Page Ten P H Y S I O T H E R A P Y April, 1953

Research in Physical Medicine and Rehabilitation

T T P O N  request to  com m ent on some subject o f interest 
and im portance to  the field o f physical medicine, I 

have chosen the subject o f research. I do this because our 
specialty is a branch o f medical science which, like all others, 
can thrive only if it has a substantial background o f funda­
m ental knowledge, and if it includes a group o f talented 
investigators endeavouring to analyse critically our basic 
knowledge and striving to develop new inform ation essential 
for progress. We are all too well aw are o f the criticism 
th at o u r therapy is based purely on empiricism and; in 
o rd e r'th a t we may take our rightful place am ong our col­
leagues, properly carried out investigative studies, leading 
to  acceptance o r discarding o f our therapeutic procedures, 
are o f great im portance.

Thinking again o f progress, we m ust all realize that 
we cannot rely on the past or present but m ust look to the 
future, which lies in the type o f young physician whom we 
can attract to our field. Physical medicine and rehabilita­
tion can never successfully be isolated from  the general 
practice o f medicine, and for research purposes should also 
be correlated w ith research in other specialties. W ith this 
concept in mind, the Branch C om m ittee on Physical 
M edicine and R ehabilitation proposed th a t model centres, 
including research departm ents, should be set up to attract 
talented young men and to m ake possible the necessary 
research and education th at results from  their activities. 
T he wisdom o f this decision has already been demonstrated 
n o t alone by the centres m ade possible by the Baruch gift, 
b u t by other centres established with similar objectives v 
during the past 10 years. F rom  these centres have come 
num erous im portant contributions to medical knowledge, 
some o f a fundam ental nature, others o f m ore immediate 
clinical application,

W hen one thinks o f some o f the comm only accepted 
therapeutic agents, such as th e application o f heat, one 
finds th a t even now m ore research is indicated, in order to 
determine its physiological effects as applied by different 
means, including th e newer methods o f micro-wave dia­
therm y and ultrasonics. The casual reader may still be 
quite perplexed by the seemingly contradictory evidence 
as to the effects on circulation by different wave-lengths o f 
radiant energy and by different frequencies o f diatherm y 
application. M ost o f the studies have been carried ou t on 
norm al subjects o r tissues, and we are still at a loss to be 
certain o f the desirability o f such physical agents upon 
pathological tissues, particularly in relationship to the 
further complexity o f effectiveness caused by widespread 
use o f antibiotics and chemotherapeutic agents. Surely

there rem ains a great challenge for investigators concerning 
this, one o f our oldest therapeutic agents.

A nother o f o u r prim ary interests for study in physical 
medicine and rehabilitation relates to  muscle physiology. 
Physiatrists ^should take m ore interest in the action of 
muscles than should probably any o th er specialty, and 
this gives them a wide field o f investigation because it 
comprises the largest single tissue o f the hum an body. 
We seek th e help o f the biochemists, o f physiologists con­
cerned with circulation, o f those interested in the biophysics 
of m uscular contraction, o f the neurophysiologists and, 
on a m ore clinical level, we study electrodiagnosis by means 
o f excitability tests and electrom yography. T his im portant 
field o f basic and clinical research w ould seem to be one that 
we, as physiatrists, should particularly foster.

Muscle physiology is of im portance primarily, how­
ever, in relation to  the function o f muscles as m otors to 
move joints, and accordingly therapeutic exercise, in its 
broadest concept, is the backbone o f our specialty. I t is 
within this category th at our possibilities o f study surely 
reach the horizon. One o f the m ost im portant aspects is, o f 
course, th a t o f motivation, because voluntary muscular 
contraction to  achieve a functional goal is our essential 
aim . The physician and therapist accordingly m ust be 
thoroughly trained and cognizant with new developments 
in the field o f psychodiagnosis and therapy, and the 
physiatrist m ust learn to appreciate the possibilities o f a 
wide variety o f stim ulative media o f treatm ent, as employed 
in occupational therapy, educational therapy, the arts and 
crafts and various socializing activities.

A t the present time it appears th a t the social and 
economic considerations o f the individual patient, in 
relation to his physical and em otional needs, are accepted 
by the physiatrist as an essential p art in the total treatm ent 
program m e o f the physician, and it has enabled our specialty 
to  accelerate at a trem endous rate. T his concept is accepted 
by the lay public and social agencies so avidly th a t we must 
consider w hether o r not we as physicians and, I hope, some 
o f us at least as scientists, accept the challenge to prove, by. 
m ethods o f research, th at w hat we are doing in this new 
field o f medical rehabilitation is really as successful over a 
long-term period as we feel it to be, and also th at we 
critically analyse the methods we use, in order to see that 
they are best adapted to the physiological needs o f our 
individual patients, and w hether or not newer and better 
m ethods cannot be developed. O ur field o f physical medicine 
and rehabilitation is so large, and it requires the help o f so

R
ep

ro
du

ce
d 

by
 S

ab
in

et
 G

at
ew

ay
 u

nd
er

 li
ce

nc
e 

gr
an

te
d 

by
 th

e 
P

ub
lis

he
r 

(d
at

ed
 2

01
3.

)