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The Role of Physiatry in the Continuum of Care

November 19, 2021
by John Ready

Typically, orthopaedics involves repairing torn ligaments or tendons, affixing plates, screws, and rods to bone, replacing joints either in part or altogether, and improving biomechanical function in the human body. While addressing the root cause through surgical intervention is often immediate, restoring function is a process that takes time, effort, and often requires coordinated care from specialist physicians in the field of physiatry.

Physiatry offers a holistic and comprehensive care plan that works in partnership with other specialties in orthopaedics, and beyond, to restore function and maximize independence for patients. As a field, physiatry is unique because it focuses on the whole patient by addressing an individual's physical, emotional, neurological, medical, vocational, and social needs.

Rummana Aslam, MBBS helps patients get back to the life they had before experiencing a severe illness, surgery, or trauma. As chief of Yale Medicine Physical Medicine & Rehabilitation, she cares for patients with back pain, joint pain, sports injuries, spinal cord injuries; amputees; and those recovering from a stroke and traumatic brain injuries (TBIs).

“While physiatry is non-surgical, physiatrists are doctors who can still administer interventional care,” Aslam said. “That can include injections to alleviate pain in conjunction with a range of other rehabilitation methods. In many instances, we work with patients and sub-specialists to help them cope with these life-altering changes and equip them with different methods to stay positive and keep going.”

Treatment can include managing a range of care options such as inpatient or outpatient rehabilitation, physical therapy, occupational therapy, speech therapy, behavioral therapy, vocational therapy, and neuropsychology.

“Take for instance, an elderly patient who falls and now requires a total hip replacement,” Aslam continued. “The overall outcome of that surgery is not solely dependent on how well things go in the operating room. The surgery is the start of that patient’s rehabilitation journey, which can be quite extensive. Should the patient receive great care in the operating room but not benefit from adequate rehab, his or her functional outcome will be dramatically lower than someone who does.”

The spectrum of patients and types of ailments range widely in physiatry. Pediatric cases often include cerebral palsy, neurological disorders, muscular dystrophy, limb deficiencies, pediatric stroke, and prosthetic orthotic management for amputees and those with congenital conditions. Various types of trauma are common in adults, along with TBIs, which can occur as a result of athletics, motor vehicle accidents, falls, or stroke, which requires comprehensive rehabilitation to maximize recovery of function and mobility. Falls and joint replacements are typical among elderly patients as is ongoing cancer rehabilitation.

Beyond coordinating care for orthopaedic sub-specialties, physiatrists also offer comprehensive wound care treatments. Most patients who have chronic or non-healing wounds suffer from a range of mental or physical disabilities. The main types of chronic wounds can include diabetic ulcers, vascular ulcers, and pressure ulcers, all of which can hinder a patient’s function, productivity, and quality of life.

“Taking care of patients suffering from chronic wounds is something I care passionately about,” Aslam said. “It is one of the main reasons I became a physiatrist.”

“The priority in wound care is to find the diagnosis,” she added. Chronic wounds are hardly ever an isolated problem. The underlying cause is what we work to address. But the chronic nature of the wounds often brings along other new and compounding factors, which can include economic factors from a patient being unable to work, stress or pressure to improve their condition, or facing a potential risk of amputation or lifelong disability. Our goal is to help patients through that process, whatever they may be facing, empower them to manage their unique situation and maintain a sense of self in the process. I call this ‘wound rehabilitation,’ which combines principles of both physiatry and wound healing and results in exceptional outcomes.’’

Submitted by John Ready on November 19, 2021