Physical medicine and rehabilitation (PM&R), or physiatry (fĭz’ē-āt’rē or fĭ-zī’ə-trē), is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist. In order to be a physiatrist in the United States, one must complete four years of medical school, one year of internship and three years of residency. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).
The term ‘physiatry’ was coined by Dr. Frank H. Krusen in 1938. The term was accepted by the American Medical Association in 1946. The field grew notably in response to the demand for sophisticated rehabilitation techniques for the large number of injured soldiers returning from World War II.
Scope of the field
Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is placed on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement & activities modification, adaptive equipments and assistive device, orthotics (braces), prosthesis, and experiential training approaches.
Physical Medicine & Rehabilitation physicians may also perform electrodiagnostics which are used to provide nervous system functional information for diagnosis and / or prognosis for various neuromuscular disorders. The common electrodiagnostic tests performed by physiatrists are nerve conduction studies (NCS) and needle electromyographies (EMG). The nerve conduction study involves electrical stimulation to peripheral nerves and the nerves’ responses are measured such as onset latency, amplitude and conduction velocity. Needle electromyography requires needle electrode insertion into the muscles to detect the electrical potential generated from muscle fibers. Abnormal electrical potentials such as fibrillation potential or positive sharp wave detected by EMG needle indicates the presence of muscle fibers that have abnormal nerve supply.
Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskeletal pain syndromes such as low back pain, fibromyalgia and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through multidisciplinary approach involving psychologists, physical therapists, occupational therapists, chiropractors, and interventional procedures when indicated. In addition to the previous methodology, stroke is often treated with the help of a speech therapist and recreational therapist when possible.
The major concern of the field is the ability of the person to function optimally within the limitations placed upon them by a disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those who may not be able to achieve full restoration. A team approach to chronic conditions is emphasized, using interdisciplinary team meetings to coordinate care of the patients.
Six formal sub-specializations are recognized by the field in the United States:
- Pain medicine
- Pediatric rehabilitation
- Spinal cord injury medicine
- Neuromuscular medicine
- Sports medicine
- Hospice and palliative medicine
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