About Physical Medicine and Rehabilitation

The Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin, comprised of 30 faculty members, along with approximately 20 residents, fellows and graduate students, is one of the largest medical rehabilitation programs in the country. There is a broad range of clinical, educational and research services available, providing comprehensive care for the disabled. Rehabilitation physicians, residents, fellows, and medical students, together with predoctoral and postdoctoral graduate students, contribute to the activities of the department. The department collaborates its skills and activities with many other affiliated medical and surgical specialties, as well as with rehabilitation teams consisting of rehabilitation nurses; speech, occupational, physical, and vocational therapists; neuropsychologists; bio-engineers; social services and case managers. Rehabilitation medicine utilizes a team approach to the treatment of disabilities. The team coordinates their skills to restore optimal physical function, to minimize psychological, vocational and social effects, to prevent physical complications, and to enhance the quality of life of those with disabilities.

Clinical and research learning opportunities are available in spinal cord injury rehabilitation, brain injury and stroke rehabilitation, pediatric rehabilitation, neurological and musculoskeletal rehabilitation, medical-legal evaluations, sports medicine, geriatric rehabilitation, electrodiagnostic medicine, exercise physiology, biomedical engineering, clinical outcomes management, and primary care of disabled individuals.


History of Physical Medicine and Rehabilitation at MCW

The Department of Physical Medicine and Rehabilitation was designated as a department in 1951, beginning as a part of the "Division" of Medicine. The Division of Medicine included Dermatology, Neurology and General Medicine, as well as PM&R. In 1959, PM&R was designated as a separate department. At the time, the medical school was part of Marquette University, and the department included Physical Therapy. In 1968, physical therapy was separated from PM&R to become part of the Division of Allied Health at Marquette University.

Ray Piaskoski, MD, was named the Director of the newly established department in 1951, and became Department Chair in 1959. Dr. Piaskoski resigned as chair in 1965 due to health issues. Robert W. Boyle, MD, was appointed chair of the department at that time and served in the role until he retired in 1973. John L. Melvin, MD, was appointed chair in 1973, and served in that role until 1991. Gerda Klingbeil, MD was the chair from 1991-1996. John Merritt, MD, was the chair from 1996-2001, and Martin Hoffman, MD, was the acting chair from 2001-2003.

Timothy R. Dillingham, MD, was appointed Department Chair in April 2003 and served in the role until September 2011. Diane W. Braza, MD, was appointed Interim Chair effective October 1, 2011 and Chair in November 2012.

The Department of Physical Medicine and Rehabilitation is a well-established program that has been in existence for over four decades, training more than a hundred and fifty physiatrists. Our current complement of 18 resident slots and six fellowship positions makes us one of the larger training programs in PMR in the United States. We have three strong teaching affiliate hospitals as described above.

The Department of PM&R at the Medical College of Wisconsin has senior researchers with substantial external funding from NIH and NIDRR, creating an exciting academic and research environment that brings the latest rehabilitation advances to the bedside and to resident education. As a clinical department, we are profitable due to our hard-working faculty, efficient operations, and favorable reimbursement environment in Milwaukee. This translates into a vibrant and enjoyable department in which you can be confident that the three years of time spent here will see stability and positive growth.

In summary, we are uniquely situated to train residents in the science and art of Physical Medicine and Rehabilitation. The strength of our department, the strong affiliate hospitals, the robust scientific community of the Medical College, and the commitment of the Physical Medicine and Rehabilitation faculty ensure that your education will be outstanding.

History of Physical Medicine and Rehabilitation

The field of physiatry dates back to the two major wars of this century. Its development was in direct response to the tremendous need, for wounded soldiers returning from the battlefields of war, to recuperate and return to duty.

Initially physiatry had close ties to the burgeoning application of physical modalities in the care of injured patients. The name physiatrist (pronounced fiz-ee-at-rist) is derived from the Greek words "physis," pertaining to physical phenomena, and "iatreia," referring to healer or physician. Thus, the physiatrist was a physician who employed physical agents.

During World War I extensive utilization of "physical reconstruction services" was instituted to improve the functional restoration of injured soldiers. In 1917 Major Frank B. Granger, Medical Corps, was designated director of the physiotherapy service of the reconstruction division. Under his leadership reconstruction units were set up in 35 general hospitals and 18 base hospitals throughout the United States In these reconstruction units, graded exercises were prescribed from level 1 to level 5 (the most difficult). Commanders were enthusiastic about the program because many injured soldiers could return to full duty status upon discharge from the hospital. Early in its development, rehabilitation was explained to other physicians as the third phase of medical care. This seemed to defuse any animosity that other specialties may have had regarding physiatry taking over aspects of their specialty.

Physicians who practiced physical therapy in the 1920's fostered the field. Radiologists, strangely enough, were the first group to use physical measures to treat patients, and the first organization for physicians using physical agents was the American College of Radiology and Physiotherapy. However, by 1938 it was obvious that physical therapy physicians had distinctly different interests from those of radiologists, and at this time the official journal, Archives of Physical Therapy, X-ray and Radium, was changed to Archives of Physical Therapy. In 1945 the journal became simply Archives of Physical Medicine. Later it became the Archives of Physical Medicine and Rehabilitation, the premiere journal in the field of rehabilitation. Those dedicated physicians who practiced physical therapy formed the core of physicians who would promote, encourage, develop, and establish the field of rehabilitation medicine.

During the 1930's a handful of physicians who practiced physical therapy planted the seeds which led to the subsequent dramatic growth of physiatry. Such physicians included John S. Coulter, MD, at Northwestern University Medical Center, Frank H. Krusen, MD, at the Mayo Clinic, and Walter J. Zeiter, MD, at the Cleveland Clinic, to name a few. Many of the physical therapy physicians were from Europe and Scandinavia , where hydrotherapy or spa therapy enjoyed greater respectability. The Society for Physical Therapy Physicians was founded in 1938. In 1939 the term "physiatrist" was proposed by Frank H. Krusen. He recognized its similarity to psychiatry and therefore suggested its current pronunciation (see above). The field of physiatry developed rapidly in response to social and medical cataclysms.

During World War II another series of events propelled physical medicine forward. The Baruch Committee was formed by a noted philanthropist, Bernard Baruch. This committee, chaired by Ray Lyman Wilbur, MD, was to study physical medicine, developing ways to expand the field, and contributing maximally to the care of injured soldiers and sailors. This committee was composed of subcommittees on education, teaching, research, public relations, rehabilitation, hydrology, occupational therapy, and prevention and body mechanics. The insightful work of the Baruch Committee members, which included Frank Krusen; Lt. Col. Benjamin A. Strickland, Jr., M.C., U.S. Army; Charles F. Behrens, M.C., U.S. Navy; Lt. Col. Howard A. Rusk, M.C., U.S. Army, to name a few, produced a blueprint for the organized growth, development, and promotion of physiatry.

The Baruch Committee, with financial backing of Bernard Baruch, awarded funds to develop physiatry programs at selected universities. Perhaps one of the committee's greatest contributions was to award training fellowships to selected physicians, enabling them to receive intensive training in physical medicine and rehabilitation (PMR). These individuals included many of the early leaders in physiatry and provided the core cadre of well trained academicians to direct residencies and PMR programs.

During this time – in 1945 – a section on Physical Medicine and Rehabilitation was established in the American Medical Association. By February 1947 the requirements for a specialty board were met, and the American Board of Physical Medicine (ABPM) was recognized by the American Medical Association, Advisory Council for Medical Specialties. During World War II there were physicians practicing physical therapy, and those who dealt mainly with rehabilitation. The rehabilitation concept and its team approach to care included corrective therapists, occupational therapists, vocational education specialists, and recreation personnel organized under the team physiatrist. The American Board of Medical Specialties saw no division between physical medicine and rehabilitation, and hence both factions were included in the ABPM. The competition between the physical medicine factions and those championing rehabilitation continued. In 1949 the ABPM, in response to guidance from the Advisory Board of Medical Specialties, became the American Board of Physical Medicine and Rehabilitation (ABPM&R), which it remains to this day. This quelled the discord between these factions.