Thomas McNalley, MD

Introduction to Rehabilitation Medicine

2011-12 Chronic Care Clerkship

Objectives

Take a functional history

Appreciate the scope and foci of rehabilitation medicine (PM&R) Reflect on the definitions of disability and impairment, and the impact of medicalization on social roles.

Function

What have you done today?

M A C/C V T

What have you done today?

Mobility Activities of Daily Living (Basic/Instrumental) Cognition/communication Vocational/avocational Transportation and community mobility

Rehabilitation Physician

PM&R physiATrist or phySIatrist? 4 yr residency

Diagnosis and mgmt of neurologic and

musculoskeletal impairment Emphasis on function Emphasis on QOL Electrodiagnosis Pain mgmt both interventional and noninterventional TEAM based intervention

Rehabilitation Team

Rehab Nursing Rehab psychology Social Work Nutrition Rehab/vocational counseling Education/school Therapists Physical Occupational Speech pathologists Recreation therapy

Conditions we Treat

Spinal cord injury Traumatic Brain Injury Stroke Multiple sclerosis Low back pain Neuromuscular disease including: Muscular dystrophies ALS Neuropathies hereditary and acquired Sports Medicine Musculoskeletal medicine

Impairment and disability

Impairment: an injury, illness, or congenital condition that causes or is likely to cause a loss or difference of physiological or psychological function.
Disability: a social construct -- the loss or limitation of opportunities to take part in society on an equal level with others due to social and environmental barriers.

Examples of impairment and disability

Impairment (cause) Abnormal gait (spastic diplegia) Executive dysfunction (TBI) Fecal incontinence (neurogenic bowel) Wheelchair use (paraplegia)

Disability Cant join soccer team Reduced educational performance Limited social interaction Reduced access to buildings fewer employment opportunities

Whos disabled?