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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 eye' a 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. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).
Basic Medical Education[edit | edit source]
United States[edit | edit source]
Basic medical Education in the United States of America (USA) takes about four years but before medical education a three-year undergraduate course must be taken (on any subject, but best if scientific, chemical or biological). In the US, this is called college. Some students may even take four-years college courses.
Only then can a medical student take the four-year medical course. After the medical course, students must enter a one-year intenship (training). To qualify as a proper medical practitioner in the US, a student must now complete a residency. The lengths of a residency may range from three years to ten, determined by which specialty the student chooses.
United Kingdom[edit | edit source]
In the United Kingdom, medical students could enter medical education straight after secondary school. They can choose how long they want the medical education to be, usually five to six years (depending on University or progress). Several universities now offer an accelerated medical course, and this takes four years (pre-clinical and clinical). After medical education, students will enter a Foundation phase (two years). The first year of the Foundation phase is called F1, and the student has already become a physician (entering F1 means entering paid employment). F1 practitioners are supervised, but F2 (year two of Foundation) practitioners may be unsupervised by a professional physician or trained medical supervisor.
After F2, a practitioner can choose to study general practice, or specialised practice. The physician can quit, or he can study further whilst working as an 'infant' physician. After the specialty or general studies, the physician qualifies as a proper medical practitioner.
Salaries afterwards range from several thousand per year to a million per year (the most common million-per-year being the specialty of private neurology).
History[edit | edit source]
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[edit | edit source]
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, adoptive equipments and assistive device, orthotics (braces), prosthesis, and experiential training approaches.
Physical Medicne & Rehabilitation physicians may also perform Electrodiagnostics which are used to provide nervous system functional information for diagnose and / or prognosis for various neuromuscular disorders. The common electrodiagnostic test performed by physiatrist are nerve conduction velocity study (NCV) and needle electromyography (EMG). Nerve conduction velocity 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 examined muscles to detect the electrical potential generated from muscle fibers. Abnormal electrical potentials suche as fibrillation potential or positive sharp wave detected by EMG needle indicates the presence of muscle fibers that lost the nerve supply.
Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskletal 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, and interventional procedures when indicated.
Philosophy[edit | edit source]
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 transdisciplinary team meetings to coordinate care of the patients.
Subspecialty[edit | edit source]
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, and hospice and palliative medicine. Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, electrodiagnostics, traumatic brain injury (TBI), and cardiopulmonary rehabilitation.
Popular textbooks[edit | edit source]
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[edit | edit source]
- Joel DeLisa (2004). Physical Medicine and Rehabilitation: Principles and Practice, Lippincott Williams & Wilkins. ISBN 0-7817-4130-0.
- Randall Braddom (2006). Physical Medicine and Rehabilitation, WB Saunders. ISBN 978-1416026105.
- Bryan J. O'Young, Mark A. Young, Steven A. Stiens (2002). Physical Medicine and Rehabilitation Secrets, Hanley & Belfus. ISBN 1-56053-437-0.
- Howard Choi, Ross Sugar, David E. Fish, Matthew Shatzer, Brian Krabak (2003). Physical Medicine and Rehabilitation Pocketpedia, Lippincott Williams & Wilkins. ISBN 0-7817-4433-4.
Journals[edit | edit source]
The two main journals of the PM&R field are Archives of Physical Medicine and Rehabilitation and American Journal of Physical Medicine and Rehabilitation. Both journals are published monthly. Archives, which had been co-owned by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and the American Congress of Rehabilitation Medicine (ACRM), will be solely owned by the Congress beginning January 2009. At that time, the Academy will launch a new journal: PM&R, The journal of injury, function and rehabilitation.
Quaterly journal Physical Medicine And Rehabilitation Clinics of North America  published by Elsevier / Saunders also provides indepth updated information on specific Physical Medicine & Rehabilitation topic.
See also[edit | edit source]
Notes[edit | edit source]
References[edit | edit source]
- Famous Canadian Physicians: Dr. Gustave Gingras at Library and Archives Canada
[edit | edit source]
Organizations[edit | edit source]
- American Academy of Physical Medicine and Rehabilitation National medical society, has a PM&R resident/medical student mentoring feature
- American Board of Physical Medicine and Rehabilitation ABMS recognized entity for board certification in PM&R
-  Courage Center, Minneapolis-based nonprofit rehabilitation and resource center for people of all ages and abilities.
- Association of Academic Physiatrists Organization consisting largely of those with interests in academic PM&R
- StudentDoctor.Net Student mentoring site, has a PM&R forum
- Physical Medicine and Rehabilitation - eMedicine Journal medical reference
- Canadian Association of Physical Medicine and Rehabilitation - Canadian National PM&R Medical Society
- International Society of Physical Medicine and Rehabilitation
- American Association of Neuromuscular and Electrodiagnostic Medicine - National medical society comprised primarily of physiatrists and neurologists who perform electrodiagnostic studies (eg. electromyography and nerve conduction studies) and provide medical care to individuals with neuromuscular disorders.
- Iranian Society of Physical Medicine and Rehabilitation
- Department B National organization providing comprehensive business resources to practicing physiatrists
- http://www.iapmr.com/ Indian Association of Physical Medicine and Rehabilitation- Physiatrists from anywhere in the world can be a life member.
Additional Resources[edit | edit source]
- Physiatry Practice Management Portal Resources for physiatrists
- Patient Information Physiatry-related informtion for patients including searchable database of physicians.
- Accurate Billing/Coding resources Comprehensive business resources for practicing physiatrists
- SpineUniverse Portal for spine-related physiatry - glossary of terms, procedures explained, global physician directory.
[edit | edit source]
- Johns Hopkins Department of Physical Medicine and Rehabilitation
- The Howard A. Rusk Institute of Rehabilitation Medicine at the New York University Medical Center
- TIRR - The Institute for Rehabilitation and Research Houston
- New York-Presbyterian Hospital
- CNS Centre for Neuro Skills
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