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The various types of treatment now given at the Foundation are corrective surgery; conservative correction of deformities by plaster casts; immobilization during early convalescence by plaster, plaster and removable splints, or removable splints; all of which are followed at some time by underwater physical therapy. In addition, the supplementary types of treatment available are hydrotherapy, heliotherapy, massage, paraffin baths, occupational therapy and walking exercises. All these forms are not indicated for any one individual, but from them appropriate treatment is available for each case.

For growing children protective apparatus is provided by plaster of Paris casts in preference to removable splints. Since concentration is necessary for proper localization, young children cannot cooperate in a treatment program of specialized exercises. Casts are removed every few weeks to allow muscle re-checks and new ones applied with the parts in the position the results of the muscle analysis and deforming tendencies require. For the adult patient, with certain distribution of muscle weakness, complete immobilization during early convalescence gives better results. For example, shoulder girdle weakness and weakness behind the thigh and in the calf respond much better to this conservative form of therapy.

Experience at the Foundation makes it apparent that exercise in the medium of warm water is required at some time during the treatment program of every patient and, at the indicated time, can bring about results impossible to obtain otherwise. Following prolonged immobilization, warm water is an excellent medium in which to increase joint motion without added discomfort. This is true whether the patient has been immobilized to provide physiological rest during early convalescence or to hold a part in proper position following operative procedures. Exercise and movement in the medium of warm water is less difficult for the patient and is the most satisfactory method by which activity can be increased from the point of complete rest to whatever degree of active independence it will be possible to obtain for the patient at the end of the prescribed treatment program.

Orthopedic appliances for the poliomyelitis patient demand careful attention to details. Fine workmanship is of no value if the appliance does not fit or properly support the part. To facilitate mobility during the first stage of weight bearing, the durability of a brace oftentimes must be sacrificed to possibly a more fragile but lighter weight material. Splints of various types, which are applied to provide rest during convalescence, must be positive, yet so designed that they can be easily removed to allow daily massage, exercises, or other forms of treatment. For a great number of patients, walking braces are permanent equipment and become almost a part of the individual. An inch added to the length or the setting back of the knee a few degrees may determine whether the patient can or cannot walk with the support. These appliances cannot be supplied from a distance but must actually be built on the patient. The several necessary fittings during construction may be done by the brace maker, but in every case the final inspection, before the patient attempts weight bearing, should be made by the attending physician.

During the latter part of the prescribed treatment program, every effort is made to fortify the individual with sufficient endurance to fit him again into an environment of normal associates. He is taught to get up and down from a sitting position without assistance, to get in and out of bed, and otherwise take care of his personal needs. In so far as possible he is trained to do all of the normal activities of everyday life with as little assistance as possible. Thus not only is the individual made more independent but the necessity of his depending on an attendant or some member of the family is reduced.

In upper extremity involvement, various types of handicrafts are valuable in teaching coordination and the finer movements characteristic of the hand. This type of exercise is applicable to those cases where there is generalized weakness or in postoperative cases where certain transplants have been done about the fingers and thumb. The prescribed program consists of leather work, weaving on hand looms, sewing, knitting, crocheting, and other work that requires intrinsic muscle activity.

Surgery in the after-treatment of poliomyelitis provides probably the most effective means of improving disabilities resulting from residual paralysis imbalance and ensuing deformities. The surgeon must know just to what extent the operation on the given part will help the individual as a whole. Any operation, regardless of the skill with which it is performed on a given part, has been ill-advised if this improved part proves of no value to the patient. Experience at the Foundation indicates that it seems preferable to delay operative procedures until at least eighteen months have elapsed from the time of the acute onset. There are exceptions to this rule, however. For example, surgical correction of contractures is done earlier if they are preventing the functioning of opposing muscle groups, disrupting weight bearing lines, or are otherwise causing undue strain on adjacent parts of the skeleton.