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By E. Franklin Livingstone, MD
The medical specialty of physical medicine and rehabilitation (physiatry), encompasses the diagnosis and treatment of a wide range of medical and physical problems. The problems can be as minor as a sore shoulder or as complicated as a spinal cord injury. The focus of this specialty is on restoring function and quality-of-life to individuals with disabling illnesses or injuries. Physiatrists diagnose and treat acute and chronic musculoskeletal pain disorders as well as disorders of the nervous, muscular, and skeletal systems. They study the appropriate use of various physical medicine modalities, such as heat, cold, exercise, traction, and electrical stimulation for motor development and pain control. Physiatrists are trained to lead a multidisciplinary team of medical professionals in the comprehensive and holistic treatment of illness and injury related disability. Indeed, the specialty of physical medicine and rehabilitation was the first to promote and develop a holistic medical team based on the interdisciplinary treatment of often complex medical, physical, and psychological problems. Many physiatrists receive extensive training in the subspecialty of Electrodiagnosis: electromyography of nerves and muscles and nerve conductivity testing.
The purpose of this article is to emphasize the physiatrist’s role as a clinician and as a forensic expert. Physiatrists are able to diagnose, evaluate, and provide a prognosis to the wide-ranging impact of disability on clients and their significant others. Physiatrists are also able to develop a comprehensive rehabilitation treatment program with short and long term goals and then oversee the progression of interdisciplinary treatment to optimize functional outcome and quality-of-life. Physiatrists are valuable consultants and expert witnesses in forensic cases, particularly cases involving injury or disease related disability with its pervasive effects and residuals.
The physiatrist is often the most qualified to determine the extent to which a disability exists, its relationship to illness or injury, and its overall impact upon the present and future life of the client. The overall analysis might include comprehensive life care planning: a study of potential and actual economic loss, a prognostication of future employability or under-employability, and cost analysis of the rehabilitation treatment program and its implementation.
Life care planning in complex cases requires multidimensional analysis. This comprehensive planning will take into account the current medical and impairment status along with progressions and secondary complications that are possible and likely to occur. Current treatment, beneficial treatment alternatives, and the likely need for future treatment must also be delineated. Specialized equipment or home modifications, transportation needs, measures in the prevention of secondary medical and physical complications, and educational and vocational considerations must be thoroughly detailed in the life care plan. In addition, emotional adjustment issues may require periodic or ongoing intervention and may have pervasive effects in functional outcomes and quality-of-life.
The determination of causation may often require multifactorial investigation. Medical and physical problems may be a composite result of illness; injury; or anatomical, physiological, congenital, or behavioral factors. Often the relative importance of the various contributing determinants must be quantified, requiring appropriate justification for any speculation. This, of course, may be quite complex, requiring a broad base of training and experience and the ability to clearly communicate and often educate those involved.
Case Study
A 62-year-old man with a history of arteriosclerosis and peripheral vascular disease was admitted to a cardiology institute for evaluation because of worsening heart failure that had been treated with diuretic medication. His medical history was complicated by adult onset diabetes and T-9 level paraplegia resulting from a motor vehicle accident 20 years previously. Complications relating to his paraplegia included recurrent urinary tract infection and an ischial pressure ulceration approximately 2 years prior to this admission that had healed completely with conservative care. An echocardiogram the prior month revealed aortic stenosis, aortic insufficiency, and an ejection fraction of 40%. He was admitted for right and left heart catheterization, coronary angiography, and evaluation of his aortic heart valve.
The cardiac catheter evaluation was complicated by his severe and advanced arteriosclerosis, causing the evaluating physician to be unable to advance the catheter through the femoral arteries. As a result, catheterization through the brachial arteries was performed, which allowed completion of the evaluation but extended the total time that the patient was lying supine on the examination table to approximately 3.5 hours. The results of the evaluation were severe aortic stenosis with calcification, mild to moderate aortic regurgitation, and severe arteriosclerosis with single vessel coronary artery arteriosclerosis. He was immediately transferred to a large, acute-care hospital for open-heart surgery for coronary artery bypass and aortic valve replacement. On admission, he was noted to have a small reddened area at the midline in his gluteal cleft, which by the next day had progressed to a small blister. During this hospitalization he also developed skin irritation and redness at both heels. These skin problems improved after they were treated conservatively, and the patient was discharged with family care and home health nursing with a small, healing, partial skin thickness ulceration at the midline in the gluteal cleft.
At home, the gluteal cleft ulcer gradually worsened, spreading to the sacral area, and prolonged pressure on the heels from mostly supine positioning resulted in ulceration of the skin over the heels, bilaterally. Eventually the sacral wound, having continued to progress, was treated with surgical debridement and a “flap” closure. Continued convalescence, mostly at bed rest per the patient’s request, led to further skin problems, including non-healing, ischemic ulcerations at several toes that became infected and eventually required bilateral below-knee amputations.
The case arose out of the alleged failure of the defendants to take necessary and proper precautions to properly cushion, pad, protect, and treat the plaintiffs’ sacral/buttocks region and heels during and after the heart catheterization procedure and during and after the open-heart surgery procedure. As a result, the plaintiff claimed he developed pressure sores on his coccyx and heels that required further hospitalization and surgery (flap repair and bilateral below knee amputations due to pressure ulcers on the buttocks and heels).
What does the CFN program do for me?
The Certified Forensic Nurse (CFN) title can demonstrate to your colleagues, patients, clients, employers, and the healthcare community that you have extensive knowledge and education, personal experience, and that you are committed to furthering your education in the forensic nursing profession. CFN also helps to contribute to the weight and relevance of your testimony and how applicable the evidence is that you must present to a court of law.
Forensic nursing is an exciting and rapidly growing specialty field that offers great opportunities and rewarding career options for nursing professionals. However, it can be challenging to set yourself apart from your peers to get the recognition and respect you deserve, both in the medical community and the legal arena.
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Want to know more about the American College of Forensic Examiners? Read the definitive history of the world's foremost association for foresnic experts, mental health professionals, and homeland security experts. If you want to understand the rise of ACFEI, this is the only book you'll ever need.
You can access United for Truth here.
Aside from our many strategic alliances and accreditations, here are some more things to keep in mind before choosing a credentialing program, and why the American College of Forensic Examiners Institute and its sister associations are a good choice to make:
For more information about credentials, the associations, or our journals, please visit us:
The American College of Forensic Examiners Institute: www.acfei.com
The American Psychotherapy Association: www.americanpsychotherapy.com
The American Association of Integrative Medicine: www.aaimedicine.com
The American Board for Certification in Homeland Security: www.abchs.com
Membership. Some of The American College of Forensic Examiners’ well-known members and Board members include; Dr. Henry Lee, Dr. Greg Vecchi, Dr. Zhaoming Chen, Dr. Marc Rabinoff, Congressmen Billy Long and Steven King, and Governor Tom Ridge. These individuals, as well as many other not listed here, have helped mold and guide ACFEI to be the prestigious, online, interactive, multimedia publisher that it is today. They have contributed their knowledge and expertise to ACFEI’s online credentialing programs such as the Certified Forensic Physician®, CFP program; the Registered Investigator®, RI®, program; and the Certified Forensic Consultant, CFC® program; to name a few.
ACFEI and all of its associations are continually seeking further validations, alliances, and accreditations in order to offer maximum continuing education benefits to its thousands of members. Sometimes it is our very members who foster these relationships; we encourage you to get involved and share your ideas for future alliances! This is a group of associations that recognize themselves as yours. We invite you to add your expertise to the pool and make it even greater.
Call (800) 423-9737 for more information, or visit acfei.com.
ACFEI is also an approved provider of training by the following professional organizations:
The outside bodies listed above, as well as the many other attest to the fact that the ACFEI has met or exceeded their regulations and standards to be approved providers of training. Organizations that represent medical doctors, accountants, psychologists, attorneys, law enforcement officers, dentists, military personnel, and numerous other professions and specialties would never approve an lesser, unregulated institution to provide training to these important persons.
Please contact either the American College of Forensic Examiners International, The American Board for Certifcation in Homeland Security, The American Association of Integrative Medicine, or the American Psychotherapy Association for more information about their respective programs, accrediting organizations, and educational opportunities:
www.acfei.com; (800) 423-9737
www.abchs.com; (877) 219-2519
www.aaimedicine.com; (877) 718-3053
www.americanpsycotherapy.com; (800) 205-9165
As the editor in chief of The Forensic Examiner, Annals of the American Psychotherapy Association, and Inside Homeland Security (all peer-reviewed and available on newsstands); and for the associations themselves (The American College of Forensic Examiners International, The American Board for Certification in Homeland Security, the American Psychotherapy Association, and the American Association of Integrative Medicine), I have the privilege of working not only with individuals with remarkable talent, credentials, experience, and professionalism here at the ACFEI Headquarters, but also with the thousands of members who renew their memberships year after year to learn, network, and even teach one another.
I am proud to work with the courses and articles conceived and written by dedicated professionals who have made it their living to help heal, defend, serve, protect, and save their fellow citizens from terrorism, criminals, mental illness, disease, and so many other world problems and pandemics. I have reviewed dozens of resumes and curriculum vitae for my peer reviewers and course authors. Their degrees, credentials, and experience speak for themselves of the excellence embraced and exuded by the associations.
Under the umbrella of the American College of Forensic Examiners International, I have reviewed and edited articles that discuss cutting-edge research written with government agents I interviewed in person at Quantico; I have met forensic legends Dr. Cyril Wecht and Dr. Henry Lee (both long-time ACFEI members); and I get to see to completion the modules and coursework that are born of the passion of many prominent individuals from an array of important fields. I know for a fact that the continuing education curricula individuals like these and others help create are forged from impeccable research, training, and consultation. These people are far too intelligent, prestigious, and philanthropic to waste their time with lesser organizations; Dr. Robert O’Block’s ACFEI stands only for legitimacy and professionalism.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Decide for yourself, as thousands wisely did before you:
www.acfei.com
www.abchs.com
www.americanpsychotherapy.com
www.aaimedicine.com
The American College of Forensic Examiners Institute began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight—homeland security, all areas of forensics, integrative medicine, and psychotherapy—are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more about each of these associations, please come see us:
The American College of Forensic Examiners: www.acfei.com
The American Board for Certification in Homeland Security: www.abchs.com
The American Association of Integrative Medicine: www.aaim.com
The American Psychotherapy Association: www.americanpsychotherapy.com
The American College of Forensic Examiners International began in 1992; it is still here. Most membership associations rise and fall in less than a decade, but the passion of ACFEI’s founder, Dr. Robert O’Block, and the thousands of reputable people his associations help each year, has fueled continued growth since ACFEI’s inception nearly two decades ago.
As we continually improve our continuing education coursework, Web presence, and printed publications, that growth is bound to continue. The fields in which our members work, study, and fight are not going anywhere anytime soon, and are dynamic and ever evolving. When you join the American Board for Certification in Homeland Security, the American Association for Integrative Medicine, the American Psychotherapy Association, or the tried-and-true American College of Forensic Examiners Institute, you will see that we rise above the competition in offering continuing education excellence. Dr. Robert O’Block has created a unique opportunity for you to meet like-minded professionals to network, learn, and teach one another and the world at large.
To learn more, please visit www.acfei.com.
What is it that draws so many—nurses, physicians, soldiers, investigators, government employees, psychologists, psychiatrists, social workers, forensic examiners, and a sheer multitude of other honorable professions—into the American College of Forensic Examiners Institute fold? Let me share with you just a few of the numerous reasons so you can better decide for yourself, as thousands wisely did before you:
Accreditation. The American College of Forensic Examiners Institute is an approved provider of continuing education by the following:
Continuing education alignments. In addition to the several accreditations above, we are also proud to inform you that:
To learn more, visit www.acfei.com
By Leann Long, BS
A Tragedy Unfolds
On the morning of February 2, 2002, the parents of Danielle van Dam were forced to face their worst nightmare when they discovered the empty bed of their 7-year-old daughter. Danielle was last seen the night before when Damon van Dam put his beautiful blue-eyed daughter to bed. The distraught parents immediately reported Danielle as missing, and an extensive search involving hundreds of volunteers began. Authorities assumed that the innocent young child was abducted from her bed while she slept on the night of February 1, 2002.
Copyright ©2009
ABFE,
ACFEI,
and ABCHS. All rights reserved. Dr. Robert O'Block, Founder, CEO, and Publisher.
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