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What interventions does a physiatrist perform?

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Division Director PM&R

Answer transcribed from Brightway's interview with Dr. Thomas Franz:

Well, when we're looking at acquired brain injury there's a wide range of medications and procedures, for example, that the physician might do over and above prescribing physical therapy or occupational therapy or speech therapy.

Spasticity or abnormal muscle tone, for example, is a very difficult problem after acquired brain injury for many people, and sometimes botulinum toxin or botox injections are used. It's first and foremost a muscle relaxing medication. It blocks some of the impulses where the nerve connects to the muscle. It's not a cosmetic or wrinkle treatment despite the popular press opinion to the contrary.

Peripheral nerve blocks can be used for the same purpose, serial casting can be prescribed which is usually done in conjunction with a physical therapist or some type of technician to reverse a contracture that might come as a result of spasticity. We may well prescribe medications to reduce the tone along the line of medications.

We may also help with behavior management. Not all physicians - even, for example, not most psychiatrists are not very comfortable with acquired brain injury and usually, either a neurologist or a neuropsychiatrist or a rehabilitation physician who has experience with brain injury will be the one to manage behavioral medications.

There is a role in using heat or electrical stimulation or pain medication to to manage pain. That's another role we fulfill as well.

Some patients require prescription of specialized equipment whether that be bracing or prosthetic devices or equipment to allow people to perform self-care tasks, whether it's something as simple as a reacher or a socket or something more complicated; for example, adaptive or assistive technologies that are computer-based.

And with the proliferation of tablets and phones most of the things that used to require a dedicated device for speech or other things are now just apps. So this has become an exploding field for us and frankly a lot of the smart home technologies are now being very useful for people with limited mobility or limited use of their their body.