Physical Medicine and Rehabilitation (PMR)
Physical Medicine and Rehabilitation (PMR) is a broad specialty. It is purely clinical branch of medicine. It is more than seven decades old branch. Well-developed and highly recognised in western countries. But it is Under-recognised, Under-utilized, Under-resourced, Under-developed, Under-advertised in India. Recently, National Medical Commission of India (NMC) made this branch mandatory in every medical college in India from year 2022. NMC gives the huge boost to this specialty that was required to survive and grow this branch.
PMR is known byother names also like Rehabilitation Medicine or Physiatry or Physical and Rehabilitation Medicine. The doctors who are practising PMR is known as Rehab physician or Physiatrist or PMR Specialist. Physiatrist are not the specialist of any specific organ. Physiatrist perspective is to treat the whole body not just the disease. Physiatrist are specialised in functioning. American Academy of PMR describes- Physiatrist/rehab physician are the doctors of nerves, muscles, bones related disorders that affects patients functioning/movement.
Our Team
Dr. Rambeer Ghuleliya
Assistant Professor
What concepts are reflected in the name Physical Medicine and Rehabilitation?
This specialty has three words in name.
Physical
- Pertaining to our Physical –ness (Body)
- Pertaining to Physical Activity (Exercises)
- Use of Physical Agents – Heat, Light, Sound, Cold, Electricity etc
Medicine
- That is chikitsa (चिकित्सा) – medical care including surgeries (शल्यचिकित्सा)
- Medication
- Non – Surgical & Surgical interventions
Rehabilitation of people with disabilities is a process aimed at enabling them to reach and maintain their optimal physical, sensory, intellectual, psychological and social functional levels. Rehabilitation provides people with disabilities, the tools they need to attain independence and self-determination.
There are 3 WHO Health indicators. Functioning along with mortality and morbidity is third indicator of health. Due to increasing burden of aging population, noncommunicable disease along with increased life expectancy affecting persons quality of life as result of decreased functioning. Rehabilitation is the best strategy for optimizing functioning. Rehabilitation improves quality of life a person by optimizing functioning.
So, we can conclude that PMR is a specialty that treats whole body by using physical agents, physical activity (exercises), medications, injections and surgeries along with the process of rehabilitation.
The philosophy of Physical Medicine and Rehabilitation is holistic, comprehensive, team-orientedcare for persons with disabilities (PWDs). PMR is specialty that cared for the whole person, not just the disease. By PMR interventions life can always be made better that is “adding life to years”. Physiatrist treating the various ailments/disorders with help of Medicine, physical agents, exercises, minimally invasive pain and spine (MIPSI) procedures and rehabilitation surgeries. PMR believes in transdisciplinary team approach by keeping patient and his/her family into the centre.This specialty provides one of most comprehensive and multifaceted modes of treatment (amongst all disciplines of medical sciences), where focus is on function of patient rather than disease.
Rehabilitation team- comprehensive rehabilitation is team approach of patient can only be achieved by rehabilitation team. Rehabilitation team comprises Physiatrist, Physiotherapist, occupational therapist, prosthetist/orthotist, vocational counsellor, clinical psychologist, etc. Other specialty physician can also be part of rehabilitation team depending on patient’s need. Physiatrist is the leader of the rehabilitation team. Physiatrists are the experts at diagnosing & treating Pain and various disabling conditions. PMR specialist treat whole person not just problem area. By PMR interventions physiatrist try to restore maximum function lost through injury/Paralysis and/or Deformity.
- Role of physiatrist – Clinical, Managerial, Academics & Research, Leadership
- Physiatrist Leadership to Rehabilitation Team – 1st Patient Contact - Clinical Work-up
- Diagnosis – Medical & Rehabilitation
- Medical & minimally invasive pain and spine procedure
- Rehabilitation Planning, Implementation & Monitoring through the team & be responsible/accountable for the same
- Team Coordination & Communication
- Communication with Patient & Family + other Physicians, Agencies (Govt./NGOs/Donors)
The process of rehabilitation involves 3 stages - Disablement, Reablement, Resettlement. Person can became disable by various disorder. Even acute neck or back pain can make a patient severely disabled. Disability may be temporary or permanent. Goals of rehabilitation is to improve quality of life by improving functioning. This goal can be achieved by treating, teaching, training and mentally tampering the patient. Treating the patients by utilizing medications, injections, physical modalities, exercise, and education individualized to the pt’s needs. Teaching the pts to take care of themselves and train them for a new job. By using these four approaches in combination we are converting a person and its care giver who otherwise be resource burner to resource earner. So ultimately, we are reintegrating the PWDs back into the society as a productive member of the society. The concept “life goes on” and everyone must live a meaningful life is the central to the philosophy of PMR.
Any patient from any department ranging from paediatric to geriatric who need rehabilitation services should be consulted/referred to PMR department. So that we can provide better outcomes for the patients.
- Various Acute/subacute/chronic pain like Arthritis/rheumatological disorders, Back & neck pain, orofacial pain, headaches, Frozen shoulder, joint pain,
- Cervicogenic headache, atypical chest pain, abdominal wall pain
- Chronic pelvic pain,
- Cancer pain management,
- Lymphedema,
- Post-surgical/posttraumatic pain disorders,
- Work related injuries, Sports injuries,
- Rheumatological disorders
- Vertigo,
- Neurological case- Radiculopathy/Neuropathy/nerve injuries/plexus injury/Bell’s palsy, Stroke, TBI, SCI,
- Cerebral palsy
- Muscle disorders- Muscle Dystrophy etc.
- Autism spectrum disorder
- Attention deficit hyperactivity disorders
- Post MI
- Pulmonary disorders like COPD
- Pressure injures
- Diabetic foot ulcers
- Osteoporosis
SCI, TBI, stroke, etc., need to be compulsorily transferred to PMR department to achieve superior outcomes, after meeting clinical stability criteria as soon as possible.
PMR can also be described as Cementing Medical Specialty that employs all available modes of treatment:
- Medication (Chemical)
- Physical Agents- Ultrasound therapy, SWD, TENS, IFT, LASER etc.
- Therapeutic Exercises
- Minimally invasive Pain and Spine Interventional procedures (MIPSI)
- Rehabilitation surgeries
- Compliments almost all clinical departments
Include those used by other physicians like medical history and physical examinations. It differs from a medical or surgical History & Physical examination because of its focus on functional status, social supports, disposition, and goals. The Physiatric H&P also identifies those systems not affected that might be used for compensation.
- Lab studies, medical imaging- X ray, CT scan, MRI, etc.
- DEXA (BMD) Scan
- Musculoskeletal Ultrasound- Stethoscope of a Physiatrist because it is the extension of clinical examination. It has diagnostic, therapeutic and prognostic role in managing various musculoskeletal pain disorders.
- EMG/NCV
- Foot Pressure analysis
- Gait analysis
- Hand held Dynamometer
- Goniometry
The Physical Medicine and Rehabilitationdepartment of Himalayan Institute of Medical Sciences started its services from24 March 2023. This department compliments almost all the clinical departments of Himalayan hospital. PMR department believes in collaborating with all the clinical departments of Himalayan hospital.
Himalayan hospital has firm belief in that social responsibility of a hospital should not be limited to provide medical services only. Himalayan hospital is committed to provide best quality and advanced comprehensive rehabilitation services to the patients. Department of PMR is on the footstep of this philosophy of hospital.
Motto of PMR department
Sbkasath, SbkaPunrvas (Colloborate with all, Rehabilitate all)
Our mission
- To provide the best possible, advanced and affordable pain management services
- To prevent unnecessary suffering of PWDs
- To restore the dignity of PWDs
- To promote the field of rehabilitation
- To provide the best possible and affordable rehabilitation care
- To improve the quality of care
- To increase the scope rehabilitation
- To increase the capacity rehabilitation services
Clinical services provided by PMR department
- OPD services
- Interventional Pain Management services- Performing various USG and fluoroscopy guided minimally invasive pain and spine procedures.
- Regenerative therapy- PRP, Dextrose prolotherapy
- Intraarticular injections
- Trigger point injection
- Epidural steroid injection
- Nerve or Ganglion or plexus block
- Botulinum toxin type A injection treatment of various pain disorders and spasticity
- Alcohol/phenol neurolysis/motor point block
- Diabetic foot ulcer management- total contact casting, offloading braces, various types of dressing.
- Deformity correction by Serial Casting
- Pressure ulcer management
- Neurogenic bowel and bladder management
- Ergonomic advises
- Architectural modification advices
- Assistive devices like mobility aid and appliances- Wheelchair etc.
- Rehabilitation services- PMR department is providing various indoor and outdoor rehabilitation services like Musculoskeletal rehabilitation, Neurorehabilitation, Paediatric rehabilitation Cancer Rehabilitation, Amputee rehabilitation, Cardiopulmonary rehabilitation, Geriatric Rehabilitation
- Apart from that PMR department also provides Physical therapy, occupational therapy, speech and language pathology, artificial limb and orthotic/prostheticservices
- Disability evaluation
Academic and Research activities
Currently one dedicated and experiencedPMR faculty providing educational guidance to MBBS graduates besides managing OPD/IPD services. PMR department Supervising, guiding and actively participating in physiotherapy UG and PG courses. The department takes keen interest in research and other academic activities as well. PMR department is integrating and collaborating with various department of institute for various research and academic purposes.
- Musculoskeletal ultrasound is the future of PMR. MSK USG is highly popular amongst PMR specialist and it is the bread and butter of PMR.
- Gait & Motion analysis
- Virtual Rehabilitation
- Robotic Rehabilitation
- 3D Printing for Orthosis/Prosthesis
- Bionic hand prosthesis
- Intrathecal baclofen pump
- Spinal Cord Stimulation
Production of PMR specialists is far less compared to the demand. Future of this branch is very bright. Almost fixed working hour, so one can spare time for family/hobbies/recreational activities. PMR is a varied and vast subject and requires subspecialty training. This will not only improve patient care but also boost interest in young aspirants. There are various subspecialty courses available in India and western countries.
- Starting indoor based rehabilitation
- Establishment of
- Musculoskeletal Pain medicine unit
- Occupational therapy unit
- Paediatric rehabilitation unit/Early sensory Integration Unit
- Speech, language, and swallowing (SLP) disorder unit
- Operation theatre for various rehabilitation surgeries
- PT unit- Gymnasium expansion
- Starting course like
- Post graduate course like MD in PMR
- Fellowship in Pain Medicine
- Fellowship in Neurorehabilitation
“It is not enough to know why people die, and what illnesses they have. Perhaps what matters even more is to know how they live… to understand how health conditions play out in their day to day life.”
Like a true friend, a physiatrist must be an optimistic spirit, a team player, and one who gives life to the immortal words of William Arthur Ward,
‘‘a true friend knows your weakness but shows 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.’’
