The examples and perspective in this article deal primarily with the United States and do not represent a worldwide view of the subject.(February 2018)
|Synonyms||Physiatrics, physiatry, rehabilitation medicine, physical and rehabilitation medicine (PRM)|
Physical medicine and rehabilitation, also known as physiatry,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 injuries, brain injuries, strokes, as well as pain or disability due to muscle, ligament or nerve damage. A physician having completed training in this field may be referred to as a physiatrist.
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 an interdisciplinary team of physical, occupational, recreational and speech therapists, 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.
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 Dr. Rusk and others, the specialty incorporated rehabilitation medicine and changed its name to Physical Medicine and Rehabilitation.
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.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.
Not only must a physiatrist have medical knowledge regarding a patient's condition, but they also need to hav 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.
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.
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.
Seven accredited sub-specializations are recognized in the United States:
Fellowship training for other unaccredited subspecialties within the field include the following:
Hemiparesis, or unilateral paresis, is weakness of one entire side of the body. Hemiplegia is, in its most severe form, complete paralysis of half of the body. Hemiparesis and hemiplegia can be caused by different medical conditions, including congenital causes, trauma, tumors, or stroke.
Neurology is a branch of medicine dealing with disorders of the nervous system. Neurology deals with the diagnosis and treatment of all categories of conditions and disease involving the central and peripheral nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.
Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. Physical therapy is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, prognosis, patient education, physical intervention, rehabilitation, disease prevention and health promotion. Physical therapists are known as physiotherapists in many 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.
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, chiropractors, physiatrists, and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine 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.
The Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is a not-for-profit nationally ranked 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. 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 the Northwestern Memorial Hospital campus and partners on research and medical efforts.
Bronson Methodist Hospital is a 434-bed non-profit teaching hospital located in downtown Kalamazoo, Michigan, United States, and is a Level I trauma center. Bronson Methodist Hospital is the flagship of the Bronson Healthcare Group, a non-profit healthcare system serving all of southwest Michigan and northern Indiana. Bronson Methodist Hospital provides care in cardiology, orthopedics, surgery, emergency medicine, neurology, oncology; in neurological care as a Comprehensive Stroke Center; in cardiac care as a Chest Pain Center; in obstetrics as a BirthPlace and high-risk pregnancy center, and in pediatrics as a children's hospital.
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, numbness, 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.
Central cord syndrome (CCS) is the most common form of cervical spinal cord injury. It is characterized by loss of motion 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. The syndrome is more common in people over the age of 50 because osteoarthritis in the neck region causes weakening of the vertebrae. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.
Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.
Shepherd Center is a private, not-for profit hospital in Atlanta, Georgia. Founded in 1975, the 152-bed hospital focuses on the medical treatment, research and rehabilitation for people with spinal cord injury and disease, acquired brain injury, multiple sclerosis, chronic pain and other neuromuscular problems.
MedStar National Rehabilitation Network is located in Washington, D.C., and specializes in treating persons with physical disabilities, including spinal cord injury, brain injury, stroke, arthritis, amputation, multiple sclerosis, post-polio syndrome, orthopedic, and other neurological conditions. National Rehabilitation Hospital was founded in 1986 by Edward A. Eckenhoff, and is a member of the MedStar Health system, the Washington, D.C.-Baltimore region's largest non-profit healthcare organization.
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 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, M.D., is a physiatrist with an international reputation in the rehabilitation of individuals with disorders of the central nervous system. He is currently 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. In 1985, Magee's brain injury rehabilitation program became the first in the nation to be accredited by the Commission on the Accreditation of Rehabilitation Facilities. Magee partnered with Jefferson Hospital to create one of the nation's 14 federally designated centers for spinal cord injury rehabilitation. Magee has been rated one of America's leading rehabilitation hospitals by U.S. News & World Report. Magee provides treatment to more than 5,000 individuals annually. Magee is authorized to treat wounded military personnel returning from war. Magee is not an Obligated Group Affiliate.
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."
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. Opened 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.
Segun Toyin Dawodu is a Nigerian Physiatrist and lawyer with the WellSpan Health, he served as an Associate Professor of Pain Medicine at Albany Medical College.
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 overall and specifically with gaining and advancing with employment. 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 enhance or impede progress.
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