AnIntroduction

PhysicalMedicine
andRehabilitation

B i
Basics
PhysicalMedicineand
Rehabilitation
PM&R

relatedterminology
physiatry /physiatrist
/ physiatrist (fiz
(fizzeeATtrist)
zee AT trist)
rehabilitationmedicine

WhatisPM&R
h
&
"Branchofmedicineemphasizing
prevention, diagnosis, and treatment of
prevention,diagnosis,andtreatmentof
disorders particularlyrelatedtonerves,
muscles, and bones thatmayproduce
muscles,andbones
that may produce
temporaryorpermanentimpairment."
AmericanAcademyofPM&R

A Ph i t i t
APhysiatrist
SSpecializesinclinicaland
i li i li i l d diagnostic
di
i
useofphysicalagents andexercises
toprovidephysiotherapyforphysical,
d h
h
f
h
l
mental,andoccupationalrehabilitation
ofpatient
Examinespatient,utilizingelectrodiagnosis and
otherdiagnosticprocedurestodetermineneed
forandextentoftherapy.
WebstersOnlineDictionary2009

AnotherLaymens
Definition
""Abranchofmedicinewhichaimsto
b
h f
d
h h
enhanceandrestorefunctionalabilityand
qualityoflifetothosewithphysical
l
flf
h
h h
l
impairmentsordisabilities."
Wikipedia.org
Physiatrists are sometimes referred to as
Physiatristsaresometimesreferredtoas

Muscledoctors

QuickClarification
Impairment
anatomicalorphysiologicaldysfunction

Disability
unabletoperforma
p
humanactivity
y

Handicap
unabletomeetasocietalrole
unable to meet a societal role

International Classificationof
Functioning, Disability,
Functioning,Disability,
andHealth(ICF)
ICF Terms
ICFTerms
Inthecontextofhealth:
Bodyfunctionsarethephysiologicalfunctionsofbodysystems(including
psychological functions)
psychologicalfunctions).
Impairments areproblemsinbodyfunctionorstructuresuchasasignificant
deviation or loss
deviationorloss.
Activity istheexecutionofataskoractionbyanindividual.
Participation isinvolvementinalifesituation.
Activitylimitationsaredifficultiesanindividualmayhaveinexecuting
activities.

Timeline
origin:asearlyasheat/coldmodalitiesused
g
y
/
forhealthbenefits(timeofHippocrates)
defined:principlesformulatedduringpostWWI
consolidated&expanded:postWWII
established:approvedasmedspecialtyin1947
evolved:in1955morethan21,200casesofpolioarereported.
evolved:
in 1955 more than 21 200 cases of polio are reported
ThepolioepidemicdominatedtheattentionofPM&Rphysicians
andrehabilitationinstitutionsexpandedfrominstitutions
D di t d t th t t
Dedicatedtothetreatmentofpolio
t f li

d
Common Conditions

E l i
Evaluation
History (includefocusonfunction),
(include focus on function)
physicalexam,and imaging

E l i
Evaluation
electromyography

nerve conduction study

nerveconductionstudy

Problems
bl
Amputation
Aphasia
CognitiveImpairment
Depression
Dysphagia
GaitDysfunction
Heterotopic Ossification
Hypoventilation

Malnutrition
Neurogenic Bladder
Pain
ParalysisandParesis
Radiculopathy
SkinBreakdown
Spasticity
WeakMuscles

Solutions
Problems
bl
Amputation
Aphasia
CognitiveImpairment
Depression
Dysphagia
GaitDysfunction
Heterotopic Ossification
Hypoventilation

Malnutrition
Neurogenic Bladder
Pain
ParalysisandParesis
Radiculopathy
SkinBreakdown
Spasticity
WeakMuscles

S l ti
Solutions
Orthoses
Amputation
Aphasia
CognitiveImpairment
Depression
Dysphagia
GaitDysfunction
Heterotopic Ossification
Hypoventilation

Malnutrition
Neurogenic Bladder
Pain
ParalysisandParesis
Radiculopathy

SkinBreakdown
Spasticity
WeakMuscles

SSolutions
l ti
Thickening
h k
Amputation
Malnutrition Mix
Aphasia
Neurogenic Bladder
CognitiveImpairment
Pain
Depression
ParalysisandParesis
Electrical
Radiculopathy
Dysphagia
Stimulation
SkinBreakdown
GaitDysfunction
Spasticity
Heterotopic Ossification
WeakMuscles
Hypoventilation

S l ti
Solutions
Amputation
Aphasia
CognitiveImpairment
Depression
Dysphagia

GaitDysfunction
Heterotopic Ossification
Hypoventilation

GaitTraining
Malnutrition
Neurogenic Bladder
Pain
ParalysisandParesis
Radiculopathy
SkinBreakdown
Spasticity
WeakMuscles

S l ti
Solutions
Medication
Manual
Amputation
Malnutrition
Aphasia Therapy
Neurogenic Bladder
CognitiveImpairment
Pain
BotoxParalysisandParesis
Depression
Dysphagia
BaclofenRadiculopathy
Pump
GaitDysfunction
SkinBreakdown
Heterotopic Ossification
Spasticity
Hypoventilation
WeakMuscles

S l ti
Solutions
WaterTherapy
Amputation
Aphasia
CognitiveImpairment
Heat/Cold
Depression
Dysphagia Transcutaneous
ElectricalNerve
GaitDysfunction
Stimulation
Heterotopic Ossification
Hypoventilation
Medication
Control

Malnutrition
Neurogenic Bladder

Pain
ParalysisandParesis
Paralysis
and Paresis
Radiculopathy
SkinBreakdown
Spasticity
WeakMuscles

S l ti
Solutions
Prostheses

Amputation
Aphasia
CognitiveImpairment
Depression
Dysphagia
GaitDysfunction
Heterotopic Ossification
Hypoventilation

Malnutrition
Neurogenic Bladder
Pain
ParalysisandParesis
Radiculopathy
SkinBreakdown
Spasticity
WeakMuscles

Goall
=OverallFunctionalEnhancement=
Maximize

Independence
I d
d
Dignity
QualityofLife

physical
psychological
social
vocational
i
l
educational

TaskatHand
k
1.
2
2.
3.
4.

Optimize Function
R li
Relieve
P i
Pain
Prevent& ManageComplications
Coordinate Care
and above all
andaboveall,

5.EducateandEmpowerPatients
p

PracticeSettings
Inpatient

And/Or

Outpatient

AcuteCareHospitals
A
C
H i l
H i l Cli i
HospitalClinic
LongTerm AcuteCareHospitals
AcuteRehabClinic
Inpatient RehabilitationUnitsof
PrivateOffice
AcuteCareHospitals
SkilledNursingHomeswithSubacute
RehabilitationPrograms
NursingHomes

SampleInpatient
Experience

BrainInjury
Burn
Cancer
Cardiac
g
NeurologicDisorder
Orthopedic

Pediatric
Polytrauma
Pulmonary
SpinalCordInjury
Stroke
Transplant

SampleOutpatient
Experience

Amputee
A th iti
Arthritis
CerebralPalsy
Fibromyalgia
b
l
EMG&NCS
Musculoskeletal
OrthoRehab

Pain
Pediatric
d
Spasticity
Spina Bifida
Spine
Stroke
WoundCare

Interdisciplinary
Teams
MedicalProfessionals

CriticalCare
GeneralSurgery
Geriatrics
InternalMedicine
Orthopedics
gy
Oncology

Neurology
Neurosurgery
Pediatrics
Psychiatry
Rheumatology
gy
Urology

Interdisciplinary Teams
AlliedHealthProfessionals

Dietician
Music Therapist
Occupational Therapist
Pet Therapist
Ph i l Therapist
Physical
Th
it
Prosthetist /Orthotist
Psychologist

RecreationalTherapist
Recreational
Therapist
RehabilitationNurse
Respiratory Therapist
RespiratoryTherapist
Speech&Language
S i l Worker
Social
W k
Vocational Counselor

PM&RResidency
OptionA

OptionB

OptionC

Categorical

Preliminary

Transitional

PGY1
PGY2
PGY3
PGY 4
PGY4

Fellowship

Fellowships
Electrodiagnostic
g
Medicine
HospiceandPalliativeMedicine*
p
InterventionalSpine
NeuromuscularMedicine*
Pain Medicine*
PainMedicine
Rheumatology
* denotes sub-specializations certified by ABPMR

Fellowships
PediatricRehabilitationMedicine*
SpinalCordInjuryMedicine*
p
SportsMedicine*
Stroke
Brain Injury Medicine*
BrainInjuryMedicine

* denotes sub-specializations certified by ABPMR

LotsofWork
ots o o Ahead
ead
Aging Population
Decreasing InjuryMortality
HighHealthcareCosts
NewApplications
InnovativeTechnology
Regeneration/Stem Cell Advances
Regeneration/StemCellAdvances
ArtificialIntelligence
Robotics &ComputerScience
& Computer Science

AdditionalResources
AssociationofAcademicPhysiatrists
www.physiatry.org
AmericanAcademyofPhysicalMedicine&Rehabilitation
www.aapmr.org
AmericanCongressofRehabilitationMedicine
www.acrm.org
AmericanBoardofPhysicalMedicine&Rehabilitation
p
g
www.abpmr.org

AdditionalResources
Journals
AmericanJournalofPhysical Medicine&Rehabilitation
www.ajpmr.org
Archives ofPhysicalMedicineandRehabilitation
y
www.archivespmr.org
PM&R
www.pmrjournal.org

Thankyou!
Theseslideswereadaptedfroma
presentation by Jiaxin Tran,MD,
presentationbyJiaxin
Tran, MD,
NewJerseyMedicalSchool UMDNJ