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dAn Introduction
Physical Medicine
and Rehabilitation
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B iBasics
• Physical Medicine and
Rehabilitation– PM&R
• related terminology– physiatry / physiatrist (fiz•zee•AT•trist)physiatry / physiatrist (fiz zee AT trist)
– rehabilitation medicine
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h &What is PM&R
"Branch of medicine emphasizing prevention, diagnosis, and treatment ofprevention, diagnosis, and treatment of disorders – particularly related to nerves, muscles, and bones – that may producemuscles, and bones that may produce temporary or permanent impairment."
‐ American Academy of PM&R
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A Ph i t i tA Physiatrist…S i li i li i l d di i• Specializes in clinical and diagnostic use of physical agents and exercises
d h h f h lto provide physiotherapy for physical, mental, and occupational rehabilitation of patient
• Examines patient, utilizing electrodiagnosis andother diagnostic procedures to determine need for and extent of therapy.
‐Webster’s Online Dictionary 2009
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Another Laymen’sDefinition
" b h f d h h"A branch of medicine which aims to enhance and restore functional ability and
l f l f h h h lquality of life to those with physical impairments or disabilities."
‐Wikipedia.org
Physiatrists are sometimes referred to asPhysiatrists are sometimes referred to as
“Muscle doctors”
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Quick Clarification
• Impairment‐ anatomical or physiological dysfunction
• Disability‐ unable to perform a human activity p y
• Handicap‐ unable to meet a societal roleunable to meet a societal role
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International Classification of Functioning, Disability,Functioning, Disability, and Health (ICF)ICF TermsICF TermsIn the context of health:Body functions are the physiological functions of body systems (includingpsychological functions)psychological functions).
Impairments are problems in body function or structure such as a significantdeviation or lossdeviation or loss.
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in executingactivities.
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Timelineorigin: as early as heat/cold modalities used
defined: principles formulated during post WWI
g y /for health benefits (time of Hippocrates)
consolidated & expanded: post‐WWII
established: approved as med specialty in 1947
evolved: in 1955 more than 21 200 cases of polio are reportedevolved: in 1955 more than 21,200 cases of polio are reported. The polio epidemic dominated the attention of PM&R physicians and rehabilitation institutions expanded from institutions D di t d t th t t t f liDedicated to the treatment of polio
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dCommon Conditions
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E l iEvaluationHistory (include focus on function)History (include focus on function),physical exam, and imaging
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E l iEvaluationelectromyography
nerve conduction studynerve conduction study
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blProblems
Amputation
Aphasia
Malnutrition
Neurogenic BladderAphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and Paresis
Dysphagia
Gait Dysfunction
Radiculopathy
Skin Breakdown
Heterotopic Ossification
Hypoventilation
Spasticity
Weak Muscles
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blSolutionsProblems
Amputation
Aphasia
Malnutrition
Neurogenic BladderAphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and Paresis
Dysphagia
Gait Dysfunction
Radiculopathy
Skin Breakdown
Heterotopic Ossification
Hypoventilation
Spasticity
Weak Muscles
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S l tiSolutionsOrthoses
Amputation
Aphasia
Malnutrition
Neurogenic Bladder
Orthoses
Aphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and Paresis
Dysphagia
Gait Dysfunction
Radiculopathy
Skin BreakdownHeterotopic Ossification
HypoventilationSpasticity
Weak Muscles
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S l tiSolutionsh k
Amputation
Aphasia
Malnutrition
Neurogenic Bladder
Thickening Mix
Cognitive Impairment
Depression
Pain
Paralysis and Paresis
DysphagiaGait Dysfunction
Radiculopathy
Skin Breakdown
Spasticity
Electrical Stimulation
Heterotopic Ossification
Hypoventilation
Spasticity
Weak Muscles
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S l tiSolutions
Amputation
Aphasia
Malnutrition
Neurogenic Bladder
Gait Training
Aphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and Paresis
Dysphagia
Gait DysfunctionRadiculopathy
Skin Breakdown
Heterotopic Ossification
Hypoventilation
Spasticity
Weak Muscles
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S l tiSolutionsMedication
Amputation
Aphasia
Malnutrition
Neurogenic Bladder
ManualTherapy
Medication
Aphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and ParesisBotox
Dysphagia
Gait Dysfunction
Radiculopathy
Skin BreakdownBaclofen Pump
Heterotopic Ossification
HypoventilationSpasticityWeak Muscles
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S l tiSolutions
Amputation
Aphasia
Malnutrition
Neurogenic Bladder
Water Therapy
Aphasia
Cognitive Impairment
Depression
Neurogenic Bladder
PainParalysis and Paresis
Heat/Cold
Dysphagia
Gait Dysfunction
Paralysis and Paresis
Radiculopathy
Skin Breakdown
TranscutaneousElectrical Nerve StimulationHeterotopic Ossification
HypoventilationSpasticity
Weak Muscles
Stimulation
MedicationControl
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S l tiSolutionsProstheses
AmputationAphasia
Malnutrition
Neurogenic Bladder
Prostheses
Aphasia
Cognitive Impairment
Depression
Neurogenic Bladder
Pain
Paralysis and ParesisDepression
Dysphagia
Gait Dysfunction
Radiculopathy
Skin Breakdown
Heterotopic Ossification
Hypoventilation
Spasticity
Weak Muscles
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lGoal‐= Overall Functional Enhancement =‐
Maximize
I d dphysical
• Independence• Dignity
psychologicalsocial
i l• Quality of Life vocationaleducational
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kTask at Hand
1. Optimize Function
2 R li P i2. Relieve Pain
3. Prevent &Manage Complications
4. Coordinate Care
and above alland above all,
5. Educate and Empower Patientsp
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Practice Settings
InpatientA C H i l
And/Or OutpatientH i l Cli iAcute Care Hospitals
Long Term Acute Care Hospitals
Hospital Clinic
Acute Rehab Clinic
Inpatient Rehabilitation Units of
Acute Care Hospitals
Private Office
Skilled Nursing Homes with Subacute
Rehabilitation Programs
Nursing Homes
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Sample InpatientExperience
• Brain Injury • Pediatric
• Burn
• Cancer
• Polytrauma
• Pulmonary
• Cardiac
• Neurologic Disorder
• Spinal Cord Injury
• Strokeg
• Orthopedic • Transplant
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Sample OutpatientExperience
• Amputee
A th iti• Pain
d• Arthritis
• Cerebral Palsy
b l
• Pediatric
• Spasticity• Fibromyalgia
• EMG & NCS• Spina Bifida
• Spine• Musculoskeletal
• Ortho‐Rehab• Stroke
• Wound Care
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Interdisciplinary Teams
Medical Professionals
• Critical Care
• General Surgery
• Neurology
• Neurosurgery
• Geriatrics
• Internal Medicine
• Pediatrics
• Psychiatry
• Orthopedics
• Oncology
• Rheumatology
• Urologygy gy
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Interdisciplinary Teams
Allied Health Professionals
• Dietician • Recreational Therapist• Dietician
• Music Therapist
• Occupational Therapist
• Recreational Therapist
• Rehabilitation Nurse
• Respiratory Therapist• Occupational Therapist
• Pet Therapist
Ph i l Th i t
• Respiratory Therapist
• Speech & Language
S i l W k• Physical Therapist
• Prosthetist / Orthotist
• Social Worker
• Vocational Counselor
• Psychologist
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PM&R Residency
PGY‐1
Option A Option B Option C
Categorical Preliminary Transitional
PGY‐2
PGY‐3
PGY‐4PGY 4
Fellowship
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Fellowships
Electrodiagnostic Medicineg
Hospice and Palliative Medicine*
Interventional Spinep
Neuromuscular Medicine*
Pain Medicine*Pain Medicine
Rheumatology
* denotes sub-specializations certified by ABPMR
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Fellowships
Pediatric Rehabilitation Medicine*
Spinal Cord Injury Medicine*
Sports Medicine*p
Stroke
Brain Injury Medicine*Brain Injury Medicine
* denotes sub-specializations certified by ABPMR
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Lots of Work Aheadots o o ead
• Aging Population• Decreasing Injury Mortality
• High Healthcare Costs• New Applications• Innovative Technology
• Regeneration/Stem Cell AdvancesRegeneration/Stem Cell Advances
• Artificial Intelligence• Robotics & Computer Science• Robotics & Computer Science
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Additional Resources
Association of Academic Physiatrists
www.physiatry.org
American Academy of Physical Medicine & Rehabilitation
www.aapmr.org
American Congress of Rehabilitation Medicine
www.acrm.org
American Board of Physical Medicine & Rehabilitation
www.abpmr.orgp g
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Additional Resources
American Journal of Physical Medicine & Rehabilitation
Journals
www.ajpmr.org
Archives of Physical Medicine and Rehabilitationy
www.archives‐pmr.org
PM&RPM&R
www.pmrjournal.org
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Thank you!
These slides were adapted from a presentation by Jiaxin Tran, MD,presentation by Jiaxin Tran, MD,
New Jersey Medical School ‐ UMDNJ