15. Recovery of the Trauma Patient



Indications to Consult Physiatry (PMR)

Purpose

To identify criteria for early physiatry (PMR) consultation and expertise on the multidisciplinary trauma care team following admission.

PMR Consult Service

The PMR consult service is ran by Dr. Dan Pierce. He is available to see consults on patients admitted to the trauma service on Monday, Wednesday, and Fridays and provide additional expertise the management and care of various injury as treatment moves from the acute phase to the recovery and rehabilitation phase.

Indications for Consult

1.  Spinal cord injury (timing: ideally as soon after admission as possible)

All acute spinal cord injured patients (cervical/thoracic/lumbosacral and conus medullaris/cauda equina), including pediatrics

Perform ISNCSCI (ASIA Impairment Scale) exam

Management of physiatry-related complications following trauma

Neurogenic bowel/bladder

Orthostatic Hypotension/Autonomic Dysreflexia

Concomitant brain injury care

Spasticity management/contracture prevention

Pulmonary/vent weaning

Prevention of skin breakdown

Pain

Assist in transition to post-acute care

Including insurance denials/peer-to-peer

Coordinate rehabilitation care (PT/OT/ST) prior to discharge

Patient/family education

Including presence at family meetings and prognosis discussions

All chronic spinal cord injured patients if they have a new injury and are admitted to trauma service

2.

 Traumatic Brain Injury (timing: ideally as soon after admission as possible)

Severe and moderate brain injuries, including pediatrics

Management of physiatry-related complications following trauma

Arousal

Agitation secondary to post-traumatic amnesia

Paroxysmal Sympathetic Hyperactivity (“neurostorming”)

Neurogenic bowel/bladder

Spasticity management/contracture prevention

Prevention of skin breakdown

Pain

Assist in transition to post-acute care

Including insurance denials/peer-to-peer

Coordinate rehabilitation care (PT/OT/ST) prior to discharge

§  Patient/family education

Including presence at family meetings and prognosis discussions

3.

 Traumatic limb loss (timing: ideally as soon after admission as possible)

Upper and Lower extremity, including pediatrics

Management of physiatry-related complications following trauma

Contracture prevention

Pain

Assist in transition to post-acute care

Including insurance denials/peer-to-peer

coordinate rehabilitation care (PT/OT/P&O) prior to discharge

Patient/family education

Including presence at family meetings and prognosis discussions

Consultations for the following injuries may also be considered and will be seen on an as needed basis during the patient's hospital admission: 

multiple musculoskeletal trauma

traumatic peripheral nerve injuries, including crush

pediatric traumas

mild-moderate brain injury

burns

other injuries requiring post-acute rehabilitation

Author(s)

Dan Pierce, MD, Department of Physical Medicine and Rehabilitation

Last Updated

June, 2023