Physical medicine and rehabilitation

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Physical medicine and rehabilitation
Rehabilitation physician polyelectromyography.png
Rehabilitation physician conducting a 10-channel dynamic polyelectromyography during a patient's dystonic event.
Occupation
Names Physician
SynonymsPhysiatry, rehabilitation medicine, PM&R
Pronunciation
Activity sectors
 Medicine
Description
Education required

Physical medicine and rehabilitation (PM&R), also known as physiatry, [1] is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions such as spinal cord injury, brain injury, musculoskeletal injury, stroke, pain and spasticity from muscle, ligament, or nerve damage. PM&R physicians lead rehabilitation teams and are trained in medication management, electrodiagnosis, and targeted injections. [2] A physician having completed training in this field may be referred to as a physiatrist.[ citation needed ]

Contents

Scope of the field

Physical medicine and rehabilitation encompasses a variety of clinical settings and patient populations.[ citation needed ]

In hospital settings, physiatrists commonly treat patients who have had an amputation, spinal cord injury, stroke, traumatic brain injury, and other debilitating injuries or conditions. In treating these patients, physiatrists lead a team of physical, occupational, respiratory, and speech therapists, as well as nurses, psychologists, and social workers. [ citation needed ].

In outpatient settings, physiatrists treat patients with muscle and joint injuries, pain syndromes, non-healing wounds, and other disabling conditions. Physiatrists are trained to perform injections into joints or muscle as a pain treatment option. Physiatrists are also trained in nerve conduction studies and electromyography. [3]

History

During the first half of the 20th century, two unofficial specialties, physical medicine and rehabilitation medicine, developed separately, but in practice both treated similar patient populations consisting of those with disabling injuries. Frank H. Krusen was a pioneer of physical medicine, which emphasized the use of physical agents, such as hydrotherapy and hyperbaric oxygen, at Temple University and then at Mayo Clinic and it was he that coined the term 'physiatry' in 1938. Rehabilitation medicine gained prominence during both World Wars in the treatment of injured soldiers and laborers. Howard A. Rusk, an internal medicine physician from Missouri, became a pioneer of rehabilitation medicine after being appointed to rehabilitate airmen during World War II. In 1944, the Baruch Committee, commissioned by philanthropist Bernard Baruch, defined the specialty as a combination of the two fields and laid the framework for its acceptance as an official medical specialty. The committee also distributed funds to establish training and research programs across the nation. The specialty that came to be known as physical medicine and rehabilitation in the United States was officially established in 1947, when an independent Board of Physical Medicine was established under the authority of the American Board of Medical Specialties. In 1949, at the insistence of Rusk and others, the specialty incorporated rehabilitation medicine and changed its name to Physical Medicine and Rehabilitation. [4] [5]

Treatment

The major goal of physical medicine and rehabilitation treatment is to help a person function optimally within the limitations placed upon them by a disabling impairment or disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those not able to achieve full restoration. A team approach to chronic conditions is emphasized to coordinate care of patients. Comprehensive rehabilitation is provided by specialists in this field, who act as facilitators, team leaders, and medical experts for rehabilitation.[ citation needed ]

In rehabilitation, goal setting is often used by the clinical care team to provide the team and the person undergoing rehabilitation for an acquired disability a direction to work towards. [6] Very low quality evidence indicates that goal setting may lead to a higher quality of life for the person with the disability, and it not clear if goal setting used in this context reduces or increases re-hospitalization or death. [6]

Not only must a physiatrist have medical knowledge regarding a patient's condition, but they also need to have practical knowledge regarding it as well. This involves issues such as: what type of wheelchair best suits the patient, what type of prosthetic would fit best, does their current house layout accommodate their handicap well, and other every day complications that their patients might have. [3]

Training

In the United States, residency training for physical medicine and rehabilitation is four years long, including an intern year of general medical training. There are 83 programs in the United States accredited by the Accreditation Council for Graduate Medical Education, in 28 states. [7]

Specifics of training differs from program to program but all residents must obtain the same fundamental skills. Residents are trained in the inpatient setting to take care of multiple types of rehabilitation including: spinal cord injury, traumatic brain injury, stroke, orthopedic injuries, cancer, cerebral palsy, burn, pediatric rehab, and other disabling injuries. The residents are also trained in the outpatient setting to know how to take care of the chronic conditions patients have following their inpatient stay. During training, residents are instructed on how to properly perform several diagnostic procedures which include electromyography, nerve conduction studies and also procedures such as joint injections and trigger point injections. [3]

Subspecialties

Seven accredited sub-specializations are recognized in the United States: [8]

Fellowship training for other unaccredited subspecialties within the field include the following: [9]

See also

Related Research Articles

<span class="mw-page-title-main">Neurology</span> Medical specialty dealing with disorders of the nervous system

Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system, using various techniques of neurotherapy.

<span class="mw-page-title-main">Neurosurgery</span> Medical specialty of disorders which affect any portion of the nervous system

Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nervous system, and cerebrovascular system. Neurosurgery as a medical specialty also includes non-surgical management of some neurological conditions.

<span class="mw-page-title-main">Physical therapy</span> Profession that helps a disabled person function in everyday life

Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.

Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.

<span class="mw-page-title-main">Nerve conduction study</span> Diagnostic test for nerve function

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, physiatrists, and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine (performing needle electromyography as part of residency training and, in some cases, acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.

<span class="mw-page-title-main">Ryan AbilityLab</span> Hospital in Illinois, United States

The Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is a not-for-profit physical medicine and rehabilitation research hospital based in Chicago, Illinois. Founded in 1954, the AbilityLab is designed for patient care, education, and research in physical medicine and rehabilitation (PM&R). The AbilityLab specializes in rehabilitation for adults and children with the most severe, complex conditions ranging from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. Affiliated with Northwestern University, the hospital is located on Northwestern’s Chicago campus and partners on research and medical efforts.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Central cord syndrome</span> Human spinal cord disorder

Central cord syndrome (CCS) is the most common form of cervical spinal cord injury (SCI). It is characterized by loss of power and sensation in arms and hands. It usually results from trauma which causes damage to the neck, leading to major injury to the central corticospinal tract of the spinal cord. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.

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Shepherd Center, located in Atlanta, Georgia, is a private, not-for-profit hospital specializing in medical treatment, research, and rehabilitation for people with complex conditions, including spinal cord injury, acquired brain injury, multi-trauma, traumatic amputations, stroke, multiple sclerosis, chronic pain, and other neuromuscular conditions.

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DMC Rehabilitation Institute of Michigan (RIM) is one of the eight hospitals affiliated with the Detroit Medical Center. RIM is one of the largest, academic, rehabilitation hospitals in the United States specializing in rehabilitation medicine and research. RIM offers clinical treatment in spinal cord injury, brain injury, stroke, complex trauma and orthopedics and catastrophic injury care. The institute is home to the Center for Spinal Cord Injury Recovery, a facility designed to implement and study innovative treatments in spinal cord injury recovery.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) is the national medical specialty society in the United States for physicians who specialize in physical medicine and rehabilitation (PM&R). These physicians are called "physiatrists" or "rehabilitation physicians". Founded in 1938, AAPM&R also offers education, advocates for PM&R, and promotes PM&R research.

Kristjan T. Ragnarsson is an American physiatrist who focuses on the rehabilitation of individuals with disorders of the central nervous system. He is the Dr. Lucy G. Moses Professor and Chair of Rehabilitation Medicine at The Mount Sinai Medical Center in New York City.

Magee Rehabilitation Hospital, part of Jefferson Health, founded in 1958, is a 96-bed specialty medical rehabilitation hospital providing physical and cognitive rehabilitation services. Magee's flagship facility is located in Center City Philadelphia. In addition to the main campus that offers comprehensive services for spinal cord injury, brain injury, stroke, orthopaedic replacement, amputation, pain management and work injury, Magee provides an expanding outpatient network serving the surrounding communities.

Walton Rehabilitation Hospital is a non-profit rehabilitation center located in Augusta, Georgia, United States which has won numerous awards for the quality of its healthcare. The hospital was founded in 1988 and is one component of the Walton Rehabilitation Health System. This hospital offers both inpatient and outpatient programs to teens and adults and assesses disabling illnesses, stroke, head injuries, spinal injuries, and orthopedic injuries. Walton is the only specialized provider of rehabilitation in the Central Savannah River Area of Georgia. Its published mission is to "enhance the quality of life for people with acquired disabilities."

TIRR Memorial Hermann is a 134-bed rehabilitation hospital, rehabilitation and research center, outpatient medical clinic and network of outpatient rehabilitation centers in Houston, Texas that offers comprehensive physical, occupational, and speech therapy services to rehabilitate patients following traumatic brain or spinal injury or to those suffering from neurologic illnesses.

<span class="mw-page-title-main">Burke Rehabilitation Hospital</span> Hospital in New York, USA

Burke Rehabilitation Hospital is a non-profit, 150-bed acute rehabilitation hospital located in White Plains, New York. It is the only hospital in Westchester County entirely dedicated to rehabilitation medicine. Opening in 1915, Burke has been involved in medical rehabilitation for over one hundred years. As of January 2016, Burke is a member of the Montefiore Health System, Inc.

Cancer rehabilitation has been defined in the scientific literature as a distinct field of medicine that focuses on reducing or eliminating side-effects of cancer treatment and improving survivors' strength, ability to function and quality of life

Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

References

  1. ↑ "physical medicine" in the American Heritage Dictionary
  2. ↑ "What is Physiatry? - HSS". Hss.edu. Retrieved 2012-10-20.
  3. 1 2 3 Lee, Peter K. W. (2011). "Defining Physiatry and Future Scope of Rehabilitation Medicine". Annals of Rehabilitation Medicine. 35 (4): 445–449. doi:10.5535/arm.2011.35.4.445. PMC   3309231 . PMID   22506158.
  4. ↑ Verville, Richard (2009). War, Politics, and Philanthropy: The History of Rehabilitation Medicine. Lanham, Maryland: University Press of America. ISBN   978-0-7618-4594-2.
  5. ↑ Dillingham, Timothy R. (2002). "Physiatry, physical medicine, and rehabilitation: historical development and military roles". Physical Medicine and Rehabilitation Clinics of North America. 13 (1): 1–16, v. doi:10.1016/S1047-9651(03)00069-X. PMID   11878077.
  6. 1 2 Levack, William M. M.; Weatherall, Mark; Hay-Smith, E. Jean C.; Dean, Sarah G.; McPherson, Kathryn; Siegert, Richard J. (2015-07-20). "Goal setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation". The Cochrane Database of Systematic Reviews. 2015 (7): CD009727. doi:10.1002/14651858.CD009727.pub2. hdl: 10292/9134 . ISSN   1469-493X. PMC   8941379 . PMID   26189709.
  7. ↑ "A Step by Step Guide to Applying for a PM&R Residency". American Academy of Physical Medicine and Rehabilitation. Retrieved 16 February 2018.
  8. ↑ "Physical Medicine and Rehabilitation". Accreditation Council for Graduate Medical Education. Retrieved 13 May 2016.
  9. ↑ "Roadmap to a fellowship - American Academy of Physical Medicine and Rehabilitation" (PDF). AAPM&R. Retrieved 2018-01-13.
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