PGY 2
CONSULTATION SERVICE AT AMCH 
The PGY-2 residents provide inpatient consultative services. Most consults are requests by other inpatient services for patient evaluation for transfer to the general rehabilitation service. Consults are seen within twenty-four hours of receiving the request. They are assigned to the residents on a rotating basis. If admitted to the rehabilitation service, the resident who had previously done the consult manages the patient. This is done to provide the resident and patient with continuity of care. Consults require that a history and physical be preformed in each case. The patient is then evaluated with the attending and a determination as to the physiatric needs is reached. At the end of PGY-2, the resident will be able to formally assess patients with regard to rehabilitation potential.
A) LEARNING OBJECTIVES
1) Perform an appropriate physiatric history & physical examination on acute hospitalized patients to determine appropriateness for acute inpatient rehabilitation services.
2) Develop competencies in
a) Determining if the patient has appropriate goals for acute rehabilitation services
b) Determining barriers to a successful discharge from the hospital environment
c) Evaluation of patients to determine level of need. Acute inpatient rehabilitation, subacute rehabilitation, nursing home placement.
d) Determining social and family factors that may impact on a successful rehabilitation and discharge to home.
3) Develop competencies in evaluating a broad spectrum of patients
at an acute tertiary care center with trauma designation. Diagnoses including, but not limited to:
• Multiple trauma
• Spinal cord injury
• Stroke
• Traumatic brain injury
• Systemic arthritis – rheumatologic disorders
• Amputations
• Total joint arthroplastics
• Oncology patients
• Cardiac and/or Pulmonary disease patients
• Generalized debility
• AIDP
• AIDS and related sequelae
• Multiple sclerosis
• Peripheral vascular disease
INPATIENT ROTATION – REHAB UNIT AT AMCH
A specialty unit designed to provide to those patients admitted to the unit, the maximum benefit of a comprehensive rehabilitation program under the direction of the Physiatrists in the Department of Physical Medicine and Rehabilitation. The rehab tem consists of the following members:
• Physicians – attending and resident
• Nursing
• Occupational therapy
• Physical Therapy
• Speech Language Pathology
• Psychology
• Social Work
• Recreational Therapy
The resident will become well versed and familiar in the role and function of each discipline as a unique entity in addition to each member’s role in the rehabilitation team. The resident will develop and utilize the skills to organize and coordinate the team to optimize patient rehabilitation. The resident will also learn to manage medical issues and understand how these issues may impact on a patient’s rehab potential.
A) LEARNING OBJECTIVES
1) determine the appropriateness of patients for the inpatient rehab unit.
a) Perform appropriate physiatric history including psychosocial, educational, functional, vocational and recreational, and physical exam.
2) Develop knowledge about the diagnosis, pathogenesis, treatment. Prevention and rehabilitation of those neuromuscular, cardiovascular, pulmonary and other system disorders common to the field of PMR in patients of both genders, and of all ages.
3) Develop skills in the evaluation and management of:
• Generalized or focal weakness
• Balance or coordination deficits
• Mobility/ADL deficits
• Sensory and/or motor deficits
• Skin integument issues
• Cognitive rehab
• Use of prosthetic and/or orthotics
• Swallowing dysfunction
• Neurogenic bowel and bladder
4) Prescription writing including exercise, modalities, precautions, adaptive equipment, prosthetics, orthotics.
5) Evaluation and management of above issues as they relate to the diagnoses of CVA, TBI, SCI, orthopedic trauma, total joint arthroplasty, inflammatory arthritis, cardiac and/or pulmonary dysfunction, PVD, cancer.
PGY 3
PEDIATRICS – OUTPATIENT AND CONSULTATION PRACTICE
A) Learning Objectives
1) Perform appropriate history and physical examination.
a) Explore possible issues of hereditary disorders, congenital, birth defect.
b) Explore prenatal, perinatal and early postnatal history
c) Explore exposure history-toxin, infectious
d) Explore maternal and paternal potential health issues as they may relate to the child
e) Learn to look for potential issues of abuse and reporting mechanisms.
2) Develop competency in the evaluation and management of the pediatric patient.
a) Cerebral palsy
b) Spinal cord injury
c) Traumatic brain injury
d) Muscular dystrophies
e) Spinal muscular atrophies
f) Congenital deformities
g) Spasticity
h) Mobility and ADL deficits
i) Down’s syndrome
j) Prosthetics and orthotics, wheelchair evaluations
k) Injured pediatric athlete
3) Develop the competencies to discuss with the parents or guardians implications of findings, diagnosis and potential management issues.
EMG CLINIC AT AMCH AND VA MEDICAL CENTER
A) LEARNING OBJECTIVES
1) Perform appropriate history and physical examination as an element of the electrodiagnostic consultation.
2) Develop knowledge about common disorders seen in an EMG laboratory, including:
• Neuropathy – acquired, hereditary, focal compression
• Myopathies – acquired, hereditary
• Radiculopathy
• Plexopathy
• Neuromuscular junction disorders.
3) Develop knowledge and skills in performing routine electrodiagnostic techniques
• Nerve conduction techniques
• Needle EMG
• Repetitive stimulation studies
• F wave, H reflex and sacral reflex testing
• Sphincter studies – urethral and anal.
4) Develop the knowledge to interpret EMG data and modify a study as data is obtained.
5) Develop the skills to convey the findings of a study and their diagnostic significance in a concise format.
NORTHWOODS ROTATION – TRAUMATIC BRAIN INJURY
A) LEARNING OBJECTIVES
1) Learn appropriate physiatric history, including the premorbid psychosocial, educational, functional, vocational, recreational components, in addition to accident history, acute and post-acute hospitalization history.
2) Learn appropriate physiatric physical examination.
3) Develop knowledge about the diagnosis, pathogenesis, treatment and prevention of the disease for adult and pediatric populations.
4) Develop knowledge in assessing the impact of TBI on
• Generalized or focal weakness
• Balance/coordination deficits
• Cognitive deficits
• Receptive and expressive dysfunctions
• Swallowing dysfunction
• Skin integrity issues
• Spasticity and heterotopic bone function
• Endocrine/hormonal dysfunction
• Pain
• Associated orthopedic trauma
• Rehab goals
5) Learn prescription writing to include exercise modalities, precautions, adaptive equipment, cognitive rehab, counseling, vocational and avocational rehab.
6) Evaluation and management of issues of spasticity. Use of chemoneurolytic procedures, botulinum toxin injections, motor point blocks, tone reducing techniques including physical agents, modalities and orthoses.
PGY 4
OUTPATIENT ROTATION AT AMCH/BONE AND JOINT CENTER AND VA HOSPITAL
A) LEARNING OBJECTIVES (PEDIATRIC & ADULT POPULATIONS)
1) Perform appropriate physiatric history and physical examination in an outpatient milieu.
2) Develop knowledge about common disorders seen in an outpatient physiatry practice, including:
• Neuromuscular disorders – acquired and congenital
• Peripheral neuropathies – acquired and hereditary
• Orthotics and prosthetics
• Wheelchair evaluations
• Chronic pain
• Spasticity
• Mobility and/or ADL deficits
• Total joint arthroplasty
• Myopathies
• Injured worker
• CNS dysfunction – CVA, TBI, SCI, MS, inherited and congenital disorders
3) Learn prescription writing to include exercise, modalities, precautions and goals as part of the management plan.
4) Learn the role of medication and the families of medications that may be used to manage various issues.
5) Learn the role of diagnostic studies such as MRI, EMG, X-RAY, ultrasound, etc. in the evaluation of the outpatient.
6) Learn about the interplay of the medico-legal system in the care of the injured worker or MVA patient.
PROSTHETICS AND ORTHOTICS CLINIC – ALBANY MEDICAL CENTER
A) LEARNING OBJECTIVES
1) Perform appropriate physiatric history, including psychosocial, educational, functional, vocational and recreational, and physical exam.
2) Develop knowledge about the diagnosis, pathogenesis, treatment and prevention of disease and injuries that relate to the field of prosthetics and orthotics, involving all ages regardless of gender.
3) Develop knowledge and skills in the evaluation of common gait deviations seen in below knee and above knee amputates.
4) Develop knowledge in prosthetic and orthotic components and their impact on lower and upper extremity function.
5) Develop knowledge of the functional capacity and limitations of prosthetic and orthotic devices.
6) Develop knowledge in prescription writing for lower extremity prostheses and orthoses, as well as upper extremity prostheses and orthoses.
7) Develop knowledge in the evaluation of prosthetic and orthotic devices for specific patients in term of fit, function and workmanship (i.e., prosthetic/orthotic checkout).
