Physical medicine and rehabilitation (PM&R)
Physical medicine and rehabilitation (PM&R), also known as physiatry, is a medical specialty focused on restoring function and improving quality of life for individuals with physical and cognitive impairments. Physiatrists, the physicians trained in this field, address a wide array of conditions arising from injuries, diseases, or congenital disorders that affect bodily functions, including those related to the bones, brain, and muscles. PM&R emphasizes a holistic approach, taking into account not only the physical aspects of the patient's condition but also emotional and psychosocial factors.
The field originated in the early 20th century, largely credited to physician Frank H. Krusen, who contributed to the establishment of structured training and certification in PM&R. Treatment approaches can include pain management, physical therapy, and the use of medical devices like prosthetics. The goal of PM&R is not necessarily to cure conditions but to help patients regain independence in daily activities and enhance their overall well-being. This specialty collaborates with various healthcare professionals to develop individualized treatment plans, addressing each patient's unique needs and challenges. Through comprehensive care, PM&R aims to empower patients to lead fulfilling lives despite their medical conditions.
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Physical medicine and rehabilitation (PM&R)
Physical medicine and rehabilitation (PM&R), also known as physiatry, is a field of medicine that deals with healing a person as a whole. It treats patients who have incurable diseases, physical and/or cognitive impairments, or disabilities that can make performing day-to-day activities difficult. These conditions, which may be inherited or caused by medical conditions, surgery, or injury can affect parts of the body including the bones, brain, joints, ligaments, muscles, nerves, spinal cord, and tendons and can cause loss of body functions. Physicians known as physiatrists are trained in PM&R to treat patients with these medical conditions. Physiatry not only treats patients' physical conditions but also takes into account illness-related functional, emotional, and psychosocial issues that may arise.
Background
Physician Frank H. Krusen is credited with the founding of the field of PM&R. Motivated by his own treatment for tuberculosis in the 1920s, Krusen decided to devote his life to researching physical medicine. He studied physical agents of healing such as light, heat, and water to treat certain medical conditions. He helped to begin a physical therapy program at Temple University in Philadelphia, Pennsylvania, and then went to work at the Mayo Clinic.
In 1936, Krusen and more than a dozen other physicians, known at the time as physical therapy physicians, began work on establishing the Department of Physical Medicine at the Mayo Clinic. The program eventually became a three-year residency, the first of its kind in the United States. The group then worked with the American Medical Association (AMA) to receive a specialty status for the branch.
Krusen came up with the term physiatrist for a doctor specializing in physical medicine in 1938. While the term was close to the word psychiatrist, he emphasized the third syllable of the word (pronounced fizz-ee-AT-rist) to avoid confusion of the two. In the years that followed, Krusen and the other physicians, now known as physiatrists, routinely met with the AMA and the American Board of Medical Specialties (ABMS). Although the groups agreed that the field should be certified, they disagreed on whether it should have its own specialty status or be grouped with another field of medicine. Krusen published the PM&R textbook Handbook of Physical Medicine and Rehabilitation in 1941.
Physiatry began to receive more attention after World War II (1939–1945) when injured soldiers returned home and needed care to help them recover and regain their lives. The AMA eventually recognized the term physiatrist in 1946. A year later, Krusen along with fellow physicians Walter Zeiter and John Coulter, again presented their plans for an American Board of Physical Medicine and Rehabilitation (ABPMR). The AMA and ABMA finally recognized the field and the board and installed Krusen as the chairman. Nearly eighty doctors took the first board exams for physical medicine that year and became certified in the new field.
Overview
Physiatrists must complete medical school and then four years of training in a PM&R residency. The ABPMR requires the passage of both written and oral examinations to become board certified in PM&R. Because of the large range of conditions physiatrists treat, many choose to complete training in additional fields such as pediatrics, internal medicine, and neurology. They may receive certification in subfields including brain injury medicine, hospice and palliative medicine, neuromuscular medicine, pain medicine, pediatric rehabilitation medicine, spinal cord injury medicine, or sports medicine.
PM&R may be used to treat numerous conditions, such as neurological disorders caused by spinal cord injury, traumatic brain injury, stroke, multiple sclerosis, and Parkinson's disease; chronic pain issues, such as back and neck pain, joint and muscle pain, arthritis, and carpal tunnel syndrome; musculoskeletal problems, such as osteoarthritis, osteoporosis, rheumatoid arthritis, and fibromyalgia; sports-related injuries, such as tendonitis, stress fractures, and concussion; genetic conditions, including cerebral palsy, muscular dystrophy, spina bifida, and Down syndrome; organ transplants; amputations; cardiac/pulmonary disease; swallowing and speech disorders; bowel and bladder problems; cancers; and burns.
Some of these conditions, such as Down syndrome, are inherited, while others, such as broken bones, may be caused by accidents. PM&R helps people live with their medical conditions. Instead of focusing on a cure—many of these conditions can only be managed, not cured—the goal of PM&R is to treat the medical issue to enhance the patient's quality of life and restore functional ability to that person. The treatment not only helps people manage physical pain but also helps patients get to a point where they can perform daily living activities—eating, dressing, bathing, using the bathroom, or moving from a wheelchair—independently.
For each individual, physiatrists create a specific patient-centered treatment plan designed to work on his or her needs exclusively. Such plans treat medical, physical, social, emotional, and work-related problems that may arise from a condition or an illness. In addition, physiatrists work with other physicians and specialists (neurologists, orthopedists, neurosurgeons, physical and occupational therapists, social services, psychiatrists, speech pathologists, etc.) to ensure that patients receive the care they need. For example, physiatrists may help amputees with the fitting and use of prostheses. They may set a plan to include pain management, physical therapy, and psychiatric care so the patient can deal with the physical and emotional issues associated with losing a limb.
Physiatrists perform and prescribe treatments such as injections, ultrasounds, discography, nerve stimulation, biopsies, and prosthetics and orthotics. For example, for muscular issues, they may use electromyography (EMG), which involves inserting tiny needles into muscles to assess movement and weakness. They use nerve conduction studies (NCS) to monitor motor and sensory responses. Peripheral joint injections can aid in bone and soft tissue disorders and may be used to treat conditions such as orthopedic or sports-related injuries. Trigger point injections used in conjunction with physical therapy can treat chronic myofascial, or soft tissue, pain. Other treatments, such as acupuncture, platelet injections, and stem cell treatments, also may be used.
Bibliography
"About Physical Medicine & Rehabilitation." American Academy of Physical Medicine and Rehabilitation, www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation. Accessed 21 Nov. 2016.
"Definition of Physical Medicine and Rehabilitation." American Board of Physical Medicine and Rehabilitation, www.abpmr.org/consumers/pmr‗definition.html. Accessed 21 Nov. 2016.
"Dr. Frank Kriise of Mayo Clinic, 75." New York Times, 18 Sept. 1973, www.nytimes.com/1973/09/18/archives/dr-frank-krusen-of-mayo-clinic-75-rehabilitation-expert-diesled.html?‗r=0. Accessed 21 Nov. 2016.
"History of the Specialty." American Academy of Physical Medicine and Rehabilitation, www.aapmr.org/about-physiatry/history-of-the-specialty. Accessed 21 Nov. 2016.
"Physiatry - Rehabilitation Medicine." Johns Hopkins Medicine, www.hopkinsmedicine.org/physical‗medicine‗rehabilitation/services/outpatient/physiatry.html. Accessed 21 Nov. 2016.
"Physical Medicine and Rehabilitation." Mayo Clinic, www.mayoclinic.org/departments-centers/physical-medicine-rehabilitation/overview. Accessed 21 Nov. 2016.
"Physical Medicine and Rehabilitation." MedlinePlus, 8 Oct. 2015, medlineplus.gov/ency/article/007448.htm. Accessed 21 Nov. 2016.
Staehler, Richard A. "What Is a Physiatrist?" Spine-health.com, 29 Sept. 2011, www.spine-health.com/treatment/spine-specialists/what-a-physiatrist. Accessed 21 Nov. 2016.