Physical Medicine and Rehabilitation · 2018-10-10 · A Physiatrist… •Specializes in clinical...
Transcript of Physical Medicine and Rehabilitation · 2018-10-10 · A Physiatrist… •Specializes in clinical...
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Physical Medicine and RehabilitationAn Introduction
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The Basics
• Physical Medicine and Rehabilitation (PM&R)
• Related terminology– Physiatry/physiatrist
– Rehabilitation Medicine
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What is PM&R
“Branch of medicine emphasizing prevention, diagnosis, and treatment of disorders – particularly related to nerves, muscles, and bones – that may produce temporary or permanent impairment.”
--American Academy of PM&R
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A Physiatrist…
• Specializes in clinical and diagnostic use of physical agents and exercises to provide physiotherapy for physical, mental, and occupational rehabilitation of patient.
• Examines patient, utilizing electrodiagnosis and other diagnostic procedures to determine need for and extent of therapy. --Webster’s Online Dictionary 2009
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Another Laymen’s Definition
“A branch of medicine which aims to enhance and restore function ability and quality of life to those with physical impairments or disabilities.”
--Wikipedia.org
Physiatrists are sometimes referred to as
Muscle Doctors
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Quick Clarification
IMPAIRMENTAnatomical or physiological dysfunction
DISABILITIYUnable to perform a human activity
HANDICAPUnable to meet a societal role
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International Classification of Functioning, Disability, and Health (ICF)
ICF Terms in the context of health:
Body functions are the physiological functions of body systems (including psychological functions).
Impairments are problems in body function or structure such as a significant deviation or loss.
Activity is the execution of a task or action by an individual.
Participation is involvement in a life situation.
Activity limitations are difficulties an individual may have in executing activities.
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Timeline
ORIGINAs early as heat/cold modalities used for health benefits (time of Hippocrates)
DEFINEDPrinciples formulated during post WWI
CONSOLIDATED & EXPANDEDPost-WWII
ESTABLISHEDApproved as medical specialty in 1947
EVOLVEDIn 1955 more than 21,200 cases of polio are reported. The polio epidemic dominated the attention of PM&R physicians and rehabilitation institutions expanded from institutions dedicated to the treatment of polio
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Common Conditions
• Spasticity and Movement Disorders• Stroke• Traumatic Brain Injury (TBI)• Spinal Cord Injury (SCI)• Multiple Sclerosis (MS) and other Neurological Conditions• Pain • Amputation• Osteoarthritis• Sports Injuries
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EvaluationHistory (include focus on function), physical exam, imaging
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Evaluation
Electromyography
Nerve Conduction Study
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Problems
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
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Problems Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Orthoses
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Electrical Stimulation
Thickening Mix
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Gait Training
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Manual Therapy
Botox Baclofen Pump
Medication
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Water Therapy
Heat/Cold
Transcutaneous Electrical Nerve Stimulation
Medication Control
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Solutions
AmputationAphasiaCognitive ImpairmentDepressionDysphagiaGait DysfunctionHeterotopic OssificationHypoventilation
MalnutritionNeurogenic BladderPainParalysis and ParesisRadiculopathySkin BreakdownSpasticityWeak Muscles
Prostheses
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GoalOverall Functional Enhancement
MAXIMIZE• Independence• Dignity• Quality of Life
PhysicalPsychologicalSocialVocationalEducational
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Task at Hand
1. Optimize Function2. Relieve Pain3. Prevent and Manage Complications4. Coordinate Care
5. Educate and Empower Patients
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Practice Settings
INPATIENT• Acute Care Hospitals
• Long Term Acute Care Hospitals
• Inpatient Rehabilitation Units of Acute Care Hospitals
• Skills Nursing Home with Subacute Rehabilitation Programs
• Nursing Homes
OUTPATIENT• Hospital Clinic
• Acute Rehab Clinic
• Private Office
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Sample Inpatient Experience
Brain InjuryBurnCancerCardiacNeurologic DisorderOrthopedic
PediatricPolytraumaPulmonarySpinal Cord InjuryStrokeTransplant
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Sample Outpatient Experience
AmputeeArthritisCerebral PalsyFibromyalgiaEMG & NCSMusculoskeletalOrtho-Rehab
PainPediatricSpasticitySpina BifidaSpineStrokeWound Care
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Interdisciplinary TeamsMedical Professionals
Critical CareGeneral SurgeryGeriatricsInternal MedicineOrthopedicsOncology
NeurologyNeurosurgeryPediatricsPsychiatryRheumatologyUrology
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Interdisciplinary TeamsAllied Health Professionals
DieticanMusic TherapistOccupational TherapistPet TherapistPhysical TherapistProsthetist / OrthotistPsychologist
Recreational TherapistRehabilitation NurseRespiratory TherapistSpeech & LanguageSocial WorkerVocational Counselor
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PM&R Residency
Option A Option B Option C
Categorical Preliminary Transitional
PGY-1
PGY-2
PGY-3
PGY-4
Fellowship
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Fellowships
ElectrodiagnosticMedicineHospice and Palliative Medicine*
Interventional SpineNeuromuscular Medicine*
Pain Medicine*
RheumatologyPediatric Rehabilitation Medicine*
Spinal Cord Injury Medicine*
Sports Medicine*
StrokeBrain Injury Medicine*
*Denotes sub-specializations certified by ABPMR
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Lots of Work Ahead
• Aging Population• Decreasing Injury Mortality• High Healthcare Costs• New Applications• Innovative Technology• Regeneration/Stem Cell Advances• Artificial Intelligence• Robotics & Computer Science
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Additional ResourcesAssociations
Association of Academic Physiatristswww.physiatry.org
American Academy of Physical Medicine & Rehabilitationwww.aapmr.org
American Congress of Rehabilitation Medicinewww.acrm.org
American Board of Physical Medicine & Rehabilitationwww.abpmr.org
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Additional ResourcesJournals
American Journal of Physical Medicine & Rehabilitationwww.ajpmr.org
Archives of Physical Medicine and Rehabilitationwww.archives-omr.org
PM&Rwww.pmrjournal.org
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Thank You!
These slides were adapted from a presentation by JiaxinTran, MD, New Jersey Medical School -UMDNJ