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

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

3. 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

4. What is physical medicine and rehabilitation (cont…)
Rehabilitation physician utilizes medications, injections, physical modalities, exercises and education to the patient needs

5. 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’’

6. 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
World Health .Net3’ ‘’ physiatric personality

7. Case example

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

9. 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

10. 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

11. 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)

12. History of PM&R

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19. 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

21. 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

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

23. 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

24. 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 ( )
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

25. 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

26. 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

27. Thank you

28. Questions?