S Hariharana, V K Sreekalaa
Department of Physical Medicine and Rehabilitation, Medical College, Thiruvananthapuram

Corresponding Author: Dr. S Hariharan, Former Professor and HOD, Physical Medicine and Rehabilitation, Medical College, Thiruvananthapuram. Phone: 9447270028. Email: drvksreekala@gmail.com

ABSTRACT

Physiatry is the medical specialty dealing with Physical Medicine and rehabilitation. Broadly speaking, the specialty deals with all pains and paralyzing syndromes –neck and back pains, joint pains, Arthritis, Paralyzing conditions, Amputations, musculoskeletal deformities, genetic disorders-Hemophilia, muscular dystrophy, myopathy etc, development delays in children including cerebral palsies, spinal deforming conditions, postural and balance disorders, obesity related conditions, sports injuries ,post fracture cases etc. In fact almost all diseases, irrespective of the specialties, will benefit a lot from physiatric PMR interventions, rather than attending to a minuscule therapy situation like physio or occupational therapy. Ability–Disability evaluation and certification is of prime importance to all the people with disabilities and this is done by the Physiatrists (PMR specialists)

Physiatry is the medical specialty dealing with Physical Medicine and rehabilitation. In some situations it is the simply connoted as Rehabilitation Medicine.1,2

Physiatrist is the modern medicine doctor specialized in Physical Medicine & Rehabilitation.

Physical Medicine denotes the judicious application of various physical modalities like heat, cold, sound, electricity, electromagnetic spectrum waves, magnetism, exercise and physical appliances (Orthotic- Prosthetics), in the treatment of various diseases and disabilities along with regular medical and surgical treatment.

Rehabilitation Medicine denotes all treatment aimed at re-enabling a person with disabilities arising out of various diseases. In the process of medical rehabilitation, the use of physical medicine principles is in high demand and hence the specialty is termed as Physical Medicine – Rehabilitation (PMR)

Historical Perspective: PMR was organized as a specialty in the 1940s in Mayo Clinic in USA under the leadership of Dr.Krusen; simultaneously in New York Dr. Howard A Rusk also developed it as Rehabilitation Medicine especially during the time of World War II. The first Rehabilitation Medicine centre was opened in New York by Dr. Howard Rusk to rehabilitate war-injured veterans.

In India also, the PMR developed around the same time. The all India Institute of Physical Medicine& Rehabilitation (AIIPMR) was established in Mumbai in the year 1954 under the leadership of Dr. M.V. Sant.  States like Kerala, Tamil Nadu, Delhi, West Bengal and Rajasthan took the early steps to sow the seeds of PMR in the 1960s and P.G.specialization training programmes for medical doctors were established in our country in the 1970s.Trivandrum Medical College in Kerala was the first in our country to start an organized PMR PG course in 1973; subsequently various states followed the suit for initiating P G PMR programmes. Now PMR is one of the most rewarding specialties –financially and socially –all over the world.

Rehabilitation Therapy: This concept of therapy has been quite vague and unorganized for long time. Physiotherapy, Occupational therapy, Speech therapy, Prosthetics-Orthotics, Psychological counseling, socio –vocational interventions, etc are the various constituent paramedical or Para rehabilitation therapy areas useful for medical rehabilitation of people with disabilities, supposed to work under qualified medical –direction and supervision .Before the development of the Physiatrists ,all these therapists were functioning under different directions from various doctors; in effect ,they were left without any supervision and the people at large could not achieve the desired effect from these therapists. All these therapists are paramedical-based, person–to-person treatment approaches, which could achieve best results only by a supervised team approach. This supervision and direction have been successfully achieved by the PMR specialists.

Physiotherapy is the Paramedical treatment field where trained physiotherapists are delivering the needed treatment modalities to the patients. The curriculum involves stress on the delivery of the treatment modalities using various physical instruments and exercises and to this end; the therapists are exposed to basic anatomy and physiology of human body along with the details of treatment of modalities. The diagnostic skill is not in the domain of these therapies. The physiotherapists, themselves have to personally institute the therapy to the patients on individual case basis.

Occupational Therapy: The Occupational therapists (OT), unlike physiotherapists, are not applying any physical modality of treatment directly to the patients. Instead, they chart out suitable activities (occupations) for the patients to do or practice by themselves in order to achieve independence in their activities of daily living. That means, the patients undergoing OT will be doing their own activities as to achieve positive outcome in their condition.

Prosthetics-Orthotics: Prosthetics involves issue and fitting of artificial limbs for various kinds of amputees, whereas Orthotics deals with the issue and fitment of appliances to the human parts which require externally added supports for their rehabilitation.

Other rehabilitation therapies – also require similar comprehension as described above.

Cases to be referred to the Physiatrists – Broadly speaking, the specialty deals with all pains and paralyzing syndromes –neck and back pains, joint pains, Arthritis, Paralyzing conditions, Amputations, musculoskeletal deformities, genetic disorders-Hemophilia, muscular dystrophy, myopathy etc, development delays in children including cerebral palsies, spinal deforming conditions ,postural and balance disorders, obesity related conditions, sports injuries ,post fracture cases etc. In fact almost all diseases, irrespective of the specialties, will benefit a lot from physiatric PMR interventions, rather than attending to a minuscule therapy situation like physio or occupational therapy. Ability–Disability evaluation and certification is of prime importance to all the people with disabilities and this is done by the Physiatrists (PMR specialists)

End Note

Author Information

  1. Dr. S Hariharan,
    Former Professor and HOD,
    Physical Medicine and Rehabilitation,
    Medical College, Thiruvananthapuram
  2. Dr. V K Sreekala,
    Professor and HOD
    Physical Medicine Rehabilitation,
    Medical College, Thiruvananthapuram   

Conflict of Interest: None declared

References

  1. Physical medicine and rehabilitation – Wikipedia, the free encyclopedia. [Source]
  2. Physiatry the definition of Physiatry by Medical dictionary. [Source]