In 1940, Sister Elizabeth Kenny, an Australian bush nurse from Queensland, arrived in North America and challenged this approach to treatment. In treating polio cases in rural Australia between 1928 and 1940, Kenny had developed a form of physical therapy that—instead of immobilizing afflicted limbs—aimed to relieve pain and spasms in polio patients through the use of hot, moist packs to relieve muscle spasm and early activity and exercise to maximize the strength of unaffected muscle fibers and promote the neuroplastic recruitment of remaining nerve cells that had not been killed by the virus. Sister Kenny later settled in Minnesota where she established the Sister Kenny Rehabilitation Institute, beginning a world-wide crusade to advocate her system of treatment. Slowly, Kenny's ideas won acceptance, and by the mid-20th century had become the hallmark for the treatment of paralytic polio. In combination with antispasmodic medications to reduce muscular contractions, Kenny's therapy is still used in the treatment of paralytic poliomyelitis.