PHYSIATRISTS GET PATIENTS ON THEIR FEET AGAIN

Gerry Salter, left, a physical therapist, talked with Dr. Bernard Burns at the St. Francis Center for Health and Rehabilitation.

At one time, the prevailing medical practice for treating injuries was bed rest, bed rest and more rest. The theory was that inactivity speeded the healing process.

However, during World War II when doctors were treating large numbers of wounded, many doctors observed that although their patients' wounds healed with time and rest, the inactivity inherent in remaining in bed exacted a toll.

"At that time when you were injured you stayed put in bed until you were well," said Dr. Bernard C. Burns. "Doctors began to notice that physically fit men who were wounded were physical wrecks after they recovered."

Doctors began incorporating exercise and sport into their patients' rehabilitation and the field of physiatry was officially born in 1947.

Physiatry is a specialized field of medicine that complements traditional forms of medicine with a focus on physical factors and therapeutic exercise.

"The idea is that just because you are sick you should not be totally at bed rest," Burns said. "It caught on and is now well accepted."

Fifty years after it was founded, the field is still a small one with only 5,000 physiatrists in the United States. Burns is the only physiatrist between St. Louis and Blytheville, Ark.

Burns came to Cape Girardeau in August after serving two years as staff physiatrist at Washington University in St. Louis. He is now on staff at Orthopaedic Associates of Southeast Missouri and directs physical rehabilitation at the St. Francis Center for Health and Rehabilitation.

Physiatry has wide-ranging applications which fall into three primary categories.

The first involves treatment of muscoloskeletal pain, which includes industrial injuries, sports injuries and degenerative conditions such as arthritis and lower back pain.

Burns focuses mainly on this aspect of physiatry, particularly the out-patient rehab of injured workers.

Although he is not specifically trained in sports medicine, Burns said the goals of maximizing a person's physical performance and controlling pain overlap with his techniques.

"A lot of sports medicine philosophies are used toward getting workers back on the job," Burns said.

In addition to helping patients recover function, control and elimination of pain are vital rehabilitation efforts.

"To allow for more meaningful rehab, you have to address pain. It is an important part of the rehab process," Burns said.

The second main area of physiatry involves rehabilitation of patients with severe impairments such as spinal cord injury, brain injury, stroke, amputation, cancer and burns.

A patient who had suffered a stroke, for example, may experience weakness on one side of the body. The physiatrist's job is such a case would be to work with the patient to return him to normal physical condition.

This branch of physiatry involves a team of various rehabilitation specialists with the physiatrist heading up the group.

At the St. Francis Center for Health and Rehabilitation, Burns leads the group in developing plans to maximize every aspect of a patients therapy.

"The various therapists and I work to plan activities for patients based their physical needs while making sure medical models are followed," Burns said.

Electrodiagnostic medicine is the third area of physiatry. Physiatrists in this sub-field are specially trained in electromyography -- the study of the effects of electric activity on muscles -- and the study of specific nerve function.