Address: Suite 2A-C, Liguanea Post Office Mall, 115 Hope Road, Kingston 6, Jamaica
Tel: (876) 978-4009-10, (876) 631- 4000, Fax : (876) 631-4070

All Posts in Category: News

PUBLISHED: A new discipline in medicine, Physiatry: Physical Medicine and Rehabilitation

INTRODUCTION

Physical Medicine and Rehabilitation (PM&R) also referred to as Physiatry, pronounced fizzy-at’-tree, (1, 2) is the area of medicine which helps patients regain control of their lives by restoring function. Rehabilitation Medicine therefore treats patients who have experienced traumatic injury after surgery or disabling diseases including various musculoskeletal or nervous system conditions, chronic pain or movement problems. Treatment utilizes physical therapeutics and/or medications, non-invasive or minimally invasive methods and usually does not include surgery (1, 3, 4, 2). The major concern of the field is the ability of persons to function optimally within the limitations placed upon them by a disease process, for which there may be no known cure. The emphasis is to attempt to regain full restoration to the premorbid level of function where possible or optimization of the quality of life for those who may not be able to achieve full restoration.

An interdisciplinary team approach is used in patient care. The Physiatrists in collaboration with physical therapists, occupational therapists, speech and language pathologists, psychologist, doctors and other rehabilitation professionals (1, 3, 4, 5) create individualized therapy plans specific to the unique needs, abilities and objectives of patients (Figure).

 

 

HISTORY

Physical Medicine and Rehabilitation was formally recognized as a specialty by the American Medical Association (AMA) with the establishment of the American Board of Physical Medicine and Rehabilitation (ABPMR) in February 1947 (4, 5, 6). Although the recognition as a specialty came in 1947, doctors practised Physical Medicine years before during World War I and II (WWI/WWII) in treating wounded soldiers and even before as seen in 1923 when the first “physical medicine” society was organized in the form of The American College of Radiology and Physical Therapy (4). Major Frank B Granger from the Medical Corps was instrumental in setting up reconstruction units in hospitals across the United States of America in 1917. Colonel Harry Mock and Dr John Coulter worked to treat soldiers with disabling conditions during WWI and during WWII. Howard Rusk furthered the establishment of rehabilitation programmes in hospitals for the Army Air Force. Dr Frank H Krusen along with the Mayo Clinic provided the first residency training programme for the Navy and Army doctors in 1936 (5) and he was later credited with coining the term “Physiatrist” in 1939. The origins of what became known as the American Academy of Physical Medicine and Rehabilitation (AAPMR) in 1956, was in a society which consisted of Radiologists and Physical Therapy Doctors; some of the latter were trained in Central Europe and Scandinavia (6) where physical therapeutics, hydrotherapy and spa treatment were well respected as a part of medical treatment (7). With the polio outbreak in 1952, Physiatry was further expanded and the field was converted from a military field to include the treatment of more civilians (3, 4, 6–10). In 1967, the Association of Academic Physiatrists (AP) was established as an organization of Physiatrists affiliated to training institutions (9).

In Great Britain, Rehabilitation Medicine also developed out of the need to treat disabled soldiers between the two World Wars. The International Federation of Physical Medicine and Rehabilitation held the second International Congress of Physical Medicine and Rehabilitation on July 14–19, 1952, after a long break following the first meeting in 1938 (8, 11). Rehabilitation Medicine was recognized as a specialty by the Royal College of Physicians in Great Britain in 1984 with the organization of Medical Disability Society in 1983, and later renamed the British Society of Rehabilitation Medicine in 1991 (10). It is to be noted that Rehabilitation Medicine had close ties with Rheumatology and both shared the same umbrella association, the British Association of Rheumatology and Rehabilitation until 1984 (10, 11).

Other countries had similar origins for rehabilitation medicine in response to wartime and Rehabilitation Medicine was recognized as a specialty over the years: Australia in 1976 (12), New Zealand in 1995 (12) and Japan in 1996 (13).

In the Caribbean, the University College of the West Indies in Jamaica appointed the then Dr John Golding as Senior Lecturer in Orthopaedics in 1953. He was instrumental in introducing Rehabilitation to Jamaica. In 1954, Sir John Golding started the Mona Rehabilitation Centre, in response to the outbreak of polio. The Mona Rehabilitation Centre was renamed Sir John Golding Rehabilitation Centre and is still treating patients with disabilities to this day (14). A Lecturer in Physical Medicine and Rehabilitation and Consultant Physiatrist was appointed at the University of the West Indies in 2008, where PM&R is now included in the curriculum for the medical and physiotherapy students.

 

TRAINING

There are many accredited residency training programmes for Physical Medicine and Rehabilitation or Rehabilitation Medicine, and duration of residency training ranges from 4–6 years depending on the country, with the first 1–2 years spent as an intern or house officer (1, 12). At the end of residency training a written and clinical exam is done and certification is granted. The field has since evolved and now offers subspecialty fellowship training in; Musculoskeletal, Spine and Sports Medicine, Brain Injury, Spinal Cord Injury, Paediatric and Geriatric Rehabilitation (1, 9, 5).

 

AREAS OF REHABILITATION

Musculoskeletal Rehabilitation: Treats acute and chronic athletic injuries, arthritis, motor vehicle injuries, physical injury, post surgery patients, deconditioned patients, work related injuries, overuse injuries, overweight patients with obesity, elderly patients who are deconditioned.

Spine Rehabilitation: Treats patients who have sustained injuries or have natural progressive degeneration of the spine with neck and back pain.

Brain Injury Rehabilitation: Treats patients after traumatic brain injury eg after motor vehicle accident, assault, falls; stroke; tumour (cancer, benign); brain injury after infection.

Spinal Cord Injury Rehabilitation: Treats patients after traumatic spinal cord injury after motor vehicle accident, assault, falls, stroke, degenerative illness of the spinal cord, tumour (cancer, benign), after infection eg meningitis, polio or other neurological illnesses.

Neurological Disease Rehabilitation: Treats patients with cerebral palsy, tropical spastic paraparesis (TSP), multiple sclerosis, diabetic peripheral neuropathy, etc.

Spasticity Management Rehabilitation: Treats patients with spasticity, stiffness in muscles which prevents free movement, coordination and function.

Cardiac Rehabilitation: Treats patients who have cardiac related illnesses, including myocardial infarction, congested heart disease or post cardiac surgery to facilitate recovery and minimized recurrence.

Pulmonary Rehabilitation: Treats patients with acute and chronic respiratory disease, including chronic obstructive pulmonary disease (COPD) and severe cases of asthma.

Cancer Rehabilitation: Treats cancer patients in an attempt to obtain maximal physical, social, psychological and vocational functioning within the limits created by the disease and its resulting treatment.

Burn Rehabilitation: Treats patients after acute phase and hospitalization, who will need rehabilitation for maintenance of range of motion and function which is critical during the initial stage of healing to prevent contractures of skin, muscles and disfigurement.

Prosthetic and Orthotics: Treats patients with upper or lower limb amputation who need prosthesis (artificial limbs) or patients needing orthosis, ie splints and braces, including patients with scoliosis or limb deformity.

 

SUMMARY

Physiatry is a relatively new area of medicine worldwide and continues to evolve to meet the medical needs of patients. The fundamental goal of Rehabilitation Medicine is functional performance and quality of life. Lord Viscount Tedder stated, “that the greatest field of the specialty lay in the restoration of individuals to full physical fitness, for he said, “life was not merely to be alive, but to be well”.

One of the highest awards in the AAPMR is the Frank H Krusen Award, and one of the awardees, Henry Betts and Joel Press, the founder of the Spine and Sports Rehabilitation Center at the Rehabilitation Institute of Chicago, say, “Medicine adds years to people’s life, Physiatry adds quality to those years.”

 

REFERENCES

1. American Academy of Physical Medicine and Rehabilitation, http://www.aapmr.org.

2. The Physiatrist, published by American Academy of PMR, May 2007.

3. Braddom RL. Physical Medicine and Rehabilitation, 2nd Edition, Philadelphia, W.B. Saunders, 2001.

4. Grabois M, Garrison SJ, Hart KA, Lehmkul LD: Physical Medicine and Rehabilitation, the Complete Approach. Cambridge, MA Blackwell Science, 2000.

5. O’Young BJ, Young MA, Steins SA. Physical Medicine and Rehabilitation Secrets, 2nd Edition, Hanley & Belfus, Inc. Philadelphia, PA.

6. Medical College of Wisconsin, http://www.mcw.edu.

7. European Society for Physical and Rehabilitation Medicine, http://www.esprm.net.

8. Annals of Physical Medicine, October 1952.

9. Association of Academic Physiatrists, http://www.physiatry.org.

10. British Society of Rehabilitation Medicine, http://www.bsrm.o.uk.

11. Tegner WS. A short history of the British Association Physical Medicine and Rheumatology. Rheum Phys Med 1972; 11: 210–12.

12. Australasian Faculty of Rehabilitation Medicine, http://www.afrm.racp.edu.au.

13. Meigen LIU. Development of Rehabilitation Medicine in Japan. JMAJ 2009; 52: 259–262.

14. Sir John Golding Rehabilitation Centre, www.springerlink.com.

Correspondence:
Dr PAU Dawson
Physical Medicine and Rehabilitation, c/o Dean’s Office
Faculty of Medical Sciences, The University of the West Indies
Kingston 7. Fax: (876) 977-6714
e-mail: drpauladawson@yahoo.com

Read the Original Article

Read More

PUBLISHED: Jamaican Children to Benefit from Spasticity Surgery, Next Week

Four-year-old Tennyson Cole will benefit from the first Selective Dorsal Rhizotomy Surgery for spasticity in cerebral palsy, to be performed in Jamaica on Monday October 12, 2009.

The surgery will be conducted by noted Paediatric Neurosurgeon from Gillette Children’s Hospital, St. Paul, Minnesota USA, Dr. Joseph Petronio.
He will be collaborating with Professor Ivor Crandon, Head of the Surgery Department and Professor of Neurosurgery at the University Hospital of the West Indies (UHWI) and Consultant Neurosurgeons, Dr. Carl Bruce and Dr. Dwight Webster.
Cerebral palsy is a non-progressive injury to a part of the central nervous system (the brain or spinal cord) that controls voluntary movements. Spasticity is a complication associated with cerebral palsy, in which increased muscle tightness causes difficulty moving the affected limbs.
Speaking with JIS News, Consultant Physiatrist at the UHWI, Dr. Paula Dawson, who is also a member of the organising team, explained that the incidence of spasticity with cerebral palsy is very high and most kids with cerebral palsy will have spasticity.
“Selective Dorsal Rhizotomy describes a surgical procedure carried out to the lower area of the back, where sensory nerve fibres in the spinal cord are identified then selectively cut,” she explained.

“With Selective Dorsal Rhizotomy, we actually go in and cut some nerve roots which are going to the muscles, but are too stiff, especially in the lower extremity, that will sometimes prevent children from walking,” Dr. Dawson added.
Emphasising the potentially detrimental effects of spasticity and the importance of treatment, she noted that if the condition is not properly diagnosed early and treatment started immediately, it may lead to deformity, in the form of muscle contractures where the limbs are rigid and the children are no longer able to stretch them out.
Dr. Petronio is part of a five-member team from the Gillette Children’s Hospital who will be in Jamaica from October 11-17, to conduct spasticity clinics and workshops. The team comprises a Neurosurgeon, a Consultant Physiatrist, a Physiotherapist, a Prostethist and Orthotist (Bracing and Splint Specialist).
Clinics will be held on October 12 and 13, at the UHWI and the Orthopedics Clinic at the Bustamante Hospital for Children (BHC), respectively.
Paediatric Physiatrist and Head of the Gillette Children’s Hospital team Dr. Mark Gourmet, will be coming to the Physiatry Clinics where he, along with a local team, will administer phenol injections and conduct bracing evaluations.

The phenol injection can effectively weaken a spastic muscle, thereby reducing spasticity and allowing improvements in range of motion. Approximately 16 children will benefit from this exercise.
In addition, visiting Prosthetist and Orthodist, William Nolin and Christine Nolin, will collaborate with a team from the Sir John Golding Rehabilitation Centre to outfit approximately 16 children with braces.
A Spasticity Lecture will also be held on Monday (October 12) at 2:30 p.m. in the Main Lecture Theatre at the University of the West Indies (UWI). Presenters will include Paediatric Physiatrist and Head of the team, Dr. Mark Gormley, who will give an overview of Spasticity Management in Children; Dr. Joseph Petronio, who will speak on Selective Dorsal Rhizotomy; Amy Schultz, who will speak on Physiotherapy after Rhizotomies; and William and Christine Nolin will expound on Orthotics in Cerebral Palsy.
This is the Minnesota team’s second visit to Jamaica. In February, they gave lectures on managing children with spasticity. Four children with spasticity were examined, and Tennyson Cole was selected to undergo Selective Dorsal Rhizotomy Surgery.

The visit is organised by the UHWI, in collaboration with the Ministry of Health, the Bustamante Hospital and the Sir John Golding Institute.Four-year-old Tennyson Cole will benefit from the first Selective Dorsal Rhizotomy Surgery for spasticity in cerebral palsy, to be performed in Jamaica on Monday (October 12). The surgery will be conducted by noted Paediatric Neurosurgeon from Gillette Children’s Hospital, St. Paul, Minnesota USA, Dr. Joseph Petronio. He will be collaborating with Professor Ivor Crandon, Head of the Surgery Department and Professor of Neurosurgery at the University Hospital of the West Indies (UHWI) and Consultant Neurosurgeons, Dr. Carl Bruce and Dr. Dwight Webster. Cerebral palsy is a non-progressive injury to a part of the central nervous system (the brain or spinal cord) that controls voluntary movements.

Spasticity is a complication associated with cerebral palsy, in which increased muscle tightness causes difficulty moving the affected limbs. Speaking with JIS News, Consultant Physiatrist at the UHWI, Dr. Paula Dawson, who is also a member of the organising team, explained that the incidence of spasticity with cerebral palsy is very high and most kids with cerebral palsy will have spasticity. “Selective Dorsal Rhizotomy describes a surgical procedure carried out to the lower area of the back, where sensory nerve fibres in the spinal cord are identified then selectively cut,” she explained. “With Selective Dorsal Rhizotomy, we actually go in and cut some nerve roots which are going to the muscles, but are too stiff, especially in the lower extremity, that will sometimes prevent children from walking,” Dr. Dawson added. Emphasising the potentially detrimental effects of spasticity and the importance of treatment, she noted that if the condition is not properly diagnosed early and treatment started immediately, it may lead to deformity, in the form of muscle contractures where the limbs are rigid and the children are no longer able to stretch them out. Dr. Petronio is part of a five-member team from the Gillette Children’s Hospital who will be in Jamaica from October 11-17, to conduct spasticity clinics and workshops. The team comprises a Neurosurgeon, a Consultant Physiatrist, a Physiotherapist, a Prostethist and Orthotist (Bracing and Splint Specialist). Clinics will be held on October 12 and 13, at the UHWI and the Orthopedics Clinic at the Bustamante Hospital for Children (BHC), respectively.

Paediatric Physiatrist and Head of the Gillette Children’s Hospital team Dr. Mark Gourmet, will be coming to the Physiatry Clinics where he, along with a local team, will administer phenol injections and conduct bracing evaluations. The phenol injection can effectively weaken a spastic muscle, thereby reducing spasticity and allowing improvements in range of motion. Approximately 16 children will benefit from this exercise. In addition, visiting Prosthetist and Orthodist, William Nolin and Christine Nolin, will collaborate with a team from the Sir John Golding Rehabilitation Centre to outfit approximately 16 children with braces. A Spasticity Lecture will also be held on Monday (October 12) at 2:30 p.m. in the Main Lecture Theatre at the University of the West Indies (UWI). Presenters will include Paediatric Physiatrist and Head of the team, Dr. Mark Gormley, who will give an overview of Spasticity Management in Children; Dr. Joseph Petronio, who will speak on Selective Dorsal Rhizotomy; Amy Schultz, who will speak on Physiotherapy after Rhizotomies; and William and Christine Nolin will expound on Orthotics in Cerebral Palsy. This is the Minnesota team’s second visit to Jamaica. In February, they gave lectures on managing children with spasticity. Four children with spasticity were examined, and Tennyson Cole was selected to undergo Selective Dorsal Rhizotomy Surgery. The visit is organised by the UHWI, in collaboration with the Ministry of Health, the Bustamante Hospital and the Sir John Golding Institute.

Read More

Read More

PUBLISHED: Jamaican-born doctor gets fellowship at top US hospital

Since 1991, U.S. News and World Report has recognised the Rehabilitation Institute of Chicago as the ‘Best Rehabilitation Hospital in America’ – no other speciality hospital has been consecutively ranked the ‘best’.

In July this year Jamaican-born Paula Dawson, a former national athlete and year 2000 graduate of the University of the West Indies (UWI), Mona, was scheduled to go to the Rehabilitation Institute of Chicago as a fellow in the Spine and Sports Rehabilitation Center.

Dawson was completing her year as academic chief resident, physical medicine and rehabilitation, at the Long Island Jewish Medical Center/North Shore, Albert Einstein School of Medicine in New York. Her appointment as academic chief resident at the 827-bed voluntary, non-profit, tertiary-care teaching hospital came in the final stretch of the years of post-graduate training she has spent there since July 2003.

She is now seeing the fulfilment of her dreams. She has always loved sports and also wanted to become a medical doctor. After her early school days at Mt. Alvernia High School and sixth-form studies at Immaculate Conception High School, she went on to the UWI, Mona where she studied successfully for a B.Sc., (Hons.) in biochemistry and zoology.

She went on to medical school at the UWI in August 1995 and was very happy there.

Best days of my life

“I spent some of the best days of my life there,” she said. “The camaraderie was great.”

Meanwhile, she had been making her mark as an athlete, giving outstanding performances in track and field, field hockey and football at the UWI from 1994 to 2000. In 1997, she was selected as Caribbean UWI Champion Female Athlete. She was a player on both the National Jamaica Football team in 1999 and on the National Jamaica Cricket team in 2001.

She served as treasurer for the Jamaica Women’s Football Association from September 1997 to March 1998.

Dawson graduated as a medical doctor in June 2000 and did her internship at the University Hospital of the West Indies with rotations in general surgery, internal medicine, obstetrics and gynaecology, paediatrics and orthopaedics.

Family practice physician

She worked in Jamaica for a while in government health clinics, and as a family-practice physician.

Meanwhile, she became a volunteer doctor with the Jamaica Sports Medicine Association and then as a member of the National Council on Continued Medical Education. Dawson was vice-president and later president of the Jamaica Medical Doctors’ Association.

However, there was an unfulfilled desire.

“I was a sportswoman first, then came school. I really wanted to do sports medicine,” she said. “For a while I thought of doing orthopaedics. I was fascinated with the precision that is involved.”

She left Jamaica and entered the Albert Einstein School of Medicine as an intern in general surgery in July 2003.

Looking back at the years she spent at the UWI, Mona, she says: “We were well trained. We developed a good work ethic and excellent discipline.”

The experience laid a solid foundation for the many years she had to spend in the Albert Einstein School of Medicine.

She said she feels humbled by the number of opportunities for personal and professional growth and development that have presented themselves in the past few years. She has met professionals who have helped to expand her horizons in the field of medicine. Even her acceptance at the renowned Rehabilitation Institute of Chicago was amazing to her as “they only take chief residents there”.

She said: “It is just about the very best place to go for training in rehabilitation.”

This month, Dawson will be one of the featured speakers at the National Medical Association Annual Convention and Scientific Assembly in Hawaii. Earlier this year, she spoke at the Fifth Caribbean Neuroscience Symposium on Surgical versus Non-operative Treatment of Lumbar Radiculopathy.

Dawson looks forward to the time when she will return to Jamaica and fulfil yet another dream: teaching others what she has learned over the years about sports medicine.

Read the Original Story

Read More