Acute Polio and Rehabilitation Insights by Ernest W. Johnson

Acute Polio and Rehabilitation Insights by Ernest W. Johnson

Ernest W. Johnson's essay explores his experiences with acute polio and the evolution of rehabilitation medicine. The narrative details his journey from medical school to becoming a leader in the field, highlighting pivotal encounters with polio patients and innovative treatment methods. Johnson discusses the challenges and successes of managing polio symptoms, including pain and weakness, and emphasizes the importance of progressive rehabilitation techniques. This essay serves as a valuable resource for medical professionals, students, and anyone interested in the history and treatment of polio.

Key Points

  • Details the author's journey through medical school and residency focusing on polio rehabilitation.
  • Explains the innovative Kenny approach to managing acute polio symptoms and muscle rehabilitation.
  • Describes the evolution of treatment techniques for polio patients over several decades.
  • Highlights the significance of electromyography in understanding polio-related muscle issues.
  • Discusses the long-term effects of polio and the management of post-polio syndrome.
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Acute polio and its evolution: reminiscences of a 'polio fellow'
Ernest W. Johnson, MD, circa 1970s
Returning from 34 months in the southeast Pacific as a GI to my home in Akron,
Ohio, I was entitled to four calendar years of a university education funded by the
GI bill. I enrolled at The Ohio State University (OSU) and while rooming with a
high school friend who was completing his last year of medical school, was given
advice-- after joining him on several clinical rotations--to finish the pre-med
requirements and use up the educational entitlement in medical school. I did!
As a fourth-year medical student, I was looking ahead to a residency choice,
considering anesthesia, pediatrics, physical medicine and rehabilitation, radiology
and psychiatry. It seemed logical to defer the final choice until I had experienced
these rotations during my internship at Philadelphia General Hospital. My post-
MD hospital year began with obstetrics and gynecology, followed by orthopedics,
ENT, endocrinology and, by the time I needed to make a selection, I was still
confused, so I flipped a coin and it came up psychiatry. I applied for and was
accepted in a program at Indiana Medical School. My choice seemed appropriate
until my rotation on psychiatry in December. It was a disaster!
As soon as I reported to the service, I was directed to an isolated, high-security
room with a locked door, solid except for a small grill. When the door slammed
shut behind me, I was imprisoned with a hypomanic patient who was manacled to
the bed. Two hours later, I was able to attract the attention of an orderly and be
released. I called Indiana and cancelled the residency, too late to apply for another.
Next day
Answering an ad in the Journal of the American Medical Association, I accepted the
position as a general practitioner with a surgeon in Findlay, Ohio. My intention was
to work a year and then reapply for a residency, with pediatrics as a tentative
option. Tentative only until I had made several home calls in the early morning
hours for a sick baby. When responses to my request to see the child in the office
next day was answered with “NO, we intend to see our regular doctor (read -
pediatrician)” that was the end of my intended career in pediatrics
My pivotal encounter with rehabilitation medicine began as I assumed my required
service in the emergency room. One of the first patients I saw was a 19-year-old
painter who had fallen from a scaffold and fractured his neck at C-6 (spared
complete spinal cord injury.) I quickly referred the patient to OSU, which had just
initiated a rehabilitation program.
Seven months later (yes, you could keep a tetraplegic person for that long) I was
asked to join the discharge conference. During that visit, I met Dr. Ralph Worden,
the founding director of the physical medicine and rehabilitation program at OSU.
He remembered me as a fourth-year medical student who had written a review
about "fibrositis" for my grade in the clinic rotation. He suggested that I apply for a
National Foundation of Infantile Paralysis fellowship. These fellowships were
instrumental in the growth of the field of rehabilitation medicine.
Many of the original leaders in rehabilitation were "polio fellows." My first year of
residency was at the Children’s Hospital in Columbus. This year was spent largely
with polio patients. At one time, there were more than 75 acute polio patients,
mostly children, although young adults were also admitted.
I remember the staff shortage, with many of my weekends spent putting on Kenny
hot packs and stretching tight, painful muscles. Kenny packs were hot wool cloth
packs which were heated to 140 degrees and then had the water spun out and
applied under canvas wraps. Burns were occasionally produced, but usually
avoided by careful application. This treatment was extremely effective in relieving
the muscular pain that was so typical of acute polio.
The pain pattern was characteristic and coincident with the meningeal symptoms in
the central nervous system invasion acutely: usually, neck, back and severe
posterior thigh and calf pain. Dr. John Guyton (one of OSU’s first residents) and I
studied these acute polio patients with electromyography that clearly showed these
symptoms were not neurologic but rather muscular in origin.
Much controversy arose about “when and if” to exercise the polio-weakened
muscles. Dr. Richard Baer, the second resident at OSU (I was the third.) began
progressive resistance exercises within the first month of acute polio and these
demonstrated no untoward effects. Dr. Worden, who had trained at the Mayo
Clinic, taught us the Sister Kenny approach to managing polio. He had spent two
years at the Kenny Institute in Minneapolis. We learned about "Kenny sticks"; these
were modified wooden underarm crutches which were shortened. Dr Worden
emphasized the need for MINIMAL bracing - none, if one could get along with
sticks. The Kenny approach for pain was to apply hot packs and stretch all of the
two-joint muscle groups.
I must acknowledge that the first resident at OSU, Dr. Richard Burk, who caught
the polio virus during his fourth year at Creighton Medical School, was treated at
the Kenny Institute. Here, he met Dr. Worden and then when Dr. Worden was
recruited to OSU, he came along.
We were introduced to the concept of "muscle alienation" -- the notion that if a
muscle drops out of a movement for a time, it loses its ability even if function
returns. The typical example is the anterior tibial muscle, which can drop out of
foot dorsiflexion during the acute phase, and then the patient uses the foot evertors
to clear the limb on swing phase.
Dr. Burk had severe residuals and used two knee-ankle-foot orthoses (KAFO) and
bilateral underarm crutches.
I want to point out that there are three distinct immunologic types of the polio
virus. Type I is the most common in most epidemics and was named for the rhesus
monkey from which the first isolated strain was obtained (Brunhilde; 1937).
Type II (Lansing) is less frequent with fewer strains, named after the first strain,
isolated in an outbreak in Lansing, Michigan in 1938.
Type III (Leon) was isolated from a youngster who died in the Los Angeles
epidemic in 1939.
When I completed my residency, I accepted the position as assistant medical
Director of the 14th Polio Respiratory and Rehabilitation Center at Columbus
Children’s Hospital, and as Chief of the Physical Medicine and Rehabilitation
department. For the next five years, I was totally into managing polio patients with
a variety of polio severity and in differing stages of the disease. I was the physician
called whenever the ER doctor found weakness. My experience was extraordinary.
I saw children with all sorts of neuromuscular conditions e.g., Guillain-Barre,
infantile botulism, leukemic infiltration of joints, spinal cord tumors, myopathies
and many others which presented as polio. My evaluations included a history and
examination for weakness and tightness. The weakness in polio was usually
asymmetric and the tightness was always present in 2-joint muscles.
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FAQs of Acute Polio and Rehabilitation Insights by Ernest W. Johnson

What innovative treatments for polio are discussed in the essay?
The essay discusses the Kenny approach, which involves the application of hot packs and stretching to alleviate muscle pain associated with acute polio. This method emphasizes minimal bracing and progressive resistance exercises to enhance muscle recovery. Johnson highlights the effectiveness of these techniques in managing pain and improving mobility for polio patients, showcasing their importance in rehabilitation.
How did Ernest W. Johnson's experiences shape his approach to rehabilitation?
Ernest W. Johnson's experiences during his medical training and early career significantly influenced his approach to rehabilitation. His encounters with polio patients, particularly in emergency settings, led him to explore innovative treatment methods. Johnson's commitment to understanding the complexities of polio and its long-term effects drove him to advocate for progressive rehabilitation strategies that prioritize patient comfort and recovery.
What are the long-term effects of polio as described in the essay?
The essay outlines various long-term effects of polio, including progressive weakness, pain, and fatigue that many survivors experience years after the initial infection. Johnson notes that these symptoms can lead to significant challenges in daily life, necessitating ongoing rehabilitation efforts. He emphasizes the importance of tailored exercise programs and pain management strategies to improve the quality of life for post-polio patients.
What role does electromyography play in understanding polio?
Electromyography (EMG) is highlighted as a crucial tool in understanding the neuromuscular implications of polio. Johnson describes how EMG helps in identifying muscle function and the extent of damage caused by the virus. This technology allows for better assessment and treatment planning, enabling healthcare providers to tailor rehabilitation strategies to individual patient needs.
What challenges did Johnson face in his early medical career related to polio?
In his early medical career, Johnson faced significant challenges, including a disastrous psychiatry rotation that led him to pivot towards rehabilitation medicine. His initial encounters with polio patients revealed the complexities of their care, particularly in emergency settings. These experiences shaped his understanding of the urgent need for effective rehabilitation strategies and informed his future work in the field.

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