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Patient / FamilyHere are some answers to questions frequently asked about the specialty of physical medicine and rehabilitation:
What is physical medicine and rehabilitation?Physical Medicine and Rehabilitation (PM&R), also called physiatry, (pronounced fizz ee at´ tree or fizz eye´ uh tree) is the branch of medicine emphasizing the prevention, diagnosis and treatment of disorders –particularly those of the musculoskeletal, cardiovascular, and pulmonary systems – that may produce temporary or permanent impairment. Physical Medicine and Rehabilitation is one of the 24 medical specialties certified by the American Board of Medical Specialties. Physiatry provides integrated care in the treatment of all neurologic and musculoskeletal disabilities from traumatic brain injury to lower back pain. The specialty focuses on the restoration of function to people with problems ranging from simple physical mobility issues to those with complex cognitive involvement. What is a physiatrist?A physiatrist, (pronounced fizz ee at' trist or fizz eye' uh trist) is a physician specializing in physical medicine and rehabilitation. Physiatrists are physicians who treat a wide range of problems from sore shoulders to spinal cord injuries. They see patients in all age groups and treat problems that touch upon all the major systems in the body. These specialists focus on restoring function to people. Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists' patients include people with arthritis, tendonitis, any kind of back pain, and work- or sports-related injuries. Physiatrists also treat serious disorders of the musculoskeletal system that result in severe functional limitations. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists coordinate the long term rehabilitation process for patients with spinal cord injuries, cancer, stroke or other neurological disorders, brain injuries, amputations and multiple sclerosis. What kind of training do physiatrists have?To become a physiatrist individuals must successfully complete four years of graduate medical education followed by four additional years of postdoctoral residency training. Residency training includes one year spent developing fundamental clinical skills and three additional years of training in the full scope of the specialty. There are currently 80 accredited residency programs in physical medicine and rehabilitation in the United States. Many physiatrists choose to pursue additional advanced degrees (MS, PhD) or complete fellowship training in a specific area of the specialty. Fellowships are available for specialized study in such areas as musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine. To become board certified in physical medicine and rehabilitation, physiatrists are required to take both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). The ABPM&R also has agreements with each of the boards of pediatrics, internal medicine, and neurology to allow special training programs leading to certification in both specialties. How did the specialty develop?The field of physical medicine and rehabilitation (PM&R) began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The Advisory Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947. What types of conditions does a physiatrist treat?Physiatrists are physicians who treat a wide range of problems from sore shoulders to spinal cord injuries. The focus of the specialty is on restoring function to people. Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists' patients also include people with arthritis, tendonitis, any kind of back pain, and work- and sports-related injuries. Physiatrists treat serious disorders of the musculoskeletal system that result in severe functional limitations as well. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists coordinate the long term rehabilitation process for people with spinal cord injuries, brain injuries, strokes, amputations, cancer, and multiple sclerosis. What is the physiatrist's role in treatment?A physiatrist may treat patients directly, lead an interdisciplinary team, or act as a consultant. Here are some scenarios that illustrate the varied roles of a physiatrist: A carpenter is lifting some heavy wood when he feels pain in his lower back and down his leg. He sees a physiatrist who does a thorough history and physical examination and performs all the testing needed to make the diagnosis: a herniated disc. The physiatrist develops an appropriate treatment program, monitoring and adjusting it as needed. With this treatment and rehabilitation program, the patient does not need surgery. A woman in a diving accident has a spinal cord injury and is paralyzed below the waist. The physiatrist assesses her injury and with the patient and a team of health care professionals determines the course of her rehabilitation. The physiatrist treats the array of medical issues that occur as the result of a spinal cord injury, and also leads the interdisciplinary team to enable the woman to reach the highest level of functioning possible. The team varies in composition depending on the needs of the patient. In addition to other physicians, the team may include health care professionals such as nurses, physical therapists, occupational therapists, social workers, neuropsychologists, and vocational counselors. A baby is born with cerebral palsy. The physiatrist is called in as the expert who advises on the correct treatment and rehabilitation that can affect the rest of the child's life. How do physiatrists diagnose?Physiatrists' diagnostic tools are the same as those used by other physicians, with the addition of special techniques in electrodiagnostic medicine like electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. These techniques help the physiatrist to diagnose conditions that cause pain, weakness, and numbness. What kinds of treatments do physiatrists offer?Physiatrists offer a broad spectrum of medical services. They do not perform surgery. Physiatrists may prescribe drugs or assistive devices, such as a brace or artificial limb. They also use diverse therapies such as heat and cold, electrotherapies, massage, biofeedback, traction, and therapeutic exercise. Where do physiatrists practice?Physiatrists practice in rehabilitation centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury, and many other special interests. What kinds of differences do physiatrists make?Since physiatrists focus on restoring patients to maximum function, the difference they make can be dramatic. In the case of the herniated disc, the physiatrist not only takes care of the acute problem, but also treats the patient until he or she returns to optimal functioning, usually without surgery. The physiatrist also teaches the patient how to prevent the injury in the future. A broken hip in an elderly patient is another example. Physiatrists can provide aggressive rehabilitation so patients can walk and even exercise again. And because the physiatrist is concerned with all areas of rehabilitation – social, vocational, and medical – the quality of life is significantly increased for patients. How can I locate a physiatrist?There are more than 7,000 physiatrists practicing in the United States today. As a public service, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) provides listings of its member physiatrists by state. Contact MedCare
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