Helping To Add Life To Years

What is a physiatrist?

Physiatry, also known as physical medicine and rehabilitation, is a non-surgical specialty that treats both orthopedic and neurological illnesses, where the patient’s quality of life is the focus. It is said that we not only add years to life, but also life to years. Also specific to physiatry is the multi-disciplinary approach in treating patients. We work closely with our physical therapists, occupational therapists, speech therapists, nurses, psychologists and case managers to achieve our goal. No discipline should have more power over another in decision-making, and so it’s more of a “roundtable” approach. I, as a physiatrist, work with traumatic brain injuries and also perform electrodiagnostic examinations, which are most often used to diagnose carpal tunnel syndrome, but also help me to diagnose nerve injuries that frequently occur in trauma patients.

What is a traumatic brain injury (TBI)?

A traumatic brain injury refers to any injury to the brain resulting from an external force, most commonly falls and motor vehicle collisions. It’s characterized by a diffuse injury, rather than a focal injury as in a stroke. As a result, patients may present with post-concussive syndrome, which is characterized by physical, cognitive and emotional complaints. The physical complaints are most commonly headaches and dizziness. The cognitive complaints are mostly impaired memory, and the emotional is most commonly depression. It is not uncommon for a patient to be very agitated following a TBI; and it may take weeks to months to get out of that stage of recovery.

Is there a cure for TBI?

There’s no cure for TBI and as a result, prevention education is paramount. So wear your helmets, always look where you dive and go in feet-first. And at this point where medicine is, treating TBI patients is tricky because there’s very little research in this area. But that’s what makes it not only challenging, but also interesting and more of an art than a science.

Are there ever any positive effects of TBI?

Some wives and/or husbands, but usually wives because TBI occurs more frequently in the male population, tell me that, “you know, my husband is so much more pleasant now.” I always find that humorous. However, most often their personality change is detrimental, hence the high divorce rate following TBI.

What is the age range of your patients?

Any age. Infants sustain TBIs from falls and grade-schoolers from bike accidents; however, most of these pediatric cases go elsewhere. For us here, we mainly get patients in their teens all the way up to 80s or 90s. I would say the bulk are in their 50s and 60s.

In your opinion, why hasn’t there been more research done on TBI?

I am not sure why, but a lot of it probably has to do with the fact that not that many people know about it and so there’s little hype and support for TBIs. There are 5.3 million people in the U.S. living with a TBI-related disability and there are well over 1.5 million new cases a year. Compare this to other illnesses such as diabetes, heart attacks, lung cancer and breast cancer, which have so much more hype and support, but occur much less frequently. I think now because of the war in Iraq and we’re finding a lot of these soldiers are coming back with TBIs, there will be much more funding and support in TBI research.

How do you involve the family in the treatment?

We work very closely with the family, and that’s actually one of the areas we try to focus on because the rehabilitation does-n’t end when they are discharged from the acute hospital or from their acute stay here - it continues for the rest of their lives. So we work very closely with the family and try to educate them about what to expect with brain injuries.

What is the average patient stay?

Typically an in-patient stay would be about 15 days, but that varies greatly. It really depends upon how much care they will have at home and if they’re making any improvements in therapy.

After their stay at the hospital, do you continue to see the patients on a long-term basis?

Following their acute rehabilitation stay, I continue to follow them as an out-patient for as long as they need my services, which may be a lifetime in some cases.

How much of recovery is in the mind, how much is medicine and how much is therapy?

All of the above. They are all important in helping a patient achieve independence and work synergistically.

Say a patient goes into the hospital with trauma to his/her head. Is it standard hospital procedure to check out the patient for TBI?

It’s not standard for hospitals to screen patients for a TBI, but it is standard to image their heads to look for intracranial bleeding. However, it is possible to sustain a TBI even if these studies are negative. Therefore, there are probably a lot of people in the community who don’t realize they have a TBI. So, the 1.5 million new cases a year I mentioned earlier is most likely an extremely low estimate.

What is the most rewarding aspect of your profession?

I don’t think it’s specific to my area, but more general to why people are drawn to medicine, which is helping others and seeing them get better. In rehabilitation we get to see this every day. People enter not being able to walk or sit, and they leave with a new appreciation.

 

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