PHYSICAL MEDICINE and REHABILITATION Past , present, and future

1. PHYSICAL MEDICINE and REHABILITATIONPast, present, and future Prof. Dr. Şafak S. Karamehmetoğlu İstanbul University Cerrahpaşa Medical Faculty Physical Medicine and Rehabilitation Department

2. HEALTH Physically, psychologically and socially complete well-being (WHO).

3. Impairment Any loss or abnormality of psychological, physiological, or anatomical structure or function.

4. Disability Any restriction or lack resulting from impairment of ability to perform an activity in the manner or within the range considered normal for a human being.

5. HANDICAP A disadvantage for a given individual resulting from an impairment or a disability that limits or prevents the fulfillment of a role that is normal (depending on the age, sex, and social and cultural factors) for that individual.

6. REHABILITATION Rehabilitation is the process of helping a person to reach the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiologic or anatomical impairment, environmental limitations, and desires and life plans.

7. MEDICINE • Preventive • Medical (and surgical) • Rehabilitation

8. Conventional Medicine • Concerned with diagnosis, • Tends to curable diseases.

9. REHABILITATION • Diagnosis is not mandatory • Concerned with functional problems

10. REHABILITATION TEAM-1 - Physiatrist (PMR Specialist) - Physiotherapist - Rehabilitation nurse - Occupational therapist - Social worker

11. REHABILITATION TEAM-2 - Speech therapist - Psychologist - Orthotist-Prosthetist - Vocational councellor - Others (doctors, etc)

12. PHYSIATRIST • Leader of the team. • Plans. • Organizes. • Directs • Coordinates. • Controls. • Motivates.

13. PHYSIOTHERAPIST • Exercise the patient especially for gross motor function. • Perform muscle strength testing. • Teach how to transfer. • Instruct the use of wheelchair, canes and crutches. • Offer physical therapy modalities. • Education of posture and walking.

14. NURSE • Directs personal care of the patient. • Bowel and bladder program. • Controls environmental factors. • Medication management. • Skin integrity. • Helps ADL and adaptive devices. • Helps the patient manage their time.

15. Occupational therapist • ADL • Trains the patient in the functional use of upper extremities. • Explores the vocational skills. • Evaluates the home and suggest modifications. • Trains patients in the use of assistive technology. • Collaborates with all the team

16. LOCOMOTOR SYSTEM • Rheumatic • Travmatic & orthopedic • Neurologic

17. Demographic Data • Name - surname: • Age: • Gender: • Profession: • Place of birth: • Marital status:

18. History & Physical Examination

19. Complaint(s) • Main complaints (pain, weakness etc.) • Others (vertigo, vomiting etc.)

20. History-1 • Date of onset • Any cause • Character and severity • Time relationship • Localisation • Associated complaints

21. History-2 • Aggravating factors • Alleviating factors • Previous treatments and effects • Progress • Remissions and exacerbations

22. History-3 • Previous diseases • Coexisting diseases • Surgical interventions • Trauma

23. History-4 • Alergy • Delivery, menses, menaupose • Smoking, alcohol and drug • Social status

24. Family History • Illness in the family • Cause of deaths

25. General health state • Fever • Blood pressure • Pulse rate • Body structure • Color changes • Edema

26. Examination of locomotor and neurologic system • Inspection • Palpation & pression • ROM • Sensation • DTR • Muscle testing • Special tests

27. Skin &mucosal examination

28. Ear-nose-throat

29. Respiratory system

30. Cardio-vascular system

31. Gastro-intestinal system

32. Urogenital system

33. Endocrine system

34. Laboratory

35. Radiography, scintigraphy and other advanced technics

36. Therapy and/or rehabilitation