The Physiatry Consult A general guide for students new to Physical Medicine and Rehabilitation

What is Physiatry? Also known as Physical Medicine and Rehabilitation (PM&R), it is a medical specialty focused on prevention, diagnosis, and nonsurgical treatment of disorders associated with disability PM&R specialists care for patients with neurological and MSK disorders, or with acute and chronic pain The quality of life medical specialty– goal to restore optimal patient function in all spheres of life, including medical, social, emotional, and vocational or avocational dimensions

Physical Medicine – Diagnosis and treatment of MSK disorders with the use of medications, modalities, procedures, assistive devices, and exercise Rehabilitation – The process of making the person with a disability “maximally able” again, through the application of rehabilitation principles and techniques

Objectives of a Comprehensive Physiatric Consultation Confirm the diagnosis and relate it to functional performance Quantify functional level and establish baseline Develop a rehabilitation problem list Provide a functional prognosis Formulate short, intermediate and long- term rehab goals with patient, family and interdisciplinary team

The Consult Reason for referral Age, sex, occupation, diagnosis/injury and its date of onset Current history and management – details of injury, or disease severity, risk factors, and active treatment Past medical history – personal, meds, allergies, family, social, review of systems …….Next page……

Current and Baseline Function Mobility – bed, transfers, ambulation ADLs – hygiene, bathing, dressing, eating, toileting Leisure function – activities for enjoyment Vocational function – volunteering, paid occupation, work at home, parenting Equipment, and home architecture

Examination Focus on areas of rehab intervention and assessment of severity of injury or diagnosis Identify risks or cause of precautions for therapies A functional neuromuscular examination should be included to assess mobility, ADLs, cognition and mental status Neurological and MSK examinations are included as necessary

Problem list and Recommendations Primary and secondary dx, date of onset and severity impairments, disabilities and handicaps identified (ie. Activity and participation) Recommendations include short-term (acute rehab plan), intermediate, and long term goals (eg. Transfer to inpatient rehab unit, and d/c planning, community reintegration as OP), precautions for interventions Estimate of prognosis for functional recovery and level of community independence

Example problem domains Spine stability Pain Spasticity Bowel and bladder function Pressure ulcers, or other skin issues Mobility and DVT prophylaxis ADLs Communication and cognition Psychosocial adaptation and supports Accessibility, discharge management Community reintegration (vocational and avocational)