INTRODUCTION TO PHYSICAL
MEDICINE AND REHABILITATION
AND ITS EVOLUTION
Dr Muhammad Fahim
MBBS, FCPS (Resident PM&R)
Objective of presentation
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To introduce speciality of PM&R
History of its evolution
Statistics in Pakistan
What is physical medicine and
rehabilitation
Medical
speciality that emphasizes
prevention, diagnosis and treatment of
patients who experience limitations in
function resulting from any disease
process, injury or trauma
What is physical medicine and
rehabilitation (cont…)
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Rehabilitation physician utilizes
medications, injections, physical
modalities, exercises and education
to the patient needs
http://www.aapmr.org
What are the mission and motto of
PM&R
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To promote person’s quality of life
and functional outcomes through a
dynamic team oriented approach
Traditional medical approach ‘’adds
years to life’’ while PM&R in its true
spirits ‘’ adds life to the years’’
What are the mission and motto of
PM&R (cont…)
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To achieve this noble goal a team
approach is required
Rehabilitation physician plays role of
team leader, as facilitator and monitors
the team work
Other valuable team members include
the physical therapist (PT), occupational
therapist (OT), speech and language
pathologist, respiratory therapist, nurse
and others
http:// World Health .Net3’ ‘’ physiatric personality
Case example
DVT/Pulmonary
thromboembolism
Postural
hypotension
Spasticity
Pneumonia
Patient with
SCI
Neuropathic pain
Pressure sore
Urinary tract
infections
Autonomic
dysreflexia
Which medical conditions are treated by
rehabilitation physician
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Primary care provider to a person
with disabilities ( offer
comprehensive care for persons
with diverse medical conditions
Common conditions treated by
rehabilitation physician
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Traumatic brain injury
Spinal cord injuries
Amputations
Stroke
Arthritis (Rheumatoid
arthritis,
osteoarthritis)
Multiple sclerosis
Fibromyalgia
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Industrial injuries
Neuromuscular
diseases
Pain disorders
(Neck. low back pain)
Neuropathies
Orthopaedic injuries
Burns complications
Cancer complications
Sports injuries
Sub specialities in PM&R
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Hospice and Palliative
Medicine
Neuromuscular
Medicine
Pain Medicine
Pediatric
Rehabilitation
Spinal Cord Injury
Medicine
Sports Medicine
Cardiopulmonary
rehabilitation
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Musculoskeletal pain
management
Rheumatological
rehabilitation
Amputee care
Electrodiagnostics
medicine
Traumatic brain injury
(TBI)
History of PM&R
History of PM&R (CONT…)
History of PM&R (CONT…)
History of PM&R (CONT…)
History of PM&R (CONT…)
History of PM&R (CONT…)
History of PM&R (CONT…)
What are requirements to become
specialist in PM&R
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MBBS degree/one year house
job/PMDC Registration
FCPS Part first exam ( medicine or
surgery and allied)
Four year residency/training in CPSP
recognized institutes
Two research articles or Dissertation
FCPS Part second exam
Recognized institutes for FCPS
training in Pakistan
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Armed forces institute of
rehabilitation medicine (AFIRM),
Rawalpindi
Department of physical medicine
and rehabilitation, Mayo hospital
Lahore
Institute of physical medicine and
rehabilitation, Dow university of
health sciences, Karachi
Recognized institutes for FCPS
training in Pakistan (cont…)
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Unfortunately KPK and Baluchistan
lack training institutes recognized
by CPSP for FCPS training in PM&R
Why there are few Rehabilitation
physicians in Pakistan
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PM&R Curriculum not included in
the syllabus of MBBS ( So under
graduate students not aware of this
speciality)
Lack of training institutes
Conclusion
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Like a true friend, Rehabilitation physician
must be an optimistic spirit, a team
player and who gives life to the immortal
words of William Arthur ward ( 18801967)
A true friend knows your weakness but
shows you 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
Recommendations
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Due to law and order conditions and
war and terrorists activities, the
burden of disabilities is increasing
day by day
Common encountered disabilities
are amputations, spinal cord
injuries and traumatic brain injuries
To manage these conditions a team
work is required
Recommendations (cont…)
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Just four specialist in physical
medicine and rehabilitation (In
whole country) are not sufficient to
manage this burden of disability
What we need is more training
institutes, PM&R course to be
included at MBBS level
Thank you
Questions?