Introduction
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 patients’ 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 person’s
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 Worker’s 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.
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. John’s 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.
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.
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" 2½ 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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