The importance of Physiatry
Medical and sociovocational rehabiltation is the responsibility of a team of
professionals headed by a physiatrist. These professionals combine and co-
ordinate to uplift the handicapped.
The diference between the clinical evaluation by a physiatrist and that ot
other physicians is that the physiatrist does not view the patient as a case, a
mere collection ot isolated findings, but provides a clear picture of how an
illness has affected a person's life-what he or she can no longer do and how
to get over the problem.
The other team members are paramedical and sociovocational.
example, the physiotherapist, occupational therapist, are in the medical
team while the social worker and vocational counselor are in the
sociovocational team.
Impairment, Disability and Handicap
The Word Health Organisation's 1980 International Classification of
Impairments, Disabilities and Handicaps (1CIDH) defines these terms as
follows
Impairment
Any loss or abnormality of psychological, physiological or anatomical
structure or function. e.g. loss of a finger, loss of conduction of impulses in
the heart, or loss of certain chemicals in the brain leading to Parkinsonism.
Disability
Any restriction or lack resulting from an impairment, of ability to perform an
activity in the manner or within the range considered normal for a human
being. e.g. dificulty in walking after lower limb amputation.
Handicap
A disadvantage for a given individual resulting from an impairment or a
disability that limits or prevents the fulfilment of a role that is nomal
(depending on the age, sex, social and cultural factors) for that individual.
Difference between impairment, Disability and Handicap
On completing the conventional clinical evaluation to find out impairment
the physiatrist often can answer fwo questions:
Why does the person have the problem?" (.e. the etiologic diagnosis), and
How is the person? (i.e., the anatomic and pathophysiologic diagnosis).
Examples of impairments are weakness due to polio, ankylosis of a joint,
and so on. Most impairments lead to disability.
To assess the extent ot disability, the physiatrist has to ask himself
HOw does the problem affect the person's life? (i.e., the functional
diagnosis), or
What activities can he not do?
infact ,it is these complaints with which the patient pproaches the doctor inthe first place.To the patient, the Functional consequences- what he or she is prevented from doing (e.g typing. cooking tennis) - are of more importance than the diagnosis. For example, a patient with a frozen shoulder,would complain of inability to tolet himself or to wear his shirt.
Furthermore, the relationship may be bi-directional for example, inabilit towalk, a disability, may lead to muscle weakness and contractures, which areimpairments.
Not every impairment may lead to a disability, for e.g, the loss of an earlobedoes not give much of a functional loss. However a road accident leading tobrain injury can lead to gross disability with multiple handicaps.
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