Specialty spotlight – rehabilitation medicine

Introduction to rehabilitation medicine

Rehabilitation medicine is a young specialty focused on the management of complex disability. It offers an opportunity of working with patients who have complex difficulties and, with other professionals, seeing them through to a good outcome for both themselves and their families.

Rehabilitation medicine offers continuity, teamwork and the opportunity of bringing together scientific and humanistic aspects of medicine in a secondary care environment. These can range from major trauma centres and hyperacute rehabilitation units to continuing care and community facilities, but all require a firm grounding in neurology, internal and musculoskeletal medicine complemented by excellent problem solving and communication skills.

It is attractive to physicians who wish to practise whole person rather than system specific medicine, and who wish to reduce the impact of disability on human flourishing. It is enjoyable work, with less out-of-hours commitment than many physicianly specialties, and it is possible to practise this specialty successfully working part time.

Specialist registrar’s view

Rehabilitation medicine brings together aspects from areas I found interesting during my core medical training: neurology, stroke medicine and elderly care. Each day I am able to work as part of a multidisciplinary team and treat a wide variety of patients with complex medical diagnoses. Through their longer length of stay in hospital, I also have the opportunity to get to know patients on a personal level as well as understanding their illnesses, disabilities and how it affects their daily life.

Rehabilitation medicine is an exciting, innovative and constantly evolving speciality. Through rehabilitation medicine, trainees will get exposure to a wide-range of patient care that allows them to build skills across many different disciplines. There are also opportunities for research and development, as well as acute/chronic management and inpatient/community work.

Dr Meena Nayar, specialist registrar in rehabilitation medicine and national trainee representative, British Society of Rehabilitation Medicine.

Training and working in rehabilitation medicine

• You can find more information on the training pathway from the Joint Royal Colleges of Physicians Training Board.
• Learn more about the recruitment and interview process by visiting the ST3 recruitment page.

Rehabilitation medicine resources

• British Society of Rehabilitation Medicine
• International Society of Physical and Rehabilitation Medicine

RCP resources

• Census of consultant physicians and higher specialty trainees in the UK 2013–14 – specialty report: rehabilitation medicine
• Consultant physicians working with patients – rehabilitation medicine chapter
• Royal College of Physicians in association with the British Society of Rehabilitation Medicine and the British Geriatrics Society. Use of antidepressant medication in adults undergoing recovery and rehabilitation following acquired brain injury (Concise Guidance). London: RCP, 2005.
• Tyerman A, Meehan M. Vocational assessment and rehabilitation after acquired brain injury. Royal College of Physicians in association with the British Society of Rehabilitation Medicine Working Party on Rehabilitation following Acquired Brain Injury, 2004.
• Clinical Medicine articles:
  • Collin C. Medical rehabilitation. Clin Med 2011;11:6–7.
  • O’Neill B, McAuley D. Sequelae and rehabilitation after critical illness. Clin Med 2011;11:609–14.
  • O’Connor RJ, Beden R, Pilling A, Chamberlain MA. What reductions in dependency costs result from treatment in an inpatient neurological rehabilitation unit for people with stroke? Clin Med 2011; 11:40–3.
  • Turner-Stokes L, Sykes N, Silber E, on behalf of the Guideline Development Group. Long-term neurological conditions: management at the interface between neurology, rehabilitation and palliative care. Clin Med 2008;8:186–91.
  • Chamberlain MA. Work, disability and rehabilitation: making the best job of it. Clin Med 2007;7:603–6.
  • Turner-Stokes L, Disler R, Williams H. The Rehabilitation Complexity Scale: a simple, practical tool to identify ‘complex specialised’ services in neurological rehabilitation. Clin Med 2007;7:593–9.
• Prolonged Disorders of Consciousness, National Clinical Guidelines, Royal College of Physicians, London  2013.
• National COPD Audit Programme: Pulmonary Rehabilitation workstream
• RCP Library resources
  • ejournals and ebooks available online to members [email library@rcplondon.ac.uk for a password] include
    • Oxford handbook of clinical rehabilitation, 2nd edn. (Oxford : Oxford University Press, 2010).
    • Clinical Rehabilitation (1998–).
    • Geriatric Orthopaedic Surgery & Rehabilitation (2010–).
    • Journal of NeuroEngineering & Rehabilitation (2009–).
    • Journal of Rehabilitation Research and Development (1990–).
  • Books available by postal loan from the library include
    • Albert SJMM (ed). War, art and surgery : the work of Henry Tonks and Julia Midgley (London : Royal College of Surgeons of England, 2014).
    • Iansek R, Morris M (eds). Rehabilitation in movement disorders (Cambridge : Cambridge University Press, 2013).
    • Hennerici MG et al. Stroke (Oxford : Oxford University Press, 2012).
    • Anderson J. War, disability and rehabilitation in Britain : 'soul of a nation' (Manchester : Manchester University Press, 2011).
    • Medical rehabilitation in 2011 and beyond : report of a joint working party of the Royal College of Physicians and the British Society of Rehabilitation Medicine (London : Royal College of Physicians of London, 2010).

Historical highlights from the library, archive and museum collection

Rehabilitation in Britain arose out of physical medicine and was initially part of rheumatology.  George Mackenzie Cochrane (1929-2003) believed that rehabilitation medicine needed to be established as a separate specialty. He represented rehabilitation when the British Society for Rheumatology and Rehabilitation and the Heberden Society considered the future of these specialties in 1983. Cochrane become the first Chairman of the British Society of Rehabilitation Medicine (BSRM), which was then called the Medical Disability Society (MDS). The rheumatologists formed the British Society for Rheumatology (BSR).

Earlier in his career, Dr Cochrane set up the first National Rehabilitation Demonstration Centre at Derbyshire Royal Infirmary. There he established a bio-engineering laboratory to produce customised equipment for disabled adults and children with members of the former Institute for Consumer Ergonomics at Loughborough University. In 1980, he moved to the Mary Marlborough Lodge, a 21-bed rehabilitation unit for people with a severe disability. Dr Cochrane established strong links with specialist clinical units, orthopaedic colleagues and Oxford University engineers, to meet the specialist needs of patients. A George Cochrane elective prize in rehabilitation medicine was set up in his name at King’s College Medical School, London.

The RCP library catalogue contains a recording of an interview with Dr Virginia Camp. She was a consultant in rheumatology and rehabilitation in the Amersham and High Wycombe districts where she built a department including inpatient beds and a hydrotherapy and acupuncture service from scratch. After retiring she worked for 5 years as a disability assessor.

A great number of rare books in the library collections concern the diagnosis and treatment of paralysis. In particular, a number of tracts from the mid-to-late 18th century describe the effectiveness of bathing in warm mineral baths for people affected by paralysis. The physician Rice Charleton (1710–1789) settled in Bath and analysed the water there, concluding that sulphur was responsible for its curative properties.