what is Physical medicine and rehabilitation
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Physical medicine and rehabilitation (PM&R) aims to enhance functional ability and quality of life for those with physical impairments. It originated during WWI to treat war veterans and focuses on disorders of nerves, muscles and bones. PM&R physicians lead an interdisciplinary team including physical, occupational and speech therapists to help patients regain independence through a range of treatments and rehabilitation approaches. The goal is to maximize patients' independence, dignity and quality of life.
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what is Physical medicine and rehabilitation
- 1. WHAT IS PHYSICAL MEDICINE AND REHABILITATION Dr. Harshaand Popalwar MBBS, MD,DNB, MNAMS, PGDHM, FDFM Specialist Department of Physical Medicine and Rehabilitation Safdarjung Hospital, New Delhi
- 2. 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
- 3. IN OTHER WORDS… "Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move." - American Academy of PM&R
- 4. ANOTHER LAYMEN’S DEFINITION "A branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities." - Wikipedia.org
- 6. HISTORY OF PM&R Comes from physikos (physical) and iatreia (art of healing) Principles started during World War I Physiotherapy and reconstruction hospitals to treat war vets
- 7. HISTORY OF PM&R 1936 first program founded at the Mayo Clinic with the support of the War Dept and US Navy 1941 World War II broadens the scope of the field 1945 section of PM&R established in the AMA
- 8. HISTORY OF PM&R (CONT…)
- 9. HISTORY OF PM&R 1946 twenty five residencies established 1952 nearly 58,000 cases of polio become a prime focus of treatment President Franklin Roosevelt brings spotlight disabled Americans 1965 Medicare and Medicaid established 1972 Medicare expands coverage to include disabled and inpatient rehabilitation
- 11. WHAT ARE THE MISSION AND MOTTO OF PM&R To promote person’s quality of life and functional outcomes through a dynamic team oriented approach Traditional medical approach ‘’adds years to life’’ while PM&R in its true spirits ‘’ adds life to the years’’
- 12. INTERDISCIPLINARY TEAM • Critical Care • Intensive Medicine • General Surgery • Neurology • Neurosurgery • Orthopedics • Psychiatry • Urology Medical Professionals
- 13. INTERDISCIPLINARY TEAM (CONT’D) Dietetic Rehabilitation Nurse Occupational Therapy Recreational Therapy Physical Therapy Prosthetics & Orthotics Psychology Respiratory Therapy Social Worker Speech & Language Therapy Vocational Counseling Allied Health Professionals
- 14. PHYSICAL THERAPIST Works on tasks Mobility Transfers Gait Car skills Pain control Education Exercise, modalities
- 15. OCCUPATIONAL THERAPIST Works on tasks of upper extremities Activities of daily living Functional transfers Splinting Modalities and motor control tasks May specialize in hand therapy
- 16. SPEECH/LANGUAGE THERAPISTS Speech and language assessment and treatment Cognitive evals and treatment Swallowing assessment and treatment Bedside Modified barium swallow testing
- 17. COUNSELOR May be social worker, psychologist Adaptation to disability
- 18. NURSING Different than acute care floor Patients are mobile and active Education Bladder and bowel programs Decubutis care
- 19. SOCIAL WORKER Discharge planning Procure equipment Follow up arrangements
- 20. THERAPEUTIC RECREATION SPECIALISTS Works with avocational tasks Hobbies and interests Field trips
- 21. PHYSIATRIST Physiatrist or Physical medicine and rehabilitation (PMR) specialist are doctors with specialization (MD/DNB) in Physical medicine and rehabilitation.
- 22. PM&R physicians practice in a variety of clinical settings, including inpatient department (IPD), outpatient department (OPD), intensive care unit (ICU), and high dependency care unit (HDU). They have a broad range of knowledge including musculoskeletal, neurological, rheumatological and cardiopulmonary systems.
- 23. Some of the common diagnoses and populations seen by inpatient physiatrists include spinal cord injury, brain injury (traumatic and non-traumatic), stroke, neck pain, low back pain, joint pain, polio, burn care, musculoskeletal and pediatric rehabilitation etc. Inpatient physiatrists are often trained using collaborative team skills and work with social workers and other paramedical persons (e.g., physical, occupational and speech therapists) to manage these issues
- 24. Outpatient physiatrists manage conditions including, spine-related pain and dysfunction, occupational injuries and overuse syndromes, neurogenic bowel/bladder, pressure injury management, spasticity management, and chronic pain. Outpatient physiatrists are typically found in multidisciplinary groups consisting of other physicians, orthopaedic surgeons, rheumatologists and/or neurosurgeons.
- 25. Patient with SCI DVT/Pulmonary thromboembolism Pneumonia Pressure sore Postural hypotension Urinary tract infections Spasticity Autonomic dysreflexia Neuropathic pain Example
- 26. PMR IS TEAM APPROACH !
- 28. GOAL -= Overall Enhancement =- Maximize Independence Dignity Quality of Life physical psychological social vocational educational
- 29. SAMPLE INPATIENT EXPERIENCE Spinal cord Traumatic Brain Stroke Polytrauma Pediatric Burn Cancer Transplant Orthopedic Pulmonary Chronic Neurology Disorder (e.g., MS) Complex Medical Disorders
- 30. SAMPLE OUTPATIENT EXPERIENCE Amputee Wound Care Spasticity Musculoskeletal Stroke • EMG & NCS • Pain • Ortho-Rehab • Spine • General • Pediatric • Arthritis • Fibromyalgia • Spina Bifida
- 31. THE REHABILITATION STAFF NURSE The goal of rehabilitation nursing is to assist individuals with disability and/or chronic illness to attain and maintain maximum function. The rehabilitation staff nurse assists clients in adapting to an altered lifestyle, while providing a therapeutic environment for client's and their family's development.
- 32. The rehabilitation staff nurse designs and implements treatment strategies that are based on scientific nursing theory related to self-care and that promote physical, psychosocial, and spiritual health. The rehabilitation staff nurse works in inpatient and outpatient settings that can be found in a range of acute to subacute rehabilitation facilities.
- 33. GENERAL RESPONSIBILITIES OF THE REHABILITATION STAFF NURSE Possesses the specialized knowledge and clinical skills necessary to provide care for people with physical disability and chronic illness Coordinates educational activities and uses appropriate resources to develop and implement an individualized teaching and discharge plan with clients and their families Performs hands-on nursing care by utilizing the nursing process to achieve quality outcomes for clients
- 34. Coordinates nursing care activities in collaboration with other members of the interdisciplinary rehabilitation team to facilitate achievement of overall goals Coordinates a holistic approach to meeting patient's medical, vocational, educational, and environmental needs Demonstrates effective oral and written communication skills to develop a rapport with clients, their families, and health team members.
- 35. ROLES AND FUNCTIONS OF THE REHABILITATION STAFF NURSE Shares information about the disease processes underlying disabilities and teaches nursing techniques to help clients and their families develop the self-care skills necessary to move toward wellness on the illness-wellness continuum Prepares clients and their families for future self-management and decision-making responsibilities by fostering clients' independence and goal achievement
- 36. Reinforces the teaching done by specialists in rehabilitation and other healthcare disciplines, provides resource materials for clients' changing needs, and provides on- going patient education after discharge Provides in-service education for healthcare team members and members of the community regarding the prevention of disabilities
- 37. ADD LIFE TO YEARS….. NOT YEARS TO LIFE !