Rehabilitation — Focusing on Function
Most medical specialties focus on a particular body part: ophthalmology (eyes), cardiology (heart); or a disease: oncology (cancer); or a definable group of patients: geriatrics (elders), pediatrics (children), obstetrics (pregnancy). Dr. Elliott Weiss, Division Head of the Department of Physical Medicine and Rehabilitation for Providence Health Care, is a specialist in Physiatry, a branch of medicine that focuses on function. “We utilize physical therapies to help patients recover from strokes, amputations, spinal cord injuries—as examples of complex medical conditions which we manage,” says Dr. Weiss, “our goal is to assist patients’ recovery in the best ways possible to improve or maintain their physical function and independence.”
Specialists in Physical Medicine and Rehabilitation coordinate the activities of a variety of health care professionals. “We were focused on ‘team care’ long before it became fashionable in the medical world,” says Dr. Weiss, “rehab medicine is all about the interactions between various care providers and working towards a common therapeutic approach.” On a daily basis Dr. Weiss encounters a large number of patients with a diverse set of needs. “The variety of patient problems I encounter is very motivating,” he says, “particularly when I can successfully help to enhance patient outcomes.”
While accidents can cause patients to require amputations, Dr. Weiss finds that vascular disease and/or diabetes in the elderly are more common causes of lost limbs. “If physicians are unable to assist a patient in maintaining the health of their leg, sometimes the only option is amputation,” says Dr. Weiss, “either above or below the knee.”
Dr. Weiss examines the underlying pathology of a patient’s condition and utilizes rehabilitation concepts to develop a therapeutic and pharmacological plan for each patient. “This plan usually includes physio and occupational therapy, medications, and/or rehabilitation nursing.” says Dr. Weiss, “there are many aspects of treatment to take into consideration.”
While each therapist on the team who works with Dr. Weiss has an in-depth understanding of their role in the treatment plan, Dr. Weiss understands how all the players work together. “While I don’t perform physiotherapy treatments,” he says, “I understand what a physiotherapist can do for a particular patient.”
An amputee needs to learn new skills for personal care and re-learn how to function independently. “An Occupational Therapist can help in this capacity,” says Dr. Weiss, “whereas a nurse assists with wound care and healing.” Dr. Weiss provides the prescription and assists in the designs of prosthetics or orthotics systems; he can also act as a facilitator and oversee the interplay between therapeutic procedures. With access to diagnostic imaging and laboratory tests, Dr. Weiss can make decisions based on all aspects of a patient’s condition.
“When a person has had an amputation, they wake up in a surgical bed with a significant body part missing and impaired ability to sit, stand and walk,” says Dr. Weiss, “we take that person from a state of dysmobility and assist them in re-learning how to walk independently.” Therapy may include work on wound healing, improvement of range of motion, management of pain through medications and physical techniques, and relearning how to perform basic daily activities. “Amputee patients need to learn to transfer from their bed to a chair, how to stand and sit, and how to regain their physical fitness after their surgery,” says Dr. Weiss, “when they are ready, they are measured and fitted for a prosthesis and they begin to learn to walk again.” The process can take 8 to 12 weeks or longer.
“One of the best things about this medical specialty is the continuity of care that I am able to provide patients,” says Dr. Weiss, “particularly for patients with long term needs.” Many people who have neurological conditions or limb loss at a young age require different treatments as they age and their body goes through physical changes. “People need consistency in the care they receive to maintain or maximize their independence,” Dr. Weiss says.
The Tapestry Foundation for Health Care recently donated $80,000 to Holy Family Hospital to update two unique care suites: Easy Street and Easy Suite. These facilities allow patients to practise essential life skills in a safe, challenging and realistic environment.
“I chose this field,” says Dr. Weiss, “because, to me, it explains why we do what we do: maximize our patients’ independence and ability to live healthy, productive lives.”
Tiko Kerr, Vancouver Artist and patient of Dr. Julio Montaner