Introduction of Physical Medicine and Rehabilitation

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Introduction of Physical Medicine and
Rehabilitation

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Physical medicine

• Treat the physical problem detected by physical
  examination
• Musculoskeletal examination
• Neurological examination
• Functional examination

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Musculoskeletal examination

• Inspection
• Palpation
• Active and passive ROM
• Joint stability
• Manual muscle testing
• Specific tests

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Specific tests for shoulder
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Demonstration of shoulder impingement
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Specific tests for lower limbs
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Specific test for contracture
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Neurological examination

• Consciousness-GCS
• Cognitive status-JOMAC
• Cranial nerves
• Sensory system- temperature, pinprick, light
  touch, vibration
• Motor coordination- HKS, FNF, RAM
• Deep tendon reflex
• Pathological reflex
• Spasticity-Modified Ashworth scale

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Brunnstrom stage Upper limb Lower limb Hand
I Flaccid Flaccid Flaccid
II Associate movement Associate movement Associate movement
III Flexion synergy Extension synergy Mass grasp with no release
IV Placing the hand behind the body Elevation of the arm to a forward-horizontal position Pronation-supination, elbow at 90 Isolated knee flexion beyond 90 or ankle dorsiflexion while sitting Lateral prehesion,release by thumb movement Semivoluntary finger extension
V 1. Arm-raising to a side-horizontal position 2. Arm-raising forward and overhead 3. Pronation-supination, elbow extended Isolated knee flexion beyond 90 or ankle dorsiflexion while standing Palmar prehension Possible cylindrical and spherical grasp Mass extension of digits
VI Isolated joint movements are now freely performed Isolated joint movements are now freely performed Isolated joint movements are now freely performed
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Rancho Los Amigos scale

• 1. No response
• 2. Generalized response to stimuli
• 3. Localized response to stimuli
• 4. Confused agitated
• 5. Confused inappropriate
• 6. Confused appropriate
• 7. Automatic appropriate
• 8. Purposeful appropriate

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Functional examination

• Bed mobility
• Sitting ability
• Standing ability
• Activity of daily living evaluationFIM
  (functional independence measure)
  instrumentSelf-care 6 items Sphincter control
  2 itemsTransfers 3 itemsLocomotion 2
  itemsCommunication 2 itemsSocial cognition
  function 3 items1-7 score is given for each item

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Rehabilitation

• Return patients suffered from diseases to
  previous function
• PMR represent a life-long care for patients of
  certain diseases
• A practical science of medicine

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Patients of PMR department

• The neonatal and child period CP, MMC, autism,
  ADHD, unspecified developmental delay
• Adolescent period sports injury, TBI, SCI, AS
• Elderly period CVA, SCI, OA, Parkinsonism, LBP,
  Frozen shoulder
• Post-operative patients

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Criteria for admission to a rehabilitation program

• Stable clinical status
• Significant persisting deficit
• Sufficient cognitive function to learn

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Subdivision of PMR department

• Physical therapy Neuro-rehabilitationPhysical
  modalitiesPediatric rehabilitationHydrotherapyC
  ardiopulmonary rehabilitation
• Occupational therapyFunctional training of daily
  livingOrthosis formingSensory-integration
  training

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Subdivision of PMR department

• Speech training and swallowing training
• Psychosocial consulting
• Vocational evaluation
• Prosthesis designing