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Thread: physiatrist

  1. #1


    Do physiatrist's generally take a more conservative aproach leaning towards rehabilitation instead of recovery? Wouldn't a person best chance at recovery/regeneration be with a neurologist. After 2 yrs of seeing a PMR I feel I do most of my own reasearch, evaluations & diagnostics. I consult with him he then writes a scrip or sends me to a specialist. Is my PMR just to overbooked?

  2. #2
    Sporto, this question is probably more appropriate for the Care or Cure forums, but I will move it to Care for now.

    There are good and bad physiatrists, just as there are good and bad neurologists. In my experience, neurologist have little experience or expertise in rehabilitation, and often fairly negative attitudes about people with SCI or about patients being real partners in their care. I think physiatrists have more training in this area, and many are involved in keeping up to date on the latest cure research.

    Right now though (at least in the USA) there is little that either a physiatrist or a neurologist can offer that will actually be effective in causing any neurologic return or cure. As new therapies emerge, we may see these provided by a multidisciplinary team that may combine a neurosurgeon, neurologist, interventional radiologist, immunologist, physiatrist and other specialists.

    If you are not happy with your current physician, I would encourage you to interview other physicians and ask very direct questions about what you feel you need, and also about how informed and up-to-date the physician is on the latest in SCI care and treatment.


    [This message was edited by SCI-Nurse on 01-15-04 at 10:52 AM.]

  3. #3
    Senior Member mike's Avatar
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    Jul 2001
    Florence, Kentucky
    Sporto, I use a Physiatrist and find her an invaluable resource for my condition. She is quite knowledgable regarding the latest medications for CP,spasticity, and other sci related problems as well as having a good background in physical therapy. My regular doctor has no knowledge regarding sci and if I left my care to a neurologist I probably would be in much worse condition then I am in now. I suggest you find a new physiatrist as many of them are excellent resources for this condition.


  4. #4
    I agree with KLD, and from my experience, continue to do your own research and manage your resources...don't hand anyone anything you can do for are safest that way....cheers and good luck.


  5. #5

    There is a rising new specialty called neurorehabilitation. At the beginning, I think that this was mostly dominated by neurologists who wanted to get into stroke rehabilitation. However, this is changing and the field is expanding. Let me address the issue of physician specialities a bit here because there is substantial confusion concerning who takes care of people with spinal cord injury.

    Physiatrists. These people do a medical internship and then a physiatry residency, usually in one of the major rehabilitation centers. Note that this is a relatively new speciality (since the 1950's). Physiatrists view themselves and train to be leaders of teams of therapists (physical, occupational, exercise, etc.) who work together to rehabilitate people. They should be knowledgeable about urinary tract infection, spasticity, decubiti, deep vein thromboses, and neuropathic pain. But, they are often not up on the latest research in the area and they must go to other specialties for definitive therapies of many of more serious problems that affect people with spinal cord injury.

    Urologists. In the early days of rehabilitation, people with urinary tract infections were referred to urologists and many urologists specialize in care of the paralyzed or spastic bladder. For most of human history, urinary tract problems were the major cause of death after spinal cord injury. They are the best at taking care of urinary tract problems but often are not trained or experienced in dealing with the other issues relating to spinal cord injury. Many urologists are heads of rehabilitation groups.

    Neurologists. Most neurologists have little or no training in the care of spinal cord injury. That is because they seldom work in rehabilitation units and are not involved in the acute care of spinal cord injury. However, they have become more involved with spinal cord injury in recent years to handle pain and spasticity problems. Some are quite good. For example, Stephen Strittmatter (the researcher at Yale) is a neurologist and he sees people with spinal cord injury. Another person is John McDonald (Wash Univ). Neurologists are also usually very knowledgeable about laboratory research. But KLD is right in that most are conservative and are not accustomed to dealing with people with chronic spinal cord injury.

    Anesthesiologists. Many anesthesiologists, because of their knowledge of drugs, have become involved in pain clinics. Because they are involved in placement of intrathecal catheters, electrical stimulators, nerve blocks, and anesthesia, some have specialized in spinal cord injury and neuropathic pain.

    Orthopedic surgeons. Many are deeply involved in spinal cord injury acute and chronic care. For example, David Apple who heads Shepard Rehabilitation Center is an orthopedic surgeon. While many orthopedic surgeons don't follow their patients after surgery, some do. Of course, they are experts on alignment and surgery of the spine. They do tendon transfers and treat shoulder, hip, HO, and other bone problems. Overseas, orthopedic surgeons usually do most of the surgery on the spinal cord. In addition, they do much of the peripheral nerve procedures. So, for example, Zhang in Shanghai and Brunelli in Brescia are both orthopedic surgeons.

    Neurosurgeons. They are usually involved at the acute surgery and hospital care of people with spinal cord injury. Most have not gotten deeply involved in rehabilitation or chronic spinal cord injury but they are the experts whenever there is a problem that involves the spinal cord or requires surgery that exposes the spinal cord. I was at the NYU Neurosurgery Department for 20 years and the department was strongly committed to spinal cord injury research. They are also the ones that are most involved in cell transplantation studies. For example, Huang in Beijing is a neurosurgeon.

    Plastic surgeons. They are often called in to fix things decubiti, carpal tunnel, and the like. Generally, they do not address more general issues of spinal cord injury.

    Gastroenterologists. People with spinal cord injury have a high incidence of gastrointestinal problems, ranging from constipation and hemorrhoids to gallbladder stones. So, gastroenterologists may be involved in the evaluation of people. They do most of the diagnostic procedures and work in conjunction with general surgeons.

    General practitioneer. Most have little or no experience with spinal cord injury. On the other hand, I have long thought that too much is blamed on spinal cord injury and not enough attention is paid to the general health and care of the individual. In my opinion, it is important to remember that people with spinal cord injury have many of the health problems that other people have. This is particularly true as more people with spinal cord injury are getting older.

    Finally, we should not forget the nurses, the physical therapists, and the occupational therapists. They have more experience with the nitty gritty details of spinal cord injury than any doctor. They are the ones who know how to solve the problems.


  6. #6
    Thanks for setting me straight on some things. Didn't meah for it to sound like I was ragging on my physiatrist he's good just overbooked. He will try most of what I have asked him. I just hit 2yrs and I want to be sure I've done all I could. I guess aside from getting into a trial or devine intervention I have done all I can do.

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