Download The Physiatry Consult (powerpoint)

The Physiatry Consult
A general guide for students new to
Physical Medicine and Rehabilitation
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
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
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 longterm rehab goals with patient, family and
interdisciplinary team
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
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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
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
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
Example problem domains
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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)