Conditions Physiatrists Treat
Physiatrists treat conditions of the bones, muscles, joints, brain and nervous system, which can affect other systems of the body and limit a person's ability to function. Here are some of the most common conditions treated:
- Brain Injury
- Cerebral Palsy
- Multiple Sclerosis and Other Neurological Conditions
- Muscular Dystrophy
- Parkinson's Disease
- Spasticity & Movement Disorders
- Spinal Cord Injury
- Spine Pain
- Sports-Related Injuries
Non-Surgical Approaches to Treatment
The PM&R physician is very skilled in performing musculoskeletal and neurologic examinations. Aside from the history and physical that are the foundation of any patient evaluation, physiatrists are also trained to utilize laboratory testing, x-rays, MRI scans, electromyography (EMG), nerve conduction studies (NCS) and psychological testing. Once a patient's conditioned is assessed, here are common treatment approaches:
- Prosthetics and Orthotics
- Electrical Stimulation
- Active Physical Therapy
- Manual Therapy
- Joint & Trigger Point Injections
- Heat/ Cold and Water Therapy
- Alternative Medicine
- Assistive Devices
Physiatrists take a unique approach on caring for the whole person, so they direct and coordinate care with a diverse rehabilitation team - all of whom work together on a patient's treatment plan. Physiatrists work with the following professionals:
- Physical Therapists
- Occupational Therapists
- Recreational Therapists
- Speech Therapists
- Rehabilitation Nurses
- Social Workers
- Prosthetists/ Orthotists
- Other Physicians (i.e. Neurologists, Orthopedic Surgeons and Primary Care Doctors)
History of Physiatry
Since the beginning of time, people have used physical means for treatment of illness and injury, including water, heat, cold, massage, light, exercise and electricity. Written accounts of physical techniques for healing can be traced as far back as the writings of Hippocrates in 400 B.C. Yet physiatry did not become recognized as a separate medical specialty until 1947. Here's how this young, dynamic specialty was formed.
During and after World War I, empirical trials indicated that various physical methods were useful to augment medical care and convalescence of patients. Physicians began practicing "physiotherapy" in "reconstruction hospitals" to rehabilitate injured and disabled soldiers. Therapeutic tools and methods were developed or improved to apply heat, massage, exercise, electrical stimulation, heliotherapy and diathermy. Physicians pioneered new medical applications of electrotherapeutics and x-rays. Functional activities of occupational therapy were extensively practiced in Army hospitals. Formal education for physiatry had its beginning in 1926 when, after service in the U.S. Army during World War I, Dr. John Stanley Coulter joined the faculty of Northwestern University Medical School as the first full-time academic physician in Physical Medicine. He became the leader of the educational development of the practice over the next two decades. He initiated the first continuing teaching program in Physical Medicine, consisting of short courses of three to six month's duration, later extended to one year for physicians in practice. Prior to that time, training in Physical Medicine had been by short preceptorship with a practitioner of some aspect of the specialty. During that period, Dr. Coulter gained recognition as the leader of the developing organizations for Physical Medicine physicians.
The 1930s brought further organization and purpose to the specialty of Physical Medicine. Additional opportunities for training physicians began to develop, and groups began to form to represent specific interests within PM&R. Frank Krusen, MD, established the Physical Medicine Program at the Mayo Clinic in 1936 and initiated the first three-year residency in Physical Medicine. Drs. Coulter and Krusen led the organization of the American Academy of Physical Medicine in 1938, and Dr. Coulter is credited with being its Organizational President. In that year, Dr. Krusen coined the word "physiatrist" to describe the small group of physicians who were dedicated to Physical Medicine as medical therapeutics to treat neurological and musculoskeletal disorders. Dr. Krusen wrote the first widely used textbook on Physical Medicine in 1941. He is recognized as the "Father of Physical Medicine." In 1946, the AMA Council on Physical Medicine voted to sponsor the term "physiatrist".
It was not until after World War II, however, that society began to understand the necessity for more advanced treatment and rehabilitation for the disabled. Due to substantial debilitating war injuries and thousands disabled by a poliomyelitis epidemic, the public became more aware. The influence of radio, movie newsreels and television brought home the reality of polio with President Franklin D. Roosevelt. These events created an increased demand for physicians trained in a comprehensive approach to rehabilitation. With cases of polio reaching nearly 58,000 in 1952, physiatrists were called upon to treat the "whole patient" and direct the restoration of the disabled and their return to functional roles in their communities.
Another way modern-day PM&R was formed was through Howard Rusk, MD, an internist who saw that passive, inactive, non-physical convalescence resulted in both physical and emotional deterioration of soldiers recovering from accident or illness. As a result, these soldiers were often classified as unfit to return to duty. Dr. Rusk set up a controlled experiment in a barrack in which active rehabilitation was carried out while others continued with passive convalescence. The rapid recovery of strength and endurance and the return to active duty due to aggressive rehabilitation were so remarkable that the Army Air Corps extended the program to all of its hospitals, and, shortly thereafter, throughout the military. After the war, Dr. Rusk transitioned to New York's Bellevue Hospital where he began his 30-year campaign to train physicians and establish rehabilitation programs to treat the whole patient. Dr. Rusk's endeavors earned him recognition as the "Father of Rehabilitation Medicine."
After World War II, under the directorship of A.B.C. Knudson, MD, the Physical Medicine and Rehabilitation Service was established within the Veterans Administration (VA). Since that time, the VA has become an important partner to university PM&R residency programs in providing training facilities, faculty and patients. PM&R is currently practiced in each of the 171 VA Medical Centers throughout the United States and Puerto Rico.
Another pioneering group was the Baruch Committee. The Committee, which served from 1943-52, awarded grants to hospitals and medical schools to establish PM&R teaching and research programs. By 1946, medical residencies or fellowships in PM&R had been established at 25 hospitals as a result of funding from the Baruch Committee. Although the grants helped expand training and research, what propelled the specialty was the recognition by the public that rehabilitation worked. Hundreds of wounded soldiers and injured civilians were being rehabilitated and returned to be productive, tax-paying members of society. This was the testimony before Congress and to the public at large that ensured the future of the specialty.
In January 1947, the Advisory Board of Medical Specialties (now the American Board of Medical Specialties) formally recognized the American Board of Physical Medicine. Two years later, at the urging of Dr. Rusk, the name was amended to include "Rehabilitation." For the first time, the specialties of Physical Medicine and Rehabilitation Medicine were under one governing board. At that time, university hospitals were offering a total of 85 positions for residents or fellows in Physical Medicine and Rehabilitation. In the 1950s, Mary Switzer, Director of the Office of Vocational Rehabilitation (OVR), brought great economic expansion to the specialty. Her advocacy for the disabled before Congress resulted in greatly increased budgets for rehabilitation services and physiatric training programs, fellowships and research. Thanks to her, regional rehabilitation research and training centers were adopted and funded by Congress. These centers remained the major resources available to physiatrists for rehabilitation research and research training until 1990, when the National Center for Medical Rehabilitation Research was established at the National Institutes of Health.
Also in the 1950s, electromyography (EMG) was introduced as a profound electrodiagnostic method for the evaluation of neuromuscular disorders. Through EMG, it is possible to localize and evaluate significant pathology of both the muscular and sensory components of the nervous system. The general acceptance of this diagnostic tool created a significant niche for the growing specialty of PM&R.
Along with the expansion of education and training opportunities in PM&R, interest in physiatric research multiplied during the 1960s. The Association of Academic Physiatrists (AAP) was formed in 1967 by Ernest W. Johnson, MD (considered the "founding father") and a small group of dedicated physiatric educators. The primary purpose of the AAP is to advance the specialty through research and education. From 1968 to 1992, the AAP grew to more than 1,000 members.
Although many physicians graduated from PM&R residency programs in the 1970s, the increase in new physiatrists was far slower than the increased demand for physiatric services. In 1974, the Commission on Rehabilitation Medicine, a group with representatives from the ABPMR, AAPM&R and the AAP, published a bulletin: Physical Medicine, Need, Supply and Demand, 1972-1987. These estimates predicted that only with a significant increase in new physiatrists would supply reach demand for 4,000 physiatrists in 1990. In the 1980s, the recognition by the American public that rehabilitation helped disabled persons resulted in the development of many community rehabilitation centers and demand for more physiatrists to direct these programs, which was in accord with the projections made by the Commission in 1974. A severe shortage of physiatrists developed, and medical students began to discover the specialty as a promising career. By 1994, the ABPMR reported 1,313 residency positions were offered and 97% of those positions were filled. Also in 1994, the number of board-certified physiatrists grew to 4,642, with 2,561 of those certified between 1984-94. To this day, the greatest unmet need in physiatry remains the need to increase the number of academic physiatrists dedicated to research and teaching.