What is Physical Medicine and Rehabilitaion?
Rehabilitation is a term which is generally perceived to be linked to physical therapy, geriatrics, drug addiction, mental disorders or care of individuals with chronic illnesses. Unfortunately this vague perception is largely prevalent in general public. The core concept of rehabilitation is also poorly understood among medical professionals. Unlike other specialties, the focus of Physical Medicine and Rehabilitation is not limited to an organ or organ system, but it concentrates on the physical and cognitive impairments, activity limitations and social empowerment. The emphasis is on abilities rather than disabilities. A rehabilitation physician is responsible for medical care as well as rehabilitation needs of an individual.
Physical Medicine and Rehabilitation (PMR), also known as Physiatry or Rehabilitation Medicine, is a branch of medicine devoted to the prevention, diagnosis and treatment of neurologic, musculoskeletal, cardiovascular, pulmonary and other disorders that may produce temporary or permanent impairment and associated functional disability. Physiatrist provides care for a broad spectrum of disorders including multiple trauma, brain injury, spinal cord disorders and stroke. PMR also focuses on restoring function to people with problems ranging from physical mobility limitations to those with complex cognitive impairments.
What is a Physiatrist?
Physiatrists, or rehabilitation physicians, are medical doctors who have completed training in the specialty of Physical Medicine and Rehabilitation. They treat any disability resulting from disease or injury involving any organ system. They manage issues that span the entire spectrum, from complicated multiple trauma to injury prevention for athletes.
The role Of a phyciatrist
As team leaders, physiatrists have to take a lead role in coordinating patient care and supervising the goal oriented rehabilitation plan. For example, when a patient with acute spinal cord injury (SCI) is admitted for inpatient rehabilitation, physiatrists perform a SCI-specific assessment, including history, physical examination, functional evaluation and assessment of the psychosocial and vocational needs of the patients. Similarly, all the rehabilitation team members perform their specific assessments and then jointly discuss the rehabilitation goals of the patient. Based upon the recommendations of the team, physiatrists direct the management plan. They are directly responsible for dealing with the medical needs of the patients. Some common medical issues specific to spinal cord injury include treatment of pain, spasticity, neurogenic bladder and bowel, pressure ulcers, autonomic instability, cardiopulmonary impairments, venous thromboembolism, osteoporosis, deconditioning, heterotropic ossification, musculoskeletal problems, mental health disorders and complications of prolonged immobility. They also assess the need for spinal or limb orthosis and determine what equipment is needed for mobility, self-care and activities of daily living in coordination with relevant members of the rehabilitation team. The primary goals of the comprehensive rehabilitation program are to facilitate neurological recovery, minimize disability, maximize functional independence, decrease caregiver burden and improve the quality of life of these individuals and to ensure social empowerment.
In outpatient settings, depending upon the interests and training of physiatrists, their scope of practice includes procedures such as nerve conduction studies, electromyography, urodynamic studies, neurotoxin therapy for spasticity and pain interventions, including intra-articular injections, rigger point injections, epidural injections and sacroiliac joint injections. Rheumatology and musculoskeletal disorders constitute the majority of patients in outpatient care. Advance procedures such as medial branch blocks, radiofrequency ablations, intrathecal baclofen pump management, treatment of headaches with neurotoxins and minimally invasive spinal procedures are also performed by many physiatrists around the world, but the expertise in Pakistan is still lacking.