INTRODUCTION TO PHYSICAL MEDICINE AND REHABILITATION AND ITS EVOLUTION Dr Muhammad Fahim MBBS, FCPS (Resident PM&R)

Objective of presentation To introduce speciality of PM&R History of its evolution Statistics in Pakistan

What is physical medicine and rehabilitation Medical speciality that emphasizes prevention, diagnosis and treatment of patients who experience limitations in function resulting from any disease process, injury or trauma

What is physical medicine and rehabilitation (cont…) Rehabilitation physician utilizes medications, injections, physical modalities, exercises and education to the patient needs http://www.aapmr.org

What are the mission and motto of PM&R To promote person’s quality of life and functional outcomes through a dynamic team oriented approach Traditional medical approach ‘’adds years to life’’ while PM&R in its true spirits ‘’ adds life to the years’’

What are the mission and motto of PM&R (cont…) To achieve this noble goal a team approach is required Rehabilitation physician plays role of team leader, as facilitator and monitors the team work Other valuable team members include the physical therapist (PT), occupational therapist (OT), speech and language pathologist, respiratory therapist, nurse and others http:// World Health .Net3’ ‘’ physiatric personality

Case example

DVT/Pulmonary thromboembolism Pneumonia Pressure sore Patient with SCI Urinary tract infections Postural hypotension Neuropathic pain Spasticity Autonomic dysreflexia

Which medical conditions are treated by rehabilitation physician Primary care provider to a person with disabilities ( offer comprehensive care for persons with diverse medical conditions

Common conditions treated by rehabilitation physician Traumatic brain injury Spinal cord injuries Amputations Stroke Arthritis (Rheumatoid arthritis, osteoarthritis) Multiple sclerosis Fibromyalgia Industrial injuries Neuromuscular diseases Pain disorders (Neck. low back pain) Neuropathies Orthopaedic injuries Burns complications Cancer complications Sports injuries

Sub specialities in PM&R Hospice and Palliative Medicine Neuromuscular Medicine Pain Medicine Pediatric Rehabilitation Spinal Cord Injury Medicine Sports Medicine Cardiopulmonary rehabilitation Musculoskeletal pain management Rheumatological rehabilitation Amputee care Electrodiagnostics medicine Traumatic brain injury (TBI)

History of PM&R

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History of PM&R (CONT…)

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What are requirements to become specialist in PM&R MBBS degree/one year house job/PMDC Registration FCPS Part first exam ( medicine or surgery and allied) Four year residency/training in CPSP recognized institutes Two research articles or Dissertation FCPS Part second exam

Recognized institutes for FCPS training in Pakistan Armed forces institute of rehabilitation medicine (AFIRM), Rawalpindi Department of physical medicine and rehabilitation, Mayo hospital Lahore Institute of physical medicine and rehabilitation, Dow university of health sciences, Karachi

Recognized institutes for FCPS training in Pakistan (cont…) Unfortunately KPK and Baluchistan lack training institutes recognized by CPSP for FCPS training in PM&R

Why there are few Rehabilitation physicians in Pakistan PM&R Curriculum not included in the syllabus of MBBS ( So under graduate students not aware of this speciality) Lack of training institutes

Conclusion Like a true friend, Rehabilitation physician must be an optimistic spirit, a team player and who gives life to the immortal words of William Arthur ward ( 1880-1967) A true friend knows your weakness but shows you your strength; feels your fears but fortifies your faith; sees your anxieties but frees your spirit; ( most importantly) recognizes your disabilities but emphasizes your possibilities

Recommendations Due to law and order conditions and war and terrorists activities, the burden of disabilities is increasing day by day Common encountered disabilities are amputations, spinal cord injuries and traumatic brain injuries To manage these conditions a team work is required

Recommendations (cont…) Just four specialist in physical medicine and rehabilitation (In whole country) are not sufficient to manage this burden of disability What we need is more training institutes, PM&R course to be included at MBBS level

Thank you

Questions?