Physical medicine and rehabilitation (PM&R) or physiatry is a branch of medicine dealing with functional restoration of a person affected by physical disability.
A physician who has completed training in this field is referred to as a physiatrist (fizz eye' a trist). In order to be a physiatrist in the United States, one must complete four years of medical school, one year of internship and three years of residency. PM&R is a relatively young specialty.
History
Among the early pioneers of the field include Dr. Frank Krusen who developed the Department of Physical Medicine at the Mayo Clinic in 1936. PM&R was recognized as a medical specialty by the American Board of Medical Specialties and the American Medical Association in 1947. The field expanded rapidly owing in large part to World War II, when many soldiers with servere disability returned to the United States and physicians were necessary to treat and manage chronic debilitating conditions. Polio epidemic in the early 1950s also helped establish the value of physiatrists in management of neuromuscular disorders. Advances that allowed longer survival from disorders as varied as spinal cord injury and stroke led to greater role of physiatrists in managing these chronic conditions. This specialty's research base is still evolving.
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, and experiential training approaches. Electrodiagnostics are used to diagnose and provide prognosis for various neuromuscular disorders.
Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskletal pain syndromes such as low back pain and fibromyalgia and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through multidisciplinary approach involving psychologists, physical therapists, occupational therapists, and interventional procedures when indicated.
Philosophy
The major concern of the field is the ability of the person to function optimally within the limitations placed upon them by a disease process for which there is no known cure. The general emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those who may not be able to achieve full restoration. A team approach to chronic conditions is emphasized, using transdisciplinary team meetings to coordinate care of the patients.
Subspecialty
Six formal sub-specializations are recognized by the field in the United States: pain medicine, pediatric rehabilitation, spinal cord injury medicine, neuromuscular medicine, sports medicine, and hospice and palliative medicine. Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, electrodiagnostics, traumatic brain injury (TBI), cardiopulmonary rehabilitation and neuromuscular disorders.
