Physical medicine and rehabilitation (PM&R), also known as physiatry, and outside the United States as physical and rehabilitation medicine (PRM), is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. Officially established in the United States in the mid-1900s, PM&R has played a major role in patient recovery following several major epidemics and both world wars. Common medical conditions treated by PM&R physicians include spinal cord injury, brain injury, musculoskeletal injury, stroke, pain, and spasticity from muscle, ligament, or nerve damage. PM&R physicians lead rehabilitation teams in inpatient and outpatient settings and are trained in medication management, electrodiagnosis, and targeted injections. A physician having completed training in this field may be referred to as a physiatrist.
Scope of the field Physical medicine and rehabilitation encompasses a variety of settings and patient populations. Physiatrists can also oversee patient care in subacute settings (Inpatient rehabilitation, LTAC, SNF). A major goal of Physiatry is to optimize function. Thus, the scope of the field is broad in terms of patient populations and conditions that are managed. In hospital settings, physiatrists commonly treat patients who have had a spinal cord injury, stroke, traumatic brain injury, amputation, or other debilitating condition requiring acute rehabilitation care. In treating these patients, physiatrists lead a team of physical, occupational, and speech therapists, as well as nurses, psychologists, and social workers who work in tandem to facilitate patient care. In the outpatient setting, physiatrists can see to the long-term care of patients with disabling conditions and management of the sequelae associated with those conditions. For example, a physiatrist could manage the bowel and bladder regimen for a SCI patient. In addition, patients can be evaluated and treated for muscle and joint injuries, pain syndromes, non-healing wounds, and other disabling conditions. Physiatrists are trained to perform injections into joints or muscle as a pain treatment option. Physiatrists are also trained in ultrasound, nerve conduction studies, and electromyography. Physical medicine in practice: Physiatrists aim to treat a wide array of diseases and disorders, and the field is continually growing. Problems with the musculoskeletal system and the central nervous system (brain and spinal cord) encompass the types of ailments patients will have. Overall the treatment can be described as focusing on restoring body structure and function (2). However there are still goals to help the patient socially and psychologically, as these injuries or ailments often take a toll on the person. Commonly treated disorders include knee or hip pain, back pain, problems walking, nervous system disorders, weakness, or chronic pain in general. Other problems, such as cardiopulmonary conditions, bladder/bowel issues, arthritis, and pneumonia are all disorders the physiatrist aims to treat.
History During the first half of the 20th century, two unofficial specialties, physical medicine and rehabilitation medicine, developed separately, but in practice both treated similar patient populations consisting of those with disabling injuries. Frank H. Krusen was a pioneer of physical medicine, which emphasized the use of physical agents, such as hydrotherapy and hyperbaric oxygen. His work began at Temple University and was continued at Mayo Clinic where he coined the term 'physiatry' in 1938. Rehabilitation medicine gained prominence during both World Wars in the treatment of injured soldiers and laborers. Howard A. Rusk, an internal medicine physician from Missouri, became a pioneer of rehabilitation medicine after being appointed to rehabilitate airmen during World War II. In 1944, the Baruch Committee, commissioned by philanthropist Bernard Baruch, defined the specialty as a combination of the two fields and laid the framework for its acceptance as an official medical specialty. The committee also distributed funds to establish training and research programs across the nation. The specialty that came to be known as physical medicine and rehabilitation in the United States was officially established in 1947, when an independent Board of Physical Medicine was established under the authority of the American Board of Medical Specialties. In 1949, at the insistence of Rusk and others, the specialty incorporated rehabilitation medicine and changed its name to Physical Medicine and Rehabilitation. PM&R has played an important role in several epidemics, including management of the long-term complications of the poliovirus. Prior to its official creation as a specialty in the United States, many modern PM&R concepts were developed following President Franklin D. Roosevelt's time at Warm Springs Resort, a hot springs spa in Georgia. He attended the facility in 1924 to assist in his recovery from paralysis secondary to the poliovirus. Due to improvements in his own condition, Roosevelt later purchased the resort in 1926 and transformed it into a medical rehabilitation center. He continued to fundraise money for the facility throughout his presidential years in the 1930s. The improvements to the facility allowed for budding physiatrists, including Dr. Robert L Bennett, to research and enhance the field of PM&R. Many of the techniques that Bennett developed at Warm Springs continue to be utilized by physiatrists today, including the refinement of manual muscle testing and the creation of several prosthetic devices.
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