Physical medicine and rehabilitation (PM&R), also known as psychiatry or rehabilitation medicine, is defined as a branch of medicine that aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. A physician having completed training in this field is referred to as a physiatrist or rehabilitation medicine specialist. Physiatrists specialize in restoring optimal function to people with injuries to the muscles, bones, tissues, and nervous system (such as stroke patients). 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 disabled people with the tools they need to attain independence and self-determination.
Glossary - For an explanations of terms used in hospitals and rehabilitation centers see Definitions Hospital Departments
Doctors who specialize in Physical Medicine and Rehabilitation are known as, 'Physiatrists,' and are experts in the diagnosis, treatment, and prevention of disabilities of all types. They work with interdisciplinary teams of experts in a number of fields, to include Nursing, Physical Therapy, Occupational Therapy, Speech and Language Pathology, Psychology, Recreational Therapy, and other Physiatrists in order to improve and maximize each individual's function, quality of life, and independence. Persons who are admitted to a rehabilitation unit in a hospital are likely to meet a Physiatrist.
Benefits of Admission to an Acute Rehabilitation Unit (ACU)
People who experience traumatic injuries such as traumatic brain injuries, or spinal cord injuries; amputations or burns can benefit from the services offered by an ACU. People who have neurological conditions; brain tumors, multiple sclerosis, or movement disorders for example, or have experienced a stroke, can as well. Other people who may benefit from the services offered by an ACU include those who experience arthritis, musculoskeletal disorders, spinal, brain, orthopedic disorders, or a generalized debility or de-conditioning. Post-surgical patients can benefit from these services too.
Common Criteria for Admission
Usually, the person seeking admission to an ACU must meet a few conditions. They must be medically stable, and be able to tolerate three or more hours of intensive rehabilitative therapies throughout the day. The person must need the services of inpatient acute rehabilitative nursing and psychiatric, occupational, or speech-language therapy, as well as medical care. The person must have a supportive social network and firm discharge plans in place, as well as the cognitive ability to carry over instructions from day to day. The person has to agree to intensive acute rehabilitation admission.
The goal of inpatient rehabilitation is to help the person to function as independently as possible, restoring the person to the highest possible physical, psychosocial and vocational independence levels possible. The staff at an inpatient rehabilitation hospital needs to have the goals of protecting the person's rights to privacy, dignity, and self-determination while retaining high ethical standards related to clinical, medical, research and managerial functions. Rehabilitative care programs evaluate the person's outcomes in functional independence, determine the length of their stay in the unit, their discharge into the community, and assess the person's ability to lead a productive lifestyle.
There is a national benchmark used by many inpatient rehabilitation facilities to measure the severity of a person's disability and document it; this benchmarking instrument is known as the, 'Functional Independence Measure (FIM).' The FIM is often used throughout the process of providing rehabilitative services in an ACU in order to monitor changes in functional status related to the person. Satisfaction on the part of the person participating in the rehabilitation process is a vital component since the person's active participation in the treatment program can influence the outcome. Functional outcome information is often used by both Departments of Rehabilitation and Post-Acute Care services in order to determine the clinical effectiveness of management of patients, as well as their ability to meet the needs of what is very often a diverse and multicultural patient population.
Common Patient Rights
Many inpatient rehabilitation units respect the rights people have while in their care. These rights commonly include things such as protection of the person's privacy, provision of enough information to both the person and their family members to make decision-making processes, and information regarding their freedom to take part in research studies, the right to do-not-resuscitate (DNR) status, and their rights regarding advanced directives. Common rights people have during stays in ACU's also include provision of information regarding services which are not provided or covered along with referrals to outside services, sensitivity to both optional treatment practices and cultural beliefs, and prohibition of psychological and physical abuse.
Therapy and Length of Stay
Many times, the person's therapy schedule will be placed in their room, as well as at the Nurse's station every morning. People will often receive three or more hours of therapy each day for five days each week. Their schedule could be changed by their rehabilitation care team to meet their individual needs. Therapy usually begins early in the morning. Team goals are commonly evaluated on a weekly basis by the rehabilitation team, and the person's length of stay is determined by a number of things. These things include their progress towards the goals that have been set, the level of involvement by family members, authorization of stay by the person's payor source, the person's active participation in the program, and their discharge plan.
Personal and Clothing Items
There are some clothing and personal items a person should bring for their stay in an ACU. These items include comfortable pants, gym shoes or footwear that is comfortable, night clothing and a robe, and some personal grooming items. The person should bring some shirts or blouses, a sweatshirt or sweater, some undergarments, and a coat as well. In many ACU's, the person's family members or caregiver is responsible for washing the person's clothes. The person's clothes, glasses, dentures and hearing aides should all be labeled. Any jewelery, cash, credit cards or additional valuables need to be left at home.
A number of inpatient rehabilitation hospitals ask people who seek admission for a completed and signed advanced directive prior to admission. An advanced directive is a document that is signed by the person prior to a serious illness, and states their desires regarding how they want medical decisions made. Advanced directives are many times kept with the person's medical records, and are the clearest demonstration of their wishes.
Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975 prohibit discrimination on the basis of race, color national origin, sexual orientation, disability and age. Inpatient rehabilitation units are required by law to respect these Acts. Many of these facilities have additional policies in place to ensure that people receiving services are satisfied.
Different rehabilitation units offer different programs where support is concerned. There may be a number of supports available for persons going through rehabilitation related to coping with disability, including community reintegration. Other forms of support may include home safety assessment, dysphagia management, skin and wound management, nutrition management, medication management, orthotic services, audiology services, vision services, self-care retraining, and communication retraining among others.
Rehabilitation often focuses on;
The type of therapy and goals of therapy is different for different people.
6 formal sub-specializations are recognized by the field in the US;
Other sub-specialties within the field that are recognized;