Historical Background

According to the World Health Organization (WHO), there are five major sub-branches in medicine. They are:
1. Promotive medicine
2. Preventive medicine
3. Curative medicine
4. Disability limitation
5. Rehabilitation medicine

Of all these sub-branches, rehabilitation medicine is the latest one. It came into existence abroad only about 30 years ago. In Thailand, it is relatively new and is not generally accepted among medical practitioners. Many Thai physicians are not even aware of what it is and how it can help patients.

After World War II, a great number of war veterans were disabled or dismembered and thus were dependent on the authorities and their family members for support. Major General Dr. Khun Prathum Rok Praharn, M.D., then the Head of Radiology, Phramongkutklao Hospital, invented the country's first false legs for these veterans, and later on started to practice hydrotherapy and other forms of physical therapy including muscle training. He is thus considered the first Thai physician who incorporated rehabilitation medicine into his treatment.

In 1947, Professor Dr. Fueng Satsanguan, M.D., then the Head of the Orthopedic Surgery Section, Surgery Department, Faculty of Medicine at Siriraj Hospital, University of Medicine, developed artificial arms for patients who underwent amputation, but these prosthetics were not effective.
In 1949, patients with arthritis started to be treated with heat. In the following years, clinical applications of electric currents for treatment, muscle training, massage, and dips in a heated whirlpool were prescribed for patients.
In 1954, a team of medical staff was sent to the USA to be trained.
In 1958, physical therapy-related courses were added to the curriculum of fourth-year medical students at the Faculty of Medicine at Siriraj Hospital.
In 1965, the School of Physical Therapy was opened at the Faculty of Medicine at Siriraj Hospital.
In 1970, a group of nurses were sent to visit rehabilitation facilities in Britain.

Unfortunately, no other rehabilitation medicine-related activities were initiated afterwards. Even medical practitioners thus generally understood that rehabilitation medicine was limited only to physical therapy until about 20 Thai medical students majoring in rehabilitation medicine graduated from the US and came back to Thailand. It was then that professional rehabilitation medicine was started in the country, and in September 1972, the Rehabilitation Association of Thailand was established.
Realizing the importance of rehabilitation medicine, the Medical Council of Thailand approved rehabilitation medicine training courses for Thai doctors in 1982. In the same way, the Thai Red Cross Society set up Thailand's first rehabilitation center at Sawangkhanivas in Samutprakarn. The 80-bed facility was opened on April 15, 1983.
The Department of Labour, Ministry of the Interior, also plans to open a vocational training center at Rangsit with assistance from the Japanese government. The Sai Jai Thai Foundation will open another rehabilitation center. Meanwhile, the Ministry of Public Health will soon oversee the official opening of the Sirindhorn Center of Medical Rehabilitation.

Responsibilities
The scope of work in the Department of Rehabilitation Medicine includes a wide variety of responsibilities. It not only offers diagnosis and treatment services to its own patients but also takes charge of patients from other departments including the Orthopedic Surgery Department, Surgery Department, Medicine Department, Department of Pediatrics, Otolaryngology Department, and Department of Obstetrics and Gynecology.     
Orthopedic Surgery     
- Once a cast has been put on patients with broken bones, they are sent to the Department of Rehabilitation Medicine, where they practice walking on crutches. The practice is required, as the crutches, if wrongly sized or wrongly used, might lead to other injuries, especially in the radial nerves at the armpits, which are probably too firmly pressed to work properly, causing dysfunction of the arms.     
- Patients with broken bones who have undergone an operation with frame suspenders need to exercise to prevent the joints and muscles from losing flexibility and strength, respectively, and to practice using walkers to help them walk until the bones are mended.     
Surgery Department     
Almost all Surgery Department patients, especially those who have undergone neurosurgery, need rehabilitation, as they are likely to have hemiparesis or specific paralysis of both of the legs or other muscles. Those having had their nerves reinervated, or spliced together, occasionally need as long as two years of rehabilitation. This is because a nerve grows only 1 mm a day; if the spliced nerve is 70 cm long, it will take 700 days, or almost two years, to grow back fully. During this period, such patients who are not put under proper care may risk permanent disability since muscles in the area might lose flexibility totally and suffer from connective tissue disorders. Lung, heart, and bypass surgery patients and those having amputations are sent to the Department of Rehabilitation Medicine to practice breathing with the stomach both before and after the surgery takes place so that they can learn to breathe fully as if making use of all of the lungs.     
Medicine Department     
Medicine Department patients with nervous disorders tend to have one type of paralysis or another. At the Department of Rehabilitation Medicine, patients whose artery walls thicken as plaque narrows or blocks the arteries can learn to exercise and breathe in particular ways to make best use of oxygen. The Department's highly trained instructors will offer guidance and answer questions about how to strengthen the heart. In other cases, diabetic patients with weakened muscles as a result of deterioration of the nerve endings need to learn to exercise properly so as to cope successfully with diabetes and maintain their health.     
Department of Pediatrics     
Some infants, polio affected children, those with meningitis, obese children and others need to rehabilitation.     
Otolaryngology Department     
Patients from this Department who require rehabilitation medicine include one with mastoditis stemming from cerebral nerve damage during an operation, resulting in specific paralysis of half of the face.     
Department of Obstetrics and Gynecology     
Only ocassionally are patients from this Department sent to the Department of Rehabilitation Medicine. The patients include pregnant women who have a backache but are afraid that medication will affect their baby, pregnant women who want to exercise to get ready for childbirth and ease delivery, and women whose chronically infected fallopian tubes cannot be cured by antibiotics and need heat treatment.
Rehabilitation medicine also covers habilitation practices, which involve training the disabled's relatives and the community in which they live to coexist happily. Unlike rehabilitation medicine, habilitation medicine is intended to prepare the non-disabled to deal with the special needs of the disabled.     
The responsibilities of the Department of Rehabilitation Medicine in a hospital     
If there are no beds particularly allocated for patients in the Department of Rehabilitation Medicine in a hospital, the Department is responsible for giving consultation to both in-patients and out-patients in need of rehabilitation. If there are beds especially for patients in the Department, in-patients from other Departments are transferred to the Department as necessary until they no longer need to be under hospital care and can receive out-patient care. Other responsibilities include offering training courses to medical staff, e.g. nurses and orderlies, on proper medical practices that correspond with rehabilitation medicine for patients with paralysis. In the case of full hospital support, these medical practices encompass speaking skills, proper use of the hands, and other skills and can later be offered as vocational training courses. If a hospital produces its own prosthetics and accessories, the Department of Rehabilitation Medicine is in charge of the factory, which supplies prosthetics not only for patients in the hospital but elsewhere.     

The objectives of the Rehabilitation Center
Services: To provide continuous rehabilitation services including physical therapy, activity therapy, psychological therapy, semantic therapy, recreation, public welfare to patients in need by coordinating and cooperating with Chulalongkorn Memorial Hospital, Siriraj Hospital, and other hospices both at the Center and at the patients' home through the highly skilled rehabilitation team. To give knowledge about proper life styles and daily routines to create conditions for safe and happy living. To offer an organization tour at the Center to interested agencies and people.

Administration: To train staff to accommodate rehabilitation needs at hospitals both in Bangkok and the vicinity. To enhance the skills and efficiency of existing staff.
In the previous year, the Center jointly established the ASEAN Rehabilitation Medicine Association (ARMA), and in 1998, hosted the first ASEAN Congress of Rehabilitation Medicine. The Center also offered a training course on activity therapy to students from Quebec, Canada.

Academics: To train local doctors in rehabilitation medicine in cooperation with Chulalongkorn Memorial Hospital. To provide special lecturers for fourth and fifth year courses in the Department of Orthopedics and Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University. To support rehabilitation-related research and textbook writing.