physical medicine and rehabilitation

physical medicine and rehabilitation, medical specialty concerned with the diagnosis, treatment, and prevention of physical impairments, particularly those associated with disorders of the muscles, nerves, bones, or brain. This specialized medical service is generally aimed at rehabilitating persons disabled by pain or ailments affecting the motor functions of the body. Physical medicine is one means employed to assist these patients to return to a comfortable and productive life, often despite the persistence of a medical problem.

For centuries people have used such natural physical agents as hot springs and sunlight to treat ailments, but the development of physical medicine as a specialized medical service took place largely after World War I. Two factors influenced its growth in the 20th century—epidemic poliomyelitis and the two World Wars—both of which created large numbers of seriously handicapped young people. Physical medicine was definitively established through the American physician Howard A. Rusk’s efforts to rehabilitate wounded soldiers during and after World War II. Physical medicine then became available for the treatment of patients with such diverse problems as fractures, burns, tuberculosis, painful backs, strokes, nerve and spinal cord injuries, diabetes, birth defects, arthritis, and vision and speech impairments. Physical medicine is closely associated with orthopedic surgery, but it is prescribed by physicians and surgeons in all branches of medicine. Physicians who specialize in physical medicine are called physiatrists.

The objectives of physical medicine are relief of pain, improvement or maintenance of functions such as strength and mobility, training in the most effective method of performing essential activities, and testing of function in various areas. Tests cover such fields as muscle strength, degree of joint mobility, breathing capacity, and muscular coordination.

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The therapeutic means most commonly employed include heat, massage, exercise, electrical currents, and functional training. Since the 1970s these basic means have been supplemented and enhanced by psychological counseling, occupational therapy, and a variety of other treatments which may be used in concert to help the disabled person achieve the fullest possible life despite the persistence of medical problems.

Heat is used generally to stimulate circulation and to relieve pain in the area treated. For example, in diathermy heat may be applied by shortwave or microwave radiation or by ultrasound. Other forms of heat therapy include the use of hot, moist compresses and hydrotherapy (immersion in hot water). Massage primarily aids circulation and relieves local pain or muscle spasm.

Exercise, the most varied and widely used of all physical treatments, is usually designed to do one or more of three things: increase the amount of motion in a joint, increase the strength in a muscle, or train a muscle to contract and relax in useful coordination with other muscles. In addition to its obvious use following stiffness or paralysis, exercise may be used to improve the breathing of patients with lung disorders, assist circulation, relax tense muscles, and correct faulty posture.

In the late 20th century high technology was increasingly harnessed in efforts to rehabilitate paraplegics, quadriplegics, and others with severely impaired motor functions. Microcomputers were developed that could send precisely coordinated jolts of electricity directly into the muscles of such patients, mimicking the cerebral impulses that could no longer reach their muscle destinations because of a severed spinal cord. The microcomputers’ sophisticated programs enable them to contract a patient’s muscles in unison so that he can actually stand and sit, walk, and even use his hands to perform relatively fine movements. Such devices were still in the experimental stage and were costly to make and use, but they seemed to be the most promising development yet in efforts to restore the power of movement to nerve injury victims.

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Other, less ambitious devices to help paralyzed patients include wheelchairs with specially equipped control systems that can be operated by the mouth and teeth movements of a quadriplegic. Mobile robotic arms have been developed that are equipped with a video camera so that they can move safely and intelligently about a patient’s house. These personal robots can receive and execute oral commands from the patient to perform such simple household tasks as filling a glass with water or taking a book off a shelf.

Functional training teaches the impaired individual how to carry out most safely and effectively the activities of daily life. This training may mean learning to use crutches, a brace, or an artificial arm; or it may involve working out and practicing the movements required to do housework with the use of only one hand or the way to board public transportation with a stiff leg. Such training often requires long hours of practice; it may be facilitated by use of devices that make it easier to fasten buttons, hold a fork, or dial a telephone.

Physical medicine and rehabilitation underwent a rapid expansion during the late 20th century, largely because of the development of antibiotics and other fundamental advances in modern medicine, which not only save the lives of many who would not have survived illness or injury in earlier decades but also prolong life in general.

Physical medicine and rehabilitation are carried out by a “rehabilitation team,” headed by a physiatrist who coordinates the team’s efforts and assesses the areas of functioning in which the patient can improve. The physical therapist uses exercise to improve the patient’s muscle strength and functioning, and a rehabilitation engineer may provide a special mechanical aid or device to assist that functioning. Meanwhile a rehabilitation nurse keeps track of the patient’s physical condition and provides him with basic medical care, while a psychological counselor helps the patient cope with the discouragement or depression produced by the condition of physical disability. Respiratory or speech therapists may also be brought in to assist the patient with breathing or speaking difficulties. Eventually an occupational therapist and a social worker will help the patient adjust to life outside of the rehabilitation institute. See also occupational therapy.