Physiatrist Or PMR Specialist: A doctor who specialized in restoring optimal function to people with injuries to the muscles, bones, ligaments, or nervous system

Physiatry is unique among medical fields in that its area of expertise addresses the function of the whole patient, as compared with a focus on an organ system or systems. Suffering an acute injury or living with chronic illness can affect the way people move and communicate, and their role in the home and workplace. Physiatry is about patient-centered care and maximizing independence and mobility with the goal of returning patients to their role in society (From AAPMR).

Major diagnoses/categories of patients seen presently by the Physiatrist

Rehabilitation Definition according to the World Health Organization:

1969: Combined and coordinated use of medical, social, educational and vocational measures for training and retraining individual to the Highest possible level of functional ability.

പുനരധിവാസം: ആരോഗ്യ, സാമൂഹിക, വിദ്യാഭ്യാസ, തൊഴിൽ മേഖലകളുടെ ഏകീകൃതവും സമന്വിതവുമായ പ്രവർത്തനത്തിലൂടെ ഒരു വ്യക്തിയുടെ, ശാരീരികവും മാനസികവുമായ കഴിവുകളെ പ്രചോദിപ്പിക്കുവാനുള്ള പരിശീലനവും, ആർജ്ജിച്ച കഴിവുകളെ നിലനിർത്തി പോരുന്നതിനുള്ള പുനഃപരിശീലനവും ആണ് പുനരധിവാസം

1993: Rehabilitation is the process of helping a person to reach the fullest physical, psychological, social, vocational, avocational, and educational potential consistent with his or her physiologic or anatomic impairment, environmental limitations, and desires and life plans.

2011: “A set of measures that assist individuals, who experience or are likely to experience disability, to achieve and maintain optimal functioning in interaction with their environments". It involves identification of a person’s problems and needs, relating the problems to relevant factors of the person and the environment, defining rehabilitation goals, planning and implementing the measures, and assessing the effects.

Aims of Rehabilitation measures

• prevention of loss of function
• slowing rate of loss of function
• improvement or restoration of function
• compensation for lost function
• Maintenance of current function.

Most effective approach for Rehabilitation is Trans-disciplinary, with good collaboration between Institution or Facility Based Services and Community Based Services

Services Offered by the Physiatrist (PMR Specialist):

As the COVID-19 Pandemic affected the way we work, all over the world, significant changes had to be made at NIPMR to continue offering medical and rehabilitation services to children and adults alike. Physiatrist, Dr. Sindhu Vijayakumar (MBBS, MD, DNB) who heads the Dept. of PMR took the lead role in proposing and implementing the new Standard Operating Procedures (SOP) according to COVID Protocol and precautions. A major shift was that of online consultations through tele-consultation mode using both telephone and video calls.

The year 2020-2021 also served as the year where major leaps in rehabilitation services advancement were planned, proposed, approved and implemented at NIPMR that elevated the institution to the status of Centre of Excellence in Disability Management. The major projects are Spinal Cord Injury Rehabilitation Unit (SCIRU), Centre for Mobility and Assistive Technology (CMAT), Instrumented Gait and Motion Analysis Lab and Virtual Reality Based Motor Rehabilitation Unit.

Effectively using the time of lockdown, the medical team was actively involved in organizing webinar series for both. patients and caregivers as well as rehabilitation professionals. The topics of such awareness series varied and covered most aspects related to management of Autism Spectrum Disorders, Down Syndrome and Cerebral Palsy.

Strictly adhering to the instructions from Govt. of Kerala from time to time, the following services were offered:

• Outpatient services:

  Comprehensive assessment is done for all new patients attending NIPMR. After thorough history taking and clinical evaluation, relevant investigations are ordered. A multidisciplinary management plan is then prescribed and patients referred to relevant departments for assessment and therapy. Follow up assessments are done at specified intervals and progress monitored.

• Inpatient services

  On February 6, 2021, the inpatient services were officially inaugurated at NIPMR with a dedicated Inpatient Spinal Cord Injury Rehabilitation Unit (SCIRU) and the first patient was admitted in March 2021.

• Tele-consultation

  A major shift in practice occurred through introduction of formal teleconsultations.

• Special Clinic – Prosthetics and Orthotics

  With special interest, the Physiatrist initiated dedicated P&O Clinics every Friday, 10 am to 12.30 pm, which will be attended by the Physiatrist, P&O team, physiotherapist, occupational therapist and MSW.

• Rehab Professionals’ Team meetings:

  To enhance quality of care, regular team meetings are held on weekly basis at SCIRU and STEPS.

• Family Meeting:

  To increase awareness and acceptance of major disabling conditions and to bring persons with disabilities to the mainstream, the Physiatrist has started conducting family meetings for patients admitted to SCIRU on weekly basis.

• Patient and Staff Education Series and Training programs:

  Various training programs were offered, mostly through online mode for rehabilitation professionals, parents or caregivers of persons with disabilities, special educators, stake holders and administrators of various rehabilitation centres, etc.

• Administration and Event Organization

  Beyond the medical services, initiative was taken in the successful organization of all events hosted by NIPMR

• Other programs were Physiatrist is involved actively are STEPS, RARRC and the upcoming CPRRC