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This chapter focuses on physical therapeutics and their prescription
to treat diagnoses with a significant symptom of pain. However,
physical medicine and rehabilitation professionals attend or administer
to persons with a wide variety of diagnoses, and they practice with
a variety of allied health professions. To apprise professional
services that the specialty of physical medicine and rehabilitation
can offer a patient, this chapter opens with a synopsis of rehabilitation
philosophy, methods, and goals. Antecedent to discussing this specialty
as it applies to pain, the chapter references current review works
that define the types of exercise and modalities. The chapter concludes
by addressing specific diagnoses and referencing the current literature
that guides the physical medicine and rehabilitation prescription.
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The field of physical medicine and rehabilitation spans the settings
of inpatient, outpatient, and home health medicine. The philosophy
of physical medicine and rehabilitation embraces an intradisciplinary
approach to patient care, with not only the patient and physician
working toward the patient’s recovery but also a team of
allied health care professionals. This team includes physical, occupational,
and speech therapists, social workers, nurses, pharmacists, psychologists,
recreational therapists, and vocational specialists.
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The goal of physical medicine and rehabilitation interventions
is the improved function of the patient, despite the presence of
permanent disease or impairment. Physical medicine and rehabilitation
teams treat a spectrum of diagnoses referred from medical, surgical,
pediatric, and traumatic specialties. The severity and complexity
of diagnoses varies from catastrophic entities such as spinal cord
injury and stroke to routine soft tissue injuries, for example,
shoulder impingement and shin splints. With more complex disease
entities in which tissue loss or tissue death has occurred (e.g.,
amputation or traumatic brain injury), successful physical medicine
and rehabilitation intervention compensates for impairment rather
than resolves or cures the disease process.
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For diagnoses with soft tissue injury (e.g., ankle sprain and
shoulder impingement), physical medicine and rehabilitation interventions
promote soft tissue healing. For all levels of injury, physical medicine
and rehabilitation interventions aim, however, to restore function
and prevent recurrent injury. Physical medicine and rehabilitation
uses a team treatment approach to restore function to patients with
soft tissue injury or permanent tissue loss. Tools of the field
include exercise, thermal and electrical modalities, as well as
education and new learning.
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Except in the case of chronic pain syndrome where pain and dysfunctional
behavior in response to the pain have become the impairment and
disease,1 pain is a symptom of a disease process
or tissue injury. This chapter discusses the physical medicine and
rehabilitation interventions for diagnoses in which pain is a complaint
or symptom; these interventions involve straightforward, applied
progressive exercise and education.
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For the treatment of the soft tissue injuries in patients who
have pain, the physician prescribes physical therapeutics, which
a physical or occupational therapist administers. The treatment
and improvement of the symptom of pain generally cannot be separated
from the treatment and improvement of the ...