Non-communicable diseases, Road Traffic Accidents (RTAs) and the resulting disability are clawing their way into our routine lifestyles at an alarming pace. It is somewhat heartening to see that disease can, many times be curbed at an early stage owing to the present day healthcare system, advanced drug care and technology. Disability and associated morbidity, on the other hand, can be a shattering experience for an individual and his family, both mentally and physically.
Often little can be done to completely reverse the grievous damage that afflicts a disabled person. The journey towards rehabilitation and restoration of function comprises of a ‘Thousand steps’. Physical Medicine and Rehabilitation (PM&R), or Physiatry (pronounced /fɪziˈætri/) takes you from the first step of that arduous uphill journey towards recovery.
Physical Medicine and Rehabilitation (PM&R) is a branch of medicine which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician who has completed training in this field is referred to as a physiatrist. PM&R is one of 24 medical specialties certified by the American Board of Medical Specialties and provides integrated care in the treatment of all conditions related to the brain, muscles, and bones, from traumatic brain injury to lower back pain. Physiatrists, or rehabilitation physicians, are medical doctors who are:
PMR is a highly specialized field that relies on an integrated team based approach to consistently deliver successful results. It is developing at a rapid pace and has evolved considerably over the past few decades. Six formal sub-specializations are recognized by the field in the United States:
Many in the field also sub-specialize in areas of care of patients with amputations, musculoskeletal medicine, electro-diagnostics, traumatic brain injury (TBI), and cardiopulmonary rehabilitation.
The history of Physical Medicine and Rehabilitation (PM&R) dates back to the 1930s when it was initially instituted to address musculoskeletal and neurological problems. PMR broadened its scope considerably after World War II, as thousands of veterans came back to the United States with serious disabilities and the task of helping them restore their productive lives provided a new direction & challenge to the field. The term 'Physiatry' was coined by Dr. Frank H. Krusen in 1938 & was accepted by the American Medical Association in 1946.
PMR is not new to India as well but this field certainly hasn’t gathered the popularity that it enjoys in the West. In India, PMR began in 1960s and the Indian Association of Physical Medicine & Rehabilitation (IAPMR) was formally registered in 1972. Dr Mary Verghese, popularly known as “Wheelchair Surgeon” underwent PMR training at Rusk Institute of Rehabilitation Medicine, New York and started one of the first Departments of PMR at Christian Medical College (CMC), Vellore. Simultaneously, the All India Institute of Physical Medicine & Rehabilitation (AIIPMR), Mumbai, an apex institute in the country for PMR was established in November 1955 in collaboration with the UNITED NATIONS ORGANISATION, assisted by an Indian expert, late Dr MV Sant. Today it’s a well equipped rehabilitation center with 60 beds, modern operation theatres & state of the art facilities like Gait Lab & CAD-CAM technology for Prosthetic & Orthotic Fabrication. PMR got another shot in the arm when Dr Howard Rusk visited All India Institute of Medical Sciences (AIIMS), New Delhi in 1960s to set up the dept., greatly aided by active participation from Dr. S K Verma. It is practically impossible to name the pioneers of PMR in India, but revolutionary work by several rehabilitation specialists has vastly improved the outlook towards PMR today.
PM&R is often called the “quality of life profession” because its aim is to enhance patient performance. It seeks to enhance the ability of an affected individual to function optimally within the limitations placed by a disease process for which there is no known cure. The emphasis is not on the full restoration to the pre-morbid level of function, but rather the optimization of the quality of life for those who may not be able to achieve full restoration.
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, physical training with therapeutic exercise, movement & activities modification, adaptive equipments and assistive device, orthotics (braces), prostheses, and experiential training approaches. Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, cerebral palsy, muscular dystrophies, meningomyelocele (MMC), stroke, musculoskeletal pain syndromes such as low back pain, 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.
The essence of a good PMR practice lies in setting up goals and following a team based approach that are essential to deliver optimal results. A team approach to chronic conditions is emphasized to coordinate care of the patients. The team usually comprises of a Physiatrist, Physiotherapist, Occupational Therapist, Speech & Language Therapist, Prosthetic & Orthotic Engineer, Rehabilitation Nurse, Counselor/Social Worker and a Psychologist. These professionals work in tandem to aid in functional recovery of the affected individual and to improve the productivity of life. The core of this team is the patient and his/her caregiver or family.
A World Health Statistics report issued by the WHO in 2008, states that the proportion of deaths due to non-communicable diseases will rise significantly by 2030. The availability of latest technology for management of various medical disorders, has led to a definite decrease in the mortality rates but not the morbidity rates. Not only has the average life span of an Indian increased from a mean of 42.4 years in 1960 to a mean of 63.7 years in 2008, the healthcare facilities available have also advanced. Although it is imperative to live an independent life in today’s fast paced world, the changing family profile in India places a greater demand on a disabled person to achieve as much purposeful recovery as quickly as possible.
Owing to these factors, functional recovery from any chronic disease assumes great importance. In such a scenario, the need for rehabilitation has increased tenfold and so has the need for quality rehabilitation centres around the country.