Physical medicine and rehabilitation
Encyclopedia
Physical medicine and rehabilitation (PM&R), physiatry f or rehabilitation medicine, is a branch of medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....

 that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

 having completed training in this field is referred to as a physiatrist or rehab medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients).

History

The term 'physiatry' was coined by Dr. Frank H. Krusen
Frank H. Krusen
Frank H. Krusen, M.D. was an American physiatrist. He is regarded as the "founder" of the field of physical medicine and rehabilitation. Dr. Krusen was the driving force behind the establishment of the first Department of Physical Medicine at Mayo Clinic in 1936...

 in 1938. The term was accepted by the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...

 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
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...

.

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 equipment and assistive device, orthotics (braces), prosthesis, and experiential training approaches.

Physical Medicine & Rehabilitation physicians may also perform electrodiagnostics
Electromyography
Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...

, which are used to provide nervous system functional information for diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

 and prognosis
Prognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...

 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 including such things 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 waves, detected by EMG needles indicate the presence of muscle fibers that have abnormal nerve supplies.

Common conditions that are treated by physiatrists include amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...

, spinal cord injury
Spinal cord injury
A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...

, sports injury, stroke
Stroke
A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

, musculoskeletal pain syndromes such as low back pain
Low back pain
Low back pain or lumbago is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is...

, fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...

, and traumatic brain injury
Traumatic brain injury
Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...

. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through a multidisciplinary approach involving psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...

s, physical therapists, occupational therapist
Occupational therapist
An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...

s, chiropractor
Chiropractor
A Chiropractor, according to the Association of Chiropractic Colleges , "focuses on the relationship between the body's main structures – the skeleton, the muscles and the nerves – and the patient's health. Chiropractors believe that health can be improved and preserved by making adjustments to...

s, 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.

Philosophy

The major concern that PM&R deals with as a medical field is the ability of a 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 not able to achieve full restoration. A team approach to chronic conditions is emphasized to coordinate care of patients. Comprehensive Rehabilitation is provided by specialists in this field, who act as a facilitator, team leader, and medical expert for rehabilitation.

Subspecialty

Six formal sub-specializations are recognized by the field in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

:
  • Hospice and Palliative Medicine
    Hospice and Palliative Medicine
    Hospice and Palliative Medicine is a formal subspecialty of medicine in the United States that focuses on symptom management, relief of suffering and end-of-life care...

  • Neuromuscular Medicine
    Neuromuscular medicine
    The field of neuromuscular medicine is an emerging subspecialty of medicine which focuses on the comprehensive medical management of individuals with neuromuscular disorders. This includes, but is not limited to, disorders of peripheral nerves, muscle and neuromuscular junctions...

  • Pain Medicine
    Pain management
    Pain management is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists,...

  • Pediatric
    Pediatrics
    Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...

     Rehabilitation
  • Spinal Cord Injury
    Spinal cord injury
    A spinal cord injury refers to any injury to the spinal cord that is caused by trauma instead of disease. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence...

     Medicine
  • Sports Medicine
    Sports medicine
    Sports medicine is a branch of medicine that deals with physical fitness, treatment and prevention of injuries related to sports and exercise...



Other subspecialties within the field that are recognized include the following:
  • Musculoskeletal pain management
  • Intervention physiatry
  • Surgical rehabilitation
  • Rheumatological rehabilitation
  • Obesity and other lifestyle disease modifications
  • Cardiopulmonary rehabilitation
  • Amputee care
  • Electrodiagnostics
    Electromyography
    Electromyography is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph, to produce a record called an electromyogram. An electromyograph detects the electrical potential generated by muscle...

  • Traumatic brain injury
    Traumatic brain injury
    Traumatic brain injury , also known as intracranial injury, occurs when an external force traumatically injures the brain. TBI can be classified based on severity, mechanism , or other features...

     (TBI)

Journals

The three main journals of the PM&R field are as follows:

All three journals are published monthly.

Archives of Physical Medicine and Rehabilitation
Archives of Physical Medicine and Rehabilitation
The is the official journal of the ', an organization focused on the creation and use of knowledge in the rehabilitation process. The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in medical...

, which had been co-owned by the American Academy of Physical Medicine and Rehabilitation
American Academy of Physical Medicine and Rehabilitation
The American Academy of Physical Medicine and Rehabilitation is the national medical specialty society for physicians who specialize in physical medicine and rehabilitation . These physicians are called “physiatrists” or “rehabilitation physicians.” Founded in 1938, the mission of AAPM&R is to...

 (AAPM&R) and the American Congress of Rehabilitation Medicine (ACRM), is now solely owned by the Congress as of January 2009. In 2009, the American Academy of Physical Medicine and Rehabilitation
American Academy of Physical Medicine and Rehabilitation
The American Academy of Physical Medicine and Rehabilitation is the national medical specialty society for physicians who specialize in physical medicine and rehabilitation . These physicians are called “physiatrists” or “rehabilitation physicians.” Founded in 1938, the mission of AAPM&R is to...

 launched a new journal, PM&R, published by Elsevier
Elsevier
Elsevier is a publishing company which publishes medical and scientific literature. It is a part of the Reed Elsevier group. Based in Amsterdam, the company has operations in the United Kingdom, USA and elsewhere....

.

Quarterly journal Physical Medicine And Rehabilitation Clinics of North Americahttp://www.theclinics.com published by Elsevier
Elsevier
Elsevier is a publishing company which publishes medical and scientific literature. It is a part of the Reed Elsevier group. Based in Amsterdam, the company has operations in the United Kingdom, USA and elsewhere....

/Saunders also provides in-depth updated information on specific Physical Medicine and Rehabilitation topic.
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