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Rehabilitation

Introduction

Physical medicine and rehabilitation is dedicated to improving function and quality of life for individuals with disabilities. Through various cognitive, physical, pharmacologic and psychological therapies, as well as ongoing research efforts, substantial progress is being made to reduce the effects of disabilities on individuals' daily lives and/or cure disabling conditions.

Who should I be seeing if I have experienced a disability?

Each neurologic (e.g., stroke, spinal cord injury) or musculoskeletal disability (e.g., low back pain) is a very specialized condition, typically with its own group of medications, professional meetings,and even medical journals. Because each of these disabilities is a specialized condition, you need to find a doctor who specializes in care and rehabilitation of these lifelong, disabling conditions. You should be seeing such an individual, in addition to seeing your family or community doctor, at least once/year.

A physiatrist (pronounced "fiz eye' uh trist") is a medical doctor (M.D.) who specializes in physical medicine and rehabilitation. Physiatrists must undergo residency training in an accredited training program, and be board certified in physical medicine and rehabilitation. Physiatrists specialize in lifelong care of individuals with disabilities, and, since they specialize in rehabilitation, can often suggest new or cutting edge techniques of which others may not be aware.

Will my insurance cover a physiatrist's care?

Most insurance plans cover physiatrist care, as it is understood that lifelong disabling conditions require regular attention from a broad certified specialist

Where do I find a physiatrist?

Physiatrists are typically listed in the telephone book, but can also often be accessed through your rehabilitation provider (e.g., physical or occupational therapist). Your family or community doctor may also be able to refer you to a physiatrist. Lastly, there are many rehabilitation hospitals located throughout the U.S. These hospitals will often have physiatry services available.

What techniques are available for pain?

Of course, you should consult a physiatrist who specializes in pain to provide you with a definitive and individualized answer to this question. However, some techniques that have shown promise include: acupuncture,acupressure (gentle pressure on the pulse points at which acupuncture needles are usually applied), gentle heat, and cold packs (e.g., application of an ice pack). Some drugs can also alleviate pain, either temporarily, or for sustained periods. Depending on the cause of the pain, therapeutic exercises prescribed by a physiatrist, such as physical therapy or aquatic therapy, can also help.

I have heard that the older you are, the harder it is to recover from an injury; is this true?

Not necessarily. Certainly, age can play a role in how your body responds to, and subsequently heals following, a neurologic or musculoskeletal injury. However, we also now know that recovery is predicted by the condition your body is in at the time of injury. For example, someone who is 50 years old, smokes, and is obese is not only at greater risk for a stroke or heart attack, but will also typically have worse outcomes if a stroke occurs than someone who is 80, exercises regularly, and does not smoke. Similarly, someone who remains active after a back or neck injury and continues to follow a regular, prescribed exercise regimen will fare better than someone who is younger but is inactive.

Many of these examples offer common sense, but too often individuals do not regularly exercise or take care of themselves as well as they could, especially after an injury or disability occurs. Yet, research suggests that,after injury, physical activity and a sensible diet are important in healing and recovery.

I have heard that, after a certain time, recovery cannot be expected after a stroke or spinal cord injury. Is this true?

Yes and No. It is true that the brain and/or spinal cord stop spontaneously healing themselves after several months. However, it is also known that the brain and/or spinal cord can often continue to reorganize and improvements in motor function can continue to occur. A key to this appears to be repeated practice with the body part(s) that are injured. For instance, if your hand was affected by your stroke, repeated use of that hand for several hours/day over an 8-10 week period can induce brain reorganization and subsequent improvements through a reimbursable outpatient program called "modified constraint induced therapy." Similarly, studies conducted at The University of Cincinnati College of Medicine suggest that biking assisted by functional electrical stimulation can also improve outcomes in spinal cord injury and stroke. The key in all of these protocols appears o be repeated muscular and brain activation, each of which occurs through repeated use.

Ironically, most patients are relatively inactive months or years after their injuries for a variety of reasons.

Does insurance cover therapy and what types of therapies are available for my injury?

There are a number of different types of therapy that may be prescribed by a physiatrist, depending on the nature and cause of your injury. Physical therapy, for example can help wit gross motor skills, balance, and walking,among other things.Occupational therapy can help with more fine motor skills, such as writing or manipulating small objects with your hands. Speech therapy can help with saying or forming words, producing air to form words, and swallowing, among others. Many other therapies, such as cognitive therapy (for thinking), aquatic therapy, or even driver rehabilitation may also be used to help you get back to daily functioning.

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Last Reviewed: May 26, 2005

Stephen J Page, PhD Stephen J Page, PhD
Director of Research, Associate Professor
Drake Center
University of Cincinnati