A holistic approach to cure cannot exclude restoration of complete physical functions of a patient. Therefore, the health care sector in the country cannot ignore the fact that physical medicine and rehabilitation is an integral part of total cure, says Director of Department of Physical Medicine and Rehabilitation at Sri Ramakrishna Hospital in Coimbatore B. Palanisamy.
But, the focus on this area of speciality is poor in even major healthcare institutions in India. Patients in many centres get discharged without going through the physiatrist for restoring the functions of a particular limb or other areas that may have been affected by injury or surgery. “It is unfortunate that the medical fraternity itself does not give this field its due importance,” he tells K.V. Prasad.
Reviewing historic trends, the principal medical challenge in future shall relate to the patients’ ability to function at a high level in personal activities. The outcome measures of improved patient functioning will be independence in carrying out self-care and activities of daily living, Dr. Palanisamy explains.
Physiatry or Physical Medicine and Rehabilitation (PM&R), a quality-of-life specialty, is a unique medical field dealing with a multitude of medical and surgical problems. Unlike other specialties, medical rehabilitation is not limited to one organ system. The specialty focuses on the restoration of function to people with problems ranging from simple physical mobility issues to those with complex cognitive involvement. The speciality came into existence in the 1930s with the physical treatment of musculoskeletal and neurological conditions. The scope of its application widened during World War II when thousands of veterans came home with battle-inflicted disabilities.
The objective of restoring their productive lives led to the expansion of the field into a specialty that dealt with all functional aspects of people with disabilities. In India, Physical Medicine and Rehabilitation is one of the medical specialties certified by the Medical Council of India.
Physiatrists work to restore patients with temporary or permanent disabilities to the fullest possible level of physical, mental, social and economic independence.
Areas of focus
Listing the areas of focus of physiatrists, Dr. Palanisamy says they often have broad practices, but some concentrate on specific areas such as cardiac rehabilitation, sports medicine, geriatric rehabilitation, or any other areas of special interest. Physiatrists also treat serious disorders of the musculoskeletal system that result in severe functional limitations, including amputation.
“Physiatrists co-ordinate the long-term rehabilitation process for all patients of a stroke, spinal cord injury, head injury and oncology units,” he says. In recent years, physiatry has seen an increased focus on musculoskeletal and industrial medicine, pain management, sports medicine and electromyography, including biofeedback. Physiatrists are involved early to assess the patient and determine how the physical impairments will influence the overall outcome of a treatment.
The focus of physiatry is on restoring function to patients, Dr. Palanisamy points out. Each patient needs distinctive care and specific goals. The physiatrist directs a comprehensive rehabilitation team of professionals that may include physical therapists, occupational therapists, orthotist and prosthetist, rehabilitation nurses, psychologists, social workers, speech-language pathologists, dieticians and others to develop a comprehensive care plan for patients.
The Graduate Medical Education National Advisory Committee (GMENAC) had mentioned the specialty of Physical Medicine and Rehabilitation as a shortage specialty. An ideal demand-supply of specialists in this area may not be possible always. The GMENAC report, which is the most comprehensive study of U.S. physician manpower to date, requires serious consideration in promoting Physical Medicine and Rehabilitation in India, says Dr. Palanisamy.