Neurologist - Physiatrist - Rehabilitative Physician: What’s the Difference?
Whether in the US or Abroad, these concerns are the same for Polio survivors. The positive impact of polio survivors seeing a Rehabilitative Physician (physiatrist) for care. What is a Rehabilitative Physician (physiatrist) ? Is that the same as a neurologist? Some are DO’s and some are MD’s. Are they the same?
What is a Rehabilitative Physician?
A rehabilitation doc (a phys-EYE-a-trist) does a medical residency learning to help people thrive with their disabilities: Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R)
What is the difference between an MD and a DO?
A doctor of osteopathic medicine (DO) is a fully trained and licensed doctor who has attended and graduated from a U.S. osteopathic medical school. A doctor of medicine (MD) has attended and graduated from a conventional medical school.
The major difference between osteopathic and allopathic doctors is that some osteopathic doctors provide manual medicine therapies, such as spinal manipulation or massage therapy, as part of their treatment.
After medical school, both MD’s and DO’s must complete residency training in their chosen specialties. They must also pass the same licensing examination before they can treat people and prescribe medications. (from the Mayo Clinic)
What is a Neurologist?
A neurologist is a doctor of medicine (MD) or a doctor of osteopathy (DO) who specializes in diseases of the nervous system. Some neurologists subspecialize in neuromuscular diseases, which is a subspecialty of diseases of the peripheral nerves (nerves in the arms and legs), the neuromuscular junctions (the nerve muscle junction), and the muscles, which includes the problems of the post-polio patient. Through their specialized knowledge of neuromuscular diseases, electormyography (EMG), and neuro-rehabilitation, these neurologists are able to diagnose and treat conditions causing pain, weakness, numbness, and tingling. (From Post-Polio Health International)
The following are further explanations from the American Academy of Physical Medicine and Rehabilitation:
What is Physical Medicine and Rehabilitation?
Physical medicine and rehabilitation (PM&R), also known as physiatry or rehabilitation medicine, aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. A physician having completed training in this field is referred to as a physiatrist. Unlike other medical specialties that focus on a medical “cure,” the goals of the physiatrist are to maximize patients’ independence in activities of daily living and improve quality of life. “Physiatrists are experts in designing comprehensive, patient-centered treatment plans, and are integral members of the care team. They utilize cutting-edge as well as time-tested treatments to maximize function and quality of life for their patients, who can range in age from infants to octogenarians.
Practice Settings
PM&R physicians practice in a variety of clinical settings, including inpatient and outpatient facilities. They have a broad range of knowledge including musculoskeletal, neurological, rheumatological and cardiovascular systems.
Some of the common diagnoses and populations seen by inpatient physiatrists include spinal cord injury, brain injury (traumatic and non-traumatic), stroke, multiple sclerosis, polio, burn care, and musculoskeletal and pediatric rehabilitation. Inpatient physiatrists are often trained using collaborative team skills and work with social workers and other allied health therapists (e.g., physical, occupational and speech) to manage these issues.
Outpatient physiatrists manage nonsurgical conditions including orthopaedic injuries, spine-related pain and dysfunction, occupational injuries and overuse syndromes, neurogenic bowel/bladder, pressure sore management, spasticity management, and chronic pain. Outpatient physiatrists are typically found in multidisciplinary groups consisting of other physiatrists, orthopaedic surgeons and/or neurosurgeons.
What is a Physiatrist?
Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.
PM&R physicians are medical doctors who have completed training in the specialty of Physical Medicine and Rehabilitation (PM&R), and may be subspecialty certified in Brain Injury Medicine, Hospice and Palliative Medicine, Neuromuscular Medicine, Pain Medicine, Pediatric Rehabilitation Medicine, Spinal Cord Injury Medicine, and/or Sports Medicine. ” Specifically, PM&R physicians:
Treat patients of all ages
Focus treatment on function
Have a broad medical expertise that allows them to treat disabling conditions throughout a person’s lifetime
Diagnose and treat pain as a result of an injury, illness, or disabling condition
Determine and lead a treatment/prevention plan
Lead a team of medical professionals, which may include physical therapists, occupational therapists, and physician extenders to optimize patient care
Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons, and many others.
Treat the whole person, not just the problem area
Depending on the injury, illness, or disabling condition, some PM&R physicians may treat their patients using the following procedures/services:
EMG/Nerve Conduction Studies
Ultrasound guided procedures
Fluoroscopy guided procedures
Injections of spine
Discography, Disc Decompression and Vertebroplasy/Kyphoplasty
Nerve Stimulators, Blocks and Ablation procedures - Peripheral and Spinal
Injections of joints
Prolotherapy
Spasticity Treatment (Phenol and Botulinum toxin injections, intrathecal baclofen pump trial and implants)
Nerve and Muscle Biopsy •Manual Medicine/Osteopathic Treatment
Prosthetics and Orthotics
Complementary-alternative medicine (i.e. acupuncture, etc.)
Disability/impairment assessment
Medical/legal consulting
Why visit a PM&R Physician
Physical Medicine and Rehabilitation (PM&R) physicians, also known as physiatrists, treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. By taking the whole body into account, they are able to accurately pinpoint problems and enhance performance without surgery. Consider seeing a PM&R physician if:
You had an accident or you have an injury or chronic condition that has left you with pain or limited function
You’re contemplating or recovering from surgery
You have an illness or treatment for an illness that has diminished your energy or ability to move easily
You’re recovering from the effects of a stroke or other problems related to nerve damage
You have chronic pain from arthritis, a repetitive stress injury, or back problems
Excess weight makes it difficult to exercise or has caused health problems
You think you’re too old to exercise
Life changes such as childbirth or menopause have created new challenges to your physical function
Getting Started
A PM&R Physician will thoroughly assess your condition, needs, and expectations and rule out any serious medical illnesses to develop a treatment plan. A clear understanding of your condition and limitations will help you and your PM&R physician to develop a treatment plan suited to your unique needs.
Tailoring Your Plan
You need the right type of exercise to effectively overcome fitness obstacles. A runner may have gained weight after being sidelined by a knee injury. A PM&R physician can prescribe tailored, low-impact activities that burn calories without aggravating the injury, simultaneously prescribing physical therapy and use of a brace to strengthen and support the knee. Another patient may be suffering from chronic neck pain. The PM&R physician might prescribe medication, stretching, and massage for short-term pain relief, as well as strengthening exercises to prevent future pain. If surgery is a necessity, PM&R physicians work with patients and their surgeons before and after surgery. By directing your treatment team and collaborating with other health care professionals, a PM&R physician is able to specially design a treatment program tailored to you.
Understanding and Identifying Your Goals
Do you want to strengthen an injured muscle, find relief from chronic pain, or walk up the stairs without being winded? A PM&R physician can work with you to determine realistic short- and long-term goals. Along the way, he or she will help you to find relief from pain, achieve successes in rehabilitation or exercise programs, overcome your setbacks, and reassess your goals if necessary.
How can I locate a rehabilitation physician?
The American Academy of Physical Medicine and Rehabilitation (AAPM&R) represents more than 9,000 rehabilitation physicians. As a public service, AAPM&R provides listings of its member rehabilitation physicians by state.
Conditions & Treatments Evaluated by Physical Medicine and Rehabilitative Physicians
PM&R physicians (or physiatrists) evaluate and treat patients with short- or long-term physical and/or cognitive impairments and disabilities that result from musculoskeletal conditions (neck or back pain, or sports or work injuries), neurological conditions (stroke, brain injury or spinal cord injury) or medical other conditions. Their goal is to decrease pain and enhance performance without surgery.
Below are some of the most common PM&R-related conditions; all are grouped by clinical area.
Essentials of Rehabilitation
Cervical, thoracic, and lumbosacral orthoses
Conceptual models of disability
Natural recovery and regeneration of the central nervous system
Medical Rehabilitation
Back and neck pain
Age-associated changes and biology of aging
Breast cancer
Cardiac rehabilitation
Exercise in the elderly
Fall prevention in the elderly
Functional outcomes after cancer rehabilitation
Geriatric frailty
Hip fracture
Lower limb prosthetics
Lymphedema
Obesity
Orthostasis
Pressure ulcers and wounds
Pulmonary rehabilitation in chronic obstructive pulmonary disease
Venous insufficiency
Pain-Neuromuscular Medicine Rehabilitation
Adult Geriatric Muscle Disease
Central Poststroke Pain
Complex Regional Pain Syndrome
Degenerative Joint Disease
Fibromyalgia
Myofascial Pain Opioid Management for Chronic Pain
Peripheral Neuropathy Pain
Phantom Pain
Poliomyelitis/Post-Polio Syndrome
Shoulder Pain in the Throwing Athlete
Side Effects of Cancer Treatment
Trigeminal Neuralgia
Ulnar Nerve Mononeuropathy at the Elbow
Upper Limb Amputations
Musculoskeletal Medicine
ACL injury and rehabilitation
Musculoskeletal Medicine
ACL Injury and Rehabilitation Adhesive Capsulitis
Adult-Onset Torticollis
Ankle Sprain
Carpal Tunnel Syndrome
Cervical Radiculopathy
Cervical Stenosis
Cervical Whiplash
Vertebral Compression Fractures
Core Strengthening
De Quervain Tenosynovitis
Downed Runner
Elbow Pain in Little League Pitchers
Epicondylosis With and Without Nerve Entrapment
Functional Rehabilitation
Iliotibial Band Syndrome
Impingement Syndromes of the Shoulder
Inflammatory Arthritides
Knee Osteoarthritis
Lumbar Disk Disorders
Lumbar Radiculopathy
Lumbar Spondylolisthesis
Lumbar Stenosis
Medial and Lateral Collateral Ligament Injuries
Osteoporosis in Rehabilitation
Patellofemoral Syndrome
Plantar Fasciitis
Pregnant Athlete
Proximal and Mid-Hamstring Strain/Tendon Tear
Pulmonary Issues in the Athlete/ExerciseInduced Asthma
Shoulder Tendon and Muscle Injuries
Sports Concussion
Tendinopathy