Physical medicine and rehabilitation
Physical medicine and rehabilitation (PM&R), or physiatry, is a branch of medicine dealing with functional restoration of a person affected by physical disability. A physician who has completed training in this field is referred to as a physiatrist [fɪz'aiətrɪst]. In order to be a physiatrist in the United States, one must complete four years of medical school, one year of internship and three years of residency. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).[1]
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History
The term 'Physiatry' was coined by Dr. Frank H. Krusen in 1938. The term was accepted by the American Medical Association in 1946. The field grew notably in response to the demand for sophisticated rehabilitation techniques for the large number of injured soldiers returning from World War II.
Scope of the field
Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is placed on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement & activities modification, adaptive equipments and assistive device, orthotics (braces), prosthesis, and experiential training approaches.
Physical Medicine & Rehabilitation physicians may also perform electrodiagnostics which are used to provide nervous system functional information for diagnosis and / or prognosis for various neuromuscular disorders. The common electrodiagnostic tests performed by physiatrists are nerve conduction velocity studies (NCVs) and needle electromyographes (EMGs). The nerve conduction velocity study involves electrical stimulation to peripheral nerves and the nerves' responses are measured such as onset latency, amplitude and conduction velocity. Needle electromyography requires needle electrode insertion into the examined muscles to detect the electrical potential generated from muscle fibers. Abnormal electrical potentials such as fibrillation potential or positive sharp wave detected by EMG needle indicates the presence of muscle fibers that lost the nerve supply.
Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskeletal pain syndromes such as low back pain, fibromyalgia and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through multidisciplinary approach involving psychologists, physical therapists, occupational therapists, chiropractors, and interventional procedures when indicated. In addition to the previous methodology, stroke is often treated with the help of a speech therapist and recreational therapist when possible.
Philosophy
The major concern of the field is the ability of the person to function optimally within the limitations placed upon them by a 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 who may not be able to achieve full restoration. A team approach to chronic conditions is emphasized, using interdisciplinary team meetings to coordinate care of the patients.
Subspecialty
Six formal sub-specializations are recognized by the field in the United States: pain medicine, pediatric rehabilitation, spinal cord injury medicine, neuromuscular medicine, sports medicine, and hospice and palliative medicine. Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, electrodiagnostics, traumatic brain injury (TBI), and cardiopulmonary rehabilitation.
Residencies in the United States
There are no clear rankings among PM&R residencies, but a list of the most commonly cited top programs in the United States would include
- Baylor College of Medicine/University of Texas at Houston Alliance Program, Houston
- Rehabilitation Institute of Chicago (RIC) at Northwestern University, Chicago
- Kessler Institute for Rehabilitation, West Orange, NJ (UMDNJ: New Jersey Medical School, Newark, NJ)
- University of Washington Program, Seattle
- Mayo Clinic Program, Rochester, MN
- Spaulding Rehabilitation Hospital of Partners HealthCare affiliated with Harvard Medical School, Boston
- Ohio State University Program, Columbus, OH
- Thomas Jefferson University Program, Philadelphia
- University of Michigan Program, Ann Arbor, MI
- Temple University Program, Philadelphia
- Johns Hopkins University Program, Baltimore, MD
- Georgetown University Hospital/National Rehabilitation Hospital, Washington, D.C.
There are approximately 350 total positions available via the National Resident Matching Program (NRMP) per year.
Notable Rehabilitation Hospitals in the United States
In addition to those associated with elite PM&R residency programs, notable US rehabilitation hospitals, many of which are teaching hospitals, include:
- Children's Specialized Hospital in Mountainside, New Jersey, a pediatric teaching hospital affiliated with both UMDNJ programs
- Kessler Institute for Rehabilitation in West Orange, NJ, affiliated with UMDNJ-New Jersey Medical School.
- Rehabilitation Institute of Chicago (RIC) at Northwestern University, Chicago
- Craig Hospital in Englewood, Colorado, a teaching hospital for University of Colorado
- Magee Rehabilitation, Philadelphia, a major teaching hospital for Thomas Jefferson University
- Moss Rehabilitation Hospital in Elkins Park, Pennsylvania, a teaching hospital for Temple and Thomas Jefferson University
- National Rehabilitation Hospital in Washington, principal teaching hospital for Georgetown University
- Rancho Los Amigos National Rehabilitation Center in Downey, California
- The Rusk Institute of Rehabilitation Medicine at the New York University Langone Medical Center in New York, major teaching site for New York University School of Medicine
- Shepard Hospital in Atlanta, major teaching affiliate for Emory University
- Spaulding Rehabilitation Hospital in Boston, a member of Partners HealthCare, affiliated with Harvard Medical School
- TIRR: The Institute for Rehabilitation and Research in Houston, Texas, principal teaching hospital for Baylor/UT residency program.
- The Rehab Center at Mission Regional Medical Center in Mission, Texas
- Johns Hopkins Physical Medicine and Rehabilitation in Baltimore, Maryland
- Rehabilitation Center at Santa Clara Valley Medical Center, San Jose, California
Popular textbooks
Two main textbooks often used by those in the specialty are Physical Medicine and Rehabilitation: Principles and Practice by Joel DeLisa and Physical Medicine and Rehabilitation Medicine by Randall Braddom. Useful handbooks for medical students and residents include Practical Manual of Physical Medicine and Rehabilitation: Diagnostics, Therapeutics and Basic Problems, 2nd. Ed. by Jackson C. Tan, PM&R Secrets by Mark Young, Brian O'Young and Steven Stiens, and PM&R Pocketpedia by Howard Choi and colleagues.
Book Reference
- Joel DeLisa (2004). Physical Medicine and Rehabilitation: Principles and Practice. Lippincott Williams & Wilkins. ISBN 0-7817-4130-0.
- Randall Braddom (2006). Physical Medicine and Rehabilitation. WB Saunders. ISBN 978-1416026105.
- Jackson C. Tan (2006). Practical Manual of Physical Medicine and Rehabilitation: Diagnostics, Therapeutics and Basic Problems, 2nd. Ed.. Elsevier Mosby. ISBN 0-323-03285-0.
- Bryan J. O'Young, Mark A. Young, Steven A. Stiens (2002). Physical Medicine and Rehabilitation Secrets. Hanley & Belfus. ISBN 1-56053-437-0.
- Howard Choi, Ross Sugar, David E. Fish, Matthew Shatzer, Brian Krabak (2003). Physical Medicine and Rehabilitation Pocketpedia. Lippincott Williams & Wilkins. ISBN 0-7817-4433-4.
Journals
The two main journals of the PM&R field are Archives of Physical Medicine and Rehabilitation and American Journal of Physical Medicine and Rehabilitation. Both journals are published monthly. Archives, which had been co-owned by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the American Congress of Rehabilitation Medicine (ACRM), will be solely owned by the Congress beginning January 2009. At that time, the Academy will launch a new journal: PM&R, The journal of injury, function and rehabilitation.[1]
Quarterly journal Physical Medicine And Rehabilitation Clinics of North America [2] published by Elsevier / Saunders also provides in-depth updated information on specific Physical Medicine and Rehabilitation topic.
Individual Residency Programs
- PM&R Residency Programs in the United States
- PM&R Residency Programs in Canada
Notes
References
- Famous Canadian Physicians: Dr. Gustave Gingras at Library and Archives Canada
External links
Organizations
- American Academy of Physical Medicine and Rehabilitation National medical society, has a PM&R resident/medical student mentoring feature
- American Board of Physical Medicine and Rehabilitation ABMS recognized entity for board certification in PM&R
- [3] Courage Center, Minneapolis-based nonprofit rehabilitation and resource center for people of all ages and abilities.
- Association of Academic Physiatrists Organization consisting largely of those with interests in academic PM&R
- StudentDoctor.Net Student mentoring site, has a PM&R forum
- Physical Medicine and Rehabilitation - eMedicine Journal medical reference
- Canadian Association of Physical Medicine and Rehabilitation - Canadian National PM&R Medical Society
- International Society of Physical Medicine and Rehabilitation
- American Association of Neuromuscular and Electrodiagnostic Medicine - National medical society comprised primarily of physiatrists and neurologists who perform electrodiagnostic studies (eg. electromyography and nerve conduction studies) and provide medical care to individuals with neuromuscular disorders.
- Iranian Society of Physical Medicine and Rehabilitation
- Department B National organization providing comprehensive business resources to practicing physiatrists
- http://www.iapmr.com/ Indian Association of Physical Medicine and Rehabilitation- Physiatrists from anywhere in the world can be a life member.
Additional Resources
- Reminiscence therapy
- Physiatry Practice Management Portal Resources for physiatrists
- Patient Information Physiatry-related information for patients including searchable database of physicians.
- SpineUniverse Portal for spine-related physiatry - glossary of terms, procedures explained, global physician directory.
Rehabilitation hospital links
- Johns Hopkins Department of Physical Medicine and Rehabilitation
- The Howard A. Rusk Institute of Rehabilitation Medicine at the New York University Medical Center
- TIRR - The Institute for Rehabilitation and Research Houston
- New York-Presbyterian Hospital
- CNS Centre for Neuro Skills
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