1. KITCHEN:
   1. ORGANIZING SPACE/WORK AREA
      • Keep all baking equipment in one cupboard
      • Keep pots and frying pans near the stove
      • Keep frequently used appliances (e.g. Toaster) on the counter
      • Set up a specific area to make coffee (i.e. A coffee station where you keep everything you need nearby.
      • Keep items to the front of the shelves and the rows shallow
      • Use plastic lid holders on inside of cupboard doors to keep lids organized
      • Eliminate clutter by organizing drawers and dividers
      • Keep unused duplicate items in other areas if needed or give away or throw out (i.e. scissors)
      • Keep frequently used items to the front of the shelf and items used less often to the back
      • Use space savers (e.g. lazy susans) and pullout shelves
      • Keep heavy jars and boxes at waist level
      • Store only light objects on the higher shelves only if absolutely necessary and use a long handled reacher or tongs to reach items
      • Keep heavy items on top shelf of refrigerator, near the front

   2. COOKING:
      • Plan meals ahead to decrease/prevent last minute tasks
      • Use precut vegetables, chopped nuts (convenience food)
      • Sit town while preparing vegetables, meat, etc., for cooking
      • Use a mirror over the stove to monitor food while sitting
      • Use electric appliances (e.g. Microwave, electric mixer/can opener/knives/fry pan)
      • Can use egg slicer for any soft vegetables
      • Place a damp cloth underneath a bowl or plate to keep it from moving
      • Use lightweight dishes/pans and serve from them
      • Use a wheeled cart to move heavy items around
      • Re-arrange kitchen to make it accessible from a seated position
      • Prepare large amounts of food that freezes well, then freeze for later meals
      • Use built up handled utensils for more comfortable grip
      • Use wall mounted manual or electric jar and can openers.
   3. CLEAN-UP:
      • Use disposable aluminum baking pans or plastic baking bags
      • Use a nonstick product on pans or line with foil before baking or frying
      • Sit on a stool while washing dishes
      • Use a wheeled cart to collect dishes from table
      • Use an easy to grip sponge to clean up rather than a thin dish cloth
2. BATHROOM:
   1. BATHING:
      • Sit on a tub bench or bath stool
      • Use a bath mitt or long handled brush/sponge
      • Install grab bars around the tub
      • Install lever-type faucets or build up the faucet handles to decrease stress on hand/finger joints
      • Use a non-skid rubber mat or strips in the tub or shower
      • Keep towels in easy reach
      • Soap on a rope or liquid soap to avoid dropping soap
      • Do not use glass containers that could be dropped and broken
   2. TOILETING:
      • Put grab bars around the toilet
      • Use a raised toilet seat
      • If a raised toilet is too high, then push a low footstool under your feet once you are sitting
   3. GROOMING:
      • Build up or extend the handles on brushes, combs, toothbrushes etc., using rulers, foam rubber, or pipe insulation
      • Use an electric toothbrush
      • Use pump dispenser type toothpaste. If you have to squeeze out toothpaste, squeeze the tube between both palms or place the tube over a damp washcloth and lean onto it
      • Place a foam curler over eyeliner or lipstick to build up a handle
      • If holding one or both arms up to wash or style hair is fatiguing, try sitting at a desk or dressing table. Prop an elbow on a book (or 2) covered with a soft towel.
   4. DRESSING:
      • Sit down to dress
      • Reorganize closet so that the shelves are lower and clothes are hung at a lower height
      • Use long handled shoehorns and sock aids
      • Wear supportive and proper fitting shoes
      • Wear "pretend" or clip-on neckties
      • To make zippers easier to grasp, use a zipper pull, add a loop chain or large paper clip
      • Replace buttons with velcro if possible, or use a buttonhook
3. LAUNDRY:
   • Do only what is necessary: buy permanent press clothing
   • Use separate baskets to sort clothes before bringing them to the laundry room or keep hampers/baskets in the laundry room to collect dirty laundry
   • Use a rolling cart to move wet clothes to the clothesline if a dryer is not available
   • Sit when sorting, folding and ironing clothes (some ironing boards are adjustable)
   • Label a basket for each family member and have each one put their own laundry away
   • Sort clean clothing and linen into different baskets and have other family members put them away.
   • Use a rolling cart if you put the laundry away
4. HOUSECLEANING:
   • Store cleaning supplies everywhere they are used
   • Wear an apron with large pockets to carry necessary cleaning supplies
   • Use a sponge mop with an easy lever-type squeezer, a "janitor's pail". move the bucket/pail of cleaning solution on a rolling dolly/caster
   • Use a long handled feather duster or dust with a mitt
   • Use automatic toilet bowl cleaner & spray on mildew remover to eliminate scrubbing
   • Put casters on furniture so they can be moved easily
   • When making beds, finish one side at a time
   • Alternate heavy and light tasks, and remember to take a break between/during tasks
   • Do only one major cleaning task a day (e.g. Laundry, cleaning the bathroom)
5. WORKPLACE:
   • Keep frequently used, necessary items in easy reach
   • Sit in a swivel chair with proper adjustable back support
   • Set the work surface at a comfortable height
   • If you are required to make many errands, use the elevator and organize the errands to make as few trips as possible
6. LEISURE:
   • Use a card rack for holding playing cards
   • Use a bookstand. Lay the newspaper on an open table rather than holding it up with your arms
   • Use felt tip pens which require less pressure to write. Also, use larger sized pens for easier grip
   • Use a push-button phone or pen tip to dial
   • Attach a gooseneck to the table then to the telephone receiver to eliminate holding the receiver.
   • Get a headset for the phone to eliminate the need to hold the receiver.
7. GARDENING OR YARDWORK:
   • Use lightweight tools with extended or built up handles.
   • Use a gardening stool
   • Use raised flower boxes or window boxes
8. FOR GOLF:
   • Play 9 holes. Take a break, then play the 2^nd 9 holes
   • Use a cart and lightweight clubs
9. FOR TRAVEL:
   • ask for a wheelchair escort to the gate
   • Ask a porter to assist with luggage or get a luggage cart, or get luggage with wheels
   • use elevators, escalators moving walkways
10. CAR:
    • get power options steering, windows, brake, locks, seat controls
    • use a wide-angled mirrors if you have decreased movement in your neck
    • build up the key tops or use key holders to make turning easier

1. Exercise must be NONFATIGUING
2. Exercise should be of LOW-INTENSITY
3. Chose LOW-IMPACT activities
4. The exercise program individualized to your needs and to your muscle groups
5. Regular WORK-rest-intervals SHOULD BE INCORPORATED INTO THE DESIGN OF THE EXERCISE PROGRAM
6. Exercise must be JUDICIOUS; that is, one must stay within reasonable bounds of the amount of exercise so that overuse problems are avoided ***remember exercise can be harmful if it is overdone
7. Exercise is performed during the "GOOD" part of your day, that is, when your muscles and body are not already tired.
8. Activities that cause an increase in muscle or joint pain or fatigue during or after the exercise program should be avoided.
9. Specific recommendations:

HOW DO YOU DETERMINE WHICH MUSCLES ARE APPROPRIATE FOR EXERCISING?

A "LIMB-SPECIFIC" CLASSIFICATION FOR MUSCLES IN DETERMINING APPROPRIATE EXCERCISE HAS BEEN DEVELOPED BY Dr. Anne Gawne, formerly Associate Director of the Post Polio Program at the National Rehabilitation Hospital in Washington, D. C.

HOW INTENSE IS INTENSE?

There area few ways that the intensity of your exercise can be monitored

1. 1 The "20% Rule" for non-fatiguing general conditioning exercise program.
2. Pain, if rated on the Pain Scale, should be "zero" or not any greater than "very weak" or "light".
   

   PAIN SCALE 10+ Maximal Pain 10 Very, Very Strong Pain 9   8   7 Very Strong Pain 6   5 Strong Pain 4 Somewhat Strong Pain 3 Moderate Pain 2 Weak Pain 1 Very Weak Pain 0.5 Very, Very Weak Pain 0 No Pain At All

3. "Perceived Exertion", if rated on the Borg Perceived Exertion Scale, does not exceed "somewhat hard/heavy".

   BORG SCALE FOR RATING PERCEIVED EXERTION 15-GRADE SCALE 10-GRADE SCALE   6   0 Nothing   7 Very, very light 0.5 Very, very weak (just noticeable)   8   1 Very weak   9 Very light   2 Weak (light) 10   3 Moderate 11 Fairly light   4 Somewhat strong 12   5 Strong (heavy) 13 Somewhat hard   6 14   7 Very strong 15 Hard   8 16   9 17 Very hard 10 Very, very strong (almost maximum) 18    19 Very, very hard ° Maximum 20    The rating of perceived exertion scales. The original scale (6-20) on the left and the newer 10-point category scale with ratio properties on the right. From Borg GA. Med Sci Sports Exerc. 1982;14:377-387.

(A NOTE FROM TONY: Please also refer to the Agre Article for examples of research exercise protocols, another background and guidance )
Strength, Endurance, and Work Capacity After Muscle Strengthening Exercise in Postpolio Subjects ABSTRACT

POLIO CLINIC
PHYSICAL THERAPY SERVICE

SUGGESTIONS FOR IMPROVING SLEEPING POSTURE: SIDE-LYING

The goal is to provide a supported resting position in order to prevent joint pain, morning stiffness, and headaches; allow for a comfortable night of sleep; and increase your energy level the next day.

The following are recommendations to try at home based on what we tried in the clinic:

1. Punch a "nest egg" in pillow for head
2. Neck roll between bed and pillow
3. Towel pad/small pillow under waist
4. Pillow between lower and upper leg

REMEMBER:

• MINOR ADJUSTMENTS TO TOWEL OR PILLOW THICKNESSES MAY BE NEEDED (THAT IS "FINE TUNING") SECONDARY TO HAVING A DIFFERENT MATTRESS TYPE AT HOME.

• THE GOAL IS TO PROVIDE ENOUGH SUPPORT SO THAT YOUR JOINTS ARE IN PROPER ALIGNMENT, ABNORMAL JOINT STRESSES ARE PREVENTED, AND & POSTURAL MUSCLES CAN RELAX.

SUGGESTIONS FOR IMPROVING SLEEPING POSTURE: ¾ SUPINE

1. Punch a 'nest egg" in the pillow for your head
2. Neck roll
3. Pillow tucked and secure along the length of your back
4. Waist pad
5. Bring bottom hip forward
6. Bring bottom shoulder out
7. Pillows between legs
8. Pillow to" hug" in front of chest

SUGGESTIONS FOR IMPROVING SLEEPING POSTURE: ¾ PRONE

1. PILLOW LENGTHEWISE UNDER TRUNK
2. PILLOW UNDER TOP LEG
3. HEAD ON PILLOW TURNED 1/4 WAY, NOT "TWISTED ALL AROUND".

Dr. Anne Gawne is at present Director of the The Post-Polio Clinic at the Roosevelt Warm Springs Institute for Rehabilitation. Her secretary Lorell can be reached at phone 706-655-5322, for appointments

You should also request to be transferred to the Information Desk located in Georgia Hall for room reservations, and if you think you will be needed brace shop work, make an appointment in the brace shop for the first morning you are there, after your evaluation by Dr. Gawne, therapist, etc., so that they start working on your needs. They are quite fast. In two or three days they have what you need ready.

Room check-in time is 3:00 p.m. and check out is 12:00 noon. Polio clinic begins at 8:30 a.m. in the Outpatient Clinic which is located in North 1 Wing. All 2 day- polio- patients will require lab work on the first morning of their clinic appointment. Coffee and sweet rolls will be available upon completion of your lab work. NOTE. PLEASE TAKE PRESCRIBED MEDICATIONS AS DIRECTED.

You will need to bring comfortable clothing, your own personal toiletry items, current medications and all equipment you currently use. You should also bring any copies of Xrays, labs or reports from your physician at home. If you require assistive equipment please contact the information Desk or Lorell Neely and arrange for this in advance. Telephones and televisions are available in the guests rooms.

All charges will be billed to your insurance or to you. They do not bill for meals, housing or transportation; therefore, you will be required to pay for these while you are here. Rooms are available in Builders Hall ($20-34) and Kress hall ($35-50) The prices at the cafeteria are based on individual servings (like Morrisons) and the average cost is approximately $2.50-$3.50 per meal. You may be asked to pay at least some of the cost not covered by your insurance for equipment purchase. Arrangements can be made at the time of purchase. They do provide transportation to and from the Airport, but this service must be requested in advance of your visit.

NOTE BY TONY: There are a few places in town where you can go for lunch. Bullock House has delicious food, as well as one or two other places. Manchester is 5 miles away, you can find supermarkets and many places to eat there. Warm Springs Village, next to the Institute is about two or three blocks' town. They have around 65 antique shops and it is a historic place. You can visit five minutes away Roosevelt's Little While House, a replica of the Washington White House – which looks like a doll house almost. Pine Mountain, Roosevelt's Park, Callaway Gardens, are from 10 to 20 miles away. One usually finishes by noon first morning – so you can take the afternoon to sightsee these places or go to Atlanta an hour away.

Warm Springs logo is " a step behind in time " . Don't take credit cards there. Only checks and cash. (The Brace shop now accepts Credit Cards)

THE ROOSEVELT WARM SPRINGS INSTITUTE FOR REHABILITATION
Roosevelt Warm Springs Institute for Rehabilitation (Roosevelt Institute)

Was founded in 1927 by Franklin D. Roosevelt as a polio aftercare facility under the name Georgia Warm Springs Foundation. Polio patients from all over the country, the world, came to Warm Springs for services.

Eventually the battle was won – polio was conquered by the vaccine. Those is Warm Springs rejoiced patients and staff alike. Polio patients continued to come to Warm Springs, throughout the forties and fifties but they were fewer in number.

The Foundation turned its vast range of expertise in rehabilitation to the treatment of people with other disabilities. The facility, however, struggled with funding difficulties.

In 1964, the Georgia Rehabilitation Agency opened the Georgia Rehabilitation Center on land deeded to the state by the Foundation. The facility was built to provide vocational rehabilitation services to the state's disabled people.

The end of an era came in 1974 when the New York-based Georgia Warm Springs Foundation sold its Warm Springs Facilities and land to the state of Georgia for ONE DOLLAR.

A new beginning was underway.

Today the Roosevelt Institute, under the state's Division of Rehabilitation Services, provides medical rehabilitation, vocational rehabilitation and independent living services to over 3,000 people each year.

People with a wide variety of disabilties are served in the institute's multifaceted programs.

These disabilities include spinal cord injuries, arthritis, amputation, post-polio, strokes, head injuries, seizure disorders, most orthopedic and neurological conditions, hearing impairments, communications disorders, emotional/psychiatric problems, developmental disabilities and industrial injuries.

The 96-bed medical rehabilitation unit offers both inpatient and outpatient services to persons with physical disabilities. Patients who require hospitalization participate in an intensive rehabilitation program designed to help them gain independence in daily living activities. The rehabilitation team plans and carries out an evaluation and treatment program individually designed for each patient.

Vocational and independent –living services assist persons with mental and/or physical disabilities in developing vocational goals, adjusting to community living, learning to live independently and adjusting to the work environment as well as gaining specific job skills which may lead to employment. The unit includes a 215-bed dormitory and a vocational training area which houses programs in radio-TV repair, auto mechanics, printshop, service skills, business education and any other.

The independent living skills training program is a six-week residential experience providing severely physical disabled persons with the skills to function independently in the community.

In addition, the Institute has a number of specialized services including a head injury rehabilitation program, an orthotics and prosthetics department, a recreation program for students and patients, an industrial injury program and a specialized program for post-polio patients.

The most impressive thing about the Roosevelt Institute, however, may not be its facilities, staff or resources, which are considerable; rather, it may be the sensitivity to a disabled person's need for renewed spirit and personal resolve. What has been know down through the years as "the Spirit of Warm Springs" that special feeling of optimism, warmth and caring, is still present.

The effort of one remarkable man, Franklin Delano Roosevelt, to regain independence has ultimately benefited thousands and continues to do so. There could be no greater legacy.

Tony's note: President Roosevelt spent in Warm Springs 2/3s of his personal fortune.

A NOTE FROM TONY:
DR. PAUL E. PEACH

Dr. Paul E. Peach, was for ten years the Medical Director at Warm Springs. I saw him in 1995-6-7,

In August 1997 he went to work in Albany , Georgia, at the Rehab Associates of South Georgia Inc.

Phone 912-434-2551 Fax 912-434-2564. - They also have a J.E. Hanger brace shop in Albany, but it is not located in the same place where Dr. Peach is, that is one of the reasons I have not gone to Albany to see Dr. Peach, because it is not a Campus site, like Warm Springs, but you have to go from one place to the other.

Dr. Peach has written many papers on the Effects of Treatment and Noncompliance on Post Polio Sequale, Overuse weakness with evidence of muscle damage in patients with residual paralysis from Polio, and Late Effects of Polio., etc.

.P.S. Hope that this may be of interest to you all. Love, Tony (female) from Santo Domingo, Dominican Republic.

February 5, 2000.