physical medicine and rehabilitationwhat is pm&r "branch of medicine emphasizing...

dAn Introduction

Physical Medicine

and Rehabilitation

B iBasics

• Physical Medicine and

Rehabilitation– PM&R

• related terminology– physiatry / physiatrist (fiz•zee•AT•trist)physiatry / physiatrist (fiz zee AT trist)

– rehabilitation medicine

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

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

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”

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

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.

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

dCommon Conditions

E l iEvaluationHistory (include focus on function)History (include focus on function),physical exam, and imaging

E l iEvaluationelectromyography

nerve conduction studynerve conduction study

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

blSolutionsProblems

Amputation

Aphasia

Malnutrition

Neurogenic BladderAphasia


Depression

Neurogenic Bladder

Pain


Dysphagia

Gait Dysfunction

Radiculopathy

Skin Breakdown


Hypoventilation

Spasticity

Weak Muscles

S l tiSolutionsOrthoses

Amputation

Aphasia

Malnutrition

Neurogenic Bladder

Orthoses

Aphasia


Depression

Neurogenic Bladder

Pain


Dysphagia

Gait Dysfunction

Radiculopathy

Skin BreakdownHeterotopic Ossification

HypoventilationSpasticity

Weak Muscles

S l tiSolutionsh k

Amputation

Aphasia

Malnutrition

Neurogenic Bladder

Thickening Mix


Depression

Pain


DysphagiaGait Dysfunction

Radiculopathy

Skin Breakdown

Spasticity

Electrical Stimulation


Hypoventilation

Spasticity

Weak Muscles

S l tiSolutions

Amputation

Aphasia

Malnutrition

Neurogenic Bladder

Gait Training

Aphasia


Depression

Neurogenic Bladder

Pain


Dysphagia

Gait DysfunctionRadiculopathy

Skin Breakdown


Hypoventilation

Spasticity

Weak Muscles

S l tiSolutionsMedication

Amputation

Aphasia

Malnutrition

Neurogenic Bladder

ManualTherapy

Medication

Aphasia


Depression

Neurogenic Bladder

Pain

Paralysis and ParesisBotox

Dysphagia

Gait Dysfunction

Radiculopathy

Skin BreakdownBaclofen Pump


HypoventilationSpasticityWeak Muscles

S l tiSolutions

Amputation

Aphasia

Malnutrition

Neurogenic Bladder

Water Therapy

Aphasia


Depression

Neurogenic Bladder

PainParalysis and Paresis

Heat/Cold

Dysphagia

Gait Dysfunction


Radiculopathy

Skin Breakdown

TranscutaneousElectrical Nerve StimulationHeterotopic Ossification

HypoventilationSpasticity

Weak Muscles

Stimulation

MedicationControl

S l tiSolutionsProstheses

AmputationAphasia

Malnutrition

Neurogenic Bladder

Prostheses

Aphasia


Depression

Neurogenic Bladder

Pain

Paralysis and ParesisDepression

Dysphagia

Gait Dysfunction

Radiculopathy

Skin Breakdown


Hypoventilation

Spasticity

Weak Muscles

lGoal‐= Overall Functional Enhancement =‐

Maximize

I d dphysical

• Independence• Dignity

psychologicalsocial

i l• Quality of Life vocationaleducational

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

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

Sample InpatientExperience

• Brain Injury • Pediatric

• Burn

• Cancer

• Polytrauma

• Pulmonary

• Cardiac

• Neurologic Disorder

• Spinal Cord Injury

• Strokeg

• Orthopedic • Transplant

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

Interdisciplinary Teams

Medical Professionals

• Critical Care

• General Surgery

• Neurology

• Neurosurgery

• Geriatrics

• Internal Medicine

• Pediatrics

• Psychiatry

• Orthopedics

• Oncology

• Rheumatology

• Urologygy gy

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

PM&R Residency

PGY‐1

Option A Option B Option C

Categorical Preliminary Transitional

PGY‐2

PGY‐3

PGY‐4PGY 4

Fellowship

Fellowships

Electrodiagnostic Medicineg

Hospice and Palliative Medicine*

Interventional Spinep

Neuromuscular Medicine*

Pain Medicine*Pain Medicine

Rheumatology

* denotes sub-specializations certified by ABPMR

Fellowships

Pediatric Rehabilitation Medicine*

Spinal Cord Injury Medicine*

Sports Medicine*p

Stroke

Brain Injury Medicine*Brain Injury Medicine

* denotes sub-specializations certified by ABPMR

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

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

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

Thank you!

These slides were adapted from a presentation by Jiaxin Tran, MD,presentation by Jiaxin Tran, MD,

New Jersey Medical School ‐ UMDNJ

physical medicine and rehabilitationwhat is pm&r "branch of medicine emphasizing...

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