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The Physiatry Consult

The Physiatry Consult. A general guide for students new to Physical Medicine and Rehabilitation. What is Physiatry?.

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The Physiatry Consult

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

  2. 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

  3. 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

  4. 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

  5. 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……

  6. 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

  7. 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

  8. 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

  9. 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)

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