ABSTRACT
Medical specialty training has undergone dramatic changes in the last 5 yr. This article was prepared by the Undergraduate Education Committee of the Association of Academic Physiatrists in an attempt to help guide medical students who are considering a career in physical medicine and rehabilitation. This report is an update of two previous articles addressing medical students' questions to assist them in making educated decisions about residency training and medical practice.
Subject(s)
Career Choice , Physical and Rehabilitation Medicine/education , Physical and Rehabilitation Medicine/organization & administration , Rehabilitation/education , Rehabilitation/organization & administration , Students, Medical/psychology , Career Mobility , Curriculum , Education, Medical, Graduate/organization & administration , Forecasting , Humans , Internship and Residency/organization & administration , Job Description , Job Satisfaction , United StatesABSTRACT
This self-directed learning module reviews and summarizes recent literature on osteoporosis. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The areas covered include pathophysiology of primary and secondary osteoporosis, effects of various pharmacologic treatments on bone metabolism, and the utility of available diagnostic tests. Management strategies for perimenopausal women as compared with postmenopausal women with established osteoporosis are discussed. This is followed by an evaluation and management plan for the older man with acute osteoporotic fracture.
Subject(s)
Osteoporosis/metabolism , Osteoporosis/rehabilitation , Bone and Bones/metabolism , Diagnosis, Differential , Female , Humans , Male , Osteoporosis/diagnosis , Osteoporosis/drug therapy , Patient Care Planning , Risk FactorsABSTRACT
This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with connective tissue diseases. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include the management of patients who have polymyalgia rheumatica, juvenile rheumatoid arthritis, ankylosing spondylitis, rheumatoid cervical spine, and rheumatoid hand.
Subject(s)
Arthritis/diagnosis , Arthritis/rehabilitation , Connective Tissue Diseases/diagnosis , Connective Tissue Diseases/rehabilitation , Arthritis/physiopathology , Connective Tissue Diseases/physiopathology , Diagnosis, Differential , Humans , Patient Care Planning , Polymyalgia Rheumatica/diagnosis , Polymyalgia Rheumatica/physiopathology , Polymyalgia Rheumatica/rehabilitation , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/physiopathology , Spondylitis, Ankylosing/rehabilitationABSTRACT
This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with osteoarthritis. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. New advances covered in this article include updates on conservative and operative treatment of lumbar spinal stenosis and pediatric hip diseases, prophylactic therapy for thromboembolic disease after lower limb joint replacement, new therapies for osteoarthritis, and the impact of exercise on outcome following hip replacement in active persons.
Subject(s)
Osteoarthritis/diagnosis , Osteoarthritis/rehabilitation , Arthroplasty/adverse effects , Exercise Therapy , Hip Fractures/etiology , Hip Fractures/rehabilitation , Humans , Osteoarthritis/physiopathology , Osteoarthritis/surgery , Patient Care Planning , Venous Thrombosis/etiology , Venous Thrombosis/prevention & controlABSTRACT
This self-directed learning module highlights assessment and therapeutic options in the rehabilitation of patients with orthopedic and musculoskeletal disorders. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses new advances in such topics as idiopathic scoliosis, nontraumatic shoulder pain, rotator cuff tendinitis, and Dupuytren's disease.
Subject(s)
Musculoskeletal Diseases/diagnosis , Musculoskeletal Diseases/rehabilitation , Braces , Diagnosis, Differential , Dupuytren Contracture/diagnosis , Dupuytren Contracture/physiopathology , Dupuytren Contracture/rehabilitation , Flatfoot/etiology , Flatfoot/physiopathology , Flatfoot/rehabilitation , Humans , Musculoskeletal Diseases/physiopathology , Patient Care Planning , Rotator Cuff/physiopathology , Scoliosis/diagnosis , Scoliosis/physiopathology , Scoliosis/rehabilitation , Tendinopathy/diagnosis , Tendinopathy/physiopathology , Tendinopathy/rehabilitationABSTRACT
A patient initially presented in the emergency room with fever, confusion, and a petechial rash. Rocky Mountain Spotted Fever (RMSF) was diagnosed and appropriate treatment was initiated. He subsequently became obtunded and required mechanical ventilation and temporary cardiac pacing. Four weeks later, he presented to our rehabilitation unit with ataxia, hyperreflexia and upper motor neuron signs, dysesthesias, sensorimotor axonopathy demonstrated by electrodiagnostic studies, and a global decrement in cognitive capability. Although he significantly improved in functional mobility and self-care, he exhibited little improvement in his cognitive impairment at 6-month follow-up. An understanding of the natural history of, and long-term impairments associated with, RMSF will be helpful to physiatrists in developing rehabilitation care plans and in assisting such patients with community re-entry.
Subject(s)
Cognition Disorders/etiology , Rocky Mountain Spotted Fever/complications , Rocky Mountain Spotted Fever/rehabilitation , Activities of Daily Living , Aged , Brain/pathology , Brain/physiopathology , Chronic Disease , Cognition Disorders/diagnosis , Electroencephalography , Follow-Up Studies , Humans , Intelligence Tests , Magnetic Resonance Imaging , Male , Neural Conduction , Peripheral Nerves/physiopathologyABSTRACT
OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT) in brain injured individuals at time of admission to a brain injury (BI) rehabilitation program. DESIGN: Prospective study, sequential case series. SETTING: University tertiary care BI rehabilitation center. DATA SET: Eighty-two traumatic brain injury (TBI) and 71 atraumatic brain injury (ABI) patients were consecutively admitted to our BI unit over a 12-month period and screened within 24 hours of admission for a lower extremity DVT with color flow duplex Doppler ultrasonography. All patients had been prophylaxed with either subcutaneous heparin anticoagulation therapy or intermittent compression devices, and all patients were within 2 months of the original BI. MAIN OUTCOME MEASURES: Evidence of intrinsic venous occlusion by duplex Doppler. RESULTS: DVTs were detected and treated prior to rehabilitation admission in three patients (2%), and these persisted at rehabilitation admission. New DVTs were detected at time of rehabilitation admission in 17 patients (11%). All were occult DVTs; none of the 17 patients had clinical findings indicative of acute DVT. No significant differences were noted in the TBI group when age, highest 24-hour Glasgow Coma Scale score, length of acute hospitalization, type of DVT prophylaxis, or presence of an extremity fracture were compared for individuals with and without DVT. No significant differences were noted in the ABI group when age, length of acute hospitalization, and type of DVT prophylaxis were compared for individuals with and without DVT. CONCLUSION: The overall incidence of DVTs was 13% and the incidence of occult DVT was 11%. Individuals with TBI had an overall incidence of DVTs of 20% and an occult DVT incidence of 18%. Individuals with ABI had an overall incidence of DVT's of 6% and an occult DVT incidence of 4%. These findings indicate the importance of baseline screening for DVT in this patient population.
Subject(s)
Brain Injuries/complications , Thrombophlebitis/etiology , Adult , Anticoagulants/therapeutic use , Brain Injuries/rehabilitation , Female , Glasgow Coma Scale , Humans , Incidence , Male , Patient Admission , Prospective Studies , Rehabilitation Centers , Thrombophlebitis/diagnostic imaging , Thrombophlebitis/epidemiology , Thrombophlebitis/prevention & control , Ultrasonography, Doppler, ColorABSTRACT
OBJECTIVES: To determine the efficacy of methylphenidate in improving attention and functional outcome in acutely brain-injured adults. DESIGN: Prospective multiple baseline design (A-A-B-A) utilized on a consecutive sample of patients. SETTING: Acute brain injury rehabilitation unit in a large academic medical center. PATIENTS: Eleven acutely brain-injured adults were included by performing below two standard deviations of the age equivalent norms on 4 of 5 neuropsychological tests for attentional capacity. One subject was withdrawn after developing tachycardia. INTERVENTION: After a 1-week baseline assessment, subjects were placed on increasing doses of methylphenidate (Ritalin) so that on Day 7 all patients received a dose of 15 mg at 8 am and 12 pm. MAIN OUTCOME MEASURES: Nine neuropsychological subtests measured attention on admission, at 1 week, while on methylphenidate, and 1 week after its discontinuation. Functional outcome was evaluated utilizing the Disability Rating Scale (DRS) at the same intervals. RESULTS: Digit Span, Mental Control, and Symbol Search scores improved significantly (p < .05) on methylphenidate (A-B) as compared with the pre-methylphenidate (A-A) period. This advantage remained when the drug was removed. The mean improvement in DRS scores on methylphenidate approached a significant difference (p < .06) from that change in the DRS scores between baseline 1 and 2. CONCLUSIONS: Use of methylphenidate in acutely brain-injured adults was well tolerated and demonstrated a significant improvement in attention compared to natural recovery in a rehabilitation setting. Methylphenidate also correlated with faster functional recovery as measured by the Disability Rating Scale although the improvement did not achieve statistical significance.
