Dr. Md.

Nurul Hoque Miah

Registrar
Dept. of PM&R, CMCH
1
ST
DAY CLASS-MORNING

1. Introduction of PM & R, What is PM&R (American board).
2. History of PM&R & definitions (Impairment, Disability,
Handicap & Rehabilitation )
3. Rehabilitation team & role of physiatrist
4. What is Physiatrist & physiotherapist
5. Scopes, Sub-specialty & spectrum of diseases in PM & R.
6. History taking of MSK problem in physiatric approach
7. Role of physical agents in PMR. What physical & mechanical
agents are use in PMR dept of CMCH
How did the specialty develop?
The field PM&R began in the 1930s to address MSK
and neurological problems

Broadened after World War II with the
concepts of Frank H. Krusen, Howard A. Rusk.

The American Board of Medical Specialties granted
PM&R its approval as a speciality of medicine in
1947.

How did the specialty develop contd..?

PM&R (Physiatry) is one of 24 medical specialties IN
USA
Total no. of physiatrists : 8815 (2010) In USA

History of PM & R in Bangladesh:
# 1972-Deptt of PM IPGMR
# 1989- FCPS in BCPS
# 1994- 1st Physiatrist: Prof. (Dr.) Aminuddin A Khan
# December 2013- Total Physiatrist 60 (1/3 Ctg.)
Physical Medicine (physiatry)
It is the branch of medical science
Deals with diagnosis and treatment of diseases
by:
physical agents, such as light, heat, cold,
electricity, magnetism.
therapeutic exercises,
massages,
manipulation
in conjunction with drugs.
What is physiatry (AAPMR) ?
Physical medicine and rehabilitation (PM &R),
also called physiatry,is the branch of medicine
emphasizing the-
# Prevention
# Diagnosis
# Treatment &
# Rehabilitation of disorders
particularly related to the nerves, muscles &
bones- that may produce temporary or
permanent impairment.
Rehabilitation (WHO)
Rehabilitation means To make fit again.
The use of all means
aimed at reducing the impact of disabling
and handicapping conditions
and at enabling people with disabilities
to achieve optimal social integration
Rehabilitation
Is a complex process
Of integraded application of many
procedures
To achieve restoration
Of an individual
At home and in the community
Of his/her optimum potential
By utilizing all his residual assets.

Subspecialty of PMR (American board
certified):

Pain medicine
Neuromuscular medicine
Spinal injury medicine
Hospice & Palliative medicine
Pediatric rehabilitation medicine
Sports medicine


What is a Physiatrist (fizz-ee-at-trist) ?
Specialist in Physical medicine & Rehab.
Another words: Rehabilitation Physician .
Experts at diagnosing and treating pain,
restore medical function lost through injury,
illness or disabling conditions
Goal is to decrease pain and enhance
performance without surgery.


What is physiotherapist ?
Physiotherapist; (medical technologist) nor
diagnose nor treat by prescribing drugs

They are entitled -
# To assess muscle power
# Mobilize and transfer the patient
# Doing therapeutic exercise &
giving physical therapy.
Scope of the Physiatrists practice

PM&R is often called the quality of life profession

Treat any disability resulting from disease or injury
involving any organ system.

The focus is not on one part of the body, but instead on the
development of a comprehensive program for putting the
pieces of a person's life back together medically,
socially, emotionally, and vocationally after injury
or disease.

Sports medicine has grown as a special interest.
Role of Physiatrist in Rehabilitation

Physiatrists will be the team leader and
design rehabilitation plan.
The multidisciplinary Medical Rehabilitation
team include:
1. Medical professionals such as
neurologists, psychiatrists, orthopedists,
neurosurgeons or urologists and
2. Non-physician health professionals
such as (a)physical therapists,(b)occupational
therapists, (c) Orthotists & prosthetists,(d)
speech pathologists,(e)Rehabilitation nurse,(f)
vocational counselors,(g) psychologists and(h)
social workers.
Role of Physiatrist in Rehabilitation:
Rehab team
Physiatrists: team
leader and rehab plan
designer.

Other medical
professionals/Doctors:
neurologists,
psychiatrists,
orthopedists,
neurosurgeons or
urologists

Non-physician health
professionals/paramedics
and others:
physical therapists
occupational therapists
orthotists & prosthetists
speech pathologists
Rehabilitation nurse
vocational counselors
psychologists and
social workers.
Impairment (WHO- 1980)
Any loss or abnormality of
psychologic,
physiologic, or
anatomic structure or function.


Disability (WHO- 1980) :
Any restriction or lack
resulting from an impairment of the
ability
to perform an activity in the manner or
within the range
considered normal for a human Being.

Handicap (WHO- 1980) :
A disadvantage for a given individual,
resulting from an impairment or a
disability,
that limits or prevents the fulfillment of a
role
that is normal (depending on age, sex,
social and cultural factors) for that
individual.

Impairment, Disability & Handicap
(WHO- 1997)
Impairment: Any loss or abnormality of body structure or
of a physiologic or psychologic function (essentially
unchanged from the 1980 definition)

Activity: The nature and extent of functioning at the
level of the person

Participation: The nature and extent of a persons
involvement in life situations in relationship to
impairments, activities, health conditions, and contextual
factors

PHYSICAL AGENTS
Infrared Radiation ( IRR )
Paraffin-wax Bath
Microwave Diathermy (MWD)
Ultrasound Therapy ( UST )
Electrical Stimulation Therapy ( EST )
Traction


EQUIPMENTS
Parallel Bar
Parallel Bar
N-K Table
Wheel Chair
Tread mill
Static Cycle


THERAPEUTIC
EXERCISE
EXERCISE DEMONSTRATION BY
PHYSIOTHERAPIST
EXERCISE DEMONSTRATION BY
PHYSIOTHERAPIST
Counseling Cerebral Palsy
Group Counseling

Key Messages
PM&R deals with PAIN management in various conditions
including cancer pain.

PM&R treat the patient upto total REHABILITATION- to
make the person FIT for the society.

MULTI DISCIPLINARY approach for patients care.

ADL advice, drugs, physical agents, exercises and orthoses
are prescribed for patients management.