Public Health and Economy

Physical Medicine

PHYSICAL MEDICINE

PHYSICAL MEDICINE also called PHYSIATRY, PHYSICAL THERAPY, OR REHABILITATION MEDICINE, medical specialty concerned with the treatment of chronic disabilities and with the restoration of normal functioning to the disabled through physical modes of treatment, such as exercise. This specialized medical service is generally aimed at rehabilitating persons disabled by pain or ailments affecting the motor functions of the body. Physical medicine is one means employed to assist these patients to return to a comfortable and productive life, often despite the persistence of a medical problem. For centuries man used such natural physical agents as hot springs and sunlight to treat his ailments, but the development of physical medicine as a specialized medical service took place largely after World War I. Two factors influenced its growth in the 20th century--epidemic poliomyelitis and the two world wars--both of which created large numbers of young, seriously handicapped persons. Physical medicine was definitively established through the American physician Howard A. Rusk's efforts to rehabilitate wounded soldiers during and after World War II. Physical medicine then became available for the treatment of patients with such diverse problems as fractures, burns, tuberculosis, painful backs, strokes, nerve and spinal cord injuries, diabetes, birth defects, arthritis, and vision and speech impairments. Physical medicine is closely associated with orthopaedic surgery, but it is also prescribed by physicians and surgeons in all branches of medicine. Physicians who specialize in physical medicine are called physiatrists. The objectives of physical medicine are relief of pain, improvement or maintenance of functions such as strength and mobility, training in the most effective method of performing essential activities, and testing of function in various areas. Tests cover such fields as muscle strength, degree of joint mobility, breathing capacity, and muscular coordination. The therapeutic means most commonly employed include heat, massage, exercise, electrical currents, and functional training. Since the 1970s these basic means have been supplemented and enhanced by psychological counselling, occupational therapy, and a variety of other treatments which may be used in concert to help the disabled person achieve the fullest possible life despite the persistence of his medical problem. Heat is used generally to stimulate circulation and to relieve pain in the area treated. It may be applied by infrared lamps, shortwave radiation, or high-frequency electrical currents (diathermy); by hot, moist compresses or immersion in hot water (hydrotherapy); or by ultrasound. Massage primarily aids circulation and relieves local pain or muscle spasm. Exercise, the most varied and widely used of all physical treatments, is usually designed to do one or more of three things: increase the amount of motion in a joint, increase the strength in a muscle, or train a muscle to contract and relax in useful coordination with other muscles. In addition to its obvious use following stiffness or paralysis, exercise may be used to improve the breathing of patients with lung disorders, assist circulation, relax tense muscles, and correct faulty posture. In the late 20th century high technology was increasingly harnessed in efforts to rehabilitate paraplegics, quadriplegics, and others with severely impaired motor functions. Microcomputers were developed that could send precisely coordinated jolts of electricity directly into the muscles of such patients, mimicking the cerebral impulses that could no longer reach their muscle destinations because of a severed spinal cord. The microcomputers' sophisticated programs enable them to contract a patient's muscles in unison so that he can actually stand and sit, walk, and even use his hands to perform relatively fine movements. Such devices were still in the experimental stage and were costly to make and use, but they seemed to be the most promising development yet in efforts to restore the power of movement to nerve injury victims. Other, less ambitious devices to help paralyzed patients include wheelchairs with specially equipped control systems that can be operated by the mouth and teeth movements of a quadriplegic. Mobile robotic arms have been developed that are equipped with a video camera so that they can move safely and intelligently about a patient's house. These personal robots can receive and execute oral commands from the patient to perform such simple household tasks as filling a glass with water or taking a book off a shelf. Functional training teaches the impaired individual how to carry out most safely and effectively the activities of daily life. This training may mean learning to use crutches, a brace, or an artificial arm; or it may involve working