Physical medicine and rehabilitation

Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability.

A physician who has completed training in this field is referred to as a physiatrist (fizz ee at' trist). 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. Three formal sub-specializations are recognized by the field in the United States: pain medicine (in conjunction with anesthesiology, neurology and psychiatry), pediatric rehabilitation, and spinal cord injury (SCI) medicine. A new formal sub-specialty based on post-residency fellowship training in Neuromuscular Medicine is forming in conjunction with Neurology. Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, electrodiagnostics, traumatic brain injury (TBI), cardiopulmonary rehabilitation and neuromuscular disorders.



History
PM&R is a relatively young specialty. Among the early pioneers of the field include Dr. Frank Krusen who developed the Department of Physical Medicine at the Mayo Clinic in 1936. PM&R was recognized as a medical specialty by the American Board of Medical Specialties and the American Medical Association in 1947. The field expanded rapidly owing in large part to World War II, when many soldiers with servere disability returned to the United States and physicians were necessary to treat and manage chronic debilitating conditions. Polio epidemic in the early 1950s also helped establish the value of physiatrists in management of neuromuscular disorders. Advances that allowed longer survival from disorders as varied as spinal cord injury and stroke led to greater role of physiatrists in managing these chronic conditions. This specialty's research base is still evolving.

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, and experiential training approaches. Electrodiagnostics are used to diagnose and provide prognosis for various neuromuscular disorders.

Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, 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 psychologist, physical therapist, occupational therapist, and interventional procedures when indicated.

Philosophy
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 cure. The general emphasis is not on the full restoration to the premorbid condition, but rather the optimization of the quality of life for those who may not achieve full restoration. Team approach to chronic conditions are emphasized, using multidisciplinary team meetings to coordinate care of the patients.



Residencies in the United States
There are no clear rankings among PM&R residencies, but among the elite programs in the United States include


 * Rehabilitation Institute of Chicago (RIC) at Northwestern University
 * University of Washington Program
 * Mayo Clinic Program
 * Kessler Institute for Rehabilitation (UMDNJ: New Jersey Medical School)
 * The Institue for Rehabilitation and Research at Baylor College of Medicine/UT Houston

There are approximately 350 total positions available via the National Resident Matching Program (NRMP) per year. This specialty's competitiveness would likely be considered to be on par with neurology or pediatrics according to the 2006 match data from the NRMP. PM&R residencies will likely become more competitive and be more recognized as the population ages and technology relating to rehabilitation becomes more advanced.

Notable Rehabilitation Hospitals in the United States
In addition to those associated with elite PM&R residency programs, notable rehabilitation hospitals in the United States include:


 * Craig Hospital in Denver, Colorado
 * Moss Rehabilitation Hospital in Philadelphia, Pennsylvania
 * Rancho Los Amigos National Rehabilitation Center in Downey, California
 * Shepard Hospital in Atlanta, Georgia
 * Spaulding Rehabilitation Hospital in Boston, Massachusetts

Popular Textbooks
Two main textbooks often used by those in the specialty are Physical Medicine and Rehabilitation: Principles and Practice by Joel DeLisa and Physical Medicine and Rehabilitation Medicine by Randall Braddom. Useful handbooks for medical students and residents include PM&R Secrets by Mark Young, Brian O'Young and Steven Stiens, and PM&R Pocketpedia by Howard Choi and colleagues.

Book Reference








Journals
The two main journals of the PM&R field are Archives of Physical Medicine and Rehabilitation and American Journal of Physical Medicine and Rehabilitation.