patients where all the team members sat in a group to discuss their various findings with a view to working out the best way to assist that person.
I was able to videotape discussions with Drs Perry and Chun which will be add to the information provided on the previous day by Dr Perlman. They were also very taken with my project and wanted to receive a copy of the tape and report. It was interesting to note the difference in approach by the neurologist vs physiatrist but there was no doubt that all techniques used were of benefit to their polio patients.

I later went back to Richard Daggett’s house and filmed him discussing the social and financial impact of post polio on him and his community – a different angle again. We enjoyed a farewell dinner and said our goodbyes to our new friend, Richard. We were very fortunate to have had him as our contact in LA and left feeling that we had achieved far more than our expectations.

So farewell to Los Angeles for tomorrow – St Louis, Missouri – here we come!