NMC Guidelines For Competency-Based Training Programme For PG Diploma In Physical Medicine And Rehabilitation (DPMR)

The National Medical Commission, NMC has released the Guidelines For Competency-Based Post-Graduate Training Programme For Diploma In Physical Medicine And Rehabilitation (DPMR).

The purpose of PG education is to create specialists who would provide high quality health care and advance the cause of science through research & training.

The goal of this programme is to standardize Physical Medicine and Rehabilitation (PMR) teaching at the Post Graduate level throughout the country so that it will benefit in achieving uniformity in postgraduate as well as undergraduate medical teaching.

Physical Medicine and Rehabilitation, also called physiatry, (pronounced fizz ee at´ tree), or physical and rehabilitation medicine emphasizes the prevention, diagnosis and treatment of disorders, particularly those of the neuro-musculo-skeletal, cardiovascular, and pulmonary systems, that may produce temporary or permanent activity limitation, disability, or participation restriction. Physical Medicine and Rehabilitation is an independent clinical discipline. PMR has a vast scope as it provides integrated comprehensive care in the diagnosis, treatment and rehabilitation management of neurological, musculo-skeletal, cardio-pulmonary disabilities from acquired or congenital conditions presenting at any stage in life from pediatric to geriatric phases. This specialty focuses on the restoration of function of people to the highest possible level, through a multi-disciplinary team approach, making use of diagnostic and therapeutic armamentarium including education and counseling, prescription of medicines, therapeutic exercises, equipments (mobility aids, orthotic-prosthetic appliances, assistive technology, physical agents and modalities, etc.), injections, surgical interventions for correction of deformities etc. in an institution-based (out-door and in- door/wards/ICUs/Nursing Homes/Old-Age Homes etc.), out-reach (Camps, Mobile Units), or community-based settings (CBR), based on the evaluation of the individual under consideration. It is also involved in disability prevention, evaluation and certification, besides development, monitoring and supervision of a rehabilitation plan and conducting research and development.

The purpose of this document is to provide teachers and learners illustrative guidelines to achieve defined outcomes through learning and assessment. This document was prepared by subject-content specialists. The Reconciliation Board of the Academic Committee has attempted to render uniformity without compromise to purpose and content of the document. Compromise in purity of syntax has been made in order to preserve the purpose and content. This has necessitated retention of "domains of learning" under the heading "competencies".

PROGRAMME OBJECTIVES

The overall objective is to impart a thorough and comprehensive training to a medical graduate so that at the end of this training she/he becomes a knowledgeable, skilled, and competent Physical Medicine and Rehabilitation specialist, capable of discharging his/her duties as expected under different settings, in an ethical manner.

The student should be able to suspect, investigate, diagnose, confirm, evaluate, certify, treat, and rehabilitate if and when a person is suffering from a temporary or permanent limitation in function, disability, or restriction in participation; the student should be able to plan, prescribe, supervise and lead the execution of rehabilitation plan through an integrated, multi-disciplinary team involving various medical, nursing, allied health professionals such as therapists (occupational therapists, physiotherapists, speech therapists etc.), counselors, and technicians (orthotic-prosthetic engineers/ technicians). The student should be able to interpret reports and plan research, teach medical and paramedical personnel, educate (1) the person with disability, (2) family, (3) rehabilitation team members and (4) the community. The student should be well versed with recent advances in the field, and with administrative, financial, ethical and legal aspects related to the specialty.

SUBJECT SPECIFIC LEARNING OBJECTIVES

Upon completion of the training and successfully qualifying in the DPMR (Diploma in Physical Medicine and Rehabilitation) examinations, the student should be able to demonstrate:

1. Theoretical knowledge: The student should be able to demonstrate possession of basic knowledge of (1) the basic medical sciences such as Anatomy, Biomechanics, Physiology, Biochemistry, Pathology, Microbiology, Pharmacology, Medical Genetics and Molecular Biology etc. as related to Physical Medicine and Rehabilitation; (2) factors which may disturb structure or function and result in disability; (3) bed-side procedures (diagnostic and therapeutic).

2. Teaching-Training: The student should be able to plan educational programmes in Rehabilitation Medicine in association with his senior colleagues/Faculty and be familiar with the modern methods of teaching and evaluation; teach and/or deliver lectures to medical students, PG students, other health professionals and persons with disabilities and their family members etc. and hold clinical demonstrations for them; write and discuss a topic for seminar or a symposium and critically discuss it; methodically summarise published

articles according to prescribed instructions and critically evaluate and discuss each selected article etc.

3. Clinical/Practical skills: The student should understand and develop competence in executing common general procedures employed in diagnosis, investigations and management of conditions encountered in rehabilitation medicine. He/she should be able to practice and handle independently most of the day to day problems as encountered in Rehabilitation Medicine in a safe, effective and ethical manner. He/she should be able to plan a comprehensive rehabilitation service independently. He/she should be able to demonstrate understanding of the fabrication and competence in prescription and check out of orthoses and prostheses, the principles, prescription and supervision of physiotherapy, occupational therapy, psycho-socio-vocational counseling. He/she should be able to practice rehabilitation medicine at the door step of community. She/he should be familiar with the common problems occurring in the urban, semi-urban, and rural areas and deal with them effectively, should be able to organize, conduct, and supervise surveys in rural, urban and industrial communities and in specified groups of population; organise and conduct camps for disability prevention and rehabilitation of disabled persons, and guide rehabilitation workers at the peripheral level for rehabilitation of persons with disabilities.

4. Research: The student should be able to recognise a research topic, state the objectives in terms of what is expected to be achieved in the end, plan a rational approach with full awareness of the statistical validity, spell out the methodology and carry out most of the technical procedures required for the study, accurately and objectively record on systematic lines the results and observations made, analyse the data using appropriate statistical approach, interpret the observations in the light of existing knowledge and highlight in what ways the study has advanced existing knowledge on the subject and what remains to be done, draw conclusions which should be reached by logical deduction and he should be able to assess evidence both as to its reliability and its relevance, write a thesis in accordance with the prescribed instructions, and be familiar with the ethical aspects of research etc.

SUBJECT SPECIFIC COMPETENCIES

The topics for MD (PMR) and Diploma (DPMR) would remain the same. However, the depth of teaching would be lesser in the Diploma course since the course contents would be covered in three papers only and the duration of the Diploma course is only two years.

By the end of the course, the student should have acquired knowledge (cognitive domain), professionalism (affective domain) and skills (psychomotor domain) as given below:

A. Cognitive domain:

1. Acquire basic knowledge of basic medical sciences such as Anatomy, Physiology, Biochemistry, Pathology, Microbiology, Pharmacology, and Molecular Biology etc. as related to Physical Medicine and Rehabilitation

2. Acquire knowledge on factors which may result in disability

3. Acquire knowledge of basic anatomy and physiology of the musculoskeletal (including Biomechanics), urogenital, cardio-pulmonary and nervous systems

4. Acquire knowledge of basic principles of diagnostic modalities as applied to Physical Medicine and Rehabilitation.

5. Understand philosophy, history, scope and need of Physical Medicine and Rehabilitation.

6. Acquire knowledge of basic concepts in Physical Medicine and Rehabilitation - definitions, rehabilitation team, team members, scope, role and responsibilities of different members.

7. Acquire knowledge of principles of evaluation and rehabilitation management of social problems

8. Acquire knowledge of principles of evaluation and rehabilitation management of vocational problems

9. Understand disability prevention & management- levels and examples

10. Understand epidemiology of disability

11. Understand the outcome measures in Physical Medicine and Rehabilitation

12. Impairment Rating and Disability Evaluation

13. Acquire knowledge of integrative Medicine and Physical Medicine and Rehabilitation

14. Understand Assistive Technology related to Physical Medicine and Rehabilitation

15. Acquire knowledge of basic principles of rehabilitative surgeries

16. Acquire knowledge of Pediatric Rehabilitation including children with Autism Spectrum Disorders, learning disabilities, multiple disabilities etc.

17. Acquire knowledge of Geriatric Rehabilitation

18. Acquire knowledge of Evidence-based Medicine and Physical Medicine and Rehabilitation

19. Understand Legislation in relations to disability- National and International

B. Affective Domain:

1. Should be able to function as a part of a team, develop an attitude of cooperation with colleagues, and interact with the patient and the clinician or other colleagues to provide the best possible diagnosis or opinion.

2. Always adopt ethical principles and maintain proper etiquette in dealings with patients, relatives and other health personnel and to respect the rights of the patient including the right to information and second opinion.

3. Develop communication skills to word reports and professional opinion as well as to interact with patients, relatives, peers and paramedical staff, and for effective teaching.

C. Psychomotor domain

At the end of the course, the student should acquire the following clinical/practical skills:

Section A:

1. Evaluation Process:

- History taking in Physical Medicine and Rehabilitation

- Clinical evaluation, Manual Muscle Strength Testing, Joint Range of Motion, Goniometry, Activities of Daily Living

- Investigations - Laboratory and Radiological imaging studies including CT Scan, MRI, diagnostic musculoskeletal ultrasound, DEXA Scan etc.

- Evaluation of neurogenic bowel and bladder dysfunction

2. Gait Analysis - Terminology, types, Clinical Applications

3. Electrodiagnostic Medicine - basic principles, clinical methods, interpretation etc.

4. Outcome Measures in Physical Medicine and Rehabilitation

5. Impairment Rating and Disability Evaluation and Certification

Section B:

6. Therapeutic Exercises- settings, equipments, applications

7. Physical Agents/Modalities - precautions, prescription, application, follow-up etc.

8. Traction, Massage - principles, types, indications, contra-indications, precautions, prescription, application, follow-up etc.

9. Electrical Stimulation - precautions, prescription, application, follow-up etc.

10. Principles and practice of Occupational Therapy

11. Training of A.D.L. (Activities of Daily Living) in various conditions

12. Injection Techniques (e.g. intra-articular, peri-articular, trigger-point, epidural etc.) in Physical Medicine and Rehabilitation

13. Interventions in Physical Medicine and Rehabilitation e.g. Botulinum toxin injection, Phenol block, Alcohol blocks etc.

14. Upper limb orthotic devices including splints - applications

15. Lower limb orthotic devices including footwear modifications - applications

16. Spinal orthoses - applications

17. Upper limb prosthetics and amputee rehabilitation

18. Lower limb prosthetics and amputee rehabilitation

19. Mobility aids, wheelchairs and seating systems

20. Low back pain and Physical Medicine and Rehabilitation

21. Musculoskeletal trauma and Physical Medicine and Rehabilitation

22. Rehabilitation of persons suffering from:

a. Arthritis including Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis etc.

b. Spinal deformity

c. Neck Pain, Shoulder Pain etc.

d. Osteoporosis

e. Sports Injury

f. burns Injury

g. Spinal Cord Injury

23. Rehabilitation of persons:

a. with obesity, dyslipidemia etc.

b. after Arthroplasty

c. after POP cast, Fracture treatment, Surgical intervention

24. Basic principles and practice of interventions and rehabilitative surgeries such as deformity correction in poliomyelitis, cerebral palsy, clubfoot, contractures, revision of amputation stump, closure of pressure sore, tendon transfers etc.

Section C:

25. Rehabilitation of persons suffering from:

a. Plexus or Nerve Injury

b. Traumatic Brain Injury

c. Stroke

d. Parkinsonism, Multiple sclerosis, Ataxia, neurodegenerative disorders etc.

e. Neuropathy, Bell's Palsy etc.

f. Hansen's Disease (Leprosy including leprosy-cured persons)

g. diseases of Muscles e.g. myopathy, motor-neuron disease, myasthenia gravis etc.

h. Cerebral Palsy

i. Spasticity

j. Poliomyelitis and its sequalae including Post-polio syndrome

k. Cardiovascular Disease e.g. CAD, MI, CABG Surgery, Angioplasty, Heart failure, Cardiac transplantation etc.

l. Pulmonary Disease e.g. COPD, Bronchiectesis, Cystic fibrosis etc.

m. Cancer

n. Patients in the ICU setting

o. Swallowing disorder

p. Bladder dysfunction

q. Bowel dysfunction

r. Vertigo

s. HIV/AIDS

t. Chronic Pain

u. Organ Transplantation

26. Pediatric Rehabilitation including children with Cerebral palsy, muscular dystrophy, Autism Spectrum Disorders, learning disabilities, neural-tube defects, multiple disabilities etc.

27. Geriatric Rehabilitation

28. Principles of evaluation and rehabilitation management of persons with:

• visual impairment

• mental retardation

• hearing /speech impairment

• psychological problems or mental illness

29. Medical/ surgical Emergencies in Physical Medicine and Rehabilitation

30. Sexuality and Disability

Section D:

31. Evidence-based Medicine and Physical Medicine and Rehabilitation

32. Legislation in relations to disability- National and International

33. Schemes and Benefits extended to persons with disabilities by the Govt.

34. Barrier-free Environment and access related issues

35. Computers in Physical Medicine and Rehabilitation

36. Assistive-technologies in rehabilitation

37. Ethical aspects in disability and rehabilitation

38. Recent Advances related to Physical Medicine and Rehabilitation

Syllabus

Course Contents:

The course content for DPMR (Diploma in Physical Medicine and Rehabilitation) is divided into three broad sections, covering three Theory Papers. However, certain degree of overlapping may occur among different sections. The contents would include the following:-

Section A:

1) Basic Anatomy and Physiology of the Musculoskeletal (including Biomechanics), Urogenital, Cardio-pulmonary and Nervous Systems etc.

2) Basics of Biochemical aspects of Calcium and Vitamin D metabolism, osteoporosis, diabetes mellitus etc.

3) Basic Pathological processes causing diseases and disabilities, healing etc.

4) Basic principles of Pharmacology as applied to the conditions encountered in Physical Medicine and Rehabilitation.

5) Basic principles of diagnostic modalities as applied to Physical Medicine and Rehabilitation.

6) Philosophy, history, scope and need of Physical Medicine and Rehabilitation.

7) Basic concepts in Physical Medicine and Rehabilitation - definitions, rehabilitation team, team members, scope, role and responsibilities of different members etc.

8) Principles of evaluation and rehabilitation management of social problems.

9) Principles of evaluation and rehabilitation management of vocational problems.

10) Organisation and administration of Physical Medicine and Rehabilitation Services.

11) Disability process. Impairment, disability, International Classifications.

12) Disability Prevention- levels and examples.

13) Epidemiology of Disability, magnitude, causes, changing trends etc.

14) Gait Analysis – Terminology, types, Clinical Applications.

15) Electrodiagnostic Medicine - basic principles, clinical methods, interpretation etc.

16) Outcome Measures in Physical Medicine and Rehabilitation.

17) Impairment Rating and Disability Evaluation.

Section B:

18) Therapeutic Exercises - principles, types, indications, contraindications.

19) Physical Agents/Modalities - principles, types, indications, contra-indications, precautions.

20) Manipulation, Traction, Massage - principles, types, indications, contra- indications, precautions.

21) Electrical Stimulation - principles, types, indications, contra-indications, precautions.

22) Principles and scope of Occupational Therapy.

23) Rationale of A.D.L. (Activities of Daily Living) in various conditions.

24) Integrative Medicine and Physical Medicine and Rehabilitation.

25) Upper limb orthotic devices including splints – principles, types, materials and indications,

26) Lower limb orthotic devices including footwear modifications– principles, types, materials and indications,

27) Spinal orthoses – principles, types, materials and indications,

28) Upper limb prosthetics and amputee rehabilitation,

29) Lower limb prosthetics and amputee rehabilitation,

30) Mobility aids, wheelchairs and seating systems,

31) Low back pain and Physical Medicine and Rehabilitation.

32) Musculoskeletal trauma and Physical Medicine and Rehabilitation.

33) Holistic Rehabilitation of persons suffering from:

• Rheumatoid Arthritis, Osteoarthritis, Ankylosing Spondylitis etc.

• Spinal deformity

• Neck Pain, Shoulder Pain etc.

• Osteoporosis

• Sports Injury

• Burns Injury

• Spinal Cord Injury (traumatic and non-traumatic)

34) Rehabilitation of persons:

• with obesity, dyslipidemia etc.

• after Arthroplasty

• after POP cast, Fracture treatment, Surgical intervention

35) Principles of Sports Medicine

36) Basic principles of rehabilitative surgeries such as deformity correction in poliomyelitis, cerebral palsy, clubfoot, contractures, revision of amputation stump, closure of pressure sore, tendon transfers etc.

Section C:

37) Holistic Rehabilitation of persons suffering from:

• Plexus or Nerve Injury

• Traumatic Brain Injury

• Stroke

• Parkinsonism, Multiple sclerosis, Ataxia, neurodegenerative disorders etc.

• Neuropathy, Bell's Palsy etc.

• Hansen's Disease

• diseases of Muscles e.g. myopathy, motor-neuron disease, myasthenia gravis etc.

• Cerebral Palsy

• Spasticity

• Poliomyelitis and its sequalae

• Cardiovascular Disease e.g. CAD, MI, CABG Surgery, Angioplasty, Cardiac transplantation etc.

• Pulmonary Disease e.g. COPD, Bronchiectesis, Cystic fibrosis etc.

• Cancer

• Swallowing disorder

• Bladder dysfunction

• Bowel dysfunction

• Vertigo

• HIV/AIDS

• Chronic Pain

• Neural tube defects like meningomyelocele and hydrocephalus etc.

38) Rehabilitation of persons:

• after Organ Transplantation

• in ICU setting

39) Pediatric Rehabilitation including children with Autism Spectrum Disorders, learning disabilities, multiple disabilities etc.

40) Geriatric Rehabilitation

41) Principles of evaluation and rehabilitation management of persons with:

• visual impairment

• mental retardation

• hearing /speech impairment

• psychological problems or mental illness

42) Medical/surgical Emergencies in Physical Medicine and Rehabilitation

43) Sexuality and Disability

Section D:

44) Evidence-based Medicine and Physical Medicine and Rehabilitation

45) Legislation in relations to disability- National and International

46) Functional evaluation, Impairment rating, disability evaluation and

certification including guidelines for these

47) Schemes and Benefits extended to persons with disabilities by the Govt.

48) Barrier-free Environment and access related issues

49) Computers in Physical Medicine and Rehabilitation

50) Recent Advances related to Physical Medicine and Rehabilitation

51) Ethical aspects in rehabilitation

TEACHING AND LEARNING METHODS

Post-Graduate Training:

A. Theoretical Methodology:

1. Symposia/Seminars:

The post graduate student would be required to present topics to the combined group of teachers and students. A free discussion would be encouraged in these activities. The topics of the symposia/seminars would be given to the PG students with the dates for presentation.

The topics for Seminars could include any of the following: Gait Analysis, Spasticity, Pressure Sores, Spinal Orthoses, Hand Splints, Assistive Technology, Psycho-Social-Vocational Aspects, Cardiac Rehabilitation, Pulmonary Rehabilitation, Neuro-developmental Techniques, Post-Polio Syndrome, Cognitive Rehabilitation, Prosthetic Feet, PTB Prosthetic, Prosthetic Terminal Devices, CAD-CAM, FES, Spinal Deformities, Rehabilitation after Arthroplasty, Epidemiology of Disability, Barrier-free Environment, Ethical Aspects, Legislation related to Disability and Rehabilitation, Community-Based Rehabilitation, Leprosy Rehabilitation, Sexuality and Disability, Rehabilitation related to HIV/AIDS, Stem Cell Therapy in Rehabilitation, Geriatric Rehabilitation, Sports Injuries Rehabilitation, Rehabilitation after Organ Transplantation, Pain Management, Analgesics, NSAIDs, DMARDs, Disability Evaluation, Interventions in Physical Medicine and Rehabilitation etc.

2. Journal Club:

This should be a regular/weekly activity. The post graduate student would be assigned /allowed to chose an article from amongst the recent publications from the list of recommended journals, present, summarise, and discuss the published article critically. The contributions made by the article in furtherance of the scientific knowledge as well as limitations (if any) should be highlighted.

3. Practical and Clinical Training: Clinical:

The student would be attached to a Faculty member to be able to pick up methods of history taking and examination in rehabilitation practice. During this period, the student would also be oriented to the common problems that present in the OPD or Wards/ICUs or are encountered in the community. The student would be supervised by Senior PG students and Faculty members.

Bedside:

The student would work up cases; learn management of cases by discussion with the senior PG students and faculty of the department. He/she would be trained in management of in-patients including performing certain procedures such as debridement, Plaster cast application, traction, catheterization, intubation etc.

Rehabilitative Interventions and Surgery:

The student would be provided with an opportunity, as far as possible, to observe, learn, assist and once proficient, perform rehabilitative surgical operations such as for correction of deformities in polio, cerebral palsy, amputation, clubfoot, pressure sore etc. including post-operative care with the assistance of Senior PG students and/or under the direct supervision of a Faculty member.

The student would also be oriented to the various sections/units in a comprehensive rehabilitation set up (such as occupational therapy, orthotics- prosthetics, physiotherapy, social works, clinical psychology, vocational guidance/counseling, educational institution and Non-Governmental Organization in the disability sector etc.) and be well informed about and demonstrated the various equipments/materials/methods used there, and the scope, role and responsibilities of different members of a rehabilitation team.

4. Training in Research Methodology

The student would be given exposure to partake in the research projects going on to learn their planning, methodology and execution to learn various aspects of research.

5. Teaching Skills

The postgraduate students shall be required to participate in the teaching and training programme of undergraduate students and interns.

6. Continuing Medical Education Programmes (CME)

At least two CME programmes should be attended by each student in 3 years.

7. Conferences

The student should attend courses, conferences and seminars relevant to the speciality.

8. Case presentation, case work up, case handling/management (once a week)

9. Attending clinical grand rounds / clinic-pathological conference

The post graduate students are encouraged to attend lectures and grand rounds of other clinical and basic science departments of the hospital.

10. Paper/poster presentation:

A post graduate student of a post graduate degree course in broad specialities/super specialities would be required to present one poster presentation, to read one paper at a national/state conference and to present one research paper which should be published/accepted for publication/sent for publication during the period of his postgraduate studies so as to make him eligible to appear at the postgraduate degree examination.

11. Teaching skills:

The post graduate students shall be required to participate in the teaching and training programme of undergraduate students and interns.

12. A logbook should be maintained recording the duration of posting, the period of absence, if any, skills performed, and remarks if any by the teacher/faculty member. The logbook should also record journal clubs, seminars attended and partaken as well as undergraduate teaching activities the post graduate student has participated and should be signed by the faculty in charge.

13. Department should encourage e-learning activities.

During the training programme, patient safety is of paramount importance, therefore skills are to be learnt initially on the models, later to be performed under supervision followed by performing independently; for this purpose, provision of surgical skills laboratories in medical colleges is mandatory.

ASSESSMENT

FORMATIVE ASSESSMENT i.e., Assessment during the training

Formative assessment should be continual and should assess medical knowledge, patient care, procedural & academic skills, interpersonal skills, professionalism, self directed learning and ability to practice in the system.

Quarterly assessment during the Diploma training should be based on:

1. Journal based / recent advances learning

2. Patient based /Laboratory or Skill based learning

3. Self directed learning and teaching

4. Departmental and interdepartmental learning activity

5. External and Outreach Activities / CMEs

The student to be assessed periodically as per categories listed in postgraduate student appraisal form (Annexure I).

SUMMATIVE ASSESSMENT, ie., at the end of training

The summative examination would be carried out as per the Rules given in POSTGRADUATE MEDICAL EDUCATION REGULATIONS, 2000.

The examination shall be in two parts:

1. Theory:

The Theory examination consists of three papers:

Paper I: Basic Sciences and Basic Concepts as applied to Physical Medicine and Rehabilitation

Paper II: Principles and Practice of Physical Medicine; and Rehabilitation Management of Musculoskeletal Conditions

Paper III: Principles and Practice of Rehabilitation Management of Neurological, Cardio-pulmonary and other Conditions including Legislation, Recent Advances as applied to Physical Medicine and Rehabilitation etc.

2. Clinical / Practical and viva voce Examination

The emphasis would be laid on the Objective Structured Clinical Examination (OSCE). Practical examination would be conducted as per following:

Long Case - One Short Cases - Three Viva-Voce involving

X-Ray/CT Scan/MRI /Bone Scan Films Rehabilitation Surgery Instruments Pathology Specimens

Physical Medicine Instruments/Equipments/Modalities Orthotic-Prosthetic Appliances

OSCE Based Examination Scheme for Diploma in Physical Medicine and Rehabilitation Examinations

Oral/Viva voce examination shall be in the following areas:

Item

i. Pathology specimens

ii. X-rays, US Scan, CT Scan, MRI etc.

iii. Surgical Instruments

iv. Prosthetic and Orthotic devices

v. Physical Medicine Instruments/Equipments

Recommended Reading Books (latest edition)

1. Braddom RL. Physical Medicine and Rehabilitation, Saunders

2. DeLisa JA. Rehabilitation Medicine: Principles and Practice. Lippincott

3. Rusk HA. Rehabilitation Medicine. CV Mosby

4. Helander E, Mendis P, Nelson G, Goerdt A. Training in the Community for People with Disabilities WHO, Geneva.

5. Helander E. Prejudice and Dignity - An Introduction to Community-Based Rehabilitation. UNDP.

6. Solomon L. Apley's System of Orthopaedics and Fractures. Arnold London

7. Fauci, Braunwald, Kasper, Hauser et al. Harrison's Principles of Internal Medicine McGraw-Hill Company

8. Vernon W Lin. Spinal Cord Medicine - Principles and Practice. Demos

Journals

Three international and two national journals (all indexed)