by Marc D. Pecha, MD
I don’t remember a class in medical school about function. We learned a lot about many diseases, but little about how those diseases affect a person’s ability to function. However, function underlies everything a rehabilitation physician does.
A physiatrist (fizz ee AT' trist), or rehabilitation physician, is a specialist who addresses how a patient adapts to his environment given his specific disability from a disease process. From an injured worker with acute pain, to an amputee, to a stroke survivor, to a spinal cord injured patient, there are many physical needs these unique patients have when trying to maintain or regain their independence.
Wagon Wheel
Like the wheel of a wagon, the field of Physical Medicine and Rehabilita-tion (PM&R) encompasses many different components that holistically address the patient’s medical condition and his ability to interact with the en-vironment. Similar to OB/GYN, PM&R has two primary divisions which overlap to some degree. Physical Medicine involves the treatment of musculoskele-tal soft tissue injuries and pain states, as well as any condition affecting the person’s ability to function. Osteo-arthritis, tendonitis, nerve injuries (e.g. carpal tunnel syndrome and other nerve entrapments, radiculopathy, brachial plexopathy, etc.), work-related injuries (i.e. Industrial Medicine), spasticity management, low-back pain, and interventional pain management (e.g. injections of joints, trigger points and botulinum injections for spasticity) are but a few of the conditions seen by a physical medicine physician. Electro-myography (EMG) is very important aspect in the diagnosis of nerve and muscular diseases and is frequently used to diagnose carpal tunnel syndrome, pinched nerves of the arm and leg, spinal stenosis and myopathies, to name a few.
Rehabilitation Medicine concerns itself with restoration of function from a variety of medical diseases and conditions. In addition to addressing the loss of function from stroke, spinal cord injury, amputation and traumatic brain injury, a rehabilitation physician also is vital in helping restore function in the medically debilitated patient (e.g. those with cardiopulmonary disease, cancer, neuromuscular disorders, sports-related injuries, etc.). There is even a subspecialty in pediatric rehabilitation that addresses functional deficits ranging from developmental delay to cerebral palsy and spina bifida to brain injuries and trauma.
Recent Advances
The 70-year-old field of PM&R has seen some remarkable advances over the decades, but the basic principles of using exercise and modalities to help achieve better function have not changed much. Therapists continue to be an integral part of the treatment regimen of many patients and their proper utilization is one of the unique abilities of rehab physicians. In a typical rehab team there are physical, occupational, speech and recreational therapists as well as rehab nurses, psychologists and case managers who work as a team to transition patients into a living environment best suitable to their abilities.
In addition to continual advances
in therapy practices and machines designed to more effectively develop a patient’s physical function, some exciting advances have revolutionized the care of those who were thought beyond improvement.
With the advancement of the computerized knee (also known as a C-leg); amputees who once were limited in where and how they could walk are now enjoying activities previously thought impossible for them. Step-over-step stair climbing, walking on uneven ground and varying their gait speed are but some of the feats previously believed beyond their capability. Recently developed medicines have brought improved pain relief with few side effects to individuals with neuropathic pain, and implantable pumps now allow much better spasticity management than was ever possible with oral medicines.
Cutting edge research into the use of adult stem cells for spinal cord injuries has shown promise in those patients for whom even a small improvement translates into a functional victory.
PM&R is well positioned to address the functional decline in the aging population. With its focus on function the field is addressing the demands of the baby-boomers who refuse to lose function in their later years. Understanding all the functional needs of patients as well as their specific pathology differentiates physiatrists and allows us to focus on what really matters to our patients — regaining function.
Marc D. Pecha, MD practices in The Rehabilitation Group in the medical center and has been in private practice for 8 years. He serves as the rehabilitation medical director for Manor Care Skilled Nursing Unit, Heartland Home Health Care and Kindred Hospital. He is board certified in electrodiagnostic medicine and is the proud father of five children.
