Treatments
The Medical Student's Guide to Physical Medicine and Rehabilitation
The physiatrist is specially trained in management of
musculoskeletal disorders and various other entities including pharmacologic
control of spasticity, chronic pain, bowel and bladder management, and
behavioral training in head-injured patients. Invasive techniques such as
injections are options for arthritis, bursitis, tenosynovitis, overuse, and
myofascial pain syndromes.
Physical medicine refers to the use of physical
principles and dynamic intervention to decrease pain, improve range of motion,
and maximize musculoskeletal function.
Examples of these agents are
listed in Table 1.
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Table 1
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Type
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Specific Modality
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superficial cold
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ice massage, ice baths
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superficial heat
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hot packs, heat lamp, paraffin baths,
fluidotherapy
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deep heat
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ultrasound, short wave, microwave
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electricity
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transcutaneous nerve stimulation (TENS), high
voltage galvanic stimulation
(HVGS), interferential current, iontophoresis, functional electrical
stimulation (FES)
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hydrotherapy
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whirlpool, contrast baths
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manual
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massage, manipulation
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other
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traction, biofeedback, positive pressure pumping,
phonophoresis, laser,
ultraviolet light, microwave diathermy
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The physiatrist is also trained in writing specific
exercise programs tailored to the patient's needs. The emphasis is on
maintaining and increasing range of motion, muscular strengthening, improving
proprioception (awareness of joint position in space) muscle relaxation, and
aerobic fitness, all in the context of improving function. Examples might
include strengthening and enhancing proprioception in a runner's sprained
ankle, improving range of motion and preventing contracture in a spastic
spinal-cord-injured patient, or providing optimal cardiopulmonary fitness in
someone who has recently suffered a myocardial infarction.
Also available to the physiatrist is a host of assistive
and adaptive equipment including gait and mobility aids, environmental control
devices, communication aids, and various other tools to allow greater
independence, optimal safety, and decreased energy expenditure in activities
of daily living (ADLs).
One area of expertise is the selection and fitting of
wheelchairs and appropriate seating. The PM&R physician is also specially
trained to prescribe proper orthoses (e.g., upper and lower limbs, and back
bracing) and to recommend prostheses to amputee patients.
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