Introduction

Poliovirus is an RNA virus transmitted via contact or droplet infection. It enters through the alimentary canal and into the bloodstream. While some infected individuals remain asymptomatic, its common symptoms include fever, headache, fatigue, stiffness in the neck or back, and pain in the limbs. No cure exists for polio, but its symptoms can be treated, and vaccination is the most effective means of its prevention (Khan, 2010; Oshinsky, 2005; Trevelyan et al., 2005). Polio persists in various Asian and African countries, and the World Health Organization continues to recommend vaccination (World Health Organization, 2021). Polio transmission surged across North America and Europe in the early 1940s, with its incidence peaking in the 1940s and 1950s (Alaranta et al., 2002; Altenbaugh, 2015; Nathanson & Kew, 2010; Rutty, 1996; Trevelyan et al., 2005). In Finland, between 1954 and 1956, approximately 700 to 800 cases were detected annually, and the total number of infected individuals was estimated at 10,000 (Valtonen et al., 2005). In 1957, vaccination campaigns began, eradicating the disease in the 1960s, but it re-emerged in 1984, with the most recent case reported in 1985 (Finnish Institute for Health and Welfare, 2019; Muiluvuori, 2010).

The onset of polio infection was sudden and its progression unusual. Since its symptoms—stiff neck, fever, nausea, and lethargy—overlapped with those of other pediatric illnesses, diagnosis was challenging. Some infected individuals became paralyzed, as the nerve cells in their spinal column were damaged and destroyed, while others died from respiratory failure. The difficulty of diagnosis and uncertainty about the origin and transmission of polio generated widespread fear (Carter, 2001; Highley, 2016; Wilson, 2005). The children and adolescents diagnosed with polio had to be immediately isolated—in hospitals, infectious disease units, or at home—throughout the acute phase of the disease, which was when the contagion risk was highest. The isolation stage lasted approximately two weeks, but the acute phase lasted totally approximately four weeks. Immediately afterward, the patients entered the challenging rehabilitation phase in the hospital or at home, which, depending on the damage wreaked on their bodies, lasted for weeks or years. Some suffered respiratory paralysis and were placed on ventilators, commonly known as iron lungs (Altenbaugh, 2015; Muiluvuori, 2010; Wilson, 2005).

Following the acute and isolation phases, the patients with polio underwent prolonged orthopedic and rehabilitation treatments. To support function and correct deformities, plaster applications, casts, physiotherapy, and orthotic devices were used. When conservative treatment proved insufficient, corrective surgical procedures—including tendon transfers, joint fusions, and epiphysiodesis to halt asymmetric bone growth—were performed. Since children’s bodies and physical autonomy were placed entirely in the hands of others, it compounded the experiences of trauma, loss of identity and control, and social isolation (Altenbaugh, 2015; Highley, 2016).

The experience of bodily objectification and loss of agency has been theorized through Foucauldian frameworks as a process of designation and division, in which a child’s disabled polio body is subjected to medical and rehabilitative discourses that effectively silence the child’s lived experience (Yoshida & Shanouda, 2015). Polio also profoundly disrupted children’s access to education and schooling, with many children relegated to special classes, denied re-entry to school, or offered only home-based instruction. Moreover, prolonged treatment increasingly blurred the boundaries between hospital, home, and school (Altenbaugh, 2006).

Rehabilitation methods changed considerably worldwide during the epidemic period. Early treatment relied on immobilization using splints and plaster casts, which often atrophied muscles and worsened deformities. A fundamental shift occurred internationally in the early 1940s, when immobilization as the dominant treatment philosophy was gradually replaced by the Kenny method, which involved hot packs, gentle muscle exercises, and active patient participation in recovery (Neumann, 2004; Rogers, 2021).

Finland did not widely adopt the Kenny method. Considered extremely taxing for the patient, the method was not recommended by the nursing textbooks of the 1950s and 1960s, and polio treatment continued to follow the prevailing nurse-centered, paternalistic care focused on symptom management (Veltheim et al., 2024). Although patient-centered care was beginning to develop, professional attitudes remained distant, and nurses’ limited awareness of children’s developmental, social, and psychological needs biased care heavily toward physical and medical concerns (Veltheim et al., 2024; Wilson, 2005). Parental presence was not considered favorably in pediatric hospital settings, and family-centered care developed slowly (Jolley & Shields, 2009). Strict hospital routines and visitor restrictions augmented children’s loneliness, and limited contact with home and family was justified by the belief that children would otherwise become disobedient (Highley, 2016). As previous Finnish research has shown, polio survivors recall the isolation phase as lonely and silent, with care perceived as cold and dismissive and children excluded from decisions about their own treatment (Elomaa-Krapu & Kaunonen, 2023). According to international research on polio survivors, children were deeply unsettled and saddened when they were sent away from home for specialized treatment; sometimes their parents and relatives could not visit them at all due to the distance between home and clinic (Sjödahl Hammarlund et al., 2021). The physical, psychological, and social suffering of young polio survivors has not been fully acknowledged, and their childhood experiences of corrective surgery and rehabilitation have not been sufficiently examined globally from a nursing perspective (Altenbaugh, 2015; Highley, 2016).

The historical origins of family-centered care are rooted in the suffering that followed World War II; in the mid-twentieth century, parents worldwide were often prevented from visiting their hospitalized children altogether or were only permitted half-an-hour-per-week visits (Jolley & Shields, 2009). The philosophy of pediatric nursing has since advanced considerably and is now grounded in family-centered care, which emphasizes the dynamic relationship between child patients and their families, the importance of maintaining normal family life, and the reduction of children’s stress (Kuo et al., 2012; Shields et al., 2012).

The present research forms part of a broader research program examining the experiences of child polio survivors and their siblings across the illness and treatment trajectory and the wider impact of the disease on families. The research program—the first nursing study to document polio survivors’ experiences in Finland during the post-war decades of the 1950s and 1960s—aims to contribute to the historical literature on pediatric care, the sequelae of polio and paralysis, and the social significance of these experiences in Finnish society. A secondary aim is to enrich understanding of the history of care provided to polio-affected children and families. Two earlier articles from this research program have been published: The first addressed children’s experiences during the isolation phase (Elomaa-Krapu & Kaunonen, 2023), and the second reported experiences from the post-isolation acute phase prior to discharge or transfer to a rehabilitation facility (Elomaa-Krapu & Kaunonen, 2024). The present article focuses on corrective surgery and rehabilitation.