The Role Of Physiatry In Various Rehabilitation
Settings
The field of Physical Medicine and Rehabilitation (PM&R) began in the
1930's to address musculoskeletal and neurological problems, but broadened
its scope considerably after World War II. The Advisory Board of
Medical Specialties granted PM&R its approval as
a specialty in 1947.
Today, physiatry is a diverse specialty. Physiatrists practice in major
rehabilitation centers, in acute care hospitals, rehabilitation hospitals,
skilled nursing facilities, subacute settings, day treatment and
outpatient settings.
The role of a physiatrist in these rehabilitation centers is that of a
primary physician who is responsible for not only rehabilitation services
rendered to patients treated therein, but also for ongoing care of all
medical problems the patients may have upon admission to the
rehabilitation service and all medical problems which may occur while the
patient is hospitalized on the rehabilitation service.
Subsequent to admission to a rehab center, the patients are examined by
the physiatrist or clinical rehabilitation specialist.
A comprehensive history and physical examination is performed. Not only
are medical orders written for the patient, but in addition, a
rehabilitation program is established. Orders are written for specific
modalities of treatment in physical therapy, occupational therapy, speech
therapy, recreational therapy and other clinical services as needed.
Subsequent to this time, there is a team meeting in which initial goals
and an interdisciplinary care plan or program is established. The
admission procedure, thus, is much more comprehensive than that of the
traditional acute hospital admission.
Staff meetings are subsequently held every week or every two weeks in
order to assess and reassess each patient's treatment program; again to
establish new goals.
These goals are integrated into the clinical protocols so that a
transdisciplinary approach can effectively predict a viable outcome and
discharge plan. When these goals are attained, a smooth transition form
the rehabilitation center to home can be achieved.
The patients in the rehabilitation centers are traditionally seen and
examined by the physiatrist either five or six days a week with the
availability on the seventh day. This frequency is necessitated by the
fact that patients are prone to a large array of medical
problems such as pulmonary, cardiovascular, endocrine problems (ie.
diabetes), and control of anticoagulation.
Additionally. the physiatrist monitors, on a daily basis, the patient's
cognitive status, strength, sensation, perceptual ability and functional
status.
These changes are then translated into potential function and the
patient's capability of engaging in functional activity is based on this
examination.
Most of the patients typically in a rehabilitation setting are of marginal
medical stability having just had a significant neurological event,
surgical procedure or significant trauma superimposed upon other chronic
medical problems.
Without physiatric medical supervision of these patients on a daily basis,
medical safety would be severely compromised.
The physician must also monitor the patient's functional status in a
therapy environment on a daily basis to determine how these
neurophysiological changes are being translated into functional activity.
This is the basis of the physiatrist's ongoing management of the patient's
rehabilitation progress. On a daily basis, the physiatrist manages the
rehabilitative care and integrated medical components of patient care.
Frequently the physiatrist requires the assistance of other medical
specialists in the care of these complex patients. When other medical
specialists are necessary for the care of a patient, it is the physiatrist
who integrates their efforts as the primary physician.
If acute medical problems develop and interfere with the patient's ability
to participate in rehabilitation, the physiatrist then must make a
decision to refer the patient back to an acute hospital or unit where more
appropriate comprehensive care can be provided.
Unlike many acute care hospitals where physical therapy functions with
superficial medical supervision, in the rehabilitation units or centers,
physiatry optimizes the resources in maximizing functional potential in
the shortest and most cost effective time frame.
This specialized intervention results in a higher functional status at the
time of discharge, shorter length of hospitalization and greater
percentage of individuals to return home.
Should you have any further questions
regarding this article, please direct your questions or comments to "Ask
the Doctor" section.
Copyright © 2004 - 2008 Taras V.
Kochno, M.D. All Rights Reserved
Board Certified in
Physical Medicine and Rehabilitation
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