The Physiatry ConsultThe Physiatry ConsultThe Physiatry ConsultThe Physiatry ConsultA general guide for students new to A general guide for students new to Physical Medicine and RehabilitationPhysical Medicine and Rehabilitation

What is Physiatry?• Also known as Physical Medicine and

Rehabilitation (PM&R), it is a medical specialty focused on prevention, diagnosis, and nonsurgical treatment of disorders associated with disability

• PM&R specialists care for patients with neurological and MSK disorders, or with acute and chronic pain

• The quality of life medical specialty– goal to restore optimal patient function in all spheres of life, including medical, social, emotional, and vocational or avocational dimensions

Physical Medicine – Diagnosis and treatment of MSK disorders with the use of medications, modalities, procedures, assistive devices, and exercise

Rehabilitation – The process of making the person with a disability “maximally able” again, through the application of rehabilitation principles and techniques

Objectives of a Comprehensive Physiatric

Consultation• Confirm the diagnosis and relate it to

functional performance• Quantify functional level and establish

baseline• Develop a rehabilitation problem list• Provide a functional prognosis• Formulate short, intermediate and long-

term rehab goals with patient, family and interdisciplinary team

The Consult• Reason for referral• Age, sex, occupation, diagnosis/injury

and its date of onset• Current history and management –

details of injury, or disease severity, risk factors, and active treatment

• Past medical history – personal, meds, allergies, family, social, review of systems

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Current and Baseline Function

Mobility – bed, transfers, ambulationADLs – hygiene, bathing, dressing, eating,

toiletingLeisure function – activities for enjoymentVocational function – volunteering, paid

occupation, work at home, parentingEquipment, and home architecture

Examination

• Focus on areas of rehab intervention and assessment of severity of injury or diagnosis

• Identify risks or cause of precautions for therapies

• A functional neuromuscular examination should be included to assess mobility, ADLs, cognition and mental status

• Neurological and MSK examinations are included as necessary

Problem list and Recommendations

• Primary and secondary dx, date of onset and severity

• impairments, disabilities and handicaps identified (ie. Activity and participation)

• Recommendations include short-term (acute rehab plan), intermediate, and long term goals (eg. Transfer to inpatient rehab unit, and d/c planning, community reintegration as OP), precautions for interventions

• Estimate of prognosis for functional recovery and level of community independence

Example problem domains

• Spine stability• Pain• Spasticity• Bowel and bladder function• Pressure ulcers, or other skin issues• Mobility and DVT prophylaxis• ADLs• Communication and cognition• Psychosocial adaptation and supports • Accessibility, discharge management • Community reintegration (vocational and avocational)