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 non-
interventional
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?