Physical medicine and rehabilitation, also called rehabilitation or physiatry (or functional rehabilitation), is the specialty of providing care for people with a handicap or physical incapacity, with the aim of minimizing it. the physical, psychological and socio-economic consequences.

The objective is therefore to improve the quality of life and the autonomy of people living with a disability, whatever it may be.

It calls on a multidisciplinary team coordinated by doctors and including physiotherapists (or physiotherapists), occupational therapists, orthotists, speech therapists, nurses and orderlies, neuropsychologists, social workers, etc.

It is a specialty that is aimed at patients of all ages, and athletes as well as non-athletes. It is at the interface of orthopedics, rheumatology and neurology.

Management in physical medicine and rehabilitation can therefore be recommended in many situations, for example:

• after illness or surgery
• after an accident or trauma
• in case of illness (chronic or not) associated with physical or neurological disabilities
• in case of chronic pain, congenital disability, etc.

Numerous disabilities and illnesses may justify treatment in physical medicine and rehabilitation, in particular:

• un stroke ;
• un head trauma ;
• neuromuscular pathologies;
• neurodegenerative pathologies (multiple sclerosis, SALAD, Parkinson…);
• hemiplegia or paraplegia;
• amputations;
• chronic low back pain and other chronic pain;
• cerebral palsy;
• respiratory or cardiac pathology (improvement of physical capacities in people with cardiac insufficiency, for example);
• a need for prostheses or devices;
• athlete follow-up (after injury, in particular).

“Rehabilitation” or rehabilitation can concern many spheres:

• speech and swallowing disorders;
• movement and walking disorders;
• muscle disorders (spasticity);
• genito-sexual and vesico-sphincteric disorders (incontinence, etc.);
• orthopedic disorders (motor retardation, abnormal growth, etc.).

The rehabilitation doctor first of all carries out an assessment which allows:

– to question the patient on the discomforts and the deficits which affect him;

– assess functional impairments objectively.

Several additional examinations can be performed, in particular using movement recording techniques or imaging techniques.

Once the assessment has been carried out, the doctor suggests the most appropriate treatment. Most often, the treatment is spread over several weeks and can combine:

• physiotherapy sessions;
• occupational therapy;
• possibly the making of small equipment or prostheses;
• the use of certain treatments, such as the injection of botulinum toxin into the muscles, infiltrations, urodynamic examinations (to assess the functioning of the bladder, etc.);
• the prescription of certain drugs, especially against pain.

Depending on the patient’s condition, rehabilitation can be carried out during brief or prolonged hospitalization or on an outpatient basis. The frequency of the sessions will be determined with the doctor.

The consultation with a rehabilitation doctor does not entail any particular risks for the patient.

Rehabilitation training in France

To become a rehabilitation doctor, the student must obtain a diploma of specialized studies (DES) in physical medicine (3):

• he must first follow, after his baccalaureate, a common first year in health studies. Note that an average of less than 20% of students manages to cross this milestone.
• the 4th, 5th and 6th years at the Faculty of Medicine constitute the clerkship
• at the end of the 6th year, students take the national classifying tests to enter the boarding school. Depending on their classification, they will be able to choose their specialty and their place of practice. The internship in physical medicine lasts 4 years (4 semesters in physical medicine; 2 semesters in neurology, pediatrics or rheumatology and 2 free internships).

Rehabilitation training in Quebec

After college studies, the student must pursue a doctorate in medicine. This first stage lasts 1 or 4 years:

• a preparatory year for medicine for students admitted with a college or university training deemed insufficient in basic biological sciences;
• two years of pre-apprenticeship;
• two years of clerkship.

Then, the student will have to specialize by following a residency in physical medicine and rehabilitation, for 5 years, which leads to a graduate diploma in physical medicine and rehabilitation recognized by the Royal College of Physicians and Surgeons of Canada.

Before going to the appointment with a rehabilitation doctor, it is important to bring the results of imaging tests already carried out and the medical file.

To find a doctor in rehabilitation:

• in Quebec, you can contact the association of physiatrists of Quebec (4);
• in France, via the National Council of the Order of Physicians5, which offers a directory of its members.

When the rehabilitation consultation is prescribed by an attending physician or by a specialist, it is covered by the Health Insurance (France) or the Régie de l’assurance maladie du Québec.