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Department of Physical Medicine and Rehabilitation, St. John's Medical College Hospital, Bangalore

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Physical Medicine & Rehabilitation (PMR) is a surgical specialty, recognised by the Medical Council of India, which aims at attaining optimal function despite the residual disability of the patient. This is achieved by cohesively treating, teaching, training and mentally tempering the disabled individual. These four approaches are used in combination to produce positive changes in all spheres of the patientsí lives, thus converting people who would otherwise be resource burners into resource earners i.e. teaching the patients to take care of themselves and train them for a new job.

The holistic approach of PMR means that a disabled patient can enjoy all facets of rehabilitation under the responsibility of one single department, where otherwise his or her care would be fragmented around many different hospital departments and non-hospital services. Thus, there is an overlap between PMR and a wide range of specialties. 

These medical and surgical specialties include General Medicine, Neurology, Orthopaedics, Paediatrics, Plastic Surgery, Psychiatry and Urology. Biomechanical Engineering and the technology related to the use of newer composites in Orthotics and Prosthetics also comes under the purview of PMR.

PMR offers all of the following elements of the rehabilitation process:

  • Medical Management: All routine medical problems including achievement of urinary continence through medications are carried out by the department.

  • Surgeries: Operations are performed for the surgical management of pressure sores, and for correction of deformities 

  • Physiotherapy: A variety of physical modalities like heat, sound, light, and electricity are used to alleviate suffering and improve functioning

  • Occupational therapy: A disabled personís functioning is enhanced by activities and skills that are taught

  • Social Work: The ultimate aim of rehabilitation is to place the disabled person back in society as a productive individual in society.  The Social Workerís sphere of action extends beyond the walls of the Hospital to ensure that vocational rehabilitation takes place

  • Orthotic and Prosthetic Services: Fitting and provision of mobility aids, such as calipers, artificial limbs, crutches and wheelchairs.

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The patients

The group of locomotor disabled people that are commonly referred for rehabilitation include those with spinal cord injuries, cerebral palsy, poliomyelitis, amputations, meningo-myelocoele, Hansen's disease, arthritis and soft tissue disorders. Less commonly referred patients include those with strokes, head injuries, muscular disorders, chronic pains, burns and cancer. 

In all the above cases a combination of medical and surgical treatment, physical and occupational training and social support are required in order to allow the patient not only to survive, but also to resume a normal life.

It can be argued that almost every patient who is discharged from a hospital would need some form of rehabilitation in order to be re-integrated into society. It is St. Johnís Medical College and Hospital's firm belief that the social responsibility of the hospital goes beyond performing a medical service. Thus in the future the department aims to promote the concept of rehabilitation in its broadest sense, including mentally handicapped, visually handicapped and geriatric populations.

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Rehabilitation Medicine

In this website the terms Rehabilitation and PMR may be used interchangeably

The aim of Rehabilitation Medicine is to convert people who are "resource burners" (both patients and their full-time care-givers) once again into "resource earners". The concept that 'life goes on', and that the patient must lead a meaningful and productive life is central to the philosophy of rehabilitation.

The process of rehabilitation includes all the steps taken to treat, train and teach the patient. These three approaches are used in combination to produce positive changes in all spheres of the patient's life. It is only in this way that the goal of rehabilitation - enabling a person to do the best that he or she is capable of doing can be achieved.

The process of rehabilitation is not restricted to a hospital. For example, recommending appropriate home modifications to provide a user-friendly environment for the patient is also a part of the lengthy but satisfying process of comprehensively rehabilitating a disabled individual.

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The importance of holistic care as practiced in Rehabilitation Medicine

The philosophy of holistic care is shared by St. John's Medical College and Hospital and the discipline of Rehabilitation Medicine. Rehabilitation usually deals with patients who have chronic problems, and such patients have a variety of needs, both medical and surgical. A spinal cord injured patient, for example, would often present with pressure sores, bladder stones, reactive depression, contractures, and autonomic dysreflexia. His' non-medical' problems might include unemployment, functional dependence on others, an impending separation from his wife, and architectural barriers within his house.

Patients with such a wide spectrum of problems do benefit if all the facets of their disability are managed by a single physician. The physiatrist - who has been trained in assessing the strengths and weakness of the patient and those of his support system - is in a unique position to most meaningfully manage the individual needs of the patient, be it surgical, medical, social, vocational, or psychological.

In traditional medicine and surgery, the rehabilitation needs of the patient are often never addressed. With modern multi-drug therapy (MDT) a pauci-bacillary patient of Hansen's disease can be declared "medically cured" 2Ĺ years after starting MDT. However for the patient such a "cure" might be meaningless, especially if he has already developed deformities.

Yet surgical correction of such a patient's deformities alone - without a comprehensive rehabilitation programme - can produce more harm than good. Dr. Paul Brand used to illustrate this point by telling how he was once blamed by a patient whose claw-hands he had operated upon. According to the patient, the surgery had actually worsened his plight, because his surgically corrected hands had been rendered useless for the only job that he knew: begging.

The strength of Rehabilitation Medicine is in its cohesive treatment plan which attempts to restore the patient as far as possible to functional independence. This holistic approach is the most rational method of caring for disabled people who are beset with a range of problems, such as the man in the above example.

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For more information contact:
The Department of Physical Medicine and Rehabilitation
St. John's Medical College and Hospital, Bangalore - 560034
Phone: +91-(0)80-2206 5256   Fax: +91-(0)80-2553 0070

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