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طب فيزيكي و توانبخشي

تهیه و تنظیم:

 دکتر علی اوشیب نتاج متخصص طب فیزیکی و توانبخشی

 

طب فيزيكي و توان بخشيPhysical Medicine and Rehabilitation يكي از رشته هاي پزشكي تخصصي  باليني  مي باشد  كه  به  ارزيابي ،  تشخيص ، درمان،پيشگيري و ارائه روشهاي توان بخشي جهت افراد داراي ناتواني (impairment) و معلوليت (disability) فيزيكي و شناختي در تمام سنين مي­پردازد.

اين تخصص با استفاده از روشهاي طب الكترودياگنوز، تزريق هاي تشخيصي و درماني، روشهاي دارويي و فيزيكي (ورزشهاي درماني، استفاده از مداليته ها، طب مانيپولاسيون، طب سوزنی) به تشخيص، درمان و تجويز روشهاي توان بخشي در بيماران دچار وضعيت هاي دردناك و شرايط محدود كننده عملكرد وناتوان كننده پرداخته و بر جلوگيري از عوارض ناشي از معلوليت ها تأكيد دارد. 

متخصص اين رشته قادر به تشخيص، درمان و ارائه روشهاي توان بخشي براي بيماريها و ناتواني­هاي عصبي، اسكلتي - عضلاني ( از جمله موارد ورزشي و شغلي ) و ناتواني ساير سيستم ها و اداره طولاني مدت بيماران معلول است .

 همچنين رهبري و هدايت تيم هاي توان بخشي چندرشته اي را براي ايجاد حداكثر بهبود عملكرد فيزيكي، رواني، اجتماعي و شغلي در افرادي كه توانايي آنها در اثر بيماري، تروما، نقص هاي مادرزادي يا درد محدود شده را بر عهده می گيرد.

اين رشته در سال 1947 در آمريکا بنيان گذاری شد. درحال حاضر حدود 30000 متخصص طب فيزيکی و توانبخشی در سرتاسر دنيا به فعاليت مشغول می باشند اما کمتر از 200 نفر در ايران حضور دارند و  متاسفانه سالانه تعدادی از متخصصين اين رشته به کشورهای غربی مهاجرت میکنند. در حالی که بر اساس استاندارد, برای ارائه خدمات مناسب طب توانبخشی نياز به حدود 2000 متخصص طب فيزيکی و توانبخشی و حدود 6000 تخت بستری در کشور داريم. اين رشته دارای فوق تخصص در زمينه های زِیر است:

طب توانبخشی ورزش

طب توانبخشی آسيب نخاع

طب توانبخشی سکته مغزی

درمان درد

الکترودياگنوز (نوار عصب و عضله و پتانسيلهای بر انگيخته)

طب توانبخشی اطفال

بعلاوه فلوشيپهای اين رشته در زمينه های: طب توانبخشی قلبی ، طب توانبخشی ريوی، طب توانبخشی ديابت ، طب توانبخشی در بيماران قطع عضو و.. است.

گزیده ای از تعریف طب فیزیکی و توانبخشی جمع آوری شده از منابع سراسر جهان :

What is a Physiatrist?

A physiatrist (fizz ee at’ trist) is a physician specializing in Physical Medicine and Rehabilitation. Physical Medicine and Rehabilitation is a discipline primarily concerned with acute and chronic problems of the neuromusculoskeletal system. The goal of the physiatrist is to restore function and relieve pain in patients with a variety of disorders using a non-surgical multidisciplinary treatment approach.

There are currently 79 accredited residency programs in physical medicine and rehabilitation in the United States.

Many physiatrists choose to pursue additional fellowship training in a specific area of the specialty. Fellowships are now available for specialized study in areas such as spine and musculoskeletal rehabilitation, pediatrics, traumatic brain injury, spinal cord injury, and sports medicine.

To become board-certified in physical medicine and rehabilitation, physiatrists are required to pass both a written and oral examination administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R).

Physiatrists may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists’ patients include people with arthritis, tendonitis, any kind of spinal pain, and work- or sports-related injuries. They are trained to perform electrodiagnostic studies in the evaluation of patients with disorders of the nervous or musculoskeletal systems. In addition, a select group of physiatrists have been fellowship trained to perform interventional spinal procedures utilizing fluoroscopic guidance.

Doctors who specialize in physiatry may practice in rehabilitation centers, hospitals, and in private offices. They can have broad practices, but many, like the physicians of Long Island Spine Rehabilitation Medicine, P.C., choose to concentrate on a particular area of care such as spine and musculoskeletal medicine.

History

The term 'physiatry' was coined by Dr. Frank H. Krusen in 1938. The term was accepted by the American Medical Association in 1946. The field grew notably in response to the demand for sophisticated rehabilitation techniques for the large number of injured soldiers returning from World War II.

 Scope of the field

Physical medicine and rehabilitation involves the management of disorders that alter the function and performance of the patient. Emphasis is placed on the optimization of function through the combined use of medications, physical modalities, physical training with therapeutic exercise, movement & activities modification, adaptive equipments and assistive device, orthotics (braces), prosthesis, and experiential training approaches.

Physical Medicine & Rehabilitation physicians may also perform electrodiagnostics which are used to provide nervous system functional information for diagnosis and / or prognosis for various neuromuscular disorders.

Common conditions that are treated by physiatrists include amputation, spinal cord injury, sports injury, stroke, musculoskeletal pain syndromes such as low back pain, fibromyalgia and traumatic brain injury. Cardiopulmonary rehabilitation involves optimizing function in those afflicted with heart or lung disease. Chronic pain management is achieved through multidisciplinary approach involving psychologists, physical therapists, occupational therapists, chiropractors, and interventional procedures when indicated. In addition to the previous methodology, stroke is often treated with the help of a speech therapist and recreational therapist when possible.

 Philosophy

The major concern of the field is the ability of the person to function optimally within the limitations placed upon them by a disease process for which there is no known cure. The emphasis is not on the full restoration to the premorbid level of function, but rather the optimization of the quality of life for those who may not be able to achieve full restoration. A team approach to chronic conditions is emphasized to coordinate care of the patients.

 Subspecialty

Six formal sub-specializations are recognized by the field in the United States:

Physiatrists treat patients in different settings such as hospitals, outpatient clinics, rehabilitation centers, nursing homes, and private practice.

Physical medicine and rehabilitation often includes physical therapy. Sometimes other physical medicine professionals are involved in the patient's care such as occupational therapists or athletic trainers. Physiatrists coordinate patient care with other doctors and Physiatry is an aggressive, nonsurgical approach to treating musculoskeletal disease and injury, including different types of pain. Similar to other types of spine specialists, physiatrists take the patient's medical history, perform a physical and neurological examination, order X-rays or other imaging studies, prescribe medications, and perform spinal injections.

The primary goal of the Physiatrist is to achieve maximum restoration of physical, psychological, social and vocational function through comprehensive rehabilitation.

What is a Physiatrist?

The purpose of this extra training is to make sure that physiatrists are focused on the patient as a whole person.

Most physicians deal with illness and possible threats to life.

The physiatrist deals with functional loss and threats to living fully -- the physical and psychological disabilities remaining after initial medical or surgical treatment.

The physiatrist often coordinates a team of other doctors and health professionals in developing and carrying out a comprehensive rehabilitation plan which extends beyond hospital walls into the patient's family, community, occupation, friends, and ultimate life style.

This rehabilitation team may include physical, occupational, and/or speech therapies, nurses and doctors from various specialties, including neurology and orthopedics, psychologists, counselors or social workers, rehabilitation engineers and others.

The physiatrist's success comes through a team effort where the patient is an integral part of the team process. Each improvement in function, however subtle, can significantly improve the life of a patient.

 

Definition of Physical Medicine and Rehabilitation

Physical medicine and rehabilitation (PM&R), also referred to as physiatry, is a medical specialty concerned with diagnosis, evaluation, and management of persons of all ages with physical and/or cognitive impairment and disability.

This specialty involves diagnosis and treatment of patients with painful or functionally limiting conditions, the management of comorbidities and co-impairments, diagnostic and therapeutic injection procedures, electrodiagnostic medicine, and emphasis on prevention of complications of disability from secondary conditions.

Physiatrists are trained in the rehabilitation of neurologic disorders, and in the diagnosis and management of impairments of the musculoskeletal (including sports and occupational aspects) and other organ systems, and the long-term management of patients with disabling conditions. Physiatrists provide leadership to multidisciplinary teams concerned with maximal restoration or development of physical, psychological, social, occupational and vocational functions in persons whose abilities have been limited by disease, trauma, congenital disorders or pain to enable people to achieve their maximum functional abilities

 

Typical procedures in inpatient and outpatient PM&R settings include:

  • Acupuncture
  • Botulinum injections
  • Consultations
  • Electromyography (EMG)
  • Evoked Potentials
  • General Rehabilitation
  • Hyperbaric Medicine (view image)
  • Independent Medical Exam
  • Injection Therapy
  • Intrathecal Pumps
  • Limb Deficiency
  • Musculoskeletal Disorders
  • Occupational Medicine
  • Orthopedic Rehabilitation
  • Pain Management
  • Pediatric Rehabilitation
  • Prosthetics/Orthotics
  • Spasticity Management
  • Spinal Cord Injury
  • Stroke
  • Traumatic Brain Injury
  • Worker’s Compensation
  • Wound Management

 

 معرفی سازمان

 قوانین و آییین نامه ها

 تعرفه های پزشکی

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نجمن طب فیزیکی  و توانبخشی ایران

شاخه مازندران

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علوم پزشکی بابل

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سایت نظام پزشکی جمهوری اسلامی ایران

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 کاهنده وزن

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طلاعیه دفتر سلامت جمعیت،خانواده

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