About Physiatry

The Dept of Rehabilitation Medicine came into existence on July 1, 1982 as the result of more than two years of effort on the part of David L. Cowen, M.D., Associate Dean for Clinical Affairs, and D. Kay Clawson, M.D., Dean, College of Medicine.

The department’s history is closely linked with the development of Cardinal Hill Hospital; a comprehensive rehabilitation facility wholly owned by the Kentucky Easter Seal Society and located two miles from the Chandler Medical Center. Cardinal Hill Hospital underwent a major reorganization in June 1978 with the arrival of Pat Rice, Associate Director for Patient Clinical Services. Patient care was organized in three diagnosis-based units and brought into line with contemporary standards of comprehensive rehabilitation.

At the time of the department’s initial planning, bed space was not available in University Hospital for a rehabilitation service, and Cardinal Hill Hospital was thought to provide an acceptable alternative site. During the same period of time, Cardinal Hill found it difficult to provide consistent qualified physician staffing to meet its patient care and accreditation criteria, and turned to the College of Medicine for assistance. An Affiliation Agreement was drawn up delineating the conditions for the relationship between the two institutions.

Medical direction at Cardinal Hill Hospital was originally provided by David B. Stevens, M.D., of the Division of Orthopedic Surgery, University of Kentucky College of Medicine. Dr. Stevens remained in this position until January 1981, when he became Medical Director of the Shriners Hospital in Lexington. In March 1981, Dr. Cowen became Cardinal Hill’s Medical Director. After several months’ experience in running the clinical activities at Cardinal Hill, it was Dr. Cowen’s belief that both the College of Medicine and Cardinal Hill would benefit by the establishment of a Dept. of Rehabilitation Medicine and the recruitment of board-certified physiatrists to staff the hospital
Funding for a Dept. of Rehabilitation Medicine had been included in the biennial budget request for several years by Dr. Clawson. In the absence of increases in the biennial budget for this purpose, sources were developed within the College of Medicine, but were initially and have remained conservative. College of Medicine administrators shared the opinion that its training program would be enhanced by the addition of such a department. A question then arose as to whether a physiatrist chairman should be recruited initially, and a search committee was constituted for this purpose. Although extensive interviews were under taken, no suitable candidate was found. The one candidate who came close to being hired, Richard F. Harvey, M.D., subsequently took a position as Medical Director of Marianjoy Hospital of Wheaton, Illinois, where he remains to this day. The decision was reached to appoint Dr. Cowen as Chairman until such time as it was felt that a full-time board-certified physiatrist chairman could be recruited. A search for junior faculty was then instituted.

During the year immediately preceding the creation of the department (1981-82), patient care at Cardinal Hill Hospital was thus under the direction of Dr. Cowen, who also assumed the direction of the Spinal Cord Injury Unit. Drs. James Bean and Phillip Tibbs of the Division of Neurosurgery were hired as attending physicians for the Brain Injury Unit, and Dr. Terrence L. Gutgsell along with his colleagues Drs. John Pappas and Barry Schumer, continued to care for the Stroke Unit patients. In May 1982, Mr. Robert Silvanik, then Executive Director of Cardinal Hill, suffered a stroke which unfortunately left him unable to return to his former position. The position of Executive Director remained vacant from this date until April 1984, when Lyman V. Ginger, Ed.D. took over as Executive Director. During the interim, administrative duties were delegated to the Associate Administrators, Pat Rice, M.S.N. and Tim Wilson.

Today almost thirty years later, the department of physical medicine and rehabilitation has become a trusted leader in physical medicine and rehabilitation throughout the Commonwealth of Kentucky. The department’s administrative offices continue to be housed at the Cardinal Hill Hospital where we still serve as the Medical Directors of the Spinal Cord Injury unit and the Traumatic Brain Injury unit, as well as provide physician staffing to the Stroke/Pulmonary Units, and General Rehabilitation Units. We are extremely proud of our resident physician training program which has taught a prestigious group of alumni who are accomplished physicians and scientists who practice throughout the United States.

Physiatry(fiz-ee-at'-ree) is a specialized field of medicine. The word combines the Greek root words for "physical" and "healing". Simply put, a physiatrist (fiz-ee-at'-rist) promotes physical healing in addition to other aspects of medicine.1

Unlike other specialites, medical rehabilitation is not limited to one organ system. Physiatrists must give attention to the whole person while focusing on the medical and functional aspects of human performance. Physiatrists work to restore disabled persons to the fullest possible level of physical, mental, social and economic independence.

Physiatrists evaluate individuals in relation to the disease and how it affects and is affected by the person's family, social environment status, and special interests.

The main goal of physiatrists is to help people recover lost functions, such as in the case of a person recovering from the functional decline secondary to a stroke. With an accident victim who experiences multiple trauma, the physiatrist supervises therapeutic interventions aimed at restoring function. Once patients stabilize enough to participate in an organized rehabilitation program, the physiatrist recommends the most appropriate level of rehabilitative care.

The second goal of a physiatrist is to prevent additional functional decline of individuals who are recovering from acute medical illness or injury. For example, a physiatrist often works to prevent deconditioning due to a head-injury person's inability or decreased ability to exercise normally.

Physiatrists also work to prevent illnesses for which people with functional limitations are at higher risk. For example, spinal cord injured patients face a higher risk of bladder or respiratory infections. Physiatrists often become the primary care physicians in these cases.

Physiatrists like to be included early in any case requiring surgical or medical intervention to assess the patient and determine how the physical impairments, disabilities, and handicaps will influence the overall outcome of a given intervention.

The Practice of Physiatry
A physiatrist often provides primary care for all patients of a stroke unit, a spinal cord injury unit, or a head injury unit within a rehabilitation hospital or a specialized facility such as a skilled nursing facility or a nursing home. Others specialize in sports medicine or pediatric rehabilitation. They treat patients directly or lead an interdisciplinary team.

Many physiatrists conduct regular outpatient clinics.  This practice allows physiatrists to follow the rehabilitation progress of patients who have been discharged from the medical facility in which they provide care.

Outpatient practice also allows physiatrists to treat and diagnose patients who are referred from other specialists for evaluations related to disability management and workers' compensation or for tests like electromyography. Physiatrists often treat people with acute pain, chronic pain, amputations, musculoskeletal disorders, arthritis, back pain, sore shoulders, or carpal tunnel syndrome.  They also treat babies with birth defects, victims of serious car accidents and elderly people with broken hips.

Upon request, physiatrists also provide consultation services for other specialists to determine the rehabilitation needs of an individual. Consultation services commonly are provided in academic medical institutions and in the context of private institutions.

A Growing Specialty
Physiatry gained official recognition as a medical specialty in 1947. Today, nearly 5,000 physiatrists work in private practice and in academic departments within college's of medicine at major universities around the United States. Over half of all active physiatrists were trained in the last decade. 1

Training for physiatrists includes a one year internship followed by a three year residency. The United States now has more than 70 such training programs, including programs at the University of Kentucky.

1 Paraphrased from The History of Physiatry, a pamphlet published by The Association of Academic Physiatrists