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A medical (in conjunction with Anesthesiology , Neurology and Psychiatry ), pediatric rehabilitation, and Spinal Cord Injury (SCI) medicine. A new formal sub-specialty based on post-residency fellowship training in Neuromuscular Medicine is forming in conjunction with Neurology . Many in the field also subspecialize in areas of amputee care, musculoskeletal medicine, Electrodiagnostics , Traumatic Brain Injury (TBI), Cardiopulmonary Rehabilitation and neuromuscular disorders. 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, and experiential training approaches. Electrodiagnostics are used to Diagnose and provide Prognosis for various neuromuscular disorders. Common conditions that are treated by physiatrists include Amputation , Spinal Cord Injury , sports injury, Stroke , 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 Psychologist , Physical Therapist , Occupational Therapist , and interventional procedures when indicated. 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 cure. The general emphasis is not on the full restoration to the premorbid condition, but rather the optimization of the quality of life for those who may not achieve full restoration. Team approach to chronic conditions are emphasized, using Multidisciplinary team meetings to coordinate care of the patients. Rehabilitation begins with identification of preserved strengths and capabilities of the patient. Residual strengths are enhanced to maximize function of the person who has been subject to disease-related impairment. This involves a holistic approach to the nature of human function. Areas of motivation and capabilities of the performer as well as the environmental contingencies are explored. Examples of environmental contingencies include opportunities afforded by the presence of other individuals (eg. caregivers, attendants) who are able to provide physical, supervisory and emotional assistance to the affected person. HISTORY PM&R is a relatively young specialty. Among the early pioneers of the field include Dr. Frank Krusen who developed the Department of Physical Medicine at the Mayo Clinic in 1936. PM&R was recognized as a medical specialty by the American Board Of Medical Specialties and the American Medical Association in 1947. The field expanded rapidly owing in large part to World War II , when many soldiers with servere disability returned to the United States and physicians were necessary to treat and manage chronic debilitating conditions. Polio epidemic in the early 1950s also helped establish the value of physiatrists in management of neuromuscular disorders. Advances that allowed longer survival from disorders as varied as Spinal Cord Injury and Stroke led to greater role of physiatrists in managing these chronic conditions. This specialty's research base is still evolving. RESIDENCIES IN THE UNITED STATES There are no clear rankings among PM&R residencies, but among the elite programs in the United States include the ). There are approximately 350 total positions available via the National Resident Matching Program (NRMP) per year. This specialty's competitiveness would likely be considered to be on par with neurology or pediatrics according to the 2006 match data from the NRMP. PM&R residencies will likely become more competitive and be more recognized as the population ages and technology relating to rehabilitation becomes more advanced. NOTABLE REHABILITATION HOSPITALS IN THE UNITED STATES POPULAR TEXTBOOKS There have been a wide array of textbooks published which provide in depth analysis and coverage of this continually evolving realm of medicine. There are 2 main textbooks often used by those in the specialty: ''Physical Medicine and Rehabilitation'' by Randall Braddom, and ''Rehabilitation Medicine'' by Joel DeLisa. There are ''many'' handbooks suitable for medical student and resident use including ''PM&R Secrets'', by Mark Young, Brian O'Young and Steven Stiens. ''PM&R Pocketpedia'' by Howard Choi et al has become a popular handbook among the trainees in recent years. INCOME Median U.S. physiatrist salary according to salary.com 2006 information is $185,571. EXTERNAL LINKS
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