Physiatry — a term used in the field of Physical Medicine and Rehabilitation (PM&R) — is a medical innovation that developed in the early 1920’s to treat some medical conditions affecting the brain, spinal cord, nerves, muscles, bones, joints, ligaments and tendons. Actually, physiatry is linked to the old testament of PM&R — also known as Rehabilitation Medicine, or Physical and Rehabilitation Medicine (PRM) — and is a branch of medicine that aims to enforce and restore functional ability and quality of life to those with physical impairments and disabilities.
Physiatrists specialise in restoring optimal function to people with injuries to the muscles, nerves, bones, joints and ligaments. This specialty come to be known as PM&R and was officially established is 1947, when an independent Board of Physical Medicine was established under the authority of American board of medical specialities.
However, the term was first coined by Physical Medicine pioneer Frank H Krusen in 1938. Rehabilitation medicine gained prominence during both World Wars in the treatment of injured solders and labourers. As a medical field, the major concern of PM&R is the ability of a person to function optimally with the limitation placed upon them by a disabling impairment or disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimisation of the quality of life for those not able to achieve full restoration of function. Physiatrists play an immense role in treating some medical conditions and need a thorough medical knowledge of the pathophysiology and consequence of the disease so as to prevent many of the catastrophes faced by those with disabling ailments. The functional role of a PM&R physician may be categorised as follows:
• Treat patients of all ages;
• Focus treatment on function;
• Have a broad medical expertise that allow them to treat disabling conditions throughout a person’s lifetime;
• Diagnose and treat pain as a result of an injury, illness or disabling conditions;
• Determine and lead a treatment/prevention plan;
• Lead a team of medical professionals, which may include a physical therapist, an occupational therapist and physician extenders to optimise patient care;
• Work with other physicians, which may include primary care physicians, neurologist, orthopaedic surgeons and many others and
• Treat the whole person, not just the problem area.
The above picture clearly outlines how the activity of a physiatrist or physical medicine specialist covers a wide range of cases — from those with brain and spinal cord injuries, to stroke and burn victims, and patients who have spine and sports injuries as well as other musculoskeletal problems.
An estimated 16 million people in Bangladesh are suffering from various forms of disabilities resulting either from illness or other injury related events and are in the darkness of medical rehabilitation programs that only have a small number of physiatrists serving a huge community. It should be noted that only 118 students graduated as physical medicine specialists (FCPS and MD in Physical Medicine and Rehabilitation) in our country and have to serve the entirety of our 160 million people. It is unfortunate and deplorable that many of our rehabilitation institutions are run by diploma physiotherapists who are supposed to be knowledgeable about the current state of rehabilitation medicine. People living with disabilities in Bangladesh are entitled to government support, but programs have been limited in scope and restricted to urban areas and the issue of disability has not been integrated into the general development programs. The perception of disability among most Bangladeshis remains largely negative, especially in rural areas, and disability is often viewed as a curse brought on by the misdeeds of parents, and is often believed to be contagious.
Disability will always remain in Bangladeshi society, with the entire social stigma attached to it. But there is a silver lining — the government is showing an increasing interest in persons with disability, and is keen to work hand-in-hand with non-government organisations on the issue. But making real progress in the field requires an integrated effort that must increase the number of graduated rehabilitation physicians who can fight disability and help those with disabilities to live a better life.
(Editor’s note: 13 oct is Physiatry Day)